Impacts of Maximizing Tendencies on Experience-Based Decisions.

PubMed

Rim, Hye Bin

2017-06-01

Previous research on risky decisions has suggested that people tend to make different choices depending on whether they acquire the information from personally repeated experiences or from statistical summary descriptions. This phenomenon, called as a description-experience gap, was expected to be moderated by the individual difference in maximizing tendencies, a desire towards maximizing decisional outcome. Specifically, it was hypothesized that maximizers' willingness to engage in extensive information searching would lead maximizers to make experience-based decisions as payoff distributions were given explicitly. A total of 262 participants completed four decision problems. Results showed that maximizers, compared to non-maximizers, drew more samples before making a choice but reported lower confidence levels on both the accuracy of knowledge gained from experiences and the likelihood of satisfactory outcomes. Additionally, maximizers exhibited smaller description-experience gaps than non-maximizers as expected. The implications of the findings and unanswered questions for future research were discussed.

Developing a systematic approach to safer medication use during pregnancy: summary of a Centers for Disease Control and Prevention--convened meeting.

PubMed

Broussard, Cheryl S; Frey, Meghan T; Hernandez-Diaz, Sonia; Greene, Michael F; Chambers, Christina D; Sahin, Leyla; Collins Sharp, Beth A; Honein, Margaret A

2014-09-01

To address information gaps that limit informed clinical decisions on medication use in pregnancy, the Centers for Disease Control and Prevention (CDC) solicited expert input on a draft prototype outlining a systematic approach to evaluating the quality and strength of existing evidence for associated risks. The draft prototype outlined a process for the systematic review of available evidence and deliberations by a panel of experts to inform clinical decision making for managing health conditions in pregnancy. At an expert meeting convened by the CDC in January 2013, participants divided into working groups discussed decision points within the prototype. This report summarizes their discussions of best practices for formulating an expert review process, developing evidence summaries and treatment guidance, and disseminating information. There is clear recognition of current knowledge gaps and a strong collaboration of federal partners, academic experts, and professional organizations willing to work together toward safer medication use during pregnancy. Published by Elsevier Inc.

Developing a systematic approach to safer medication use during pregnancy: summary of a Centers for Disease Control and Prevention—convened meeting

PubMed Central

Broussard, Cheryl S.; Frey, Meghan T.; Hernandez-Diaz, Sonia; Greene, Michael F.; Chambers, Christina D.; Sahin, Leyla; Collins Sharp, Beth A.; Honein, Margaret A.

2015-01-01

To address information gaps that limit informed clinical decisions on medication use in pregnancy, the Centers for Disease Control and Prevention (CDC) solicited expert input on a draft prototype outlining a systematic approach to evaluating the quality and strength of existing evidence for associated risks. The draft prototype outlined a process for the systematic review of available evidence and deliberations by a panel of experts to inform clinical decision making for managing health conditions in pregnancy. At an expert meeting convened by the CDC in January 2013, participants divided into working groups discussed decision points within the prototype. This report summarizes their discussions of best practices for formulating an expert review process, developing evidence summaries and treatment guidance, and disseminating information. There is clear recognition of current knowledge gaps and a strong collaboration of federal partners, academic experts, and professional organizations willing to work together toward safer medication use during pregnancy. PMID:24881821

A meta-analytic review of two modes of learning and the description-experience gap.

PubMed

Wulff, Dirk U; Mergenthaler-Canseco, Max; Hertwig, Ralph

2018-02-01

People can learn about the probabilistic consequences of their actions in two ways: One is by consulting descriptions of an action's consequences and probabilities (e.g., reading up on a medication's side effects). The other is by personally experiencing the probabilistic consequences of an action (e.g., beta testing software). In principle, people taking each route can reach analogous states of knowledge and consequently make analogous decisions. In the last dozen years, however, research has demonstrated systematic discrepancies between description- and experienced-based choices. This description-experience gap has been attributed to factors including reliance on a small set of experience, the impact of recency, and different weighting of probability information in the two decision types. In this meta-analysis focusing on studies using the sampling paradigm of decisions from experience, we evaluated these and other determinants of the decision-experience gap by reference to more than 70,000 choices made by more than 6,000 participants. We found, first, a robust description-experience gap but also a key moderator, namely, problem structure. Second, the largest determinant of the gap was reliance on small samples and the associated sampling error: free to terminate search, individuals explored too little to experience all possible outcomes. Third, the gap persisted when sampling error was basically eliminated, suggesting other determinants. Fourth, the occurrence of recency was contingent on decision makers' autonomy to terminate search, consistent with the notion of optional stopping. Finally, we found indications of different probability weighting in decisions from experience versus decisions from description when the problem structure involved a risky and a safe option. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Implementation of a Tool to Enhance Evidence-Informed Decision Making in Public Health: Identifying Barriers and Facilitating Factors

ERIC Educational Resources Information Center

van der Heide, Iris; van der Noordt, Maaike; Proper, Karin I.; Schoemaker, Casper; van den Berg, Matthijs; Hamberg-van Reenen, Heleen H.

2016-01-01

One of the barriers regarding evidence-informed decision making is the gap between the needs of policy makers and the ways researchers present evidence. This pilot study evaluates the barriers and facilitators to the implementation of a tool to enhance transparent and unambiguous communication on scientific evidence by knowledge workers.…

Human Factors in Intelligence, Surveillance, and Reconnaissance: Gaps for Soldiers and Technology Recommendations

DTIC Science & Technology

2014-07-01

technology work seeks to address gaps in the management, processing, and fusion of heterogeneous (i.e., soft and hard ) information to aid human decision...and bandwidth) to exploit the vast and growing amounts of data [16], [17]. There is also a broad research program on techniques for soft and hard ...Mott, G. de Mel, and T. Pham, “Integrating hard and soft information sources for D2D using controlled natural language,” in Proc. Information Fusion

Bicycle and pedestrian data : sources, needs, & gaps

DOT National Transportation Integrated Search

2000-01-01

This report provides a review of existing sources of bicycle and pedestrian-related information, including their uses, quality, and limitations. It also includes information from a broad range of decision-makers, researchers, planners, and other user...

Exploring Institutional Mechanisms for Scientific Input into the Management Cycle of the National Protected Area Network of Peru: Gaps and Opportunities.

PubMed

López-Rodríguez, M D; Castro, H; Arenas, M; Requena-Mullor, J M; Cano, A; Valenzuela, E; Cabello, J

2017-12-01

Understanding how to improve decision makers' use of scientific information across their different scales of management is a core challenge for narrowing the gap between science and conservation practice. Here, we present a study conducted in collaboration with decision makers that aims to explore the functionality of the mechanisms for scientific input within the institutional setting of the National Protected Area Network of Peru. First, we analyzed institutional mechanisms to assess the scientific information recorded by decision makers. Second, we developed two workshops involving scientists, decision makers and social actors to identify barriers to evidence-based conservation practice. Third, we administered 482 questionnaires to stakeholders to explore social perceptions of the role of science and the willingness to collaborate in the governance of protected areas. The results revealed that (1) the institutional mechanisms did not effectively promote the compilation and application of scientific knowledge for conservation practice; (2) six important barriers hindered scientific input in management decisions; and (3) stakeholders showed positive perceptions about the involvement of scientists in protected areas and expressed their willingness to collaborate in conservation practice. This collaborative research helped to (1) identify gaps and opportunities that should be addressed for increasing the effectiveness of the institutional mechanisms and (2) support institutional changes integrating science-based strategies for strengthening scientific input in decision-making. These insights provide a useful contextual orientation for scholars and decision makers interested in conducting empirical research to connect scientific inputs with operational aspects of the management cycle in other institutional settings around the world.

Exploring Institutional Mechanisms for Scientific Input into the Management Cycle of the National Protected Area Network of Peru: Gaps and Opportunities

NASA Astrophysics Data System (ADS)

López-Rodríguez, M. D.; Castro, H.; Arenas, M.; Requena-Mullor, J. M.; Cano, A.; Valenzuela, E.; Cabello, J.

2017-12-01

Understanding how to improve decision makers' use of scientific information across their different scales of management is a core challenge for narrowing the gap between science and conservation practice. Here, we present a study conducted in collaboration with decision makers that aims to explore the functionality of the mechanisms for scientific input within the institutional setting of the National Protected Area Network of Peru. First, we analyzed institutional mechanisms to assess the scientific information recorded by decision makers. Second, we developed two workshops involving scientists, decision makers and social actors to identify barriers to evidence-based conservation practice. Third, we administered 482 questionnaires to stakeholders to explore social perceptions of the role of science and the willingness to collaborate in the governance of protected areas. The results revealed that (1) the institutional mechanisms did not effectively promote the compilation and application of scientific knowledge for conservation practice; (2) six important barriers hindered scientific input in management decisions; and (3) stakeholders showed positive perceptions about the involvement of scientists in protected areas and expressed their willingness to collaborate in conservation practice. This collaborative research helped to (1) identify gaps and opportunities that should be addressed for increasing the effectiveness of the institutional mechanisms and (2) support institutional changes integrating science-based strategies for strengthening scientific input in decision-making. These insights provide a useful contextual orientation for scholars and decision makers interested in conducting empirical research to connect scientific inputs with operational aspects of the management cycle in other institutional settings around the world.

Decision Making Under Uncertainty - Bridging the Gap Between End User Needs and Science Capability

NASA Astrophysics Data System (ADS)

Verdon-Kidd, D. C.; Kiem, A.; Austin, E. K.

2012-12-01

Successful adaptation outcomes depend on decision making based on the best available climate science information. However, a fundamental barrier exists, namely the 'gap' between information that climate science can currently provide and the information that is practically useful for end users and decision makers. This study identifies the major contributing factors to the 'gap' from an Australian perspective and provides recommendations as to ways in which the 'gap' may be narrowed. This was achieved via a literature review, online survey (targeted to providers of climate information and end users of that information), workshop (where both climate scientists and end users came together to discuss key issues) and focus group. The study confirmed that uncertainty in climate science is a key barrier to adaptation. The issue of uncertainty was found to be multi-faceted, with issues identified in terms of communication of uncertainty, misunderstanding of uncertainty and the lack of tools/methods to deal with uncertainty. There were also key differences in terms of expectations for the future - most end users were of the belief that uncertainty associated with future climate projections would reduce within the next five to 10 years, however producers of climate science information were well aware that this would most likely not be the case. This is a concerning finding as end users may delay taking action on adaptation and risk planning until the uncertainties are reduced - a situation which may never eventuate or may occur after the optimal time for action. Improved communication and packaging of climate information was another key theme that was highlighted in this study. Importantly, it was made clear that improved communication is not just about more glossy brochures and presentations by climate scientists, rather there is a role for a program or group to fill this role (coined a 'knowledge broker' during the workshop and focus group). The role of the 'knowledge broker' would be to package, translate (both from end user to scientist and scientist to end user) and transform climate information. Importantly communication of uncertainty needs to be improved so that end users are aware of all the caveats and what can realistically be expected from climate science now and in the near future. Overall this study confirmed that there is indeed a 'gap' between end user's needs and science capability, particularly with respect to uncertainty, communication and packaging of climate information. This 'gap' has been a barrier to successful climate change adaptation in the past. While it is unrealistic to think we could ever close the 'gap' completely, based on the recommendations provided in this paper, it may be possible to bridge the 'gap' (or at least improve people's awareness of the 'gap'). Furthermore, the insights gained and recommendations provided from this study, while based on an Australian context, are likely to be applicable to many other regions of the world, grappling with similar issues.

Eco-informatics for decision makers advancing a research agenda

USGS Publications Warehouse

Cushing, J.B.; Wilson, T.; Brandt, L.; Gregg, V.; Spengler, S.; Borning, A.; Delcambre, L.; Bowker, G.; Frame, M.; Fulop, J.; Hert, C.; Hovy, E.; Jones, J.; Landis, E.; Schnase, J.L.; Schweik, C.; Sonntag, W.; ,

2005-01-01

Resource managers often face significant information technology (IT) problems when integrating ecological or environmental information to make decisions. At a workshop sponsored by the NSF and USGS in December 2004, university researchers, natural resource managers, and information managers met to articulate IT problems facing ecology and environmental decision makers. Decision making IT problems were identified in five areas: 1) policy, 2) data presentation, 3) data gaps, 4) tools, and 5) indicators. To alleviate those problems, workshop participants recommended specific informatics research in modeling and simulation, data quality, information integration and ontologies, and social and human aspects. This paper reports the workshop findings, and briefly compares these with research that traditionally falls under the emerging eco-informatics rubric. ?? Springer-Verlag Berlin Heidelberg 2005.

GAP Analysis Bulletin Number 15

USGS Publications Warehouse

Maxwell, Jill; Gergely, Kevin; Aycrigg, Jocelyn; Canonico, Gabrielle; Davidson, Anne; Coffey, Nicole

2008-01-01

The Mission of the Gap Analysis Program (GAP) is to promote conservation by providing broad geographic information on biological diversity to resource managers, planners, and policy makers who can use the information to make informed decisions. As part of the National Biological Information Infrastructure (NBII) ?a collaborative program to provide increased access to data and information on the nation?s biological resources--GAP data and analytical tools have been used in hundreds of applications: from basic research to comprehensive state wildlife plans; from educational projects in schools to ecoregional assessments of biodiversity. The challenge: keeping common species common means protecting them BEFORE they become threatened. To do this on a state or regional basis requires key information such as land cover descriptions, predicted distribution maps for native animals, and an assessment of the level of protection currently given to those plants and animals. GAP works cooperatively with Federal, state, and local natural resource professionals and academics to provide this kind of information. GAP activities focus on the creation of state and regional databases and maps that depict patterns of land management, land cover, and biodiversity. These data can be used to identify ?gaps? in conservation--instances where an animal or plant community is not adequately represented on the existing network of conservation lands. GAP is administered through the U.S. Geological Survey. Through building partnerships among disparate groups, GAP hopes to foster the kind of collaboration that is needed to address conservation issues on a broad scale. For more information, contact: John Mosesso National GAP Director 703-648-4079 Kevin Gergely National GAP Operations Manager 208-885-3565

Influence of an Intermediate Option on the Description-Experience Gap and Information Search

PubMed Central

Sharma, Neha; Debnath, Shoubhik; Dutt, Varun

2018-01-01

Research shows that people tend to overweight small probabilities in description and underweight them in experience, thereby leading to a different pattern of choices between description and experience; a phenomenon known as the Description-Experience (DE) gap. However, little is known on how the addition of an intermediate option and contextual framing influences the DE gap and people’s search strategies. This paper tests the effects of an intermediate option and contextual framing on the DE gap and people’s search strategies, where problems require search for information before a consequential choice. In the first experiment, 120 participants made choice decisions across investment problems that differed in the absence or presence of an intermediate option. Results showed that adding an intermediate option did not reduce the DE gap on the maximizing option across a majority of problems. There were a large majority of choices for the intermediate option. Furthermore, there was an increase in switching between options due to the presence of the intermediate option. In the second experiment, 160 participants made choice decisions in problems like those presented in experiment 1; however, problems lacked the investment framing. Results replicated findings from the first experiment and showed a similar DE gap on the maximizing option in a majority of problems in both the absence and presence of the intermediate option. Again, there were a large majority of choices for the intermediate option. Also, there was an increase in switching between options due to the presence of the intermediate option. Meta-analyses revealed that the absence or presence of the intermediate option created certain differences in the strength of frequency and recency processes. Also, a single natural-mean heuristic model was able to account for the experimental results across both experiments. We discuss implications of our findings to consequential decisions made after information search. PMID:29643821

Influence of an Intermediate Option on the Description-Experience Gap and Information Search.

PubMed

Sharma, Neha; Debnath, Shoubhik; Dutt, Varun

2018-01-01

Research shows that people tend to overweight small probabilities in description and underweight them in experience, thereby leading to a different pattern of choices between description and experience; a phenomenon known as the Description-Experience (DE) gap. However, little is known on how the addition of an intermediate option and contextual framing influences the DE gap and people's search strategies. This paper tests the effects of an intermediate option and contextual framing on the DE gap and people's search strategies, where problems require search for information before a consequential choice. In the first experiment, 120 participants made choice decisions across investment problems that differed in the absence or presence of an intermediate option. Results showed that adding an intermediate option did not reduce the DE gap on the maximizing option across a majority of problems. There were a large majority of choices for the intermediate option. Furthermore, there was an increase in switching between options due to the presence of the intermediate option. In the second experiment, 160 participants made choice decisions in problems like those presented in experiment 1; however, problems lacked the investment framing. Results replicated findings from the first experiment and showed a similar DE gap on the maximizing option in a majority of problems in both the absence and presence of the intermediate option. Again, there were a large majority of choices for the intermediate option. Also, there was an increase in switching between options due to the presence of the intermediate option. Meta-analyses revealed that the absence or presence of the intermediate option created certain differences in the strength of frequency and recency processes. Also, a single natural-mean heuristic model was able to account for the experimental results across both experiments. We discuss implications of our findings to consequential decisions made after information search.

Co-producing resilient solutions to climate change: Bridging the gap between science and decision-making around nexus issues

NASA Astrophysics Data System (ADS)

Howarth, C.

2016-12-01

The nexus represents a multi-dimensional means of scientific enquiry encapsulating the complex and non-linear interactions between water, energy, food, environment with the climate, and wider implications for society. These resources are fundamental for human life but are negatively affected by climate change. Methods of analysis, which are currently used, were not built to represent complex systems and are insufficiently equipped to understand positive and negative externalities generated by interactions among different stakeholders involved in the nexus. In addition misalignment between the science that scientists produce and the evidence decision-makers need leads to a range of complexities within the science-policy interface. Adopting a bottom-up, participative approach, the results of five themed workshops organized in the UK (focusing on: shocks and hazards, infrastructure, local economy, governance and governments, finance and insurance) featuring 80 stakeholders from academia, government and industry allow us to map perceptions of opportunities and challenges of better informing decision making on climate change when there is a strong disconnect between the evidence scientists provide and the actions decision makers take. The research identified key areas where gaps could be bridged between science and action and explores how a knowledge co-production approach can help identify opportunities for building a more effective and legitimate policy agenda to face climate risks. Concerns, barriers and opportunities to better inform decision making centred on four themes: communication and collaboration, decision making processes, social and cultural dimensions, and the nature of responses to nexus shocks. In so doing, this analysis provides an assessment of good practice on climate decision-making and highlights opportunities for improvement to bridge gaps in the science-policy interface

Passing Decisions in Football: Introducing an Empirical Approach to Estimating the Effects of Perceptual Information and Associative Knowledge.

PubMed

Steiner, Silvan

2018-01-01

The importance of various information sources in decision-making in interactive team sports is debated. While some highlight the role of the perceptual information provided by the current game context, others point to the role of knowledge-based information that athletes have regarding their team environment. Recently, an integrative perspective considering the simultaneous involvement of both of these information sources in decision-making in interactive team sports has been presented. In a theoretical example concerning passing decisions, the simultaneous involvement of perceptual and knowledge-based information has been illustrated. However, no precast method of determining the contribution of these two information sources empirically has been provided. The aim of this article is to bridge this gap and present a statistical approach to estimating the effects of perceptual information and associative knowledge on passing decisions. To this end, a sample dataset of scenario-based passing decisions is analyzed. This article shows how the effects of perceivable team positionings and athletes' knowledge about their fellow team members on passing decisions can be estimated. Ways of transfering this approach to real-world situations and implications for future research using more representative designs are presented.

Passing Decisions in Football: Introducing an Empirical Approach to Estimating the Effects of Perceptual Information and Associative Knowledge

PubMed Central

Steiner, Silvan

2018-01-01

The importance of various information sources in decision-making in interactive team sports is debated. While some highlight the role of the perceptual information provided by the current game context, others point to the role of knowledge-based information that athletes have regarding their team environment. Recently, an integrative perspective considering the simultaneous involvement of both of these information sources in decision-making in interactive team sports has been presented. In a theoretical example concerning passing decisions, the simultaneous involvement of perceptual and knowledge-based information has been illustrated. However, no precast method of determining the contribution of these two information sources empirically has been provided. The aim of this article is to bridge this gap and present a statistical approach to estimating the effects of perceptual information and associative knowledge on passing decisions. To this end, a sample dataset of scenario-based passing decisions is analyzed. This article shows how the effects of perceivable team positionings and athletes' knowledge about their fellow team members on passing decisions can be estimated. Ways of transfering this approach to real-world situations and implications for future research using more representative designs are presented. PMID:29623057

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

NASA Astrophysics Data System (ADS)

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

2017-12-01

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

Information Engineering and Workflow Design in a Clinical Decision Support System for Colorectal Cancer Screening in Iran.

PubMed

Maserat, Elham; Seied Farajollah, Seiede Sedigheh; Safdari, Reza; Ghazisaeedi, Marjan; Aghdaei, Hamid Asadzadeh; Zali, Mohammad Reza

2015-01-01

Colorectal cancer is a major cause of morbidity and mortality throughout the world. Colorectal cancer screening is an optimal way for reducing of morbidity and mortality and a clinical decision support system (CDSS) plays an important role in predicting success of screening processes. DSS is a computer-based information system that improves the delivery of preventive care services. The aim of this article was to detail engineering of information requirements and work flow design of CDSS for a colorectal cancer screening program. In the first stage a screening minimum data set was determined. Developed and developing countries were analyzed for identifying this data set. Then information deficiencies and gaps were determined by check list. The second stage was a qualitative survey with a semi-structured interview as the study tool. A total of 15 users and stakeholders' perspectives about workflow of CDSS were studied. Finally workflow of DSS of control program was designed by standard clinical practice guidelines and perspectives. Screening minimum data set of national colorectal cancer screening program was defined in five sections, including colonoscopy data set, surgery, pathology, genetics and pedigree data set. Deficiencies and information gaps were analyzed. Then we designed a work process standard of screening. Finally workflow of DSS and entry stage were determined. A CDSS facilitates complex decision making for screening and has key roles in designing optimal interactions between colonoscopy, pathology and laboratory departments. Also workflow analysis is useful to identify data reconciliation strategies to address documentation gaps. Following recommendations of CDSS should improve quality of colorectal cancer screening.

Methanol as an Automotive Fuel : With Special Emphasis on Methanol-Gasoline Blends

DOT National Transportation Integrated Search

1977-04-01

This report reviews the available information on methanol as related to its potential use as an automotive fuel. Information gaps critical to assessment and future decisions are delineated and suggestions made for necessary R&D efforts. In this conte...

WILDLIFE HEALTH 2.0: BRIDGING THE KNOWLEDGE-TO-ACTION GAP.

PubMed

Stephen, Craig

2017-01-01

The unprecedented threats to the health and sustainability of wildlife populations are inspiring conversations on the need to change the way knowledge is generated, valued, and used to promote action to protect wildlife health. Wildlife Health 2.0 symbolizes the need to investigate how to improve connections between research expertise and policy or practices to protect wildlife health. Two imperatives drive this evolution: 1) growing frustrations that research is inadequately being used to inform management decisions and 2) the realization that scientific certainty is context specific for complex socioecologic issues, such as wildlife health. Failure to appreciate the unpredictability of complex systems or to incorporate ethical and cultural dimensions of decisions has limited the contribution of research to decision making. Wildlife health can draw from scholarship in other fields, such as public health and conservation, to bridge the knowledge-to-action gap. Efforts to integrate science into decisions are more likely to be effective when they enhance relevance, credibility, and legitimacy of information for people who will make or be affected by management decisions. A Wildlife Health 2.0 agenda is not a rejection of the current research paradigm but rather a call to expand our areas of inquiry to ensure that the additional contextual understanding is generated to help decision makers make good choices.

Capacity Building on the Use of Earth Observation for Bridging the Gaps between Science and Policy

NASA Astrophysics Data System (ADS)

Thapa, R. B.; Bajracharya, B.

2017-12-01

Although the geospatial technologies and Earth observation (EO) data are getting more accessible, lack of skilled human resources and institutional capacities are the major hurdles in the effective applications in Hindu Kush Himalayan (HKH) region. Designing efficient and cost effective capacity building (CB) programs fitting needs by different users on the use of EO information for decision making will provide options in bridging the gaps in the region. This paper presents the strategies adopted by SERVIR-HKH as an attempt to strengthen the capacity of governments and development stakeholders in the region. SERVIR-HKH hub plays vital role in CB on EO applications by bringing together the leading scientists from the Globe and the key national institutions and stakeholders in the region. We conducted country consultation workshops in Afghanistan, Bangladesh, Pakistan, and Nepal to identify national priorities, requirements and the capacity of the institutions to utilize EO information in decision making. The need assessments were focused on four thematic areas of SERVIR where capacity gaps in utilization of EO data in policy decisions were identified in thirteen key service areas. Geospatial capacities in GIT infrastructure, data, and human resources were varied. Linking EO information to policy decision is mostly lacking. Geospatial data sharing provision among the institutions in the region is poor. We developed a capacity building strategy for HKH region which bridges the gaps in a coordinated manner through customized training programs, institutional strengthening, coordination and regional cooperation. Using the strategy, we conducted training on FEWS NET remote sensing products for agro-climatological analysis, which focused on technical interpretation and analysis of the remote sensing and modeled products, eg, CHIRPS, RFE2, CHIRTS, GFS, NDVI, GeoCLIM and GeoGLAM. Scientists from USGS FEWS NET program delivered the training to mid-level managers and decision makers. We also carried out on-the-job trainings on wheat mapping using multi-sensor EO data for co-development of methodologies and implementation on sustainable basis. In this presentation, we will also present the lesson learned from capacity building efforts at SERVIR-HKH and how we envision the best practices for other SERVIR hubs.

Bridging the gap between the economic evaluation literature and daily practice in occupational health: a qualitative study among decision-makers in the healthcare sector.

PubMed

van Dongen, Johanna M; Tompa, Emile; Clune, Laurie; Sarnocinska-Hart, Anna; Bongers, Paulien M; van Tulder, Maurits W; van der Beek, Allard J; van Wier, Marieke F

2013-06-03

Continued improvements in occupational health can only be ensured if decisions regarding the implementation and continuation of occupational health and safety interventions (OHS interventions) are based on the best available evidence. To ensure that this is the case, scientific evidence should meet the needs of decision-makers. As a first step in bridging the gap between the economic evaluation literature and daily practice in occupational health, this study aimed to provide insight into the occupational health decision-making process and information needs of decision-makers. An exploratory qualitative study was conducted with a purposeful sample of occupational health decision-makers in the Ontario healthcare sector. Eighteen in-depth interviews were conducted to explore the process by which occupational health decisions are made and the importance given to the financial implications of OHS interventions. Twenty-five structured telephone interviews were conducted to explore the sources of information used during the decision-making process, and decision-makers' knowledge on economic evaluation methods. In-depth interview data were analyzed according to the constant comparative method. For the structured telephone interviews, summary statistics were prepared. The occupational health decision-making process generally consists of three stages: initiation stage, establishing the need for an intervention; pre-implementation stage, developing an intervention and its business case in order to receive senior management approval; and implementation and evaluation stage, implementing and evaluating an intervention. During this process, information on the financial implications of OHS interventions was found to be of great importance, especially the employer's costs and benefits. However, scientific evidence was rarely consulted, sound ex-post program evaluations were hardly ever performed, and there seemed to be a need to advance the economic evaluation skill set of decision-makers. Financial information is particularly important at the front end of implementation decisions, and can be a key deciding factor of whether to go forward with a new OHS intervention. In addition, it appears that current practice in occupational health in the healthcare sector is not solidly grounded in evidence-based decision-making and strategies should be developed to improve this.

Bridging the gap between the economic evaluation literature and daily practice in occupational health: a qualitative study among decision-makers in the healthcare sector

PubMed Central

2013-01-01

Background Continued improvements in occupational health can only be ensured if decisions regarding the implementation and continuation of occupational health and safety interventions (OHS interventions) are based on the best available evidence. To ensure that this is the case, scientific evidence should meet the needs of decision-makers. As a first step in bridging the gap between the economic evaluation literature and daily practice in occupational health, this study aimed to provide insight into the occupational health decision-making process and information needs of decision-makers. Methods An exploratory qualitative study was conducted with a purposeful sample of occupational health decision-makers in the Ontario healthcare sector. Eighteen in-depth interviews were conducted to explore the process by which occupational health decisions are made and the importance given to the financial implications of OHS interventions. Twenty-five structured telephone interviews were conducted to explore the sources of information used during the decision-making process, and decision-makers’ knowledge on economic evaluation methods. In-depth interview data were analyzed according to the constant comparative method. For the structured telephone interviews, summary statistics were prepared. Results The occupational health decision-making process generally consists of three stages: initiation stage, establishing the need for an intervention; pre-implementation stage, developing an intervention and its business case in order to receive senior management approval; and implementation and evaluation stage, implementing and evaluating an intervention. During this process, information on the financial implications of OHS interventions was found to be of great importance, especially the employer’s costs and benefits. However, scientific evidence was rarely consulted, sound ex-post program evaluations were hardly ever performed, and there seemed to be a need to advance the economic evaluation skill set of decision-makers. Conclusions Financial information is particularly important at the front end of implementation decisions, and can be a key deciding factor of whether to go forward with a new OHS intervention. In addition, it appears that current practice in occupational health in the healthcare sector is not solidly grounded in evidence-based decision-making and strategies should be developed to improve this. PMID:23731570

Towards a Context-Aware Proactive Decision Support Framework

DTIC Science & Technology

2013-11-15

initiative that has developed text analytic technology that crosses the semantic gap into the area of event recognition and representation. The...recognizing operational context, and techniques for recognizing context shift. Additional research areas include: • Adequately capturing users...Universal Interaction Context Ontology [12] might serve as a foundation • Instantiating formal models of decision making based on information seeking

Applying a Data Stewardship Maturity Matrix to the NOAA Observing System Portfolio Integrated Assessment Process

NASA Astrophysics Data System (ADS)

Peng, G.; Austin, M.

2017-12-01

Identification and prioritization of targeted user community needs are not always considered until after data has been created and archived. Gaps in data curation and documentation in the data production and delivery phases limit data's broad utility specifically for decision makers. Expert understanding and knowledge of a particular dataset is often required as a part of the data and metadata curation process to establish the credibility of the data and support informed decision-making. To enhance curation practices, content from NOAA's Observing System Integrated Assessment (NOSIA) Value Tree, NOAA's Data Catalog/Digital Object Identifier (DOI) projects (collection-level metadata) have been integrated with Data/Stewardship Maturity Matrices (data and stewardship quality information) focused on assessment of user community needs. This results in user focused evidence based decision making tools created by NOAA's National Environmental Satellite, Data, and Information Service (NESDIS) through identification and assessment of data content gaps related to scientific knowledge and application to key areas of societal benefit. Through enabling user need feedback from the beginning of data creation through archive allows users to determine the quality and value of data that is fit for purpose. Data gap assessment and prioritization are presented in a user-friendly way using the data stewardship maturity matrices as measurement of data management quality. These decision maker tools encourages data producers and data providers/stewards to consider users' needs prior to data creation and dissemination resulting in user driven data requirements increasing return on investment. A use case focused on need for NOAA observations linked societal benefit will be used to demonstrate the value of these tools.

Exposing ecological and economic costs of the research-implementation gap and compromises in decision making.

PubMed

Kareksela, Santtu; Moilanen, Atte; Ristaniemi, Olli; Välivaara, Reima; Kotiaho, Janne S

2018-02-01

The frequently discussed gap between conservation science and practice is manifest in the gap between spatial conservation prioritization plans and their implementation. We analyzed the research-implementation gap of one zoning case by comparing results of a spatial prioritization analysis aimed at avoiding ecological impact of peat mining in a regional zoning process with the final zoning plan. We examined the relatively complex planning process to determine the gaps among research, zoning, and decision making. We quantified the ecological costs of the differing trade-offs between ecological and socioeconomic factors included in the different zoning suggestions by comparing the landscape-level loss of ecological features (species occurrences, habitat area, etc.) between the different solutions for spatial allocation of peat mining. We also discussed with the scientists and planners the reasons for differing zoning suggestions. The implemented plan differed from the scientists suggestion in that its focus was individual ecological features rather than all the ecological features for which there were data; planners and decision makers considered effects of peat mining on areas not included in the prioritization analysis; zoning was not truly seen as a resource-allocation process and not emphasized in general minimizing ecological losses while satisfying economic needs (peat-mining potential); and decision makers based their prioritization of sites on site-level information showing high ecological value and on single legislative factors instead of finding a cost-effective landscape-level solution. We believe that if the zoning and decision-making processes are very complex, then the usefulness of science-based prioritization tools is likely to be reduced. Nevertheless, we found that high-end tools were useful in clearly exposing trade-offs between conservation and resource utilization. © 2017 Society for Conservation Biology.

CDC Grand Rounds: Modeling and Public Health Decision-Making.

PubMed

Fischer, Leah S; Santibanez, Scott; Hatchett, Richard J; Jernigan, Daniel B; Meyers, Lauren Ancel; Thorpe, Phoebe G; Meltzer, Martin I

2016-12-09

Mathematical models incorporate various data sources and advanced computational techniques to portray real-world disease transmission and translate the basic science of infectious diseases into decision-support tools for public health. Unlike standard epidemiologic methods that rely on complete data, modeling is needed when there are gaps in data. By combining diverse data sources, models can fill gaps when critical decisions must be made using incomplete or limited information. They can be used to assess the effect and feasibility of different scenarios and provide insight into the emergence, spread, and control of disease. During the past decade, models have been used to predict the likelihood and magnitude of infectious disease outbreaks, inform emergency response activities in real time (1), and develop plans and preparedness strategies for future events, the latter of which proved invaluable during outbreaks such as severe acute respiratory syndrome and pandemic influenza (2-6). Ideally, modeling is a multistep process that involves communication between modelers and decision-makers, allowing them to gain a mutual understanding of the problem to be addressed, the type of estimates that can be reliably generated, and the limitations of the data. As models become more detailed and relevant to real-time threats, the importance of modeling in public health decision-making continues to grow.

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

Lockwood, Jr., Neil; McLellan, Jason G; Crossley, Brian

The Resident Fish Stock Status above Chief Joseph and Grand Coulee Dams Project, commonly known as the Joint Stock Assessment Project (JSAP) is a management tool using ecosystem principles to manage artificial fish assemblages and native fish in altered environments existing in the Columbia River System above Chief Joseph and Grand Coulee Dams (blocked area). The three-phase approach of this project will enhance the fisheries resources of the blocked area by identifying data gaps, filling data gaps with research, and implementing management recommendations based on research results. The Blocked Area fisheries information housed in a central location will allow managersmore » to view the entire system while making decisions, rather than basing management decisions on isolated portions of the system. The JSAP (NWPPC program measure 10.8B.26) is designed and guided jointly by fisheries managers in the blocked area and the Columbia Basin blocked area management plan (1998). The initial year of the project (1997) identified the need for a central data storage and analysis facility, coordination with the StreamNet project, compilation of blocked area fisheries information, and a report on the ecological condition of the Spokane River System. These needs were addressed in 1998 by acquiring a central location with a data storage and analysis system, coordinating a pilot project with StreamNet, compiling fisheries distribution data throughout the blocked area, identifying data gaps based on compiled information, and researching the ecological condition of the Spokane River. In order to ensure that any additional information collected throughout the life of this project will be easily stored and manipulated by the central storage facility, it was necessary to develop standardized methodologies between the JSAP fisheries managers. The use of common collection and analytical tools is essential to the process of streamlining joint management decisions. In 1999 and 2000 the project began to address some of the identified data gaps, throughout the blocked area, with a variety of newly developed sampling projects, as well as, continuing with ongoing data collection of established projects.« less

Virtual Close Quarter Battle (CQB) Graphical Decision Trainer

DTIC Science & Technology

2002-09-01

leave a gap in what would traditionally be thought of as an ideal locomotion device. Research has shown that the introduction of vestibular cues in...NAVAL POSTGRADUATE SCHOOL Monterey, California THESIS VIRTUAL CLOSE QUARTER BATTLE (CQB) GRAPHICAL DECISION TRAINER by Jordan Reece...including suggestions for reducing this burden, to Washington headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson

Health social workers sources of knowledge for decision making in practice.

PubMed

McDermott, Fiona; Henderson, Annabel; Quayle, Carol

2017-10-01

This article presents findings from research examining knowledge social workers in a health network in Victoria, Australia identified as informing their decision-making. Data for 13 patients, and in-depth interviews with six social workers who worked with these patients, were studied. A thematic analysis of interviews revealed that participants identified reliance on past experience and contextual/situational information as underpinning their decisions, demonstrating their commitment to person-in-environment perspectives. However, despite the availability of a repository of empirical evidence, no respondent made use of this. This study provided insight into health practitioners' sources of knowledge, highlighting gaps and areas for further exploration.

A Perspective from the National Consortium for Secondary STEM Schools

ERIC Educational Resources Information Center

Bonds, Crystal

2016-01-01

This article addresses the role of National Consortium for Secondary STEM Schools in the process of data-informed decision-making for both improving and addressing achievement gaps in participatory specialized STEM high schools.

SOUTHWEST REGIONAL GAP ANALYSIS PROJECT: THE SECOND GENERATION

EPA Science Inventory

The project goal of providing useful information to the regional, state, and community stakeholders to assist them in understanding the environment, setting priorities, and making important decisions relative to conservation and sustainable resource management.

End-of-life decision making by family caregivers of persons with advanced dementia: A literature review of decision aids.

PubMed

Xie, Bo; Berkley, Amy S; Kwak, Jung; Fleischmann, Kenneth R; Champion, Jane Dimmitt; Koltai, Kolina S

2018-01-01

To investigate existing knowledge in the literature about end-of-life decision making by family caregivers of persons with dementia, focusing on decision aids for caregivers of persons with advanced dementia, and to identify gaps in the literature that can guide future research. A literature review through systematic searches in PubMed, CINAHL Plus with Full Text, and PsycINFO was conducted in February 2018; publications with full text in English and published in the past 10 years were selected in multiple steps. The final sample included five decision aids with predominantly Caucasian participants; three of them had control groups, and three used audiovisual technology in presenting the intervention materials. No other technology was used in any intervention. Existing interventions lacked tailoring of information to caregivers' preferences for different types and amounts of information necessary to make decisions consistent with patients' values. Research is needed in exploring the use of technology in decision aids that could provide tailored information to facilitate caregivers' decision making. More diverse samples are needed.

State Legislators' Sources and Use of Information: Bridging the Gap between Research and Policy

ERIC Educational Resources Information Center

Dodson, Elizabeth A.; Geary, Nora A.; Brownson, Ross C.

2015-01-01

Research can inform policymakers of public health issues and shape policy decisions, hopefully benefiting public health; thus, improving dissemination of research to policymakers is important for developing effective public health policies that improve health and health equity. However, the utilization of research among policymakers is often not…

Bridging the Gap between Designers and Consumers: The Role of Effective and Accurate Personas

ERIC Educational Resources Information Center

Miaskiewicz, Tomasz

2010-01-01

Firms now routinely collect information about the needs of their customers, but this information is not sufficiently considered during product design decisions. This research examines the relationship between designers and consumers to build an understanding of how the consumer should be represented to increase the consumer focus during the…

Personalized Surgical Risk Assessment Using Population-Based Data Analysis

ERIC Educational Resources Information Center

AbuSalah, Ahmad Mohammad

2013-01-01

The volume of information generated by healthcare providers is growing at a relatively high speed. This tremendous growth has created a gap between knowledge and clinical practice that experts say could be narrowed with the proper use of healthcare data to guide clinical decisions and tools that support rapid information availability at the…

Addressing the Challenges in Tonsillectomy Research to Inform Health Care Policy: A Review.

PubMed

Mandavia, Rishi; Schilder, Anne G M; Dimitriadis, Panagiotis A; Mossialos, Elias

2017-09-01

Eighty-five percent of investment in medical research has been wasted, with lack of effect on clinical practice and policy. There is increasing effort to improve the likelihood of research being used to influence clinical practice and policy. Tonsillectomy is one of the most common otorhinolaryngologic surgical procedures, and its frequency, cost, and morbidity create a clear need for evidence-based guidelines and policy. The first systematic review on tonsillectomy was conducted 40 years ago and highlighted the lack of definitive evidence for the procedure. Since that study, the body of evidence has still not been able to sufficiently inform policy. This review provides an overview of the key challenges in research to inform tonsillectomy policy and recommendations to help bridge the evidence-policy gap. The challenges in using research to inform policy can be summarized as 4 main themes: (1) non-policy-focused evidence and lack of available evidence, (2) quality of evidence, (3) communication of research findings, and (4) coordinating time frames. Researchers and decision makers should be aware of the limitations of research designs and conflicts of interest that can undermine policy decisions. Researchers must work with decision makers and patients throughout the research process to identify areas of unmet need and political priority, align research and policy time frames, and disseminate research findings. Incentives for researchers should be reorganized to promote dissemination of findings. It is important to consider why evidence gaps in tonsillectomy research have not been addressed during the past 40 years despite considerable investment in time and resources. These findings and recommendations will help produce research that is more responsive to policy gaps and more likely to result in policy changes.

Social Science and the Courts: Challenges and Strategies for Bridging Gaps between Law and Research

ERIC Educational Resources Information Center

Morgan, Julie Margetta; Pullin, Diana

2010-01-01

Social scientists collect vital information that bears on issues of education policy. When the courts are faced with an opportunity to make a decision that shapes education, judges need access to high-quality research, but they must also be convinced that it can be useful in their decision making. This article approaches the question of how social…

Science in Society: Bridging the gap to connect science to decision makers

NASA Astrophysics Data System (ADS)

Jones, L.; Bwarie, J.; Pearce, I.

2016-12-01

The gap between science and decision making in our society can be large and multi-faceted, involving communication, process, cultural and even subconscious differences. In sweeping generalization, scientists reject anecdotes, focus on uncertainty and details, and expect conflict as part of the scientific process, while non-scientists respond to stories, want certainty and the big picture, and see conflict as a reason to reject the message. Bridging this gap often requires ongoing collaboration to find the intersection of three independent domains: what science can provide, the technical information decision makers need to make the most effective choices and what information decision makers need to motivate action. For ten years, the USGS has experimented with improving the usefulness of its science through the SAFRR (Science Application for Risk Reduction) Project and its predecessor, the Multi Hazards Demonstration Project in Southern California. Through leading and participating in these activities, we have recognized 3 steps that have been essential to successful partnerships between scientists and decision makers. First, determining what makes for a successful product cannot be done in isolation by either scientists or users. The users may want something science cannot produce (e.g., accurate short-term earthquake predictions), while the scientists can fail to see that the product they know how to make may not be relevant to the decisions that need to be made. Real discussions with real exchange and absorption of information on both sides makes for the most useful products. Second, most scientific results need work beyond what belongs in a journal to create a product that can be used. This is not just a different style of communication, but analyses that focus on the community's local questions rather than on scientific advances. Third, probabilities of natural hazards almost never motivate action to mitigate. The probabilities are usually low on human time scales and focus on the uncertainty, conveying a strong message that the hazard may not happen. Presenting the hazard as absolutely certain to occur, just on an unknown time scale is scientifically identical, but conveys a very different emotional message.

Closing data gaps for LCA of food products: estimating the energy demand of food processing.

PubMed

Sanjuán, Neus; Stoessel, Franziska; Hellweg, Stefanie

2014-01-21

Food is one of the most energy and CO2-intensive consumer goods. While environmental data on primary agricultural products are increasingly becoming available, there are large data gaps concerning food processing. Bridging these gaps is important; for example, the food industry can use such data to optimize processes from an environmental perspective, and retailers may use this information for purchasing decisions. Producers and retailers can then market sustainable products and deliver the information demanded by governments and consumers. Finally, consumers are increasingly interested in the environmental information of foods in order to lower their consumption impacts. This study provides estimation tools for the energy demand of a representative set of food process unit operations such as dehydration, evaporation, or pasteurization. These operations are used to manufacture a variety of foods and can be combined, according to the product recipe, to quantify the heat and electricity demand during processing. In combination with inventory data on the production of the primary ingredients, this toolbox will be a basis to perform life cycle assessment studies of a large number of processed food products and to provide decision support to the stakeholders. Furthermore, a case study is performed to illustrate the application of the tools.

Understanding cognitive processes behind acceptance or refusal of phase I trials.

PubMed

Pravettoni, Gabriella; Mazzocco, Ketti; Gorini, Alessandra; Curigliano, Giuseppe

2016-04-01

Participation in phase I trials gives patients the chance to obtain control over their disease by trying an experimental therapy. The patients' vulnerability, the informed consent process aiming at understanding the purpose and potential benefits of the phase I trial, and the complexity of the studies may impact the patient's final decision. Emotionally difficult health conditions may induce patients to succumb to cognitive biases, allocating attention only on a part of the provided information. Filling the gap in patients' information process can foster the implementation of strategies to help physicians tailor clinical trials' communication providing personalized support and tailored medical information around patients' need, so avoiding cognitive biases in patients and improving informed shared decision quality. The aim of the present review article focuses on the analysis of cognitive and psychological factors that affect patients' decision to participate or not to early phase clinical trials. Copyright © 2016. Published by Elsevier Ireland Ltd.

Analysis of Stakeholder-Defined Needs in Northeast U.S. Coastal Communities to Determine Gaps in Research Informing Coastal Resilience Planning

NASA Astrophysics Data System (ADS)

Molino, G. D.; Kenney, M. A.; Sutton-Grier, A.; Penn, K.

2017-12-01

The impacts of climate change on our coastlines are increasing pressure on communities, ecosystems, infrastructure, and state-to-local economies in the northeastern United States (U.S.). As a result of current or imminent risk of acute and chronic hazards, local, state and regional entities have taken steps to identify and address vulnerabilities to climate change. Decisions to increase coastal infrastructure resilience and grey, green, and cultural infrastructure solutions requires physical, natural, and social science that is useful for decision-making and effective science translation mechanisms. Despite the desire to conduct or fund science that meets the needs of communities, there has been no comprehensive analysis to determine stakeholder-defined research needs. To address this gap, this study conducts a stakeholder needs analysis in northeast U.S. coastal communities to determine gaps in information and translation processes supporting coastal resilience planning. Documents were sourced from local, state, and regional organizations in both the public and private sectors, using the northeast region defined by the third National Climate Assessment. Modeled after Dilling et al. (2015), a deductive coding schema was developed that categorized documents using specific search terms such as "Location and condition of infrastructure" and "Proactive planning". A qualitative document analysis was then executed using NVivo to formally identify patterns and themes present in stakeholder surveys, workshop proceedings, and reports. Initial stakeholder priorities centered around incorporation of climate science into planning and decision making regarding vulnerabilities of infrastructure, enhanced emergency planning and response, and communication of key information.

New institutional mechanisms to bridge the information gap between climate science and public policy decisions

NASA Astrophysics Data System (ADS)

Rogers, W.; Gulledge, J. M.

2010-12-01

Many decision makers lack actionable scientific information needed to prepare for future challenges associated with climate change. Although the scope and quality of available scientific information has increased dramatically in recent years, this information does not always reach - or is not presented in a form that is useful to - decision makers who need it. The producer (i.e. scientists) community tends to be stovepiped, even though consumers (i.e. decision makers) often need interdisciplinary science and analysis. Consumers, who may also be stovepiped in various agencies or subject areas, may lack familiarity with or access to these separate communities, as well as the tools or time to navigate scientific information and disciplines. Closing the communication gap between these communities could be facilitated by institutionalizing processes designed for this purpose. We recommend a variety of mainstreaming policies within the consumer community, as well as mechanisms to generate a strong demand signal that will resonate more strongly with the producer community. We also recommend institutional reforms and methods of incentivizing policy-oriented scientific analysis within the producer community. Our recommendations focus on improving information flow to national security and foreign policy decision makers, but many are relevant to public policy writ large. Recommendations for Producers 1. The scientific community should formally encourage collaborations between natural and social scientists and reward publications in interdisciplinary outlets Incentives could include research funding and honorary awards recognizing service to public policy. 2. Academic merit review should reward research grants and publications targeted at interdisciplinary and/or policy-oriented audiences. Reforms of merit review may require new policies and engaged institutional leadership. Recommendations for Consumers 1. Congress should amend Title VI of the National Defense Education Act to encourage the development of multidisciplinary educational programs on the national security implications of climate change. 2. Federal agencies should establish funding programs to encourage producers to provide scientific information tailored to consumer needs. 3. The Department of State should appoint climate advisors to serve within the regional bureaus and on the policy and planning staff. 4. Federal agencies, the Department of Education, and the National Science Foundation should develop programs to stimulate new interdisciplinary research partnerships and training of a new generation of interdisciplinary climate change risk thinkers, assessors and managers. 5. Federal agencies should encourage Senior Executive Service decision makers to participate in science policy certi¬fication workshops and include science and technology policy as a core curricu¬lum component of the SES Federal Candidate Development Program. These recommendations are described in detail in a report published by the Center for a New American Security: Rogers, W. and J. Gulledge (2010) Lost in Translation: Closing the Gap Between Climate Science and National Security Policy (available online: http://cnas.org/node/4391)

Robust climate policies under uncertainty: a comparison of robust decision making and info-gap methods.

PubMed

Hall, Jim W; Lempert, Robert J; Keller, Klaus; Hackbarth, Andrew; Mijere, Christophe; McInerney, David J

2012-10-01

This study compares two widely used approaches for robustness analysis of decision problems: the info-gap method originally developed by Ben-Haim and the robust decision making (RDM) approach originally developed by Lempert, Popper, and Bankes. The study uses each approach to evaluate alternative paths for climate-altering greenhouse gas emissions given the potential for nonlinear threshold responses in the climate system, significant uncertainty about such a threshold response and a variety of other key parameters, as well as the ability to learn about any threshold responses over time. Info-gap and RDM share many similarities. Both represent uncertainty as sets of multiple plausible futures, and both seek to identify robust strategies whose performance is insensitive to uncertainties. Yet they also exhibit important differences, as they arrange their analyses in different orders, treat losses and gains in different ways, and take different approaches to imprecise probabilistic information. The study finds that the two approaches reach similar but not identical policy recommendations and that their differing attributes raise important questions about their appropriate roles in decision support applications. The comparison not only improves understanding of these specific methods, it also suggests some broader insights into robustness approaches and a framework for comparing them. © 2012 RAND Corporation.

The emergency patient's participation in medical decision-making.

PubMed

Wang, Li-Hsiang; Goopy, Suzanne; Lin, Chun-Chih; Barnard, Alan; Han, Chin-Yen; Liu, Hsueh-Erh

2016-09-01

The purpose of this research was to explore the medical decision-making processes of patients in emergency departments. Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients. This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan. Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim. The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage. The findings fill a gap in knowledge about the decision-making process among emergency patients. The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff. © 2016 John Wiley & Sons Ltd.

An Ecobehavioral Analysis of Child Academic Engagement: Implications for Preschool Children Not Responding to Instructional Intervention

ERIC Educational Resources Information Center

Greenwood, Charles R.; Beecher, Constance; Atwater, Jane; Petersen, Sarah; Schiefelbusch, Jean; Irvin, Dwight

2018-01-01

A gap exists in the information needed to make intervention decisions with preschool children who are unresponsive to instructional intervention. "Multi-Tiered System of Supports/Response to Intervention" (MTSS/RTI) progress monitoring is helpful in indicating when an intervention change is needed but provides little information on what…

Experiences in Bridging the Gap between Science and Decision Making at NASA's GSFC Earth Science Data and Information Services Center (GES DISC)

NASA Technical Reports Server (NTRS)

Kempler, Steven; Teng, Bill; Friedl, Lawrence; Lynnes, Chris; Leptoukh, Gregory

2008-01-01

Recognizing the significance of NASA remote sensing Earth science data in monitoring and better understanding our planet s natural environment, NASA has implemented the Decision Support Through Earth Science Research Results program (NASA ROSES solicitations). a) This successful program has yielded several monitoring, surveillance, and decision support systems through collaborations with benefiting organizations. b) The Goddard Space Flight Center (GSFC) Earth Sciences Data and Information Services Center (GES DISC) has participated in this program on two projects (one complete, one ongoing), and has had opportune ad hoc collaborations gaining much experience in the formulation, management, development, and implementation of decision support systems utilizing NASA Earth science data. c) In addition, GES DISC s understanding of Earth science missions and resulting data and information, including data structures, data usability and interpretation, data interoperability, and information management systems, enables the GES DISC to identify challenges that come with bringing science data to decision makers. d) The purpose of this presentation is to share GES DISC decision support system project experiences in regards to system sustainability, required data quality (versus timeliness), data provider understanding of how decisions are made, and the data receivers willingness to use new types of information to make decisions, as well as other topics. In addition, defining metrics that really evaluate success will be exemplified.

Experiencing biodiversity as a bridge over the science-society communication gap.

PubMed

Meinard, Yves; Quétier, Fabien

2014-06-01

Drawing on the idea that biodiversity is simply the diversity of living things, and that everyone knows what diversity and living things mean, most conservation professionals eschew the need to explain the many complex ways in which biodiversity is understood in science. On many biodiversity-related issues, this lack of clarity leads to a communication gap between science and the general public, including decision makers who must design and implement biodiversity policies. Closing this communication gap is pivotal to the ability of science to inform sound environmental decision making. To address this communication gap, we propose a surrogate of biodiversity for communication purposes that captures the scientific definition of biodiversity yet can be understood by nonscientists; that is, biodiversity as a learning experience. The prerequisites of this or any other biodiversity communication surrogate are that it should have transdisciplinary relevance; not be measurable; be accessible to a wide audience; be usable to translate biodiversity issues; and understandably encompass biodiversity concepts. Biodiversity as a learning experience satisfies these prerequisites and is philosophically robust. More importantly, it can effectively contribute to closing the communication gap between biodiversity science and society at large. © 2013 Society for Conservation Biology.

Research on Decision-Making Support of Chineserural Land Tenure Information System

NASA Astrophysics Data System (ADS)

Tan, Jun; Su, Hongyou

Since 1949, the information of land tenure has a positive effect on defining the scope of collective land and state-owned land, implementing the system of cultivated land protection and land use control, designing general land use planning, etc. But as the economic and social development, the existing land tenure information is not appropriate anymore and results in many problems. The emphasis in the near future should be placed on establishing rural land tenure information system including cadastral management system, the uniform property registration system and cadastral management information system, defining the scope and content of various collective land ownership, securing peasants' land tenure rights, shortening the gap between urban and rural areas, all of which will guarantee the effective use of information of land tenure for the government's decision-making.

Models in animal collective decision-making: information uncertainty and conflicting preferences

PubMed Central

Conradt, Larissa

2012-01-01

Collective decision-making plays a central part in the lives of many social animals. Two important factors that influence collective decision-making are information uncertainty and conflicting preferences. Here, I bring together, and briefly review, basic models relating to animal collective decision-making in situations with information uncertainty and in situations with conflicting preferences between group members. The intention is to give an overview about the different types of modelling approaches that have been employed and the questions that they address and raise. Despite the use of a wide range of different modelling techniques, results show a coherent picture, as follows. Relatively simple cognitive mechanisms can lead to effective information pooling. Groups often face a trade-off between decision accuracy and speed, but appropriate fine-tuning of behavioural parameters could achieve high accuracy while maintaining reasonable speed. The right balance of interdependence and independence between animals is crucial for maintaining group cohesion and achieving high decision accuracy. In conflict situations, a high degree of decision-sharing between individuals is predicted, as well as transient leadership and leadership according to needs and physiological status. Animals often face crucial trade-offs between maintaining group cohesion and influencing the decision outcome in their own favour. Despite the great progress that has been made, there remains one big gap in our knowledge: how do animals make collective decisions in situations when information uncertainty and conflict of interest operate simultaneously? PMID:23565335

Time to treatment and acute coronary syndromes: bridging the gap in rapid decision making.

PubMed

Peacock, W Frank

2010-01-01

The role of cardiac biomarkers in the diagnosis, risk stratification, and treatment of patients with chest pain and suspected acute coronary syndromes (ACS) has continued to evolve. Although it is clear that troponin (Tn) measurement provides independent prognostic information in patients with suspected ACS, it is less well established that early B-type natriuretic peptide (BNP) measurement provides additional incremental prognostic information above and beyond electrocardiography and Tn measurement. It is useful to identify patients at high risk for adverse events through measurement of Tn and BNP levels so that timely treatment decisions can be made.

Adult Age Differences in Dual Information Processes: Implications for the Role of Affective and Deliberative Processes in Older Adults' Decision Making.

PubMed

Peters, Ellen; Hess, Thomas M; Västfjäll, Daniel; Auman, Corinne

2007-03-01

Age differences in affective/experiential and deliberative processes have important theoretical implications for judgment and decision theory and important pragmatic implications for older-adult decision making. Age-related declines in the efficiency of deliberative processes predict poorer-quality decisions as we age. However, age-related adaptive processes, including motivated selectivity in the use of deliberative capacity, an increased focus on emotional goals, and greater experience, predict better or worse decisions for older adults depending on the situation. The aim of the current review is to examine adult age differences in affective and deliberative information processes in order to understand their potential impact on judgments and decisions. We review evidence for the role of these dual processes in judgment and decision making and then review two representative life-span perspectives (based on aging-related changes to cognitive or motivational processes) on the interplay between these processes. We present relevant predictions for older-adult decisions and make note of contradictions and gaps that currently exist in the literature. Finally, we review the sparse evidence about age differences in decision making and how theories and findings regarding dual processes could be applied to decision theory and decision aiding. In particular, we focus on prospect theory (Kahneman & Tversky, 1979) and how prospect theory and theories regarding age differences in information processing can inform one another. © 2007 Association for Psychological Science.

Beyond the Academic Journal: Unfreezing Misconceptions About Mental Illness and Gun Violence Through Knowledge Translation to Decision-Makers.

PubMed

Horwitz, Joshua; Grilley, Anna; Kennedy, Orla

2015-06-01

In a policy arena characterized by polarized debate, such as the consideration of legal interventions to prevent gun violence, research evidence is an important tool to inform decision-making processes. However, unless the evidence is communicated to stakeholders who can influence policy decisions, the research will often remain an academic exercise with little practical impact. The Educational Fund to Stop Violence's process of "unfreezing" individual perceptions and conventional interpretations of the relationship between mental illness and gun violence, forming a consensus, and translating this knowledge to stakeholders through state discussion forums is one way to inform policy change. The recent passage of gun violence prevention legislation in California provides an example of successfully closing the knowledge translation gap between research and decision-making processes. Copyright © 2015 John Wiley & Sons, Ltd.

Decision Points and Considerations for Identifying Rural Districts That Have Closed Student Achievement Gaps. REL 2016-130

ERIC Educational Resources Information Center

Culbertson, Michael J.; Billig, Shelley H.

2016-01-01

Rural districts have long faced challenges in closing achievement gaps between subgroups of students. This brief report describes key decision points and considerations for decision-makers interested in identifying rural districts that have closed academic achievement gaps. Examining practices in these districts may suggest activities associated…

Evidence-informed decision making for nutrition: African experiences and way forward.

PubMed

Aryeetey, Richmond; Holdsworth, Michelle; Taljaard, Christine; Hounkpatin, Waliou Amoussa; Colecraft, Esi; Lachat, Carl; Nago, Eunice; Hailu, Tesfaye; Kolsteren, Patrick; Verstraeten, Roos

2017-11-01

Although substantial amount of nutrition research is conducted in Africa, the research agenda is mainly donor-driven. There is a clear need for a revised research agenda in Africa which is both driven by and responding to local priorities. The present paper summarises proceedings of a symposium on how evidence can guide decision makers towards context-appropriate priorities and decisions in nutrition. The paper focuses on lessons learnt from case studies by the Evidence Informed Decision Making in Nutrition and Health Network implemented between 2015 and 2016 in Benin, Ghana and South Africa. Activities within these countries were organised around problem-oriented evidence-informed decision-making (EIDM), capacity strengthening and leadership and horizontal collaboration. Using a combination of desk-reviews, stakeholder influence-mapping, semi-structured interviews and convening platforms, these country-level studies demonstrated strong interest for partnership between researchers and decision makers, and use of research evidence for prioritisation and decision making in nutrition. Identified capacity gaps were addressed through training workshops on EIDM, systematic reviews, cost-benefit evaluations and evidence contextualisation. Investing in knowledge partnerships and development of capacity and leadership are key to drive appropriate use of evidence in nutrition policy and programming in Africa.

Pros and cons of healthcare information technology implementation: the pros win.

PubMed

Maffei, Roxana

2006-01-01

Countless studies and investigations have been performed siding either for or against the implementation of technology in the healthcare setting. This article presents both sides of this debate, with an obvious conclusion that the pros of this debate win. The practice of information technology in the medical domain lags behind its knowledge and discovery by at least 7 years. The key to closing this gap is to show, through various studies, how information technology systems provide decision support to users at the point in time when decisions are needed. What the reader will obtain from this article is that the pros for information technology implementation in healthcare settings weigh much more and have a greater effect than the cons.

Robustness of risk maps and survey networks to knowledge gaps about a new invasive pest.

PubMed

Yemshanov, Denys; Koch, Frank H; Ben-Haim, Yakov; Smith, William D

2010-02-01

In pest risk assessment it is frequently necessary to make management decisions regarding emerging threats under severe uncertainty. Although risk maps provide useful decision support for invasive alien species, they rarely address knowledge gaps associated with the underlying risk model or how they may change the risk estimates. Failure to recognize uncertainty leads to risk-ignorant decisions and miscalculation of expected impacts as well as the costs required to minimize these impacts. Here we use the information gap concept to evaluate the robustness of risk maps to uncertainties in key assumptions about an invading organism. We generate risk maps with a spatial model of invasion that simulates potential entries of an invasive pest via international marine shipments, their spread through a landscape, and establishment on a susceptible host. In particular, we focus on the question of how much uncertainty in risk model assumptions can be tolerated before the risk map loses its value. We outline this approach with an example of a forest pest recently detected in North America, Sirex noctilio Fabricius. The results provide a spatial representation of the robustness of predictions of S. noctilio invasion risk to uncertainty and show major geographic hotspots where the consideration of uncertainty in model parameters may change management decisions about a new invasive pest. We then illustrate how the dependency between the extent of uncertainties and the degree of robustness of a risk map can be used to select a surveillance network design that is most robust to knowledge gaps about the pest.

Spinal Cord Injury Clinical Registries: Improving Care across the SCI Care Continuum by Identifying Knowledge Gaps.

PubMed

Dvorak, Marcel F; Cheng, Christiana L; Fallah, Nader; Santos, Argelio; Atkins, Derek; Humphreys, Suzanne; Rivers, Carly S; White, Barry A B; Ho, Chester; Ahn, Henry; Kwon, Brian K; Christie, Sean; Noonan, Vanessa K

2017-10-15

Timely access and ongoing delivery of care and therapeutic interventions is needed to maximize recovery and function after traumatic spinal cord injury (tSCI). To ensure these decisions are evidence-based, access to consistent, reliable, and valid sources of clinical data is required. The Access to Care and Timing Model used data from the Rick Hansen SCI Registry (RHSCIR) to generate a simulation of healthcare delivery for persons after tSCI and to test scenarios aimed at improving outcomes and reducing the economic burden of SCI. Through model development, we identified knowledge gaps and challenges in the literature and current health outcomes data collection throughout the continuum of SCI care. The objectives of this article were to describe these gaps and to provide recommendations for bridging them. Accurate information on injury severity after tSCI was hindered by difficulties in conducting neurological assessments and classifications of SCI (e.g., timing), variations in reporting, and the lack of a validated SCI-specific measure of associated injuries. There was also limited availability of reliable data on patient factors such as multi-morbidity and patient-reported measures. Knowledge gaps related to structures (e.g., protocols) and processes (e.g., costs) at each phase of care have prevented comprehensive evaluation of system performance. Addressing these knowledge gaps will enhance comparative and cost-effectiveness evaluations to inform decision-making and standards of care. Recommendations to do so were: standardize data element collection and facilitate database linkages, validate and adopt more outcome measures for SCI, and increase opportunities for collaborations with stakeholders from diverse backgrounds.

Spinal Cord Injury Clinical Registries: Improving Care across the SCI Care Continuum by Identifying Knowledge Gaps

PubMed Central

Cheng, Christiana L.; Fallah, Nader; Santos, Argelio; Atkins, Derek; Humphreys, Suzanne; Rivers, Carly S.; White, Barry A.B.; Ho, Chester; Ahn, Henry; Kwon, Brian K.; Christie, Sean; Noonan, Vanessa K.

2017-01-01

Abstract Timely access and ongoing delivery of care and therapeutic interventions is needed to maximize recovery and function after traumatic spinal cord injury (tSCI). To ensure these decisions are evidence-based, access to consistent, reliable, and valid sources of clinical data is required. The Access to Care and Timing Model used data from the Rick Hansen SCI Registry (RHSCIR) to generate a simulation of healthcare delivery for persons after tSCI and to test scenarios aimed at improving outcomes and reducing the economic burden of SCI. Through model development, we identified knowledge gaps and challenges in the literature and current health outcomes data collection throughout the continuum of SCI care. The objectives of this article were to describe these gaps and to provide recommendations for bridging them. Accurate information on injury severity after tSCI was hindered by difficulties in conducting neurological assessments and classifications of SCI (e.g., timing), variations in reporting, and the lack of a validated SCI-specific measure of associated injuries. There was also limited availability of reliable data on patient factors such as multi-morbidity and patient-reported measures. Knowledge gaps related to structures (e.g., protocols) and processes (e.g., costs) at each phase of care have prevented comprehensive evaluation of system performance. Addressing these knowledge gaps will enhance comparative and cost-effectiveness evaluations to inform decision-making and standards of care. Recommendations to do so were: standardize data element collection and facilitate database linkages, validate and adopt more outcome measures for SCI, and increase opportunities for collaborations with stakeholders from diverse backgrounds. PMID:28745934

Application of Toxicogenomics in Decision Making in Ecological and Human Health Risk Assessment

EPA Science Inventory

Uncertainties in risk assessment arise from sparse or inadequate data including gaps in our understanding of mode of action, the exposure-dose-response pathway, cross-species toxicokinetic and toxicodynamic information, and/or exposure data. There is an expectation that toxicogen...

Computational Linguistics in Military Operations

DTIC Science & Technology

2010-01-01

information dominance at the operational and tactical level of war in future warfare. Discussion: Mastering culture and language in a foreign country is decisive to understand the operational environment. In addition, the ability to understand and speak a foreign language is a prerequisite to achieve truly comprehension of an unfamiliar culture. Lasting operations in Afghanistan and Iraq and the necessity to breach the language gap lead to progress in the field of Machine Translation and the development of technical solutions to close the gap in the past decade. This paper

Physicians' intentions and use of three patient decision aids

PubMed Central

Graham, Ian D; Logan, Jo; Bennett, Carol L; Presseau, Justin; O'Connor, Annette M; Mitchell, Susan L; Tetroe, Jacqueline M; Cranney, Ann; Hebert, Paul; Aaron, Shawn D

2007-01-01

Background Decision aids are evidence based tools that assist patients in making informed values-based choices and supplement the patient-clinician interaction. While there is evidence to show that decision aids improve key indicators of patients' decision quality, relatively little is known about physicians' acceptance of decision aids or factors that influence their decision to use them. The purpose of this study was to describe physicians' perceptions of three decision aids, their expressed intent to use them, and their subsequent use of them. Methods We conducted a cross-sectional survey of random samples of Canadian respirologists, family physicians, and geriatricians. Three decision aids representing a range of health decisions were evaluated. The survey elicited physicians' opinions on the characteristics of the decision aid and their willingness to use it. Physicians who indicated a strong likelihood of using the decision aid were contacted three months later regarding their actual use of the decision aid. Results Of the 580 eligible physicians, 47% (n = 270) returned completed questionnaires. More than 85% of the respondents felt the decision aid was well developed and that it presented the essential information for decision making in an understandable, balanced, and unbiased manner. A majority of respondents (>80%) also felt that the decision aid would guide patients in a logical way, preparing them to participate in decision making and to reach a decision. Fewer physicians (<60%) felt the decision aid would improve the quality of patient visits or be easily implemented into practice and very few (27%) felt that the decision aid would save time. Physicians' intentions to use the decision aid were related to their comfort with offering it to patients, the decision aid topic, and the perceived ease of implementing it into practice. While 54% of the surveyed physicians indicated they would use the decision aid, less than a third followed through with this intention. Conclusion Despite strong support for the format, content, and quality of patient decision aids, and physicians' stated intentions to adopt them into clinical practice, most did not use them within three months of completing the survey. There is a wide gap between intention and behaviour. Further research is required to study the determinants of this intention-behaviour gap and to develop interventions aimed at barriers to physicians' use of decision aids. PMID:17617908

Cross-sectional study to examine evidence-based practice skills and behaviors of physical therapy graduates: is there a knowledge-to-practice gap?

PubMed

Manns, Patricia J; Norton, Amy V; Darrah, Johanna

2015-04-01

Curricula changes in physical therapist education programs in Canada emphasize evidence-based practice skills, including literature retrieval and evaluation. Do graduates use these skills in practice? The aim of this study was to evaluate the use of research information in the clinical decision making of therapists with different years of experience and evidence-based practice preparation. Perceptions about evidence-based practice were explored qualitatively. A cross-sectional study with 4 graduating cohorts was conducted. Eighty physical therapists representing 4 different graduating cohorts participated in interviews focused on 2 clinical scenarios. Participants had varying years of clinical experience (range=1-15 years) and academic knowledge of evidence-based practice skills. Therapists discussed the effectiveness of interventions related to the scenarios and identified the sources of information used to reach decisions. Participants also answered general questions related to evidence-based practice knowledge. Recent graduates demonstrated better knowledge of evidence-based practice skills compared with therapists with 6 to 15 years of clinical experience. However, all groups used clinical experience most frequently as their source of information for clinical decisions. Research evidence was infrequently included in decision making. This study used a convenience sample of therapists who agreed to volunteer for the study. The results suggest a knowledge-to-practice gap; graduates are not using the new skills to inform their practice. Tailoring academic evidence-based activities more to the time constraints of clinical practice may help students to be more successful in applying evidence in practice. Academic programs need to do more to create and nurture environments in both academic and clinical settings to ensure students practice using evidence-based practice skills across settings. © 2015 American Physical Therapy Association.

Information needs and experiences: an audit of UK cancer patients.

PubMed

Cox, Anna; Jenkins, Valerie; Catt, Susan; Langridge, Carolyn; Fallowfield, Lesley

2006-09-01

As part of a multi-centred UK study evaluating multidisciplinary team communication, the information needs, decision making preferences and information experiences of 394 cancer patients were audited. A majority of patients (342/394, 87%) wanted all possible information, both good and bad news. Assuming that all clinicians had equal skill, the majority of patients (350/394, 89%) expressed no preference for the sex of their doctor. The largest proportion of patients (153/394, 39%) wanted to share responsibility for decision making, preference was significantly influenced by age (chi2=17.42, df=4 P=0.002) with older patients more likely to prefer the doctor to make the decisions. A majority of patients reported receiving information regarding their initial tests (313/314, 100%), diagnosis (382/382, 100%), surgery (374/375, 100%) and prognosis (308/355, 87%), fewer recalled discussions concerning clinical trials (119/280, 43%), family history (90/320, 28%) or psychosocial issues, notably sexual well-being (116/314, 37%). Cancer patients want to be fully informed and share decision making responsibility, but do not report receiving sufficient information in all areas. Multidisciplinary cancer teams need to ensure that where appropriate, someone provides patients with information about clinical trials, familial risk and psychosocial issues. Regular audits highlight gaps and omissions in the information given to patients.

Laboratory Studies on Surface Sampling of Bacillus anthracis Contamination: Summary, Gaps, and Recommendations

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

Piepel, Gregory F.; Amidan, Brett G.; Hu, Rebecca

2011-11-28

This report summarizes previous laboratory studies to characterize the performance of methods for collecting, storing/transporting, processing, and analyzing samples from surfaces contaminated by Bacillus anthracis or related surrogates. The focus is on plate culture and count estimates of surface contamination for swab, wipe, and vacuum samples of porous and nonporous surfaces. Summaries of the previous studies and their results were assessed to identify gaps in information needed as inputs to calculate key parameters critical to risk management in biothreat incidents. One key parameter is the number of samples needed to make characterization or clearance decisions with specified statistical confidence. Othermore » key parameters include the ability to calculate, following contamination incidents, the (1) estimates of Bacillus anthracis contamination, as well as the bias and uncertainties in the estimates, and (2) confidence in characterization and clearance decisions for contaminated or decontaminated buildings. Gaps in knowledge and understanding identified during the summary of the studies are discussed and recommendations are given for future studies.« less

Equality bias impairs collective decision-making across cultures

PubMed Central

Mahmoodi, Ali; Bang, Dan; Olsen, Karsten; Zhao, Yuanyuan Aimee; Shi, Zhenhao; Broberg, Kristina; Safavi, Shervin; Han, Shihui; Nili Ahmadabadi, Majid; Frith, Chris D.; Roepstorff, Andreas; Rees, Geraint; Bahrami, Bahador

2015-01-01

We tend to think that everyone deserves an equal say in a debate. This seemingly innocuous assumption can be damaging when we make decisions together as part of a group. To make optimal decisions, group members should weight their differing opinions according to how competent they are relative to one another; whenever they differ in competence, an equal weighting is suboptimal. Here, we asked how people deal with individual differences in competence in the context of a collective perceptual decision-making task. We developed a metric for estimating how participants weight their partner’s opinion relative to their own and compared this weighting to an optimal benchmark. Replicated across three countries (Denmark, Iran, and China), we show that participants assigned nearly equal weights to each other’s opinions regardless of true differences in their competence—even when informed by explicit feedback about their competence gap or under monetary incentives to maximize collective accuracy. This equality bias, whereby people behave as if they are as good or as bad as their partner, is particularly costly for a group when a competence gap separates its members. PMID:25775532

Equality bias impairs collective decision-making across cultures.

PubMed

Mahmoodi, Ali; Bang, Dan; Olsen, Karsten; Zhao, Yuanyuan Aimee; Shi, Zhenhao; Broberg, Kristina; Safavi, Shervin; Han, Shihui; Nili Ahmadabadi, Majid; Frith, Chris D; Roepstorff, Andreas; Rees, Geraint; Bahrami, Bahador

2015-03-24

We tend to think that everyone deserves an equal say in a debate. This seemingly innocuous assumption can be damaging when we make decisions together as part of a group. To make optimal decisions, group members should weight their differing opinions according to how competent they are relative to one another; whenever they differ in competence, an equal weighting is suboptimal. Here, we asked how people deal with individual differences in competence in the context of a collective perceptual decision-making task. We developed a metric for estimating how participants weight their partner's opinion relative to their own and compared this weighting to an optimal benchmark. Replicated across three countries (Denmark, Iran, and China), we show that participants assigned nearly equal weights to each other's opinions regardless of true differences in their competence-even when informed by explicit feedback about their competence gap or under monetary incentives to maximize collective accuracy. This equality bias, whereby people behave as if they are as good or as bad as their partner, is particularly costly for a group when a competence gap separates its members.

Economic evaluation of pharmacogenomics: a value-based approach to pragmatic decision making in the face of complexity.

PubMed

Snyder, Susan R; Mitropoulou, Christina; Patrinos, George P; Williams, Marc S

2014-01-01

Evidence of the value of pharmacogenomic testing is needed to inform policymakers and clinicians for decision making related to adoption and coverage, and to facilitate prioritization for research and development. Pharmacogenomics has an important role in creating a more efficient healthcare system, and this article addresses how economic evaluation can strategically target evidence gaps for public health priorities with examples from pharmacogenomic medicine. This article begins with a review of the need for and use of economic evaluations in value-based decision making for pharmacogenomic testing. Three important gaps are described with examples demonstrating how they can be addressed: (1) projected impact of hypothetical new technology, (2) pre-implementation assessment of a specific technology, and (3) post-implementation assessment from relevant analytical stakeholder perspectives. Additional needs, challenges and approaches specific to pharmacogenomic economic evaluation in the developing world are also identified. These pragmatic approaches can provide much needed evidence to support real-world value-based decision making for pharmacogenomic-based screening and treatment strategies. © 2014 S. Karger AG, Basel.

Bridge over troubled waters: A Synthesis Session to connect ...

EPA Pesticide Factsheets

Lack of access to relevant scientific data has limited decision makers from incorporating scientific information into their management and policy schemes. Yet, there is increasing interest among decision makers and scientists to integrate coastal and marine science into the policy and management process. Strategies designed to build communication between decision makers and scientists can be an effective means to disseminate and/or generate policy relevant scientific information. Here researchers develop, test, and present a workshop model designed to bridge the gap between coastal and marine decision makers and scientists. Researchers identify successful components of such a workshop as well as areas for improvement and recommendations to design and conduct similar workshops in the future. This novel workshop format can be used in other fora to effectively connect decision makers and scientists, and to initiate an iterative process to generate and transfer policy relevant scientific information into evidence-based decisions, an important element in protecting coastal and marine resources. In this paper we develop and present a model for increasing collaboration between scientists and decision makers to promote evidence based decisions. Successes and areas for improvement in the tested model are discussed. This novel workshop model is intended to build and sustain connections, with the ultimate goal of creating better policy and management practices. In a recent

Variables within a Household That Influence Quality-of-Life Outcomes for Individuals with Intellectual and Developmental Disabilities Living in the Community: Discovering the Gaps

ERIC Educational Resources Information Center

Francis, Grace Lucille; Blue-Banning, Martha; Turnbull, Rud

2014-01-01

Individuals with intellectual and developmental disabilities (IDD) and their families face many important decisions as the individuals with IDD enter adulthood, including where to live. Although there are numerous housing options for individuals with IDD outside of institutions, there is a paucity of information available to inform them about how…

Assessing Option Grid® practicability and feasibility for facilitating shared decision making: An exploratory study.

PubMed

Tsulukidze, Maka; Grande, Stuart W; Gionfriddo, Michael R

2015-07-01

To assess the feasibility of Option Grids(®)for facilitating shared decision making (SDM) in simulated clinical consultations and explore clinicians' views on their practicability. We used mixed methods approach to analyze clinical consultations using the Observer OPTION instrument and thematic analysis for follow-up interviews with clinicians. Clinicians achieved high scores on information sharing and low scores on preference elicitation and integration. Four themes were identified: (1) Barriers affect practicability of Option Grids(®); (2) Option Grids(®) facilitate the SDM process; (3) Clinicians are aware of the gaps in their practice of SDM; (4) Training and ongoing feedback on the optimal use of Option Grids(®) are necessary. Use of Option Grids(®) by clinicians with background knowledge in SDM did not facilitate optimal levels of competency on the SDM core concepts of preference elicitation and integration. Future research must evaluate the impact of training on the use of Option Grids(®), and explore how best to help clinicians bridge the gap between knowledge and action. Clinicians proficiently imparting information in simulations struggled to elicit and integrate patient preferences - understanding this gap and developing strategies to close it are the next steps for implementing SDM into clinical practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Informed decision-making in elective major vascular surgery: analysis of 145 surgeon-patient consultations.

PubMed

Etchells, Edward; Ferrari, Michel; Kiss, Alex; Martyn, Nikki; Zinman, Deborah; Levinson, Wendy

2011-06-01

Prior studies show significant gaps in the informed decision-making process, a central goal of surgical care. These studies have been limited by their focus on low-risk decisions, single visits rather than entire consultations, or both. Our objectives were, first, to rate informed decision-making for major elective vascular surgery based on audiotapes of actual physician-patient conversations and, second, to compare ratings of informed decision-making for first visits to ratings for multiple visits by the same patient over time. We prospectively enrolled patients for whom vascular surgical treatment was a potential option at a tertiary care outpatient vascular surgery clinic. We audio-taped all surgeon-patient conversations, including multiple visits when necessary, until a decision was made. Using an existing method, we evaluated the transcripts for elements of decision-making, including basic elements (e.g., an explanation of the clinical condition), intermediate elements (e.g., risks and benefits) and complex elements (e.g., uncertainty around the decision). We analyzed 145 surgeon-patient consultations. Overall, 45% of consultations contained complex elements, whereas 23% did not contain the basic elements of decision-making. For the 67 consultations that involved multiple visits, ratings were significantly higher when evaluating all visits (50% complex elements) compared with evaluating only the first visit (33% complex elements, p < 0.001.) We found that 45% of consultations contained complex elements, which is higher than prior studies with similar methods. Analyzing decision-making over multiple visits yielded different results than analyzing decision-making for single visits.

Implications of the Value of Hydrologic Information to Reservoir Operations--Learning from the Past

ERIC Educational Resources Information Center

Hejazi, Mohamad Issa

2009-01-01

Closing the gap between theoretical reservoir operation and the real-world implementation remains a challenge in contemporary reservoir operations. Past research has focused on optimization algorithms and establishing optimal policies for reservoir operations. In this research, we attempt to understand operators' release decisions by investigating…

Public perceptions and information gaps in solar energy in Texas

NASA Astrophysics Data System (ADS)

Rai, Varun; Beck, Ariane L.

2015-07-01

Studying the behavioral aspects of the individual decision-making process is important in identifying and addressing barriers in the adoption of residential solar photovoltaic (PV). However, there is little systematic research focusing on these aspects of residential PV in Texas, an important, large, populous state, with a range of challenges in the electricity sector including increasing demand, shrinking reserve margins, constrained water supply, and challenging emissions reduction targets under proposed federal regulations. This paper aims to address this gap through an empirical investigation of a new survey-based dataset collected in Texas on solar energy perceptions and behavior. The results of this analysis offer insights into the perceptions and motivations influencing intentions and behavior toward solar energy in a relatively untapped market and help identify information gaps that could be targeted to alleviate key barriers to adopting solar, thereby enabling significant emissions reductions in the residential sector in Texas.

Ensuring Adequate Health and Safety Information for Decision Makers during Large-Scale Chemical Releases

NASA Astrophysics Data System (ADS)

Petropoulos, Z.; Clavin, C.; Zuckerman, B.

2015-12-01

The 2014 4-Methylcyclohexanemethanol (MCHM) spill in the Elk River of West Virginia highlighted existing gaps in emergency planning for, and response to, large-scale chemical releases in the United States. The Emergency Planning and Community Right-to-Know Act requires that facilities with hazardous substances provide Material Safety Data Sheets (MSDSs), which contain health and safety information on the hazardous substances. The MSDS produced by Eastman Chemical Company, the manufacturer of MCHM, listed "no data available" for various human toxicity subcategories, such as reproductive toxicity and carcinogenicity. As a result of incomplete toxicity data, the public and media received conflicting messages on the safety of the contaminated water from government officials, industry, and the public health community. Two days after the governor lifted the ban on water use, the health department partially retracted the ban by warning pregnant women to continue avoiding the contaminated water, which the Centers for Disease Control and Prevention deemed safe three weeks later. The response in West Virginia represents a failure in risk communication and calls to question if government officials have sufficient information to support evidence-based decisions during future incidents. Research capabilities, like the National Science Foundation RAPID funding, can provide a solution to some of the data gaps, such as information on environmental fate in the case of the MCHM spill. In order to inform policy discussions on this issue, a methodology for assessing the outcomes of RAPID and similar National Institutes of Health grants in the context of emergency response is employed to examine the efficacy of research-based capabilities in enhancing public health decision making capacity. The results of this assessment highlight potential roles rapid scientific research can fill in ensuring adequate health and safety data is readily available for decision makers during large-scale chemical releases.

The absence of wild game and fish species from the USDA National Nutrient Database for standard reference: addressing information gaps in wild caught foods.

PubMed

Tidball, Moira M; Tidball, Keith G; Curtis, Paul

2014-01-01

We highlighted gaps in nutritional data for wild game meat and wild caught fish that have a regulated harvesting season in New York State, and examined the possible role that wild game and fish play in current trends towards consumption of local, healthy meat sources. This project is part of larger study that examines family food decision-making, and explores possibilities for leveraging the locavore movement in support of consumption of wild game and fish.

Outbreak Column 16: Cognitive errors in outbreak decision making.

PubMed

Curran, Evonne T

2015-01-01

During outbreaks, decisions must be made without all the required information. People, including infection prevention and control teams (IPCTs), who have to make decisions during uncertainty use heuristics to fill the missing data gaps. Heuristics are mental model short cuts that by-and-large enable us to make good decisions quickly. However, these heuristics contain biases and effects that at times lead to cognitive (thinking) errors. These cognitive errors are not made to deliberately misrepresent any given situation; we are subject to heuristic biases when we are trying to perform optimally. The science of decision making is large; there are over 100 different biases recognised and described. Outbreak Column 16 discusses and relates these heuristics and biases to decision making during outbreak prevention, preparedness and management. Insights as to how we might recognise and avoid them are offered.

Consumer Engagement in Health IT: Distinguishing Rhetoric from Reality.

PubMed

Gold, Marsha; Hossain, Mynti; Mangum, Amy

2015-01-01

Policymakers want health information technology (health IT) to support consumer engagement to help achieve national health goals. In this paper, we review the evidence to compare the rhetoric with the reality of current practice. Our environmental scan shows that consumer demand exists for electronic access to personal health information, but that technical and system or political barriers still limit the value of the available information and its potential benefits. There is a gap between current reality and the goals for consumer engagement. Actions that may help bridge this gap include: (1) resolving technical barriers to health information exchange (HIE); (2) developing more consumer-centric design and functionality; (3) reinforcing incentives that attract provider support by showing that consumer engagement is in their interest; and (4) building a stronger empirical case to convince decision makers that consumer engagement will lead to better care, improved health outcomes, and lower costs.

From Population Databases to Research and Informed Health Decisions and Policy.

PubMed

Machluf, Yossy; Tal, Orna; Navon, Amir; Chaiter, Yoram

2017-01-01

In the era of big data, the medical community is inspired to maximize the utilization and processing of the rapidly expanding medical datasets for clinical-related and policy-driven research. This requires a medical database that can be aggregated, interpreted, and integrated at both the individual and population levels. Policymakers seek data as a lever for wise, evidence-based decision-making and information-driven policy. Yet, bridging the gap between data collection, research, and policymaking, is a major challenge. To bridge this gap, we propose a four-step model: (A) creating a conjoined task force of all relevant parties to declare a national program to promote collaborations; (B) promoting a national digital records project, or at least a network of synchronized and integrated databases, in an accessible transparent manner; (C) creating an interoperative national research environment to enable the analysis of the organized and integrated data and to generate evidence; and (D) utilizing the evidence to improve decision-making, to support a wisely chosen national policy. For the latter purpose, we also developed a novel multidimensional set of criteria to illuminate insights and estimate the risk for future morbidity based on current medical conditions. Used by policymakers, providers of health plans, caregivers, and health organizations, we presume this model will assist transforming evidence generation to support the design of health policy and programs, as well as improved decision-making about health and health care, at all levels: individual, communal, organizational, and national.

Bridging the guideline implementation gap: a systematic, document-centered approach to guideline implementation.

PubMed

Shiffman, Richard N; Michel, George; Essaihi, Abdelwaheb; Thornquist, Elizabeth

2004-01-01

A gap exists between the information contained in published clinical practice guidelines and the knowledge and information that are necessary to implement them. This work describes a process to systematize and make explicit the translation of document-based knowledge into workflow-integrated clinical decision support systems. This approach uses the Guideline Elements Model (GEM) to represent the guideline knowledge. Implementation requires a number of steps to translate the knowledge contained in guideline text into a computable format and to integrate the information into clinical workflow. The steps include: (1) selection of a guideline and specific recommendations for implementation, (2) markup of the guideline text, (3) atomization, (4) deabstraction and (5) disambiguation of recommendation concepts, (6) verification of rule set completeness, (7) addition of explanations, (8) building executable statements, (9) specification of origins of decision variables and insertions of recommended actions, (10) definition of action types and selection of associated beneficial services, (11) choice of interface components, and (12) creation of requirement specification. The authors illustrate these component processes using examples drawn from recent experience translating recommendations from the National Heart, Lung, and Blood Institute's guideline on management of chronic asthma into a workflow-integrated decision support system that operates within the Logician electronic health record system. Using the guideline document as a knowledge source promotes authentic translation of domain knowledge and reduces the overall complexity of the implementation task. From this framework, we believe that a better understanding of activities involved in guideline implementation will emerge.

"Scrubbing" Data for D3M

ERIC Educational Resources Information Center

Mercurius, Neil

2005-01-01

Data-driven decision-making (D3M) appears to be the new buzz phrase for this century, the information age. On the education front, teachers and administrators are engaging in data-centered dialog in grade-level meetings, lounges, hallways, and classrooms as they brainstorm toward closing the gap in student achievement. Clearly, such discussion…

Potential uses of Bayesian networks as tools for synthesis of systematic reviews of complex interventions.

PubMed

Stewart, G B; Mengersen, K; Meader, N

2014-03-01

Bayesian networks (BNs) are tools for representing expert knowledge or evidence. They are especially useful for synthesising evidence or belief concerning a complex intervention, assessing the sensitivity of outcomes to different situations or contextual frameworks and framing decision problems that involve alternative types of intervention. Bayesian networks are useful extensions to logic maps when initiating a review or to facilitate synthesis and bridge the gap between evidence acquisition and decision-making. Formal elicitation techniques allow development of BNs on the basis of expert opinion. Such applications are useful alternatives to 'empty' reviews, which identify knowledge gaps but fail to support decision-making. Where review evidence exists, it can inform the development of a BN. We illustrate the construction of a BN using a motivating example that demonstrates how BNs can ensure coherence, transparently structure the problem addressed by a complex intervention and assess sensitivity to context, all of which are critical components of robust reviews of complex interventions. We suggest that BNs should be utilised to routinely synthesise reviews of complex interventions or empty reviews where decisions must be made despite poor evidence. Copyright © 2013 John Wiley & Sons, Ltd.

Robust evaluation of time series classification algorithms for structural health monitoring

NASA Astrophysics Data System (ADS)

Harvey, Dustin Y.; Worden, Keith; Todd, Michael D.

2014-03-01

Structural health monitoring (SHM) systems provide real-time damage and performance information for civil, aerospace, and mechanical infrastructure through analysis of structural response measurements. The supervised learning methodology for data-driven SHM involves computation of low-dimensional, damage-sensitive features from raw measurement data that are then used in conjunction with machine learning algorithms to detect, classify, and quantify damage states. However, these systems often suffer from performance degradation in real-world applications due to varying operational and environmental conditions. Probabilistic approaches to robust SHM system design suffer from incomplete knowledge of all conditions a system will experience over its lifetime. Info-gap decision theory enables nonprobabilistic evaluation of the robustness of competing models and systems in a variety of decision making applications. Previous work employed info-gap models to handle feature uncertainty when selecting various components of a supervised learning system, namely features from a pre-selected family and classifiers. In this work, the info-gap framework is extended to robust feature design and classifier selection for general time series classification through an efficient, interval arithmetic implementation of an info-gap data model. Experimental results are presented for a damage type classification problem on a ball bearing in a rotating machine. The info-gap framework in conjunction with an evolutionary feature design system allows for fully automated design of a time series classifier to meet performance requirements under maximum allowable uncertainty.

Readability of menopause web sites: a cross-sectional study.

PubMed

Charbonneau, Deborah H

2012-01-01

More women are frequently referring to the Internet for health information, yet the readability of information about menopause on the Internet has not been widely studied. To address this gap, this study examined the readability of information about menopause on 25 Internet Web sites. Findings included that information on the Web sites had a reading level higher than the recommended sixth-grade level, and culturally appropriate health information was lacking. Health educators and practitioners are in a pivotal role to help women understand information useful for healthcare decisions. Several criteria are discussed to help practitioners evaluate Web sites.

Evidence-based medicine, the research-practice gap, and biases in medical and surgical decision making in dermatology.

PubMed

Eaglstein, William H

2010-10-01

The objectives of this article are to promote a better understanding of a group of biases that influence therapeutic decision making by physicians/dermatologists and to raise the awareness that these biases contribute to a research-practice gap that has an impact on physicians and treatment solutions. The literature included a wide range of peer-reviewed articles dealing with biases in decision making, evidence-based medicine, randomized controlled clinical trials, and the research-practice gap. Bias against new therapies, bias in favor of indirect harm or omission, and bias against change when multiple new choices are offered may unconsciously affect therapeutic decision making. Although there is no comprehensive understanding or theory as to how choices are made by physicians, recognition of certain cognition patterns and their associated biases will help narrow the research-practice gap and optimize decision making regarding therapeutic choices.

Designing healthcare information technology to catalyse change in clinical care.

PubMed

Lester, William T; Zai, Adrian H; Grant, Richard W; Chueh, Henry C

2008-01-01

The gap between best practice and actual patient care continues to be a pervasive problem in our healthcare system. Efforts to improve on this knowledge-performance gap have included computerised disease management programs designed to improve guideline adherence. However, current computerised reminder and decision support interventions directed at changing physician behaviour have had only a limited and variable effect on clinical outcomes. Further, immediate pay-for-performance financial pressures on institutions have created an environment where disease management systems are often created under duress, appended to existing clinical systems and poorly integrated into the existing workflow, potentially limiting their real-world effectiveness. The authors present a review of disease management as well as a conceptual framework to guide the development of more effective health information technology (HIT) tools for translating clinical information into clinical action.

Involvement and Influence of Healthcare Providers, Family Members, and Other Mutation Carriers in the Cancer Risk Management Decision-Making Process of BRCA1 and BRCA2 Mutation Carriers.

PubMed

Puski, Athena; Hovick, Shelly; Senter, Leigha; Toland, Amanda Ewart

2018-03-29

Deciding between increased cancer screening or prophylactic surgery and the timing of such procedures can be a difficult and complex process for women with BRCA mutations. There are gaps in our understanding of involvement of others in the decision-making process for women with BRCA mutations. This study evaluated the management decision-making process of women with BRCA mutations, focusing on the involvement of others. Grounded theory was used to analyze and code risk management decision-making information from interviews with 20 BRCA mutation carriers. Unaffected at-risk participants with a BRCA mutation, those under age 40, and those with no children described having a difficult time making risk management decisions. Physicians were an integral part of the decision-making process by providing decisional support and management recommendations. Family members and other mutation carriers filled similar yet distinct roles by providing experiential information as well as decisional and emotional support for carriers. Participants described genetic counselors as short-term providers of risk information and management recommendations. The study findings suggest that unaffected at-risk women, women under 40, and those who do not have children may benefit from additional support and information during the decision-making process. Genetic counselors are well trained to help women through this process and connect them with resources, and may be under-utilized in long-term follow-up for women with a BRCA mutation.

Insights into water managers' perception and handling of uncertainties - a study of the role of uncertainty in practitioners' planning and decision-making

NASA Astrophysics Data System (ADS)

Höllermann, Britta; Evers, Mariele

2017-04-01

Planning and decision-making under uncertainty is common in water management due to climate variability, simplified models, societal developments, planning restrictions just to name a few. Dealing with uncertainty can be approached from two sites, hereby affecting the process and form of communication: Either improve the knowledge base by reducing uncertainties or apply risk-based approaches to acknowledge uncertainties throughout the management process. Current understanding is that science more strongly focusses on the former approach, while policy and practice are more actively applying a risk-based approach to handle incomplete and/or ambiguous information. The focus of this study is on how water managers perceive and handle uncertainties at the knowledge/decision interface in their daily planning and decision-making routines. How they evaluate the role of uncertainties for their decisions and how they integrate this information into the decision-making process. Expert interviews and questionnaires among practitioners and scientists provided an insight into their perspectives on uncertainty handling allowing a comparison of diverse strategies between science and practice as well as between different types of practitioners. Our results confirmed the practitioners' bottom up approach from potential measures upwards instead of impact assessment downwards common in science-based approaches. This science-practice gap may hinder effective uncertainty integration and acknowledgement in final decisions. Additionally, the implementation of an adaptive and flexible management approach acknowledging uncertainties is often stalled by rigid regulations favouring a predict-and-control attitude. However, the study showed that practitioners' level of uncertainty recognition varies with respect to his or her affiliation to type of employer and business unit, hence, affecting the degree of the science-practice-gap with respect to uncertainty recognition. The level of working experience was examined as a cross-cutting property of science and practice with increasing levels of uncertainty awareness and integration among more experienced researchers and practitioners. In conclusion, our study of water managers' perception and handling of uncertainties provides valuable insights for finding routines for uncertainty communication and integration into planning and decision-making processes by acknowledging the divers perceptions among producers, users and receivers of uncertainty information. These results can contribute to more effective integration of hydrological forecast and improved decisions.

An integrated model of decision-making in health contexts: the role of science education in health education

NASA Astrophysics Data System (ADS)

Arnold, Julia C.

2018-03-01

Health education is to foster health literacy, informed decision-making and to promote health behaviour. To date, there are several models that seek to explain health behaviour (e.g. the Theory of Planned Behaviour or the Health Belief Model). These models include motivational factors (expectancies and values) that play a role in decision-making in health contexts. In this theoretical paper, it is argued that none of these models makes consequent use of expectancy-value pairs. It is further argued that in order to make these models fruitful for science education and for informed decision-making, models should systematically incorporate knowledge as part of the decision-making process. To fill this gap, this theoretical paper introduces The Integrated Model of Decision-Making in Health Contexts. This model includes three types of knowledge (system health knowledge, action-related health knowledge and effectiveness health knowledge) as influencing factors for motivational factors (perceived health threat, attitude towards health action, attitude towards health outcome and subjective norm) that are formed of expectancy-value pairs and lead to decisions. The model's potential for health education in science education as well as research implications is discussed.

Bridging the Gap: Tailor-made Information Products for Decision Makers

NASA Astrophysics Data System (ADS)

Mandler, B. E.; Rose, C. A.; Gonzales, L. M.; Boland, M. A.

2016-12-01

The American Geosciences Institute (AGI) is launching a new information platform designed to link decision makers with information generated by geoscientific research. Decision makers, especially those at the state and local level, frequently need scientific information but do not always have easy access to it, while scientists create new knowledge but often lack opportunities to communicate this knowledge more broadly to the people who need it the most. Major differences in communication styles and language can also hinder the use of scientific information by decision makers. AGI is building an online portfolio of case studies and fact sheets that are based on cutting-edge research presented in a format and style that meets the needs and expectations of decision makers. Based on discussions with state and local decision makers around the country, AGI has developed a template for these products. Scientists are invited to write short (500-700-word) summaries of their research and the ways in which it provides useful tools and information to decision makers. We are particularly interested in showcasing actionable information derived from basic or applied research. Researchers are encouraged to contact AGI to discuss topics that may be an appropriate basis for case studies or fact sheets, and AGI may also contact researchers based on scientific needs identified during our discussions with decision makers. All submissions will be edited and reviewed by AGI staff and an external peer review team before being published online and made available to decision makers through AGI's Critical Issues web platform and extensive professional networks. Publicizing the results of scientific research to key legislative, regulatory, advisory, and engaged citizen groups and individuals broadens the impact of scientists' research and highlights the value and importance of the geosciences to society. By presenting the information in a format that is designed with the end-user in mind, this initiative provides a much-needed service to decision makers at all levels and serves the geoscience community by increasing the distribution and dissemination of research findings. We will discuss early results and challenges from this program, and feedback from state and local decision makers.

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.

Assessing the impact of a medical librarian on identification of valid and actionable practice gaps for a continuing medical education committee.

PubMed

Bartkowiak, Barbara A; Safford, Lindsey A; Stratman, Erik J

2014-01-01

Identifying educational needs related to professional practice gaps can be a complex process for continuing medical education (CME) committees and for physicians who submit activity applications. Medical librarians possess unique skills that may be useful for identifying practice gaps relevant to CME committees. We assessed this assumption by assessing a medical librarian's contributions to practice gap identification for the Marshfield Clinic's CME Committee. We reviewed all locally relevant, locally actionable practice gaps identified annually by various stakeholders and presented to our CME Committee from 2010 to 2013. Total numbers of practice gaps identified, total categorized as actionable, and numbers of subsequent activities resulting from these gaps were calculated for each year. Medical librarian totals were compared to those of other CME committee stakeholders to determine the relative contribution. The medical librarian identified unique, actionable published practice gaps that directly contributed to CME activity planning. For each study year, contributions by the medical librarian grew, from 0 of 27 actionable gaps validated by CME Committee in 2010 to 49 of 108 (45.4%) in 2013. With the librarian's assistance, the number of valid practice gaps submitted between 2010 and 2013 by stakeholders climbed from 23 for 155 activities (14.8%) to 133 for 157 activities (84.7%). Medical librarians can provide a valuable service to CME committees by identifying valid professional practice gaps that inform decisions about educational activities aimed at improving clinical practice. Medical librarians bring into deliberations unique information, including national health policy priorities, practice gaps found in the literature, and point-of-care search engine statistics. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

A Synthesis Of Knowledge About Caregiver Decision Making Finds Gaps In Support For Those Who Care For Aging Loved Ones.

PubMed

Garvelink, Mirjam M; Ngangue, Patrice A G; Adekpedjou, Rheda; Diouf, Ndeye T; Goh, Larissa; Blair, Louisa; Légaré, France

2016-04-01

We conducted a mixed-methods knowledge synthesis to assess the effectiveness of interventions to improve caregivers' involvement in decision making with seniors, and to describe caregivers' experiences of decision making in the absence of interventions. We analyzed forty-nine qualitative, fourteen quantitative, and three mixed-methods studies. The qualitative studies indicated that caregivers had unmet needs for information, discussions of values and needs, and decision support, which led to negative sentiments after decision making. Our results indicate that there have been insufficient quantitative evaluations of interventions to involve caregivers in decision making with seniors and that the evaluations that do exist found few clinically significant effects. Elements of usual care that received positive evaluations were the availability of a decision coach and a supportive decision-making environment. Additional rigorously evaluated interventions are needed to help caregivers be more involved in decision making with seniors. Project HOPE—The People-to-People Health Foundation, Inc.

Informed consent and decision-making about adult-to-adult living donor liver transplantation: a systematic review of empirical research.

PubMed

Gordon, Elisa J; Daud, Amna; Caicedo, Juan Carlos; Cameron, Kenzie A; Jay, Colleen; Fryer, Jonathan; Beauvais, Nicole; Skaro, Anton; Baker, Talia

2011-12-27

Adult-to-adult living donor liver transplantation (LDLT) is a complex procedure that poses serious health risks to and provides no direct health benefit for the donor. Because of this uneven risk-benefit ratio, ensuring donor autonomy through informed consent is critical. To assess the current knowledge pertaining to informed consent for LDLT, we conducted a systematic review of the empirical literature on donors' decision-making process, comprehension about risks and outcomes, and information needs for LDLT. Of the 1423 identified articles, 24 met final review criteria, representing the perspective of approximately 2789 potential and actual donors. As donors' decisions to donate often occur before evaluation, they often make uninformed decisions. The review found that 88% to 95% of donors reported understanding information clinicians disclosed about risks and benefits. However, donors reported unmet information needs, knowledge gaps regarding risks, and unanticipated complications. Few donors reported feeling pressure to donate. Most studies were limited by cultural differences, small sample sizes, inconsistent measures, and poor methodological approaches. This systematic review suggests that informed consent for LDLT is sub-optimal as donors do not adequately appreciate disclosed information during the informed consent process, despite United Network for Organ Sharing/CMS regulations requiring formal psychological evaluation of donor candidates. Interventions are needed to improve donor-clinician communication during the LDLT informed consent process such as through the use of comprehension assessment tools and e-health educational tools that leverage adult learning theory to effectively convey LDLT outcome data.

Decision Analysis in the U.S. Army’s Capabilties Needs Analysis: Applications of Decision Analysis Methods to Capabilities Resource Allocation and Capabilities Development Decisions

DTIC Science & Technology

2015-10-01

capability to meet the task to the standard under the condition, nothing more or less, else the funding is wasted . Also, that funding for the...bin to segregate gaps qualitatively before the gap value model determined preference among gaps within the bins. Computation of a gap’s...for communication, interpretation, or processing by humans or by automatic means (as it pertains to modeling and simulation). Delphi Method -- a

Use of comparative effectiveness research in drug coverage and pricing decisions: a six-country comparison.

PubMed

Sorenson, Corinna

2010-07-01

Comparative effectiveness research (CER) has assumed an increasing role in drug coverage and, in some cases, pricing decisions in Europe, as decision-makers seek to obtain better value for money. This issue brief comparatively examines the use of CER across six countries--Denmark, England, France, Germany, the Netherlands, and Sweden. With CER gaining traction in the United States, these international experiences offer insights and potential lessons. Investing in CER can help address the current gap in publicly available, credible, up-to-date, and scientifically based comparative information on the effectiveness of drugs and other health interventions. This information can be used to base coverage and pricing decisions on evidence of value, thereby facilitating access to and public and private investment in the most beneficial new drugs and technologies. In turn, use of CER creates incentives for more efficient, high-quality health care and encourages development of innovative products that offer measurable value to patients.

Evidence & Gap Maps: A tool for promoting evidence informed policy and strategic research agendas.

PubMed

Snilstveit, Birte; Vojtkova, Martina; Bhavsar, Ami; Stevenson, Jennifer; Gaarder, Marie

2016-11-01

A range of organizations are engaged in the production of evidence on the effects of health, social, and economic development programs on human welfare outcomes. However, evidence is often scattered around different databases, web sites, and the gray literature and is often presented in inaccessible formats. Lack of overview of the evidence in a specific field can be a barrier to the use of existing research and prevent efficient use of limited resources for new research. Evidence & Gap Maps (EGMs) aim to address these issues and complement existing synthesis and mapping approaches. EGMs are a new addition to the tools available to support evidence-informed policymaking. To provide an accessible resource for researchers, commissioners, and decision makers, EGMs provide thematic collections of evidence structured around a framework which schematically represents the types of interventions and outcomes of relevance to a particular sector. By mapping the existing evidence using this framework, EGMs provide a visual overview of what we know and do not know about the effects of different programs. They make existing evidence available, and by providing links to user-friendly summaries of relevant studies, EGMs can facilitate the use of existing evidence for decision making. They identify key "gaps" where little or no evidence from impact evaluations and systematic reviews is available and can be a valuable resource to inform a strategic approach to building the evidence base in a particular sector. The article will introduce readers to the concept and methods of EGMs and present a demonstration of the EGM tool using existing examples. Copyright © 2016 Elsevier Inc. All rights reserved.

Who Am I to Decide Whether This Person Is to Die Today? Physicians' Life-or-Death Decisions for Elderly Critically Ill Patients at the Emergency Department-ICU Interface: A Qualitative Study.

PubMed

Fassier, Thomas; Valour, Elizabeth; Colin, Cyrille; Danet, François

2016-07-01

We explored physicians' perceptions of and attitudes toward triage and end-of-life decisions for elderly critically ill patients at the emergency department (ED)-ICU interface. This was a qualitative study with thematic analysis of data collected through semistructured interviews (15 emergency physicians and 9 ICU physicians) and nonparticipant observations (324 hours, 8 units, in 2 hospitals in France). Six themes emerged: (1) Physicians revealed a representation of elderly patients that comprised both negative and positive stereotypes, and expressed the concept of physiologic age. (2) These age-related factors influenced physicians' decisionmaking in resuscitate/not resuscitate situations. (3) Three main communication patterns framed the decisions: interdisciplinary decisions, decisions by 2 physicians on their own, and unilateral decisions by 1 physician; however, some physicians avoided decisions, facing uncertainty and conflicts. (4) Conflicts and communication gaps occurred at the ED-ICU interface and upstream of the ED-ICU interface. (5) End-of-life decisions were perceived as more complex in the ED, in the absence of family or of information about elderly patients' end-of-life preferences, and when there was conflict with relatives, time pressure, and a lack of training in end-of-life decisionmaking. (6) During decisionmaking, patients' safety and quality of care were potentially compromised by delayed or denied intensive care and lack of palliative care. These qualitative findings highlight the cognitive heuristics and biases, interphysician conflicts, and communication gaps influencing physicians' triage and end-of-life decisions for elderly critically ill patients at the ED-ICU interface and suggest strategies to improve these decisions. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

An evaluation of the science needs to inform decisions on Outer Continental Shelf energy development in the Chukchi and Beaufort Seas, Alaska

USGS Publications Warehouse

Holland-Bartels, Leslie; Pierce, Brenda

2011-01-01

The U. S. Geological Survey (USGS) was asked to conduct an initial, independent evaluation of the science needs that would inform the Administration's consideration of the right places and the right ways in which to develop oil and gas resources in the Arctic Outer Continental Shelf (OCS), particularly focused on the Beaufort and Chukchi Seas. Oil and gas potential is significant in Arctic Alaska. Beyond petroleum potential, this region supports unique fish and wildlife resources and ecosystems, and indigenous people who rely on these resources for subsistence. This report summarizes key existing scientific information and provides initial guidance of what new and (or) continued research could inform decision making. This report is presented in a series of topical chapters and various appendixes each written by a subset of the USGS OCS Team based on their areas of expertise. Three chapters (Chapters 2, 3, and 4) provide foundational information on geology; ecology and subsistence; and climate settings important to understanding the conditions pertinent to development in the Arctic OCS. These chapters are followed by three chapters that examine the scientific understanding, science gaps, and science sufficiency questions regarding oil-spill risk, response, and impact (Chapter 5), marine mammals and anthropogenic noise (Chapter 6), and cumulative impacts (Chapter 7). Lessons learned from the 1989 Exxon Valdez Oil Spill are included to identify valuable "pre-positioned" science and scientific approaches to improved response and reduced uncertainty in damage assessment and restoration efforts (appendix D). An appendix on Structured Decision Making (appendix C) is included to illustrate the value of such tools that go beyond, but incorporate, science in looking at what can/should be done about policy and implementation of Arctic development. The report provides a series of findings and recommendations for consideration developed during the independent examination of science gaps and sufficiency. These recommendations are important for understanding what the USGS discovered in the course of this study and to help inform and improve decision making.

Bridging the gap between strategic and management forest inventories

Treesearch

Ronald E. McRoberts

2009-01-01

Strategic forest inventory programs collect information for a large number of variables on a relatively sparse array of field plots. Data from these inventories are used to produce estimates for large areas such as states and provinces, regions, or countries. The purpose of management forest inventories is to guide management decisions for small areas such as stands....

Heat and Health in a Changing Climate: Building a Decision Support Tool for California Public Health Officials

NASA Astrophysics Data System (ADS)

Steinberg, N.

2017-12-01

There is considerable interest in overlaying climate projections with social vulnerability maps as a mechanism for targeting community adaptation efforts. Yet the identification of relevant factors for adaptation- and resilience-based decisions remain a challenge. Our findings show that successful adaptation interventions are more likely when factors are grouped and spatially represented. By designing a decision-support tool that is focused on informing long-term planning to mitigate the public health impacts of extreme heat, communities can more easily integrate climate, land use, and population characteristics into local planning processes. The ability to compare risks and potential health impacts across census tracts may also position local practitioners to leverage scarce resources. This presentation will discuss the information gaps identified by planners and public health practitioners throughout California and illustrate the spatial variations of key health risk factors.

Professional Development to Improve Accommodations Decisions--A Review of the Literature. Synthesis Report 84

ERIC Educational Resources Information Center

Hodgson, Jennifer R.; Lazarus, Sheryl S.; Thurlow, Martha L.

2011-01-01

Teachers play an important role in making decisions about students' accommodations for instruction and assessment. Although teachers are a significant part of the decision-making process, "gaps" in teachers' accommodations knowledge are well documented. Some of these gaps may be due to challenges in providing teacher professional…

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

PubMed

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

2017-01-01

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

A decision framework for coordinating bioterrorism planning: lessons from the BioNet program.

PubMed

Manley, Dawn K; Bravata, Dena M

2009-01-01

Effective disaster preparedness requires coordination across multiple organizations. This article describes a detailed framework developed through the BioNet program to facilitate coordination of bioterrorism preparedness planning among military and civilian decision makers. The authors and colleagues conducted a series of semistructured interviews with civilian and military decision makers from public health, emergency management, hazardous material response, law enforcement, and military health in the San Diego area. Decision makers used a software tool that simulated a hypothetical anthrax attack, which allowed them to assess the effects of a variety of response actions (eg, issuing warnings to the public, establishing prophylaxis distribution centers) on performance metrics. From these interviews, the authors characterized the information sources, technologies, plans, and communication channels that would be used for bioterrorism planning and responses. The authors used influence diagram notation to describe the key bioterrorism response decisions, the probabilistic factors affecting these decisions, and the response outcomes. The authors present an overview of the response framework and provide a detailed assessment of two key phases of the decision-making process: (1) pre-event planning and investment and (2) incident characterization and initial responsive measures. The framework enables planners to articulate current conditions; identify gaps in existing policies, technologies, information resources, and relationships with other response organizations; and explore the implications of potential system enhancements. Use of this framework could help decision makers execute a locally coordinated response by identifying the critical cues of a potential bioterrorism event, the information needed to make effective response decisions, and the potential effects of various decision alternatives.

Identifying attributes of food literacy: a scoping review.

PubMed

Azevedo Perry, Elsie; Thomas, Heather; Samra, H Ruby; Edmonstone, Shannon; Davidson, Lyndsay; Faulkner, Amy; Petermann, Lisa; Manafò, Elizabeth; Kirkpatrick, Sharon I

2017-09-01

An absence of food literacy measurement tools makes it challenging for nutrition practitioners to assess the impact of food literacy on healthy diets and to evaluate the outcomes of food literacy interventions. The objective of the present scoping review was to identify the attributes of food literacy. A scoping review of peer-reviewed and grey literature was conducted and attributes of food literacy identified. Subjects included in the search were high-risk groups. Eligible articles were limited to research from Canada, USA, the UK, Australia and New Zealand. The search identified nineteen peer-reviewed and thirty grey literature sources. Fifteen identified food literacy attributes were organized into five categories. Food and Nutrition Knowledge informs decisions about intake and distinguishing between 'healthy' and 'unhealthy' foods. Food Skills focuses on techniques of food purchasing, preparation, handling and storage. Self-Efficacy and Confidence represent one's capacity to perform successfully in specific situations. Ecologic refers to beyond self and the interaction of macro- and microsystems with food decisions and behaviours. Food Decisions reflects the application of knowledge, information and skills to make food choices. These interdependent attributes are depicted in a proposed conceptual model. The lack of evaluated tools inhibits the ability to assess and monitor food literacy; tailor, target and evaluate programmes; identify gaps in programming; engage in advocacy; and allocate resources. The present scoping review provides the foundation for the development of a food literacy measurement tool to address these gaps.

Parental influences on adolescent decision making and contraceptive use.

PubMed

Commendador, Kathleen A

2010-01-01

This article reviews the literature in the area of parental and maternal influences on contraceptive decision making, thus determining future directions of research and potential interventions. A review of published literature using PubMed, CINAHL, Infotrak, Science and Technology, and Medline spanning 1980-2007 was used to gather information. Results from 35 research studies and 15 scholarly articles were included. The search terms adolescent decision making, maternal influences on adolescent contraceptive decision making, adolescent contraceptive decision making, paternal influences on adolescent decision making, and contraception were used to gather data. The literature reveals there is an association between parental communication, parenting style, and adolescent sexual activity and contraception use. Maternal communication has been shown to delay sexual intercourse and increase contraceptive use. Maternal communication has rich potential as an intervention to impact positive adolescent sexual decision making and contraception use. Gaps in the research identified were the lack of studies on the influences on parenting style and the father/adolescent influences on sexual initiation and contraceptive decision making.

Measuring, managing and maximizing refinery performance

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

Bascur, O.A.; Kennedy, J.P.

1996-01-01

Implementing continuous quality improvement is a confluence of total quality management, people empowerment, performance indicators and information engineering. Supporting information technologies allow a refiner to narrow the gap between management objectives and the process control level. Dynamic performance monitoring benefits come from production cost savings, improved communications and enhanced decision making. A refinery workgroup information flow model helps automate continuous improvement of processes, performance and the organization. The paper discusses the rethinking of refinery operations, dynamic performance monitoring, continuous process improvement, the knowledge coordinator and repository manager, an integrated plant operations workflow, and successful implementation.

Understanding information and education gaps among people with type 1 diabetes: a qualitative investigation.

PubMed

Rankin, David; Heller, Simon; Lawton, Julia

2011-04-01

Many patients with type 1 diabetes struggle to self-manage this chronic disease, often because they have a poor knowledge and understanding of the condition. However, little attention has been paid to examining the reasons for this poor knowledge/understanding. To inform future educational interventions, we explored patients' accounts of the education and information they had received since diagnosis, and the reasons behind gaps in their diabetes knowledge. Semi-structured interviews were conducted with 30 type 1 diabetes patients enrolled on a structured education programme in the UK. Data were analysed using an inductive, thematic approach. Patients' accounts illustrated a number of knowledge deficits which were influenced by various lifecourse events. Reasons for deficits included: diagnosis at a young age and assumption of decision-making responsibility by parents; lack of engagement with information when feeling well; transitions in care; inconsistency in information provision; and, lack of awareness that knowledge was poor or incomplete. Patients' knowledge deficits can arise for different reasons, at different points in the lifecourse, and may change over time. The delivery of individualised education should take account of the origins of patients' knowledge gaps and be provided on a regular and on-going basis. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Experiences in Bridging the Gap Between Science and Decision Making at NASAs GSFC Earth Sciences Data and Information Services Center (GES DISC)

NASA Astrophysics Data System (ADS)

Kempler, S.; Teng, W.; Friedl, L.; Lynnes, C.

2008-12-01

In recognizing the significance of NASA remote sensing Earth science data in monitoring and better understanding our planet's natural environment, NASA has implemented the 'Decision Support Through Earth Science Research Results' program to solicit "proposals that develop and demonstrate innovative and practicable applications of NASA Earth science observations and research"that focus on improving decision making activities", as stated in the NASA ROSES-2008, A.18 solicitation. This very successful program has yielded several monitoring, surveillance, and decision support systems through collaborations with benefiting organizations in the areas of agriculture, air quality, disaster management, ecosystems, public health, water resources, and aviation weather. The Goddard Space Flight Center (GSFC) Earth Sciences Data and Information Services Center (GES DISC) has participated in this program on two projects (one complete, one ongoing), and has had opportune ad hoc collaborations gaining much experience in the formulation, management, development, and implementation of decision support systems utilizing NASA Earth science data. Coupling this experience with the GES DISC's total understanding and vast experience regarding Earth science missions and resulting data and information, including data structures, data usability and interpretation, data interoperability, and information management systems, the GES DISC is in the unique position to more readily identify challenges that come with bringing science data to decision makers. These challenges consist of those that can be met within typical science data usage frameworks, as well as those challenges that arise when utilizing science data for previously unplanned applications, such as decision support systems. The purpose of this presentation is to share GES DISC decision support system project experiences in regards to system sustainability, required data quality (versus timeliness), data provider understanding how decisions are made, which leads to the data receivers willingness to use new types of information to make decisions, as well as other topics. In addition, defining metrics that 'really' evaluate success will be exemplified.

Cross-scale phenological data integration to benefit resource management and monitoring

USGS Publications Warehouse

Richardson, Andrew D.; Weltzin, Jake F.; Morisette, Jeffrey T.

2017-01-01

Climate change is presenting new challenges for natural resource managers charged with maintaining sustainable ecosystems and landscapes. Phenology, a branch of science dealing with seasonal natural phenomena (bird migration or plant flowering in response to weather changes, for example), bridges the gap between the biosphere and the climate system. Phenological processes operate across scales that span orders of magnitude—from leaf to globe and from days to seasons—making phenology ideally suited to multiscale, multiplatform data integration and delivery of information at spatial and temporal scales suitable to inform resource management decisions.A workshop report: Workshop held June 2016 to investigate opportunities and challenges facing multi-scale, multi-platform integration of phenological data to support natural resource management decision-making.

Performance needs assessment of maternal and newborn health service delivery in urban and rural areas of Osun State, South-West, Nigeria.

PubMed

Esan, Oluwaseun T; Fatusi, Adesegun O

2014-06-01

The study aimed to determine performance and compare gaps in maternal and newborn health (MNH) services in urban and rural areas of Osun State, Nigeria, to inform decisions for improved services. This study involved 14 urban and 10 rural-based randomly selected PHC facilities. Using a Performance Needs Assessment framework, desired performances were determined by key stakeholders and actual performances measured by conducting facility survey. Questionnaire interview of 143 health workers and 153 antenatal clients were done. Performance gaps were determined for the urban and rural areas and compared using Chi-square tests with SPSS version 17. PHC facilities and health workers in Osun State, Nigeria, were found to have significant gaps in MNH service performance and this was worse in the rural areas. Root cause of most of the performance gaps was poor political will of local government authorities. Improved government commitment to MNH is needful to address most of the gaps.

Harnessing Vehicle-to-Pedestrian (V2P) Communication Technology: Sending Traffic Warnings to Texting Pedestrians.

PubMed

Rahimian, Pooya; O'Neal, Elizabeth E; Zhou, Shiwen; Plumert, Jodie M; Kearney, Joseph K

2018-06-01

We examined how sending mobile-device warnings to texting pedestrians when they initiate an unsafe road crossing influences their decisions and actions. Pedestrian texting has been identified as a key risk factor in pedestrian-vehicle collisions. Advances in sensing and communications technology offer the possibility of providing pedestrians with information about traffic conditions to assist them in safely crossing traffic-filled roadways. However, it is unclear how this information can be most effectively communicated to pedestrians. We examined how texting and nontexting pedestrians crossed roads with continuous traffic in a large-screen, immersive pedestrian simulator using a between-subjects design with three conditions: texting, warning, and control. Texting participants in the warning condition received an alarm on their cell phone when they began to cross a dangerously small gap. The results demonstrate the detrimental influence of texting on pedestrians' gap selection, movement timing, and gaze behavior, and show the potential of warnings to improve decision making and safety. However, the results also reveal the limits of warning texting participants once they initiate a crossing and possible overreliance on technology that may lead to reduced situation awareness. Mobile devices and short-range communication technologies offer enormous potential to assist pedestrians, but further study is needed to better understand how to provide useful information in a timely manner. The technology for communicating traffic information to pedestrians via mobile devices is on the horizon. Research on how such information influences all aspects of pedestrian behavior is critical to developing effective solutions.

Bridging the Guideline Implementation Gap: A Systematic, Document-Centered Approach to Guideline Implementation

PubMed Central

Shiffman, Richard N.; Michel, George; Essaihi, Abdelwaheb; Thornquist, Elizabeth

2004-01-01

Objective: A gap exists between the information contained in published clinical practice guidelines and the knowledge and information that are necessary to implement them. This work describes a process to systematize and make explicit the translation of document-based knowledge into workflow-integrated clinical decision support systems. Design: This approach uses the Guideline Elements Model (GEM) to represent the guideline knowledge. Implementation requires a number of steps to translate the knowledge contained in guideline text into a computable format and to integrate the information into clinical workflow. The steps include: (1) selection of a guideline and specific recommendations for implementation, (2) markup of the guideline text, (3) atomization, (4) deabstraction and (5) disambiguation of recommendation concepts, (6) verification of rule set completeness, (7) addition of explanations, (8) building executable statements, (9) specification of origins of decision variables and insertions of recommended actions, (10) definition of action types and selection of associated beneficial services, (11) choice of interface components, and (12) creation of requirement specification. Results: The authors illustrate these component processes using examples drawn from recent experience translating recommendations from the National Heart, Lung, and Blood Institute's guideline on management of chronic asthma into a workflow-integrated decision support system that operates within the Logician electronic health record system. Conclusion: Using the guideline document as a knowledge source promotes authentic translation of domain knowledge and reduces the overall complexity of the implementation task. From this framework, we believe that a better understanding of activities involved in guideline implementation will emerge. PMID:15187061

An environmental scan of advance care planning decision AIDS for patients undergoing major surgery: a study protocol.

PubMed

Aslakson, Rebecca A; Schuster, Anne L R; Miller, Judith; Weiss, Matthew; Volandes, Angelo E; Bridges, John F P

2014-01-01

Patients who undergo major surgery are at risk for perioperative morbidity and mortality. It would be appropriate to initiate advance care planning with patients prior to surgery, but surgeons may experience difficulty initiating such conversations. Rather than focus on changing clinician behavior, advance care planning decision aids can be an innovative vehicle to motivate advance care planning among surgical patients and their families. The purpose of this paper is to describe a study protocol for conducting an environmental scan concerning advance care planning decision aids that may be relevant to patients undergoing high-risk surgery. This study will gather information from written or verbal data sources that incorporate professional and lay perspectives: a systematic review, a grey literature review, key informant interviews, and patient and family engagement. It is envisioned that this study will generate three outcomes: a synthesis of current evidence, a summary of gaps in knowledge, and a taxonomy of existing advance care planning decision aids. This environmental scan will demonstrate principles of patient-centered outcomes research, and it will exemplify a pioneering approach for reviewing complex interventions. Anticipated limitations are that information will be gathered from a small sample of patients and families, and that potentially relevant information could also be missing from the environmental scan due to the inclusion/exclusion criteria. Outcomes from the environmental scan will inform future patient-centered research to develop and evaluate a new decision aid.

Geospatial decision support systems for societal decision making

USGS Publications Warehouse

Bernknopf, R.L.

2005-01-01

While science provides reliable information to describe and understand the earth and its natural processes, it can contribute more. There are many important societal issues in which scientific information can play a critical role. Science can add greatly to policy and management decisions to minimize loss of life and property from natural and man-made disasters, to manage water, biological, energy, and mineral resources, and in general, to enhance and protect our quality of life. However, the link between science and decision-making is often complicated and imperfect. Technical language and methods surround scientific research and the dissemination of its results. Scientific investigations often are conducted under different conditions, with different spatial boundaries, and in different timeframes than those needed to support specific policy and societal decisions. Uncertainty is not uniformly reported in scientific investigations. If society does not know that data exist, what the data mean, where to use the data, or how to include uncertainty when a decision has to be made, then science gets left out -or misused- in a decision making process. This paper is about using Geospatial Decision Support Systems (GDSS) for quantitative policy analysis. Integrated natural -social science methods and tools in a Geographic Information System that respond to decision-making needs can be used to close the gap between science and society. The GDSS has been developed so that nonscientists can pose "what if" scenarios to evaluate hypothetical outcomes of policy and management choices. In this approach decision makers can evaluate the financial and geographic distribution of potential policy options and their societal implications. Actions, based on scientific information, can be taken to mitigate hazards, protect our air and water quality, preserve the planet's biodiversity, promote balanced land use planning, and judiciously exploit natural resources. Applications using the GDSS have demonstrated the benefits of utilizing science for policy decisions. Investment in science reduces decision-making uncertainty and reducing that uncertainty has economic value.

Key Factors in Obstetric Delivery Decision-Making among Asian and Pacific Islander Women by English Proficiency.

PubMed

Davis, Chevelle Ma; Guo, Mary; Miyamura, Jill; Chang, Ann; Nelson-Hurwitz, Denise C; Sentell, Tetine

2017-10-01

Childbirth is the most common reason women are hospitalized in the United States. Understanding (1) how expectant mothers gather information to decide where to give birth, and (2) who helps make that decision, provides critical health communication and decision-making insights. Diverse Asian American and Pacific Islander (AA/PI) perspectives on such topics are understudied, particularly among those with limited English proficiency (LEP). LEP is defined as having a limited ability to read, write, speak, or understand English. To address this research gap, we interviewed 400 women (18+ years) with a recent live birth on O'ahu, Hawai'i. Participants completed a 1-hour, in-person interview in English (n=291), Tagalog (n=42), Chinese (n=36), or Marshallese (n=31). Women were asked (1) what information was most important in deciding where to deliver and why; and (2) who participated in the decision-making and why. Responses were compared by LEP (n=71; 18%) vs English-proficient (n=329; 82%) in qualitative and quantitative analyses. Both LEP and English-proficient participants reported their obstetrician as the most important source of health information. Significantly more LEP participants valued advice from family or acquaintances as important sources of information compared to English-proficient participants. The top three health decision-makers for both those with LEP and English-proficient participants were themselves, their obstetrician, and their spouse, which did not differ significantly by language proficiency. These findings provide insights into health information sources and decision-making across diverse AA/PI populations, including those with LEP, and can help direct health interventions such as disseminating patient education and healthcare quality information.

Bridging the gaps in the Health Management Information System in the context of a changing health sector

PubMed Central

2010-01-01

Background The Health Management Information System (HMIS) is crucial for evidence-based policy-making, informed decision-making during planning, implementation and evaluation of health programs; and for appropriate use of resources at all levels of the health system. This study explored the gaps and factors influencing HMIS in the context of a changing health sector in Tanzania. Methods A cross sectional descriptive study was conducted in 11 heath facilities in Kilombero district between January and February 2008. A semi-structured questionnaire was used to interview 43 health workers on their knowledge, attitude, practice and factors for change on HMIS and HMIS booklets from these facilities were reviewed for completeness. Results Of all respondents, 81% had never been trained on HMIS, 65% did not properly define this system, 54% didn't know who is supposed to use the information collected and 42% did not use the collected data for planning, budgeting and evaluation of services provision. Although the attitude towards the system was positive among 91%, the reviewed HMIS booklets were never completed in 25% - 55% of the facilities. There were no significant differences in knowledge, attitude and practice on HMIS between clinicians and nurses. The most common type of HMIS booklets which were never filled were those for deliveries (55%). The gaps in the current HMIS were linked to lack of training, inactive supervision, staff workload pressure and the lengthy and laborious nature of the system. Conclusions This research has revealed a state of poor health data collection, lack of informed decision-making at the facility level and the factors for change in the country's HMIS. It suggests need for new innovations including incorporation of HMIS in the ongoing reviews of the curricula for all cadres of health care providers, development of more user-friendly system and use of evidence-based John Kotter's eight-step process for implementing successful changes in this system. PMID:20579336

Bridging the gaps in the Health Management Information System in the context of a changing health sector.

PubMed

Nyamtema, Angelo S

2010-06-25

The Health Management Information System (HMIS) is crucial for evidence-based policy-making, informed decision-making during planning, implementation and evaluation of health programs; and for appropriate use of resources at all levels of the health system. This study explored the gaps and factors influencing HMIS in the context of a changing health sector in Tanzania. A cross sectional descriptive study was conducted in 11 heath facilities in Kilombero district between January and February 2008. A semi-structured questionnaire was used to interview 43 health workers on their knowledge, attitude, practice and factors for change on HMIS and HMIS booklets from these facilities were reviewed for completeness. Of all respondents, 81% had never been trained on HMIS, 65% did not properly define this system, 54% didn't know who is supposed to use the information collected and 42% did not use the collected data for planning, budgeting and evaluation of services provision. Although the attitude towards the system was positive among 91%, the reviewed HMIS booklets were never completed in 25% - 55% of the facilities. There were no significant differences in knowledge, attitude and practice on HMIS between clinicians and nurses. The most common type of HMIS booklets which were never filled were those for deliveries (55%). The gaps in the current HMIS were linked to lack of training, inactive supervision, staff workload pressure and the lengthy and laborious nature of the system. This research has revealed a state of poor health data collection, lack of informed decision-making at the facility level and the factors for change in the country's HMIS. It suggests need for new innovations including incorporation of HMIS in the ongoing reviews of the curricula for all cadres of health care providers, development of more user-friendly system and use of evidence-based John Kotter's eight-step process for implementing successful changes in this system.

Distinguishing Intentional Releases from Natural Occurrences ...

EPA Pesticide Factsheets

Report The purpose of this report was to: (1) survey the scientific literature to determine the current state of the science regarding the presence of Bacillus anthracis in the environment and outbreaks of anthrax; (2) identify characteristics that would enable a screening of information about outbreaks to rapidly assess whether an intentional release was a likely cause (in United States settings) in order to inform remediation decisions; and (3) identify gaps in risk-related knowledge associated with B. anthracis events in the United States.

Consumer Engagement in Health IT: Distinguishing Rhetoric from Reality

PubMed Central

Gold, Marsha; Hossain, Mynti; Mangum, Amy

2015-01-01

Rationale: Policymakers want health information technology (health IT) to support consumer engagement to help achieve national health goals. In this paper, we review the evidence to compare the rhetoric with the reality of current practice. Current Reality and Barriers: Our environmental scan shows that consumer demand exists for electronic access to personal health information, but that technical and system or political barriers still limit the value of the available information and its potential benefits. Conclusions and Policy Implications: There is a gap between current reality and the goals for consumer engagement. Actions that may help bridge this gap include: (1) resolving technical barriers to health information exchange (HIE); (2) developing more consumer-centric design and functionality; (3) reinforcing incentives that attract provider support by showing that consumer engagement is in their interest; and (4) building a stronger empirical case to convince decision makers that consumer engagement will lead to better care, improved health outcomes, and lower costs. PMID:26665120

Incorporating uncertainty in watershed management decision-making: A mercury TMDL case study

USGS Publications Warehouse

Labiosa, W.; Leckie, J.; Shachter, R.; Freyberg, D.; Rytuba, J.; ,

2005-01-01

Water quality impairment due to high mercury fish tissue concentrations and high mercury aqueous concentrations is a widespread problem in several sub-watersheds that are major sources of mercury to the San Francisco Bay. Several mercury Total Maximum Daily Load regulations are currently being developed to address this problem. Decisions about control strategies are being made despite very large uncertainties about current mercury loading behavior, relationships between total mercury loading and methyl mercury formation, and relationships between potential controls and mercury fish tissue levels. To deal with the issues of very large uncertainties, data limitations, knowledge gaps, and very limited State agency resources, this work proposes a decision analytical alternative for mercury TMDL decision support. The proposed probabilistic decision model is Bayesian in nature and is fully compatible with a "learning while doing" adaptive management approach. Strategy evaluation, sensitivity analysis, and information collection prioritization are examples of analyses that can be performed using this approach.

How Numeracy Influences Risk Comprehension and Medical Decision Making

PubMed Central

Reyna, Valerie F.; Nelson, Wendy L.; Han, Paul K.; Dieckmann, Nathan F.

2009-01-01

We review the growing literature on health numeracy, the ability to understand and use numerical information, and its relation to cognition, health behaviors, and medical outcomes. Despite the surfeit of health information from commercial and noncommercial sources, national and international surveys show that many people lack basic numerical skills that are essential to maintain their health and make informed medical decisions. Low numeracy distorts perceptions of risks and benefits of screening, reduces medication compliance, impedes access to treatments, impairs risk communication (limiting prevention efforts among the most vulnerable), and, based on the scant research conducted on outcomes, appears to adversely affect medical outcomes. Low numeracy is also associated with greater susceptibility to extraneous factors (i.e., factors that do not change the objective numerical information). That is, low numeracy increases susceptibility to effects of mood or how information is presented (e.g., as frequencies vs. percentages) and to biases in judgment and decision making (e.g., framing and ratio bias effects). Much of this research is not grounded in empirically supported theories of numeracy or mathematical cognition, which are crucial for designing evidence-based policies and interventions that are effective in reducing risk and improving medical decision making. To address this gap, we outline four theoretical approaches (psychophysical, computational, standard dual-process, and fuzzy trace theory), review their implications for numeracy, and point to avenues for future research. PMID:19883143

Farmers' climate information needs for long-term adaptive decisions: A case study of almonds in CA

NASA Astrophysics Data System (ADS)

Jagannathan, K. A.; Jones, A. D.; Pathak, T. B.; Kerr, A. C.; Doll, D.

2016-12-01

Despite advances in climate modeling and projections, several sources report that current tools and models are not widely used in the agriculture sector. Farmers, depending on their local context, require information on very specific climatic metrics such as start of rains during the planting season, number of low temperature days during the growing season, etc. However, such specific climatic information is either not available, and/or is not synthesized and communicated in a manner that is accessible to these decision-makers. This research aims to bridge the gap between climate information and decision-making needs, by providing an improved understanding of what farmers' consider as relevant climate information, and how these needs compare with current modeling capabilities. Almond is a perennial crop, so any changes in climate within its 25-30 year lifetime can have an adverse impact on crop yield. This makes almond growers vulnerable to medium and long-term climate change. Hence, providing appropriate information on future climate projections can help guide their decisions on crop types & varieties, as well as management practices that are better adapted to future climatic conditions. Semi-structured exploratory interviews have been conducted with almond growers, farm advisors, and other industry stakeholders, with three goals: (1) to understand how growers have used climate information in the past; (2) to identify key climatic variables that are relevant - including appropriate temporal scales and acceptable uncertainty levels; and (3) to understand communication methods that could improve the usability of climate information for farm-level decision-making. The interviews showcased a great diversity amongst growers in terms of how they used weather/climate information. Discussions also indicated that there was a potential for climate information to impact long-term decisions, but only if it is provided within the right context, terminology, and communication channels. The findings offer valuable bottom-up insights into farmers' perspectives on relevance of climate information. These results will also be compared with current modeling capabilities in order to synthesize conclusions for improving the usability of climate science for agricultural decision-makers.

Young Children’s Sensitivity to Their Own Ignorance in Informing Others

PubMed Central

Kim, Sunae; Paulus, Markus; Sodian, Beate; Proust, Joelle

2016-01-01

Prior research suggests that young children selectively inform others depending on others’ knowledge states. Yet, little is known whether children selectively inform others depending on their own knowledge states. To explore this issue, we manipulated 3- to 4-year-old children’s knowledge about the content of a box and assessed the impact on their decisions to inform another person. Moreover, we assessed the presence of uncertainty gestures while they inform another person in light of the suggestions that children's gestures reflect early developing, perhaps transient, epistemic sensitivity. Finally, we compared children’s performance in the informing context to their explicit verbal judgment of their knowledge states to further confirm the existence of a performance gap between the two tasks. In their decisions to inform, children tend to accurately assess their ignorance, whereas they tend to overestimate their own knowledge states when asked to explicitly report them. Moreover, children display different levels of uncertainty gestures depending on the varying degrees of their informational access. These findings suggest that children’s implicit awareness of their own ignorance may be facilitated in a social, communicative context. PMID:27023683

What Explains the Gender Gap in Financial Literacy? The Role of Household Decision Making.

PubMed

Fonseca, Raquel; Mullen, Kathleen J; Zamarro, Gema; Zissimopoulos, Julie

2012-01-01

Using newly collected data from the RAND American Life Panel, we examine potential explanations for the gender gap in financial literacy, including the role of marriage and who within a couple makes the financial decisions. Blinder-Oaxaca decomposition reveals the majority of the gender gap in financial literacy is not explained by differences in the characteristics of men and women-but rather differences in coefficients, or how literacy is produced. We find that financial decision making of couples is not centralized in one spouse although it is sensitive to the relative education level of spouses.

What Explains the Gender Gap in Financial Literacy? The Role of Household Decision Making

PubMed Central

FONSECA, RAQUEL; MULLEN, KATHLEEN J.; ZAMARRO, GEMA; ZISSIMOPOULOS, JULIE

2012-01-01

Using newly collected data from the RAND American Life Panel, we examine potential explanations for the gender gap in financial literacy, including the role of marriage and who within a couple makes the financial decisions. Blinder–Oaxaca decomposition reveals the majority of the gender gap in financial literacy is not explained by differences in the characteristics of men and women—but rather differences in coefficients, or how literacy is produced. We find that financial decision making of couples is not centralized in one spouse although it is sensitive to the relative education level of spouses. PMID:23049140

Patient and physician views of shared decision making in cancer.

PubMed

Tamirisa, Nina P; Goodwin, James S; Kandalam, Arti; Linder, Suzanne K; Weller, Susan; Turrubiate, Stella; Silva, Colleen; Riall, Taylor S

2017-12-01

Engaging patients in shared decision making involves patient knowledge of treatment options and physician elicitation of patient preferences. Our aim was to explore patient and physician perceptions of shared decision making in clinical encounters for cancer care. Patients and physicians were asked open-ended questions regarding their perceptions of shared decision making throughout their cancer care. Transcripts of interviews were coded and analysed for shared decision-making themes. At an academic medical centre, 20 cancer patients with a range of cancer diagnoses, stages of cancer and time from diagnosis, and eight physicians involved in cancer care were individually interviewed. Most physicians reported providing patients with written information. However, most patients reported that written information was too detailed and felt that the physicians did not assess the level of information they wished to receive. Most patients wanted to play an active role in the treatment decision, but also wanted the physician's recommendation, such as what their physician would choose for him/herself or a family member in a similar situation. While physicians stated that they incorporated patient autonomy in decision making, most provided data without making treatment recommendations in the format preferred by most patients. We identified several communication gaps in cancer care. While patients want to be involved in the decision-making process, they also want physicians to provide evidence-based recommendations in the context of their individual preferences. However, physicians often are reluctant to provide a recommendation that will bias the patient. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Climate Change Boot Camps: Targeting Policy Makers and Outreach Trainers in Arizona to Improve Climate Literacy

NASA Astrophysics Data System (ADS)

Ferguson, D. B.; Guido, Z. S.; Buizer, J.; Roy, M.

2010-12-01

Bringing climate change issues into focus for decision makers is a growing challenge. Decision makers are often confronted with unique informational needs, a lack of useable information, and needs for customized climate change training, among other issues. Despite significant progress in improving climate literacy among certain stakeholders such as water managers, recent reports have highlighted the growing demand for climate-change information in regions and sectors across the US. In recent years many ventures have sprung up to address these gaps and have predominantly focused on K-12 education and resource management agencies such as the National Park Service and National Weather Service. However, two groups that are critical for integrating climate information into actions have received less attention: (1) policy makers and (2) outreach experts, such as Cooperative Extension agents. Climate Change Boot Camps (CCBC) is a joint effort between the Climate Assessment for the Southwest (CLIMAS)—a NOAA Regionally Integrated Sciences and Assessments (RISA) program—and researchers at Arizona State University to diagnose climate literacy and training gaps in Arizona and develop a process that converts these deficiencies into actionable knowledge among the two aforementioned groups. This presentation will highlight the initial phases of the CCBC process, which has as its outcomes the identification of effective strategies for reaching legislators, climate literacy and training needs for both policy makers and trainers, and effective metrics to evaluate the success of these efforts. Specific attention is given to evaluating the process from initial needs assessment to the effectiveness of the workshops. Web curriculum and training models made available on the internet will also be developed, drawing on extensive existing Web resources for other training efforts and converted to meet the needs of these two groups. CCBC will also leverage CLIMAS’ long history of engaging with stakeholders in the Southwest to facilitate to use of climate information in the decision process.

Tight coupling between coral reef morphology and mapped resilience in the Red Sea.

PubMed

Rowlands, Gwilym; Purkis, Sam; Bruckner, Andrew

2016-04-30

Lack of knowledge on the conservation value of different reef types can stymie decision making, and result in less optimal management solutions. Addressing the information gap of coral reef resilience, we produce a map-based Remote Sensed Resilience Index (RSRI) from data describing the spatial distribution of stressors, and properties of reef habitats on the Farasan Banks, Saudi Arabia. We contrast the distribution of this index among fourteen reef types, categorized on a scale of maturity that includes juvenile (poorly aggraded), mature (partially aggraded), and senile (fully aggraded) reefs. Sites with high reef resilience can be found in most detached reef types; however they are most common in mature reefs. We aim to stimulate debate on the coupling that exists between geomorphology and conservation biology, and consider how such information can be used to inform management decisions. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

NASA Astrophysics Data System (ADS)

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

2015-12-01

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

Does the Medicare Part D Decision-Making Experience Differ by Rural/Urban Location?

PubMed

Henning-Smith, Carrie; Casey, Michelle; Moscovice, Ira

2017-01-01

Although much has been written about Medicare Part D enrollment, much less is known about beneficiaries' personal experiences with choosing a Part D plan, especially among rural residents. This study sought to address this gap by examining geographic differences in Part D enrollees' perceptions of the plan decision-making process, including their confidence in their choice, their knowledge about the program, and their satisfaction with available information. We used data from the 2012 Medicare Current Beneficiary Survey and included adults ages 65 and older who were enrolled in Part D at the time of the survey (n = 3,706). We used ordered logistic regression to model 4 outcomes based on beneficiaries' perceptions of the Part D decision-making and enrollment process, first accounting only for differences by rurality, then adjusting for sociodemographic, health, and coverage characteristics. Overall, half of all beneficiaries were not very confident in their Part D knowledge. Rural beneficiaries had lower odds of being confident in the plan they chose and in being satisfied with the amount of information available to them during the decision-making process. After adjusting for all covariates, micropolitan residents continued to have lower odds of being confident in the plan that they chose. Policy-makers should pay particular attention to making information about Part D easily accessible for all beneficiaries and to addressing unique barriers that rural residents have in accessing information while making decisions, such as reduced Internet availability. Furthermore, confidence in the decision-making process may be improved by simplifying the Part D program. © 2016 National Rural Health Association.

Sensitivity of super-efficient data envelopment analysis results to individual decision-making units: an example of surgical workload by specialty.

PubMed

Dexter, Franklin; O'Neill, Liam; Xin, Lei; Ledolter, Johannes

2008-12-01

We use resampling of data to explore the basic statistical properties of super-efficient data envelopment analysis (DEA) when used as a benchmarking tool by the manager of a single decision-making unit. Our focus is the gaps in the outputs (i.e., slacks adjusted for upward bias), as they reveal which outputs can be increased. The numerical experiments show that the estimates of the gaps fail to exhibit asymptotic consistency, a property expected for standard statistical inference. Specifically, increased sample sizes were not always associated with more accurate forecasts of the output gaps. The baseline DEA's gaps equaled the mode of the jackknife and the mode of resampling with/without replacement from any subset of the population; usually, the baseline DEA's gaps also equaled the median. The quartile deviations of gaps were close to zero when few decision-making units were excluded from the sample and the study unit happened to have few other units contributing to its benchmark. The results for the quartile deviations can be explained in terms of the effective combinations of decision-making units that contribute to the DEA solution. The jackknife can provide all the combinations contributing to the quartile deviation and only needs to be performed for those units that are part of the benchmark set. These results show that there is a strong rationale for examining DEA results with a sensitivity analysis that excludes one benchmark hospital at a time. This analysis enhances the quality of decision support using DEA estimates for the potential ofa decision-making unit to grow one or more of its outputs.

A conceptual model of Verbal Exchange Health Literacy

PubMed Central

Harrington, Kathleen F.; Valerio, Melissa A.

2014-01-01

Objective To address a gap in understanding of verbal exchange (oral and aural) health literacy by describing the systematic development of a verbal exchange health literacy (VEHL) definition and model which hypothesizes the role of VEHL in health outcomes. Methods Current health literacy and communication literature was systematically reviewed and combined with qualitative patient and provider data that were analyzed using a grounded theory approach. Results Analyses of current literature and formative data indicated the importance of verbal exchange in the clinical setting and revealed various factors associated with the patient-provider relationship and their characteristics that influence decision making and health behaviors. VEHL is defined as the ability to speak and listen that facilitates exchanging, understanding, and interpreting of health information for health-decision making, disease management and navigation of the healthcare system. A model depiction of mediating and influenced factors is presented. Conclusion A definition and model of VEHL is a step towards addressing a gap in health literacy knowledge and provides a foundation for examining the influence of VEHL on health outcomes. Practice Implications VEHL is an extension of current descriptions of health literacy and has implications for patient-provider communication and health decision making. PMID:24291145

Going the Extra Mile: Making Climate Data and Information Usable for Decision Making (Invited)

NASA Astrophysics Data System (ADS)

Garfin, G. M.

2013-12-01

Actionable science, defined as 'data, analysis, and forecasts that are sufficiently predictive, accepted and understandable to support decision-making,' is the holy grail for climate scientists engaged in working with decision makers, to provide the scientific basis for adaptation planning and decisions. The literature on boundary organizations and science translation offers guidelines and best practices for the generation of climate information that is useful and usable for policy and operational decisions. Guidelines emphasize understanding decision contexts and constraints, trust building, development of a shared vision of usable science, co-production of knowledge, iterative and sustained engagement, and the development and leveraging of knowledge networks and communities of practice. Some studies offer the advice that climate change is fraught with irreducible or slowly reducible uncertainties; hence, the adoption of adaptive risk management approaches is more valuable in the near-term than scientific effort to reduce uncertainty or combine data in novel ways. Nevertheless, many water resource managers still seek science that reduces uncertainties, assurance that the range of projections will not change, evidence of cause and effect (e.g., atmospheric circulation patterns linked to regional precipitation anomalies) and information that is as close to deterministic as possible. So, how does the scientific community move forward on initiatives that integrate paleoclimate, observations, and model projections, to inform water resource management? There are no simple answers, because the uses of climate and hydrological data and information are context dependent. Scientists have products -- data and information -- and they need to research characteristics of the consumers of their product. What is the consumer's operating procedure, and world view? How does the consumer handle uncertainty? What is their tolerance for risk? What social and political factors, environmental impact covenants, and professional standards constrain their use of new data sources, or combinations of data? What data do they currently use, and what are their protocols and standards for quality assurance? For individual projects, this may entail understanding data requirements, such as time step, format, techniques, abilities to change operational practices, and so on. It also may require an understanding of an organization's structure and internal communication. Are you working with upper management, middle management, technicians? Among those, who are early adopters, credible messengers, champions for your product? This endeavor, to get one's product into use, may also entail understanding use of data and information to inform decisions. For instance information may be consulted or used passively in deliberations; it may be used to communicate risk or justify actions; it may be incorporated directly into operational models, planning, and policy. As a community, scientists must make clear the uncertainties associated with products, the best practices for using a plethora of products, as well as the benefits -- in ways that are transparent and testable. As an analogue, consider the gap between the discovery of ENSO, the staggering impacts of the 1982-83 event, the successful prediction of the 1997-98 event, the regular incorporation of ENSO in seasonal prediction, public familiarity with 'El Nino,' and the persistent gap in forecast use.

Delivering patient decision aids on the Internet: definitions, theories, current evidence, and emerging research areas

PubMed Central

2013-01-01

Background In 2005, the International Patient Decision Aids Standards Collaboration identified twelve quality dimensions to guide assessment of patient decision aids. One dimension—the delivery of patient decision aids on the Internet—is relevant when the Internet is used to provide some or all components of a patient decision aid. Building on the original background chapter, this paper provides an updated definition for this dimension, outlines a theoretical rationale, describes current evidence, and discusses emerging research areas. Methods An international, multidisciplinary panel of authors examined the relevant theoretical literature and empirical evidence through 2012. Results The updated definition distinguishes Internet-delivery of patient decision aids from online health information and clinical practice guidelines. Theories in cognitive psychology, decision psychology, communication, and education support the value of Internet features for providing interactive information and deliberative support. Dissemination and implementation theories support Internet-delivery for providing the right information (rapidly updated), to the right person (tailored), at the right time (the appropriate point in the decision making process). Additional efforts are needed to integrate the theoretical rationale and empirical evidence from health technology perspectives, such as consumer health informatics, user experience design, and human-computer interaction. Despite Internet usage ranging from 74% to 85% in developed countries and 80% of users searching for health information, it is unknown how many individuals specifically seek patient decision aids on the Internet. Among the 86 randomized controlled trials in the 2011 Cochrane Collaboration’s review of patient decision aids, only four studies focused on Internet-delivery. Given the limited number of published studies, this paper particularly focused on identifying gaps in the empirical evidence base and identifying emerging areas of research. Conclusions As of 2012, the updated theoretical rationale and emerging evidence suggest potential benefits to delivering patient decision aids on the Internet. However, additional research is needed to identify best practices and quality metrics for Internet-based development, evaluation, and dissemination, particularly in the areas of interactivity, multimedia components, socially-generated information, and implementation strategies. PMID:24625064

Producing More Actionable Science Isn't the Problem; It's Providing Decision-Makers with Access to Right Actionable Knowledge

NASA Astrophysics Data System (ADS)

Trexler, M.

2017-12-01

Policy-makers today have almost infinite climate-relevant scientific and other information available to them. The problem for climate change decision-making isn't missing science or inadequate knowledge of climate risks; the problem is that the "right" climate change actionable knowledge isn't getting to the right decision-maker, or is getting there too early or too late to effectively influence her decision-making. Actionable knowledge is not one-size-fit-all, and for a given decision-maker might involve scientific, economic, or risk-based information. Simply producing more and more information as we are today is not the solution, and actually makes it harder for individual decision-makers to access "their" actionable knowledge. The Climatographers began building the Climate Web five years ago to test the hypothesis that a knowledge management system could help navigate the gap between infinite information and individual actionable knowledge. Today the Climate Web's more than 1,500 index terms allow instant access to almost any climate change topic. It is a curated public-access knowledgebase of more than 1,000 books, 2,000 videos, 15,000 reports and articles, 25,000 news stories, and 3,000 websites. But it is also much more, linking together tens of thousands of individually extracted ideas and graphics, and providing Deep Dives into more than 100 key topics from changing probability distributions of extreme events to climate communications best practices to cognitive dissonance in climate change decision-making. The public-access Climate Web is uniquely able to support cross-silo learning, collaboration, and actionable knowledge dissemination. The presentation will use the Climate Web to demonstrate why knowledge management should be seen as a critical component of science and policy-making collaborations.

A Pilot Study of Neonatologists' Decision-Making Roles in Delivery Room Resuscitation Counseling for Periviable Births.

PubMed

Tucker Edmonds, Brownsyne; McKenzie, Fatima; Panoch, Janet E; White, Douglas B; Barnato, Amber E

2016-07-01

Relatively little is known about neonatologists' roles in helping families navigate the difficult decision to attempt or withhold resuscitation for a neonate delivering at the threshold of viability. Therefore, we aimed to describe the "decision-making role" of neonatologists in simulated periviable counseling sessions. We conducted a qualitative content analysis of audio-recorded simulation encounters and post-encounter debriefing interviews collected as part of a single-center simulation study of neonatologists' resuscitation counseling practices in the face of ruptured membranes at 23 weeks gestation. We trained standardized patients to request a recommendation if the physician presented multiple treatment options. We coded each encounter for communication behaviors, applying an adapted, previously developed coding scheme to classify physicians into four decision-making roles (informative, facilitative, collaborative, or directive). We also coded post-simulation debriefing interviews for responses to the open-ended prompt: "During this encounter, what did you feel was your role in the management decision-making process?" Fifteen neonatologists (33% of the division) participated in the study; audio-recorded debriefing interviews were available for 13. We observed 9 (60%) take an informative role, providing medical information only; 2 (13%) take a facilitative role, additionally eliciting the patient's values; 3 (20%) take a collaborative role, additionally engaging the patient in deliberation and providing a recommendation; and 1 (7%) take a directive role, making a treatment decision independent of the patient. Almost all (10/13, 77%) of the neonatologists described their intended role as informative. Neonatologists did not routinely elicit preferences, engage in deliberation, or provide treatment recommendations-even in response to requests for recommendations. These findings suggest there may be a gap between policy recommendations calling for shared decision making and actual clinical practice.

Application and Validation of Concept Maturity Assessment Framework

DTIC Science & Technology

2011-03-01

process. The following chapter will discuss a proposed methodology for validation of the concept maturity framwork and its Concept Evaluation and...of each contractor‟s conceptual solution and any gaps in information that may have been overlooked. The organization also commented that the... conceptual and does not have a specific system tied to it is often vulnerable to losing interest and potentially funding from decision makers. However

From Vision to Action: How School Districts Use Data to Improve Performance. 3D: Data-Driven Decision Making

ERIC Educational Resources Information Center

Henke, Karen Greenwood

2005-01-01

With the passage of "No Child Left Behind" in 2001, schools are expected to provide a standards-based curriculum for students to attain math and reading proficiency and demonstrate progress each year. "NCLB" requires more frequent student testing with publicly reported results in an effort to close the achievement gap and to inform parents,…

The CHOICE pilot project: Challenges of implementing a combined peer work and shared decision-making programme in an early intervention service.

PubMed

Simmons, Magenta B; Coates, Dominiek; Batchelor, Samantha; Dimopoulos-Bick, Tara; Howe, Deborah

2017-12-12

Youth participation is central to early intervention policy and quality frameworks. There is good evidence for peer support (individuals with lived experience helping other consumers) and shared decision making (involving consumers in making decisions about their own care) in adult settings. However, youth programs are rarely tested or described in detail. This report aims to fill this gap by describing a consumer focused intervention in an early intervention service. This paper describes the development process, intervention content and implementation challenges of the Choices about Healthcare Options Informed by Client Experiences and Expectations (CHOICE) Pilot Project. This highly novel and innovative project combined both youth peer work and youth shared decision making. Eight peer workers were employed to deliver an online shared decision-making tool at a youth mental health service in New South Wales, Australia. The intervention development involved best practice principles, including international standards and elements of co-design. The implementation of the peer workforce in the service involved a number of targeted strategies designed to support this new service model. However, several implementation challenges were experienced which resulted in critical learning about how best to deliver these types of interventions. Delivering peer work and shared decision making within an early intervention service is feasible, but not without challenges. Providing adequate detail about interventions and implementation strategies fills a critical gap in the literature. Understanding optimal youth involvement strategies assists others to deliver acceptable and effective services to young people who experience mental ill health. © 2017 John Wiley & Sons Australia, Ltd.

Evidence‐based disparities: examining the gap between health expectations and experiences

PubMed Central

Vashdi, Dana R.; Zalmanovitch, Yair

2012-01-01

Abstract Context  In a time of economic austerity, one of the most daunting questions is who decides on healthcare rationing? In the current study, we sought to examine if the public can in fact provide meaningful information regarding healthcare policy issues. Based on theories of public policy, this paper tries to find out if patients behave akin to ‘responsible citizens’ and can provide differentiated expectations between three healthcare dimensions. Methods  One thousand two‐hundred eleven individuals participated in a telephone interview. Participants were asked two series of questions, one regarding their views on the primary care, prevention and promotion practices they experience with their healthcare provider and one regarding the importance of these practices to them. We calculated a difference score representing the gap in each healthcare dimension. Findings  In all three healthcare dimensions, the mean gap is in the positive side of the axis indicating that the public does not receive what it expects to receive, or in policy terms there is ‘a responsiveness deficit’. The mean gap in relation to primary care is significantly lower than the mean gap in both preventive care and health promotion. Conclusions  The public can provide meaningful information even in areas of endless demand and can provide an addition point of view to be considered by policy makers in complicated healthcare rationing decisions. PMID:22738086

Collaboration and co-production of climate knowledge: lessons from a network on the front-line

NASA Astrophysics Data System (ADS)

Kettle, N.

2016-12-01

The science-practice gap is broadly considered a major barrier to the production and application of decision-relevant science. This study uses a social network analysis, based on 126 interviews, to analyze the roles and network ties among climate scientists, service providers, and decision makers in Alaska. Our research highlights the importance of key actors and significant differences in bonding and bridging ties across roles - structural characteristics that provide a basis for informing recommendations to build adaptive capacity and support the co-production of knowledge. Our findings also illustrate that some individuals in the network engage in multiple roles, suggesting that conceptualizing the science-practice interface as consisting of "producers" and "consumers" oversimplifies how individuals engage in climate science, services, and decision making. This research supports the notion that the development and use of climate information is a networked phenomenon. It also emphasizes the importance of centralized individuals who are capable of engaging in multiple roles for the transition of knowledge action.

Barriers, facilitators and views about next steps to implementing supports for evidence-informed decision-making in health systems: a qualitative study.

PubMed

Ellen, Moriah E; Léon, Grégory; Bouchard, Gisèle; Ouimet, Mathieu; Grimshaw, Jeremy M; Lavis, John N

2014-12-05

Mobilizing research evidence for daily decision-making is challenging for health system decision-makers. In a previous qualitative paper, we showed the current mix of supports that Canadian health-care organizations have in place and the ones that are perceived to be helpful to facilitate the use of research evidence in health system decision-making. Factors influencing the implementation of such supports remain poorly described in the literature. Identifying the barriers to and facilitators of different interventions is essential for implementation of effective, context-specific, supports for evidence-informed decision-making (EIDM) in health systems. The purpose of this study was to identify (a) barriers and facilitators to implementing supports for EIDM in Canadian health-care organizations, (b) views about emerging development of supports for EIDM, and (c) views about the priorities to bridge the gaps in the current mix of supports that these organizations have in place. This qualitative study was conducted in three types of health-care organizations (regional health authorities, hospitals, and primary care practices) in two Canadian provinces (Ontario and Quebec). Fifty-seven in-depth semi-structured telephone interviews were conducted with senior managers, library managers, and knowledge brokers from health-care organizations that have already undertaken strategic initiatives in knowledge translation. The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software. Limited resources (i.e., money or staff), time constraints, and negative attitudes (or resistance) toward change were the most frequently identified barriers to implementing supports for EIDM. Genuine interest from health system decision-makers, notably their willingness to invest money and resources and to create a knowledge translation culture over time in health-care organizations, was the most frequently identified facilitator to implementing supports for EIDM. The most frequently cited views about emerging development of supports for EIDM were implementing accessible and efficient systems to support the use of research in decision-making (e.g., documentation and reporting tools, communication tools, and decision support tools) and developing and implementing an infrastructure or position where the accountability for encouraging knowledge use lies. The most frequently stated priorities for bridging the gaps in the current mix of supports that these organizations have in place were implementing technical infrastructures to support research use and to ensure access to research evidence and establishing formal or informal ties to researchers and knowledge brokers outside the organization who can assist in EIDM. These results provide insights on the type of practical implementation imperatives involved in supporting EIDM.

Implementing shared decision making in federally qualified health centers, a quasi-experimental design study: the Office-Guidelines Applied to Practice (Office-GAP) program.

PubMed

Olomu, Adesuwa; Hart-Davidson, William; Luo, Zhehui; Kelly-Blake, Karen; Holmes-Rovner, Margaret

2016-08-02

Use of Shared Decision-Making (SDM) and Decision Aids (DAs) has been encouraged but is not regularly implemented in primary care. The Office-Guidelines Applied to Practice (Office-GAP) intervention is an application of a previous model revised to address guidelines based care for low-income populations with diabetes and coronary heart disease (CHD). To evaluate Office-GAP Program feasibility and preliminary efficacy on medication use, patient satisfaction with physician communication and confidence in decision in low-income population with diabetes and coronary heart disease (CHD) in a Federally Qualified Healthcare Center (FQHC). Ninety-five patients participated in an Office-GAP program. A quasi-experimental design study, over 6 months with 12-month follow-up. Office-GAP program integrates health literacy, communication skills education for patients and physicians, patient/physician decision support tools and SDM into routine care. 1) Implementation rates of planned program elements 2) Patient satisfaction with communication and confidence in decision, and 3) Medication prescription rates. We used the GEE method for hierarchical logistic models, controlling for confounding. Feasibility of the Office-GAP program in the FQHC setting was established. We found significant increase in use of Aspirin/Plavix, statin and beta-blocker during follow-up compared to baseline: Aspirin OR 1.5 (95 % CI: 1.1, 2.2) at 3-months, 1.9 (1.3, 2.9) at 6-months, and 1.8 (1.2, 2.8) at 12-months. Statin OR 1.1 (1.0, 1.3) at 3-months and 1.5 (1.1, 2.2) at 12-months; beta-blocker 1.8 (1.1, 2.9) at 6-months and 12-months. Program elements were consistently used (≥ 98 % clinic attendance at training and tool used). Patient satisfaction with communication and confidence in decision increased. The use of Office-GAP program to teach SDM and use of DAs in real time was demonstrated to be feasible in FQHCs. It has the potential to improve satisfaction with physician communication and confidence in decisions and to improve medication use. The Office-GAP program is a brief, efficient platform for delivering patient and provider education in SDM and could serve as a model for implementing guideline based care for all chronic diseases in outpatient clinical settings. Further evaluation is needed to establish feasibility outside clinical study, reach, effectiveness and cost-effectiveness of this approach.

Co-Operative Advances in Behavioral Health and Performance Research and Operations

NASA Technical Reports Server (NTRS)

VanderArk, Stephen T.; Leveton, Lauren B.

2011-01-01

In organizations that engage in both operations and applied research, with operational needs guiding research questions and research informing improved operations, the ideal goal is a synergy of ideas and information. In reality, this ideal synergy is often lacking. Real-time operational needs driving day-to-day decisions, lack of communication, lag time in getting research advances plugged into operations can cause both areas to suffer from this gap between operations and research. At Johnson Space Center, the Behavior Health and Performance group (BHP) strives to bridge this gap by following a Human Research Program framework: Expectations of future operational needs identify the knowledge gaps; the gaps in turn guide research leading to a product that is transitioned into operations. Thus, the direction those of us in research take is in direct response to current and future needs of operations. Likewise, those of us in operations actively seek knowledge that is supported by evidence-based research. We make an ongoing effort to communicate across the research and operations gap by working closely with each other and making a conscious effort to keep each other informed. The objective of the proposed panel discussion is to demonstrate through the following presentations the results of a successful collaboration between research and operations and to provide ASMA members with more practical knowledge and strategies for building these bridges to serve our field of practice well. The panel will consist of six presenters from BHP operations, internal BHP research, and external research instigated by BHP who together represent the entire BHP Research Transition to Operations Framework

Public Health Information Systems: Priorities and Practices for Successful Deployments.

PubMed

Pearce, Martin

2016-01-01

A fast paced workshop designed for senior public health decision makers and clinical leaders implementing information systems to support delivery of public health programs. The tutorial will introduce public health information systems and provide best practices for implementing solutions related to immunization, communicable disease case management and outbreak management. Using a combination of formats, the tutorial will: • Highlight key functionality of public health information systems. • Review global crises currently exposing gaps and deficiencies in public health information. • Examine governance, planning, and implementation priorities. • Highlight considerations supporting implementations nationally and in special populations. • Provide real, actionable lessons learned to take away and apply in the real world.

Federated health information architecture: Enabling healthcare providers and policymakers to use data for decision-making.

PubMed

Kumar, Manish; Mostafa, Javed; Ramaswamy, Rohit

2018-05-01

Health information systems (HIS) in India, as in most other developing countries, support public health management but fail to enable healthcare providers to use data for delivering quality services. Such a failure is surprising, given that the population healthcare data that the system collects are aggregated from patient records. An important reason for this failure is that the health information architecture (HIA) of the HIS is designed primarily to serve the information needs of policymakers and program managers. India has recognised the architectural gaps in its HIS and proposes to develop an integrated HIA. An enabling HIA that attempts to balance the autonomy of local systems with the requirements of a centralised monitoring agency could meet the diverse information needs of various stakeholders. Given the lack of in-country knowledge and experience in designing such an HIA, this case study was undertaken to analyse HIS in the Bihar state of India and to understand whether it would enable healthcare providers, program managers and policymakers to use data for decision-making. Based on a literature review and data collected from interviews with key informants, this article proposes a federated HIA, which has the potential to improve HIS efficiency; provide flexibility for local innovation; cater to the diverse information needs of healthcare providers, program managers and policymakers; and encourage data-based decision-making.

ToxPi GUI: an interactive visualization tool for transparent integration of data from diverse sources of evidence.

PubMed

Reif, David M; Sypa, Myroslav; Lock, Eric F; Wright, Fred A; Wilson, Ander; Cathey, Tommy; Judson, Richard R; Rusyn, Ivan

2013-02-01

Scientists and regulators are often faced with complex decisions, where use of scarce resources must be prioritized using collections of diverse information. The Toxicological Prioritization Index (ToxPi™) was developed to enable integration of multiple sources of evidence on exposure and/or safety, transformed into transparent visual rankings to facilitate decision making. The rankings and associated graphical profiles can be used to prioritize resources in various decision contexts, such as testing chemical toxicity or assessing similarity of predicted compound bioactivity profiles. The amount and types of information available to decision makers are increasing exponentially, while the complex decisions must rely on specialized domain knowledge across multiple criteria of varying importance. Thus, the ToxPi bridges a gap, combining rigorous aggregation of evidence with ease of communication to stakeholders. An interactive ToxPi graphical user interface (GUI) application has been implemented to allow straightforward decision support across a variety of decision-making contexts in environmental health. The GUI allows users to easily import and recombine data, then analyze, visualize, highlight, export and communicate ToxPi results. It also provides a statistical metric of stability for both individual ToxPi scores and relative prioritized ranks. The ToxPi GUI application, complete user manual and example data files are freely available from http://comptox.unc.edu/toxpi.php.

Supporting Fisheries Management by Means of Complex Models: Can We Point out Isles of Robustness in a Sea of Uncertainty?

PubMed Central

Gasche, Loïc; Mahévas, Stéphanie; Marchal, Paul

2013-01-01

Ecosystems are usually complex, nonlinear and strongly influenced by poorly known environmental variables. Among these systems, marine ecosystems have high uncertainties: marine populations in general are known to exhibit large levels of natural variability and the intensity of fishing efforts can change rapidly. These uncertainties are a source of risks that threaten the sustainability of both fish populations and fishing fleets targeting them. Appropriate management measures have to be found in order to reduce these risks and decrease sensitivity to uncertainties. Methods have been developed within decision theory that aim at allowing decision making under severe uncertainty. One of these methods is the information-gap decision theory. The info-gap method has started to permeate ecological modelling, with recent applications to conservation. However, these practical applications have so far been restricted to simple models with analytical solutions. Here we implement a deterministic approach based on decision theory in a complex model of the Eastern English Channel. Using the ISIS-Fish modelling platform, we model populations of sole and plaice in this area. We test a wide range of values for ecosystem, fleet and management parameters. From these simulations, we identify management rules controlling fish harvesting that allow reaching management goals recommended by ICES (International Council for the Exploration of the Sea) working groups while providing the highest robustness to uncertainties on ecosystem parameters. PMID:24204873

Supporting fisheries management by means of complex models: can we point out isles of robustness in a sea of uncertainty?

PubMed

Gasche, Loïc; Mahévas, Stéphanie; Marchal, Paul

2013-01-01

Ecosystems are usually complex, nonlinear and strongly influenced by poorly known environmental variables. Among these systems, marine ecosystems have high uncertainties: marine populations in general are known to exhibit large levels of natural variability and the intensity of fishing efforts can change rapidly. These uncertainties are a source of risks that threaten the sustainability of both fish populations and fishing fleets targeting them. Appropriate management measures have to be found in order to reduce these risks and decrease sensitivity to uncertainties. Methods have been developed within decision theory that aim at allowing decision making under severe uncertainty. One of these methods is the information-gap decision theory. The info-gap method has started to permeate ecological modelling, with recent applications to conservation. However, these practical applications have so far been restricted to simple models with analytical solutions. Here we implement a deterministic approach based on decision theory in a complex model of the Eastern English Channel. Using the ISIS-Fish modelling platform, we model populations of sole and plaice in this area. We test a wide range of values for ecosystem, fleet and management parameters. From these simulations, we identify management rules controlling fish harvesting that allow reaching management goals recommended by ICES (International Council for the Exploration of the Sea) working groups while providing the highest robustness to uncertainties on ecosystem parameters.

From research to evidence-informed decision making: a systematic approach

PubMed Central

Poot, Charlotte C; van der Kleij, Rianne M; Brakema, Evelyn A; Vermond, Debbie; Williams, Siân; Cragg, Liza; van den Broek, Jos M; Chavannes, Niels H

2018-01-01

Abstract Background Knowledge creation forms an integral part of the knowledge-to-action framework aimed at bridging the gap between research and evidence-informed decision making. Although principles of science communication, data visualisation and user-centred design largely impact the effectiveness of communication, their role in knowledge creation is still limited. Hence, this article aims to provide researchers a systematic approach on how knowledge creation can be put into practice. Methods A systematic two-phased approach towards knowledge creation was formulated and executed. First, during a preparation phase the purpose and audience of the knowledge were defined. Subsequently, a developmental phase facilitated how the content is ‘said’ (language) and communicated (channel). This developmental phase proceeded via two pathways: a translational cycle and design cycle, during which core translational and design components were incorporated. The entire approach was demonstrated by a case study. Results The case study demonstrated how the phases in this systematic approach can be operationalised. It furthermore illustrated how created knowledge can be delivered. Conclusion The proposed approach offers researchers a systematic, practical and easy-to-implement tool to facilitate effective knowledge creation towards decision-makers in healthcare. Through the integration of core components of knowledge creation evidence-informed decision making will ultimately be optimized. PMID:29538728

Understanding Early Decisions to Withdraw Life-Sustaining Therapy in Cardiac Arrest Survivors. A Qualitative Investigation.

PubMed

Dale, Craig M; Sinuff, Tasnim; Morrison, Laurie J; Golan, Eyal; Scales, Damon C

2016-07-01

Early withdrawal of life-sustaining therapy contributes to the majority of deaths following out-of-hospital cardiac arrest (OHCA), despite current recommendations for delayed neurological prognostication (≥72 h) after treatment with targeted temperature management. Little is known about clinicians' experiences of early withdrawal of life support decisions in patients with OHCA. To explore clinicians' experiences and perceptions of early withdrawal of life support decisions and barriers to guideline-concordant neurological prognostication in comatose survivors of OHCA treated with targeted temperature management. We conducted qualitative interviews with intensive care unit (ICU) physicians and nurses following withdrawal of life support in comatose patients with OHCA treated with targeted temperature management. The study was carried out across 18 academic and community hospitals participating in a multicenter, stepped-wedge, cluster-randomized controlled trial designed to improve quality-of-care processes for patients after OHCA in Ontario, Canada. We used a focused thematic analysis to capture barriers to guideline-concordant neurological prognostication and used these barriers to identify potentially modifiable issues. The core thematic finding was a high emotional burden of ICU family-team communication in which strong feelings inhibited information transfer and delayed decision making following OHCA. Four subthemes describing sources of communication strain were identified: (1) requests from family members to provide early outcome predictions, (2) incomplete family comprehension of critical care, (3) family requests for early withdrawal of life support based on their understanding of patients' preferences and values, and (4) family-team communication gaps related to prognostic uncertainty. Participants worried that gaps in timely and clear prognostic information contributed to surrogates' perceptions of a poor outcome and to inappropriately early decisions to withdraw life support. Family-team communication difficulties may be an underestimated factor leading to early withdrawal of life support in ICUs for individuals who initially survive OHCA.

A Techno-Economic Look at SiC WBG from Wafer to Motor Drive

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

Bench Reese, Samantha R; Horowitz, Kelsey A; Remo, Timothy W

Techno-economic analysis helps benchmark and deliver supply chain and manufacturing insights that can be leveraged by decision-makers to inform investment strategies, policy, and other decisions to promote economic growth and competitiveness. Silicon Carbide (SiC) wide-band gap (WBG) technologies is poised to be an integral contributor to the clean energy economy. We use bottoms-up regional manufacturing cost models to show SiC power electronics, manufactured in volume, could result in final product cost parity with those manufactured with silicon. The models are further leveraged to show innovation pathways to lower cost and potentially expanded technology adoption.

[Which research is needed to support clinical decision-making on integrative medicine? Can comparative effectiveness research close the gap?].

PubMed

Witt, Claudia M; Huang, Wen-jing; Lao, Lixing; Berman, Brian M

2013-08-01

In clinical research on complementary and integrative medicine, experts and scientists have often pursued a research agenda in spite of an incomplete understanding of the needs of end users. Consequently, the majority of previous clinical trials have mainly assessed the efficacy of interventions. Scant data is available on their effectiveness. Comparative effectiveness research (CER) promises to support decision makers by generating evidence that compares the benefits and harms of best care options. This evidence, more generalizable than evidence generated by traditional randomized clinical trials (RCTs), is better suited to inform real-world care decisions. An emphasis on CER supports the development of the evidence base for clinical and policy decision-making. Whereas in most areas of complementary and integrative medicine data on CER is scarce, available acupuncture research already contributes to CER evidence. This paper will introduce CER and make suggestions for future research.

Which research is needed to support clinical decision-making on integrative medicine?- Can comparative effectiveness research close the gap?

PubMed

Witt, Claudia M; Huang, Wen-jing; Lao, Lixing; Bm, Berman

2012-10-01

In clinical research on complementary and integrative medicine, experts and scientists have often pursued a research agenda in spite of an incomplete understanding of the needs of end users. Consequently, the majority of previous clinical trials have mainly assessed the efficacy of interventions. Scant data is available on their effectiveness. Comparative effectiveness research (CER) promises to support decision makers by generating evidence that compares the benefits and harms of the best care options. This evidence, more generalizable than the evidence generated by traditional randomized controlled trials (RCTs), is better suited to inform real-world care decisions. An emphasis on CER supports the development of the evidence base for clinical and policy decision-making. Whereas in most areas of complementary and integrative medicine data on comparative effectiveness is scarce, available acupuncture research already contributes to CER evidence. This paper will introduce CER and make suggestions for future research.

Looking beyond the forest: Using harvest plots, gap analysis, and expert consultations to assess effectiveness, engage stakeholders, and inform policy.

PubMed

Burns, J; Polus, S; Brereton, L; Chilcott, J; Ward, S E; Pfadenhauer, L M; Rehfuess, E A

2018-03-01

We describe a combination of methods for assessing the effectiveness of complex interventions, especially where substantial heterogeneity with regard to the population, intervention, comparison, outcomes, and study design of interest is expected. We applied these methods in a recent systematic review of the effectiveness of reinforced home-based palliative care (rHBPC) interventions, which included home-based care with an additional and explicit component of lay caregiver support. We first summarized the identified evidence, deemed inappropriate for statistical pooling, graphically by creating harvest plots. Although very useful as a tool for summary and presentation of overall effectiveness, such graphical summary approaches may obscure relevant differences between studies. Thus, we then used a gap analysis and conducted expert consultations to look beyond the aggregate level at how the identified evidence of effectiveness may be explained. The goal of these supplemental methods was to step outside of the conventional systematic review and explore this heterogeneity from a broader perspective, based on the experience of palliative care researchers and practitioners. The gap analysis and expert consultations provided valuable input into possible underlying explanations in the evidence, which could be helpful in the further adaptation and testing of existing rHBPC interventions or the development and evaluation of new ones. We feel that such a combination of methods could prove accessible, understandable, and useful in informing decisions and could thus help increase the relevance of systematic reviews to the decision-making process. Copyright © 2017 John Wiley & Sons, Ltd.

Using health technology assessment to identify gaps in evidence and inform study design for comparative effectiveness research.

PubMed

Tunis, Sean R; Turkelson, Charles

2012-12-01

Health technology assessment (HTA) is primarily used as a tool to ensure that clinical and policy decisions are made with the benefit of a systematic analysis of all completed research. This article describes the progress and potential for HTA reports to improve the quality and relevance of future research and to better serve the information needs of patients, clinicians, payers, and other decision makers. We conducted a review of the current published literature and working papers describing past, ongoing, and future initiatives that rely on HTA reports to identify gaps in evidence and improve the design of future research. Although still in a developmental stage, significant progress is under way to improve methods for using HTA reports for the systematic identification of research gaps, prioritization of future research, and improvement of study designs. Several well-defined frameworks have been developed to assist those who produce HTA to become more effective in these additional domains of work. A recurring element of this work is the importance of meaningfully involving stakeholders in the process of defining future research needs and designing studies to address them. Patients, clinicians, and payers are important audiences for completed research and are now recognized as serving an important role in determining what future research is needed. There are substantial opportunities to improve the quality, relevance, and efficiency of clinical research. Recent efforts are beginning to demonstrate the potential to build on the work invested in developing HTA reports to provide a roadmap toward these objectives.

Decision technologies and the independent professional: the future's challenge to learning and leadership

PubMed Central

Dowie, J.

2001-01-01

Most references to "leadership" and "learning" as sources of quality improvement in medical care reflect an implicit commitment to the decision technology of "clinical judgement". All attempts to sustain this waning decision technology by clinical guidelines, care pathways, "evidence based practice", problem based curricula, and other stratagems only increase the gap between what is expected of doctors in today's clinical situation and what is humanly possible, hence the morale, stress, and health problems they are increasingly experiencing. Clinical guidance programmes based on decision analysis represent the coming decision technology, and proactive adaptation will produce independent doctors who can deliver excellent evidence based and preference driven care while concentrating on the human aspects of the therapeutic relation, having been relieved of the unbearable burdens of knowledge and information processing currently laid on them. History is full of examples of the incumbents of dominant technologies preferring to die than to adapt, and medicine needs both learning and leadership if it is to avoid repeating this mistake. Key Words: decision technology; clinical guidance programmes; decision analysis PMID:11700381

Achieving Robustness to Uncertainty for Financial Decision-making

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

Barnum, George M.; Van Buren, Kendra L.; Hemez, Francois M.

2014-01-10

This report investigates the concept of robustness analysis to support financial decision-making. Financial models, that forecast future stock returns or market conditions, depend on assumptions that might be unwarranted and variables that might exhibit large fluctuations from their last-known values. The analysis of robustness explores these sources of uncertainty, and recommends model settings such that the forecasts used for decision-making are as insensitive as possible to the uncertainty. A proof-of-concept is presented with the Capital Asset Pricing Model. The robustness of model predictions is assessed using info-gap decision theory. Info-gaps are models of uncertainty that express the “distance,” or gapmore » of information, between what is known and what needs to be known in order to support the decision. The analysis yields a description of worst-case stock returns as a function of increasing gaps in our knowledge. The analyst can then decide on the best course of action by trading-off worst-case performance with “risk”, which is how much uncertainty they think needs to be accommodated in the future. The report also discusses the Graphical User Interface, developed using the MATLAB® programming environment, such that the user can control the analysis through an easy-to-navigate interface. Three directions of future work are identified to enhance the present software. First, the code should be re-written using the Python scientific programming software. This change will achieve greater cross-platform compatibility, better portability, allow for a more professional appearance, and render it independent from a commercial license, which MATLAB® requires. Second, a capability should be developed to allow users to quickly implement and analyze their own models. This will facilitate application of the software to the evaluation of proprietary financial models. The third enhancement proposed is to add the ability to evaluate multiple models simultaneously. When two models reflect past data with similar accuracy, the more robust of the two is preferable for decision-making because its predictions are, by definition, less sensitive to the uncertainty.« less

Anticipating the Ethical Challenges of Psychiatric Genetic Testing.

PubMed

Appelbaum, Paul S; Benston, Shawna

2017-07-01

Genetic testing for mental illness is likely to become increasingly prevalent as the science behind it is refined. This article identifies anticipated ethical challenges for patients, psychiatrists, and genetic counselors and makes recommendations for addressing them. Many of the ethical challenges of psychiatric genetic testing are likely to stem from failures to comprehend the nature and implications of test results. Recent studies have identified gaps in the knowledge base of psychiatrists and genetic counselors, which limit their abilities to provide patients with appropriate education. A small number of studies have demonstrated the value of counseling in empowering patients to deal with relevant genetic information. Psychiatrists and other health professionals must be able to assist patients and families in making informed decisions about genetic testing and interpreting test results. Filling their knowledge gaps on these issues will be a critical step towards meeting these responsibilities.

An Overview of Power Capability Requirements for Exploration Missions

NASA Technical Reports Server (NTRS)

Davis, Jose M.; Cataldo, Robert L.; Soeder, James F.; Manzo, Michelle A.; Hakimzadeh, Roshanak

2005-01-01

Advanced power is one of the key capabilities that will be needed to achieve NASA's missions of exploration and scientific advancement. Significant gaps exist in advanced power capabilities that are on the critical path to enabling human exploration beyond Earth orbit and advanced robotic exploration of the solar system. Focused studies and investment are needed to answer key development issues for all candidate technologies before down-selection. The viability of candidate power technology alternatives will be a major factor in determining what exploration mission architectures are possible. Achieving the capabilities needed to enable the CEV, Moon, and Mars missions is dependent on adequate funding. Focused investment in advanced power technologies for human and robotic exploration missions is imperative now to reduce risk and to make informed decisions on potential exploration mission decisions beginning in 2008. This investment would begin the long lead-time needed to develop capabilities for human exploration missions in the 2015 to 2030 timeframe. This paper identifies some of the key technologies that will be needed to fill these power capability gaps. Recommendations are offered to address capability gaps in advanced power for Crew Exploration Vehicle (CEV) power, surface nuclear power systems, surface mobile power systems, high efficiency power systems, and space transportation power systems. These capabilities fill gaps that are on the critical path to enabling robotic and human exploration missions. The recommendations address the following critical technology areas: Energy Conversion, Energy Storage, and Power Management and Distribution.

PRIORITIES FOR HEALTH ECONOMIC METHODOLOGICAL RESEARCH: RESULTS OF AN EXPERT CONSULTATION.

PubMed

Tordrup, David; Chouaid, Christos; Cuijpers, Pim; Dab, William; van Dongen, Johanna Maria; Espin, Jaime; Jönsson, Bengt; Léonard, Christian; McDaid, David; McKee, Martin; Miguel, José Pereira; Patel, Anita; Reginster, Jean-Yves; Ricciardi, Walter; Rutten-van Molken, Maureen; Rupel, Valentina Prevolnik; Sach, Tracey; Sassi, Franco; Waugh, Norman; Bertollini, Roberto

2017-01-01

The importance of economic evaluation in decision making is growing with increasing budgetary pressures on health systems. Diverse economic evidence is available for a range of interventions across national contexts within Europe, but little attention has been given to identifying evidence gaps that, if filled, could contribute to more efficient allocation of resources. One objective of the Research Agenda for Health Economic Evaluation project is to determine the most important methodological evidence gaps for the ten highest burden conditions in the European Union (EU), and to suggest ways of filling these gaps. The highest burden conditions in the EU by Disability Adjusted Life Years were determined using the Global Burden of Disease study. Clinical interventions were identified for each condition based on published guidelines, and economic evaluations indexed in MEDLINE were mapped to each intervention. A panel of public health and health economics experts discussed the evidence during a workshop and identified evidence gaps. The literature analysis contributed to identifying cross-cutting methodological and technical issues, which were considered by the expert panel to derive methodological research priorities. The panel suggests a research agenda for health economics which incorporates the use of real-world evidence in the assessment of new and existing interventions; increased understanding of cost-effectiveness according to patient characteristics beyond the "-omics" approach to inform both investment and disinvestment decisions; methods for assessment of complex interventions; improved cross-talk between economic evaluations from health and other sectors; early health technology assessment; and standardized, transferable approaches to economic modeling.

Assessing physician-parent communication during emergency medical procedures in children: an observational study in a low-literacy Latino patient population.

PubMed

Dahl, Aaron; Sinha, Madhumita; Rosenberg, David I; Tran, Melissa; Valdez, André

2015-05-01

Effective physician-patient communication is critical to the clinical decision-making process. We studied parental recall of information provided during an informed consent discussion process before performance of emergency medical procedures in a pediatric emergency department of an inner-city hospital with a large bilingual population. Fifty-five parent/child dyads undergoing emergency medical procedures were surveyed prospectively in English/Spanish postprocedure for recall of informed consent information. Exact logistic regression was used to predict the ability to name a risk, benefit, and alternative to the procedure based on a parent's language, education, and acculturation. Among English-speaking parents, there tended to be higher proportions that could name a risk, benefit, or alternative. Our regression models showed overall that the parents with more than a high school education tended to have nearly 5 times higher odds of being able to name a risk. A gap in communication may exist between physicians and patients (or parents of patients) during the consent-taking process, and this gap may be impacted by socio-demographic factors such as language and education level.

Understanding decision-making towards housework among women with upper limb repetitive strain injury.

PubMed

Cheung, Therma W C; Clemson, Lindy; O'Loughlin, Kate; Shuttleworth, Russell

2016-02-01

Among women with upper limb repetitive strain injury (RSI), occupational therapy interventions include education to facilitate ergonomic practices in housework. From a client-centred perspective, an understanding of women's decision-making about housework is needed to design effective occupational therapy programmes. This study addresses a gap in research in this area by exploring women's views about changing housework habits. The aim was to construct a conceptual representation to explain decision-making in housework by drawing on experiences of a sample of Singapore Chinese women with upper limb RSI from one hand therapy clinic. Based on a constructivist grounded theory methodology, data were collected through in-depth interviewing with 15 women. Interviews were audiotaped and transcribed. Data were analysed with line by line coding, focussed coding and axial coding with constant comparison throughout data collection. Decision-making in housework among these women involved three main themes: (i) emotional attachment to housework; (ii) cognitively informed decision; and (iii) emotionally influenced decision. Women with upper limb RSI had to make cognitive decisions for or against a change in housework to manage their condition. However, the women's cognitively informed decisions were shaped by their emotional attachment to housework. As such, they experienced strong emotional barriers to changing their housework practices even when they had cognitively accepted the necessity and possibility of making a change. Therapists need to be aware that counselling to address the emotional barriers experienced by women is important during ergonomic education. © 2016 Occupational Therapy Australia.

Evidence for informing health policy development in Low-income Countries (LICs): perspectives of policy actors in Uganda

PubMed Central

Nabyonga-Orem, Juliet; Mijumbi, Rhona

2015-01-01

Background: Although there is a general agreement on the benefits of evidence informed health policy development given resource constraints especially in Low-Income Countries (LICs), the definition of what evidence is, and what evidence is suitable to guide decision-making is still unclear. Our study is contributing to filling this knowledge gap. We aimed to explore health policy actors’ views regarding what evidence they deemed appropriate to guide health policy development. Methods: Using exploratory qualitative methods, we conducted interviews with 51 key informants using an in-depth interview guide. We interviewed a diverse group of stakeholders in health policy development and knowledge translation in the Uganda health sector. Data were analyzed using inductive content analysis techniques. Results: Different stakeholders lay emphasis on different kinds of evidence. While donors preferred international evidence and Ministry of Health (MoH) officials looked to local evidence, district health managers preferred local evidence, evidence from routine monitoring and evaluation, and reports from service providers. Service providers on the other hand preferred local evidence and routine monitoring and evaluation reports whilst researchers preferred systematic reviews and clinical trials. Stakeholders preferred evidence covering several aspects impacting on decision-making highlighting the fact that although policy actors look for factual information, they also require evidence on context and implementation feasibility of a policy decision. Conclusion: What LICs like Uganda categorize as evidence suitable for informing policy encompasses several types with no consensus on what is deemed as most appropriate. Evidence must be of high quality, applicable, acceptable to the users, and informing different aspects of decision-making. PMID:25905479

The multiple resource inventory decision-making process

Treesearch

Victor A. Rudis

1993-01-01

A model of the multiple resource inventory decision-making process is presented that identifies steps in conducting inventories, describes the infrastructure, and points out knowledge gaps that are common to many interdisciplinary studies.Successful efforts to date suggest the need to bridge the gaps by sharing elements, maintain dialogue among stakeholders in multiple...

Sustainability Tools Inventory - Initial Gaps Analysis | Science ...

EPA Pesticide Factsheets

This report identifies a suite of tools that address a comprehensive set of community sustainability concerns. The objective is to discover whether "gaps" exist in the tool suite’s analytic capabilities. These tools address activities that significantly influence resource consumption, waste generation, and hazard generation including air pollution and greenhouse gases. In addition, the tools have been evaluated using four screening criteria: relevance to community decision making, tools in an appropriate developmental stage, tools that may be transferrable to situations useful for communities, and tools with requiring skill levels appropriate to communities. This document provides an initial gap analysis in the area of community sustainability decision support tools. It provides a reference to communities for existing decision support tools, and a set of gaps for those wishing to develop additional needed tools to help communities to achieve sustainability. It contributes to SHC 1.61.4

Knowledge Translation for Cardiovascular Disease Research and Management in Japan

PubMed Central

Shommu, Nusrat S

2017-01-01

Knowledge translation is an essential and emerging arena in healthcare research. It is the process of aiding the application of research knowledge into clinical practice or policymaking. Individuals at all levels of the health care system, including patients, healthcare professionals, and policymakers, are affected by the gaps that exist between research evidence and practice; the process of knowledge translation plays a role in bridging these gaps and incorporating high-quality clinical research into decision-making. Cardiovascular disease (CVD) management is a crucial area of healthcare where information gaps are known to exist. Although Japan has one of the lowest risks and mortality rates from CVDs, an increasing trend of cardiovascular incidence and changes in the risk factor conditions have been observed in recent years. This article provides an overview of knowledge translation and its importance in the cardiovascular health of the Japanese population, and describes the key steps of a typical knowledge translation strategy. PMID:28757537

Knowledge Translation for Cardiovascular Disease Research and Management in Japan.

PubMed

Shommu, Nusrat S; Turin, Tanvir C

2017-09-01

Knowledge translation is an essential and emerging arena in healthcare research. It is the process of aiding the application of research knowledge into clinical practice or policymaking. Individuals at all levels of the health care system, including patients, healthcare professionals, and policymakers, are affected by the gaps that exist between research evidence and practice; the process of knowledge translation plays a role in bridging these gaps and incorporating high-quality clinical research into decision-making. Cardiovascular disease (CVD) management is a crucial area of healthcare where information gaps are known to exist. Although Japan has one of the lowest risks and mortality rates from CVDs, an increasing trend of cardiovascular incidence and changes in the risk factor conditions have been observed in recent years. This article provides an overview of knowledge translation and its importance in the cardiovascular health of the Japanese population, and describes the key steps of a typical knowledge translation strategy.

How social stigma sustains the HIV treatment gap for MSM in Mpumalanga, South Africa.

PubMed

Maleke, Kabelo; Daniels, Joseph; Lane, Tim; Struthers, Helen; McIntyre, James; Coates, Thomas

2017-11-01

There are gaps in HIV care for men who have sex with men (MSM) in African settings, and HIV social stigma plays a significant role in sustaining these gaps. We conducted a three-year research project with 49 HIV-positive MSM in two districts in Mpumalanga Province, South Africa, to understand the factors that inform HIV care seeking behaviors. Semi-structured focus group discussions and interviews were conducted in IsiZulu, SiSwati, and some code-switching into English, and these were audio-recorded, transcribed, and translated into English. We used a constant comparison approach to analyze these data. HIV social stigma centered around gossip that sustained self-diagnosis and delayed clinical care with decisions to use traditional healers to mitigate the impact of gossip on their lives. More collaboration models are needed between traditional healers and health professionals to support the global goals for HIV testing and treatment.

How social cognition can inform social decision making.

PubMed

Lee, Victoria K; Harris, Lasana T

2013-12-25

Social decision-making is often complex, requiring the decision-maker to make inferences of others' mental states in addition to engaging traditional decision-making processes like valuation and reward processing. A growing body of research in neuroeconomics has examined decision-making involving social and non-social stimuli to explore activity in brain regions such as the striatum and prefrontal cortex, largely ignoring the power of the social context. Perhaps more complex processes may influence decision-making in social vs. non-social contexts. Years of social psychology and social neuroscience research have documented a multitude of processes (e.g., mental state inferences, impression formation, spontaneous trait inferences) that occur upon viewing another person. These processes rely on a network of brain regions including medial prefrontal cortex (MPFC), superior temporal sulcus (STS), temporal parietal junction, and precuneus among others. Undoubtedly, these social cognition processes affect social decision-making since mental state inferences occur spontaneously and automatically. Few studies have looked at how these social inference processes affect decision-making in a social context despite the capability of these inferences to serve as predictions that can guide future decision-making. Here we review and integrate the person perception and decision-making literatures to understand how social cognition can inform the study of social decision-making in a way that is consistent with both literatures. We identify gaps in both literatures-while behavioral economics largely ignores social processes that spontaneously occur upon viewing another person, social psychology has largely failed to talk about the implications of social cognition processes in an economic decision-making context-and examine the benefits of integrating social psychological theory with behavioral economic theory.

How social cognition can inform social decision making

PubMed Central

Lee, Victoria K.; Harris, Lasana T.

2013-01-01

Social decision-making is often complex, requiring the decision-maker to make inferences of others' mental states in addition to engaging traditional decision-making processes like valuation and reward processing. A growing body of research in neuroeconomics has examined decision-making involving social and non-social stimuli to explore activity in brain regions such as the striatum and prefrontal cortex, largely ignoring the power of the social context. Perhaps more complex processes may influence decision-making in social vs. non-social contexts. Years of social psychology and social neuroscience research have documented a multitude of processes (e.g., mental state inferences, impression formation, spontaneous trait inferences) that occur upon viewing another person. These processes rely on a network of brain regions including medial prefrontal cortex (MPFC), superior temporal sulcus (STS), temporal parietal junction, and precuneus among others. Undoubtedly, these social cognition processes affect social decision-making since mental state inferences occur spontaneously and automatically. Few studies have looked at how these social inference processes affect decision-making in a social context despite the capability of these inferences to serve as predictions that can guide future decision-making. Here we review and integrate the person perception and decision-making literatures to understand how social cognition can inform the study of social decision-making in a way that is consistent with both literatures. We identify gaps in both literatures—while behavioral economics largely ignores social processes that spontaneously occur upon viewing another person, social psychology has largely failed to talk about the implications of social cognition processes in an economic decision-making context—and examine the benefits of integrating social psychological theory with behavioral economic theory. PMID:24399928

A QUESTIONNAIRE TO ASSESS THE RELEVANCE AND CREDIBILITY OF OBSERVATIONAL STUDIES TO INFORM HEALTH CARE DECISION MAKING: AN ISPOR-AMCP-NPC GOOD PRACTICE TASK FORCE REPORT

PubMed Central

Berger, Marc L; Martin, Bradley C; Husereau, Don; Worley, Karen; Allen, Dan; Yang, Winnie; Mullins, C. Daniel; Kahler, Kristijan; Quon, Nicole C.; Devine, Scott; Graham, John; Cannon, Eric; Crown, William

2014-01-01

Evidence-based healthcare decisions are best informed by comparisons of all relevant interventions used to treat conditions in specific patient populations. Observational studies are being performed to help fill evidence gaps. However, widespread adoption of evidence from observational studies has been limited due to a variety of factors, including the lack of consensus regarding accepted principles for their evaluation and interpretation. Two Task Forces were formed to develop questionnaires to assist decision makers in evaluating observational studies, with one Task Force addressing retrospective research and the other prospective research. The intent was to promote a structured approach to reduce the potential for subjective interpretation of evidence and drive consistency in decision-making. Separately developed questionnaires were combined into a single questionnaire consisting of 33 items. These were divided into two domains: relevance and credibility. Relevance addresses the extent to which findings, if accurate, apply to the setting of interest to the decision maker. Credibility addresses the extent to which the study findings accurately answer the study question. The questionnaire provides a guide for assessing the degree of confidence that should be placed from observational studies and promotes awareness of the subtleties involved in evaluating those. PMID:24636373

Influencing health policy through public deliberation: Lessons learned from two decades of Citizens'/community juries.

PubMed

Degeling, Chris; Rychetnik, Lucie; Street, Jackie; Thomas, Rae; Carter, Stacy M

2017-04-01

Citizens'/community juries [CJs] engage members of the public in policy decision-making processes. CJs can be employed to develop policy responses to health problems that require the consideration of both community values and scientific evidence. Based on the principles of deliberative democracy, recent reviews indicate that findings from CJs have successfully been used to influence health policy decision-making. Despite this evidence of success, there appears to be a gap between the goals of health researchers who organize CJs and the needs of policy actors and decision makers. Drawing on our experiences working with CJs and recent research on CJ methods, we describe a synopsis of the current state of the art organized around four key questions, and informed by insights from deliberative theory and critical policy studies. Our intention is to stimulate further discussion as to the types of health policy questions that can be usefully addressed through public deliberation, and provide guidance on the methodological and political dimensions that need to be considered in deciding whether a CJ is an appropriate approach for informing a policy decision-making process. Copyright © 2017 Elsevier Ltd. All rights reserved.

Using GRADE as a framework to guide research on the sexual and reproductive health and rights (SRHR) of women living with HIV - methodological opportunities and challenges.

PubMed

Siegfried, Nandi; Narasimhan, Manjulaa; Kennedy, Caitlin E; Welbourn, Alice; Yuvraj, Anandi

2017-09-01

In March 2016, WHO reviewed evidence to develop global recommendations on the sexual and reproductive health and rights (SRHR) of women living with HIV. Systematic reviews and a global survey of women living with HIV informed the guideline development decision-making process. New recommendations covered abortion, Caesarean section, safe disclosure, and empowerment and self-efficacy interventions. Identification of key research gaps is part of the WHO guidelines development process, but consistent methods to do so are lacking. Our method aimed to ensure consistency and comprised the systematic application of a framework based on GRADE (Grading of Recommendations, Assessment, Development and Evaluation) to the process. The framework incorporates the strength and quality rating of recommendations and the priorities reported by women in the survey to inform research prioritisation. For each gap, we also articulated: (1) the most appropriate and robust study design to answer the question; (2) alternative pragmatic designs if the ideal design is not feasible; and (3) the methodological challenges facing researchers through identifying potential biases. We found 12 research gaps and identified five appropriate study designs to address the related questions: (1) Cross-sectional surveys; (2) Qualitative interview-driven studies; (3) Registries; (4) Randomised controlled trials; and (5) Medical record audit. Methodological challenges included selection, recruitment, misclassification, measurement and contextual biases, and confounding. In conclusion, a framework based on GRADE can provide a systematic approach to identifying research gaps from a WHO guideline. Incorporation of the priorities of women living with HIV into the framework systematically ensures that women living with HIV can shape future policy decisions affecting their lives. Implementation science and participatory research are appropriate over-arching approaches to enhance uptake of interventions and to ensure inclusion of women living with HIV at all stages of the research process.

Designing Health Information Technology Tools to Prevent Gaps in Public Health Insurance.

PubMed

Hall, Jennifer D; Harding, Rose L; DeVoe, Jennifer E; Gold, Rachel; Angier, Heather; Sumic, Aleksandra; Nelson, Christine A; Likumahuwa-Ackman, Sonja; Cohen, Deborah J

2017-06-23

Changes in health insurance policies have increased coverage opportunities, but enrollees are required to annually reapply for benefits which, if not managed appropriately, can lead to insurance gaps. Electronic health records (EHRs) can automate processes for assisting patients with health insurance enrollment and re-enrollment. We describe community health centers' (CHC) workflow, documentation, and tracking needs for assisting families with insurance application processes, and the health information technology (IT) tool components that were developed to meet those needs. We conducted a qualitative study using semi-structured interviews and observation of clinic operations and insurance application assistance processes. Data were analyzed using a grounded theory approach. We diagramed workflows and shared information with a team of developers who built the EHR-based tools. Four steps to the insurance assistance workflow were common among CHCs: 1) Identifying patients for public health insurance application assistance; 2) Completing and submitting the public health insurance application when clinic staff met with patients to collect requisite information and helped them apply for benefits; 3) Tracking public health insurance approval to monitor for decisions; and 4) assisting with annual health insurance reapplication. We developed EHR-based tools to support clinical staff with each of these steps. CHCs are uniquely positioned to help patients and families with public health insurance applications. CHCs have invested in staff to assist patients with insurance applications and help prevent coverage gaps. To best assist patients and to foster efficiency, EHR based insurance tools need comprehensive, timely, and accurate health insurance information.

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

PubMed

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

2016-01-01

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

Bridging the Gap Between Surveyors and the Geo-Spatial Society

NASA Astrophysics Data System (ADS)

Müller, H.

2016-06-01

For many years FIG, the International Association of Surveyors, has been trying to bridge the gap between surveyors and the geospatial society as a whole, with the geospatial industries in particular. Traditionally the surveying profession contributed to the good of society by creating and maintaining highly precise and accurate geospatial data bases, based on an in-depth knowledge of spatial reference frameworks. Furthermore in many countries surveyors may be entitled to make decisions about land divisions and boundaries. By managing information spatially surveyors today develop into the role of geo-data managers, the longer the more. Job assignments in this context include data entry management, data and process quality management, design of formal and informal systems, information management, consultancy, land management, all that in close cooperation with many different stakeholders. Future tasks will include the integration of geospatial information into e-government and e-commerce systems. The list of professional tasks underpins the capabilities of surveyors to contribute to a high quality geospatial data and information management. In that way modern surveyors support the needs of a geo-spatial society. The paper discusses several approaches to define the role of the surveyor within the modern geospatial society.

Sovereign Citizen Movement: An Empirical Study on the Rise in Activity, Explanations of Growth, and Policy Prescriptions

DTIC Science & Technology

2016-09-01

The United States faces a domestic threat that is largely ignored by counterterrorism practitioners and policy: the Sovereign Citizens Movement. The...adherents. This thesis addresses the dearth of information on the Sovereign Citizens Movement. It relies on both quantitative and qualitative research...be harnessed into quality policy decisions. This work proves the increasing trend in Sovereign Citizen activities, exposes the gaps in the present

Social modulation of decision-making: a cross-species review

PubMed Central

van den Bos, Ruud; Jolles, Jolle W.; Homberg, Judith R.

2013-01-01

Taking decisions plays a pivotal role in daily life and comprises a complex process of assessing and weighing short-term and long-term costs and benefits of competing actions. Decision-making has been shown to be affected by factors such as sex, age, genotype, and personality. Importantly, also the social environment affects decisions, both via social interactions (e.g., social learning, cooperation and competition) and social stress effects. Although everyone is aware of this social modulating role on daily life decisions, this has thus far only scarcely been investigated in human and animal studies. Furthermore, neuroscientific studies rarely discuss social influence on decision-making from a functional perspective such as done in behavioral ecology studies. Therefore, the first aim of this article is to review the available data of the influence of the social context on decision-making both from a causal and functional perspective, drawing on animal and human studies. Also, there is currently still a gap between decision-making in real life where influences of the social environment are extensive, and decision-making as measured in the laboratory, which is often done without any (deliberate) social influences. However, methods are being developed to bridge this gap. Therefore, the second aim of this review is to discuss these methods and ways in which this gap can be increasingly narrowed. We end this review by formulating future research questions. PMID:23805092

Identity economics and the brain: uncovering the mechanisms of social conflict

PubMed Central

Huettel, Scott A.; Kranton, Rachel E.

2012-01-01

Social contexts can have dramatic effects on decisions. When individuals recognize each other as coming from the same social group, they can coordinate their actions towards a common goal. Conversely, information about group differences can lead to conflicts both economic and physical. Understanding how social information shapes decision processes is now a core goal both of behavioural economics and neuroeconomics. Here, we describe the foundations for research that combines the theoretical framework from identity economics with the experimental methods of neuroscience. Research at this intersection would fill important gaps in the literature not addressed by current approaches in either of these disciplines, nor within social neuroscience, psychology or other fields. We set forth a simple taxonomy of social contexts based on the information content they provide. And, we highlight the key questions that would be addressed by a new ‘identity neuroeconomics’. Such research could serve as an important and novel link between the social and natural sciences. PMID:22271784

Supporting Coral Reef Ecosystem Management Decisions Appropriate to Climate Change

NASA Astrophysics Data System (ADS)

Hendee, J. C.; Fletcher, P.; Shein, K. A.

2013-05-01

There has been a perception that the myriad of environmental information products derived from satellite and other instrumental sources means ipso facto that there is a direct use for them by environmental managers. Trouble is, as information providers, for the most part we don't really know what decisions managers face daily, nor is it a trivial matter to ascertain the effect of management decisions on the environment, at least in a time frame that facilitates timely maintenance and enhancement of decision support software. To bridge this gap in understanding, we conducted a Needs Assessment (using methodology from the NOAA/Coastal Services Center's Product Design and Evaluation training program) from December, 2011 through May, 2012, in which we queried 15 resource managers in southeast Florida to identify the types of climate data and information products they needed to understand the effects of climate change in their region of purview, and how best these products should be delivered and subsequently enhanced or corrected. Our intent has been to develop a suite of software and information products customized specifically for environmental managers. This report summarizes our success to date, including a report on the development of software for gathering and presenting specific types of climate data, and a narrative about how some U.S. government sponsored efforts, such as Giovanni and TerraVis, as well as non-governmental sponsored efforts such as Marxan, Zonation, SimCLIM, and other off-the-shelf software might be customized for use in specific regions.

Unmet needs, burden of treatment, and patient engagement in multiple sclerosis: A combined perspective from the MS in the 21st Century Steering Group.

PubMed

Rieckmann, Peter; Centonze, Diego; Elovaara, Irina; Giovannoni, Gavin; Havrdová, Eva; Kesselring, Jurg; Kobelt, Gisela; Langdon, Dawn; Morrow, Sarah A; Oreja-Guevara, Celia; Schippling, Sven; Thalheim, Christoph; Thompson, Heidi; Vermersch, Patrick; Aston, Karen; Bauer, Birgit; Demory, Christy; Giambastiani, Maria Paz; Hlavacova, Jana; Nouvet-Gire, Jocelyne; Pepper, George; Pontaga, Maija; Rogan, Emma; Rogalski, Chrystal; van Galen, Pieter; Ben-Amor, Ali-Frédéric

2018-01-01

Patient engagement is vital in multiple sclerosis (MS) in order to optimise outcomes for patients, society and healthcare systems. It is essential to involve all stakeholders in potential solutions, working in a multidisciplinary way to ensure that people with MS (PwMS) are included in shared decision-making and disease management. To start this process, a collaborative, open environment between PwMS and healthcare professionals (HCPs) is required so that similarities and disparities in the perception of key areas in patient care and unmet needs can be identified. With this patient-centred approach in mind, in 2016 the MS in the 21st Century Steering Group formed a unique collaboration to include PwMS in the Steering Group to provide a platform for the patient voice. The MS in the 21st Century initiative set out to foster engagement through a series of open-forum joint workshops. The aims of these workshops were: to identify similarities and disparities in the perception and prioritisation in three key areas (unmet needs, the treatment burden in MS, and factors that impact patient engagement), and to provide practical advice on how the gaps in perception and understanding in these key areas could be bridged. Combined practical advice and direction are provided here as eight actions: 1. Improve communication to raise the quality of HCP-patient interaction and optimise the limited time available for consultations. 2. Heighten the awareness of 'hidden' disease symptoms and how these can be managed. 3. Improve the dialogue surrounding the benefit versus risk issues of therapies to help patients become fully informed and active participants in their healthcare decisions. 4. Provide accurate, lucid information in an easily accessible format from reliable sources. 5. Encourage HCPs and multidisciplinary teams to acquire and share new knowledge and information among their teams and with PwMS. 6. Foster greater understanding and awareness of challenges faced by PwMS and HCPs in treating MS. 7. Collaborate to develop local education, communication and patient-engagement initiatives. 8. Motivate PwMS to become advocates for self-management in MS care. Our study of PwMS and HCPs in the MS in the 21st Century initiative has highlighted eight practical actions. These actions identify how differences and gaps in unmet needs, treatment burden, and patient engagement between PwMS and HCPs can be bridged to improve MS disease management. Of particular interest now are patient-centred educational resources that can be used during time-limited consultations to enhance understanding of disease and improve communication. Actively bridging these gaps in a joint approach enables PwMS to take part in shared decision-making; with improved communication and reliable information, patients can make informed decisions with their HCPs, as part of their own personalised disease management. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Energy decisions reframed as justice and ethical concerns

NASA Astrophysics Data System (ADS)

Sovacool, Benjamin K.; Heffron, Raphael J.; McCauley, Darren; Goldthau, Andreas

2016-05-01

All too often, energy policy and technology discussions are limited to the domains of engineering and economics. Many energy consumers, and even analysts and policymakers, confront and frame energy and climate risks in a moral vacuum, rarely incorporating broader social justice concerns. Here, to remedy this gap, we investigate how concepts from justice and ethics can inform energy decision-making by reframing five energy problems — nuclear waste, involuntary resettlement, energy pollution, energy poverty and climate change — as pressing justice concerns. We conclude by proposing an energy justice framework centred on availability, affordability, due process, transparency and accountability, sustainability, equity and responsibility, which highlights the futurity, fairness and equity dimensions of energy production and use.

Assessing the conceptual clarity and evidence base of quality criteria/standards developed for evaluating decision aids

PubMed Central

McDonald, Heather; Charles, Cathy; Gafni, Amiram

2011-01-01

Abstract Context  Promoting patient participation in treatment decision making is of increasing interest to researchers, clinicians and policy makers. Decision aids (DAs) are advocated as one way to help achieve this goal. Despite their proliferation, there has been little agreement on criteria or standards for evaluating these tools. To fill this gap, an international collaboration of researchers and others interested in the development, content and quality of DAs have worked over the past several years to develop a checklist and, based on this checklist, an instrument for determining whether any given DA meets a defined set of quality criteria. Objective/Methods  In this paper, we offer a framework for assessing the conceptual clarity and evidence base used to support the development of quality criteria/standards for evaluating DAs. We then apply this framework to assess the conceptual clarity and evidence base underlying the International Patient Decision Aids Standards (IPDAS) checklist criteria for one of the checklist domains: how best to present in DAs probability information to patients on treatment benefits and risks. Conclusion  We found that some of the central concepts underlying the presenting probabilities domain were not defined. We also found gaps in the empirical evidence and theoretical support for this domain and criteria within this domain. Finally, we offer suggestions for steps that should be undertaken for further development and refinement of quality standards for DAs in the future. PMID:22050440

Analysis of Automated Aircraft Conflict Resolution and Weather Avoidance

NASA Technical Reports Server (NTRS)

Love, John F.; Chan, William N.; Lee, Chu Han

2009-01-01

This paper describes an analysis of using trajectory-based automation to resolve both aircraft and weather constraints for near-term air traffic management decision making. The auto resolution algorithm developed and tested at NASA-Ames to resolve aircraft to aircraft conflicts has been modified to mitigate convective weather constraints. Modifications include adding information about the size of a gap between weather constraints to the routing solution. Routes that traverse gaps that are smaller than a specific size are not used. An evaluation of the performance of the modified autoresolver to resolve both conflicts with aircraft and weather was performed. Integration with the Center-TRACON Traffic Management System was completed to evaluate the effect of weather routing on schedule delays.

Effects of major-road vehicle speed and driver age and gender on left-turn gap acceptance.

PubMed

Yan, Xuedong; Radwan, Essam; Guo, Dahai

2007-07-01

Because the driver's gap-acceptance maneuver is a complex and risky driving behavior, it is a highly concerned topic for traffic safety and operation. Previous studies have mainly focused on the driver's gap acceptance decision itself but did not pay attention to the maneuver process and driving behaviors. Using a driving simulator experiment for left-turn gap acceptance at a stop-controlled intersection, this study evaluated the effects of major traffic speed and driver age and gender on gap acceptance behaviors. The experiment results illustrate relationships among drivers' left-turn gap decision, driver's acceleration rate, steering action, and the influence of the gap-acceptance maneuver on the vehicles in the major traffic stream. The experiment results identified an association between high crash risk and high traffic speed at stop-controlled intersections. The older drivers, especially older female drivers, displayed a conservative driving attitude as a compensation for reduced driving ability, but also showed to be the most vulnerable group for the relatively complex driving maneuvers.

Barriers to participation in mental health research: findings from the Genetics and Psychosis (GAP) Study.

PubMed

Woodall, Anna; Howard, Louise; Morgan, Craig

2011-01-01

The aim of this study was to investigate why people with a first episode of psychosis choose or decline to participate in mental health research, using a qualitative study design. Participants were recruited via referrals from the Genetics and Psychosis (GAP) study. A total of 26 individuals with a first-episode of psychosis (nine of whom declined participation in the GAP study and 17 who participated) were individually interviewed and asked about their attitudes towards mental health research participation. Thematic analysis of interview transcripts was used to determine dominant themes and sub-themes on what constituted barriers and facilitators to participation. Reasons for research participation identified included a desire to help others, curiosity, and positive experiences with clinicians. Decisions to participate or not were also influenced by practical issues, including the timing of the approach, researchers' communication skills and whether individuals had concerns that it may be potentially harmful to their health. Other barriers to participation included patients' conceptualizations of mental health problems and the influence of other inpatients. Information on barriers and facilitators to recruitment in mental health research could inform recruitment strategies, thereby maximizing recruitment rates and minimizing the risk of selection biases.

Effective information channels for reducing costs of environmentally- friendly technologies: evidence from residential PV markets

NASA Astrophysics Data System (ADS)

Rai, Varun; Robinson, Scott A.

2013-03-01

Realizing the environmental benefits of solar photovoltaics (PV) will require reducing costs associated with perception, informational gaps and technological uncertainties. To identify opportunities to decrease costs associated with residential PV adoption, in this letter we use multivariate regression models to analyze a unique, household-level dataset of PV adopters in Texas (USA) to systematically quantify the effect of different information channels on aspiring PV adopters’ decision-making. We find that the length of the decision period depends on the business model, such as whether the system was bought or leased, and on special opportunities to learn, such as the influence of other PV owners in the neighborhood. This influence accrues passively through merely witnessing PV systems in the neighborhood, increasing confidence and motivation, as well as actively through peer-to-peer communications. Using these insights we propose a new framework to provide public information on PV that could drastically reduce barriers to PV adoption, thereby accelerating its market penetration and environmental benefits. This framework could also serve as a model for other distributed generation technologies.

Robustness of risk maps and survey networks to knowledge gaps about a new invasive pest

Treesearch

Denys Yemshanov; Frank H. Koch; Yakov Ben-Haim; William D. Smith

2010-01-01

In pest risk assessment it is frequently necessary to make management decisions regarding emerging threats under severe uncertainty. Although risk maps provide useful decision support for invasive alien species, they rarely address knowledge gaps associated with the underlying risk model or how they may change the risk estimates. Failure to recognize uncertainty leads...

Planning and design of a knowledge based system for green manufacturing management

NASA Astrophysics Data System (ADS)

Kamal Mohd Nawawi, Mohd; Mohd Zuki Nik Mohamed, Nik; Shariff Adli Aminuddin, Adam

2013-12-01

This paper presents a conceptual design approach to the development of a hybrid Knowledge Based (KB) system for Green Manufacturing Management (GMM) at the planning and design stages. The research concentrates on the GMM by using a hybrid KB system, which is a blend of KB system and Gauging Absences of Pre-requisites (GAP). The hybrid KB/GAP system identifies all potentials elements of green manufacturing management issues throughout the development of this system. The KB system used in the planning and design stages analyses the gap between the existing and the benchmark organizations for an effective implementation through the GAP analysis technique. The proposed KBGMM model at the design stage explores two components, namely Competitive Priority and Lean Environment modules. Through the simulated results, the KBGMM System has identified, for each modules and sub-module, the problem categories in a prioritized manner. The System finalized all the Bad Points (BP) that need to be improved to achieve benchmark implementation of GMM at the design stage. The System provides valuable decision making information for the planning and design a GMM in term of business organization.

Can Climate Information be relevant to decision making for Agriculture on the 1-10 year timescale? Case studies from southern Africa

NASA Astrophysics Data System (ADS)

Fujisawa, Mariko

2016-04-01

Climate forecasts have been developed to assist decision making in sectors averse to, and affected by, climate risks, and agriculture is one of those. In agriculture and food security, climate information is now used on a range of timescales, from days (weather), months (seasonal outlooks) to decades (climate change scenarios). Former researchers have shown that when seasonal climate forecast information was provided to farmers prior to decision making, farmers adapted by changing their choice of planting seeds and timing or area planted. However, it is not always clear that the end-users' needs for climate information are met and there might be a large gap between information supplied and needed. It has been pointed out that even when forecasts were available, they were often not utilized by farmers and extension services because of lack of trust in the forecast or the forecasts did not reach the targeted farmers. Many studies have focused on the use of either seasonal forecasts or longer term climate change prediction, but little research has been done on the medium term, that is, 1 to 10 year future climate information. The agriculture and food system sector is one potential user of medium term information, as land use policy and cropping systems selection may fall into this time scale and may affect farmers' decision making process. Assuming that reliable information is provided and it is utilized by farmers for decision making, it might contribute to resilient farming and indeed to longer term food security. To this end, we try to determine the effect of medium term climate information on farmers' strategic decision making process. We explored the end-users' needs for climate information and especially the possible role of medium term information in agricultural system, by conducting interview surveys with farmers and agricultural experts. In this study, the cases of apple production in South Africa, maize production in Malawi and rice production in Tanzania will be presented. With case studies of various crops, we also aim to identify what climatic factors and timescale of prediction may be critical to what crop types of farmers, which may be of value to climate prediction community to further develop climate prediction useful for agricultural system.

Evidence for informing health policy development in Low-income Countries (LICs): perspectives of policy actors in Uganda.

PubMed

Nabyonga-Orem, Juliet; Mijumbi, Rhona

2015-03-08

Although there is a general agreement on the benefits of evidence informed health policy development given resource constraints especially in Low-Income Countries (LICs), the definition of what evidence is, and what evidence is suitable to guide decision-making is still unclear. Our study is contributing to filling this knowledge gap. We aimed to explore health policy actors' views regarding what evidence they deemed appropriate to guide health policy development. Using exploratory qualitative methods, we conducted interviews with 51 key informants using an in-depth interview guide. We interviewed a diverse group of stakeholders in health policy development and knowledge translation in the Uganda health sector. Data were analyzed using inductive content analysis techniques. Different stakeholders lay emphasis on different kinds of evidence. While donors preferred international evidence and Ministry of Health (MoH) officials looked to local evidence, district health managers preferred local evidence, evidence from routine monitoring and evaluation, and reports from service providers. Service providers on the other hand preferred local evidence and routine monitoring and evaluation reports whilst researchers preferred systematic reviews and clinical trials. Stakeholders preferred evidence covering several aspects impacting on decision-making highlighting the fact that although policy actors look for factual information, they also require evidence on context and implementation feasibility of a policy decision. What LICs like Uganda categorize as evidence suitable for informing policy encompasses several types with no consensus on what is deemed as most appropriate. Evidence must be of high quality, applicable, acceptable to the users, and informing different aspects of decision-making. © 2015 by Kerman University of Medical Sciences.

Designing evaluation studies to optimally inform policy: what factors do policy-makers in China consider when making resource allocation decisions on healthcare worker training programmes?

PubMed

Wu, Shishi; Legido-Quigley, Helena; Spencer, Julia; Coker, Richard James; Khan, Mishal Sameer

2018-02-23

In light of the gap in evidence to inform future resource allocation decisions about healthcare provider (HCP) training in low- and middle-income countries (LMICs), and the considerable donor investments being made towards training interventions, evaluation studies that are optimally designed to inform local policy-makers are needed. The aim of our study is to understand what features of HCP training evaluation studies are important for decision-making by policy-makers in LMICs. We investigate the extent to which evaluations based on the widely used Kirkpatrick model - focusing on direct outcomes of training, namely reaction of trainees, learning, behaviour change and improvements in programmatic health indicators - align with policy-makers' evidence needs for resource allocation decisions. We use China as a case study where resource allocation decisions about potential scale-up (using domestic funding) are being made about an externally funded pilot HCP training programme. Qualitative data were collected from high-level officials involved in resource allocation at the national and provincial level in China through ten face-to-face, in-depth interviews and two focus group discussions consisting of ten participants each. Data were analysed manually using an interpretive thematic analysis approach. Our study indicates that Chinese officials not only consider information about the direct outcomes of a training programme, as captured in the Kirkpatrick model, but also need information on the resources required to implement the training, the wider or indirect impacts of training, and the sustainability and scalability to other settings within the country. In addition to considering findings presented in evaluation studies, we found that Chinese policy-makers pay close attention to whether the evaluations were robust and to the composition of the evaluation team. Our qualitative study indicates that training programme evaluations that focus narrowly on direct training outcomes may not provide sufficient information for policy-makers to make decisions on future training programmes. Based on our findings, we have developed an evidence-based framework, which incorporates but expands beyond the Kirkpatrick model, to provide conceptual and practical guidance that aids in the design of training programme evaluations better suited to meet the information needs of policy-makers and to inform policy decisions.

Informing the development of an Internet-based chronic pain self-management program.

PubMed

Gogovor, Amédé; Visca, Regina; Auger, Claudine; Bouvrette-Leblanc, Lucie; Symeonidis, Iphigenia; Poissant, Lise; Ware, Mark A; Shir, Yoram; Viens, Natacha; Ahmed, Sara

2017-01-01

Self-management can optimize health outcomes for individuals with chronic pain (CP), an increasing fiscal and social burden in Canada. However, self-management is rarely integrated into the regular care (team activities and medical treatment) patients receive. Health information technology offers an opportunity to provide regular monitoring and exchange of information between patient and care team. To identify information needs and gaps in chronic pain management as well as technology features to inform the development of an Internet-based self-management program. Two methods were used. First was a structured literature review: electronic databases were searched up to 2015 with combinations of MeSH terms and text-words such as chronic pain, self-management, self-efficacy, technology, Internet-based, patient portal, and e-health. A narrative synthesis of the characteristics and content of Internet-based pain management programs emerging from the literature review and how they relate to gaps in chronic pain management were completed. Second, four audiotaped focus group sessions were conducted with individuals with chronic pain and caregivers (n=9) and health professionals (n=7) recruited from three multidisciplinary tertiary and rehabilitation centres. A thematic analysis of the focus group transcripts was conducted. Thirty-nine primary articles related to 20 patient-oriented Internet-based programs were selected. Gaps in CP management included lack of knowledge, limited access to health care, suboptimal care, and lack of self-management support. Overall, 14 themes related to information needs and gaps in care were identified by both health professionals and patients, three were exclusive to patients and five to health professionals. Common themes from the focus groups included patient education on chronic pain care, attitude-belief-culture, financial and legal issues, end-of-program crash, and motivational content. Internet-based programs contain automated, communication and decision support features that can address information and care gaps reported by patients and clinicians. However, focus groups identified functionalities not reported in the literature, non-medical and condition- and context-specific information, integration of personal health records, and the role of the different health professionals in chronic pain management were not identified. These gaps need to be considered in the future development of Internet-based programs. While the association between the mechanisms of Internet-based programs' features and outcomes is not clearly established, the results of this study indicate that interactivity, personalization and tailored messages, combined with therapist contact will maximize the effectiveness of an Internet-based chronic pain program in enhancing self-management. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Knowledge translation is the use of knowledge in health care decision making.

PubMed

Straus, Sharon E; Tetroe, Jacqueline M; Graham, Ian D

2011-01-01

To provide an overview of the science and practice of knowledge translation. Narrative review outlining what knowledge translation is and a framework for its use. Knowledge translation is defined as the use of knowledge in practice and decision making by the public, patients, health care professionals, managers, and policy makers. Failures to use research evidence to inform decision making are apparent across all these key decision maker groups. There are several proposed theories and frameworks for achieving knowledge translation. A conceptual framework developed by Graham et al., termed the knowledge-to-action cycle, provides an approach that builds on the commonalities found in an assessment of planned action theories. Review of the evidence base for the science and practice of knowledge translation has identified several gaps including the need to develop valid strategies for assessing the determinants of knowledge use and for evaluating sustainability of knowledge translation interventions. Copyright © 2011 Elsevier Inc. All rights reserved.

Conflicting health information: a critical research need.

PubMed

Carpenter, Delesha M; Geryk, Lorie L; Chen, Annie T; Nagler, Rebekah H; Dieckmann, Nathan F; Han, Paul K J

2016-12-01

Conflicting health information is increasing in amount and visibility, as evidenced most recently by the controversy surrounding the risks and benefits of childhood vaccinations. The mechanisms through which conflicting information affects individuals are poorly understood; thus, we are unprepared to help people process conflicting information when making important health decisions. In this viewpoint article, we describe this problem, summarize insights from the existing literature on the prevalence and effects of conflicting health information, and identify important knowledge gaps. We propose a working definition of conflicting health information and describe a conceptual typology to guide future research in this area. The typology classifies conflicting information according to four fundamental dimensions: the substantive issue under conflict, the number of conflicting sources (multiplicity), the degree of evidence heterogeneity and the degree of temporal inconsistency. © 2015 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Pre-consultation educational group intervention to improve shared decision-making for postmastectomy breast reconstruction: a pilot randomized controlled trial.

PubMed

Causarano, Natalie; Platt, Jennica; Baxter, Nancy N; Bagher, Shaghayegh; Jones, Jennifer M; Metcalfe, Kelly A; Hofer, Stefan O P; O'Neill, Anne C; Cheng, Terry; Starenkyj, Elizabeth; Zhong, Toni

2015-05-01

Breast cancer survivors who make preference-sensitive decisions about postmastectomy breast reconstruction often have large gaps in knowledge and undergo procedures that are misaligned with their treatment goals. We evaluated the feasibility and effect of a pre-consultation educational group intervention on the decision-making process for breast reconstruction. We conducted a pilot randomized controlled trial (RCT) where participants were randomly assigned to the intervention with routine education or routine education alone. The outcomes evaluated were decisional conflict, decision self-efficacy, satisfaction with information, perceived involvement in care, and uptake of reconstruction following surgical consultation. Trial feasibility and acceptability were evaluated, and effect sizes were calculated to determine the primary outcome for the full-scale RCT. Of the 41 patients enrolled, recruitment rate was 72 %, treatment fidelity was 98 %, and retention rate was 95 %. The Cohen's d effect size in reduction of decisional conflict was moderate to high for the intervention group compared to routine education (0.69, 95 % CI = 0.02-1.42), while the effect sizes of increase in decision self-efficacy (0.05, 95 % CI = -0.60-0.71) and satisfaction with information (0.11, 95 % CI = -0.53-0.76) were small. A higher proportion of patients receiving routine education signed informed consent to undergo breast reconstruction (14/20 or 70 %) compared to the intervention group (8/21 or 38 %) P = 0.06. A pre-consultation educational group intervention improves patients' shared decision-making quality compared to routine preoperative patient education. A full-scale definitive RCT is warranted based on high feasibility outcomes, and the primary outcome for the main trial will be decisional conflict.

Current understanding of decision-making in adolescents with cancer: A narrative systematic review

PubMed Central

Day, Emma; Jones, Louise; Langner, Richard; Bluebond-Langner, Myra

2016-01-01

Background: Policy guidance and bioethical literature urge the involvement of adolescents in decisions about their healthcare. It is uncertain how roles and expectations of adolescents, parents and healthcare professionals influence decision-making and to what extent this is considered in guidance. Aims: To identify recent empirical research on decision-making regarding care and treatment in adolescent cancer: (1) to synthesise evidence to define the role of adolescents, parents and healthcare professionals in the decision-making process and (2) to identify gaps in research. Design: A narrative systematic review of qualitative, quantitative and mixed-methods research. We adopted a textual approach to synthesis, using a theoretical framework of interactionism to interpret findings. Data Sources: The databases MEDLINE, PsycINFO, SCOPUS, EMBASE and CINHAL were searched from 2001 through May 2015 for publications on decision-making for adolescents (13–19 years) with cancer. Results: Twenty-eight articles were identified. Adolescents and parents initially find it difficult to participate in decision-making due to a lack of options in the face of protocol-driven care. Parent and adolescent preferences for information and response to loss of control vary between individuals and over time. No studies indicate parental or adolescent preference for a high degree of independence in decision-making. Conclusion: Striving to make parents and adolescents fully informed or urge them towards more independence than they prefer may add to distress and confusion. This may interfere with their ability to participate in their preferred way in decisions about care and treatment. Future research should include analysis of on-ground interactions among parents, adolescents and clinicians across the trajectory. PMID:27160700

Ag2S atomic switch-based `tug of war' for decision making

NASA Astrophysics Data System (ADS)

Lutz, C.; Hasegawa, T.; Chikyow, T.

2016-07-01

For a computing process such as making a decision, a software controlled chip of several transistors is necessary. Inspired by how a single cell amoeba decides its movements, the theoretical `tug of war' computing model was proposed but not yet implemented in an analogue device suitable for integrated circuits. Based on this model, we now developed a new electronic element for decision making processes, which will have no need for prior programming. The devices are based on the growth and shrinkage of Ag filaments in α-Ag2+δS gap-type atomic switches. Here we present the adapted device design and the new materials. We demonstrate the basic `tug of war' operation by IV-measurements and Scanning Electron Microscopy (SEM) observation. These devices could be the base for a CMOS-free new computer architecture.For a computing process such as making a decision, a software controlled chip of several transistors is necessary. Inspired by how a single cell amoeba decides its movements, the theoretical `tug of war' computing model was proposed but not yet implemented in an analogue device suitable for integrated circuits. Based on this model, we now developed a new electronic element for decision making processes, which will have no need for prior programming. The devices are based on the growth and shrinkage of Ag filaments in α-Ag2+δS gap-type atomic switches. Here we present the adapted device design and the new materials. We demonstrate the basic `tug of war' operation by IV-measurements and Scanning Electron Microscopy (SEM) observation. These devices could be the base for a CMOS-free new computer architecture. Electronic supplementary information (ESI) available. See DOI: 10.1039/c6nr00690f

A questionnaire to assess the relevance and credibility of observational studies to inform health care decision making: an ISPOR-AMCP-NPC Good Practice Task Force report.

PubMed

Berger, Marc L; Martin, Bradley C; Husereau, Don; Worley, Karen; Allen, J Daniel; Yang, Winnie; Quon, Nicole C; Mullins, C Daniel; Kahler, Kristijan H; Crown, William

2014-03-01

Evidence-based health care decisions are best informed by comparisons of all relevant interventions used to treat conditions in specific patient populations. Observational studies are being performed to help fill evidence gaps. Widespread adoption of evidence from observational studies, however, has been limited because of various factors, including the lack of consensus regarding accepted principles for their evaluation and interpretation. Two task forces were formed to develop questionnaires to assist decision makers in evaluating observational studies, with one Task Force addressing retrospective research and the other Task Force addressing prospective research. The intent was to promote a structured approach to reduce the potential for subjective interpretation of evidence and drive consistency in decision making. Separately developed questionnaires were combined into a single questionnaire consisting of 33 items. These were divided into two domains: relevance and credibility. Relevance addresses the extent to which findings, if accurate, apply to the setting of interest to the decision maker. Credibility addresses the extent to which the study findings accurately answer the study question. The questionnaire provides a guide for assessing the degree of confidence that should be placed from observational studies and promotes awareness of the subtleties involved in evaluating those. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

[Hospital self-management policy in Chile: perceptions of decision-makers].

PubMed

Méndez, Claudio A; Miranda, Christian; Torres, M Cristina; Márquez, Myriam

2013-01-01

To learn the perceptions of decision-makers concerning the imple-men-t-ation stage of a hospital self-management policy in two highly complex hospitals in southern Chile. A descriptive, exploratory, qualitative study based on semi-structured in-depth interviews of decision-makers at the Regional Hospital of Valdivia and the Hospital San José de Osorno from August 2010 to December 2011. A convenience sample of 26 decision-makers was selected. The 26 interviews were recorded and transcribed verbatim. The information was analyzed using inductive content analysis. The interviewees consider the concept of self-management to be determined by autonomy in decision-making about resource allocation and the financing of health service delivery in the hospitals. They also stated that human resources and financing policies should be included to improve the implementation stage. They related weaknesses with the lack of organizational capabilities and managerial skills in the health teams implementing the changes. Conceptually, the hospital self-management policy is based on financial autonomy, and implementation is affected by persistent capacity gaps in policy design.

Inexact Socio-Dynamic Modeling of Groundwater Contamination Management

NASA Astrophysics Data System (ADS)

Vesselinov, V. V.; Zhang, X.

2015-12-01

Groundwater contamination may alter the behaviors of the public such as adaptation to such a contamination event. On the other hand, social behaviors may affect groundwater contamination and associated risk levels such as through changing ingestion amount of groundwater due to the contamination. Decisions should consider not only the contamination itself, but also social attitudes on such contamination events. Such decisions are inherently associated with uncertainty, such as subjective judgement from decision makers and their implicit knowledge on selection of whether to supply water or reduce the amount of supplied water under the scenario of the contamination. A socio-dynamic model based on the theories of information-gap and fuzzy sets is being developed to address the social behaviors facing the groundwater contamination and applied to a synthetic problem designed based on typical groundwater remediation sites where the effects of social behaviors on decisions are investigated and analyzed. Different uncertainties including deep uncertainty and vague/ambiguous uncertainty are effectively and integrally addressed. The results can provide scientifically-defensible decision supports for groundwater management in face of the contamination.

Dual conception of risk in the Iowa Gambling Task: effects of sleep deprivation and test-retest gap.

PubMed

Singh, Varsha

2013-01-01

Risk in the Iowa Gambling Task (IGT) is often understood in terms of intertemporal choices, i.e., preference for immediate outcomes in favor of delayed outcomes is considered risky decision making. According to behavioral economics, healthy decision makers are expected to refrain from choosing the short-sighted immediate gain because, over time (10 trials of the IGT), the immediate gains result in a long term loss (net loss). Instead decision makers are expected to maximize their gains by choosing options that, over time (10 trials), result in delayed or long term gains (net gain). However, task choices are sometimes made on the basis of the frequency of reward and punishment such that frequent rewards/infrequent punishments are favored over infrequent rewards/frequent punishments. The presence of these two attributes (intertemporality and frequency of reward) in IGT decision making may correspond to the emotion-cognition dichotomy and reflect a dual conception of risk. Decision making on the basis of the two attributes was tested under two conditions: delay in retest and sleep deprivation. An interaction between sleep deprivation and time delay was expected to attenuate the difference between the two attributes. Participants were 40 male university students. Analysis of the effects of IGT attribute type (intertemporal vs. frequency of reinforcement), sleep deprivation (sleep deprivation vs. no sleep deprivation), and test-retest gap (short vs. long delay) showed a significant within-subjects effect of IGT attribute type thus confirming the difference between the two attributes. Sleep deprivation had no effect on the attributes, but test-retest gap and the three-way interaction between attribute type, test-retest gap, and sleep deprivation were significantly different. Post-hoc tests revealed that sleep deprivation and short test-retest gap attenuated the difference between the two attributes. Furthermore, the results showed an expected trend of increase in intertemporal decision making at retest suggesting that intertemporal decision making benefited from repeated task exposure. The present findings add to understanding of the emotion-cognition dichotomy. Further, they show an important time-dependent effect of a universally experienced constraint (sleep deprivation) on decision making. It is concluded that risky decision making in the IGT is contingent on the attribute under consideration and is affected by factors such as time elapsed and constraint experienced before the retest.

Evaluating a Modular Decision Support Application for Colorectal Cancer Screening

PubMed Central

Diiulio, Julie B.; Borders, Morgan R.; Sushereba, Christen E.; Saleem, Jason J.; Haverkamp, Donald; Imperiale, Thomas F.

2017-01-01

Summary Background There is a need for health information technology evaluation that goes beyond randomized controlled trials to include consideration of usability, cognition, feedback from representative users, and impact on efficiency, data quality, and clinical workflow. This article presents an evaluation illustrating one approach to this need using the Decision-Centered Design framework. Objective To evaluate, through a Decision-Centered Design framework, the ability of the Screening and Surveillance App to support primary care clinicians in tracking and managing colorectal cancer testing. Methods We leveraged two evaluation formats, online and in-person, to obtain feedback from a range primary care clinicians and obtain comparative data. Both the online and in-person evaluations used mock patient data to simulate challenging patient scenarios. Primary care clinicians responded to a series of colorectal cancer-related questions about each patient and made recommendations for screening. We collected data on performance, perceived workload, and usability. Key elements of Decision-Centered Design include evaluation in the context of realistic, challenging scenarios and measures designed to explore impact on cognitive performance. Results Comparison of means revealed increases in accuracy, efficiency, and usability and decreases in perceived mental effort and workload when using the Screening and Surveillance App. Conclusion The results speak to the benefits of using the Decision-Centered Design approach in the analysis, design, and evaluation of Health Information Technology. Furthermore, the Screening and Surveillance App shows promise for filling decision support gaps in current electronic health records. PMID:28197619

Improving healthcare consumer effectiveness: an Animated, Self-serve, Web-based Research Tool (ANSWER) for people with early rheumatoid arthritis.

PubMed

Li, Linda C; Adam, Paul; Townsend, Anne F; Stacey, Dawn; Lacaille, Diane; Cox, Susan; McGowan, Jessie; Tugwell, Peter; Sinclair, Gerri; Ho, Kendall; Backman, Catherine L

2009-08-20

People with rheumatoid arthritis (RA) should use DMARDs (disease-modifying anti-rheumatic drugs) within the first three months of symptoms in order to prevent irreversible joint damage. However, recent studies report the delay in DMARD use ranges from 6.5 months to 11.5 months in Canada. While most health service delivery interventions are designed to improve the family physician's ability to refer to a rheumatologist and prescribe treatments, relatively little has been done to improve the delivery of credible, relevant, and user-friendly information for individuals to make treatment decisions. To address this care gap, the Animated, Self-serve, Web-based Research Tool (ANSWER) will be developed and evaluated to assist people in making decisions about the use of methotrexate, a type of DMARD. The objectives of this project are: 1) to develop ANSWER for people with early RA; and 2) to assess the extent to which ANSWER reduces people's decisional conflict about the use of methotrexate, improves their knowledge about RA, and improves their skills of being 'effective healthcare consumers'. Consistent with the International Patient Decision Aid Standards, the development process of ANSWER will involve: 1.) creating a storyline and scripts based on the best evidence on the use of methotrexate and other management options in RA, and the contextual factors that affect a patient's decision to use a treatment as found in ERAHSE; 2.) using an interactive design methodology to create, test, analyze and refine the ANSWER prototype; 3.) testing the content and user interface with health professionals and patients; and 4.) conducting a pilot study with 51 patients, who are diagnosed with RA in the past 12 months, to assess the extent to which ANSWER improves the quality of their decisions, knowledge and skills in being effective consumers. We envision that the ANSWER will help accelerate the dissemination of knowledge and skills necessary for people with early RA to make informed choices about treatment and to manage their health. The latest in animation and online technology will ensure ANSWER fills a knowledge translation gap, focusing on the next generation of people living with RA.

Design and Implementation of a Cloud Computing Adoption Decision Tool: Generating a Cloud Road.

PubMed

Bildosola, Iñaki; Río-Belver, Rosa; Cilleruelo, Ernesto; Garechana, Gaizka

2015-01-01

Migrating to cloud computing is one of the current enterprise challenges. This technology provides a new paradigm based on "on-demand payment" for information and communication technologies. In this sense, the small and medium enterprise is supposed to be the most interested, since initial investments are avoided and the technology allows gradual implementation. However, even if the characteristics and capacities have been widely discussed, entry into the cloud is still lacking in terms of practical, real frameworks. This paper aims at filling this gap, presenting a real tool already implemented and tested, which can be used as a cloud computing adoption decision tool. This tool uses diagnosis based on specific questions to gather the required information and subsequently provide the user with valuable information to deploy the business within the cloud, specifically in the form of Software as a Service (SaaS) solutions. This information allows the decision makers to generate their particular Cloud Road. A pilot study has been carried out with enterprises at a local level with a two-fold objective: to ascertain the degree of knowledge on cloud computing and to identify the most interesting business areas and their related tools for this technology. As expected, the results show high interest and low knowledge on this subject and the tool presented aims to readdress this mismatch, insofar as possible.

Design and Implementation of a Cloud Computing Adoption Decision Tool: Generating a Cloud Road

PubMed Central

Bildosola, Iñaki; Río-Belver, Rosa; Cilleruelo, Ernesto; Garechana, Gaizka

2015-01-01

Migrating to cloud computing is one of the current enterprise challenges. This technology provides a new paradigm based on “on-demand payment” for information and communication technologies. In this sense, the small and medium enterprise is supposed to be the most interested, since initial investments are avoided and the technology allows gradual implementation. However, even if the characteristics and capacities have been widely discussed, entry into the cloud is still lacking in terms of practical, real frameworks. This paper aims at filling this gap, presenting a real tool already implemented and tested, which can be used as a cloud computing adoption decision tool. This tool uses diagnosis based on specific questions to gather the required information and subsequently provide the user with valuable information to deploy the business within the cloud, specifically in the form of Software as a Service (SaaS) solutions. This information allows the decision makers to generate their particular Cloud Road. A pilot study has been carried out with enterprises at a local level with a two-fold objective: to ascertain the degree of knowledge on cloud computing and to identify the most interesting business areas and their related tools for this technology. As expected, the results show high interest and low knowledge on this subject and the tool presented aims to readdress this mismatch, insofar as possible. PMID:26230400

What factors hinder the decision-making process for women with cancer and contemplating fertility preservation treatment?

PubMed

Jones, Georgina; Hughes, Jane; Mahmoodi, Neda; Smith, Emily; Skull, Jonathan; Ledger, William

2017-07-01

Although fertility preservation (FP) treatment options have increased, the existing evidence suggests that many women with cancer do not feel well supported in making these decisions, but find them stressful and complex and fail to take up fertility care at this crucial time. Whilst existing reviews have all made important contributions to our understanding of the FP decision-making process, none of them examine solely and specifically these processes for women of reproductive age with a diagnosis of any cancer, leaving a gap in the knowledge base. Given the expectation that care is patient-centred, our review aims to address this gap which may be of help to those managing patients struggling to make difficult decisions in the often brief period before potentially sterilizing cancer treatment is started. Underpinning this narrative review was the question 'What factors hinder the decision-making process for women with any cancer and contemplating FP treatment?' Our objectives were to (i) assess and summarize this existing literature, (ii) identify the factors that hinder this decision-making process, (iii) explore to what extent these factors may differ for women choosing different methods of FP and (iv) make recommendations for service delivery and future research. A systematic search of the medical and social science literature from the 1 January 2005 up to the end of January 2016 was carried out using three electronic databases (Web of Science (PubMed), Ovid SP Medline and CINAHL via Ebsco). Included in the review were quantitative, qualitative and mixed-method studies. Reference lists of relevant papers were also hand searched. From the 983 papers identified, 46 papers were included. Quality assessment was undertaken using the Mixed Methods Appraisal Tool and thematic analysis was used to analyse the data. From the analysis, 6 key themes with 15 sub-themes emerged: (i) fertility information provision (lack of information, timing of the information, patient-provider communication); (ii) fear concerning the perceived risks associated with pursuing FP (delaying cancer treatment, aggravating a hormone positive cancer and consequences of a future pregnancy); (iii) non-referral from oncology (personal situation, having a hormone positive cancer, FP not a priority and transition between service issues); (iv) the dilemma (in survival mode, whether to prioritize one treatment over another); (v) personal situation (parity, relationship status) and (iv) costs (financial concerns). This review has found that a wide range of internal and external factors impact the FP decision-making process. Key external issues related to current service delivery such as the provision and timing of FP information, and lack of referral from oncology to the fertility clinic. However, internal issues such as women's fears concerning the perceived risks associated with pursuing FP also hindered decision-making but these 'risks' were typically overestimated and non-evidence based. These findings suggest that the implementation of a range of decision support interventions may be of benefit within the clinical care pathway of FP and cancer. Women would benefit from the provision of more evidence-based FP information, ideally received at cancer diagnosis, in advance of seeing a fertility specialist, for example through the implementation of patient decision aids. Healthcare professionals in both oncology and fertility services may also benefit from the implementation of training programmes and educational tools targeted at improving the communication skills needed to improve collaborative decision-making and deliver care that is patient-centred. Exploration of the current barriers, both intellectual and practical, that prevent some patients from accepting FP will help care providers to do better for their patients in the future. Finally, the extent to which a poorer prognosis and moral, ethical and religious beliefs influence the FP decision-making process also warrant further research. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

SAMS--a systems architecture for developing intelligent health information systems.

PubMed

Yılmaz, Özgün; Erdur, Rıza Cenk; Türksever, Mustafa

2013-12-01

In this paper, SAMS, a novel health information system architecture for developing intelligent health information systems is proposed and also some strategies for developing such systems are discussed. The systems fulfilling this architecture will be able to store electronic health records of the patients using OWL ontologies, share patient records among different hospitals and provide physicians expertise to assist them in making decisions. The system is intelligent because it is rule-based, makes use of rule-based reasoning and has the ability to learn and evolve itself. The learning capability is provided by extracting rules from previously given decisions by the physicians and then adding the extracted rules to the system. The proposed system is novel and original in all of these aspects. As a case study, a system is implemented conforming to SAMS architecture for use by dentists in the dental domain. The use of the developed system is described with a scenario. For evaluation, the developed dental information system will be used and tried by a group of dentists. The development of this system proves the applicability of SAMS architecture. By getting decision support from a system derived from this architecture, the cognitive gap between experienced and inexperienced physicians can be compensated. Thus, patient satisfaction can be achieved, inexperienced physicians are supported in decision making and the personnel can improve their knowledge. A physician can diagnose a case, which he/she has never diagnosed before, using this system. With the help of this system, it will be possible to store general domain knowledge in this system and the personnel's need to medical guideline documents will be reduced.

Factors affecting decision making about fertility preservation after cancer diagnosis: a qualitative study.

PubMed

Peddie, V L; Porter, M A; Barbour, R; Culligan, D; MacDonald, G; King, D; Horn, J; Bhattacharya, S

2012-08-01

To increase our understanding of factors underlying the decision to store gametes after the diagnosis of cancer. Qualitative interview study. Andrology, Haematology, and Oncology Departments of a Scottish teaching hospital, and patients' own homes. Sixteen men and 18 women aged 17-49 years recently diagnosed with cancer; 15 health professionals concerned in cancer care. Audio-recorded semi-structured interviews were transcribed verbatim and analysed thematically. Topics included perceptions of diagnosis; prognosis; future reproductive choices; priorities; quality of information received; communication and decisions made about future reproductive choices; and the role of partners, family, friends and healthcare professionals. Professional interviews examined their role in decision making and that of protocols and guidelines, together with information emerging from patient interview analysis. Themes identified following analysis of interview transcripts. The primary barriers to pursuing fertility preservation were the way in which information was provided and the 'urgent need for treatment' conveyed by staff. Survival was always viewed as paramount, with future fertility secondary. Sperm banking was viewed as 'part and parcel' of oncology care, and the majority of men quickly stored sperm as 'insurance' against future infertility. Few women were afforded the opportunity to discuss their options, reflecting clinicians' reservations about the experimental nature of egg and ovarian tissue cryopreservation, and the need for partner involvement in embryo storage. Significant gaps in the information provided to young women diagnosed with cancer suggest the need for an early appointment with a fertility expert. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

The Value of Information in Decision-Analytic Modeling for Malaria Vector Control in East Africa.

PubMed

Kim, Dohyeong; Brown, Zachary; Anderson, Richard; Mutero, Clifford; Miranda, Marie Lynn; Wiener, Jonathan; Kramer, Randall

2017-02-01

Decision analysis tools and mathematical modeling are increasingly emphasized in malaria control programs worldwide to improve resource allocation and address ongoing challenges with sustainability. However, such tools require substantial scientific evidence, which is costly to acquire. The value of information (VOI) has been proposed as a metric for gauging the value of reduced model uncertainty. We apply this concept to an evidenced-based Malaria Decision Analysis Support Tool (MDAST) designed for application in East Africa. In developing MDAST, substantial gaps in the scientific evidence base were identified regarding insecticide resistance in malaria vector control and the effectiveness of alternative mosquito control approaches, including larviciding. We identify four entomological parameters in the model (two for insecticide resistance and two for larviciding) that involve high levels of uncertainty and to which outputs in MDAST are sensitive. We estimate and compare a VOI for combinations of these parameters in evaluating three policy alternatives relative to a status quo policy. We find having perfect information on the uncertain parameters could improve program net benefits by up to 5-21%, with the highest VOI associated with jointly eliminating uncertainty about reproductive speed of malaria-transmitting mosquitoes and initial efficacy of larviciding at reducing the emergence of new adult mosquitoes. Future research on parameter uncertainty in decision analysis of malaria control policy should investigate the VOI with respect to other aspects of malaria transmission (such as antimalarial resistance), the costs of reducing uncertainty in these parameters, and the extent to which imperfect information about these parameters can improve payoffs. © 2016 Society for Risk Analysis.

Communication as a Strategic Activity (Invited)

NASA Astrophysics Data System (ADS)

Fischhoff, B.

2010-12-01

Effective communication requires preparation. The first step is explicit analysis of the decisions faced by audience members, in order to identify the facts essential to their choices. The second step is assessing their current beliefs, in order to identify the gaps in their understanding, as well as their natural ways of thinking. The third step is drafting communications potentially capable of closing those gaps, taking advantage of the relevant behavioral science. The fourth step is empirically evaluating those communications, refining them as necessary. The final step is communicating through trusted channels, capable of getting the message out and receiving needed feedback. Executing these steps requires a team involving subject matter experts (for ensuring that the science is right), decision analysts (for identifying the decision-critical facts), behavioral scientists (for designing and evaluating messages), and communication specialists (for creating credible channels). Larger organizations should be able to assemble those teams and anticipate their communication needs. However, even small organizations, individuals, or large organizations that have been caught flat-footed can benefit from quickly assembling informal teams, before communicating in ways that might undermine their credibility. The work is not expensive, but does require viewing communication as a strategic activity, rather than an afterthought. The talk will illustrate the science base, with a few core research results; note the risks of miscommunication, with a few bad examples; and suggest the opportunities for communication leadership, focusing on the US Food and Drug Administration.

An exploratory analysis of the nature of informal knowledge underlying theories of planned action used for public health oriented knowledge translation.

PubMed

Kothari, Anita; Boyko, Jennifer A; Campbell-Davison, Andrea

2015-09-09

Informal knowledge is used in public health practice to make sense of research findings. Although knowledge translation theories highlight the importance of informal knowledge, it is not clear to what extent the same literature provides guidance in terms of how to use it in practice. The objective of this study was to address this gap by exploring what planned action theories suggest in terms of using three types of informal knowledge: local, experiential and expert. We carried out an exploratory secondary analysis of the planned action theories that informed the development of a popular knowledge translation theory. Our sample included twenty-nine (n = 29) papers. We extracted information from these papers about sources of and guidance for using informal knowledge, and then carried out a thematic analysis. We found that theories of planned action provide guidance (including sources of, methods for identifying, and suggestions for use) for using local, experiential and expert knowledge. This study builds on previous knowledge translation related work to provide insight into the practical use of informal knowledge. Public health practitioners can refer to the guidance summarized in this paper to inform their decision-making. Further research about how to use informal knowledge in public health practice is needed given the value being accorded to using informal knowledge in public health decision-making processes.

How much is new information worth? Evaluating the financial benefit of resolving management uncertainty

USGS Publications Warehouse

Maxwell, Sean L.; Rhodes, Jonathan R.; Runge, Michael C.; Possingham, Hugh P.; Ng, Chooi Fei; McDonald Madden, Eve

2015-01-01

Conservation decision-makers face a trade-off between spending limited funds on direct management action, or gaining new information in an attempt to improve management performance in the future. Value-of-information analysis can help to resolve this trade-off by evaluating how much management performance could improve if new information was gained. Value-of-information analysis has been used extensively in other disciplines, but there are only a few examples where it has informed conservation planning, none of which have used it to evaluate the financial value of gaining new information. We address this gap by applying value-of-information analysis to the management of a declining koala Phascolarctos cinereuspopulation. Decision-makers responsible for managing this population face uncertainty about survival and fecundity rates, and how habitat cover affects mortality threats. The value of gaining new information about these uncertainties was calculated using a deterministic matrix model of the koala population to find the expected population growth rate if koala mortality threats were optimally managed under alternative model hypotheses, which represented the uncertainties faced by koala managers. Gaining new information about survival and fecundity rates and the effect of habitat cover on mortality threats will do little to improve koala management. Across a range of management budgets, no more than 1·7% of the budget should be spent on resolving these uncertainties. The value of information was low because optimal management decisions were not sensitive to the uncertainties we considered. Decisions were instead driven by a substantial difference in the cost efficiency of management actions. The value of information was up to forty times higher when the cost efficiencies of different koala management actions were similar. Synthesis and applications. This study evaluates the ecological and financial benefits of gaining new information to inform a conservation problem. We also theoretically demonstrate that the value of reducing uncertainty is highest when it is not clear which management action is the most cost efficient. This study will help expand the use of value-of-information analyses in conservation by providing a cost efficiency metric by which to evaluate research or monitoring.

Narrowing the Achievement Gap in a (Re) Segregated Urban School District: Research, Policy and Practice. The Achievement Gap, Research, Practice, and Policy

ERIC Educational Resources Information Center

Ikpa, Vivian W.; McGuire, C. Kent

2009-01-01

The interplay between sociopolitical forces and economic agendas becomes apparent when one examines the June 28, 2007 United States Supreme Court Decision, Parents Involved In Community Schools v. Seattle School District . In a reversal of the 1954 Brown Decision, the United States Supreme Court ruled that public schools could not use race as a…

European Natural Disaster Coordination and Information System for Aviation (EUNADICS-AV)

NASA Astrophysics Data System (ADS)

Wotawa, Gerhard; Hirtl, Marcus; Arnold, Delia; Katzler-Fuchs, Susanne; Pappalardo, Gelsomina; Mona, Lucia; Sofiev, Mikhail; de Leeuw, Gerrit; Theys, Nicolas; Brenot, Hugues; Plu, Matthieu; Rockitansky, Carl-Herbert; Eschbacher, Kurt; Apituley, Arnoud; Som de Cerff, Wim

2017-04-01

Commercial aviation is one of the key infrastructures of our modern world. Even short interruptions can cause economic damages summing up to the Billion-Euro range. As evident from the past, aviation shows vulnerability with regard to natural hazards. Safe flight operations, air traffic management and air traffic control is a shared responsibility of EUROCONTROL, national authorities, airlines and pilots. All stakeholders have one common goal, namely to warrant and maintain the safety of flight crews and passengers. Currently, however, there is a significant gap in the Europe-wide availability of real time hazard measurement and monitoring information for airborne hazards describing "what, where, how much" in 3 dimensions, combined with a near-real-time European data analysis and assimilation system. This gap creates circumstances where various stakeholders in the system may base their decisions on different data and information. The H-2020 project EUNADICS-AV ("European Natural Disaster Coordination and Information System for Aviation"), started in October 2016, intends to close this gap in data and information availability, enabling all stakeholders in the aviation system to obtain fast, coherent and consistent information. The project intends to combine and harmonize data from satellite earth observation, ground based and airborne platforms, and to integrate them into state-of-the art data assimilation and analysis systems. Besides operational data sources, data from the research community are integrated as well. Hazards considered in the project include volcano eruptions, nuclear accidents and events, and forest fires. The availability of consistent and coherent data analysis fields based on all available measurements will greatly enhances our capability to respond to disasters effectively and efficiently, minimizing system downtimes and thus economic damage while maintaining the safety of millions of passengers.

Visualizing TZVOLCANO GNSS Data with Grafana via the EarthCube Cyberinfrastructure CHORDS: an Example of Dashboard Creation for the Geosciences

NASA Astrophysics Data System (ADS)

Nguyen, T. T.; Stamps, D. S.

2017-12-01

Visualizing societally relevant data in easy to comprehend formats is necessary for making informed decisions by non-scientist stakeholders. Despite scientists' efforts to inform the public, there continues to be a disconnect in information between stakeholders and scientists. Closing the gap in knowledge requires increased communication between the two groups facilitated by models and data visualizations. In this work we use real-time streaming data from TZVOLCANO, a network of GNSS/GPS sensors that monitor the active volcano Ol Doinyo Lengai in Tanzania, as a test-case for visualizing societally relevant data. Real-time data from TZVOLCANO is streamed into the US NSF Geodesy Facility UNAVCO archive (www.unavco.org) from which data are made available through the EarthCube cyberinfrastructure CHORDS (Cloud-Hosted Real-Time Data Services for the geosciences). CHORDS uses InfluxDB to make streaming data accessible in Grafana: an open source software that specializes in the display of time series analysis. With over 350 downloadable "dashboards", Grafana serves as an emerging software for data visualizations. Creating user-friendly visualizations ("dashboards") for the TZVOLCANO GNSS/GPS data in Tanzania can help scientists and stakeholders communicate effectively so informed decisions can be made about volcanic hazards during a time-sensitive crisis. Our use of Grafana's dashboards for one specific case-study provides an example for other geoscientists to develop analogous visualizations with the objectives of increasing the knowledge of the general public and facilitating a more informed decision-making process.

First Year Projects and Activities of the Environmental Remote Sensing Applications Laboratory (ERSAL)

NASA Technical Reports Server (NTRS)

Poulton, C. E.; Faulkner, D. P.

1973-01-01

Activities, pilot projects, and research that will effectively close the gap between state-of-the-art remote sensing technology and the potential users and beneficiaries of this technological and scientific progress are discussed in light of the first year of activity. A broad spectrum of resource and man-environment problems are described in terms of the central thrust of the first-year program to support land use planning decisions with information derived from the interpretation of NASA highlight and satellite imagery.

Transforming care delivery through health information technology.

PubMed

Wheatley, Benjamin

2013-01-01

The slow but progressive adoption of health information technology (IT) nationwide promises to usher in a new era in health care. Electronic health record systems provide a complete patient record at the point of care and can help to alleviate some of the challenges of a fragmented delivery system, such as drug-drug interactions. Moreover, health IT promotes evidence-based practice by identifying gaps in recommended treatment and providing clinical decision-support tools. In addition, the data collected through digital records can be used to monitor patient outcomes and identify potential improvements in care protocols. Kaiser Permanente continues to advance its capability in each of these areas.

Bioinformatics for Exploration

NASA Technical Reports Server (NTRS)

Johnson, Kathy A.

2006-01-01

For the purpose of this paper, bioinformatics is defined as the application of computer technology to the management of biological information. It can be thought of as the science of developing computer databases and algorithms to facilitate and expedite biological research. This is a crosscutting capability that supports nearly all human health areas ranging from computational modeling, to pharmacodynamics research projects, to decision support systems within autonomous medical care. Bioinformatics serves to increase the efficiency and effectiveness of the life sciences research program. It provides data, information, and knowledge capture which further supports management of the bioastronautics research roadmap - identifying gaps that still remain and enabling the determination of which risks have been addressed.

Overcoming the knowledge-behavior gap: The effect of evidence-based HPV vaccination leaflets on understanding, intention, and actual vaccination decision.

PubMed

Wegwarth, O; Kurzenhäuser-Carstens, S; Gigerenzer, G

2014-03-10

Informed decision making requires transparent and evidence-based (=balanced) information on the potential benefit and harms of medical preventions. An analysis of German HPV vaccination leaflets revealed, however, that none met the standards of balanced risk communication. We surveyed a sample of 225 girl-parent pairs in a before-after design on the effects of balanced and unbalanced risk communication on participants' knowledge about cervical cancer and the HPV vaccination, their perceived risk, their intention to have the vaccine, and their actual vaccination decision. The balanced leaflet increased the number of participants who were correctly informed about cervical cancer and the HPV vaccine by 33 to 66 absolute percentage points. In contrast, the unbalanced leaflet decreased the number of participants who were correctly informed about these facts by 0 to 18 absolute percentage points. Whereas the actual uptake of the HPV vaccination 14 months after the initial study did not differ between the two groups (22% balanced leaflet vs. 23% unbalanced leaflet; p=.93, r=.01), the originally stated intention to have the vaccine reliably predicted the actual vaccination decision for the balanced leaflet group only (concordance between intention and actual uptake: 97% in the balanced leaflet group, rs=.92, p=.00; 60% in the unbalanced leaflet group, rs=.37, p=.08). In contrast to a unbalanced leaflet, a balanced leaflet increased people's knowledge of the HPV vaccination, improved perceived risk judgments, and led to an actual vaccination uptake, which first was robustly predicted by people's intention and second did not differ from the uptake in the unbalanced leaflet group. These findings suggest that balanced reporting about HPV vaccination increases informed decisions about whether to be vaccinated and does not undermine actual uptake. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Informal Institutional Responses to Government Interventions: Lessons from Madhupur National Park, Bangladesh

NASA Astrophysics Data System (ADS)

Rahman, H. M. Tuihedur; Sarker, Swapan Kumar; Hickey, Gordon M.; Mohasinul Haque, M.; Das, Niamjit

2014-11-01

Madhupur National Park is renowned for severe resource ownership conflicts between ethnic communities and government authorities in Bangladesh. In this study, we applied the Institutional Analysis and Development framework to identify: (i) past and present informal institutional structures within the ethnic Garo community for land resource management; (ii) the origin of the land ownership dispute; (iii) interaction mechanisms between formal and informal institutions; and (iv) change in land management authority and informal governance structures. We identify that the informal institutions of the traditional community have undergone radical change due to government interventions with implications for the regulation of land use, informal institutional functions, and joint-decision-making. Importantly, the government's persistent denial of the role of existing informal institutions is widening the gap between government and community actors, and driving land ownership conflicts in a cyclic way with associated natural resource degradation.

Informal institutional responses to government interventions: lessons from Madhupur National Park, Bangladesh.

PubMed

Rahman, H M Tuihedur; Sarker, Swapan Kumar; Hickey, Gordon M; Mohasinul Haque, M; Das, Niamjit

2014-11-01

Madhupur National Park is renowned for severe resource ownership conflicts between ethnic communities and government authorities in Bangladesh. In this study, we applied the Institutional Analysis and Development framework to identify: (i) past and present informal institutional structures within the ethnic Garo community for land resource management; (ii) the origin of the land ownership dispute; (iii) interaction mechanisms between formal and informal institutions; and (iv) change in land management authority and informal governance structures. We identify that the informal institutions of the traditional community have undergone radical change due to government interventions with implications for the regulation of land use, informal institutional functions, and joint-decision-making. Importantly, the government's persistent denial of the role of existing informal institutions is widening the gap between government and community actors, and driving land ownership conflicts in a cyclic way with associated natural resource degradation.

Linking ecosystem characteristics to final ecosystem services for public policy.

PubMed

Wong, Christina P; Jiang, Bo; Kinzig, Ann P; Lee, Kai N; Ouyang, Zhiyun

2015-01-01

Governments worldwide are recognising ecosystem services as an approach to address sustainability challenges. Decision-makers need credible and legitimate measurements of ecosystem services to evaluate decisions for trade-offs to make wise choices. Managers lack these measurements because of a data gap linking ecosystem characteristics to final ecosystem services. The dominant method to address the data gap is benefit transfer using ecological data from one location to estimate ecosystem services at other locations with similar land cover. However, benefit transfer is only valid once the data gap is adequately resolved. Disciplinary frames separating ecology from economics and policy have resulted in confusion on concepts and methods preventing progress on the data gap. In this study, we present a 10-step approach to unify concepts, methods and data from the disparate disciplines to offer guidance on overcoming the data gap. We suggest: (1) estimate ecosystem characteristics using biophysical models, (2) identify final ecosystem services using endpoints and (3) connect them using ecological production functions to quantify biophysical trade-offs. The guidance is strategic for public policy because analysts need to be: (1) realistic when setting priorities, (2) attentive to timelines to acquire relevant data, given resources and (3) responsive to the needs of decision-makers. © 2014 The Authors. Ecology Letters published by John Wiley & Sons Ltd and CNRS.

Linking ecosystem characteristics to final ecosystem services for public policy

PubMed Central

Wong, Christina P; Jiang, Bo; Kinzig, Ann P; Lee, Kai N; Ouyang, Zhiyun

2015-01-01

Governments worldwide are recognising ecosystem services as an approach to address sustainability challenges. Decision-makers need credible and legitimate measurements of ecosystem services to evaluate decisions for trade-offs to make wise choices. Managers lack these measurements because of a data gap linking ecosystem characteristics to final ecosystem services. The dominant method to address the data gap is benefit transfer using ecological data from one location to estimate ecosystem services at other locations with similar land cover. However, benefit transfer is only valid once the data gap is adequately resolved. Disciplinary frames separating ecology from economics and policy have resulted in confusion on concepts and methods preventing progress on the data gap. In this study, we present a 10-step approach to unify concepts, methods and data from the disparate disciplines to offer guidance on overcoming the data gap. We suggest: (1) estimate ecosystem characteristics using biophysical models, (2) identify final ecosystem services using endpoints and (3) connect them using ecological production functions to quantify biophysical trade-offs. The guidance is strategic for public policy because analysts need to be: (1) realistic when setting priorities, (2) attentive to timelines to acquire relevant data, given resources and (3) responsive to the needs of decision-makers. PMID:25394857

Examining the relationship between critical-thinking skills and decision-making ability of emergency medicine students.

PubMed

Heidari, Mohammad; Ebrahimi, Parvin

2016-10-01

Critical-thinking ability would enable students to think creatively and make better decisions and makes them make a greater effort to concentrate on situations related to clinical matters and emergencies. This can bridge the gap between the clinical and theoretical training. Therefore, the aim of the present study is to examine the relationship between critical-thinking ability and decision-making skills of the students of Emergency Medicine. This descriptive and analytical research was conducted on all the students of medical emergency students ( n = 86) in Shahrekord, Iran. The demographic information questionnaire, the California Critical Thinking Skills Test, and a decision-making researcher-made questionnaire were used to collect data. The data were analyzed by SPSS software version 16 using descriptive and analytical statistical tests and Pearson's correlation coefficient. The results of the present study indicate that the total mean score for the critical thinking was 8.32 ± 2.03 and for decision making 8.66 ± 1.89. There is a significant statistical relationship between the critical-thinking score and decision-making score ( P < 0.05). Although critical-thinking skills and decision-making ability are essential for medical emergency professional competence, the results of this study show that these skills are poor among the students.

Examining the relationship between critical-thinking skills and decision-making ability of emergency medicine students

PubMed Central

Heidari, Mohammad; Ebrahimi, Parvin

2016-01-01

Background and Aims: Critical-thinking ability would enable students to think creatively and make better decisions and makes them make a greater effort to concentrate on situations related to clinical matters and emergencies. This can bridge the gap between the clinical and theoretical training. Therefore, the aim of the present study is to examine the relationship between critical-thinking ability and decision-making skills of the students of Emergency Medicine. Materials and Methods: This descriptive and analytical research was conducted on all the students of medical emergency students (n = 86) in Shahrekord, Iran. The demographic information questionnaire, the California Critical Thinking Skills Test, and a decision-making researcher-made questionnaire were used to collect data. The data were analyzed by SPSS software version 16 using descriptive and analytical statistical tests and Pearson's correlation coefficient. Results: The results of the present study indicate that the total mean score for the critical thinking was 8.32 ± 2.03 and for decision making 8.66 ± 1.89. There is a significant statistical relationship between the critical-thinking score and decision-making score (P < 0.05). Conclusions: Although critical-thinking skills and decision-making ability are essential for medical emergency professional competence, the results of this study show that these skills are poor among the students. PMID:27829713

Children’s Safety Initiative: A National Assessment of Pediatric Educational Needs amongEmergency Medical Services Providers

PubMed Central

Hansen, Matthew; Meckler, Garth; Dickinson, Caitlyn; Dickenson, Kathryn; Jui, Jonathan; Lambert, William; Guise, Jeanne-Marie

2014-01-01

Objective Emergency Medical Services (EMS) providers may have critical knowledge gaps in pediatric care due to lack of exposure and training. There is currently little evidence to guide educators to the knowledge gaps most likely to improve patient safety. The objective of this study was to identify educational needs of EMS providers related to pediatric care in various domains in order to inform development of curricula. Methods The Children’s Safety Initiative-EMS performed a three-phase Delphi survey on patient safety in pediatric emergencies among providers and content experts in pediatric emergency care including physicians, nurses and pre-hospital providers of all levels. Each round included questions related to educational needs of providers or the effect of training on patient safety events. We identified knowledge gaps in the following domains: case exposure, competency and knowledge, assessment and decision making, and critical thinking and proficiency. Individual knowledge gaps were ranked by portion of respondents who ranked them “highly likely” (likert-type score 7–10 out of 10) to contribute to safety events. Results There were 737 respondents who were included in analysis of the first phase of the survey. Paramedics were 50.8% of respondents; EMT-Basics/first responders were 22% and physicians 11.4%. The top educational priorities identified in the final round of the survey include: pediatric airway management, responder anxiety when working with children, and general pediatric skills among providers. The top three needs in decision-making include knowing when to alter plans mid-course, knowing when to perform and advanced airway, and assessing pain in children. The top 3 technical or procedural skills needs were pediatric advanced airway, neonatal resuscitation, and intravenous/intraosseos access. For neonates, specific educational needs identified included knowing appropriate vital signs and preventing hypothermia. Conclusions This is the first large-scale Delphi survey related to pediatric pre-hospital education. Our results provide foundational information related to the educational needs of pre-hospital providers. Medical directors and educators can use the results to shape future curricular development. PMID:25296191

Children's safety initiative: a national assessment of pediatric educational needs among emergency medical services providers.

PubMed

Hansen, Matthew; Meckler, Garth; Dickinson, Caitlyn; Dickenson, Kathryn; Jui, Jonathan; Lambert, William; Guise, Jeanne-Marie

2015-01-01

Emergency medical services (EMS) providers may have critical knowledge gaps in pediatric care due to lack of exposure and training. There is currently little evidence to guide educators to the knowledge gaps that most need to be addressed to improve patient safety. The objective of this study was to identify educational needs of EMS providers related to pediatric care in various domains in order to inform development of curricula. The Children's Safety Initiative-EMS performed a three-phase Delphi survey on patient safety in pediatric emergencies among providers and content experts in pediatric emergency care, including physicians, nurses, and prehospital providers of all levels. Each round included questions related to educational needs of providers or the effect of training on patient safety events. We identified knowledge gaps in the following domains: case exposure, competency and knowledge, assessment and decision making, and critical thinking and proficiency. Individual knowledge gaps were ranked by portion of respondents who ranked them "highly likely" (Likert-type score 7-10 out of 10) to contribute to safety events. There were 737 respondents who were included in analysis of the first phase of the survey. Paramedics were 50.8% of respondents, EMT-basics/first responders were 22%, and physicians 11.4%. The top educational priorities identified in the final round of the survey include pediatric airway management, responder anxiety when working with children, and general pediatric skills among providers. The top three needs in decision-making include knowing when to alter plans mid-course, knowing when to perform an advanced airway, and assessing pain in children. The top 3 technical or procedural skills needs were pediatric advanced airway, neonatal resuscitation, and intravenous/intraosseous access. For neonates, specific educational needs identified included knowing appropriate vital signs and preventing hypothermia. This is the first large-scale Delphi survey related to pediatric prehospital education. Our results provide foundational information related to the educational needs of prehospital providers. Medical directors and educators can use the results to shape future curricular development.

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.

Assessing land-use impacts on biodiversity using an expert systems tool

USGS Publications Warehouse

Crist, P.J.; Kohley, T.W.; Oakleaf, J.

2000-01-01

Habitat alteration, in the form of land-use development, is a leading cause of biodiversity loss in the U.S. and elsewhere. Although statutes in the U.S. may require consideration of biodiversity in local land-use planning and regulation, local governments lack the data, resources, and expertise to routinely consider biotic impacts that result from permitted land uses. We hypothesized that decision support systems could aid solution of this problem. We developed a pilot biodiversity expert systems tool (BEST) to test that hypothesis and learn what additional scientific and technological advancements are required for broad implementation of such a system. BEST uses data from the U.S. Geological Survey's Gap Analysis Program (GAP) and other data in a desktop GIS environment. The system provides predictions of conflict between proposed land uses and biotic elements and is intended for use at the start of the development review process. Key challenges were the development of categorization systems that relate named land-use types to ecological impacts, and relate sensitivities of biota to ecological impact levels. Although the advent of GAP and sophisticated desktop GIS make such a system feasible for broad implementation, considerable ongoing research is required to make the results of such a system scientifically sound, informative, and reliable for the regulatory process. We define a role for local government involvement in biodiversity impact assessment, the need for a biodiversity decision support system, the development of a prototype system, and scientific needs for broad implementation of a robust and reliable system.

Communication gaps in nursing home transfers to the ED: impact on turnaround time, disposition, and diagnostic testing.

PubMed

Nelson, Drew; Washton, Danae; Jeanmonod, Rebecca

2013-04-01

This study aims to determine the source of communication gaps in history of present illness (HPI), medical history, and advanced directives in nursing home (NH) patients transferred to the emergency department (ED). We also attempt to determine if these gaps create differences in patient turnaround time (TAT), disposition decision, or diagnostic testing. A convenience sample of patients transferred from NHs to a level 1 community trauma center was enrolled by the physicians caring for them. The physicians assessed the adequacy and source of the history for each patient. The patient's chart was then retrospectively reviewed to determine disposition, ED TAT, and diagnostic tests ordered. One hundred patients were enrolled. Physicians found that NH paperwork contained adequate HPI 35% of the time. Patients could provide their own HPI 28% of the time. In 32% of patients, adequate HPI could not be obtained from the patient, NH paperwork, or NH personnel. Comparing patients in whom adequate HPI was available (n = 68) to those in whom HPI was not available (n = 32), there was no difference in TAT (146 vs 173 minutes, P = .22), admissions (60% vs 66%, P = .66), or diagnostic testing (P = .89-1.0). Emergency department physicians often do not have adequate HPI in patients transferred from NHs. The absence of adequate information does not affect patient TAT, disposition decision, or ED diagnostic testing. Copyright © 2013 Elsevier Inc. All rights reserved.

L.E.A.D.: a framework for evidence gathering and use for the prevention of obesity and other complex public health problems.

PubMed

Chatterji, Madhabi; Green, Lawrence W; Kumanyika, Shiriki

2014-02-01

This article summarizes a comprehensive, systems-oriented framework designed to improve the use of a wide variety of evidence sources to address population-wide obesity problems. The L.E.A.D. framework (for Locate the evidence, Evaluate the evidence, Assemble the evidence, and inform Decisions), developed by an expert consensus committee convened by the Institute of Medicine, is broadly applicable to complex, community-wide health problems. The article explains how to use the framework, presenting an evidence typology that helps specify relevant research questions and includes examples of how particular research methodologies and sources of evidence relate to questions that stem from decision-maker needs. The utility of a range of quantitative, qualitative, and mixed method designs and data sources for assembling a broad and credible evidence base is discussed, with a call for ongoing "evidence generation" to fill information gaps using the recommended systems perspective.

Modeling approaches for characterizing and evaluating environmental exposure to engineered nanomaterials in support of risk-based decision making.

PubMed

Hendren, Christine Ogilvie; Lowry, Michael; Grieger, Khara D; Money, Eric S; Johnston, John M; Wiesner, Mark R; Beaulieu, Stephen M

2013-02-05

As the use of engineered nanomaterials becomes more prevalent, the likelihood of unintended exposure to these materials also increases. Given the current scarcity of experimental data regarding fate, transport, and bioavailability, determining potential environmental exposure to these materials requires an in depth analysis of modeling techniques that can be used in both the near- and long-term. Here, we provide a critical review of traditional and emerging exposure modeling approaches to highlight the challenges that scientists and decision-makers face when developing environmental exposure and risk assessments for nanomaterials. We find that accounting for nanospecific properties, overcoming data gaps, realizing model limitations, and handling uncertainty are key to developing informative and reliable environmental exposure and risk assessments for engineered nanomaterials. We find methods suited to recognizing and addressing significant uncertainty to be most appropriate for near-term environmental exposure modeling, given the current state of information and the current insufficiency of established deterministic models to address environmental exposure to engineered nanomaterials.

Natural capital and ecosystem services informing decisions: From promise to practice

PubMed Central

Guerry, Anne D.; Polasky, Stephen; Lubchenco, Jane; Chaplin-Kramer, Rebecca; Daily, Gretchen C.; Griffin, Robert; Ruckelshaus, Mary; Bateman, Ian J.; Duraiappah, Anantha; Elmqvist, Thomas; Feldman, Marcus W.; Folke, Carl; Hoekstra, Jon; Kareiva, Peter M.; Keeler, Bonnie L.; Li, Shuzhuo; McKenzie, Emily; Ouyang, Zhiyun; Reyers, Belinda; Ricketts, Taylor H.; Rockström, Johan; Tallis, Heather; Vira, Bhaskar

2015-01-01

The central challenge of the 21st century is to develop economic, social, and governance systems capable of ending poverty and achieving sustainable levels of population and consumption while securing the life-support systems underpinning current and future human well-being. Essential to meeting this challenge is the incorporation of natural capital and the ecosystem services it provides into decision-making. We explore progress and crucial gaps at this frontier, reflecting upon the 10 y since the Millennium Ecosystem Assessment. We focus on three key dimensions of progress and ongoing challenges: raising awareness of the interdependence of ecosystems and human well-being, advancing the fundamental interdisciplinary science of ecosystem services, and implementing this science in decisions to restore natural capital and use it sustainably. Awareness of human dependence on nature is at an all-time high, the science of ecosystem services is rapidly advancing, and talk of natural capital is now common from governments to corporate boardrooms. However, successful implementation is still in early stages. We explore why ecosystem service information has yet to fundamentally change decision-making and suggest a path forward that emphasizes: (i) developing solid evidence linking decisions to impacts on natural capital and ecosystem services, and then to human well-being; (ii) working closely with leaders in government, business, and civil society to develop the knowledge, tools, and practices necessary to integrate natural capital and ecosystem services into everyday decision-making; and (iii) reforming institutions to change policy and practices to better align private short-term goals with societal long-term goals. PMID:26082539

Evidence used in model-based economic evaluations for evaluating pharmacogenetic and pharmacogenomic tests: a systematic review protocol

PubMed Central

Peters, Jaime L; Cooper, Chris; Buchanan, James

2015-01-01

Introduction Decision models can be used to conduct economic evaluations of new pharmacogenetic and pharmacogenomic tests to ensure they offer value for money to healthcare systems. These models require a great deal of evidence, yet research suggests the evidence used is diverse and of uncertain quality. By conducting a systematic review, we aim to investigate the test-related evidence used to inform decision models developed for the economic evaluation of genetic tests. Methods and analysis We will search electronic databases including MEDLINE, EMBASE and NHS EEDs to identify model-based economic evaluations of pharmacogenetic and pharmacogenomic tests. The search will not be limited by language or date. Title and abstract screening will be conducted independently by 2 reviewers, with screening of full texts and data extraction conducted by 1 reviewer, and checked by another. Characteristics of the decision problem, the decision model and the test evidence used to inform the model will be extracted. Specifically, we will identify the reported evidence sources for the test-related evidence used, describe the study design and how the evidence was identified. A checklist developed specifically for decision analytic models will be used to critically appraise the models described in these studies. Variations in the test evidence used in the decision models will be explored across the included studies, and we will identify gaps in the evidence in terms of both quantity and quality. Dissemination The findings of this work will be disseminated via a peer-reviewed journal publication and at national and international conferences. PMID:26560056

How to achieve benefit from mission-oriented research: lessons from the U.S. Department of Agriculture and the Naval Research Laboratory

NASA Astrophysics Data System (ADS)

Logar, N. J.

2006-12-01

Does the research performed by government mission agencies contribute to improved decision-making? Climate research within the U.S. Department of Agriculture (USDA) has the stated goal of providing "optimal benefit" to decision makers on all levels, and the meteorology division of Department of Defense's Naval Research Laboratory promises research directed towards application. Assuming that research can lead to benefit for decision makers with minimal guidance can lead to irrelevance, wasted effort, and missed opportunities. Moving beyond the assumption leads to critical consideration of processes creating climate and meteorological science. I report the results of contextual mapping, of research on decision processes, and of interviews with agency scientists and users of science to evaluate their science regimes. In the case of the USDA scientists do target stakeholders through formal and informal mechanisms, but much of the science does not find use due to institutional constraints, political considerations, and disciplinary inertia. The research results will provide options for closing these policy gaps, such as higher-level stakeholder interaction and better representation of diverse interests. I apply the economic concept of supply and demand to describe where supply of science provides decision support that matches user demand, and where science policies might miss opportunities or mischaracterize research as useful to a specific user. This analysis leads to increased understanding of how factors such as the definition of scientific problems, hierarchies in science decision-making structures, quality control mechanisms beyond peer review, distribution of participants in the knowledge production enterprise, and social accountability guide the process of producing useful information.

Natural capital and ecosystem services informing decisions: From promise to practice.

PubMed

Guerry, Anne D; Polasky, Stephen; Lubchenco, Jane; Chaplin-Kramer, Rebecca; Daily, Gretchen C; Griffin, Robert; Ruckelshaus, Mary; Bateman, Ian J; Duraiappah, Anantha; Elmqvist, Thomas; Feldman, Marcus W; Folke, Carl; Hoekstra, Jon; Kareiva, Peter M; Keeler, Bonnie L; Li, Shuzhuo; McKenzie, Emily; Ouyang, Zhiyun; Reyers, Belinda; Ricketts, Taylor H; Rockström, Johan; Tallis, Heather; Vira, Bhaskar

2015-06-16

The central challenge of the 21st century is to develop economic, social, and governance systems capable of ending poverty and achieving sustainable levels of population and consumption while securing the life-support systems underpinning current and future human well-being. Essential to meeting this challenge is the incorporation of natural capital and the ecosystem services it provides into decision-making. We explore progress and crucial gaps at this frontier, reflecting upon the 10 y since the Millennium Ecosystem Assessment. We focus on three key dimensions of progress and ongoing challenges: raising awareness of the interdependence of ecosystems and human well-being, advancing the fundamental interdisciplinary science of ecosystem services, and implementing this science in decisions to restore natural capital and use it sustainably. Awareness of human dependence on nature is at an all-time high, the science of ecosystem services is rapidly advancing, and talk of natural capital is now common from governments to corporate boardrooms. However, successful implementation is still in early stages. We explore why ecosystem service information has yet to fundamentally change decision-making and suggest a path forward that emphasizes: (i) developing solid evidence linking decisions to impacts on natural capital and ecosystem services, and then to human well-being; (ii) working closely with leaders in government, business, and civil society to develop the knowledge, tools, and practices necessary to integrate natural capital and ecosystem services into everyday decision-making; and (iii) reforming institutions to change policy and practices to better align private short-term goals with societal long-term goals.

Approaching system equilibrium with accurate or not accurate feedback information in a two-route system

NASA Astrophysics Data System (ADS)

Zhao, Xiao-mei; Xie, Dong-fan; Li, Qi

2015-02-01

With the development of intelligent transport system, advanced information feedback strategies have been developed to reduce traffic congestion and enhance the capacity. However, previous strategies provide accurate information to travelers and our simulation results show that accurate information brings negative effects, especially in delay case. Because travelers prefer to the best condition route with accurate information, and delayed information cannot reflect current traffic condition but past. Then travelers make wrong routing decisions, causing the decrease of the capacity and the increase of oscillations and the system deviating from the equilibrium. To avoid the negative effect, bounded rationality is taken into account by introducing a boundedly rational threshold BR. When difference between two routes is less than the BR, routes have equal probability to be chosen. The bounded rationality is helpful to improve the efficiency in terms of capacity, oscillation and the gap deviating from the system equilibrium.

Protecting posted genes: social networking and the limits of GINA.

PubMed

Soo-Jin Lee, Sandra; Borgelt, Emily

2014-01-01

The combination of decreased genotyping costs and prolific social media use is fueling a personal genetic testing industry in which consumers purchase and interact with genetic risk information online. Consumers and their genetic risk profiles are protected in some respects by the 2008 federal Genetic Information Nondiscrimination Act (GINA), which forbids the discriminatory use of genetic information by employers and health insurers; however, practical and technical limitations undermine its enforceability, given the everyday practices of online social networking and its impact on the workplace. In the Web 2.0 era, employers in most states can legally search about job candidates and employees online, probing social networking sites for personal information that might bear on hiring and employment decisions. We examine GINA's protections for online sharing of genetic information as well as its limitations, and propose policy recommendations to address current gaps that leave employees' genetic information vulnerable in a Web-based world.

Launching a virtual decision lab: development and field-testing of a web-based patient decision support research platform.

PubMed

Hoffman, Aubri S; Llewellyn-Thomas, Hilary A; Tosteson, Anna N A; O'Connor, Annette M; Volk, Robert J; Tomek, Ivan M; Andrews, Steven B; Bartels, Stephen J

2014-12-12

Over 100 trials show that patient decision aids effectively improve patients' information comprehension and values-based decision making. However, gaps remain in our understanding of several fundamental and applied questions, particularly related to the design of interactive, personalized decision aids. This paper describes an interdisciplinary development process for, and early field testing of, a web-based patient decision support research platform, or virtual decision lab, to address these questions. An interdisciplinary stakeholder panel designed the web-based research platform with three components: a) an introduction to shared decision making, b) a web-based patient decision aid, and c) interactive data collection items. Iterative focus groups provided feedback on paper drafts and online prototypes. A field test assessed a) feasibility for using the research platform, in terms of recruitment, usage, and acceptability; and b) feasibility of using the web-based decision aid component, compared to performance of a videobooklet decision aid in clinical care. This interdisciplinary, theory-based, patient-centered design approach produced a prototype for field-testing in six months. Participants (n = 126) reported that: the decision aid component was easy to use (98%), information was clear (90%), the length was appropriate (100%), it was appropriately detailed (90%), and it held their interest (97%). They spent a mean of 36 minutes using the decision aid and 100% preferred using their home/library computer. Participants scored a mean of 75% correct on the Decision Quality, Knowledge Subscale, and 74 out of 100 on the Preparation for Decision Making Scale. Completing the web-based decision aid reduced mean Decisional Conflict scores from 31.1 to 19.5 (p < 0.01). Combining decision science and health informatics approaches facilitated rapid development of a web-based patient decision support research platform that was feasible for use in research studies in terms of recruitment, acceptability, and usage. Within this platform, the web-based decision aid component performed comparably with the videobooklet decision aid used in clinical practice. Future studies may use this interactive research platform to study patients' decision making processes in real-time, explore interdisciplinary approaches to designing web-based decision aids, and test strategies for tailoring decision support to meet patients' needs and preferences.

The 3rd Report on Climate Change in Catalonia: a joint initiative to bridge the gap between Science and Decision-Making

NASA Astrophysics Data System (ADS)

Queralt, Arnau; Llasat, Maria del Carmen; Serena, Josep Maria; Pont, Isabel

2017-04-01

In January 2017 the Government of Catalonia (Advisory Council for the Sustainable Development, Catalan Office for Climate Change, and Meteorological Service of Catalonia) and the Institute for Catalan Studies presented the Third Report on Climate Change in Catalonia, whose aims are (1) to gather and summarise the most recent information on climate change and its effects on the natural and human systems in Catalonia (and to identify existing knowledge gaps), (2) to make recommendations to decision-makers, and (3) to rise decision-makers and citizens awareness on the effects of climate change and the importance of reinforce mitigation and adaptation efforts. Although climate change is a global phenomenon, impacts and subsequent adaptive action may differ across countries and regions. In accordance to this, and with the aim of downscaling the contents of the IPCC reports, the first report on climate change in Catalonia was published in 2005 and was followed by a second edition in 2010. Directly linked to this second report, the Catalan Panel on Climate Change was established. During a year and a half more than 130 authors and 40 scientific and technical revisers (assisted by a board and technical staff from the leading institutions) have participated in the third assessment of climate change in Catalonia. The report updates the observations and projections related to the climate evolution at Catalonia and its impacts, gathering the most advanced scientific knowledge and providing the Catalan Government with sectorial recommendations to face these impacts. After its official launch in January 2017, the report will be presented and discussed with several ministers and officials within the Catalan Government, but also with the main stakeholders. These presentations and dialogue are strategic actions for bridging the gap between Science and Policy-making regarding climate change. An executive summary identifying in a very focused way the main messages arising from the report has been prepared to contribute to this information sharing process. The summary has been prepared in English, French and Spanish in order to share the information with the International Community. The promoters of this report are highly interested in making a broad diffusion of its conclusions and recommendations among stakeholders and citizens. According to this, an ambitious communication plan has been designed, including 10 sectorial workshops around Catalonia, specific presentations to selected stakeholders and institutions, and high impact articles and programs in the media. This communication plan will be implemented throughout the year 2017. The report has been published and disseminated thanks to the contribution of "La Caixa" Banking Foundation.

Alternatives Assessment Frameworks: Research Needs for the Informed Substitution of Hazardous Chemicals

PubMed Central

Jacobs, Molly M.; Malloy, Timothy F.; Tickner, Joel A.; Edwards, Sally

2015-01-01

Background Given increasing pressures for hazardous chemical replacement, there is growing interest in alternatives assessment to avoid substituting a toxic chemical with another of equal or greater concern. Alternatives assessment is a process for identifying, comparing, and selecting safer alternatives to chemicals of concern (including those used in materials, processes, or technologies) on the basis of their hazards, performance, and economic viability. Objectives The purposes of this substantive review of alternatives assessment frameworks are to identify consistencies and differences in methods and to outline needs for research and collaboration to advance science policy practice. Methods This review compares methods used in six core components of these frameworks: hazard assessment, exposure characterization, life-cycle impacts, technical feasibility evaluation, economic feasibility assessment, and decision making. Alternatives assessment frameworks published from 1990 to 2014 were included. Results Twenty frameworks were reviewed. The frameworks were consistent in terms of general process steps, but some differences were identified in the end points addressed. Methodological gaps were identified in the exposure characterization, life-cycle assessment, and decision–analysis components. Methods for addressing data gaps remain an issue. Discussion Greater consistency in methods and evaluation metrics is needed but with sufficient flexibility to allow the process to be adapted to different decision contexts. Conclusion Although alternatives assessment is becoming an important science policy field, there is a need for increased cross-disciplinary collaboration to refine methodologies in support of the informed substitution and design of safer chemicals, materials, and products. Case studies can provide concrete lessons to improve alternatives assessment. Citation Jacobs MM, Malloy TF, Tickner JA, Edwards S. 2016. Alternatives assessment frameworks: research needs for the informed substitution of hazardous chemicals. Environ Health Perspect 124:265–280; http://dx.doi.org/10.1289/ehp.1409581 PMID:26339778

Heart rate variability indicates emotional value during pro-social economic laboratory decisions with large external validity.

PubMed

Fooken, Jonas

2017-03-10

The present study investigates the external validity of emotional value measured in economic laboratory experiments by using a physiological indicator of stress, heart rate variability (HRV). While there is ample evidence supporting the external validity of economic experiments, there is little evidence comparing the magnitude of internal levels of emotional stress during decision making with external stress. The current study addresses this gap by comparing the magnitudes of decision stress experienced in the laboratory with the stress from outside the laboratory. To quantify a large change in HRV, measures observed in the laboratory during decision-making are compared to the difference between HRV during a university exam and other mental activity for the same individuals in and outside of the laboratory. The results outside the laboratory inform about the relevance of laboratory findings in terms of their relative magnitude. Results show that psychologically induced HRV changes observed in the laboratory, particularly in connection with social preferences, correspond to large effects outside. This underscores the external validity of laboratory findings and shows the magnitude of emotional value connected to pro-social economic decisions in the laboratory.

Treatment algorithms and protocolized care.

PubMed

Morris, Alan H

2003-06-01

Excess information in complex ICU environments exceeds human decision-making limits and likely contributes to unnecessary variation in clinical care, increasing the likelihood of clinical errors. I reviewed recent critical care clinical trials searching for information about the impact of protocol use on clinically pertinent outcomes. Several recently published clinical trials illustrate the importance of distinguishing efficacy and effectiveness trials. One of these trials illustrates the danger of conducting effectiveness trials before the efficacy of an intervention is established. The trials also illustrate the importance of distinguishing guidelines and inadequately explicit protocols from adequately explicit protocols. Only adequately explicit protocols contain enough detail to lead different clinicians to the same decision when faced with the same clinical scenario. Differences between guidelines and protocols are important. Guidelines lack detail and provide general guidance that requires clinicians to fill in many gaps. Computerized or paper-based protocols are detailed and, when used for complex clinical ICU problems, can generate patient-specific, evidence-based therapy instructions that can be carried out by different clinicians with almost no interclinician variability. Individualization of patient therapy can be preserved by these protocols when they are driven by individual patient data. Explicit decision-support tools (eg, guidelines and protocols) have favorable effects on clinician and patient outcomes and can reduce the variation in clinical practice. Guidelines and protocols that aid ICU decision makers should be more widely distributed.

Evaluating the quality and use of economic data in decisions about essential medicines.

PubMed

Moucheraud, Corrina; Wirtz, Veronika J; Reich, Michael R

2015-10-01

To evaluate the quality of economic data provided in applications to the World Health Organization (WHO) Model List of Essential Medicines and to evaluate the role of these data in decision-making by the expert committee that considers the applications. We analysed applications submitted to the WHO Expert Committee on the Selection and Use of Essential Medicines between 2002 and 2013. The completeness of data on the price and cost-effectiveness of medicines was extracted from application documents and coded using a four-point scale. We recorded whether or not the expert committee discussed economic information and the outcomes of each application. Associations between the completeness of economic data and application outcomes were assessed using χ 2 tests. The expert committee received 134 applications. Only eight applications (6%) included complete price data and economic evaluation data. Many applicants omitted or misinterpreted the economic evaluation section of the application form. Despite the lack of economic data, all applications were reviewed by the committee. There was no significant association between the completeness of economic information and application outcomes. The expert committee tried to address information gaps in applications by further review and analysis of data related to the application. The World Health Organization should revise the instructions to applicants on economic data requirements; develop new mechanisms to assist applicants in completing the application process; and define methods for the use of economic data in decision-making.

Representation of potential information gain to measure the price of anarchy on ISR activities

NASA Astrophysics Data System (ADS)

Ortiz-Peña, Hector J.; Hirsch, Michael; Karwan, Mark; Nagi, Rakesh; Sudit, Moises

2013-05-01

One of the main technical challenges facing intelligence analysts today is effectively determining information gaps from huge amounts of collected data. Moreover, getting the right information to/from the right person (e.g., analyst, warfighter on the edge) at the right time in a distributed environment has been elusive to our military forces. Synchronization of Intelligence, Surveillance, and Reconnaissance (ISR) activities to maximize the efficient utilization of limited resources (both in quantity and capabilities) has become critically important to increase the accuracy and timeliness of overall information gain. Given this reality, we are interested in quantifying the degradation of solution quality (i.e., information gain) as a centralized system synchronizing ISR activities (from information gap identification to information collection and dissemination) moves to a more decentralized framework. This evaluation extends the concept of price of anarchy, a measure of the inefficiency of a system when agents maximize decisions without coordination, by considering different levels of decentralization. Our initial research representing the potential information gain in geospatial and time discretized spaces is presented. This potential information gain map can represent a consolidation of Intelligence Preparation of the Battlefield products as input to automated ISR synchronization tools. Using the coordination of unmanned vehicles (UxVs) as an example, we developed a mathematical programming model for multi-perspective optimization in which each UxV develops its own fight plan to support mission objectives based only on its perspective of the environment (i.e., potential information gain map). Information is only exchanged when UxVs are part of the same communication network.

Managing Research in a Risk World

NASA Technical Reports Server (NTRS)

Anton, W.; Havenhill, M.

2014-01-01

The Office of Chief Medical Officer (OCHMO) owns all human health and performance risks managed by the Human System Risk Board (HSRB). While the HSRB manages the risks, the Human Research Program (HRP) manages the research portion of the overall risk mitigation strategy for these risks. The HSRB manages risks according to a process that identifies and analyzes risks, plans risk mitigation and tracks and reviews the implementation of these strategies according to its decisions pertaining to the OCHMO risk posture. HRP manages risk research work using an architecture that describes evidence-based risks, gaps in our knowledge about characterizing or mitigating the risk, and the tasks needed to produce deliverables to fill the gaps and reduce the risk. A planning schedule reflecting expected research milestones is developed, and as deliverables and new evidence are generated, research progress is tracked via the Path to Risk Reduction (PRR) that reflects a risk's research plan for a design reference mission. HRP's risk research process closely interfaces with the HSRB risk management process. As research progresses, new deliverables and evidence are used by the HSRB in conjunction with other operational and non-research evidence to inform decisions pertaining to the likelihood and consequence of the risk and risk posture. Those decisions in turn guide forward work for research as it contributes to overall risk mitigation strategies. As HRP tracks its research work, it aligns its priorities by assessing the effectiveness of its contributions and maintaining specific core competencies that would be invaluable for future work for exploration missions.

Joining Forces for Food Security - Linking Earth Observation and Crowd-sourcing for improved Decision-support

NASA Astrophysics Data System (ADS)

Enenkel, M.; Dorigo, W.; See, L. M.; Vinck, P.; Papp, A.

2014-12-01

Droughts statistically exceed all other natural disasters in complexity, spatio-temporal extent and number of people affected. Triggered by crop failure, food insecurity is a major manifestation of agricultural drought and water scarcity. However, other socio-economic precursors, such as chronically low levels of disaster preparedness, hampered access to food security or a lack of social safety nets are equally important factors. We will present the first results of the SATIDA (Satellite Technologies for Improved Drought-Risk Assessment) project, which advances three complementary developments. First, an existing drought indicator is enhanced by replacing in-situ measurements on rainfall and surface air temperature with satellite-derived datasets. We identify the vegetation status via a new noise-corrected and gap-filled vegetation index. In addition, we introduce a soil moisture component to close the gap between rainfall deficiencies, extreme temperature and the first visible impacts of atmospheric anomalies on vegetation. Second, once calibrated, the index is forced with seasonal forecasts to quantify their uncertainty and added value in the regions of interest. Third, a mobile application is developed to disseminate relevant visualizations to decision-makers in affected areas, to collect additional information about socio-economic conditions and to validate the output of the drought index in real conditions. Involving Doctors without Borders (MSF) as a key user, SATIDA aims at decreasing uncertainties in decision-making via a more holistic risk framework, resulting in longer lead times for disaster logistics in the preparedness phase.

Confidentiality and Privacy for Smartphone Applications in Child and Adolescent Psychiatry: Unmet Needs and Practical Solutions.

PubMed

Wu, Emily; Torous, John; Hardaway, Rashad; Gutheil, Thomas

2017-01-01

This article summarizes the current literature on clinical knowledge and practical gaps regarding the confidentiality and privacy for smartphone and connected devices in child and adolescent psychiatry and offers practical solutions and consideration for the next steps for the field. Important issues to consider include disclosure of information sharing, access privilege, privacy and trust, risk and benefit analysis, and the need for standardization. Through understanding the privacy and confidentiality concerns regarding digital devices, child and adolescent psychiatrists can guide patients and parents though informed decision-making and also help shape how the field creates the next generation of these tools. Copyright © 2016 Elsevier Inc. All rights reserved.

Evidence-based decision-making 7: Knowledge translation.

PubMed

Manns, Braden J

2015-01-01

There is a significant gap between what is known and what is implemented by key stakeholders in practice (the evidence to practice gap). The primary purpose of knowledge translation is to address this gap, bridging evidence to clinical practice. The knowledge to action cycle is one framework for knowledge translation that integrates policy-makers throughout the research cycle. The knowledge to action cycle begins with the identification of a problem (usually a gap in care provision). After identification of the problem, knowledge creation is undertaken, depicted at the center of the cycle as a funnel. Knowledge inquiry is at the wide end of the funnel, and moving down the funnel, the primary data is synthesized into knowledge products in the form of educational materials, guidelines, decision aids, or clinical pathways. The remaining components of the knowledge to action cycle refer to the action of applying the knowledge that has been created. This includes adapting knowledge to local context, assessing barriers to knowledge use, selecting, tailoring implementing interventions, monitoring knowledge use, evaluating outcomes, and sustaining knowledge use. Each of these steps is connected by bidirectional arrows and ideally involves healthcare decision-makers and key stakeholders at each transition.

Understanding Adherence and Prescription Patterns Using Large-Scale Claims Data.

PubMed

Bjarnadóttir, Margrét V; Malik, Sana; Onukwugha, Eberechukwu; Gooden, Tanisha; Plaisant, Catherine

2016-02-01

Advanced computing capabilities and novel visual analytics tools now allow us to move beyond the traditional cross-sectional summaries to analyze longitudinal prescription patterns and the impact of study design decisions. For example, design decisions regarding gaps and overlaps in prescription fill data are necessary for measuring adherence using prescription claims data. However, little is known regarding the impact of these decisions on measures of medication possession (e.g., medication possession ratio). The goal of the study was to demonstrate the use of visualization tools for pattern discovery, hypothesis generation, and study design. We utilized EventFlow, a novel discrete event sequence visualization software, to investigate patterns of prescription fills, including gaps and overlaps, utilizing large-scale healthcare claims data. The study analyzes data of individuals who had at least two prescriptions for one of five hypertension medication classes: ACE inhibitors, angiotensin II receptor blockers, beta blockers, calcium channel blockers, and diuretics. We focused on those members initiating therapy with diuretics (19.2%) who may have concurrently or subsequently take drugs in other classes as well. We identified longitudinal patterns in prescription fills for antihypertensive medications, investigated the implications of decisions regarding gap length and overlaps, and examined the impact on the average cost and adherence of the initial treatment episode. A total of 790,609 individuals are included in the study sample, 19.2% (N = 151,566) of whom started on diuretics first during the study period. The average age was 52.4 years and 53.1% of the population was female. When the allowable gap was zero, 34% of the population had continuous coverage and the average length of continuous coverage was 2 months. In contrast, when the allowable gap was 30 days, 69% of the population showed a single continuous prescription period with an average length of 5 months. The average prescription cost of the period of continuous coverage ranged from US$3.44 (when the maximum gap was 0 day) to US$9.08 (when the maximum gap was 30 days). Results were less impactful when considering overlaps. This proof-of-concept study illustrates the use of visual analytics tools in characterizing longitudinal medication possession. We find that prescription patterns and associated prescription costs are more influenced by allowable gap lengths than by definitions and treatment of overlap. Research using medication gaps and overlaps to define medication possession in prescription claims data should pay particular attention to the definition and use of gap lengths.

Use of a modified GreenScreen tool to conduct a screening-level comparative hazard assessment of conventional silver and two forms of nanosilver.

PubMed

Sass, Jennifer; Heine, Lauren; Hwang, Nina

2016-11-08

Increased concern for potential health and environmental impacts of chemicals, including nanomaterials, in consumer products is driving demand for greater transparency regarding potential risks. Chemical hazard assessment is a powerful tool to inform product design, development and procurement and has been integrated into alternative assessment frameworks. The extent to which assessment methods originally designed for conventionally-sized materials can be used for nanomaterials, which have size-dependent physical and chemical properties, have not been well established. We contracted with a certified GreenScreen profiler to conduct three GreenScreen hazard assessments, for conventional silver and two forms of nanosilver. The contractor summarized publicly available literature, and used defined GreenScreen hazard criteria and expert judgment to assign and report hazard classification levels, along with indications of confidence in those assignments. Where data were not available, a data gap (DG) was assigned. Using the individual endpoint scores, an aggregated benchmark score (BM) was applied. Conventional silver and low-soluble nanosilver were assigned the highest possible hazard score and a silica-silver nanocomposite called AGS-20 could not be scored due to data gaps. AGS-20 is approved for use as antimicrobials by the US Environmental Protection Agency. An existing method for chemical hazard assessment and communication can be used - with minor adaptations- to compare hazards across conventional and nano forms of a substance. The differences in data gaps and in hazard profiles support the argument that each silver form should be considered unique and subjected to hazard assessment to inform regulatory decisions and decisions about product design and development. A critical limitation of hazard assessments for nanomaterials is the lack of nano-specific hazard data - where data are available, we demonstrate that existing hazard assessment systems can work. The work is relevant for risk assessors and regulators. We recommend that regulatory agencies and others require more robust data sets on each novel nanomaterial before granting market approval.

What can the rangeland decision-making survey do for you?

USDA-ARS?s Scientific Manuscript database

Every day, rangeland managers make complicated decisions to balance multiple outcomes. The complex nature of ranch decision-making is not well understood by scientists, policy makers or the general public. To fill this gap, the Wyoming Stock Growers Association has partnered with the Agricultural Re...

Nurse aide decision making in nursing homes: factors affecting empowerment.

PubMed

Chaudhuri, Tanni; Yeatts, Dale E; Cready, Cynthia M

2013-09-01

To evaluate factors affecting structural empowerment among nurse aides in nursing homes. Structural empowerment can be defined as the actual rather than perceived ability to make autonomous decisions within an organisation. Given the paucity of research on the subject, this study helps to close the gap by identifying factors that affect nurse aide empowerment, that is, decision-making among nurse aides. The data for the study come from self-administered questionnaires distributed to direct-care workers (nurse aides) in 11 nursing homes in a southern state in the USA. Ordinary least square regression models were estimated to analyse the effects of demographic predictors, personal factors (competency, emotional exhaustion and positive attitude) and structural characteristics (coworker and supervisor support, information availability and shared governance) on nurse aide decision-making. Findings suggest race among demographic predictors, emotional exhaustion among personal characteristics, and supervisor support, and shared governance among structural factors, significantly affect nurse aide decision-making. It is important to explore race as one of the central determinants of structural empowerment among nurse aides. In addition, the nature and type of emotional exhaustion that propels decision-making needs to be further examined. The study shows the importance of shared governance and supervisor support for fostering nurse aide empowerment. © 2013 Blackwell Publishing Ltd.

Why is it hard to make progress in assessing children's decision-making competence?

PubMed

Hein, Irma M; Troost, Pieter W; Broersma, Alice; de Vries, Martine C; Daams, Joost G; Lindauer, Ramón J L

2015-01-10

For decades, the discussion on children's competence to consent to medical issues has concentrated around normative concerns, with little progress in clinical practices. Decision-making competence is an important condition in the informed consent model. In pediatrics, clinicians need to strike a proper balance in order to both protect children's interests when they are not fully able to do so themselves and to respect their autonomy when they are. Children's competence to consent, however, is currently not assessed in a standardized way. Moreover, the correlation between competence to give informed consent and age in children has never been systematically investigated, nor do we know which factors exactly contribute to children's competence.This article aims at identifying these gaps in knowledge and suggests options for dealing with the obstacles in empirical research in order to advance policies and practices regarding children's medical decision-making competence. Understanding children's competency is hampered by the law. Legislative regulations concerning competency are established on a strong presumption that persons older than a certain age are competent, whereas younger persons are not. Furthermore, a number of contextual factors are believed to be of influence on a child's decision-making competence: the developmental stage of children, the influence of parents and peers, the quality of information provision, life experience, the type of medical decision, and so on. Ostensibly, these diverse and extensive barriers hinder any form of advancement in this conflicted area. Addressing these obstacles encourages the discussion on children's competency, in which the most prominent question concerns the lack of a clear operationalization of children's competence to consent. Empirical data are needed to substantiate the discussion. The empirical approach offers an opportunity to give direction to the debate. Recommendations for future research include: studying a standardized assessment instrument covering all four relevant dimensions of competence (understanding, reasoning, appreciation, expressing a choice), including a study population of children covering the full age range of 7 to 18 years, improving information provision, and assessing relevant contextual data.

An evaluation of health benefit modification in Taft-Hartley health and welfare funds: implications for encouraging tobacco-cessation coverage.

PubMed

Au-Yeung, Caroline M; Weisman, Susan R; Hennrikus, Deborah J; Forster, Jean L; Skoog, Rodney; Luneburg, Wade; Hesse, Bernie

2010-12-01

An estimated one fifth of all U.S. adult smokers receive health benefits through insurance plans administered by Taft-Hartley Health and Welfare Funds. Most funds do not offer comprehensive tobacco-cessation services to fund participants despite evidence that doing so would be cost effective and save lives. This paper examines the decision-making processes of Minnesota-based fund trustees and advisors to identify factors that influence decisions about modifications to benefits. Formative data about the process by which funds make health benefit modifications were collected in 2007-2008 from 25 in-depth key informant interviews with fund trustees and a cross-section of fund advisors, including administrators, attorneys, and healthcare business consultants. Analyses were performed using a general inductive approach to identify conceptual themes, employing qualitative data analysis software. The most commonly cited factors influencing trustees' decisions about health plan benefit modifications-including modifications regarding tobacco-cessation benefits-were benefit costs, participants' demand for services, and safeguarding participants' health. Barriers included information gaps, concerns about participants' response, and difficulty projecting benefit utilization and success. Advisors wielded considerable influence in decision-making processes. Trustees relied on a small pool of business, legal, and administrative advisors to provide guidance and recommendations about possible health plan benefit modifications. Providing advisors with evidence-based information and resources about benefit design, cost/return-on-investment (ROI), effectiveness, and promotion may be an effective means to influence funds to provide comprehensive tobacco-cessation benefits. Copyright © 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Web-based cancer communication and decision making systems: connecting patients, caregivers, and clinicians for improved health outcomes.

PubMed

DuBenske, Lori L; Gustafson, David H; Shaw, Bret R; Cleary, James F

2010-01-01

Over the cancer disease trajectory, from diagnosis and treatment to remission or end of life, patients and their families face difficult decisions. The provision of information and support when most relevant can optimize cancer decision making and coping. An interactive health communication system (IHCS) offers the potential to bridge the communication gaps that occur among patients, family, and clinicians and to empower each to actively engage in cancer care and shared decision making. This is a report of the authors' experience (with a discussion of relevant literature) in developing and testing a Web-based IHCS-the Comprehensive Health Enhancement Support System (CHESS)-for patients with advanced lung cancer and their family caregivers. CHESS provides information, communication, and coaching resources as well as a symptom tracking system that reports health status to the clinical team. Development of an IHCS includes a needs assessment of the target audience and applied theory informed by continued stakeholder involvement in early testing. Critical issues of IHCS implementation include 1) need for interventions that accommodate a variety of format preferences and technology comfort ranges; 2) IHCS user training, 3) clinician investment in IHCS promotion, and 4) IHCS integration with existing medical systems. In creating such comprehensive systems, development strategies need to be grounded in population needs with appropriate use of technology that serves the target users, including the patient/family, clinical team, and health care organization. Implementation strategies should address timing, personnel, and environmental factors to facilitate continued use and benefit from IHCS.

Health Consumers eHealth Literacy to Decrease Disparities in Accessing eHealth Information.

PubMed

Park, Hyejin; Cormier, Eileen; Glenna, Gordon

2016-01-01

The purpose of this study was to assess the perceived eHealth literacy of a general health consumer population so that health care professionals can effectively address skills gaps in health consumers' ability to access and use high quality online health information. Participants were recruited from three public library branches in a Northeast Florida community. The eHealth literacy scale (eHEALS) was used. The majority of participants (n = 108) reported they knew how and where to find health information and how to use it to make health decisions; knowledge of what health resources were available and confidence in the ability to distinguish high from low quality information was considerably less. The findings suggest the need for eHealth education and support to health consumers from health care professionals, in particular, how to access and evaluate the quality of health information.

Educating Parents About Pediatric Research: Children and Clinical Studies Website Qualitative Evaluation.

PubMed

Marceau, Lisa D; Welch, Lisa C; Pemberton, Victoria L; Pearson, Gail D

2016-07-01

A gap in information about pediatric clinical trials exists, and parents remain uncertain about what is involved in research studies involving children. We aimed to understand parent perspectives about pediatric clinical research after viewing the online Children and Clinical Studies (CaCS) program. Using a qualitative descriptive study design, we conducted focus groups with parents and phone interviews with physicians. Three themes emerged providing approaches to improve parent's understanding of clinical research by including strategies where parents (a) hear from parents like themselves to learn about pediatric research, (b) receive general clinical research information to complement study-specific details, and (c) are provided more information about the role of healthy child volunteers. Parents found the website a valuable tool that would help them make a decision about what it means to participate in research. This tool can assist parents, providers, and researchers by connecting general information with study-specific information. © The Author(s) 2015.

NASA/SDIO Space Environmental Effects on Materials Workshop, part 1

NASA Technical Reports Server (NTRS)

Teichman, Louis A. (Compiler); Stein, Bland A. (Compiler)

1989-01-01

The present state of knowledge regarding space environmental effects on materials is described and the knowledge gaps that prevent informed decisions on the best use of advanced materials in space for long-duration NASA and Strategic Defense Initiative Organization (SDIO) missions are identified. Establishing priorities for future ground-based and space-based materials research was a major goal. The end product was an assessment of the current state-of-the-art in space environmental effects on materials in order to develop a national plan for spaceflight experiments.

Geospatial Technology in Disease Mapping, E- Surveillance and Health Care for Rural Population in South India

NASA Astrophysics Data System (ADS)

Praveenkumar, B. A.; Suresh, K.; Nikhil, A.; Rohan, M.; Nikhila, B. S.; Rohit, C. K.; Srinivas, A.

2014-11-01

Providing Healthcare to rural population has been a challenge to the medical service providers especially in developing countries. For this to be effective, scalable and sustainable, certain strategic decisions have to be taken during the planning phase. Also, there is a big gap between the services available and the availability of doctors and medical resources in rural areas. Use of Information Technology can aid this deficiency to a good extent. In this paper, a mobile application has been developed to gather data from the field. A cloud based interface has been developed to store the data in the cloud for effective usage and management of the data. A decision tree based solution developed in this paper helps in diagnosing a patient based on his health parameters. Interactive geospatial maps have been developed to provide effective data visualization facility. This will help both the user community as well as decision makers to carry out long term strategy planning.

The combination of direct and paired link graphs can boost repetitive genome assembly

PubMed Central

Shi, Wenyu; Ji, Peifeng

2017-01-01

Abstract Currently, most paired link based scaffolding algorithms intrinsically mask the sequences between two linked contigs and bypass their direct link information embedded in the original de Bruijn assembly graph. Such disadvantage substantially complicates the scaffolding process and leads to the inability of resolving repetitive contig assembly. Here we present a novel algorithm, inGAP-sf, for effectively generating high-quality and continuous scaffolds. inGAP-sf achieves this by using a new strategy based on the combination of direct link and paired link graphs, in which direct link is used to increase graph connectivity and to decrease graph complexity and paired link is employed to supervise the traversing process on the direct link graph. Such advantage greatly facilitates the assembly of short-repeat enriched regions. Moreover, a new comprehensive decision model is developed to eliminate the noise routes accompanying with the introduced direct link. Through extensive evaluations on both simulated and real datasets, we demonstrated that inGAP-sf outperforms most of the genome scaffolding algorithms by generating more accurate and continuous assembly, especially for short repetitive regions. PMID:27924003

Pedestrian temporal and spatial gap acceptance at mid-block street crossing in developing world.

PubMed

Pawar, Digvijay S; Patil, Gopal R

2015-02-01

Most of the midblock pedestrian crossings on urban roads in India are uncontrolled; wherein the high degree of discretion in pedestrians' behavior while crossing the traffic stream, has made the situation complex to analyze. Vehicles do not yield to pedestrians, even though the traffic laws give priority to pedestrians over motorized vehicles at unsignalized pedestrian crossings. Therefore, a pedestrian has to decide if an available gap is safe or not for crossing. This paper aims to investigate pedestrian temporal and spatial gap acceptance for midblock street crossings. Field data were collected using video camera at two midblock pedestrian crossings. The data extraction in laboratory resulted in 1107 pedestrian gaps. Available gaps, pedestrians' decision, traffic volume, etc. were extracted from the videos. While crossing a road with multiple lanes, rolling gap acceptance behavior was observed. Using binary logit analysis, six utility models were developed, three each for temporal and spatial gaps. The 50th percentile temporal and spatial gaps ranged from 4.1 to 4.8s and 67 to 79 m respectively, whereas the 85th percentile temporal and spatial gaps ranged from 5 to 5.8s and 82 to 95 m respectively. These gap values were smaller than that reported in the studies in developed countries. The speed of conflicting vehicle was found to be significant in spatial gap but not in temporal gap acceptance. The gap acceptance decision was also found to be affected by the type of conflicting vehicles. The insights from this study can be used for the safety and performance evaluation of uncontrolled midblock street crossings in developing countries. Copyright © 2014 Elsevier Ltd and National Safety Council. All rights reserved.

Filling the Gaps in a Fragmented Health Care System: Development of the Health and Welfare Information Portal (ZWIP).

PubMed

Robben, Sarah Hm; Huisjes, Mirjam; van Achterberg, Theo; Zuidema, Sytse U; Olde Rikkert, Marcel Gm; Schers, Henk J; Heinen, Maud M; Melis, René Jf

2012-09-19

Current health care systems are not optimally designed to meet the needs of our aging populations. First, the fragmentation of care often results in discontinuity of care that can undermine the quality of care provided. Second, patient involvement in care decisions is not sufficiently facilitated. To describe the development and the content of a program aimed at: (1) facilitating self-management and shared decision making by frail older people and informal caregivers, and (2) reducing fragmentation of care by improving collaboration among professionals involved in the care of frail older people through a combined multidisciplinary electronic health record (EHR) and personal health record (PHR). We used intervention mapping to systematically develop our program in six consecutive steps. Throughout this development, the target populations (ie, professionals, frail older people, and informal caregivers) were involved extensively through their participation in semi-structured interviews and working groups. We developed the Health and Welfare Information Portal (ZWIP), a personal, Internet-based conference table for multidisciplinary communication and information exchange for frail older people, their informal caregivers, and professionals. Further, we selected and developed methods for implementation of the program, which included an interdisciplinary educational course for professionals involved in the care of frail older people, and planned the evaluation of the program. This paper describes the successful development and the content of the ZWIP as well as the strategies developed for its implementation. Throughout the development, representatives of future users were involved extensively. Future studies will establish the effects of the ZWIP on self-management and shared decision making by frail older people as well as on collaboration among the professionals involved.

Bridging the Gap Between NASA Earth Observations and Decision Makers Through the NASA Develop National Program

NASA Astrophysics Data System (ADS)

Remillard, C. M.; Madden, M.; Favors, J.; Childs-Gleason, L.; Ross, K. W.; Rogers, L.; Ruiz, M. L.

2016-06-01

The NASA DEVELOP National Program bridges the gap between NASA Earth Science and society by building capacity in both participants and partner organizations that collaborate to conduct projects. These rapid feasibility projects highlight the capabilities of satellite and aerial Earth observations. Immersion of decision and policy makers in these feasibility projects increases awareness of the capabilities of Earth observations and contributes to the tools and resources available to support enhanced decision making. This paper will present the DEVELOP model, best practices, and two case studies, the Colombia Ecological Forecasting project and the Miami-Dade County Ecological Forecasting project, that showcase the successful adoption of tools and methods for decision making. Through over 90 projects each year, DEVELOP is always striving for the innovative, practical, and beneficial use of NASA Earth science data.

The construct-behavior gap in behavioral decision research: A challenge beyond replicability.

PubMed

Regenwetter, Michel; Robinson, Maria M

2017-10-01

Behavioral decision research compares theoretical constructs like preferences to behavior such as observed choices. Three fairly common links from constructs to behavior are (1) to tally, across participants and decision problems, the number of choices consistent with one predicted pattern of pairwise preferences; (2) to compare what most people choose in each decision problem against a predicted preference pattern; or (3) to enumerate the decision problems in which two experimental conditions generate a 1-sided significant difference in choice frequency 'consistent' with the theory. Although simple, these theoretical links are heuristics. They are subject to well-known reasoning fallacies, most notably the fallacy of sweeping generalization and the fallacy of composition. No amount of replication can alleviate these fallacies. On the contrary, reiterating logically inconsistent theoretical reasoning over and again across studies obfuscates science. As a case in point, we consider pairwise choices among simple lotteries and the hypotheses of overweighting or underweighting of small probabilities, as well as the description-experience gap. We discuss ways to avoid reasoning fallacies in bridging the conceptual gap between hypothetical constructs, such as, for example, "overweighting" to observable pairwise choice data. Although replication is invaluable, successful replication of hard-to-interpret results is not. Behavioral decision research stands to gain much theoretical and empirical clarity by spelling out precise and formally explicit theories of how hypothetical constructs translate into observable behavior. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

The Business of Co-Production: Assessing Efforts to Bridge Science and Decision-Making for Adaptation in California

NASA Astrophysics Data System (ADS)

Webber, S.; MacDonald, G. M.

2016-12-01

The last decades have seen scholars argue for a greater integration of science and decision-making in order to more effectively respond to climate change. It has been suggested that overcoming the gap between science, on the one hand, and policy-making and management, on the other, requires building bridges through methods of co-production, creating actionable science, or through boundary organizations. In this paper, we review attempts at co-production for policy-making and management in the context of climate change adaptation in California. Building on field research, including numerous interviews conducted with scientists and decision-makers who are co-producers of adaptation projects, we make three arguments. First, we show that an emphasis on co-production and science-informed climate change adaptation decision-making has bolstered a contract-oriented, and decentralized network-based model of producing climate science. Second, reviewing successes and failures in co-production - as reported in interviews - indicates that it is principally in cases of neatly defined, and spatially and temporarily narrow decision-making contexts, and with highly motivated decision-makers, that climate science is used. Finally, we suggest that the ideas of co-production and actionable science may have increased the institutional and organizational burden at the science-decision interface, lengthening the boundary-organization-chain rather than necessarily facilitating adaptive policy-making and management.

Effects of informed consent for individual genome sequencing on relevant knowledge.

PubMed

Kaphingst, K A; Facio, F M; Cheng, M-R; Brooks, S; Eidem, H; Linn, A; Biesecker, B B; Biesecker, L G

2012-11-01

Increasing availability of individual genomic information suggests that patients will need knowledge about genome sequencing to make informed decisions, but prior research is limited. In this study, we examined genome sequencing knowledge before and after informed consent among 311 participants enrolled in the ClinSeq™ sequencing study. An exploratory factor analysis of knowledge items yielded two factors (sequencing limitations knowledge; sequencing benefits knowledge). In multivariable analysis, high pre-consent sequencing limitations knowledge scores were significantly related to education [odds ratio (OR): 8.7, 95% confidence interval (CI): 2.45-31.10 for post-graduate education, and OR: 3.9; 95% CI: 1.05, 14.61 for college degree compared with less than college degree] and race/ethnicity (OR: 2.4, 95% CI: 1.09, 5.38 for non-Hispanic Whites compared with other racial/ethnic groups). Mean values increased significantly between pre- and post-consent for the sequencing limitations knowledge subscale (6.9-7.7, p < 0.0001) and sequencing benefits knowledge subscale (7.0-7.5, p < 0.0001); increase in knowledge did not differ by sociodemographic characteristics. This study highlights gaps in genome sequencing knowledge and underscores the need to target educational efforts toward participants with less education or from minority racial/ethnic groups. The informed consent process improved genome sequencing knowledge. Future studies could examine how genome sequencing knowledge influences informed decision making. © 2012 John Wiley & Sons A/S.

Perceived Barriers and Facilitators of Using a Web-Based Interactive Decision Aid for Colorectal Cancer Screening in Community Practice Settings: Findings From Focus Groups With Primary Care Clinicians and Medical Office Staff

PubMed Central

2013-01-01

Background Information is lacking about the capacity of those working in community practice settings to utilize health information technology for colorectal cancer screening. Objective To address this gap we asked those working in community practice settings to share their perspectives about how the implementation of a Web-based patient-led decision aid might affect patient-clinician conversations about colorectal cancer screening and the day-to-day clinical workflow. Methods Five focus groups in five community practice settings were conducted with 8 physicians, 1 physician assistant, and 18 clinic staff. Focus groups were organized using a semistructured discussion guide designed to identify factors that mediate and impede the use of a Web-based decision aid intended to clarify patient preferences for colorectal cancer screening and to trigger shared decision making during the clinical encounter. Results All physicians, the physician assistant, and 8 of the 18 clinic staff were active participants in the focus groups. Clinician and staff participants from each setting reported a belief that the Web-based patient-led decision aid could be an informative and educational tool; in all but one setting participants reported a readiness to recommend the tool to patients. The exception related to clinicians from one clinic who described a preference for patients having fewer screening choices, noting that a colonoscopy was the preferred screening modality for patients in their clinic. Perceived barriers to utilizing the Web-based decision aid included patients’ lack of Internet access or low computer literacy, and potential impediments to the clinics’ daily workflow. Expanding patients’ use of an online decision aid that is both easy to access and understand and that is utilized by patients outside of the office visit was described as a potentially efficient means for soliciting patients’ screening preferences. Participants described that a system to link the online decision aid to a computerized reminder system could promote a better understanding of patients’ screening preferences, though some expressed concern that such a system could be difficult to keep up and running. Conclusions Community practice clinicians and staff perceived the Web-based decision aid technology as promising but raised questions as to how the technology and resultant information would be integrated into their daily practice workflow. Additional research investigating how to best implement online decision aids should be conducted prior to the widespread adoption of such technology so as to maximize the benefits of the technology while minimizing workflow disruptions. PMID:24351420

From Information to Urban Sustainability through Innovations in Citizen Centered Transparency Mechanism

NASA Astrophysics Data System (ADS)

Tiwari, A.

2017-12-01

Current urban information mechanisms in developing countries operate only through linear exchanges between institutions and users and therefore reinforce hierarchical relationships. Coupled with conflicting interests and perspectives of stakeholders in multilevel climate-governance and absence of grassroots information-networking for adaptation decision-making, there are therefore, existing information gaps. Central to urban sustainability is the need for citizen centered transparency (CCT) mechanisms that encompass and address the needs of the marginalized and vulnerable communities in developing countries especially. The study discloses the existing information gaps through information-needs assessment of stakeholders, and attempts to chart the desired course for responsible action within frame-work of Citizen Centered Transparency (CCT) mechanism. This involved analysis of several urban development projects for Indian metropolitans that mainly involved end-user association, and the parameters considered for breaking complexity for assessment included: a. Feedback: Ends-user feedback to improve resource consumption literacy and consequently urban behaviour and sustainable lifestyles(feedback technology, consumption displays, eco-labeling, billing, advisory services, sensor technology), and b. Administrative Traditions and Institutional Policy: Rewarding-punishing to enforce desired action(subsidies, taxation). The research thus answered: 1.Who gets the information whereas who requires it (Equity in Information Distribution)? and 2. How can information translate to responsible action in future (Transparency of Execution)? Findings suggested that, how, by using the CCT innovations it is practically possible to embed responsibilities in urban development planning, and manifesting environmental goals in municipal policies so that they bear clear potential short-term benefits, short-term costs, and have maximum compliance with the objectives of sustainable urban development.

Efficient Computation of Info-Gap Robustness for Finite Element Models

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

Stull, Christopher J.; Hemez, Francois M.; Williams, Brian J.

2012-07-05

A recent research effort at LANL proposed info-gap decision theory as a framework by which to measure the predictive maturity of numerical models. Info-gap theory explores the trade-offs between accuracy, that is, the extent to which predictions reproduce the physical measurements, and robustness, that is, the extent to which predictions are insensitive to modeling assumptions. Both accuracy and robustness are necessary to demonstrate predictive maturity. However, conducting an info-gap analysis can present a formidable challenge, from the standpoint of the required computational resources. This is because a robustness function requires the resolution of multiple optimization problems. This report offers anmore » alternative, adjoint methodology to assess the info-gap robustness of Ax = b-like numerical models solved for a solution x. Two situations that can arise in structural analysis and design are briefly described and contextualized within the info-gap decision theory framework. The treatments of the info-gap problems, using the adjoint methodology are outlined in detail, and the latter problem is solved for four separate finite element models. As compared to statistical sampling, the proposed methodology offers highly accurate approximations of info-gap robustness functions for the finite element models considered in the report, at a small fraction of the computational cost. It is noted that this report considers only linear systems; a natural follow-on study would extend the methodologies described herein to include nonlinear systems.« less

Influence of management and environment on Australian wheat: information for sustainable intensification and closing yield gaps

NASA Astrophysics Data System (ADS)

Bryan, B. A.; King, D.; Zhao, G.

2014-04-01

In the future, agriculture will need to produce more, from less land, more sustainably. But currently, in many places, actual crop yields are below those attainable. We quantified the ability for agricultural management to increase wheat yields across 179 Mha of potentially arable land in Australia. Using the Agricultural Production Systems Simulator (APSIM), we simulated the impact on wheat yield of 225 fertilization and residue management scenarios at a high spatial, temporal, and agronomic resolution from 1900 to 2010. The influence of management and environmental variables on wheat yield was then assessed using Spearman’s non-parametric correlation test with bootstrapping. While residue management showed little correlation, fertilization strongly increased wheat yield up to around 100 kg N ha-1 yr-1. However, this effect was highly dependent on the key environment variables of rainfall, temperature, and soil water holding capacity. The influence of fertilization on yield was stronger in cooler, wetter climates, and in soils with greater water holding capacity. We conclude that the effectiveness of management intensification to increase wheat yield is highly dependent upon local climate and soil conditions. We provide context-specific information on the yield benefits of fertilization to support adaptive agronomic decision-making and contribute to the closure of yield gaps. We also suggest that future assessments consider the economic and environmental sustainability of management intensification for closing yield gaps.

A patient-centered research agenda for the care of the acutely ill older patient.

PubMed

Wald, Heidi L; Leykum, Luci K; Mattison, Melissa L P; Vasilevskis, Eduard E; Meltzer, David O

2015-05-01

Hospitalists and others acute-care providers are limited by gaps in evidence addressing the needs of the acutely ill older adult population. The Society of Hospital Medicine sponsored the Acute Care of Older Patients Priority Setting Partnership to develop a research agenda focused on bridging this gap. Informed by the Patient-Centered Outcomes Research Institute framework for identification and prioritization of research areas, we adapted a methodology developed by the James Lind Alliance to engage diverse stakeholders in the research agenda setting process. The work of the Partnership proceeded through 4 steps: convening, consulting, collating, and prioritizing. First, the steering committee convened a partnership of 18 stakeholder organizations in May 2013. Next, stakeholder organizations surveyed members to identify important unanswered questions in the acute care of older persons, receiving 1299 responses from 580 individuals. Finally, an extensive and structured process of collation and prioritization resulted in a final list of 10 research questions in the following areas: advanced-care planning, care transitions, delirium, dementia, depression, medications, models of care, physical function, surgery, and training. With the changing demographics of the hospitalized population, a workforce with limited geriatrics training, and gaps in evidence to inform clinical decision making for acutely ill older patients, the identified research questions deserve the highest priority in directing future research efforts to improve care for the older hospitalized patient and enrich training. © 2015 Society of Hospital Medicine.

Improving access to shared decision-making for Hispanics/Latinos with inadequately controlled type 2 diabetes mellitus

PubMed Central

Davidson, Jaime A; Rosales, Aracely; Shillington, Alicia C; Bailey, Robert A; Kabir, Chris; Umpierrez, Guillermo E

2015-01-01

Purpose To describe the cultural and linguistic adaptation and Spanish translation of an English-language patient decision aid (PDA) for use in supporting shared decision-making in Hispanics/Latinos with type 2 diabetes mellitus (T2DM), a group at a high risk for complications. Patients and methods A steering committee of endocrinologists, a primary care physician, a certified diabetes educator, and a dietician, each with extensive experience in providing care to Hispanics/Latinos was convened to assess a PDA developed for English-speaking patients with T2DM. English content was reviewed for cultural sensitivity and appropriateness for a Hispanic/Latino population. A consensus-building process and iterative version edits incorporated clinician perspectives. The content was adapted to be consistent with traditional Hispanic/Latino cultural communication precepts (eg, avoidance of hostile confrontation; value for warm interaction; respect for authority; value of family support for decisions). The PDA was translated by native-speaking individuals with diabetes expertise. Results The PDA underwent testing during cognitive interviews with ten Spanish-speaking Hispanics/Latinos with T2DM to ensure that the content is reflective of the experience, understanding, and language Hispanic/Latino patients use to describe diabetes and treatment. Content edits were made to assure a literacy level appropriate to the audience, and the PDA was produced for online video dissemination. Conclusion High-quality, well-developed tools to facilitate shared decision-making in populations with limited access to culturally sensitive information can narrow gaps and align care with individual patient preferences. A newly developed PDA is available for shared decision-making that provides culturally appropriate treatment information for inadequately controlled Hispanics/Latinos with T2DM. The impact on the overall health of patients and care management of T2DM requires further study. PMID:25995623

Integrating Ecosystem-Based Management Principles of Adaptive Management and Stakeholder Engagement in California Fisheries

NASA Astrophysics Data System (ADS)

Erickson, A.; Martone, R. G.; Hazen, L.; Mease, L.; Gourlie, D.; Le Cornu, E.; Ourens, R.; Micheli, F.

2016-12-01

California's fisheries management law, the Marine Life Management Act (MLMA) of 1998, signaled a transformative shift from traditional single-species management to an ecosystem-based approach. In response, the fisheries management community in California is striving to integrate new science and management innovations while maximizing its limited capacity. However, data gaps, high compliance costs, capacity constraints, and limited access to the best available data and technologies persist. Here we present two decision support tools being developed to aid California fisheries managers as they continue to implement ecosystem-based management (EBM). First, to practice adaptive management, a key principle of EBM, managers must know whether and how their decisions are meeting their management objectives over time. Based on a cross-walk of MLMA goals with metrics and indicators from sustainable fishery certification programs, we present a flexible and practical tool for tracking fishery management performance in California. We showcase a draft series of decision trees and questionnaires managers can use to quantitatively or qualitatively measure both ecological and social outcomes, helping them to prioritize management options and limited resources. Second, state fisheries managers acknowledge the need for more effective stakeholder engagement to facilitate and inform decision-making and long-term outcomes, another key principle of EBM. Here, we present a pilot version of a decision-support tool to aid managers in choosing the most appropriate stakeholder engagement strategies in various types of decision contexts. This online tool will help staff identify their engagement goals, when they can strategically engage stakeholders based on their needs, and the fishery characteristics that will inform how engagement strategies are tailored to specific contexts. We also share opportunities to expand these EBM tools to other resource management contexts and scales.

Factors influencing a nurse's decision to question medication administration in a neonatal clinical care unit.

PubMed

Aydon, Laurene; Hauck, Yvonne; Zimmer, Margo; Murdoch, Jamee

2016-09-01

The aim of this study was to identify factors that influence nurse's decisions to question concerning aspects of medication administration within the context of a neonatal clinical care unit. Medication error in the neonatal setting can be high with this particularly vulnerable population. As the care giver responsible for medication administration, nurses are deemed accountable for most errors. However, they are recognised as the forefront of prevention. Minimal evidence is available around reasoning, decision making and questioning around medication administration. Therefore, this study focuses upon addressing the gap in knowledge around what nurses believe influences their decision to question. A critical incident design was employed where nurses were asked to describe clinical incidents around their decision to question a medication issue. Nurses were recruited from a neonatal clinical care unit and participated in an individual digitally recorded interview. One hundred and three nurses participated between December 2013-August 2014. Use of the constant comparative method revealed commonalities within transcripts. Thirty-six categories were grouped into three major themes: 'Working environment', 'Doing the right thing' and 'Knowledge about medications'. Findings highlight factors that influence nurses' decision to question issues around medication administration. Nurses feel it is their responsibility to do the right thing and speak up for their vulnerable patients to enhance patient safety. Negative dimensions within the themes will inform planning of educational strategies to improve patient safety, whereas positive dimensions must be reinforced within the multidisciplinary team. The working environment must support nurses to question and ultimately provide safe patient care. Clear and up to date policies, formal and informal education, role modelling by senior nurses, effective use of communication skills and a team approach can facilitate nurses to appropriately question aspects around medication administration. © 2016 John Wiley & Sons Ltd.

Integrating Ecosystem-Based Management Principles of Adaptive Management and Stakeholder Engagement in California Fisheries

NASA Astrophysics Data System (ADS)

Erickson, A.; Martone, R. G.; Hazen, L.; Mease, L.; Gourlie, D.; Le Cornu, E.; Ourens, R.; Micheli, F.

2016-02-01

California's fisheries management law, the Marine Life Management Act (MLMA) of 1998, signaled a transformative shift from traditional single-species management to an ecosystem-based approach. In response, the fisheries management community in California is striving to integrate new science and management innovations while maximizing its limited capacity. However, data gaps, high compliance costs, capacity constraints, and limited access to the best available data and technologies persist. Here we present two decision support tools being developed to aid California fisheries managers as they continue to implement ecosystem-based management (EBM). First, to practice adaptive management, a key principle of EBM, managers must know whether and how their decisions are meeting their management objectives over time. Based on a cross-walk of MLMA goals with metrics and indicators from sustainable fishery certification programs, we present a flexible and practical tool for tracking fishery management performance in California. We showcase a draft series of decision trees and questionnaires managers can use to quantitatively or qualitatively measure both ecological and social outcomes, helping them to prioritize management options and limited resources. Second, state fisheries managers acknowledge the need for more effective stakeholder engagement to facilitate and inform decision-making and long-term outcomes, another key principle of EBM. Here, we present a pilot version of a decision-support tool to aid managers in choosing the most appropriate stakeholder engagement strategies in various types of decision contexts. This online tool will help staff identify their engagement goals, when they can strategically engage stakeholders based on their needs, and the fishery characteristics that will inform how engagement strategies are tailored to specific contexts. We also share opportunities to expand these EBM tools to other resource management contexts and scales.

Improving access to shared decision-making for Hispanics/Latinos with inadequately controlled type 2 diabetes mellitus.

PubMed

Davidson, Jaime A; Rosales, Aracely; Shillington, Alicia C; Bailey, Robert A; Kabir, Chris; Umpierrez, Guillermo E

2015-01-01

To describe the cultural and linguistic adaptation and Spanish translation of an English-language patient decision aid (PDA) for use in supporting shared decision-making in Hispanics/Latinos with type 2 diabetes mellitus (T2DM), a group at a high risk for complications. A steering committee of endocrinologists, a primary care physician, a certified diabetes educator, and a dietician, each with extensive experience in providing care to Hispanics/Latinos was convened to assess a PDA developed for English-speaking patients with T2DM. English content was reviewed for cultural sensitivity and appropriateness for a Hispanic/Latino population. A consensus-building process and iterative version edits incorporated clinician perspectives. The content was adapted to be consistent with traditional Hispanic/Latino cultural communication precepts (eg, avoidance of hostile confrontation; value for warm interaction; respect for authority; value of family support for decisions). The PDA was translated by native-speaking individuals with diabetes expertise. The PDA underwent testing during cognitive interviews with ten Spanish-speaking Hispanics/Latinos with T2DM to ensure that the content is reflective of the experience, understanding, and language Hispanic/Latino patients use to describe diabetes and treatment. Content edits were made to assure a literacy level appropriate to the audience, and the PDA was produced for online video dissemination. High-quality, well-developed tools to facilitate shared decision-making in populations with limited access to culturally sensitive information can narrow gaps and align care with individual patient preferences. A newly developed PDA is available for shared decision-making that provides culturally appropriate treatment information for inadequately controlled Hispanics/Latinos with T2DM. The impact on the overall health of patients and care management of T2DM requires further study.

Right and access to healthcare for undocumented children: addressing the gap between international conventions and disparate implementations in North America and Europe.

PubMed

Ruiz-Casares, Mónica; Rousseau, Cécile; Derluyn, Ilse; Watters, Charles; Crépeau, François

2010-01-01

Limited access to healthcare for vulnerable immigrant children in Europe and North America is increasingly worrisome as immigration policies harden. This paper analyzes the gap between States' obligations under international human rights law and the disparate local implementations in diverse countries. Studies that are both multidisciplinary and incorporate micro and macro level indicators are needed to reveal discrepancies between entitlements and access. It is argued that the lack of available data on the magnitude of the problem and on its individual and public health consequences stems from the conflicting situation faced by health institutions required to simultaneously protect the best interest of each child and allocate limited resources. Collaboration in research is urgently needed to assist policy-makers and institutions make informed decisions. Copyright 2009 Elsevier Ltd. All rights reserved.

IT investments can add business value.

PubMed

Williams, Terry G

2002-05-01

Investment in information technology (IT) is costly, but necessary to enable healthcare organizations to improve their infrastructure and achieve other improvement initiatives. Such an investment is even more costly, however, if the technology does not appropriately enable organizations to perform business processes that help them accomplish their mission of providing safe, high-quality care cost-effectively. Before committing to a costly IT investment, healthcare organizations should implement a decision-making process that can help them choose, implement, and use technology that will provide sustained business value. A seven-step decision-making process that can help healthcare organizations achieve this result involves performing a gap analysis, assessing and aligning organizational goals, establishing distributed accountability, identifying linked organizational-change initiatives, determining measurement methods, establishing appropriate teams to ensure systems are integrated with multidisciplinary improvement methods, and developing a plan to accelerate adoption of the IT product.

Effects of Information Visualization on Older Adults' Decision-Making Performance in a Medicare Plan Selection Task: A Comparative Usability Study.

PubMed

Price, Margaux M; Crumley-Branyon, Jessica J; Leidheiser, William R; Pak, Richard

2016-06-01

Technology gains have improved tools for evaluating complex tasks by providing environmental supports (ES) that increase ease of use and improve performance outcomes through the use of information visualizations (info-vis). Complex info-vis emphasize the need to understand individual differences in abilities of target users, the key cognitive abilities needed to execute a decision task, and the graphical elements that can serve as the most effective ES. Older adults may be one such target user group that would benefit from increased ES to mitigate specific declines in cognitive abilities. For example, choosing a prescription drug plan is a necessary and complex task that can impact quality of life if the wrong choice is made. The decision to enroll in one plan over another can involve comparing over 15 plans across many categories. Within this context, the large amount of complex information and reduced working memory capacity puts older adults' decision making at a disadvantage. An intentionally designed ES, such as an info-vis that reduces working memory demand, may assist older adults in making the most effective decision among many options. The objective of this study is to examine whether the use of an info-vis can lower working memory demands and positively affect complex decision-making performance of older adults in the context of choosing a Medicare prescription drug plan. Participants performed a computerized decision-making task in the context of finding the best health care plan. Data included quantitative decision-making performance indicators and surveys examining previous history with purchasing insurance. Participants used a colored info-vis ES or a table (no ES) to perform the decision task. Task difficulty was manipulated by increasing the number of selection criteria used to make an accurate decision. A repeated measures analysis was performed to examine differences between the two table designs. Twenty-three older adults between the ages of 66 and 80 completed the study. There was a main effect for accuracy such that older adults made more accurate decisions in the color info-vis condition than the table condition. In the low difficulty condition, participants were more successful at choosing the correct answer when the question was about the gap coverage attribute in the info-vis condition. Participants also made significantly faster decisions in the info-vis condition than in the table condition. Reducing the working memory demand of the task through the use of an ES can improve decision accuracy, especially when selection criteria is only focused on a single attribute of the insurance plan.

Workshop summary: 'Integrating air quality and climate mitigation - is there a need for new metrics to support decision making?'

NASA Astrophysics Data System (ADS)

von Schneidemesser, E.; Schmale, J.; Van Aardenne, J.

2013-12-01

Air pollution and climate change are often treated at national and international level as separate problems under different regulatory or thematic frameworks and different policy departments. With air pollution and climate change being strongly linked with regard to their causes, effects and mitigation options, the integration of policies that steer air pollutant and greenhouse gas emission reductions might result in cost-efficient, more effective and thus more sustainable tackling of the two problems. To support informed decision making and to work towards an integrated air quality and climate change mitigation policy requires the identification, quantification and communication of present-day and potential future co-benefits and trade-offs. The identification of co-benefits and trade-offs requires the application of appropriate metrics that are well rooted in science, easy to understand and reflect the needs of policy, industry and the public for informed decision making. For the purpose of this workshop, metrics were loosely defined as a quantified measure of effect or impact used to inform decision-making and to evaluate mitigation measures. The workshop held on October 9 and 10 and co-organized between the European Environment Agency and the Institute for Advanced Sustainability Studies brought together representatives from science, policy, NGOs, and industry to discuss whether current available metrics are 'fit for purpose' or whether there is a need to develop alternative metrics or reassess the way current metrics are used and communicated. Based on the workshop outcome the presentation will (a) summarize the informational needs and current application of metrics by the end-users, who, depending on their field and area of operation might require health, policy, and/or economically relevant parameters at different scales, (b) provide an overview of the state of the science of currently used and newly developed metrics, and the scientific validity of these metrics, (c) identify gaps in the current information base, whether from the scientific development of metrics or their application by different users.

Analyzing the "CareGap": assessing gaps in adherence to clinical guidelines in adult soft tissue sarcoma.

PubMed

Waks, Zeev; Goldbraich, Esther; Farkash, Ariel; Torresani, Michele; Bertulli, Rossella; Restifo, Nicola; Locatelli, Paolo; Casali, Paolo; Carmeli, Boaz

2013-01-01

Clinical decision support systems (CDSSs) are gaining popularity as tools that assist physicians in optimizing medical care. These systems typically comply with evidence-based medicine and are designed with input from domain experts. Nonetheless, deviations from CDSS recommendations are abundant across a broad spectrum of disorders, raising the question as to why this phenomenon exists. Here, we analyze this gap in adherence to a clinical guidelines-based CDSS by examining the physician treatment decisions for 1329 adult soft tissue sarcoma patients in northern Italy using patient-specific parameters. Dubbing this analysis "CareGap", we find that deviations correlate strongly with certain disease features such as local versus metastatic clinical presentation. We also notice that deviations from the guideline-based CDSS suggestions occur more frequently for patients with shorter survival time. Such observations can direct physicians' attention to distinct patient cohorts that are prone to higher deviation levels from clinical practice guidelines. This illustrates the value of CareGap analysis in assessing quality of care for subsets of patients within a larger pathology.

Using Co-production to Enhance Co-production: Cultivating institutional capacity through exchange between climate science, social science, and practice

NASA Astrophysics Data System (ADS)

Kalafatis, S.

2015-12-01

Many climate scientists and boundary organizations have accumulated years of experience providing decision support for climate adaptation related to landscape change. The Great Lakes Integrated Sciences + Assessments (GLISA) is one such organization that has developed a reputation for providing stakeholders with climate change decision support throughout the Great Lakes region of North America. After five years of applied outreach, GLISA climate scientists working with practitioners identified three common limitations across projects that were slowing down the use of information, describing them as mismatched terminology, unrealistic expectations, and disordered integration. Discussions with GLISA-affiliated social scientists revealed compelling parallels between these observations and the existing social science literature on the persistent "usability gap" in information use as well as opportunities to preemptively overcome these barriers. The discovery of these overlaps between the climate scientists' experience of barriers and the social science literature as well as strategies to systematically address them demonstrate the potential for boundary organizations to act as incubators of more and more efficient co-production over time. To help illustrate these findings, this presentation also provides an example of decision-making for adaptation in the face of landscape change in which GLISA scientists assisted Isle Royale National Park with assessing the implications of future ecological transitions for current wildlife management efforts.

Bridging the gap: exploring the barriers to using economic evidence in healthcare decision making and strategies for improving uptake.

PubMed

Merlo, Gregory; Page, Katie; Ratcliffe, Julie; Halton, Kate; Graves, Nicholas

2015-06-01

Evidence from economic evaluations is often not used to inform healthcare policy despite being well regarded by policy makers and physicians. This article employs the accessibility and acceptability framework to review the barriers to using evidence from economic evaluation in healthcare policy and the strategies used to overcome these barriers. Economic evaluations are often inaccessible to policymakers due to the absence of relevant economic evaluations, the time and cost required to conduct and interpret economic evaluations, and lack of expertise to evaluate quality and interpret results. Consistently reported factors that limit the translation of findings from economic evaluations into healthcare policy include poor quality of research informing economic evaluations, assumptions used in economic modelling, conflicts of interest, difficulties in transferring resources between sectors, negative attitudes to healthcare rationing, and the absence of equity considerations. Strategies to overcome these barriers have been suggested in the literature, including training, structured abstract databases, rapid evaluation, reporting checklists for journals, and considering factors other than cost effectiveness in economic evaluations, such as equity or budget impact. The factors that prevent or encourage decision makers to use evidence from economic evaluations have been identified, but the relative importance of these factors to decision makers is uncertain.

Characterization of the hydrologic resources of San Miguel County, New Mexico, and identification of hydrologic data gaps, 2011

USGS Publications Warehouse

Matherne, Anne Marie; Stewart, Anne M.

2012-01-01

The U.S. Geological Survey (USGS), in cooperation with San Miguel County, New Mexico, conducted a study to assess publicly available information regarding the hydrologic resources of San Miguel County and to identify data gaps in that information and hydrologic information that could aid in the management of available water resources. The USGS operates four continuous annual streamgages in San Miguel County. Monthly discharge at these streamgages is generally bimodally distributed, with most runoff corresponding to spring runoff and to summer monsoonal rains. Data compiled since 1951 on the geology and groundwater resources of San Miguel County are generally consistent with the original characterization of depth and availability of groundwater resources and of source aquifers. Subsequent exploratory drilling identified deep available groundwater in some locations. Most current (2011) development of groundwater resources is in western San Miguel County, particularly in the vicinity of El Creston hogback, the hogback ridge just west of Las Vegas, where USGS groundwater-monitoring wells indicate that groundwater levels are declining. Regarding future studies to address identified data gaps, the ability to evaluate and quantify surface-water resources, both as runoff and as potential groundwater recharge, could be enhanced by expanding the network of streamgages and groundwater-monitoring wells throughout the county. A series of seepage surveys along the lengths of the rivers could help to determine locations of surface-water losses to and gains from the local groundwater system and could help to quantify the component of streamflow attributable to irrigation return flow; associated synoptic water-quality sampling could help to identify potential effects to water quality attributable to irrigation return flow. Effects of groundwater withdrawals on streamflow could be assessed by constructing monitoring wells along transects between production wells and stream reaches of interest to monitor decline or recovery of the water table, to quantify the timing and extent of water-table response, and to identify the spatial extent of capture zones. Assessment of groundwater potential could be aided by a county-wide distribution of water-level information and by a series of maps of groundwater potential, compiled for each individual aquifer, including saline aquifers, for which the potential for municipal use through desalination could be explored. A county-wide geographic information system hydrologic geodatabase could provide a comprehensive picture of water use in San Miguel County and could be used by San Miguel County as a decision-support tool for future management decisions.

Bridging gaps in health information systems: a case study from Somaliland, Somalia.

PubMed

Askar, Ahmed; Ardakani, Malekafzali; Majdzade, Reza

2018-01-02

Reliable and timely health information is fundamental for health information systems (HIS) to work effectively. This case study aims to assess Somaliland HIS in terms of its contextual situation, major weaknesses and proposes key evidence-based recommendations. Data were collected through national level key informants' interviews, observations, group discussion and scoring using the HIS framework and assessment tool developed by World Health Organization Health Metrics Network (WHO/HMN). The study found major weaknesses including: no policy, strategic plan and legal framework in place; fragmented sub-information systems; Poor information and communications technology (ICT) infrastructure; poorly motivated and under-skilled personnel; dependence on unsustainable external funds; no census or civil registration in place; data from private health sector not captured; insufficient technical capacity to analyse data collected by HIS; and information is not widely shared, disseminated or utilized for decision-making. We recommend developing a national HIS strategic plan that harmonizes and directs collective efforts to become a more integrated, cost-effective and sustainable HIS.

Achieving Sustainability Goals for Urban Coasts in the US Northeast: Research Needs and Challenges

NASA Technical Reports Server (NTRS)

Close, Sarah L.; Montalto, Franco; Orton, Philip; Antoine, Adrienne; Peters, Danielle; Jones, Hunter; Parris, Adam; Blumberg, Alan

2016-01-01

In the wake of Hurricane Sandy and other recent extreme events, urban coastal communities in the northeast region of the United States are beginning or stepping up efforts to integrate climate adaptation and resilience into long-term coastal planning. Natural and nature-based shoreline strategies have emerged as essential components of coastal resilience and are frequently cited by practitioners, scientists, and the public for the wide range of ecosystem services they can provide. However, there is limited quantitative information associating particular urban shoreline design strategies with specific levels of ecosystem service provision, and research on this issue is not always aligned with decision context and decision-maker needs. Engagement between the research community, local government officials and sustainability practitioners, and the non-profit and private sectors can help bridge these gaps. A workshop to bring together these groups discussed research gaps and challenges in integrating ecosystem services into urban sustainability planning in the urban northeast corridor. Many themes surfaced repeatedly throughout workshop deliberations, including the challenges associated with ecosystem service valuation, the transferability of research and case studies within and outside the region, and the opportunity for urban coastal areas to be a focal point for education and outreach efforts related to ecosystem services.

Modelling ecosystem service flows under uncertainty with stochiastic SPAN

USGS Publications Warehouse

Johnson, Gary W.; Snapp, Robert R.; Villa, Ferdinando; Bagstad, Kenneth J.

2012-01-01

Ecosystem service models are increasingly in demand for decision making. However, the data required to run these models are often patchy, missing, outdated, or untrustworthy. Further, communication of data and model uncertainty to decision makers is often either absent or unintuitive. In this work, we introduce a systematic approach to addressing both the data gap and the difficulty in communicating uncertainty through a stochastic adaptation of the Service Path Attribution Networks (SPAN) framework. The SPAN formalism assesses ecosystem services through a set of up to 16 maps, which characterize the services in a study area in terms of flow pathways between ecosystems and human beneficiaries. Although the SPAN algorithms were originally defined deterministically, we present them here in a stochastic framework which combines probabilistic input data with a stochastic transport model in order to generate probabilistic spatial outputs. This enables a novel feature among ecosystem service models: the ability to spatially visualize uncertainty in the model results. The stochastic SPAN model can analyze areas where data limitations are prohibitive for deterministic models. Greater uncertainty in the model inputs (including missing data) should lead to greater uncertainty expressed in the model’s output distributions. By using Bayesian belief networks to fill data gaps and expert-provided trust assignments to augment untrustworthy or outdated information, we can account for uncertainty in input data, producing a model that is still able to run and provide information where strictly deterministic models could not. Taken together, these attributes enable more robust and intuitive modelling of ecosystem services under uncertainty.

Advance care planning among Colombian, Mexican, and Puerto Rican women with a cancer diagnosis.

PubMed

Carrion, Iraida V; Nedjat-Haiem, Frances R; Martinez-Tyson, Dinorah; Castañeda, Heide

2013-05-01

Limited knowledge exists pertaining to advance care planning (ACP) among Colombian, Mexican, and Puerto Rican women with a cancer diagnosis living in Central Florida, in the USA. The purpose of the study is to identify factors that facilitated the completion of ACP and decisions making patterns among the three groups of Latinas. The research method used was an exploratory qualitative in-depth open-ended semi-structured interview with a grounded theoretical approach and thematic analysis. The interviews were conducted in Spanish with a purposeful sample of 45 Latinas (15 in each group) diagnosed with cancer. A total of ten women (22 %) in the study documented at least one form of ACP. Thirty-five women identified obstacles to accessing information regarding ACP, relating this to insurance and financial factors. Among the Colombian women, one completed a living will, health care surrogate, and power of attorney (all forms of ACP), and three just a living will. Two Puerto Rican women completed all, two a living will, and one both a living will and an enduring power of attorney. Only one Mexican woman completed a living will. This study identifies a knowledge gap regarding ACP among Latina women with cancer diagnosis living in Central Florida, in the USA. Differences between the three groups exist as a result of migration/immigration history, family support, education, English language proficiency, income, knowledge gaps, and information ascertained by medical and health professionals. These differences contribute to their readiness, receptiveness, and willingness to engage in documenting a living will, a health care surrogate, and an enduring power of attorney for health decisions.

Online Impact Prioritization of Essential Climate Variables on Climate Change

NASA Astrophysics Data System (ADS)

Forsythe-Newell, S. P.; Barkstrom, B. B.; Roberts, K. P.

2007-12-01

The National Oceanic & Atmospheric Administration (NOAA)'s NCDC Scientific Data Stewardship (SDS) Team has developed an online prototype that is capable of displaying the "big picture" perspective of all Essential Climate Variable (ECV) impacts on society and value to the IPCC. This prototype ECV-Model provides the ability to visualize global ECV information with options to drill down in great detail. It offers a quantifiable prioritization of ECV impacts that potentially may significantly enhance collaboration with respect to dealing effectively with climate change. The ECV-Model prototype assures anonymity and provides an online input mechanism for subject matter experts and decision makers to access, review and submit: (1) ranking of ECV"s, (2) new ECV's and associated impact categories and (3) feedback about ECV"s, satellites, etc. Input and feedback are vetted by experts before changes or additions are implemented online. The SDS prototype also provides an intuitive one-stop web site that displays past, current and planned launches of satellites; and general as well as detailed information in conjunction with imagery. NCDC's version 1.0 release will be available to the public and provide an easy "at-a-glance" interface to rapidly identify gaps and overlaps of satellites and associated instruments monitoring climate change ECV's. The SDS version 1.1 will enhance depiction of gaps and overlaps with instruments associated with In-Situ and Satellites related to ECVs. NOAA's SDS model empowers decision makers and the scientific community to rapidly identify weaknesses and strengths in monitoring climate change ECV's and potentially significantly enhance collaboration.

Energy consumption behavior in the commercial sector: An ethnographic analysis of utility bill information and customer comprehension in the workplace

NASA Astrophysics Data System (ADS)

Payne, Christopher Todd

The commercial and industrial sectors of the United States compose roughly one-third of total United States energy consumption. Many studies have suggested that significant cost-effective energy savings opportunities exist in this sector, but there is a gap between predictions of potential and actual investment in energy-efficient technologies. Very few studies have been conducted to examine the decision-making environment of the business sector. In particular, there is essentially no information about how small-business decision-makers make choices about energy consumption. My research is intended to begin the process of understanding this important arena of energy consumption behavior. Using semi-structured interview techniques, I interviewed forty-four businesses in ten states. The focus of the interviews was the business decision-maker's handling and use of the utility bill---the main (often sole) piece of information that links energy consumption to cost. Through the interviews, I collected information about how utility bills are understood and misunderstood, what components of the bill are seen as useful or confusing, and how energy consumption was seen in the context of larger business decision-making. In addition, I collected data on two forms of energy consumption feedback: historic consumption feedback, in which informants compared their current energy use to patterns of their own energy consumption over time; and group comparison consumption feedback, in which informants compared their energy consumption to the consumption of a group of similar energy consumers. Finally, I collected data on sources of information to which decision-makers turned when they wanted to seek more information about energy consumption alternatives. Overall, my findings suggest that the current utility bill format is often misunderstood. In many cases, particularly in the small-business and medium-size-business categories, the link between energy consumption and energy cost is broken. The result is a sense of disempowerment for many consumers. Rather than seeing their energy consumption as something under their control, they instead view the energy bill as an unavoidable component of operating a business, comparing it to other required expenses like rent or taxes. Reaction to changes in the utility bill to provide consumption feedback were mixed. Improvements to self-comparison information provided on the bill were generally viewed positively. On the other hand, energy consumption comparisons with similar groups of customers were viewed with a great deal of skepticism. The idea of group comparison was generally discarded as impractical or invalid. This research improves academic understanding of the energy consumption decision-making environment in the business sector. By developing a better understanding of the context in which these energy consumption decisions are made, the research suggests opportunities for improvements to the mechanisms by which business decision-makers gain information about energy consumption alternatives and energy efficiency opportunities. Improvements to the information provided on the utility bill could enhance the linkage between energy consumption and energy cost for commercial-sector decision-makers, particularly in the small business sector. This could, in turn, lead to greater attention to economic opportunities for energy consumption reduction. Ultimately, improved utility bill information could result in energy and cost savings to business consumers.

Promoting social responsibility amongst health care users: medical tourists' perspectives on an information sheet regarding ethical concerns in medical tourism.

PubMed

Adams, Krystyna; Snyder, Jeremy; Crooks, Valorie A; Johnston, Rory

2013-12-06

Medical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the feedback from former Canadian medical tourists regarding the use of an information sheet to address this knowledge gap and raise awareness of the safety and ethical concerns related to medical tourism. According to feedback provided in interviews with former Canadian medical tourists, the majority of participants responded positively to the information sheet and indicated that this document prompted them to engage in further consideration of these issues. Participants indicated some frustration after reading the information sheet regarding a lack of know-how in terms of learning more about the concerns discussed in the document and changing their decision-making. This frustration was due to participants' desperation for medical care, a topic which participants frequently discussed regarding ethical concerns related to health care provision. The overall perceptions of former medical tourists indicate that an information sheet may promote further consideration of ethical concerns of medical tourism. However, given that these interviews were performed with former medical tourists, it remains unknown whether such a document might impact upon the decision-making of prospective medical tourists. Furthermore, participants indicated a need for an additional tool such as a website for continued discussion about these concerns. As such, along with dissemination of the information sheet, future research implications should include the development of a website for ongoing discussion that could contribute to a raised awareness of these concerns and potentially increase social responsibility in the medical tourism industry.

Promoting social responsibility amongst health care users: medical tourists’ perspectives on an information sheet regarding ethical concerns in medical tourism

PubMed Central

2013-01-01

Background Medical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the feedback from former Canadian medical tourists regarding the use of an information sheet to address this knowledge gap and raise awareness of the safety and ethical concerns related to medical tourism. Results According to feedback provided in interviews with former Canadian medical tourists, the majority of participants responded positively to the information sheet and indicated that this document prompted them to engage in further consideration of these issues. Participants indicated some frustration after reading the information sheet regarding a lack of know-how in terms of learning more about the concerns discussed in the document and changing their decision-making. This frustration was due to participants’ desperation for medical care, a topic which participants frequently discussed regarding ethical concerns related to health care provision. Conclusions The overall perceptions of former medical tourists indicate that an information sheet may promote further consideration of ethical concerns of medical tourism. However, given that these interviews were performed with former medical tourists, it remains unknown whether such a document might impact upon the decision-making of prospective medical tourists. Furthermore, participants indicated a need for an additional tool such as a website for continued discussion about these concerns. As such, along with dissemination of the information sheet, future research implications should include the development of a website for ongoing discussion that could contribute to a raised awareness of these concerns and potentially increase social responsibility in the medical tourism industry. PMID:24314027

Balancing emotion and cognition: a case for decision aiding in conservation efforts.

PubMed

Wilson, Robyn S

2008-12-01

Despite advances in the quality of participatory decision making for conservation, many current efforts still suffer from an inability to bridge the gap between science and policy. Judgment and decision-making research suggests this gap may result from a person's reliance on affect-based shortcuts in complex decision contexts. I examined the results from 3 experiments that demonstrate how affect (i.e., the instantaneous reaction one has to a stimulus) influences individual judgments in these contexts and identified techniques from the decision-aiding literature that help encourage a balance between affect-based emotion and cognition in complex decision processes. In the first study, subjects displayed a lack of focus on their stated conservation objectives and made decisions that reflected their initial affective impressions. Value-focused approaches may help individuals incorporate all the decision-relevant objectives by making the technical and value-based objectives more salient. In the second study, subjects displayed a lack of focus on statistical risk and again made affect-based decisions. Trade-off techniques may help individuals incorporate relevant technical data, even when it conflicts with their initial affective impressions or other value-based objectives. In the third study, subjects displayed a lack of trust in decision-making authorities when the decision involved a negatively affect-rich outcome (i.e., a loss). Identifying shared salient values and increasing procedural fairness may help build social trust in both decision-making authorities and the decision process.

Location choices for climate change and transportation decision making.

DOT National Transportation Integrated Search

2015-01-01

This research aims to fill the gap in the knowledge between residential location decisions and : preferences and the resulting travel outcomes. In this first phase, the revealed connections between : residential choices and travel patterns are examin...

NASA/SDIO Space Environmental Effects on Materials Workshop, part 2

NASA Technical Reports Server (NTRS)

Teichman, Louis A. (Compiler); Stein, Bland A. (Compiler)

1989-01-01

The National Aeronautics and Space Administration (NASA) and the Strategic Defense Initiative Organization (SDIO) cosponsored a workshop on Space Environmental Effects on Materials. The joint workshop was designed to inform participants of the present state of knowledge regarding space environmental effects on materials and to identify knowledge gaps that prevent informed decisions on the best use of advanced materials in space for long duration NASA and SDIO missions. Establishing priorities for future ground based and space based materials research was a major goal of the workshop. The end product of the workshop was an assessment of the current state-of-the-art in space environmental effects on materials in order to develop a national plan for spaceflight experiments.

[Dangers and risks of black market anabolic steroid abuse in sports --gas chromatography-mass spectrometry analyses].

PubMed

Ritsch, M; Musshoff, F

2000-03-01

Anabolic steroids have become increasingly popular among athletes even at subcompetitive or recreational level instead of extensive doping tests, educational campaigns and lethal incidents. Nowadays, the fitness boom has also produced a population of steroid users at high school level and also under non-sports practicing children. After opening the borders to East Europe an explosion of the black-market for anabolic steroids occurred. Beside the well-known side effects of anabolic steroids new problems and risks occurred due to fake drugs from the black market. This review ist subdivided into two parts: We provide a detailed review of the literature an anabolic steroids to the reader the information needed to make an informed decision an the relative risks and benefits of anabolic steroids. Secondly, we evaluated 40 "anabolic steroids" obtained from the black market using mass spectrometry or gas chromatography analysis to evaluate the real pharmacological compounds. As the results of this analysis, we found that 15 (37.5%) these drugs contained different or any pharmacological compounds as labeled. From the external packing, a differentiation between original and the fake drugs was impossible. Therefore, a large information and credibility gap concerning anabolic steroids particular those from the black market exists between the athletes and the medical and scientific communities. We believe that this gap can only be closed if both groups are be better informed about anabolic steroids.

From disease to desire, pleasure to the pill: A qualitative study of adolescent learning about sexual health and sexuality in Chile.

PubMed

Macintyre, Anna K-J; Montero Vega, Adela Rosa; Sagbakken, Mette

2015-09-23

Sexual and reproductive rights include access to accurate and appropriate information in order to make informed decisions. In the current age of media globalization and Internet, adolescents are exposed to information about sexual health and sexuality from a myriad of sources. The objective of this study was to explore sources of information and adolescent learning about sexual health and sexuality in Santiago, Chile. Data collection included four focus group discussions with a total of 24 adolescents 18-19 years old, 20 semi-structured interviews with adolescents 16-19 years old, and seven interviews with key informants working with adolescents. Audio recordings were transcribed verbatim and analysed using content analysis. The primary sources of sexual health and sexuality information were parents, teachers and friends, whilst secondary sources included health professionals for females and Internet for males. Information provided by the trusted sources of parents, teachers and health professionals tended to focus on biological aspects of sexuality, particularly pregnancy and sexually transmitted infections. Limited emphasis was placed on topics such as love, attraction, pleasure, relationships, abstinence and sexual violence. Information focused primarily on heterosexual relations and reproduction. Adolescents learnt about relationships and sexual acts through friends, partners and, for many males, pornography. Findings indicate a lack of available information on partner communication, setting personal limits, and contraception, including morally neutral and medically correct information about emergency contraception. This study highlights numerous gaps between adolescent information needs and information provided by parents, teachers and health professionals. The priority these trusted sources place on providing biological information overshadows learning about emotional and relational aspects of sexuality. This biological rationalization of adolescent sexual behaviour neglects the way gender inequality, peer-pressure, coercion, media eroticization and religion influence adolescent sexual decision-making. The heteronormativity of information excludes other sexual orientations and disregards the diverse spectrum of human sexual behaviours. Finally, the limited provision of practical information hinders development of skills necessary for ensuring safe, consensual and pleasurable sexual relations. Trusted adults are encouraged to engage adolescents in critical reflection on a broad range of sexuality topics, dispelling myths, and building knowledge and skills necessary to make informed decisions.

Assessment of Risk Communication about Undercooked Hamburgers by Restaurant Servers.

PubMed

Thomas, Ellen M; Binder, Andrew R; McLAUGHLIN, Anne; Jaykus, Lee-Ann; Hanson, Dana; Powell, Douglas; Chapman, Benjamin

2016-12-01

According to the U.S. Food and Drug Administration 2013 Model Food Code, it is the duty of a food establishment to disclose and remind consumers of risk when ordering undercooked food such as ground beef. The purpose of this study was to explore actual risk communication behaviors of food establishment servers. Secret shoppers visited 265 restaurants in seven geographic locations across the United States, ordered medium rare burgers, and collected and coded risk information from chain and independent restaurant menus and from server responses. The majority of servers reported an unreliable method of doneness (77%) or other incorrect information (66%) related to burger doneness and safety. These results indicate major gaps in server knowledge and risk communication, and the current risk communication language in the Model Food Code does not sufficiently fill these gaps. The question is "should servers even be acting as risk communicators?" There are numerous challenges associated with this practice, including high turnover rates, limited education, and the high stress environment based on pleasing a customer. If servers are designated as risk communicators, food establishment staff should be adequately trained and provided with consumer advisory messages that are accurate, audience appropriate, and delivered in a professional manner so that customers can make informed food safety decisions.

The challenge of obtaining information necessary for multi-criteria decision analysis implementation: the case of physiotherapy services in Canada

PubMed Central

2013-01-01

Background As fiscal constraints dominate health policy discussions across Canada and globally, priority-setting exercises are becoming more common to guide the difficult choices that must be made. In this context, it becomes highly desirable to have accurate estimates of the value of specific health care interventions. Economic evaluation is a well-accepted method to estimate the value of health care interventions. However, economic evaluation has significant limitations, which have lead to an increase in the use of Multi-Criteria Decision Analysis (MCDA). One key concern with MCDA is the availability of the information necessary for implementation. In the Fall 2011, the Canadian Physiotherapy Association embarked on a project aimed at providing a valuation of physiotherapy services that is both evidence-based and relevant to resource allocation decisions. The framework selected for this project was MCDA. We report on how we addressed the challenge of obtaining some of the information necessary for MCDA implementation. Methods MCDA criteria were selected and areas of physiotherapy practices were identified. The building up of the necessary information base was a three step process. First, there was a literature review for each practice area, on each criterion. The next step was to conduct interviews with experts in each of the practice areas to critique the results of the literature review and to fill in gaps where there was no or insufficient literature. Finally, the results of the individual interviews were validated by a national committee to ensure consistency across all practice areas and that a national level perspective is applied. Results Despite a lack of research evidence on many of the considerations relevant to the estimation of the value of physiotherapy services (the criteria), sufficient information was obtained to facilitate MCDA implementation at the local level. Conclusions The results of this research project serve two purposes: 1) a method to obtain information necessary to implement MCDA is described, and 2) the results in terms of information on the benefits provided by each of the twelve areas of physiotherapy practice can be used by decision-makers as a starting point in the implementation of MCDA at the local level. PMID:23688138

Responding to Nonwords in the Lexical Decision Task: Insights from the English Lexicon Project

PubMed Central

Yap, Melvin J.; Sibley, Daragh E.; Balota, David A.; Ratcliff, Roger; Rueckl, Jay

2014-01-01

Researchers have extensively documented how various statistical properties of words (e.g., word-frequency) influence lexical processing. However, the impact of lexical variables on nonword decision-making performance is less clear. This gap is surprising, since a better specification of the mechanisms driving nonword responses may provide valuable insights into early lexical processes. In the present study, item-level and participant-level analyses were conducted on the trial-level lexical decision data for almost 37,000 nonwords in the English Lexicon Project in order to identify the influence of different psycholinguistic variables on nonword lexical decision performance, and to explore individual differences in how participants respond to nonwords. Item-level regression analyses reveal that nonword response time was positively correlated with number of letters, number of orthographic neighbors, number of affixes, and baseword number of syllables, and negatively correlated with Levenshtein orthographic distance and baseword frequency. Participant-level analyses also point to within- and between-session stability in nonword responses across distinct sets of items, and intriguingly reveal that higher vocabulary knowledge is associated with less sensitivity to some dimensions (e.g., number of letters) but more sensitivity to others (e.g., baseword frequency). The present findings provide well-specified and interesting new constraints for informing models of word recognition and lexical decision. PMID:25329078

The harms of screening: a proposed taxonomy and application to lung cancer screening.

PubMed

Harris, Russell P; Sheridan, Stacey L; Lewis, Carmen L; Barclay, Colleen; Vu, Maihan B; Kistler, Christine E; Golin, Carol E; DeFrank, Jessica T; Brewer, Noel T

2014-02-01

Making rational decisions about screening requires information about its harms, but high-quality evidence is often either not available or not used. One reason may be that we lack a coherent framework, a taxonomy, for conceptualizing and studying these harms. To create a taxonomy, we categorized harms from several sources: systematic reviews of screening, other published literature, and informal discussions with clinicians and patients. We used this information to develop an initial taxonomy and vetted it with local and national experts, making revisions as needed. We propose a taxonomy with 4 domains of harm from screening: physical effects, psychological effects, financial strain, and opportunity costs. Harms can occur at any step of the screening cascade. We provide definitions for each harm domain and illustrate the taxonomy using the example of screening for lung cancer. The taxonomy provides a systematic way to conceptualize harms as experienced by patients. As shown in the lung cancer screening example, the taxonomy also makes clear where (which domains of harms and which parts of the screening cascade) we have useful information and where there are gaps in our knowledge. The taxonomy needs further testing and validation across a broad range of screening programs. We hope that further development of this taxonomy can improve our thinking about the harms of screening, thus informing our research, policy making, and decision making with patients about the wisdom of screening.

System-Level Action Required for Wide-Scale Improvement in Quality of Primary Health Care: Synthesis of Feedback from an Interactive Process to Promote Dissemination and Use of Aggregated Quality of Care Data.

PubMed

Bailie, Jodie; Laycock, Alison; Matthews, Veronica; Bailie, Ross

2016-01-01

There is an enduring gap between recommended practice and care that is actually delivered; and there is wide variation between primary health care (PHC) centers in delivery of care. Where aspects of care are not being done well across a range of PHC centers, this is likely due to inadequacies in the broader system. This paper aims to describe stakeholders' perceptions of the barriers and enablers to addressing gaps in Australian Aboriginal and Torres Strait Islander chronic illness care and child health, and to identify key drivers for improvement. This paper draws on data collected as part of a large-scale continuous quality improvement project in Australian Indigenous PHC settings. We undertook a qualitative assessment of stakeholder feedback on the main barriers and enablers to addressing gaps in care for Aboriginal and Torres Strait Islander children and in chronic illness care. Themes on barriers and enablers were further analyzed to develop a "driver diagram," an improvement tool used to locate barriers and enablers within causal pathways (as primary and secondary drivers), enabling them to be targeted by tailored interventions. We identified 5 primary drivers and 11 secondary drivers of high-quality care, and associated strategies that have potential for wide-scale implementation to address barriers and enablers for improving care. Perceived barriers to addressing gaps in care included both health system and staff attributes. Primary drivers were: staff capability to deliver high-quality care; availability and use of clinical information systems and decision support tools; embedding of quality improvement processes and data-driven decision-making; appropriate and effective recruitment and retention of staff; and community capacity, engagement and mobilization for health. Suggested strategies included mechanisms for increasing clinical supervision and support, staff retention, reorientation of service delivery, use of information systems and community health literacy. The findings identify areas of focus for development of barrier-driven, tailored interventions to improve health outcomes. They reinforce the importance of system-level action to improve health center performance and health outcomes, and of developing strategies to address system-wide challenges that can be adapted to local contexts.

Shared decision making in the safety net: where do we go from here?

PubMed

Bouma, Angelique B; Tiedje, Kristina; Poplau, Sara; Boehm, Deborah H; Shah, Nilay D; Commers, Matthew J; Linzer, Mark; Montori, Victor M

2014-01-01

Shared decision making (SDM) is an interactive process between clinicians and patients in which both share information, deliberate together, and make clinical decisions. Clinics serving safety net patients face special challenges, including fewer resources and more challenging work environments. The use of SDM within safety net institutions has not been well studied. We recruited a convenience sample of 15 safety net primary care clinicians (13 physicians, 2 nurse practitioners). Each answered a 9-item SDM questionnaire and participated in a semistructured interview. From the transcribed interviews and questionnaire data, we identified themes and suggestions for introducing SDM into a safety net environment. Clinicians reported only partially fulfilling the central components of SDM (sharing information, deliberating, and decision making). Most clinicians expressed interest in SDM by stating that they "selected a treatment option together" with patients (8 of 15 in strong or complete agreement), but only a minority (3 of 15) "thoroughly weighed the different treatment options" together with patients. Clinicians attributed this gap to many barriers, including time pressure, overwhelming visit content, patient preferences, and lack of available resources. All clinicians believed that lack of time made it difficult to practice SDM. To increase use of SDM in the safety net, efficient SDM interventions designed for this environment, team care, and patient engagement in SDM will need further development. Future studies should focus on adapting SDM to safety net settings and determine whether SDM can reduce health care disparities.

Agency, contract and governance: shifting shapes of accountability in the health care arena.

PubMed

Tuohy, Carolyn Hughes

2003-01-01

Current ideas about the role of the state include an enthusiasm for mechanisms of "indirect" or "third-party" governance. The health care arena, in which models of indirect governance have a long history, is an important test bed for these ideas. Classically, the arena was marked by trust-based, principal-agent relationships established to overcome information gaps. Over time (and to different degrees across nations), emphasis shifted to contractual relationships assuming relatively well-informed actors and then to performance monitoring and information sharing within complex and loosely coupled networks. In this latest stage, there is a risk that some important features of democratic leadership, and of decision making in the health care arena, will be eclipsed. Accountability mechanisms must clearly locate responsibility for actions and must allow for the exercise of professional judgment.

Climate Services - Innovation for Smart Solutions

NASA Astrophysics Data System (ADS)

Jacob, Daniela

2015-04-01

Living in a changing climate is becoming an increasing challenge for all kinds of human activities. Mitigation of global warming is of utmost importance to avoid further and stronger changes in our climate. At the same time, adaptation to today's and future changes is needed. To address both, a new field of activity developed within the last couple of years: climate services. They develop and deliver easy understandable and useful information for decision makers in public and private business and society as a whole. The German Climate Service Center 2.0 was one of the first institutions worldwide bridging the gap between scientific climate change knowledge and user needs. Developing prototype products and services, the Climate Service Center 2.0 orients its activities toward consultation of climate change topics and adaptation to climate change impacts. It prepares high quality and state of the art information for decision makers. What have we learned and where are we heading to? What are the roles of partners and networks? And how might a new field of expertise like climate services develop and stimulate the job market? These questions will be discussed and examples will be given.

Eliciting expert opinion for economic models: an applied example.

PubMed

Leal, José; Wordsworth, Sarah; Legood, Rosa; Blair, Edward

2007-01-01

Expert opinion is considered as a legitimate source of information for decision-analytic modeling where required data are unavailable. Our objective was to develop a practical computer-based tool for eliciting expert opinion about the shape of the uncertainty distribution around individual model parameters. We first developed a prepilot survey with departmental colleagues to test a number of alternative approaches to eliciting opinions on the shape of the uncertainty distribution around individual parameters. This information was used to develop a survey instrument for an applied clinical example. This involved eliciting opinions from experts to inform a number of parameters involving Bernoulli processes in an economic model evaluating DNA testing for families with a genetic disease, hypertrophic cardiomyopathy. The experts were cardiologists, clinical geneticists, and laboratory scientists working with cardiomyopathy patient populations and DNA testing. Our initial prepilot work suggested that the more complex elicitation techniques advocated in the literature were difficult to use in practice. In contrast, our approach achieved a reasonable response rate (50%), provided logical answers, and was generally rated as easy to use by respondents. The computer software user interface permitted graphical feedback throughout the elicitation process. The distributions obtained were incorporated into the model, enabling the use of probabilistic sensitivity analysis. There is clearly a gap in the literature between theoretical elicitation techniques and tools that can be used in applied decision-analytic models. The results of this methodological study are potentially valuable for other decision analysts deriving expert opinion.

Informing disinvestment with limited evidence: cobalamin deficiency in the fatigued.

PubMed

Mnatzaganian, George; Karnon, Jonathan; Moss, John R; Elshaug, Adam G; Metz, Michael; Frank, Oliver R; Hiller, Janet E

2015-01-01

Health technology reassessment and disinvestment can be difficult due to uncertainties regarding available evidence. Pathology testing to investigate cobalamin (vitamin B12) deficiency is a strong case in point. We conducted a 3-month economic evaluation of five strategies for diagnosing and treating cobalamin deficiency in adult patients hypothetically presenting with new unexplained fatigue in the primary care setting. The first consultation per patient was considered. Screening tests other than serum cobalamin were not included. A cost-effectiveness analysis was undertaken using a decision tree to represent the diagnostic / treatment pathways, with relevant cost and utility scores assigned to different stages in the evaluation process. Input parameter values were estimated from published evidence, supplemented by expert opinion, with sensitivity analysis undertaken to represent parameter uncertainty. Ordering serum vitamin B12 to assess cobalamin deficiency among patients with unexplained fatigue was not cost-effective in any patient population, irrespective of pretest prevalence of this deficiency. For patients with a pretest prevalence above 1 percent, treating all with oral vitamin B12 supplements without testing was most cost-effective, whereas watchful waiting with symptoms monitoring was most cost-effective for patients with lower pretest prevalence probabilities. Substantial evidence gaps exist for parameter estimation: questionable cobalamin deficiency levels in the fatigued; debatable treatment methods; unknown natural history of the condition. Despite this, we reveal a robust path for disinvestment decision making in the face of a paradox between the evidence required to inform disinvestment compared with its paucity in informing initial funding decisions.

The Development of an eHealth Tool Suite for Prostate Cancer Patients and Their Partners

PubMed Central

Van Bogaert, Donna; Hawkins, Robert; Pingree, Suzanne; Jarrard, David

2013-01-01

Background eHealth resources for people facing health crises must balance the expert knowledge and perspective of developers and clinicians against the very different needs and perspectives of prospective users. This formative study explores the information and support needs of posttreatment prostate cancer patients and their partners as a way to improve an existing eHealth information and support system called CHESS (Comprehensive Health Enhancement Support System). Methods Focus groups with patient survivors and their partners were used to identify information gaps and information-seeking milestones. Results Both patients and partners expressed a need for assistance in decision making, connecting with experienced patients, and making sexual adjustments. Female partners of patients are more active in searching for cancer information. All partners have information and support needs distinct from those of the patient. Conclusions Findings were used to develop a series of interactive tools and navigational features for the CHESS prostate cancer computer-mediated system. PMID:22591675

76 FR 37371 - Agency Information Collection: Comment Request for National Gap Analysis Program Evaluation

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-27

... Gap Analysis Program (GAP). The information collected will provide information for the Program's... DEPARTMENT OF THE INTERIOR U.S. Geological Survey [USGS--GX10RB0000SDP00] Agency Information Collection: Comment Request for National Gap Analysis Program Evaluation AGENCY: United States Geological...

Building the Capacity for Climate Services: Thoughts on Training Next Generation Climate Science Integrators

NASA Astrophysics Data System (ADS)

Garfin, G. M.; Brugger, J.; Gordon, E. S.; Barsugli, J. J.; Rangwala, I.; Travis, W.

2015-12-01

For more than a decade, stakeholder needs assessments and reports, including the recent National Climate Assessment, have pointed out the need for climate "science translators" or "science integrators" who can help bridge the gap between the cultures and contexts of researchers and decision-makers. Integration is important for exchanging and enhancing knowledge, building capacity to use climate information in decision making, and fostering more robust planning for decision-making in the context of climate change. This talk will report on the characteristics of successful climate science integrators, and a variety of models for training the upcoming generation of climate science integrators. Science integration characteristics identified by an experienced vanguard in the U.S. include maintaining credibility in both the scientific and stakeholder communities, a basic respect for stakeholders demonstrated through active listening, and a deep understanding of the decision-making context. Drawing upon the lessons of training programs for Cooperative Extension, public health professionals, and natural resource managers, we offer ideas about training next generation climate science integrators. Our model combines training and development of skills in interpersonal relations, communication of science, project implementation, education techniques and practices - integrated with a strong foundation in disciplinary knowledge.

Capturing Old-Growth Values for Use in Forest Decision-Making

NASA Astrophysics Data System (ADS)

Owen, Rochelle J.; Duinker, Peter N.; Beckley, Thomas M.

2009-02-01

Old-growth forests have declined significantly across the world. Decisions related to old growth are often mired in challenges of value diversity, conflict, data gaps, and resource pressures. This article describes old-growth values of citizens and groups in Nova Scotia, Canada, for integration in sustainable forest management (SFM) decision-making. The study is based on data from 76 research subjects who participated in nine field trips to forest stands. Research subjects were drawn from Aboriginal groups, environmental organizations, forestry professionals, and rural and urban publics. Diaries, group discussions, and rating sheets were used to elicit information during the field trips. Findings show that different elicitation techniques can influence the articulation of intensity with which some values are held. In addition, certain values are more often associated with old-growth than with other forest-age classes. Some values associated with old-growth are considered more important than others, and some silvicultural treatments are perceived to compromise old-growth values more than others. Demographic characteristics, such as constituency group, gender, and age, are shown to influence value priorities. Ideas on how to incorporate old-growth values into SFM decision-making are highlighted.

Feasibility of web-based decision aids in neurological patients.

PubMed

van Til, Janine A; Drossaert, Constance H C; Renzenbrink, Gerbert J; Snoek, Govert J; Dijkstra, Evelien; Stiggelbout, Anne M; Ijzerman, Maarten J

2010-01-01

Decision aids (DAs) may be helpful in improving patients' participation in medical decision-making. We investigated the potential for web-based DAs in a rehabilitation population. Two self-administered DAs focused on the treatment of acquired ankle-foot impairment in stroke and the treatment of arm-hand function in cervical spinal cord injury (SCI). Data collection comprised a telephone interview and a self-reported paper questionnaire. Of the patients who agreed to participate, 39 stroke patients (44%) and 38 patients with SCI (78%) returned a questionnaire. More than 75% of patients expressed a need for more information about the treatment of disease-related impairment. The DAs were highly appreciated by both patient groups. Nearly all patients expressed a positive attitude towards the use of the web-based DAs in general practice. The DAs had a positive effect on the knowledge about the treatment alternatives in the stroke patients (P = 0.001), although not in the patients with SCI. The DAs reduced patients' conflict about treatment (P < 0.05). The effect of the DAs on patients' desired role in decision-making was limited. Web-based aids are feasible in the rehabilitation population with access to a computer and can improve the knowledge gaps in patients.

20170913 - Systematic Approaches to Biological/Chemical Read-Across for Hazard Identification (EMGS)

EPA Science Inventory

Read-across is a well-established data gap filling technique used within chemical category and analogue approaches for regulatory purposes. The category/analogue workflow comprises a number of steps starting from decision context, data gap analysis through to analogue identificat...

Long-Term Information Management (LTIM) of Safeguards Data at Repositories: Phase II

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

Haddal, Risa N.

One of the challenges of implementing safeguards for geological repositories will be the long-term preservation of safeguards-related data for 100 years or more. While most countries considering the construction and operation of such facilities agree that safeguards information should be preserved, there are gaps with respect to standardized requirements, guidelines, timescales, and approaches. This study analyzes those gaps and explores research to clarify stakeholder needs, identify current policies, approaches, best practices and international standards, and explores existing safeguards information management infrastructure. The study also attempts to clarify what a safeguards data classification system might look like, how long data shouldmore » be retained, and how information should be exchanged between stakeholders at different phases of a repository’s life cycle. The analysis produced a variety of recommendations on what information to preserve, how to preserve it, where to store it, retention options and how to exchange information in the long term. Key findings include the use of the globally recognized international records management standard, ISO15489, for guidance on the development of information management systems, and the development of a Key Information File (KIF). The KIF could be used to identify only the most relevant, high-level safeguards information and the history of decision making about the repository. The study also suggests implementing on-site and off-site records storage in digital and physical form; developing a safeguards data classification system; long-term records retention with periodic reviews every 5 to 10 years during each phase of the repository life cycle; and establishing transition procedures well in advance so that data shepherds and records officers can transfer information with incoming facility managers effectively and efficiently. These and other recommendations are further analyzed in this study.« less

Mind the Gap: Governance Mechanisms and Health Workforce Outcomes

PubMed Central

Hastings, Stephanie E.; Mallinson, Sara; Armitage, Gail D.; Jackson, Karen; Suter, Esther

2014-01-01

Attempts at health system reform have not been as successful as governments and health authorities had hoped. Working from the premise that health system governance and changes to the workforce are at the heart of health system performance, we conducted a systematic review examining how they are linked. Key messages from the report are that: (1) leadership, communication and engagement are crucial to workforce change; (2) workforce outcomes need to be considered in conjunction with patient outcomes; and (3) decision-makers and researchers need to work together to develop an evidence base to inform future reform planning. PMID:25410700

Improving the evidence base for better comparative effectiveness research.

PubMed

Brophy, James M

2015-09-01

The last 20 years has documented that the evidence base for informed clinical decision-making is often suboptimal. It is hoped that high-quality comparative effectiveness research may fill these knowledge gaps. Implicit in these changing paradigms is the underlying assumption that the published evidence, when available, is valid. It is posited here that this assumption is sometimes questionable. However, several recent methods that may improve the design and analysis of comparative effectiveness research have appeared and are discussed here. Examples from the cardiology literature are provided, but it is believed the highlighted principles are applicable to other branches of medicine.

Vision for a worldwide fluvial-sediment information network

USGS Publications Warehouse

Gray, J.R.; Osterkamp, W.R.

2007-01-01

The WoFSIN is described in the ensuing sections in stand-alone fashion, followed by a section that describes the complementary aspects of the WoFSIN and the International Sediment Initiative. Thus, our first objective is to describe the fundamental components of a WoFSIN. Our second objective is to identify overlap or gaps between the WoFSIN and ISI concepts that might be useful in refining the ISI’s ability to meet its global mission to develop decision support for sediment management at the global scale more fully, cost-effectively, and (or) with enhanced quality.

South Asian migrant women and HIV/STIs: knowledge, attitudes and practices and the role of sexual power.

PubMed

Gagnon, Anita J; Merry, Lisa; Bocking, Jacqueline; Rosenberg, Ellen; Oxman-Martinez, Jacqueline

2010-01-01

Differences in relationship power dynamics or migration factors may affect knowledge, attitudes, and practices (KAP) towards HIV/AIDS and sexually transmitted infections (STIs) in resettling Migrant women. A sample of 122 women and men born in India, Sri Lanka, Pakistan or Bangladesh and residing in Montreal completed questionnaires on HIV/STI KAP and decision-making power Within sexual relationships. Knowledge gaps and stigmatizing attitudes were found. STI/HIV information available in one's language and other educational strategies that consider women's Power may improve KAP among South Asian migrant women.

Big data, little security: Addressing security issues in your platform

NASA Astrophysics Data System (ADS)

Macklin, Thomas; Mathews, Joseph

2017-05-01

This paper describes some patterns for information security problems that consistently emerge among traditional enterprise networks and applications, both with respect to cyber threats and data sensitivity. We draw upon cases from qualitative studies and interviews of system developers, network operators, and certifiers of military applications. Specifically, the problems discussed involve sensitivity of data aggregates, training efficacy, and security decision support in the human machine interface. While proven techniques can address many enterprise security challenges, we provide additional recommendations on how to further improve overall security posture, and suggest additional research thrusts to address areas where known gaps remain.

Developing and Evaluating Workshop Frameworks to Improve Climate Literacy

NASA Astrophysics Data System (ADS)

Averyt, K.; Alvord, C.; Joyce, L. A.; Lukas, J.; Barsugli, J. J.; Owen, G.; Udall, B.

2009-12-01

A burgeoning need for climate information is rising from a variety of stakeholders. A new federal report encourages federal resource management efforts to consider climate in assessments-leaving agency scientists and resource managers searching for appropriate data and methodologies. At the other end of the spectrum, small-scale decision makers realize the need to develop scientifically-informed climate adaptation plans, but are unclear about what science is relevant. It is becoming necessary to improve the climate literacy across all sectors. However, past examples illustrate that climate science has been insufficiently communicated, resulting in perceptions that misinform decision-making and planning. Given the necessity to include climate science in planning on multiple scales, scientific educators must work with stakeholders to determine how best to improve climate literacy. Doing so will reduce uncertainty in the application of climate data in planning, and thus mitigate vulnerabilities to the impacts of climate change. Here, we present the design and assessment of two workshop frameworks intended to improve the climate literacy of two distinct entities with different climate information needs. This work represents initial steps by the Western Water Assessment, a NOAA- Regionally Integrated Sciences and Assessments (RISA) Program, towards the development of a suite of process-oriented frameworks geared toward improving the climate literacy of different users with distinct informational needs. Both workshops focused on water-related climate issues: the first (Dealing with Drought: Climate Change in Colorado) was geared toward an audience with minimal exposure to climate information; the second was for US Forest Service hydrologists and managers with technical backgrounds. In both cases, the workshop format included presentations of relevant climate science, introductions to varied climate tools and products, and a needs-and-gaps assessment. Evaluation of each workshop drew upon a variety of tested social science methods, such as focus groups, decision games, surveys, and structured interviews. The efficacy of the framework developed was assessed by evaluating the relationship among the climate information presented, user perceptions about climate information, and incorporation into decision-making. In addition to climate literacy evaluations, participants were presented with a scenario at the beginning of the meeting, and were asked to report periodically on their thoughts on how to approach the scenario as new information was presented throughout the workshop. This allowed us to track the co-evolution of climate literacy, accuracy of data interpretation, and the sophistication of participants’ decision-making. In the 12-months after each workshop, we will track how the climate literacy of the participants evolves, and how their informational needs for decision-making change. The results here will frame a process for how a larger, federal climate-training program might be conducted, and how training needs can be assessed through climate literacy assessments.

Land cover map for map zones 8 and 9 developed from SAGEMAP, GNN, and SWReGAP: a pilot for NWGAP

Treesearch

James S. Kagan; Janet L. Ohmann; Matthew Gregory; Claudine Tobalske

2008-01-01

As part of the Northwest Gap Analysis Project, land cover maps were generated for most of eastern Washington and eastern Oregon. The maps were derived from regional SAGEMAP and SWReGAP data sets using decision tree classifiers for nonforest areas, and Gradient Nearest Neighbor imputation modeling for forests and woodlands. The maps integrate data from regional...

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

PubMed Central

2013-01-01

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

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

PubMed

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

2013-08-08

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

Reassessing the approach to informed consent: the case of unrelated hematopoietic stem cell transplantation in adult thalassemia patients

PubMed Central

2014-01-01

Introduction The informed consent process is the legal embodiment of the fundamental right of the individual to make decisions affecting his or her health., and the patient’s permission is a crucial form of respect of freedom and dignity, it becomes extremely important to enhance the patient’s understanding and recall of the information given by the physician. This statement acquires additional weight when the medical treatment proposed can potentially be detrimental or even fatal. This is the case of thalassemia patients pertaining to class 3 of the Pesaro classification where Allogenic hematopoietic stem cell transplantation (HSCT) remains the only potentially curative treatment. Unfortunately, this kind of intervention is burdened by an elevated transplantation-related mortality risk (TRM: all deaths considered related to transplantation), equal to 30% according to published reports. In thalassemia, the role of the patient in the informed consent process leading up to HSCT has not been fully investigated. This study investigated the hypothesis that information provided by physicians in the medical scenario of HSCT is not fully understood by patients and that misunderstanding and communication biases may affect the clinical decision-making process. Methods A questionnaire was either mailed or given personally to 25 patients. A second questionnaire was administered to the 12 physicians attending the patients enrolled in this study. Descriptive statistics were used to evaluate the communication factors. Results The results pointed out the difference between the risks communicated by physicians and the risks perceived by patients. Besides the study highlighted the mortality risk considered to be acceptable by patients and that considered to be acceptable by physicians. Conclusions Several solutions have been suggested to reduce the gap between communicated and perceived data. A multi-disciplinary approach may possibly help to attenuate some aspects of communication bias. Several tools have also been proposed to fill or to attenuate the gap between communicated and perceived data. But the most important tool is the ability of the physician to comprehend the right place of conscious consent in the relationship with the patient. PMID:25115172

Modeling pedestrian gap crossing index under mixed traffic condition.

PubMed

Naser, Mohamed M; Zulkiple, Adnan; Al Bargi, Walid A; Khalifa, Nasradeen A; Daniel, Basil David

2017-12-01

There are a variety of challenges faced by pedestrians when they walk along and attempt to cross a road, as the most recorded accidents occur during this time. Pedestrians of all types, including both sexes with numerous aging groups, are always subjected to risk and are characterized as the most exposed road users. The increased demand for better traffic management strategies to reduce the risks at intersections, improve quality traffic management, traffic volume, and longer cycle time has further increased concerns over the past decade. This paper aims to develop a sustainable pedestrian gap crossing index model based on traffic flow density. It focusses on the gaps accepted by pedestrians and their decision for street crossing, where (Log-Gap) logarithm of accepted gaps was used to optimize the result of a model for gap crossing behavior. Through a review of extant literature, 15 influential variables were extracted for further empirical analysis. Subsequently, data from the observation at an uncontrolled mid-block in Jalan Ampang in Kuala Lumpur, Malaysia was gathered and Multiple Linear Regression (MLR) and Binary Logit Model (BLM) techniques were employed to analyze the results. From the results, different pedestrian behavioral characteristics were considered for a minimum gap size model, out of which only a few (four) variables could explain the pedestrian road crossing behavior while the remaining variables have an insignificant effect. Among the different variables, age, rolling gap, vehicle type, and crossing were the most influential variables. The study concludes that pedestrians' decision to cross the street depends on the pedestrian age, rolling gap, vehicle type, and size of traffic gap before crossing. The inferences from these models will be useful to increase pedestrian safety and performance evaluation of uncontrolled midblock road crossings in developing countries. Copyright © 2017 National Safety Council and Elsevier Ltd. All rights reserved.

Information needs of mothers regarding communicating BRCA1/2 cancer genetic test results to their children.

PubMed

Tercyak, Kenneth P; Peshkin, Beth N; Demarco, Tiffani A; Patenaude, Andrea Farkas; Schneider, Katherine A; Garber, Judy E; Valdimarsdottir, Heiddis B; Schwartz, Marc D

2007-01-01

Mothers who participate in genetic testing for hereditary breast/ovarian cancer risk must decide if, when, and how to ultimately share their BRCA1 and BRCA2 (BRCA1/2) test results with their minor-age children. One of the primary aides for mothers in making this decision is cancer genetic counseling. However, counseling is limited in how well it can educate mothers about such decisions without the availability of resources that are specific to family communication and genetic testing per se. In an effort to fill this gap and identify mothers most likely to benefit from such resources, surveys were conducted with 187 mothers undergoing BRCA1/2 testing who had children 8-21 years old. Data were collected weeks after genetic testing but prior to mothers' learning of their test results; quantitative assessments of informational resource needs (i.e., speaking with previous BRCA1/2 testing participants who are parents regarding their experiences, reading educational literature about options and what to expect, speaking with a family counselor, attending a family support group, and self-nominated other resources), testing motivations, decision making vigilance, and decisional conflict regarding communicating test results to children were included. Mothers' most-to-least frequently cited information resource needs were: literature (93.4%), family counseling (85.8%), prior participants (79.0%), support groups (53.9%), and other (28.9%; e.g., pediatricians and psychologists). Seventy-eight percent of mothers were interested in accessing three or more resources. In multivariate regression analyses, testing motivations (beta = 0.35, p = 0.03), decision-making vigilance (beta = 0.16, p = 0.00), and decisional conflict (beta = 0.10, p = 0.00) were associated with mothers' need level; mothers with a greater interest in testing to learn about their children's risks, those with more vigilant decision-making styles, and those with higher decisional conflict had the greatest need. In conjunction with enhanced genetic counseling focusing on family disclosure, educational literature, and psychosocial support may promote improved outcomes.

The Science-Policy Link: Stakeholder Reactions to the Uncertainties of Future Sea Level Rise

NASA Astrophysics Data System (ADS)

Plag, H.; Bye, B.

2011-12-01

Policy makers and stakeholders in the coastal zone are equally challenged by the risk of an anticipated rise of coastal Local Sea Level (LSL) as a consequence of future global warming. Many low-lying and often densely populated coastal areas are under risk of increased inundation. More than 40% of the global population is living in or near the coastal zone and this fraction is steadily increasing. A rise in LSL will increase the vulnerability of coastal infrastructure and population dramatically, with potentially devastating consequences for the global economy, society, and environment. Policy makers are faced with a trade-off between imposing today the often very high costs of coastal protection and adaptation upon national economies and leaving the costs of potential major disasters to future generations. They are in need of actionable information that provides guidance for the development of coastal zones resilient to future sea level changes. Part of this actionable information comes from risk and vulnerability assessments, which require information on future LSL changes as input. In most cases, a deterministic approach has been applied based on predictions of the plausible range of future LSL trajectories as input. However, there is little consensus in the scientific community on how these trajectories should be determined, and what the boundaries of the plausible range are. Over the last few years, many publications in Science, Nature and other peer-reviewed scientific journals have revealed a broad range of possible futures and significant epistemic uncertainties and gaps concerning LSL changes. Based on the somewhat diffuse science input, policy and decision makers have made rather different choices for mitigation and adaptation in cases such as Venice, The Netherlands, New York City, and the San Francisco Bay area. Replacing the deterministic, prediction-based approach with a statistical one that fully accounts for the uncertainties and epistemic gaps would provide a different kind of science input to policy makers and stakeholders. Like in many other insurance problems (for example, earthquakes), where deterministic predictions are not possible and decisions have to be made on the basis of statistics and probabilities, the statistical approach to coastal resilience would require stakeholders to make decisions on the basis of probabilities instead of predictions. The science input for informed decisions on adaptation would consist of general probabilities of decadal to century scale sea level changes derived from paleo records, including the probabilities for large and rapid rises. Similar to other problems where the appearance of a hazard is associated with a high risk (like a fire in a house), this approach would also require a monitoring and warning system (a "smoke detector") capable of detecting any onset of a rapid sea level rise.

Japanese consumer preferences for milk certified with the good agricultural practice(GAP) label.

PubMed

Aizaki, Hideo; Nanseki, Teruaki; Zhou, Hui

2013-01-01

This study examined Japanese consumers' valuation of a good agricultural practice (GAP) label on packaged milk and investigated the effect of detailed GAP information on valuation. A total of 624 Japanese consumers were asked to select their most preferred milk through an online survey. The milk was assumed to have three attributes: the GAP label, Hazard Analysis and Critical Control Points certification, and price. The results showed that consumers' valuation of GAP was significantly positive. Although providing additional GAP information to a respondent who was aware of GAP and what it means had a positive effect on the consumers' valuation of GAP, provision of this information had no effect if the respondent knew about GAP either moderately or slightly, and had a negative effect if the respondent did not know about GAP at all. To increase broad consumer awareness and valuation of GAP, it is important to provide GAP information according to the requirements of consumers. © 2012 The Authors. Animal Science Journal © 2012 Japanese Society of Animal Science.

Human Research Program Space Human Factors Engineering (SHFE) Standing Review Panel (SRP)

NASA Technical Reports Server (NTRS)

Wichansky, Anna; Badler, Norman; Butler, Keith; Cummings, Mary; DeLucia, Patricia; Endsley, Mica; Scholtz, Jean

2009-01-01

The Space Human Factors Engineering (SHFE) Standing Review Panel (SRP) evaluated 22 gaps and 39 tasks in the three risk areas assigned to the SHFE Project. The area where tasks were best designed to close the gaps and the fewest gaps were left out was the Risk of Reduced Safety and Efficiency dire to Inadequate Design of Vehicle, Environment, Tools or Equipment. The areas where there were more issues with gaps and tasks, including poor or inadequate fit of tasks to gaps and missing gaps, were Risk of Errors due to Poor Task Design and Risk of Error due to Inadequate Information. One risk, the Risk of Errors due to Inappropriate Levels of Trust in Automation, should be added. If astronauts trust automation too much in areas where it should not be trusted, but rather tempered with human judgment and decision making, they will incur errors. Conversely, if they do not trust automation when it should be trusted, as in cases where it can sense aspects of the environment such as radiation levels or distances in space, they will also incur errors. This will be a larger risk when astronauts are less able to rely on human mission control experts and are out of touch, far away, and on their own. The SRP also identified 11 new gaps and five new tasks. Although the SRP had an extremely large quantity of reading material prior to and during the meeting, we still did not feel we had an overview of the activities and tasks the astronauts would be performing in exploration missions. Without a detailed task analysis and taxonomy of activities the humans would be engaged in, we felt it was impossible to know whether the gaps and tasks were really sufficient to insure human safety, performance, and comfort in the exploration missions. The SRP had difficulty evaluating many of the gaps and tasks that were not as quantitative as those related to concrete physical danger such as excessive noise and vibration. Often the research tasks for cognitive risks that accompany poor task or information design addressed only part, but not all, of the gaps they were programmed to fill. In fact the tasks outlined will not close the gap but only scratch the surface in many cases. In other cases, the gap was written too broadly, and really should be restated in a more constrained way that can be addressed by a well-organized and complementary set of tasks. In many cases, the research results should be turned into guidelines for design. However, it was not clear whether the researchers or another group would construct and deliver these guidelines.

Considerations in the construction of an instrument to assess attitudes regarding critical illness gene variation research.

PubMed

Freeman, Bradley D; Kennedy, Carie R; Bolcic-Jankovic, Dragana; Eastman, Alexander; Iverson, Ellen; Shehane, Erica; Celious, Aaron; Barillas, Jennifer; Clarridge, Brian

2012-02-01

Clinical studies conducted in intensive care units are associated with logistical and ethical challenges. Diseases investigated are precipitous and life-threatening, care is highly technological, and patients are often incapacitated and decision-making is provided by surrogates. These investigations increasingly involve collection of genetic data. The manner in which the exigencies of critical illness impact attitudes regarding genetic data collection is unstudied. Given interest in understanding stakeholder preferences as a foundation for the ethical conduct of research, filling this knowledge gap is timely. The conduct of opinion research in the critical care arena is novel. This brief report describes the development of parallel patient/surrogate decision-maker quantitative survey instruments for use in this environment. Future research employing this instrument or a variant of it with diverse populations promises to inform research practices in critical illness gene variation research.

Considerations in the Construction of an Instrument to Assess Attitudes Regarding Critical Illness Gene Variation Research

PubMed Central

Freeman, Bradley D.; Kennedy, Carie R.; Bolcic-Jankovic, Dragana; Eastman, Alexander; Iverson, Ellen; Shehane, Erica; Celious, Aaron; Barillas, Jennifer; Clarridge, Brian

2012-01-01

Clinical studies conducted in intensive care units are associated with logistical and ethical challenges. Diseases investigated are precipitous and life-threatening, care is highly technological, and patients are often incapacitated and decision-making is provided by surrogates. These investigations increasingly involve collection of genetic data. The manner in which the exigencies of critical illness impact attitudes regarding genetic data collection is unstudied. Given interest in understanding stakeholder preferences as a foundation for the ethical conduct of research, filling this knowledge gap is timely. The conduct of opinion research in the critical care arena is novel. This brief report describes the development of parallel patient/surrogate decision-maker quantitative survey instruments for use in this environment. Future research employing this instrument or a variant of it with diverse populations promises to inform research practices in critical illness gene variation research. PMID:22378135

Swarm-based medicine.

PubMed

Putora, Paul Martin; Oldenburg, Jan

2013-09-19

Occasionally, medical decisions have to be taken in the absence of evidence-based guidelines. Other sources can be drawn upon to fill in the gaps, including experience and intuition. Authorities or experts, with their knowledge and experience, may provide further input--known as "eminence-based medicine". Due to the Internet and digital media, interactions among physicians now take place at a higher rate than ever before. With the rising number of interconnected individuals and their communication capabilities, the medical community is obtaining the properties of a swarm. The way individual physicians act depends on other physicians; medical societies act based on their members. Swarm behavior might facilitate the generation and distribution of knowledge as an unconscious process. As such, "swarm-based medicine" may add a further source of information to the classical approaches of evidence- and eminence-based medicine. How to integrate swarm-based medicine into practice is left to the individual physician, but even this decision will be influenced by the swarm.

A First Step towards a Clinical Decision Support System for Post-traumatic Stress Disorders.

PubMed

Ma, Sisi; Galatzer-Levy, Isaac R; Wang, Xuya; Fenyö, David; Shalev, Arieh Y

2016-01-01

PTSD is distressful and debilitating, following a non-remitting course in about 10% to 20% of trauma survivors. Numerous risk indicators of PTSD have been identified, but individual level prediction remains elusive. As an effort to bridge the gap between scientific discovery and practical application, we designed and implemented a clinical decision support pipeline to provide clinically relevant recommendation for trauma survivors. To meet the specific challenge of early prediction, this work uses data obtained within ten days of a traumatic event. The pipeline creates personalized predictive model for each individual, and computes quality metrics for each predictive model. Clinical recommendations are made based on both the prediction of the model and its quality, thus avoiding making potentially detrimental recommendations based on insufficient information or suboptimal model. The current pipeline outperforms the acute stress disorder, a commonly used clinical risk factor for PTSD development, both in terms of sensitivity and specificity.

Understanding ecosystem services adoption by natural resource managers and research ecologists

USGS Publications Warehouse

Engel, Daniel; Evans, Mary; Low, Bobbi S.; Schaeffer, Jeff

2017-01-01

The ecosystem services (ES) paradigm has gained much traction as a natural resource management approach due to its comprehensive nature and ability to provide quantitative tools to improve decision-making. However, it is still uncertain whether and how practitioners have adopted the ES paradigm into their work and how this aligns with resource management information needs. To address this, we surveyed natural resource managers within the Great Lakes region about their use of ES information in decision-making. We complemented our manager survey with in-depth interviews of a related population—research ecologists at the U.S. Geological Survey Great Lakes Science Center. In this study, managers and ecologists almost unanimously agreed that ES were appropriate to consider in resource management. We also found high congruence between managers and ecologists in the ES considered most relevant to their work, with provision of habitat, recreation and tourism, biological control, and primary production being the ES ranked highly by both groups. However, a disconnect arose when research ecologists deemed the information they provide regarding ES as adequate for management needs, but managers disagreed. Furthermore, managers reported that they would use economic information about ES if they had access to that information. We believe this data deficiency could represent a gap in scientific coverage by ecologists, but it may also simply reflect an underrepresentation of ecological economists who can translate ecological knowledge of ES providers into economic information that many managers desired.

NASA Program Office Technology Investments to Enable Future Missions

NASA Astrophysics Data System (ADS)

Thronson, Harley; Pham, Thai; Ganel, Opher

2018-01-01

The Cosmic Origins (COR) and Physics of the Cosmos (PCOS) Program Offices (POs) reside at NASA GSFC and implement priorities for the NASA HQ Astrophysics Division (APD). One major aspect of the POs’ activities is managing our Strategic Astrophysics Technology (SAT) program to mature technologies for future strategic missions. The Programs follow APD guidance on which missions are strategic, currently informed by the NRC’s 2010 Decadal Survey report, as well as APD’s Implementation Plan and the Astrophysics Roadmap.In preparation for the upcoming 2020 Decadal Survey, the APD has established Science and Technology Definition Teams (STDTs) to study four large-mission concepts: the Origins Space Telescope (née, Far-IR Surveyor), Habitable Exoplanet Imaging Mission, Large UV/Optical/IR Surveyor, and Lynx (née, X-ray Surveyor). The STDTs will develop the science case and design reference mission, assess technology development needs, and estimate the cost of their concept. A fifth team, the L3 Study Team (L3ST), was charged to study potential US contributions to ESA’s planned Laser Interferometer Space Antenna (LISA) gravitational-wave observatory.The POs use a rigorous and transparent process to solicit technology gaps from the scientific and technical communities, and prioritize those entries based on strategic alignment, expected impact, cross-cutting applicability, and urgency. For the past two years, the technology-gap assessments of the four STDTs and the L3ST are included in our process. Until a study team submits its final report, community-proposed changes to gaps submitted or adopted by a study team are forwarded to that study team for consideration.We discuss our technology development process, with strategic prioritization informing calls for SAT proposals and informing investment decisions. We also present results of the 2017 technology gap prioritization and showcase our current portfolio of technology development projects. To date, 96 COR and 86 PCOS SAT proposals have been received, of which 22 COR and 28 PCOS projects were awarded. For more information, see the Program Annual Technology Reports available through the PO Technology web page at https://apd440.gsfc.nasa.gov/technology.html .

NASA Astrophysics Prioritizes Technology Development Funding for Strategic Missions

NASA Astrophysics Data System (ADS)

Thronson, Harley A.; Pham, Bruce; Ganel, Opher

2017-01-01

The Cosmic Origins (COR) and Physics of the Cosmos (PCOS) Program Offices (POs) reside at NASA GSFC and implement priorities for the NASA HQ Astrophysics Division (APD). One major aspect of the POs’ activities is managing our Strategic Astrophysics Technology (SAT) program to mature technologies for future strategic missions. The Programs follow APD guidance on which missions are strategic, currently informed by the NRC’s 2010 Decadal Survey report, as well as APD’s Implementation Plan and the Astrophysics Roadmap.In preparation for the upcoming 2020 Decadal Survey, the APD has established Science and Technology Definition Teams (STDTs) to study four large-mission concepts: the Origins Space Telescope, Habitable Exoplanet Imaging Mission, Large UV/Optical/IR Surveyor, and X-ray Surveyor. The STDTs will develop the science case and design reference mission, assess technology development needs, and estimate the cost of their concept. A fifth team, the L3 Study Team (L3ST), was charged to study potential US contributions to ESA’s planned L3 gravitational-wave observatory.The POs use a rigorous and transparent process to solicit technology gaps from the scientific and technical communities, and prioritize those entries based on strategic alignment, expected impact, cross-cutting applicability, and urgency. Starting in 2016, the technology-gap assessments of the four STDTs and the L3ST are included in our process. Until a study team submits its final report, community-proposed changes to gaps submitted or adopted by a study team are forwarded to that study team for consideration.We discuss our technology development process, with strategic prioritization informing calls for SAT proposals and informing investment decisions. We also present results of this year’s technology gap prioritization and showcase our current portfolio of technology development projects. To date, 77 COR and 80 PCOS SAT proposals have been received, of which 18 COR and 22 PCOS projects were funded (PCOS awards starting in 2017 have yet to be announced). For more information, see the respective Program Annual Technology Reports under the technology tabs of the COR website at cor.gsfc.nasa.gov and the PCOS website at pcos.gsfc.nasa.gov.

Risky Decision Making in a Laboratory Driving Task Is Associated with Health Risk Behaviors during Late Adolescence but Not Adulthood

ERIC Educational Resources Information Center

Kim-Spoon, Jungmeen; Kahn, Rachel; Deater-Deckard, Kirby; Chiu, Pearl; Steinberg, Laurence; King-Casas, Brooks

2016-01-01

Adolescence is characterized by increasing incidence of health risk behaviors, including experimentation with drugs and alcohol. To fill the gap in our understanding of the associations between risky decision-making and health risk behaviors, we investigated associations between laboratory-based risky decision-making using the Stoplight task and…

IMPROVED SCIENCE AND DECISION SUPPORT FOR MANAGING WATERSHED NUTRIENT LOADS

EPA Science Inventory

The proposed research addresses two critical gaps in the TMDL process: (1) the inadequacy of presently existing receiving water models to accurately simulate nutrient-sediment-water interactions and fixed plants; and (2) the lack of decision-oriented optimization f...

National and State Treatment Need and Capacity for Opioid Agonist Medication-Assisted Treatment

PubMed Central

Campopiano, Melinda; Baldwin, Grant; McCance-Katz, Elinore

2015-01-01

Objectives. We estimated national and state trends in opioid agonist medication-assisted treatment (OA-MAT) need and capacity to identify gaps and inform policy decisions. Methods. We generated national and state rates of past-year opioid abuse or dependence, maximum potential buprenorphine treatment capacity, number of patients receiving methadone from opioid treatment programs (OTPs), and the percentage of OTPs operating at 80% capacity or more using Substance Abuse and Mental Health Services Administration data. Results. Nationally, in 2012, the rate of opioid abuse or dependence was 891.8 per 100 000 people aged 12 years or older compared with national rates of maximum potential buprenorphine treatment capacity and patients receiving methadone in OTPs of, respectively, 420.3 and 119.9. Among states and the District of Columbia, 96% had opioid abuse or dependence rates higher than their buprenorphine treatment capacity rates; 37% had a gap of at least 5 per 1000 people. Thirty-eight states (77.6%) reported at least 75% of their OTPs were operating at 80% capacity or more. Conclusions. Significant gaps between treatment need and capacity exist at the state and national levels. Strategies to increase the number of OA-MAT providers are needed. PMID:26066931

Ecosystem service information to benefit sustainability standards for commodity supply chains.

PubMed

Chaplin-Kramer, Rebecca; Jonell, Malin; Guerry, Anne; Lambin, Eric F; Morgan, Alexis J; Pennington, Derric; Smith, Nathan; Franch, Jane Atkins; Polasky, Stephen

2015-10-01

The growing base of information about ecosystem services generated by ecologists, economists, and other scientists could improve the implementation, monitoring, and evaluation of commodity-sourcing standards being adopted by corporations to mitigate risk in their supply chains and achieve sustainability goals. This review examines various ways that information about ecosystem services could facilitate compliance with and auditing of commodity-sourcing standards. We also identify gaps in the current state of knowledge on the ecological effectiveness of sustainability standards and demonstrate how ecosystem-service information could complement existing monitoring efforts to build credible evidence. This paper is a call to the ecosystem-service scientists to engage in this decision context and tailor the information they are generating to the needs of the standards community, which we argue would offer greater efficiency of standards implementation for producers and enhanced effectiveness for standard scheme owners and corporations, and should thus lead to more sustainable outcomes for people and nature. © 2015 New York Academy of Sciences.

Adherence to infection prevention and control guidelines: A vignette-based study of decision-making and risk-taking in young adults with cystic fibrosis.

PubMed

Bowmer, Grace; Latchford, Gary; Duff, Alistair; Denton, Miles; Dye, Louise; Lawton, Clare; Lee, Tim

2017-01-01

Balancing cystic fibrosis (CF) care with demands of normal life is associated with decreased adherence to infection prevention and control (IPC) guidelines. Adults with CF, aged 18-25years, were invited to participate via UK CF Trust social media platforms. An online survey evaluated participants' decision-making in nine clinician-rated vignettes and assessed the perceived influence of infection-related information sources. Participants (n=87, mean 21.4years [SD=2.45]; 75% female) were less likely to engage in the high-risk scenarios, although demonstrated greater awareness of cross-infection than environmental risks. Associations between risk-perception and willingness to participate in five vignette-based hypothetical activities were significant (p<0.05). Thematic analysis emphasised influences of past experience and a need to achieve good quality of life. Knowledge gaps were evident. People with CF make decisions that discriminate between risk-levels but are not always based on robust knowledge. They also show some inclination towards engaging in risky behaviours. Copyright © 2016 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Developing a translational ecology workforce

USGS Publications Warehouse

Schwartz, Mark W.; Hiers, J. Kevin; Davis, Frank W.; Garfin, Gregg; Jackson, Stephen T.; Terando, Adam J.; Woodhouse, Connie A.; Morelli, Toni; Williamson, Matthew A.; Brunson, Mark W.

2017-01-01

We define a translational ecologist as a professional ecologist with diverse disciplinary expertise and skill sets, as well as a suitable personal disposition, who engages across social, professional, and disciplinary boundaries to partner with decision makers to achieve practical environmental solutions. Becoming a translational ecologist requires specific attention to obtaining critical non‐scientific disciplinary breadth and skills that are not typically gained through graduate‐level education. Here, we outline a need for individuals with broad training in interdisciplinary skills, use our personal experiences as a basis for assessing the types of interdisciplinary skills that would benefit potential translational ecologists, and present steps that interested ecologists may take toward becoming translational. Skills relevant to translational ecologists may be garnered through personal experiences, informal training, short courses, fellowships, and graduate programs, among others. We argue that a translational ecology workforce is needed to bridge the gap between science and natural resource decisions. Furthermore, we argue that this task is a cooperative responsibility of individuals interested in pursuing these careers, educational institutions interested in training scientists for professional roles outside of academia, and employers seeking to hire skilled workers who can foster stakeholder‐engaged decision making.

Integrating uncertainty into public energy research and development decisions

NASA Astrophysics Data System (ADS)

Anadón, Laura Díaz; Baker, Erin; Bosetti, Valentina

2017-05-01

Public energy research and development (R&D) is recognized as a key policy tool for transforming the world's energy system in a cost-effective way. However, managing the uncertainty surrounding technological change is a critical challenge for designing robust and cost-effective energy policies. The design of such policies is particularly important if countries are going to both meet the ambitious greenhouse-gas emissions reductions goals set by the Paris Agreement and achieve the required harmonization with the broader set of objectives dictated by the Sustainable Development Goals. The complexity of informing energy technology policy requires, and is producing, a growing collaboration between different academic disciplines and practitioners. Three analytical components have emerged to support the integration of technological uncertainty into energy policy: expert elicitations, integrated assessment models, and decision frameworks. Here we review efforts to incorporate all three approaches to facilitate public energy R&D decision-making under uncertainty. We highlight emerging insights that are robust across elicitations, models, and frameworks, relating to the allocation of public R&D investments, and identify gaps and challenges that remain.

Final Report: Towards an Emergent Model of Technology Adoption for Accelerating the Diffusion of Residential Solar PV

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

Rai, Varun

This project sought to enable electric utilities in Texas to accelerate diffusion of residential solar photovoltaic (PV) by systematically identifying and targeting existing barriers to PV adoption. A core goal of the project was to develop an integrated research framework that combines survey research, econometric modeling, financial modeling, and implementation and evaluation of pilot projects to study the PV diffusion system. This project considered PV diffusion as an emergent system, with attention to the interactions between the constituent parts of the PV socio-technical system including: economics of individual decision-making; peer and social influences; behavioral responses; and information and transaction costs.more » We also conducted two pilot projects, which have yielded new insights into behavioral and informational aspects of PV adoption. Finally, this project has produced robust and generalizable results that will provide deeper insights into the technology-diffusion process that will be applicable for the design of utility programs for other technologies such as home-energy management systems and plug-in electric vehicles. When we started this project in 2013 there was little systematic research on characterizing the decision-making process of households interested in adopting PV. This project was designed to fill that research gap by analyzing the PV adoption process from the consumers' decision-making perspective and with the objective to systematically identifying and addressing the barriers that consumers face in the adoption of PV. The two key components of that decision-making process are consumers' evaluation of: (i) uncertainties and non-monetary costs associated with the technology and (ii) the direct monetary cost-benefit. This project used an integrated approach to study both the non-monetary and the monetary components of the consumer decision-making process.« less

What influences patient decision-making in amyotrophic lateral sclerosis multidisciplinary care? A study of patient perspectives.

PubMed

Hogden, Anne; Greenfield, David; Nugus, Peter; Kiernan, Matthew C

2012-01-01

Patients with amyotrophic lateral sclerosis (ALS) are required to make decisions concerning quality of life and symptom management over the course of their disease. Clinicians perceive that patients' ability to engage in timely decision-making is extremely challenging. However, we lack patient perspectives on this issue. This study aimed to explore patient experiences of ALS, and to identify factors influencing their decision-making in the specialized multidisciplinary care of ALS. An exploratory study was conducted. Fourteen patients from two specialized ALS multidisciplinary clinics participated in semistructured interviews that were audio recorded and transcribed. Data were analyzed for emergent themes. Decision-making was influenced by three levels of factors, ie, structural, interactional, and personal. The structural factor was the decision-making environment of specialized multidisciplinary ALS clinics, which supported decision-making by providing patients with disease-specific information and specialized care planning. Interactional factors were the patient experiences of ALS, including patients' reaction to the diagnosis, response to deterioration, and engagement with the multidisciplinary ALS team. Personal factors were patients' personal philosophies, including their outlook on life, perceptions of control, and planning for the future. Patient approaches to decision-making reflected a focus on the present, rather than anticipating future progression of the disease and potential care needs. Decision-making for symptom management and quality of life in ALS care is enhanced when the patient's personal philosophy is supported by collaborative relationships between the patient and the multidisciplinary ALS team. Patients valued the support provided by the multidisciplinary team; however, their focus on living in the present diverged from the efforts of health professionals to prepare patients and their carers for the future. The challenge facing health professionals is how best to engage each patient in decision-making for their future needs, to bridge this gap.

Making the Case for the Outlier: Researcher Reflections of an African-American Female Deputy Superintendent Who Decided to Close the Achievement Gap

ERIC Educational Resources Information Center

Beard, Karen Stansberry

2012-01-01

This article presents researcher reflections of a case study of a Black female deputy superintendent who made the value-driven decision to close the achievement gap in her district. I posit that she is an outlier because she is Black and female in a predominantly white male field of practice, she effectively closed the achievement gap through her…

Web-Based Cancer Communication and Decision Making Systems: Connecting Patients, Caregivers, and Clinicians for Improved Health Outcomes

PubMed Central

DuBenske, Lori L.; Gustafson, David H.; Shaw, Bret R.; Cleary, James F.

2011-01-01

Over the cancer disease trajectory, from diagnosis and treatment to remission or end of life, patients and their families face difficult decisions. The provision of information and support when most relevant can optimize cancer decision making and coping. An interactive health communication system (IHCS) offers the potential to bridge the communication gaps that occur among patients, family, and clinicians and to empower each to actively engage in cancer care and shared decision making. This is a report of the authors' experience (with a discussion of relevant literature) in developing and testing a Web-based IHCS—the Comprehensive Health Enhancement Support System (CHESS)—for patients with advanced lung cancer and their family caregivers. CHESS provides information, communication, and coaching resources as well as a symptom tracking system that reports health status to the clinical team. Development of an IHCS includes a needs assessment of the target audience and applied theory informed by continued stakeholder involvement in early testing. Critical issues of IHCS implementation include 1) need for interventions that accommodate a variety of format preferences and technology comfort ranges; 2) IHCS user training, 3) clinician investment in IHCS promotion, and 4) IHCS integration with existing medical systems. In creating such comprehensive systems, development strategies need to be grounded in population needs with appropriate use of technology that serves the target users, including the patient/family, clinical team, and health care organization. Implementation strategies should address timing, personnel, and environmental factors to facilitate continued use and benefit from IHCS. An interactive health communication system (IHCS) offers one platform for providing the information, communication, and coaching resources that cancer patients and their families need to understand the disease, find support, and develop decision-making and coping skills. One such IHCS—the Comprehensive Health Enhancement Support System (CHESS)—has evolved over the past 20 years. Based on our recent experience creating and testing a new version of CHESS—“Coping with Lung Cancer: A Network of Support”—this article outlines the issues faced in developing and implementing such a system within the cancer context. PMID:21041539

Clinical decision making: how surgeons do it.

PubMed

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

2013-06-01

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

Mind the Gap: Assessing the Disconnect Between Postpartum Health Information Desired and Health Information Received.

PubMed

Guerra-Reyes, Lucia; Christie, Vanessa M; Prabhakar, Annu; Siek, Katie A

Seeking and receiving health information are critical aspects of prenatal and postpartum care; however, many informational sources lack postpartum content. This study explores the gaps between information desired and information received postpartum and identifies the sources women use for health information seeking, with an emphasis on emergent online and mobile phone-based resources. Participants were recruited from our community partners' client base for a cross-sectional study. Mothers (n = 77) of a child 48 months or younger completed a survey on health information seeking, health information needs, and technology use. Postpartum health information gaps were defined as topics about which a participant indicated that she wanted information, but did not receive information. Bivariate analyses assessed the association between demographic characteristics, sources of health information used during pregnancy, and postpartum information gaps. Health care providers, Internet-based resources, and mobile applications were common sources of health information during pregnancy. Mental and sexual health were the most common types of postpartum health information gaps. In bivariate analyses, higher income and education were associated with postpartum information gaps in mental health and sexual health, respectively (p < .05). Postpartum health information gaps were common in this sample, particularly for topics in mental and sexual health. Unexpected associations between higher levels of education and income and postpartum health information gaps were observed in bivariate analyses. Health educators have the opportunity to capitalize on high rates of Internet information seeking by providing health information online. Health care providers must incorporate mental and sexual health into routine postpartum care. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Effects of Information Visualization on Older Adults’ Decision-Making Performance in a Medicare Plan Selection Task: A Comparative Usability Study

PubMed Central

Price, Margaux M; Crumley-Branyon, Jessica J; Leidheiser, William R

2016-01-01

Background Technology gains have improved tools for evaluating complex tasks by providing environmental supports (ES) that increase ease of use and improve performance outcomes through the use of information visualizations (info-vis). Complex info-vis emphasize the need to understand individual differences in abilities of target users, the key cognitive abilities needed to execute a decision task, and the graphical elements that can serve as the most effective ES. Older adults may be one such target user group that would benefit from increased ES to mitigate specific declines in cognitive abilities. For example, choosing a prescription drug plan is a necessary and complex task that can impact quality of life if the wrong choice is made. The decision to enroll in one plan over another can involve comparing over 15 plans across many categories. Within this context, the large amount of complex information and reduced working memory capacity puts older adults’ decision making at a disadvantage. An intentionally designed ES, such as an info-vis that reduces working memory demand, may assist older adults in making the most effective decision among many options. Objective The objective of this study is to examine whether the use of an info-vis can lower working memory demands and positively affect complex decision-making performance of older adults in the context of choosing a Medicare prescription drug plan. Methods Participants performed a computerized decision-making task in the context of finding the best health care plan. Data included quantitative decision-making performance indicators and surveys examining previous history with purchasing insurance. Participants used a colored info-vis ES or a table (no ES) to perform the decision task. Task difficulty was manipulated by increasing the number of selection criteria used to make an accurate decision. A repeated measures analysis was performed to examine differences between the two table designs. Results Twenty-three older adults between the ages of 66 and 80 completed the study. There was a main effect for accuracy such that older adults made more accurate decisions in the color info-vis condition than the table condition. In the low difficulty condition, participants were more successful at choosing the correct answer when the question was about the gap coverage attribute in the info-vis condition. Participants also made significantly faster decisions in the info-vis condition than in the table condition. Conclusions Reducing the working memory demand of the task through the use of an ES can improve decision accuracy, especially when selection criteria is only focused on a single attribute of the insurance plan. PMID:27251110

Assessment of policy and access to HIV prevention, care, and treatment services for men who have sex with men and for sex workers in Burkina Faso and Togo.

PubMed

Duvall, Sandra; Irani, Laili; Compaoré, Cyrille; Sanon, Patrice; Bassonon, Dieudonne; Anato, Simplice; Agounke, Jeannine; Hodo, Ama; Kugbe, Yves; Chaold, Gertrude; Nigobora, Berry; MacInnis, Ron

2015-03-01

In Burkina Faso and Togo, key populations of men who have sex with men (MSM) and sex workers (SW) have a disproportionately higher HIV prevalence. This study analyzed the 2 countries' policies impacting MSM and SW; to what extent the policies and programs have been implemented; and the role of the enabling environment, country leadership, and donor support. The Health Policy Project's Policy Assessment and Advocacy Decision Model methodology was used to analyze policy and program documents related to key populations, conduct key informant interviews, and hold stakeholder meetings to validate the findings. Several policy barriers restrict MSM/SW from accessing services. Laws criminalizing MSM/SW, particularly anti-solicitation laws, result in harassment and arrests of even nonsoliciting MSM/SW. Policy gaps exist, including few MSM/SW-supportive policies and HIV prevention measures, e.g., lubricant not included in the essential medicines list. The needs of key populations are generally not met due to policy gaps around MSM/SW participation in decision-making and funding allocation for MSM/SW-specific programming. Misaligned policies, eg, contradictory informed consent laws and protocols, and uneven policy implementation, such as stockouts of sexually transmitted infection kits, HIV testing materials, and antiretrovirals, undermine evidence-based policies. Even in the presence of a supportive donor and political community, public stigma and discrimination (S&D) create a hostile enabling environment. Policies are needed to address S&D, particularly health care provider and law enforcement training, and to authorize, fund, guide, and monitor services for key populations. MSM/SW participation and development of operational guidelines can improve policy implementation and service uptake.

Can role-play with interactive simulations enhance climate change knowledge, affect and intent to act?

NASA Astrophysics Data System (ADS)

Rooney-varga, J. N.; Sterman, J.; Fracassi, E. P.; Franck, T.; Kapmeier, F.; Kurker, V.; Jones, A.; Rath, K.

2017-12-01

The strong scientific consensus about the reality and risks of anthropogenic climate change stands in stark contrast to widespread confusion and complacency among the public. Many efforts to close that gap, grounded in the information deficit model of risk communication, provide scientific information on climate change through reports and presentations. However, research shows that showing people research does not work: the gap between scientific and public understanding of climate change remains wide. Tools that are rigorously grounded in the science and motivate action on climate change are urgently needed. Here we assess the impact of one such tool, an interactive, role-play simulation, World Climate. Participants take the roles of delegates to the UN climate negotiations and are challenged to create an agreement limiting warming to no more than 2°C. The C-ROADS climate simulation model then provides participants with immediate feedback about the expected impacts of their decisions. Participants use C-ROADS to explore the climate system and use the results to refine their negotiating positions, learning about climate change while experiencing the social dynamics of negotiations and decision-making. Pre- and post-survey results from 21 sessions in eight nations showed significant gains in participants' climate change knowledge, affective engagement, intent to take action, and desire to learn. Contrary to the deficit model, gains in participants' desire to learn more and intention to act were associated with gains in affective engagement, particularly feelings of urgency and hope, but not climate knowledge. Gains were just as strong among participants who oppose government regulation, suggesting the simulation's potential to reach across political divides. Results indicate that simulations like World Climate offer a climate change communication tool that enables people to learn and feel for themselves, which together have the potential to motivate action informed by science.

Global Environmental Alert Service

NASA Astrophysics Data System (ADS)

Grasso, V. F.; Cervone, G.; Singh, A.; Kafatos, M.

2006-12-01

Every year natural disasters such as earthquakes, floods, hurricanes, tsunamis, etc. occur around the world, causing hundreds of thousands of deaths and injuries, billions of dollars in economic losses, and destroying natural landmarks and adveresely affecting ecosystems. Due to increasing urbanization, and increasingly higher percentage of the world's population living in megacities, the existence of nuclear power plants and other facilities whose potential destruction poses unacceptable high risks, natural hazards represent an increasing threat for economic losses, as well as risk to people and property. Warning systems represent an innovative and effective approach to mitigate the risks associated with natural hazards. Several state-of-the-art analyses show that early warning technologies are now available for most natural hazards and systems are already in operation in some parts of the world. Nevertheless, recent disasters such as the 2004 Indian Ocean tsunami, the 2005 Kashmir earthquake and the 2005 Katrina hurricane, highlighted inadequacies in early warning system technologies. Furthermore, not all available technologies are deployed in every part of the world, due to the lack of awareness and resources in the poorer countries, leaving very large and densely populated areas at risk. Efforts towards the development of a global warning system are necessary for filling the gaps of existing technologies. A globally comprehensive early warning system based on existing technologies will be a means to consolidate scientific knowledge, package it in a form usable to international and national decision makers and actively disseminate this information to protect people and properties. There is not a single information broker who searches and packages the policy relevant material and delivers it in an understandable format to the public and decision makers. A critical review of existing systems reveals the need for the innovative service. We propose here a Global Environmental Alert Service (GEAS) that could provide information from monitoring, Earth observing and early warning systems to users in a near real time mode and bridge the gap between the scientific community and policy makers. Characteristics and operational aspects of GEAS are discussed.

New Directions in Health Risk Assessment: A REACH for the Future?

EPA Science Inventory

Health risk assessments have been used to support many decisions in the US to reduce risks from pollutant exposures. These decisions have been highly successful in protecting public health despite uncertainty due to gaps in knowledge and methodological limitations. In recent yea...

Decision Support for Renewal of Wastewater Collection and Water Distribution Systems

EPA Science Inventory

The objective of this study was to identify the current decision support methodologies, models and approaches being used for determining how to rehabilitate or replace underground utilities; identify the critical gaps of these current models through comparison with case history d...

A Pilot Study of Pedestrians with Visual Impairments Detecting Traffic Gaps and Surges Containing Hybrid Vehicles

PubMed Central

Emerson, Robert Wall; Naghshineh, Koorosh; Hapeman, Julie; Wiener, William

2010-01-01

The increasing number of hybrid and quiet internal combustion engine vehicles may impact the travel abilities of pedestrians who are blind. Pedestrians who rely on auditory cues for structuring their travel may face challenges in making crossing decisions in the presence of quiet vehicles. This article describes results of initial studies looking at the crossing decisions of pedestrians who are blind at an uncontrolled crossing (no traffic control) and a light controlled intersection. The presence of hybrid vehicles was a factor in each situation. At the uncontrolled crossing, Toyota hybrids were most difficult to detect but crossing decisions were made more often in small gaps ended by a Honda hybrid. These effects were seen only at speed under 20 mph. At the light controlled intersection, parallel surges of traffic were most difficult to detect when made up only of a Ford Escape hybrid. Results suggest that more controlled studies of vehicle characteristics impacting crossing decisions of pedestrians who are blind are warranted. PMID:21379367

A Pilot Study of Pedestrians with Visual Impairments Detecting Traffic Gaps and Surges Containing Hybrid Vehicles.

PubMed

Emerson, Robert Wall; Naghshineh, Koorosh; Hapeman, Julie; Wiener, William

2011-03-01

The increasing number of hybrid and quiet internal combustion engine vehicles may impact the travel abilities of pedestrians who are blind. Pedestrians who rely on auditory cues for structuring their travel may face challenges in making crossing decisions in the presence of quiet vehicles. This article describes results of initial studies looking at the crossing decisions of pedestrians who are blind at an uncontrolled crossing (no traffic control) and a light controlled intersection. The presence of hybrid vehicles was a factor in each situation. At the uncontrolled crossing, Toyota hybrids were most difficult to detect but crossing decisions were made more often in small gaps ended by a Honda hybrid. These effects were seen only at speed under 20 mph. At the light controlled intersection, parallel surges of traffic were most difficult to detect when made up only of a Ford Escape hybrid. Results suggest that more controlled studies of vehicle characteristics impacting crossing decisions of pedestrians who are blind are warranted.

Advances on a Decision Analytic Approach to Exposure-Based Chemical Prioritization.

PubMed

Wood, Matthew D; Plourde, Kenton; Larkin, Sabrina; Egeghy, Peter P; Williams, Antony J; Zemba, Valerie; Linkov, Igor; Vallero, Daniel A

2018-05-11

The volume and variety of manufactured chemicals is increasing, although little is known about the risks associated with the frequency and extent of human exposure to most chemicals. The EPA and the recent signing of the Lautenberg Act have both signaled the need for high-throughput methods to characterize and screen chemicals based on exposure potential, such that more comprehensive toxicity research can be informed. Prior work of Mitchell et al. using multicriteria decision analysis tools to prioritize chemicals for further research is enhanced here, resulting in a high-level chemical prioritization tool for risk-based screening. Reliable exposure information is a key gap in currently available engineering analytics to support predictive environmental and health risk assessments. An elicitation with 32 experts informed relative prioritization of risks from chemical properties and human use factors, and the values for each chemical associated with each metric were approximated with data from EPA's CP_CAT database. Three different versions of the model were evaluated using distinct weight profiles, resulting in three different ranked chemical prioritizations with only a small degree of variation across weight profiles. Future work will aim to include greater input from human factors experts and better define qualitative metrics. © 2018 Society for Risk Analysis.

On genomics, kin, and privacy

PubMed Central

Telenti, Amalio; Ayday, Erman; Hubaux, Jean Pierre

2014-01-01

The storage of greater numbers of exomes or genomes raises the question of loss of privacy for the individual and for families if genomic data are not properly protected. Access to genome data may result from a personal decision to disclose, or from gaps in protection. In either case, revealing genome data has consequences beyond the individual, as it compromises the privacy of family members. Increasing availability of genome data linked or linkable to metadata through online social networks and services adds one additional layer of complexity to the protection of genome privacy.  The field of computer science and information technology offers solutions to secure genomic data so that individuals, medical personnel or researchers can access only the subset of genomic information required for healthcare or dedicated studies. PMID:25254097

Studying PubMed usages in the field for complex problem solving: Implications for tool design

PubMed Central

Song, Jean; Tonks, Jennifer Steiner; Meng, Fan; Xuan, Weijian; Ameziane, Rafiqa

2012-01-01

Many recent studies on MEDLINE-based information seeking have shed light on scientists’ behaviors and associated tool innovations that may improve efficiency and effectiveness. Few if any studies, however, examine scientists’ problem-solving uses of PubMed in actual contexts of work and corresponding needs for better tool support. Addressing this gap, we conducted a field study of novice scientists (14 upper level undergraduate majors in molecular biology) as they engaged in a problem solving activity with PubMed in a laboratory setting. Findings reveal many common stages and patterns of information seeking across users as well as variations, especially variations in cognitive search styles. Based on findings, we suggest tool improvements that both confirm and qualify many results found in other recent studies. Our findings highlight the need to use results from context-rich studies to inform decisions in tool design about when to offer improved features to users. PMID:24376375

Health literacy and patient portals.

PubMed

Gu, Yulong; Orr, Martin; Warren, Jim

2015-06-01

Health literacy has been described as the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Improving health literacy may serve to promote concordance with therapy, engage patients in their own health care, and improve health outcomes. Patient portal technology aims at enabling patients and families to have easy access to key information in their own medical records and to communicate with their health care providers electronically. However, there is a gap in our understanding of how portals will improve patient outcome. The authors believe patient portal technology presents an opportunity to improve patient concordance with prescribed therapy, if adequate support is provided to equip patients (and family/carers) with the knowledge needed to utilise the health information available via the portals. Research is needed to understand what a health consumer will use patient portals for and how to support a user to realise the technology's potential.

The Neural Basis of Long-Distance Navigation in Birds.

PubMed

Mouritsen, Henrik; Heyers, Dominik; Güntürkün, Onur

2016-01-01

Migratory birds can navigate over tens of thousands of kilometers with an accuracy unobtainable for human navigators. To do so, they use their brains. In this review, we address how birds sense navigation- and orientation-relevant cues and where in their brains each individual cue is processed. When little is currently known, we make educated predictions as to which brain regions could be involved. We ask where and how multisensory navigational information is integrated and suggest that the hippocampus could interact with structures that represent maps and compass information to compute and constantly control navigational goals and directions. We also suggest that the caudolateral nidopallium could be involved in weighing conflicting pieces of information against each other, making decisions, and helping the animal respond to unexpected situations. Considering the gaps in current knowledge, some of our suggestions may be wrong. However, our main aim is to stimulate further research in this fascinating field.

The GMOseek matrix: a decision support tool for optimizing the detection of genetically modified plants.

PubMed

Block, Annette; Debode, Frédéric; Grohmann, Lutz; Hulin, Julie; Taverniers, Isabel; Kluga, Linda; Barbau-Piednoir, Elodie; Broeders, Sylvia; Huber, Ingrid; Van den Bulcke, Marc; Heinze, Petra; Berben, Gilbert; Busch, Ulrich; Roosens, Nancy; Janssen, Eric; Žel, Jana; Gruden, Kristina; Morisset, Dany

2013-08-22

Since their first commercialization, the diversity of taxa and the genetic composition of transgene sequences in genetically modified plants (GMOs) are constantly increasing. To date, the detection of GMOs and derived products is commonly performed by PCR-based methods targeting specific DNA sequences introduced into the host genome. Information available regarding the GMOs' molecular characterization is dispersed and not appropriately organized. For this reason, GMO testing is very challenging and requires more complex screening strategies and decision making schemes, demanding in return the use of efficient bioinformatics tools relying on reliable information. The GMOseek matrix was built as a comprehensive, online open-access tabulated database which provides a reliable, comprehensive and user-friendly overview of 328 GMO events and 247 different genetic elements (status: 18/07/2013). The GMOseek matrix is aiming to facilitate GMO detection from plant origin at different phases of the analysis. It assists in selecting the targets for a screening analysis, interpreting the screening results, checking the occurrence of a screening element in a group of selected GMOs, identifying gaps in the available pool of GMO detection methods, and designing a decision tree. The GMOseek matrix is an independent database with effective functionalities in a format facilitating transferability to other platforms. Data were collected from all available sources and experimentally tested where detection methods and certified reference materials (CRMs) were available. The GMOseek matrix is currently a unique and very valuable tool with reliable information on GMOs from plant origin and their present genetic elements that enables further development of appropriate strategies for GMO detection. It is flexible enough to be further updated with new information and integrated in different applications and platforms.

The GMOseek matrix: a decision support tool for optimizing the detection of genetically modified plants

PubMed Central

2013-01-01

Background Since their first commercialization, the diversity of taxa and the genetic composition of transgene sequences in genetically modified plants (GMOs) are constantly increasing. To date, the detection of GMOs and derived products is commonly performed by PCR-based methods targeting specific DNA sequences introduced into the host genome. Information available regarding the GMOs’ molecular characterization is dispersed and not appropriately organized. For this reason, GMO testing is very challenging and requires more complex screening strategies and decision making schemes, demanding in return the use of efficient bioinformatics tools relying on reliable information. Description The GMOseek matrix was built as a comprehensive, online open-access tabulated database which provides a reliable, comprehensive and user-friendly overview of 328 GMO events and 247 different genetic elements (status: 18/07/2013). The GMOseek matrix is aiming to facilitate GMO detection from plant origin at different phases of the analysis. It assists in selecting the targets for a screening analysis, interpreting the screening results, checking the occurrence of a screening element in a group of selected GMOs, identifying gaps in the available pool of GMO detection methods, and designing a decision tree. The GMOseek matrix is an independent database with effective functionalities in a format facilitating transferability to other platforms. Data were collected from all available sources and experimentally tested where detection methods and certified reference materials (CRMs) were available. Conclusions The GMOseek matrix is currently a unique and very valuable tool with reliable information on GMOs from plant origin and their present genetic elements that enables further development of appropriate strategies for GMO detection. It is flexible enough to be further updated with new information and integrated in different applications and platforms. PMID:23965170

Mainstreaming conservation agriculture in Malawi: Knowledge gaps and institutional barriers.

PubMed

Dougill, Andrew J; Whitfield, Stephen; Stringer, Lindsay C; Vincent, Katharine; Wood, Benjamin T; Chinseu, Edna L; Steward, Peter; Mkwambisi, David D

2017-06-15

Conservation agriculture (CA) practices of reduced soil tillage, permanent organic soil coverage and intercropping/crop rotation, are being advocated globally, based on perceived benefits for crop yields, soil carbon storage, weed suppression, reduced soil erosion and improved soil water retention. However, some have questioned their efficacy due to uncertainty around the performance and trade-offs associated with CA practices, and their compatibility with the diverse livelihood strategies and varied agro-ecological conditions across African smallholder systems. This paper assesses the role of key institutions in Malawi in shaping pathways towards more sustainable land management based on CA by outlining their impact on national policy-making and the design and implementation of agricultural development projects. It draws on interviews at national, district and project levels and a multi-stakeholder workshop that mapped the institutional landscape of decision-making for agricultural land management practices. Findings identify knowledge gaps and institutional barriers that influence land management decision-making and constrain CA uptake. We use our findings to set out an integrated roadmap of research needs and policy options aimed at supporting CA as a route to enhanced sustainable land management in Malawi. Findings offer lessons that can inform design, planning and implementation of CA projects, and identify the multi-level institutional support structures required for mainstreaming sustainable land management in sub-Saharan Africa. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

Waters, M.D.; Stack, H.F.; Garrett, N.E.

A graphic approach, terms a Genetic Activity Profile (GAP), was developed to display a matrix of data on the genetic and related effects of selected chemical agents. The profiles provide a visual overview of the quantitative (doses) and qualitative (test results) data for each chemical. Either the lowest effective dose or highest ineffective dose is recorded for each agent and bioassay. Up to 200 different test systems are represented across the GAP. Bioassay systems are organized according to the phylogeny of the test organisms and the end points of genetic activity. The methodology for producing and evaluating genetic activity profilemore » was developed in collaboration with the International Agency for Research on Cancer (IARC). Data on individual chemicals were compiles by IARC and by the US Environmental Protection Agency (EPA). Data are available on 343 compounds selected from volumes 1-53 of the IARC Monographs and on 115 compounds identified as Superfund Priority Substances. Software to display the GAPs on an IBM-compatible personal computer is available from the authors. Structurally similar compounds frequently display qualitatively and quantitatively similar profiles of genetic activity. Through examination of the patterns of GAPs of pairs and groups of chemicals, it is possible to make more informed decisions regarding the selection of test batteries to be used in evaluation of chemical analogs. GAPs provided useful data for development of weight-of-evidence hazard ranking schemes. Also, some knowledge of the potential genetic activity of complex environmental mixtures may be gained from an assessment of the genetic activity profiles of component chemicals. The fundamental techniques and computer programs devised for the GAP database may be used to develop similar databases in other disciplines. 36 refs., 2 figs.« less

Making Invasion models useful for decision makers; incorporating uncertainty, knowledge gaps, and decision-making preferences

Treesearch

Denys Yemshanov; Frank H Koch; Mark Ducey

2015-01-01

Uncertainty is inherent in model-based forecasts of ecological invasions. In this chapter, we explore how the perceptions of that uncertainty can be incorporated into the pest risk assessment process. Uncertainty changes a decision maker’s perceptions of risk; therefore, the direct incorporation of uncertainty may provide a more appropriate depiction of risk. Our...

Impact of clinical and health services research projects on decision-making: a qualitative study.

PubMed

Solans-Domènech, Maite; Adam, Paula; Guillamón, Imma; Permanyer-Miralda, Gaietà; Pons, Joan M V; Escarrabill, Joan

2013-05-10

This article reports on the impact assessment experience of a funding program of non-commercial clinical and health services research. The aim was to assess the level of implementation of results from a subgroup of research projects (on respiratory diseases), and to detect barriers (or facilitators) in the translation of new knowledge to informed decision-making. A qualitative study was performed. The sample consisted of six projects on respiratory diseases funded by the Agency for Health Quality and Assessment of Catalonia between 1996 and 2004. Semi-structured interviews to key informants including researchers and healthcare decision-makers were carried out. Interviews were recorded, transcribed verbatim and analysed on an individual (key informant) and group (project) basis. In addition, the differences between achieved and expected impacts were described. Twenty-three semi-structured interviews were conducted. Most participants indicated changes in health services or clinical practice had resulted from research. The channels used to transfer new knowledge were mainly conventional ones, but also in less explicit ways, such as with the involvement of local scientific societies, or via debates and discussions with colleagues and local leaders. The barriers and facilitators identified were mostly organizational (in research management, and clinical and healthcare practice), although there were also some related to the nature of the research as well as personal factors. Both the expected and achieved impacts enabled the identification of the gaps between what is expected and what is truly achieved. In this study and according to key informants, the impact of these research projects on decision-making can be direct (the application of a finding or innovation) or indirect, contributing to a more complex change in clinical practice and healthcare organization, both having other contextual factors. The channels used to transfer this new knowledge to clinical practice are complex. Local scientific societies and the relationships between researchers and decision-makers can play a very important role. Specifically, the relationships between managers and research teams and the mutual knowledge of their activity have shown to be effective in applying research funding to practice and decision-making. Finally the facilitating factors and barriers identified by the respondents are closely related to the idiosyncrasy of the human relations between the different stakeholders involved.

The Role of Federal Government for Climate Adaptation in the Urban Context: Results of a workshop (Invited)

NASA Astrophysics Data System (ADS)

Buizer, J.; Chhetri, N.; Roy, M.

2010-12-01

Extreme weather events in urban areas such as torrential rainfall in Chicago and London, floods in Boston and Elbe and heat waves in Europe have shed stark light on cities’ vulnerability to the effects of climate change. At the same time, cities themselves are significant net contributors to GHG’s attributable to climatic changes through the built environment (e.g. housing, roads, and parking lots), transport, consumption and recreation. In the arid region of southwestern United States, issues associated with the adequacy of water resources, urban heat island, and air quality best exemplify these contributions. This duality - cities as impacted by, and contributors to extreme climatic patterns induced by climate change, and the specific climate information needed for decision-making by city planners - provided the impetus for a two-day workshop in January 2009. Organized by Arizona State University, the workshop included city managers, planners, private sector stakeholders, water managers, researchers, and Federal program managers. The aim was to identify information needs, and data and research gaps, as well as to design strategies to address climate uncertainty. Two key approaches discussed were: a) building multiple, flexible scenarios and modeling efforts that enable decision-makers to plan for a number of possible futures, and b) matching Federal climate assets to local, regional and sectoral needs through continuous collaboration that supports decision-making within the social, economic, and political context of the place. Federal leadership in facilitating, coordinating and informing efforts that nurture the creative intellectual capacity of cities to produce integrated solutions to mitigate the effects of and adapt to climate change will go a long way in addressing urban climate adaptation in the United States. Participants outlined a number of concerns and suggestions for Federal government leaders and services associated with a national climate network. Concerns included a broad range of issues, including flood protection, sea level rise, extreme events, infrastructure investment decisions, water supply, storm-water and wastewater management, public education and outreach. Suggestions included an in-depth exploration of new roles for federal agencies, as well as new partnerships with state and local entities, the private sector, and non-governmental entities; developing specialized communicators and trusted information brokers who can connect federal science agencies to local decision makers; and integrating federal decision making with local implementation.

Impact of clinical and health services research projects on decision-making: a qualitative study

PubMed Central

2013-01-01

Background This article reports on the impact assessment experience of a funding program of non-commercial clinical and health services research. The aim was to assess the level of implementation of results from a subgroup of research projects (on respiratory diseases), and to detect barriers (or facilitators) in the translation of new knowledge to informed decision-making. Methods A qualitative study was performed. The sample consisted of six projects on respiratory diseases funded by the Agency for Health Quality and Assessment of Catalonia between 1996 and 2004. Semi-structured interviews to key informants including researchers and healthcare decision-makers were carried out. Interviews were recorded, transcribed verbatim and analysed on an individual (key informant) and group (project) basis. In addition, the differences between achieved and expected impacts were described. Results Twenty-three semi-structured interviews were conducted. Most participants indicated changes in health services or clinical practice had resulted from research. The channels used to transfer new knowledge were mainly conventional ones, but also in less explicit ways, such as with the involvement of local scientific societies, or via debates and discussions with colleagues and local leaders. The barriers and facilitators identified were mostly organizational (in research management, and clinical and healthcare practice), although there were also some related to the nature of the research as well as personal factors. Both the expected and achieved impacts enabled the identification of the gaps between what is expected and what is truly achieved. Conclusions In this study and according to key informants, the impact of these research projects on decision-making can be direct (the application of a finding or innovation) or indirect, contributing to a more complex change in clinical practice and healthcare organization, both having other contextual factors. The channels used to transfer this new knowledge to clinical practice are complex. Local scientific societies and the relationships between researchers and decision-makers can play a very important role. Specifically, the relationships between managers and research teams and the mutual knowledge of their activity have shown to be effective in applying research funding to practice and decision-making. Finally the facilitating factors and barriers identified by the respondents are closely related to the idiosyncrasy of the human relations between the different stakeholders involved. PMID:23663364

Aging and consumer decision making

PubMed Central

Carpenter, Stephanie M.; Yoon, Carolyn

2013-01-01

Research on consumer decision making and aging is especially important for fostering a better understanding of ways to maintain consumer satisfaction and high decision quality across the life span. We provide a review of extant research on the effects of normal aging on cognition and decision processes and how these age-related processes are influenced by task environment, meaningfulness of the task, and consumer expertise. We consider how research centered on these topics generates insights about changes in consumption decisions that occur with aging and identify a number of gaps and directions for future research. PMID:22360794

Food Security as a Constraint on National Policy Decision Making in the Arab Region: A Case Study on Food Security in Sudan

DTIC Science & Technology

2009-04-17

12 Food Shortage alld The Killg of Egypt Visioll ----------------------------------------------------------- 13 Arab Security Gap ...intervention widened the gap in the value of food commodities in the Arab countries among investors and farmers. 5. Reduction in food production due to drought...seeds and also conduct pre-harvest crop assessments to identify agricultural and livestock gaps among the Sudanese2o. On the other hand, the UN

Identifying Health Consumers' eHealth Literacy to Decrease Disparities in Accessing eHealth Information.

PubMed

Park, Hyejin; Cormier, Eileen; Gordon, Glenna; Baeg, Jung Hoon

2016-02-01

The increasing amount of health information available on the Internet highlights the importance of eHealth literacy skills for health consumers. Low eHealth literacy results in disparities in health consumers' ability to access and use eHealth information. The purpose of this study was to assess the perceived eHealth literacy of a general health consumer population so that healthcare professionals can effectively address skills gaps in health consumers' ability to access and use high-quality online health information. Participants were recruited from three public library branches in a Northeast Florida community. The eHealth Literacy Scale was used. The majority of participants (n = 108) reported they knew how and where to find health information and how to use it to make health decisions; knowledge of what health resources were available and confidence in the ability to distinguish high- from low-quality information were considerably less. The findings suggest the need for eHealth education and support to health consumers from healthcare professionals, in particular, how to access and evaluate the quality of health information.

Evaluating public participation in Chinese EIA. An integrated Public Participation Index and its application to the case of the New Beijing Airport

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

Brombal, Daniele; Moriggi, Angela; Department of Environmental Sciences, Informatics and Statistics, University Ca' Foscari Venice

In recent years, China's government authorities have devoted increasing attention to the role of public participation processes in Environmental Impact Assessment (EIA). The capacity of these processes to influence decision-making remains widely debated. This paper aims at appraising the institutional rationale informing the implementation of public participation in China's EIA, benchmarking it against three conceptualisations: (1) Normative, based on objectives of empowerment and democratisation; (2) Substantive, where participation is pursued mainly to improve quality of decisions; (3) Instrumental, seeking participation as an instrument to legitimise decision-making processes. The appraisal is carried out by means of a new integrated index (Publicmore » Participation Index, PPI), which is applied to a case study representative of latest advancements in EIA public participation practices in China, namely the “New Beijing Airport Project”. Located 46 km south of downtown Beijing, the project was approved in 2014 and it is currently under construction. Results of the PPI application to this case study indicate that, despite progress made in recent years, the implementation of public participation in Chinese EIA still largely responds to an instrumental rationale, with limited capacity for the public to affect decisions. - Highlights: • In recent years China has strengthened EIA public participation (PP) legislation. • Despite progress, implementation of PP remains informed by an instrumental rationale. • A large gap exists between principles enunciated in regulations and implementation. • The Public Participation Index can be used to monitor China's EIA PP development.« less

"Know What to Do If You Encounter a Flash Flood": Mental Models Analysis for Improving Flash Flood Risk Communication and Public Decision Making.

PubMed

Lazrus, Heather; Morss, Rebecca E; Demuth, Julie L; Lazo, Jeffrey K; Bostrom, Ann

2016-02-01

Understanding how people view flash flood risks can help improve risk communication, ultimately improving outcomes. This article analyzes data from 26 mental models interviews about flash floods with members of the public in Boulder, Colorado, to understand their perspectives on flash flood risks and mitigation. The analysis includes a comparison between public and professional perspectives by referencing a companion mental models study of Boulder-area professionals. A mental models approach can help to diagnose what people already know about flash flood risks and responses, as well as any critical gaps in their knowledge that might be addressed through improved risk communication. A few public interviewees mentioned most of the key concepts discussed by professionals as important for flash flood warning decision making. However, most interviewees exhibited some incomplete understandings and misconceptions about aspects of flash flood development and exposure, effects, or mitigation that may lead to ineffective warning decisions when a flash flood threatens. These include important misunderstandings about the rapid evolution of flash floods, the speed of water in flash floods, the locations and times that pose the greatest flash flood risk in Boulder, the value of situational awareness and environmental cues, and the most appropriate responses when a flash flood threatens. The findings point to recommendations for ways to improve risk communication, over the long term and when an event threatens, to help people quickly recognize and understand threats, obtain needed information, and make informed decisions in complex, rapidly evolving extreme weather events such as flash floods. © 2015 Society for Risk Analysis.

30 CFR 585.705 - When must I use a Certified Verification Agent (CVA)?

Code of Federal Regulations, 2014 CFR

2014-07-01

... with your SAP under § 585.610(a)(9), COP under § 585.626(b)(20), or GAP under § 585.645(c)(5). (1) BOEM... decision on your SAP, COP, or GAP. (2) If BOEM does not waive the requirement for a CVA, you may file an...

30 CFR 585.705 - When must I use a Certified Verification Agent (CVA)?

Code of Federal Regulations, 2013 CFR

2013-07-01

... with your SAP under § 585.610(a)(9), COP under § 585.626(b)(20), or GAP under § 585.645(c)(5). (1) BOEM... decision on your SAP, COP, or GAP. (2) If BOEM does not waive the requirement for a CVA, you may file an...

Aiming at Narrowing Social Gaps in Israel through a Special Program of Everyman's University.

ERIC Educational Resources Information Center

Guri, Sarah

The philosophy and implementation of the Community Leaders Project at Everyman's University (EU), the Open University of Israel, are discussed. The project is designed to narrow social gaps in Israel by upgrading the educational level of disadvantaged populations and by developing indigeneous leadership for decision-making in the most…

Minding the Gap: Investing in a Skilled Manufacturing Workforce

ERIC Educational Resources Information Center

Richard, Alan

2015-01-01

Advanced manufacturing is growing and thriving in the United States. Companies are in great need of reliable employees who can communicate well, effectively make decisions, and are interested in long-term careers with opportunity for advancement. Employers have identified a need for a more robust talent pipeline to narrow America's skills gap--a…

Symmetry in cold-to-hot and hot-to-cold valuation gaps.

PubMed

Fisher, Geoffrey; Rangel, Antonio

2014-01-01

Individuals commonly mispredict their future preferences when they make decisions in a visceral state different from their anticipated state at consumption. In the research reported here, we asked subjects to bid on different foods while exogenously varying their hunger levels at the time of decision and at the time of consumption. This procedure allowed us to test whether cold-to-hot and hot-to-cold gaps are symmetric in size and driven by similar mechanisms. We found that the effect size was symmetric: Hungry subjects overbid 20¢ for a snack they would eat later when they were satiated, and satiated subjects underbid 19¢ for a snack they would eat later when they were hungry. Furthermore, we found evidence that these gaps were driven by symmetric mechanisms that operate on the evaluation of visceral features of food, such as taste, as opposed to more cognitive features, such as healthiness.

The financing gaps framework: using need, potential spending and expected spending to allocate development assistance for health

PubMed Central

Haakenstad, Annie; Templin, Tara; Lim, Stephen; Bump, Jesse B; Dieleman, Joseph

2018-01-01

Abstract As growth in development assistance for health levels off, development assistance partners must make allocation decisions within tighter budget constraints. Furthermore, with the advent of comprehensive and comparable burden of disease and health financing estimates, empirical evidence can increasingly be used to direct funding to those most in need. In our ‘financing gaps framework’, we propose a new approach for harnessing information to make decisions about health aid. The framework was designed to be forward-looking, goal-oriented, versatile and customizable to a range of organizational contexts and health aims. Our framework brings together expected health spending, potential health spending and spending need, to orient financing decisions around international health targets. As an example of how the framework could be applied, we develop a case study, focused on global goals for child health. The case study harnesses data from the Global Burden of Disease 2013 Study, Financing Global Health 2015, the WHO Global Health Observatory and National Health Accounts. Funding flows are tied to progress toward the Sustainable Development Goal’s target for reductions in under-five mortality. The flexibility and comprehensiveness of our framework makes it adaptable for use by a diverse set of governments, donors, policymakers and other stakeholders. The framework can be adapted to short‐ or long‐run time frames, cross‐country or subnational scales, and to a number of specific health focus areas. Depending on donor preferences, the framework can be deployed to incentivize local investments in health, ensuring the long-term sustainability of health systems in low- and middle-income countries, while also furnishing international support for progress toward global health goals. PMID:29415240

Enhancing Health-Care Services with Mixed Reality Systems

NASA Astrophysics Data System (ADS)

Stantchev, Vladimir

This work presents a development approach for mixed reality systems in health care. Although health-care service costs account for 5-15% of GDP in developed countries the sector has been remarkably resistant to the introduction of technology-supported optimizations. Digitalization of data storing and processing in the form of electronic patient records (EPR) and hospital information systems (HIS) is a first necessary step. Contrary to typical business functions (e.g., accounting or CRM) a health-care service is characterized by a knowledge intensive decision process and usage of specialized devices ranging from stethoscopes to complex surgical systems. Mixed reality systems can help fill the gap between highly patient-specific health-care services that need a variety of technical resources on the one side and the streamlined process flow that typical process supporting information systems expect on the other side. To achieve this task, we present a development approach that includes an evaluation of existing tasks and processes within the health-care service and the information systems that currently support the service, as well as identification of decision paths and actions that can benefit from mixed reality systems. The result is a mixed reality system that allows a clinician to monitor the elements of the physical world and to blend them with virtual information provided by the systems. He or she can also plan and schedule treatments and operations in the digital world depending on status information from this mixed reality.

The persuasion context and results in online opinion seeking: effects of message and source-the moderating role of network managers.

PubMed

Cabezudo, Rebeca San José; Izquierdo, Carmen Camarero; Pinto, Javier Rodríguez

2013-11-01

Online opinion networks are areas for social exchange, or conversational networks, made up of individuals actively involved in sharing experiences and opinions concerning matters of mutual interest between consumers or concerning their experience with a given product or service. We pinpoint a gap in the literature regarding how the persuasion process occurs when individuals seek opinions online, including the results process. In an attempt to find an answer, we draw on traditional theories related to information processing. These are mostly taken from the field of psychology and enable us to identify which signals or aspects of communication or opinions the individuals focus their attention on (message and source) and the value attached to such communications as well as how much they impact individuals' purchase decisions, bearing in mind the medium (or online opinion network) in which the opinions are located. Findings from those interviewed support the idea that the quality of information on the Internet, as well as trust in the source of said information, or in the opinion of network users, have an impact on the informational value obtained from involvement in this online opinion seeking and on purchasing decisions. Moreover, depending on the kind of network (firm or brand controlled, review Web sites, and user-controlled nonofficial opinion networks), the quality of the information or trust in the users will have a different bearing in the persuasion process.

Choice-Supportive Misremembering: A New Taxonomy and Review

PubMed Central

Lind, Martina; Visentini, Mimì; Mäntylä, Timo; Del Missier, Fabio

2017-01-01

Although the literature on the influence of memory on decisions is well developed, research on the effects of decision making on memory is rather sparse and scattered. Choice-supportive misremembering (i.e., misremembering choice-related information that boosts the chosen option and/or demotes the foregone options) has been observed in several studies and has the potential to affect future choices. Nonetheless, no attempt has been made to review the relevant literature, categorize the different types of choice-supportive misremembering observed, and critically appraise the existing evidence and proposed explanations. Thus, starting from a new theoretically motivated and empirically grounded taxonomy, we review the current research. Our taxonomy classifies choice-supportive misremembering into four conceptually distinct types: misattribution is when information is attributed to the wrong source, fact distortion when the facts are remembered in a distorted manner, false memory when items that were not part of the original decision scenarios are remembered as presented and, finally, selective forgetting is when information is selectively forgotten. After assessing the impact of various potentially moderating factors, we evaluate the evidence for each type of misremembering and conclude that the support for the phenomenon is solid in relation to misattribution when recognition memory is assessed, but significantly weaker for the other three types, and when other memory tests are used to assess memory. Finally, we review the cognitive and emotional explanations proposed for choice-supportive misremembering in the light of the available evidence and identify the main gaps in the current knowledge and the more promising avenues for future research. PMID:29255436

Conceptualizing intragroup and intergroup dynamics within a controlled crowd evacuation.

PubMed

Elzie, Terra; Frydenlund, Erika; Collins, Andrew J; Robinson, R Michael

2015-01-01

Social dynamics play a critical role in successful pedestrian evacuations. Crowd modeling research has made progress in capturing the way individual and group dynamics affect evacuations; however, few studies have simultaneously examined how individuals and groups interact with one another during egress. To address this gap, the researchers present a conceptual agent-based model (ABM) designed to study the ways in which autonomous, heterogeneous, decision-making individuals negotiate intragroup and intergroup behavior while exiting a large venue. A key feature of this proposed model is the examination of the dynamics among and between various groupings, where heterogeneity at the individual level dynamically affects group behavior and subsequently group/group interactions. ABM provides a means of representing the important social factors that affect decision making among diverse social groups. Expanding on the 2013 work of Vizzari et al., the researchers focus specifically on social factors and decision making at the individual/group and group/group levels to more realistically portray dynamic crowd systems during a pedestrian evacuation. By developing a model with individual, intragroup, and intergroup interactions, the ABM provides a more representative approximation of real-world crowd egress. The simulation will enable more informed planning by disaster managers, emergency planners, and other decision makers. This pedestrian behavioral concept is one piece of a larger simulation model. Future research will build toward an integrated model capturing decision-making interactions between pedestrians and vehicles that affect evacuation outcomes.

Responding to nonwords in the lexical decision task: Insights from the English Lexicon Project.

PubMed

Yap, Melvin J; Sibley, Daragh E; Balota, David A; Ratcliff, Roger; Rueckl, Jay

2015-05-01

Researchers have extensively documented how various statistical properties of words (e.g., word frequency) influence lexical processing. However, the impact of lexical variables on nonword decision-making performance is less clear. This gap is surprising, because a better specification of the mechanisms driving nonword responses may provide valuable insights into early lexical processes. In the present study, item-level and participant-level analyses were conducted on the trial-level lexical decision data for almost 37,000 nonwords in the English Lexicon Project in order to identify the influence of different psycholinguistic variables on nonword lexical decision performance and to explore individual differences in how participants respond to nonwords. Item-level regression analyses reveal that nonword response time was positively correlated with number of letters, number of orthographic neighbors, number of affixes, and base-word number of syllables, and negatively correlated with Levenshtein orthographic distance and base-word frequency. Participant-level analyses also point to within- and between-session stability in nonword responses across distinct sets of items, and intriguingly reveal that higher vocabulary knowledge is associated with less sensitivity to some dimensions (e.g., number of letters) but more sensitivity to others (e.g., base-word frequency). The present findings provide well-specified and interesting new constraints for informing models of word recognition and lexical decision. (c) 2015 APA, all rights reserved).

Interpretable Categorization of Heterogeneous Time Series Data

NASA Technical Reports Server (NTRS)

Lee, Ritchie; Kochenderfer, Mykel J.; Mengshoel, Ole J.; Silbermann, Joshua

2017-01-01

We analyze data from simulated aircraft encounters to validate and inform the development of a prototype aircraft collision avoidance system. The high-dimensional and heterogeneous time series dataset is analyzed to discover properties of near mid-air collisions (NMACs) and categorize the NMAC encounters. Domain experts use these properties to better organize and understand NMAC occurrences. Existing solutions either are not capable of handling high-dimensional and heterogeneous time series datasets or do not provide explanations that are interpretable by a domain expert. The latter is critical to the acceptance and deployment of safety-critical systems. To address this gap, we propose grammar-based decision trees along with a learning algorithm. Our approach extends decision trees with a grammar framework for classifying heterogeneous time series data. A context-free grammar is used to derive decision expressions that are interpretable, application-specific, and support heterogeneous data types. In addition to classification, we show how grammar-based decision trees can also be used for categorization, which is a combination of clustering and generating interpretable explanations for each cluster. We apply grammar-based decision trees to a simulated aircraft encounter dataset and evaluate the performance of four variants of our learning algorithm. The best algorithm is used to analyze and categorize near mid-air collisions in the aircraft encounter dataset. We describe each discovered category in detail and discuss its relevance to aircraft collision avoidance.

Influence of strategic direction for NHS Scotland knowledge services on indexing policy for the NHS Scotland e-library.

PubMed

McLeod, Lorraine; Thain, Annette; Wales, Ann

2005-03-01

Indexing policy for the NHS Scotland e-Library needs to maximize future inter-operability with other significant health- and social-care-related resources. The strategic drive towards integration and partnership working means that the indexing system has to be widely acceptable to the full range of disciplines within the integrated health-care family. Indexes identified by various means and then shortlisted using predefined criteria. Three subject indexes have been chosen--Medical Subject Headings (MeSH), CareData and the Government Category List (GCL), plus mapping between natural language and MeSH terms. This decision was a reasonable compromise between the strategy-driven aim of seamless access for all 'partners in care', and practical constraints of time/manpower. Other authority files (e.g. geographical area, language) are also standards based, and customised to reflect the information needs of an increasingly integrated health-care system. No single index could provide the scope required to meet the widening range of NHS information need. The influence of high-level strategic aims and objectives have extended their reach to influence indexing policy for the e-Library. Our indexing policy will continue to evolve and contribute to a knowledge management infrastructure capable of supporting current and future NHS Scotland information needs and strategy. Layperson terminology was identified as a gap; additional measures to address this gap are highlighted.

Hospital charitable lotteries: taking a gamble on systems thinking.

PubMed

Reynolds, Jennifer

2013-12-01

The presence of lotteries can be witnessed worldwide. Charitable lotteries are often portrayed as 'good works', and recently, hospitals have utilized them as a popular fundraising vehicle to raise necessary funds to help achieve organizational goals and objectives. Research indicates that lotteries contribute to gambling-related harms; however, research into charitable lotteries has been underdeveloped. Both the gambling and the health care industries are complex and evolving, consisting of many interacting stakeholders with often different and competing interests. This article seeks to present systems thinking as a conceptual framework to help fill the gap in understanding the use of gambling within hospitals and its possible benefits and unforeseen negative consequences. Addressing the gap in knowledge is important to help inform decision making aimed at reducing gambling-related harms. This article proposes how the school of systems thinking, specifically framing hospitals as complex adaptive systems and system dynamics modelling, can be utilized to understand the policy implications of the adoption of lotteries as a revenue source for hospitals. Hospitals have a duty to care, inform and protect. Hospital charitable lotteries have become big business; however, its incorporation into critical funding strategies needs to be carefully understood. Systems thinking theory and methodologies provide an integrated approach to examine this dynamic and evolving fundraising initiative. Findings from this article can inform the development of action strategies, including policy development at multiple levels. © 2013 John Wiley & Sons Ltd.

Using quality and safety education for nurses to guide clinical teaching on a new dedicated education unit.

PubMed

McKown, Terri; McKeon, Leslie; McKown, Leslie; Webb, Sherry

2011-12-01

Gaps exist in health professional education versus the demands of current practice. Leveraging front-line nurses to teach students exemplary practice in a Dedicated Education Unit (DEU) may narrow this gap. The DEU is an innovative model for experiential learning, capitalizing on the expertise of staff nurses as clinical teachers. This study evaluated the effectiveness of a new academic-practice DEU in facilitating quality and safety competency achievement among students. Six clinical teachers received education in clinical teaching and use of Quality and Safety Education for Nurses (QSEN) competencies to guide acquisition of essential knowledge, skills, and attitudes for continuous health care improvement. Twelve students assigned to the six teachers completed daily logs for the 10-week practicum. Findings suggest that DEU students achieved QSEN competencies through clinical teacher mentoring in interdisciplinary collaboration, using electronic information for best practice and patient teaching, patient/family decision making, quality improvement, and resolution of safety issues.

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

Allen, Melissa R.; Aziz, H. M. Abdul; Coletti, Mark A.

Changing human activity within a geographical location may have significant influence on the global climate, but that activity must be parameterized in such a way as to allow these high-resolution sub-grid processes to affect global climate within that modeling framework. Additionally, we must have tools that provide decision support and inform local and regional policies regarding mitigation of and adaptation to climate change. The development of next-generation earth system models, that can produce actionable results with minimum uncertainties, depends on understanding global climate change and human activity interactions at policy implementation scales. Unfortunately, at best we currently have only limitedmore » schemes for relating high-resolution sectoral emissions to real-time weather, ultimately to become part of larger regions and well-mixed atmosphere. Moreover, even our understanding of meteorological processes at these scales is imperfect. This workshop addresses these shortcomings by providing a forum for discussion of what we know about these processes, what we can model, where we have gaps in these areas and how we can rise to the challenge to fill these gaps.« less

Reductionism in the comments and autobiographical accounts of prominent psychologists.

PubMed

Martin, Jack; Dawda, Darek

2002-01-01

Many of the researchers in the field of psychological science use strategies and methods in which human actions and experiences are reduced to behavioral contingencies, statistical regularities, neurophysiological states and processes, and computational functions and models. However, many psychologists talk readily and easily about how their research might assist human agents to solve problems, cope, make decisions, self-regulate, and more generally "make a difference" and "take control." The authors considered informally selected comments by several eminent psychologists, and more formally, 73 autobiographical accounts of prominent psychologists to see what could be learned about the attitudes of these psychologists toward reductionism in their own work and in the field of psychology in general. In interpreting these comments and accounts, the authors posit a gap between many psychologists' contemplation of their work and their actual research practices. The authors also suggest that such a gap may be related to psychologists' educational experiences and their scholarly and professional socialization, as well as to their subdisciplinary attachments and contexts.

Public Resistance is Waste-Based and What to Do About That - 13412

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

Ford, Laurie

2013-07-01

'Nuclear Communicators' connect a highly advanced sci-tech world with the world of everyday living. One challenge is helping stakeholders fit together three Big Ideas: (1) the valuable nuclear energy resource, (2) nuclear energy's invisible mortal dangers and potential bad-guy threats, and (3) critical scientific and engineering knowledge that is far over the heads of average (grade 8) USA reading levels. This article provides an overview of what does - and does not - work in our public communications. What does not work: 1. Going off topic. Address what concerns people most: how to manage nuclear wastes. 2. Underestimating public intelligence.more » What works: 1. Doing your homework on community history regarding nuclear materials. 2. Having discussion forums and public meetings with special guests from industry, government, and local leaders. 3. Regular cycles of communication with community groups to build a long-term dialogue. Solutions to some communication challenges require handling four gaps and one jungle: 1. Facts gap - Honest information about waste disposition. 2. Time gap - The timelines associated with waste management include 300 years, 10,000 years, and 703.8 million years. How do we talk about this? 3. Money gap - Who pays for new waste management challenges and technologies? 4. Confidence gap - Link local options to regional, national, and global knowledge. 5. Decision jungle - How can we make waste management rules and infrastructure more logical and transparent? Public communication needs to be grounded in facts for people who want to be credible actors in the new nuclear world. (authors)« less

The Impact of Militarism, Patriarchy, and Culture on Israeli Women's Reproductive Health and Well-Being.

PubMed

Granek, Leeat; Nakash, Ora

2017-12-01

In this paper, we situate and frame Israeli women's reproductive health within the social, historical, political, cultural, and geographical context of Israeli women's lives. We used a theoretical review in this paper. Militarism, patriarchy, and cultural values heavily shape and influence Jewish and Arab women's access to and experience of reproductive health when it comes to the imperative to have children, pregnancy, birth, access to contraception and abortion, and other reproductive healthcare services. We discuss five main factors pertaining to Israeli women's reproductive health including (1) fertility and emphasis on reproduction; (2) infertility; (3) pregnancy, birth, and miscarriage; (4) reproductive rights including contraception and abortion; and (5) maternity leave and accessible childcare. Israel is a pro-natalist country, in which both Jewish and Arab women share many of the consequences of the social imperative to have children. Though Arab women, as part of their double minority status, are exposed to more mental health risks pre- and postpartum, the personal and public reproductive health decisions and reproductive healthcare services are largely shaped by similar social forces. These include the patriarchal and religious culture that dictates a value system that highly cherishes motherhood, and within the military political context of the on-going Israeli-Palestinian conflict and past social and political traumas. We address four major gaps that need to be addressed in order to improve Israeli women's reproductive health and well-being that include the neoliberal gap, the information gap, the reproductive health services gap, and the leadership and policy gap.

“I didn’t even know what I was looking for”: A qualitative study of the decision-making processes of Canadian medical tourists

PubMed Central

2012-01-01

Background Medical tourism describes the private purchase and arrangement of medical care by patients across international borders. Increasing numbers of medical facilities in countries around the world are marketing their services to a receptive audience of international patients, a phenomenon that has largely been made possible by the growth of the Internet. The growth of the medical tourism industry has raised numerous concerns around patient safety and global health equity. In spite of these concerns, there is a lack of empirical research amongst medical tourism stakeholders. One such gap is a lack of engagement with medical tourists themselves, where there is currently little known about how medical tourists decide to access care abroad. We address this gap through examining aspects of Canadian medical tourists’ decision-making processes. Methods Semi-structured phone interviews were administered to 32 Canadians who had gone abroad as medical tourists. Interviews touched on motivations, assessment of risks, information seeking processes, and experiences at home and abroad. A thematic analysis of the interview transcripts followed. Results Three overarching themes emerged from the interviews: (1) information sources consulted; (2) motivations, considerations, and timing; and (3) personal and professional supports drawn upon. Patient testimonials and word of mouth connections amongst former medical tourists were accessed and relied upon more readily than the advice of family physicians. Neutral, third-party information sources were limited, which resulted in participants also relying on medical tourism facilitators and industry websites. Conclusions While Canadian medical tourists are often thought to be motivated by wait times for surgery, cost and availability of procedures were common primary and secondary motivations for participants, demonstrating that motivations are layered and dynamic. The findings of this analysis offer a number of important factors that should be considered in the development of informational interventions targeting medical tourists. It is likely that trends observed amongst Canadian medical tourists apply to those from other nations due to the key role the transnational medium of the Internet plays in facilitating patients’ private international medical travel. PMID:22769723

Reviewing innovative Earth observation solutions for filling science-policy gaps in hydrology

NASA Astrophysics Data System (ADS)

Lehmann, Anthony; Giuliani, Gregory; Ray, Nicolas; Rahman, Kazi; Abbaspour, Karim C.; Nativi, Stefano; Craglia, Massimo; Cripe, Douglas; Quevauviller, Philippe; Beniston, Martin

2014-10-01

Improved data sharing is needed for hydrological modeling and water management that require better integration of data, information and models. Technological advances in Earth observation and Web technologies have allowed the development of Spatial Data Infrastructures (SDIs) for improved data sharing at various scales. International initiatives catalyze data sharing by promoting interoperability standards to maximize the use of data and by supporting easy access to and utilization of geospatial data. A series of recent European projects are contributing to the promotion of innovative Earth observation solutions and the uptake of scientific outcomes in policy. Several success stories involving different hydrologists' communities can be reported around the World. Gaps still exist in hydrological, agricultural, meteorological and climatological data access because of various issues. While many sources of data exists at all scales it remains difficult and time-consuming to assemble hydrological information for most projects. Furthermore, data and sharing formats remain very heterogeneous. Improvements require implementing/endorsing some commonly agreed standards and documenting data with adequate metadata. The brokering approach allows binding heterogeneous resources published by different data providers and adapting them to tools and interfaces commonly used by consumers of these resources. The challenge is to provide decision-makers with reliable information, based on integrated data and tools derived from both Earth observations and scientific models. Successful SDIs rely therefore on various aspects: a shared vision between all participants, necessity to solve a common problem, adequate data policies, incentives, and sufficient resources. New data streams from remote sensing or crowd sourcing are also producing valuable information to improve our understanding of the water cycle, while field sensors are developing rapidly and becoming less costly. More recent data standards are enhancing interoperability between hydrology and other scientific disciplines, while solutions exist to communicate uncertainty of data and models, which is an essential pre-requisite for decision-making. Distributed computing infrastructures can handle complex and large hydrological data and models, while Web Processing Services bring the flexibility to develop and execute simple to complex workflows over the Internet. The need for capacity building at human, infrastructure and institutional levels is also a major driver for reinforcing the commitment to SDI concepts.

"I didn't even know what I was looking for": A qualitative study of the decision-making processes of Canadian medical tourists.

PubMed

Johnston, Rory; Crooks, Valorie A; Snyder, Jeremy

2012-07-07

Medical tourism describes the private purchase and arrangement of medical care by patients across international borders. Increasing numbers of medical facilities in countries around the world are marketing their services to a receptive audience of international patients, a phenomenon that has largely been made possible by the growth of the Internet. The growth of the medical tourism industry has raised numerous concerns around patient safety and global health equity. In spite of these concerns, there is a lack of empirical research amongst medical tourism stakeholders. One such gap is a lack of engagement with medical tourists themselves, where there is currently little known about how medical tourists decide to access care abroad. We address this gap through examining aspects of Canadian medical tourists' decision-making processes. Semi-structured phone interviews were administered to 32 Canadians who had gone abroad as medical tourists. Interviews touched on motivations, assessment of risks, information seeking processes, and experiences at home and abroad. A thematic analysis of the interview transcripts followed. Three overarching themes emerged from the interviews: (1) information sources consulted; (2) motivations, considerations, and timing; and (3) personal and professional supports drawn upon. Patient testimonials and word of mouth connections amongst former medical tourists were accessed and relied upon more readily than the advice of family physicians. Neutral, third-party information sources were limited, which resulted in participants also relying on medical tourism facilitators and industry websites. While Canadian medical tourists are often thought to be motivated by wait times for surgery, cost and availability of procedures were common primary and secondary motivations for participants, demonstrating that motivations are layered and dynamic. The findings of this analysis offer a number of important factors that should be considered in the development of informational interventions targeting medical tourists. It is likely that trends observed amongst Canadian medical tourists apply to those from other nations due to the key role the transnational medium of the Internet plays in facilitating patients' private international medical travel.

OPTIMIZING USABILITY OF AN ECONOMIC DECISION SUPPORT TOOL: PROTOTYPE OF THE EQUIPT TOOL.

PubMed

Cheung, Kei Long; Hiligsmann, Mickaël; Präger, Maximilian; Jones, Teresa; Józwiak-Hagymásy, Judit; Muñoz, Celia; Lester-George, Adam; Pokhrel, Subhash; López-Nicolás, Ángel; Trapero-Bertran, Marta; Evers, Silvia M A A; de Vries, Hein

2018-01-01

Economic decision-support tools can provide valuable information for tobacco control stakeholders, but their usability may impact the adoption of such tools. This study aims to illustrate a mixed-method usability evaluation of an economic decision-support tool for tobacco control, using the EQUIPT ROI tool prototype as a case study. A cross-sectional mixed methods design was used, including a heuristic evaluation, a thinking aloud approach, and a questionnaire testing and exploring the usability of the Return of Investment tool. A total of sixty-six users evaluated the tool (thinking aloud) and completed the questionnaire. For the heuristic evaluation, four experts evaluated the interface. In total twenty-one percent of the respondents perceived good usability. A total of 118 usability problems were identified, from which twenty-six problems were categorized as most severe, indicating high priority to fix them before implementation. Combining user-based and expert-based evaluation methods is recommended as these were shown to identify unique usability problems. The evaluation provides input to optimize usability of a decision-support tool, and may serve as a vantage point for other developers to conduct usability evaluations to refine similar tools before wide-scale implementation. Such studies could reduce implementation gaps by optimizing usability, enhancing in turn the research impact of such interventions.

Evaluation of the Effectiveness of Stormwater Decision Support Tools for Infrastructure Selection and the Barriers to Implementation

NASA Astrophysics Data System (ADS)

Spahr, K.; Hogue, T. S.

2016-12-01

Selecting the most appropriate green, gray, and / or hybrid system for stormwater treatment and conveyance can prove challenging to decision markers across all scales, from site managers to large municipalities. To help streamline the selection process, a multi-disciplinary team of academics and professionals is developing an industry standard for selecting and evaluating the most appropriate stormwater management technology for different regions. To make the tool more robust and comprehensive, life-cycle cost assessment and optimization modules will be included to evaluate non-monetized and ecosystem benefits of selected technologies. Initial work includes surveying advisory board members based in cities that use existing decision support tools in their infrastructure planning process. These surveys will qualify the decisions currently being made and identify challenges within the current planning process across a range of hydroclimatic regions and city size. Analysis of social and other non-technical barriers to adoption of the existing tools is also being performed, with identification of regional differences and institutional challenges. Surveys will also gage the regional appropriateness of certain stormwater technologies based off experiences in implementing stormwater treatment and conveyance plans. In additional to compiling qualitative data on existing decision support tools, a technical review of components of the decision support tool used will be performed. Gaps in each tool's analysis, like the lack of certain critical functionalities, will be identified and ease of use will be evaluated. Conclusions drawn from both the qualitative and quantitative analyses will be used to inform the development of the new decision support tool and its eventual dissemination.

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

PubMed Central

2011-01-01

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

Managing distrust-induced risk with deposit in supply chain contract decisions.

PubMed

Han, Guanghua; Dong, Ming; Sun, Qi

2014-01-01

This paper studies the trust issue in a two-echelon supply chain information sharing process. In a supply chain, the retailer reports the forecasted demand to the supplier. Traditionally, the supplier's trust in the retailer's reported information is based on the retailer's reputation. However, this paper considers that trust is random and is also affected by the reputation and the demand gap. The supplier and retailer have been shown to have different evaluations regarding the degree of trust. Furthermore, distrust is inherently linked to perceived risk. To mitigate perceived risk, a two-stage decision process with an unpayback deposit contract is proposed. At the first stage, the supplier and the retailer negotiate the deposit contract. At the second stage, a Stackelberg game is used to determine the retailer's reported demand and the supplier's production quantity. We show that the deposits from the retailer's and supplier's perspectives are different. When the retailer's reported demand is equal to the supplier's forecasted demand, the retailer's evaluation of the deposit is more than that of supplier's. When the retailer's reported demand is equal to the retailer's forecasted demand, the deposit from the retailer's perspective is at the lowest level.

The Evolution of System Safety at NASA

NASA Technical Reports Server (NTRS)

Dezfuli, Homayoon; Everett, Chris; Groen, Frank

2014-01-01

The NASA system safety framework is in the process of change, motivated by the desire to promote an objectives-driven approach to system safety that explicitly focuses system safety efforts on system-level safety performance, and serves to unify, in a purposeful manner, safety-related activities that otherwise might be done in a way that results in gaps, redundancies, or unnecessary work. An objectives-driven approach to system safety affords more flexibility to determine, on a system-specific basis, the means by which adequate safety is achieved and verified. Such flexibility and efficiency is becoming increasingly important in the face of evolving engineering modalities and acquisition models, where, for example, NASA will increasingly rely on commercial providers for transportation services to low-earth orbit. A key element of this objectives-driven approach is the use of the risk-informed safety case (RISC): a structured argument, supported by a body of evidence, that provides a compelling, comprehensible and valid case that a system is or will be adequately safe for a given application in a given environment. The RISC addresses each of the objectives defined for the system, providing a rational basis for making informed risk acceptance decisions at relevant decision points in the system life cycle.

Mixed messages in learning communication skills? Students comparing role model behaviour in clerkships with formal training.

PubMed

Essers, Geurt; Van Weel-Baumgarten, Evelyn; Bolhuis, Sanneke

2012-01-01

Medical students learn professional communication through formal training and in clinical practice. Physicians working in clinical practice have a powerful influence on student learning. However, they may demonstrate communication behaviours not aligning with recommendations in training programs. This study aims to identify more precisely what differences students perceive between role model communication behaviour during clerkships and formal training. In a cross-sectional study, data were collected about physicians' communication performance as perceived by students. Students filled out a questionnaire in four different clerkships in their fourth and fifth year. Just over half of the students reported communication similar to formal training. This was especially true for students in the later clerkships (paediatrics and primary care). Good examples were seen in providing information corresponding to patients' needs and in shared decision making, although students often noted that in fact the doctor made the decision. Bad examples were observed in exploring cognitions and emotions, and in providing information meeting patient's pace. Further study is needed on actual physician behaviour in clinical practice. From our results, we conclude that students need help in reflecting on and learning from the gap in communication patterns they observe in training versus clinical practice.

Managing Distrust-Induced Risk with Deposit in Supply Chain Contract Decisions

PubMed Central

Han, Guanghua; Dong, Ming; Sun, Qi

2014-01-01

This paper studies the trust issue in a two-echelon supply chain information sharing process. In a supply chain, the retailer reports the forecasted demand to the supplier. Traditionally, the supplier's trust in the retailer's reported information is based on the retailer's reputation. However, this paper considers that trust is random and is also affected by the reputation and the demand gap. The supplier and retailer have been shown to have different evaluations regarding the degree of trust. Furthermore, distrust is inherently linked to perceived risk. To mitigate perceived risk, a two-stage decision process with an unpayback deposit contract is proposed. At the first stage, the supplier and the retailer negotiate the deposit contract. At the second stage, a Stackelberg game is used to determine the retailer's reported demand and the supplier's production quantity. We show that the deposits from the retailer's and supplier's perspectives are different. When the retailer's reported demand is equal to the supplier's forecasted demand, the retailer's evaluation of the deposit is more than that of supplier's. When the retailer's reported demand is equal to the retailer's forecasted demand, the deposit from the retailer's perspective is at the lowest level. PMID:25054190

Close the Gap: A Multiple Case Study about the Decision-Making Process of Administrators in Ohio Districts

ERIC Educational Resources Information Center

Guthrie, Tammy Reutzel

2017-01-01

Research has identified evidenced-based practices and programs that are successful for increasing the learning outcomes of students with disabilities which in turn helps narrow the achievement gap between the student subgroup and non-disabled peers. Employing the identified practices has produced inconsistent results and led to a closer…

National GAP Conference 2007-Discussion Groups Report

USGS Publications Warehouse

Ratz, Joan M.; Lamb, Berton Lee

2010-01-01

We led two discussion groups during the 2007 National GAP Conference. These discussion groups provided information to help develop a survey of National Gap Analysis Program (GAP) data users. One group discussed technical issues, and the second group discussed the use of GAP data for decisionmaking. Themes emerging from the technical issues group included concerns about data quality, need for information on how to use data, and passive data distribution. The decisionmaking discussion included a wide range of topics including the need to understand presentation of information, the need to connect with and understand users of data, the revision of GAP's mission, and the adaptability of products and data. The decisionmaking group also raised concerns regarding technical issues. One conclusion is that a deep commitment to ongoing information transfer and support is a key component of success for the GAP program.

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

Information Technology and Community Restoration Studies/Task 1: Information Technology

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

Upton, Jaki F.; Lesperance, Ann M.; Stein, Steven L.

2009-11-19

Executive Summary The Interagency Biological Restoration Demonstration—a program jointly funded by the Department of Defense's Defense Threat Reduction Agency and the Department of Homeland Security's (DHS's) Science and Technology Directorate—is developing policies, methods, plans, and applied technologies to restore large urban areas, critical infrastructures, and Department of Defense installations following the intentional release of a biological agent (anthrax) by terrorists. There is a perception that there should be a common system that can share information both vertically and horizontally amongst participating organizations as well as support analyses. A key question is: "How far away from this are we?" As partmore » of this program, Pacific Northwest National Laboratory conducted research to identify the current information technology tools that would be used by organizations in the greater Seattle urban area in such a scenario, to define criteria for use in evaluating information technology tools, and to identify current gaps. Researchers interviewed 28 individuals representing 25 agencies in civilian and military organizations to identify the tools they currently use to capture data needed to support operations and decision making. The organizations can be grouped into five broad categories: defense (Department of Defense), environmental/ecological (Environmental Protection Agency/Ecology), public health and medical services, emergency management, and critical infrastructure. The types of information that would be communicated in a biological terrorism incident include critical infrastructure and resource status, safety and protection information, laboratory test results, and general emergency information. The most commonly used tools are WebEOC (web-enabled crisis information management systems with real-time information sharing), mass notification software, resource tracking software, and NW WARN (web-based information to protect critical infrastructure systems). It appears that the current information management tools are used primarily for information gathering and sharing—not decision making. Respondents identified the following criteria for a future software system. It is easy to learn, updates information in real time, works with all agencies, is secure, uses a visualization or geographic information system feature, enables varying permission levels, flows information from one stage to another, works with other databases, feeds decision support tools, is compliant with appropriate standards, and is reasonably priced. Current tools have security issues, lack visual/mapping functions and critical infrastructure status, and do not integrate with other tools. It is clear that there is a need for an integrated, common operating system. The system would need to be accessible by all the organizations that would have a role in managing an anthrax incident to enable regional decision making. The most useful tool would feature a GIS visualization that would allow for a common operating picture that is updated in real time. To capitalize on information gained from the interviews, the following activities are recommended: • Rate emergency management decision tools against the criteria specified by the interviewees. • Identify and analyze other current activities focused on information sharing in the greater Seattle urban area. • Identify and analyze information sharing systems/tools used in other regions.« less

Using info-Gap Decision Theory for Water Resources Planning Under Severe Uncertainty

NASA Astrophysics Data System (ADS)

Korteling, B.; Brazier, R.; Kapelan, Z.; Dessai, S.

2012-12-01

Water resource managers are required to develop comprehensive water resource plans based on severely uncertain information of the effects of climate change on local hydrology and future socio-economic changes on localised demand. In England and Wales, current water resource planning methodologies include a headroom estimation process that quantifies uncertainty based on only one point of an assumed range of deviations from the expected climate and projected demand 25 years into the future. There are many situations where there is not enough knowledge to be able to estimate a representative probability of occurrence, or to be confident that the tails of an assumed probability distribution will not exhibit unexpected skewness, or that the kurtosis of a distribution differs from the norm. These situations can be considered severely uncertain. Information-Gap decision theory offers a method to sample a wider range of uncertainty than with traditional methods, and as a result, compare the robustness of various water resource management options under conditions of severe uncertainty. A more robust management option is one that delivers the same level of performance as other options at higher levels of uncertainty. A case study is based on a Water Supply Area that encompasses the county of Cornwall in southwest England containing 17 reservoirs and 19 demand nodes. The performance success of management options are evaluated primarily by measures of water availability including a reservoir risk measure that tests the probability and magnitude that strategic reservoir storage levels fall below the drought management curve under adverse conditions and also a safety margin deficit that tests how quickly reservoir levels can return to optimum operating levels in favourable conditions. Multi-Criteria Decision Analysis (MCDA) is used to test the effectiveness of different management options with different weightings for metrics other than water availability including; capital and operating costs, costs to customers, carbon emissions, environmental impact and social acceptability. Findings show that beyond the uncertainty range explored with the traditional headroom method, preference reversals can occur, i.e. some management options that underperform at lower uncertainties, outperform at higher levels of uncertainty. This study also shows that when 50% or more of the population adopts demand side management, efficiency related measures and innovative options such as rainwater collection can perform equally well or better than some supply side options. The additional use of MCDA shifts the focus away from reservoir expansion options that perform best with respect to water availability, to combined strategies that include innovative demand side management actions of rainwater collection and greywater reuse as well as efficiency measures and additional regional transfers. This research illustrates how an Info-Gap based approach can offer a comprehensive picture of potential supply/demand futures and a rich variety of information to support adaptive management of water systems under severe uncertainty.

Assessing Lay Understanding of Common Presentations of Earthquake Hazard Information

NASA Astrophysics Data System (ADS)

Thompson, K. J.; Krantz, D. H.

2010-12-01

The Working Group on California Earthquake Probabilities (WGCEP) includes, in its introduction to earthquake rupture forecast maps, the assertion that "In daily living, people are used to making decisions based on probabilities -- from the flip of a coin (50% probability of heads) to weather forecasts (such as a 30% chance of rain) to the annual chance of being killed by lightning (about 0.0003%)." [3] However, psychology research identifies a large gap between lay and expert perception of risk for various hazards [2], and cognitive psychologists have shown in numerous studies [1,4-6] that people neglect, distort, misjudge, or misuse probabilities, even when given strong guidelines about the meaning of numerical or verbally stated probabilities [7]. The gap between lay and expert use of probability needs to be recognized more clearly by scientific organizations such as WGCEP. This study undertakes to determine how the lay public interprets earthquake hazard information, as presented in graphical map form by the Uniform California Earthquake Rupture Forecast (UCERF), compiled by the WGCEP and other bodies including the USGS and CGS. It also explores alternate ways of presenting hazard data, to determine which presentation format most effectively translates information from scientists to public. Participants both from California and from elsewhere in the United States are included, to determine whether familiarity -- either with the experience of an earthquake, or with the geography of the forecast area -- affects people's ability to interpret an earthquake hazards map. We hope that the comparisons between the interpretations by scientific experts and by different groups of laypeople will both enhance theoretical understanding of factors that affect information transmission and assist bodies such as the WGCEP in their laudable attempts to help people prepare themselves and their communities for possible natural hazards. [1] Kahneman, D & Tversky, A (1979). Prospect Theory: An Analysis of Decision under Risk. Econometrica, XLVII: 263-291. [2] Fischhoff, B, Slovic, P, Lichtenstein, S, Read, S & Combs, B (1978). How safe is safe enough? A psychometric study of attitudes towards technological risks and benefits. Pol Sci, 9, 127-152. [3] http://www.scec.org/ucerf/ [4] Hau, R, Pleskac, TJ, Kiefer, J & Hertwig, R (2008). The Description-Experience Gap in Risky Choice: The Role of Sample Size and Experienced Probabilities. J Behav Decis Making, 21: 493-518. [5] Lichtenstein, S, Slovic, P, Fischhoff, B, Layman, M & Combs, B (1978). Judged frequency of lethal events. J Exp Psy: Human Learning and Memory, 4, 551-578. [6] Hertwig, R, Barron, G, Weber, EU & Erev, I (2006). The role of information sampling in risky choice. In K Fiedler & P Juslin (Eds), Information sampling and adaptive cognition. Pp 75-91. New York: Cambridge University Press. [7] Budescu, DV, Broomell, S & Por HH (2009). Improving communication of uncertainty in the reports of the intergovernmental panel on climate change. Psychol Sci, 20(3), 299-308.

Health Information Economy: Literature Review.

PubMed

Ebrahimi, Kamal; Roudbari, Masoud; Sadoughi, Farahnaz

2015-04-19

Health Information Economy (HIE) is one of the broader, more complex, and challenging and yet important topics in the field of health science that requires the identification of its dimensions for planning and policy making. The aim of this study was to determine HIE concept dimensions. This paper presents a systematic methodology for analyzing the trends of HIE. For this purpose, the main keywords of this area were identified and searched in the databases and from among 4775 retrieved sources, 12 sources were studied in the field of HIE. Information Economy (IE) in the world has passed behind four paradigms that involve the information evaluation perspective, the information technology perspective, the asymmetric information perspective and information value perspective. In this research, the fourth perspective in the HIE was analyzed. The main findings of this research were categorized in three major groups, including the flow of information process in the field of health (production. collection, processing and dissemination), and information applications in the same field (education, research, health industry, policy, legislation, and decision-making) and the underlying fields. According to the findings, HIE has already developed a theoretical and conceptual gap that due to its importance in the next decade would be one of the research approaches to health science.

Research gaps in routine health information system design barriers to data quality and use in low- and middle-income countries: A literature review.

PubMed

Kumar, Manish; Gotz, David; Nutley, Tara; Smith, Jason B

2018-01-01

Despite the potential impact of health information system (HIS) design barriers on health data quality and use and, ultimately, health outcomes in low- and middle-income countries (LMICs), no comprehensive literature review has been conducted to study them in this context. We therefore conducted a formal literature review to understand system design barriers to data quality and use in LMICs and to identify any major research gaps related understanding how system design affects data use. We conducted an electronic search across 4 scientific databases-PubMed, Web of Science, Embase, and Global Health-and consulted a data use expert. Following a systematic inclusion and exclusion process, 316 publications (316 abstracts and 18 full papers) were included in the review. We found a paucity of scientific publications that explicitly describe system design factors that hamper data quality or data use for decision making. Although user involvement, work flow, human-computer interactions, and user experience are critical aspects of system design, our findings suggest that these issues are not discussed or conceptualized in the literature. Findings also showed that individual training efforts focus primarily on imparting data analysis skills. The adverse impact of HIS design barriers on data integrity and health system performance may be even bigger in LMICs than elsewhere, leading to errors in population health management and clinical care. We argue for integrating systems thinking into HIS strengthening efforts to reduce the HIS design-user reality gap. Copyright © 2017 John Wiley & Sons, Ltd.

How to prepare a systematic review of economic evaluations for clinical practice guidelines: database selection and search strategy development (part 2/3).

PubMed

Thielen, F W; Van Mastrigt, Gapg; Burgers, L T; Bramer, W M; Majoie, Hjm; Evers, Smaa; Kleijnen, J

2016-12-01

This article is part of the series "How to prepare a systematic review of economic evaluations (EES) for informing evidence-based healthcare decisions", in which a five-step approach is proposed. Areas covered: This paper focuses on the selection of relevant databases and developing a search strategy for detecting EEs, as well as on how to perform the search and how to extract relevant data from retrieved records. Expert commentary: Thus far, little has been published on how to conduct systematic review EEs. Moreover, reliable sources of information, such as the Health Economic Evaluation Database, have ceased to publish updates. Researchers are thus left without authoritative guidance on how to conduct SR-EEs. Together with van Mastrigt et al. we seek to fill this gap.

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.

The Global Burden of Occupational Disease.

PubMed

Rushton, Lesley

2017-09-01

Burden of occupational disease estimation contributes to understanding of both magnitude and relative importance of different occupational hazards and provides essential information for targeting risk reduction. This review summarises recent key findings and discusses their impact on occupational regulation and practice. New methods have been developed to estimate burden of occupational disease that take account of the latency of many chronic diseases and allow for exposure trends and workforce turnover. Results from these studies have shown in several countries and globally that, in spite of improvements in workplace technology, practices and exposures over the last decades, occupational hazards remain an important cause of ill health and mortality worldwide. Major data gaps have been identified particularly regarding exposure information. Reliable data on employment and disease are also lacking especially in developing countries. Burden of occupational disease estimates form an important part of decision-making processes.

Dysfunctions of decision-making and cognitive control as transdiagnostic mechanisms of mental disorders: advances, gaps, and needs in current research.

PubMed

Goschke, Thomas

2014-01-01

Disadvantageous decision-making and impaired volitional control over actions, thoughts, and emotions are characteristics of a wide range of mental disorders such as addiction, eating disorders, depression, and anxiety disorders and may reflect transdiagnostic core mechanisms and possibly vulnerability factors. Elucidating the underlying neurocognitive mechanisms is a precondition for moving from symptom-based to mechanism-based disorder classifications and ultimately mechanism-targeted interventions. However, despite substantial advances in basic research on decision-making and cognitive control, there are still profound gaps in our current understanding of dysfunctions of these processes in mental disorders. Central unresolved questions are: (i) to which degree such dysfunctions reflect transdiagnostic mechanisms or disorder-specific patterns of impairment; (ii) how phenotypical features of mental disorders relate to dysfunctional control parameter settings and aberrant interactions between large-scale brain systems involved in habit and reward-based learning, performance monitoring, emotion regulation, and cognitive control; (iii) whether cognitive control impairments are consequences or antecedent vulnerability factors of mental disorders; (iv) whether they reflect generalized competence impairments or context-specific performance failures; (v) whether not only impaired but also chronic over-control contributes to mental disorders. In the light of these gaps, needs for future research are: (i) an increased focus on basic cognitive-affective mechanisms underlying decision and control dysfunctions across disorders; (ii) longitudinal-prospective studies systematically incorporating theory-driven behavioural tasks and neuroimaging protocols to assess decision-making and control dysfunctions and aberrant interactions between underlying large-scale brain systems; (iii) use of latent-variable models of cognitive control rather than single tasks; (iv) increased focus on the interplay of implicit and explicit cognitive-affective processes; (v) stronger focus on computational models specifying neurocognitive mechanisms underlying phenotypical expressions of mental disorders. Copyright © 2013 John Wiley & Sons, Ltd.

Practicing What You Preach: Achieving Unity of Effort and Unified Action During Domestic Response Operations

DTIC Science & Technology

2007-05-10

planners will also benefit from experiencing the regimented military decision - making process and working with experienced operational planners. This...picture of the disaster area for the senior decision -makers, duplication of efforts, gaps in addressing requests for assistance, and the inefficient...Guard Atlantic Area. Interview by author, 25 March 2007. Mr. Doane stated that the JTF operated “in a vacuum” and “outside the inter-agency decision

Responding to Nonwords in the Lexical Decision Task: Insights from the English Lexicon Project

ERIC Educational Resources Information Center

Yap, Melvin J.; Sibley, Daragh E.; Balota, David A.; Ratcliff, Roger; Rueckl, Jay

2015-01-01

Researchers have extensively documented how various statistical properties of words (e.g., word frequency) influence lexical processing. However, the impact of lexical variables on nonword decision-making performance is less clear. This gap is surprising, because a better specification of the mechanisms driving nonword responses may provide…

An Exploration of Factors Influencing Effective Teachers' Decisions to Remain in Urban School Settings

ERIC Educational Resources Information Center

Grizzle, Alison L.

2010-01-01

Existing problems identified in the literature on teacher retention and resilience include (a) a gap in understanding factors influencing urban teacher retention; (b) lack of clarity on multiple factors swaying teachers' decisions to remain despite challenges; (c) overlapping definitions of teacher retention, attrition, and resilience; and (d)…

Reluctant to Change: Self-Enhancing Responses to Diverging Performance Measures

ERIC Educational Resources Information Center

Audia, Pino G.; Brion, Sebastien

2007-01-01

Although there is extensive evidence that past performance influences the propensity to make changes, research on how decision makers respond to diverging performance measures has been sparse. This paper addresses this gap in an experimental and a field study in which we examine how decision makers respond to the ambiguity introduced by two…

Mind the Gap: A Case Study of Values-Based Decision Making in a Nonprofit Organization

ERIC Educational Resources Information Center

Craft, Jana L.

2013-01-01

Using an exploratory case study approach, this research examined the consistency between espoused and enacted values within a large nonprofit organization known as an ethical leader in the human services industry. This research explored ethical business culture, ethical decision making, deontological and utilitarian moral paradigms and learning…

Uncovering Beliefs about the Role of Faith in Curriculum Decisions: A Vignette Approach

ERIC Educational Resources Information Center

Stevens, Carla R.

2014-01-01

Accessing and assessing the controlling beliefs of teachers about the role of faith in curriculum decisions is an essential first step in efforts to address the gap between the faith integration mission of Christian schools and actual practices (Boerema, 2011). Without intervention, teachers' beliefs about teaching--shaped by early classroom…

Preparing Students for Front-Line Management: Non-Routine Day-to-Day Decisions

ERIC Educational Resources Information Center

Clydesdale, Greg; Tan, John

2009-01-01

Purpose: This paper attempts to reduce the gap between management education and practice. It emphasises day-to-day decisions that middle and lower level managers make. The purpose is to provide an education framework embodying a flexible approach to interpretation and solution creation, suitable for situations of ambiguity and uncertainty.…

Perception, Interpretation and Decision Making: Understanding Gaps between Competence and Performance--A Commentary

ERIC Educational Resources Information Center

Mason, John

2016-01-01

This papers comments on the contributions of "ZDM Mathematics Education" dedicated to the theme "Perception, interpretation and decision making: understanding the missing link between competence and performance". The papers within this issue are brought together under the perspective of the stated aims of this issue, and then…

Gaps of Decision Support Models for Pipeline Renewal and Recommendations for Improvement

EPA Science Inventory

In terms of the development of software for decision support for pipeline renewal, more attention to date has been paid to the development of asset management models that help an owner decide on which portions of a system to prioritize needed actions. There has been much less w...

GAPS OF DECISION SUPPORT MODELS FOR PIPELINE RENEWAL AND RECOMMENDATIONS FOR IMPROVEMENT (SLIDE)

EPA Science Inventory

In terms of the development of software for decision support for pipeline renewal, more attention to date has been paid to the development of asset management models that help an owner decide on which portions of a system to prioritize needed actions. There has been much less wor...

An Agenda for Climate Impacts Science

NASA Astrophysics Data System (ADS)

Kaye, J. A.

2009-12-01

The report Global Change Impacts in the United States released by the US Global Change Research Program in June 2009 identifies a number of areas in which inadequate information or understanding hampers our ability to estimate likely future climate change and its impacts. In this section of the report, the focus is on those areas of climate science that could contribute most towards advancing our knowledge of climate change impacts and those aspects of climate change responsible for these impacts in order to continue to guide decision making. The Report identifies the six most important gaps in knowledge and offers some thoughts on how to address those gaps: 1. Expand our understanding of climate change impacts. There is a clear need to increase understanding of how ecosystems, social and economic systems, human health, and the built environment will be affected by climate change in the context of other stresses. 2. Refine ability to project climate change, including extreme events, at local scales. While climate change is a global issue, it has a great deal of regional variability. There is an indisputable need to improve understanding of climate system effects at these smaller scales, because these are often the scales of decision-making in society. This includes advances in modeling capability and observations needed to address local scales and high-impact extreme events. 3. Expand capacity to provide decision makers and the public with relevant information on climate change and its impacts. Significant potential exists in the US to create more comprehensive measurement, archive, and data-access systems that could provide great benefit to society, which requires defining needed information, gathering it, expanding capacity to deliver it, and improving tools by which decision makers use it to best advantage. 4. Improve understanding of thresholds likely to lead to abrupt changes in climate or ecosystems. Potential areas of research include thresholds that could lead to rapid changes in ice-sheet dynamics that could impact future sea-level rise and tipping points in biological systems (including those that may be associated with ocean acidification). 5. Improve understanding of the most effective ways to reduce the rate and magnitude of climate change, as well as unintended consequences of such actions. Research will help to identify the desired mix of mitigation options necessary to control the rate and magnitude of climate change, and to examine possible unintended consequences of mitigation options. 6. Enhance understanding of how society can adapt to climate change. There is currently limited knowledge about the ability of communities, regions, and sectors to adapt to future climate change. It is important to improve understanding of how to enhance society’s capacity to adapt to a changing climate in the context of other environmental stresses.

Knowledge engineering for health: a new discipline required to bridge the "ICT gap" between research and healthcare.

PubMed

Beck, Tim; Gollapudi, Sirisha; Brunak, Søren; Graf, Norbert; Lemke, Heinz U; Dash, Debasis; Buchan, Iain; Díaz, Carlos; Sanz, Ferran; Brookes, Anthony J

2012-05-01

Despite vast amount of money and research being channeled toward biomedical research, relatively little impact has been made on routine clinical practice. At the heart of this failure is the information and communication technology "chasm" that exists between research and healthcare. A new focus on "knowledge engineering for health" is needed to facilitate knowledge transmission across the research-healthcare gap. This discipline is required to engineer the bidirectional flow of data: processing research data and knowledge to identify clinically relevant advances and delivering these into healthcare use; conversely, making outcomes from the practice of medicine suitably available for use by the research community. This system will be able to self-optimize in that outcomes for patients treated by decisions that were based on the latest research knowledge will be fed back to the research world. A series of meetings, culminating in the "I-Health 2011" workshop, have brought together interdisciplinary experts to map the challenges and requirements for such a system. Here, we describe the main conclusions from these meetings. An "I4Health" interdisciplinary network of experts now exists to promote the key aims and objectives, namely "integrating and interpreting information for individualized healthcare," by developing the "knowledge engineering for health" domain. © 2012 Wiley Periodicals, Inc.

Pathways to Science and Engineering Bachelor's Degrees for Men and Women.

PubMed

Legewie, Joscha; DiPrete, Thomas A

2014-02-18

Despite the striking reversal of the gender gap in educational attainment and the near-gender parity in math performance, women pursue science and engineering (S/E) degrees at much lower rates than their male peers do. Current efforts to increase the number of women in these fields focus on different life-course periods but lack a clear understanding of the importance of these periods and how orientations toward S/E fields develop over time. In this article, we examine the gendered pathways to a S/E bachelor's degree from middle school to high school and college based on a representative sample from the 1973 to 1974 birth cohort. Using a counterfactual decomposition analysis, we determine the relative importance of these different life-course periods and thereby inform the direction of future research and policy. Our findings confirm previous research that highlights the importance of early encouragement for gender differences in S/E degrees, but our findings also attest to the high school years as a decisive period for the gender gap, while challenging the focus on college in research and policy. Indeed, if female high school seniors had the same orientation toward and preparation for S/E fields as their male peers, the gender gap in S/E degrees would be closed by as much as 82 percent.

Behavioral economics: the key to closing the gap on maternal, newborn and child survival for Millennium Development Goals 4 and 5?

PubMed

Buttenheim, Alison M; Asch, David A

2013-05-01

Millennium Development Goals (MDGs) 4 and 5 set ambitious targets to reduce maternal, newborn and child mortality by 2015. With 2015 fast approaching, there has been a concerted effort in the global health community to "close the gap" on the MDG targets. Recent consensus initiatives and frameworks have refocused attention on evidence-based, low-cost interventions that can reduce mortality and morbidity, and have argued for additional funding to increase access to and coverage of these life-saving interventions. However, funding alone will not close the gap on MDGs 4 and 5. Even when high-quality, affordable products and services are readily available, uptake is often low. Progress will therefore require not just money, but also advances in health-related behavior change and decision-making. Behavioral economics offers one way to achieve real progress by improving our understanding of how individuals make choices under information and time constraints, and by offering new approaches to make it easier for individuals to do what is in their best interest and harder to do what is not. We introduce five behavioral economic principles and demonstrate how they could boost efforts to improve maternal, newborn, and child health in pursuit of MDGs 4 and 5.

The influence of patient portals on users' decision making is insufficiently investigated: A systematic methodological review.

PubMed

Fraccaro, Paolo; Vigo, Markel; Balatsoukas, Panagiotis; Buchan, Iain E; Peek, Niels; van der Veer, Sabine N

2018-03-01

Patient portals are considered valuable conduits for supporting patients' self-management. However, it is unknown why they often fail to impact on health care processes and outcomes. This may be due to a scarcity of robust studies focusing on the steps that are required to induce improvement: users need to effectively interact with the portal (step 1) in order to receive information (step 2), which might influence their decision-making (step 3). We aimed to explore this potential knowledge gap by investigating to what extent each step has been investigated for patient portals, and explore the methodological approaches used. We performed a systematic literature review using Coiera's information value chain as a guiding theoretical framework. We searched MEDLINE and Scopus by combining terms related to patient portals and evaluation methodologies. Two reviewers selected relevant papers through duplicate screening, and one extracted data from the included papers. We included 115 articles. The large majority (n = 104) evaluated aspects related to interaction with patient portals (step 1). Usage was most often assessed (n = 61), mainly by analysing system interaction data (n = 50), with most authors considering participants as active users if they logged in at least once. Overall usability (n = 57) was commonly assessed through non-validated questionnaires (n = 44). Step 2 (information received) was investigated in 58 studies, primarily by analysing interaction data to evaluate usage of specific system functionalities (n = 34). Eleven studies explicitly assessed the influence of patient portals on patients' and clinicians' decisions (step 3). Whereas interaction with patient portals has been extensively studied, their influence on users' decision-making remains under-investigated. Methodological approaches to evaluating usage and usability of portals showed room for improvement. To unlock the potential of patient portals, more (robust) research should focus on better understanding the complex process of how portals lead to improved health and care. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

Integrated climate and land change research to improve decision-making and resource management in Southern Africa: The SASSCAL approach

NASA Astrophysics Data System (ADS)

Helmschrot, J.; Olwoch, J. M.

2017-12-01

The ability of countries in southern Africa to jointly respond to climate challenges with scientifically informed and evidence-based actions and policy decisions remains low due to limited scientific research capacity and infrastructure. The Southern African Science Service Centre for Climate Change and Adaptive Land Management (SASSCAL; www.sasscal.org) addresses this gap by implementing a high-level framework to guide research and innovation investments in climate change and adaptive land management interventions in Southern Africa. With a strong climate service component as cross-cutting topic, SASSCAL's focus is to improve the understanding of climate and land management change impacts on the natural and socio-economic environment in Southern Africa. The paper presents a variety of SASSCAL driven activities which contribute to better understand climate and long-term environmental change dynamics at various temporal and spatial scales in Southern Afrika and how these activities are linked to support research and decision-making to optimize agricultural practices as well as sustainable environmental and water resources management. To provide consistent and reliable climate information for Southern Africa, SASSCAL offers various climate services ranging from real-time climate observation across the region utilizing the SASSCAL WeatherNet to regional climate change analysis and modelling efforts at seasonal-to-decadal timescales using climate data from various sources. SASSCAL also offers the current state of the environment in terms of recent data on changes in the environment that are necessary for setting appropriate adaptation strategies . The paper will further demonstrate how these services are utilized for interdisciplinary research on the impact of climate change on natural resources and socio-economic development in the SASSCAL countries and how this knowledge can be effectively used to mitigate and adapt to climate change by informed decision-making from farm to regional level.

Creating a process for incorporating epidemiological modelling into outbreak management decisions.

PubMed

Akselrod, Hana; Mercon, Monica; Kirkeby Risoe, Petter; Schlegelmilch, Jeffrey; McGovern, Joanne; Bogucki, Sandy

2012-01-01

Modern computational models of infectious diseases greatly enhance our ability to understand new infectious threats and assess the effects of different interventions. The recently-released CDC Framework for Preventing Infectious Diseases calls for increased use of predictive modelling of epidemic emergence for public health preparedness. Currently, the utility of these technologies in preparedness and response to outbreaks is limited by gaps between modelling output and information requirements for incident management. The authors propose an operational structure that will facilitate integration of modelling capabilities into action planning for outbreak management, using the Incident Command System (ICS) and Synchronization Matrix framework. It is designed to be adaptable and scalable for use by state and local planners under the National Response Framework (NRF) and Emergency Support Function #8 (ESF-8). Specific epidemiological modelling requirements are described, and integrated with the core processes for public health emergency decision support. These methods can be used in checklist format to align prospective or real-time modelling output with anticipated decision points, and guide strategic situational assessments at the community level. It is anticipated that formalising these processes will facilitate translation of the CDC's policy guidance from theory to practice during public health emergencies involving infectious outbreaks.

Knee osteoarthritis and role for surgical intervention: lessons learned from randomized clinical trials and population-based cohorts.

PubMed

Buchbinder, Rachelle; Richards, Bethan; Harris, Ian

2014-03-01

Over the last decade, there has been increased recognition of the importance of high-quality randomized controlled trials in determining the role of surgery for knee osteoarthritis. This review highlights key findings from the best available studies, and considers whether or not this knowledge has resulted in better evidence-based care. Use of arthroscopy to treat knee osteoarthritis has not declined despite strong evidence-based recommendations that do not sanction its use. A large randomized controlled trial has demonstrated that arthroscopic partial meniscectomy followed by a standardized physical therapy program results in similar improvements in pain and function at 6 and 12 months in comparison to physical therapy alone in patients with knee osteoarthritis and a symptomatic meniscal tear, confirming the findings of two previous trials. Two recent randomized controlled trials have demonstrated that decision aids help people to reach better-informed decisions about total knee arthroplasty. A majority of studies have indicated that for people with obesity the positive results of total knee arthroplasty may be compromised by postoperative complications, particularly infection. More efforts are needed to overcome significant evidence-practice gaps in the surgical management of knee osteoarthritis, particularly arthroscopy. Decision aids are a promising tool.

An Empirically Calibrated Model of Cell Fate Decision Following Viral Infection

NASA Astrophysics Data System (ADS)

Coleman, Seth; Igoshin, Oleg; Golding, Ido

The life cycle of the virus (phage) lambda is an established paradigm for the way genetic networks drive cell fate decisions. But despite decades of interrogation, we are still unable to theoretically predict whether the infection of a given cell will result in cell death or viral dormancy. The poor predictive power of current models reflects the absence of quantitative experimental data describing the regulatory interactions between different lambda genes. To address this gap, we are constructing a theoretical model that captures the known interactions in the lambda network. Model assumptions and parameters are calibrated using new single-cell data from our lab, describing the activity of lambda genes at single-molecule resolution. We began with a mean-field model, aimed at exploring the population averaged gene-expression trajectories under different initial conditions. Next, we will develop a stochastic formulation, to capture the differences between individual cells within the population. The eventual goal is to identify how the post-infection decision is driven by the interplay between network topology, initial conditions, and stochastic effects. The insights gained here will inform our understanding of cell fate choices in more complex cellular systems.

A conceptual framework for understanding the perspectives on the causes of the science-practice gap in ecology and conservation.

PubMed

Bertuol-Garcia, Diana; Morsello, Carla; N El-Hani, Charbel; Pardini, Renata

2018-05-01

Applying scientific knowledge to confront societal challenges is a difficult task, an issue known as the science-practice gap. In Ecology and Conservation, scientific evidence has been seldom used directly to support decision-making, despite calls for an increasing role of ecological science in developing solutions for a sustainable future. To date, multiple causes of the science-practice gap and diverse approaches to link science and practice in Ecology and Conservation have been proposed. To foster a transparent debate and broaden our understanding of the difficulties of using scientific knowledge, we reviewed the perceived causes of the science-practice gap, aiming to: (i) identify the perspectives of ecologists and conservation scientists on this problem, (ii) evaluate the predominance of these perspectives over time and across journals, and (iii) assess them in light of disciplines studying the role of science in decision-making. We based our review on 1563 sentences describing causes of the science-practice gap extracted from 122 articles and on discussions with eight scientists on how to classify these sentences. The resulting process-based framework describes three distinct perspectives on the relevant processes, knowledge and actors in the science-practice interface. The most common perspective assumes only scientific knowledge should support practice, perceiving a one-way knowledge flow from science to practice and recognizing flaws in knowledge generation, communication, and/or use. The second assumes that both scientists and decision-makers should contribute to support practice, perceiving a two-way knowledge flow between science and practice through joint knowledge-production/integration processes, which, for several reasons, are perceived to occur infrequently. The last perspective was very rare, and assumes scientists should put their results into practice, but they rarely do. Some causes (e.g. cultural differences between scientists and decision-makers) are shared with other disciplines, while others seem specific to Ecology and Conservation (e.g. inadequate research scales). All identified causes require one of three general types of solutions, depending on whether the causal factor can (e.g. inadequate research questions) or cannot (e.g. scientific uncertainty) be changed, or if misconceptions (e.g. undervaluing abstract knowledge) should be solved. The unchanged predominance of the one-way perspective over time may be associated with the prestige of evidence-based conservation and suggests that debates in Ecology and Conservation lag behind trends in other disciplines towards bidirectional views ascribing larger roles to decision-makers. In turn, the two-way perspective seems primarily restricted to research traditions historically isolated from mainstream conservation biology. All perspectives represented superficial views of decision-making by not accounting for limits to human rationality, complexity of decision-making contexts, fuzzy science-practice boundaries, ambiguity brought about by science, and different types of knowledge use. However, joint knowledge-production processes from the two-way perspective can potentially allow for democratic decision-making processes, explicit discussions of values and multiple types of science use. To broaden our understanding of the interface and foster productive science-practice linkages, we argue for dialogue among different research traditions within Ecology and Conservation, joint knowledge-production processes between scientists and decision-makers and interdisciplinarity across Ecology, Conservation and Political Science in both research and education. © 2017 Cambridge Philosophical Society.

Building Capacity to Use Earth Observations in Decision Making for Climate, Health, Agriculture and Natural Disasters

NASA Astrophysics Data System (ADS)

Robertson, A. W.; Ceccato, P.

2015-12-01

In order to fill the gaps existing in climate and public health, agriculture, natural disasters knowledge and practices, the International Research Institute for Climate and Society (IRI) has developed a Curriculum for Best Practices in Climate Information. This Curriculum builds on the experience of 10 years courses on 'Climate Information' and captures lessons and experiences from different tailored trainings that have been implemented in many countries in Africa, Asia and Latin America. In this presentation, we will provide examples of training activities we have developed to bring remote sensing products to monitor climatic and environmental information into decision processes that benefited users such as the World Health Organization, Ministries of Health, Ministries of Agriculture, Universities, Research Centers such as CIFOR and FIOCRUZ. The framework developed by IRI to provide capacity building is based on the IDEAS framework: Innovation (research) Around climate impacts, evaluation of interventions, and the value of climate information in reducing risks and maximizing opportunities Demonstration E.g. in-country GFCS projects in Tanzania and Malawi - or El Nino work in Ethiopia Education Academic and professional training efforts Advocacy This might focus on communication of variability and change? We are WHO collaborating center so are engaged through RBM/Global Malaria Programme Service ENACTS and Data library key to this. Country data better quality than NASA as incorporates all relevant station data and NASA products. This presentation will demonstrate how the IDEAS framework has been implemented and lessons learned.

Mapping of species richness for conservation of biological diversity: conceptual and methodological issues

Treesearch

M.J. Conroy; B.R. Noon

1996-01-01

Biodiversity mapping (e.g., the Gap Analysis Program [GAP]), in which vegetative features and categories of land use are mapped at coarse spatial scales, has been proposed as a reliable tool for land use decisions (e.g., reserve identification, selection, and design). This implicitly assumes that species richness data collected at coarse spatiotemporal scales provide a...

Child Pedestrians' Judgments of Safe Crossing Gaps at Three Different Vehicle Approach Speeds: A Preliminary Study.

ERIC Educational Resources Information Center

Connelly, Marie L.; And Others

1996-01-01

Judgments made by four children between seven and nine years of age regarding the safety of crossing a road in front of an approaching vehicle were studied. All participants consistently allowed smaller safety gaps as vehicle speeds increased, and three children often made potentially dangerous decisions at high vehicle speeds. (Author/PB)

The Arf GAP CNT-2 regulates the apoptotic fate in C. elegans asymmetric neuroblast divisions.

PubMed

Singhvi, Aakanksha; Teuliere, Jerome; Talavera, Karla; Cordes, Shaun; Ou, Guangshuo; Vale, Ronald D; Prasad, Brinda C; Clark, Scott G; Garriga, Gian

2011-06-07

During development, all cells make the decision to live or die. Although the molecular mechanisms that execute the apoptotic program are well defined, less is known about how cells decide whether to live or die. In C. elegans, this decision is linked to how cells divide asymmetrically [1, 2]. Several classes of molecules are known to regulate asymmetric cell divisions in metazoans, yet these molecules do not appear to control C. elegans divisions that produce apoptotic cells [3]. We identified CNT-2, an Arf GTPase-activating protein (GAP) of the AGAP family, as a novel regulator of this type of neuroblast division. Loss of CNT-2 alters daughter cell size and causes the apoptotic cell to adopt the fate of its sister cell, resulting in extra neurons. CNT-2's Arf GAP activity is essential for its function in these divisions. The N terminus of CNT-2, which contains a GTPase-like domain that defines the AGAP class of Arf GAPs, negatively regulates CNT-2's function. We provide evidence that CNT-2 regulates receptor-mediated endocytosis and consider the implications of its role in asymmetric cell divisions. Copyright © 2011 Elsevier Ltd. All rights reserved.

The Effect of Information Provision on Public Consensus about Climate Change.

PubMed

Deryugina, Tatyana; Shurchkov, Olga

2016-01-01

Despite over 20 years of research and scientific consensus on the topic, climate change continues to be a politically polarizing issue. We conducted a survey experiment to test whether providing the public with information on the exact extent of scientific agreement about the occurrence and causes of climate change affects respondents' own beliefs and bridges the divide between conservatives and liberals. First, we show that the public significantly underestimated the extent of the scientific consensus. We then find that those given concrete information about scientists' views were more likely to report believing that climate change was already underway and that it was caused by humans. However, their beliefs about the necessity of making policy decisions and their willingness to donate money to combat climate change were not affected. Information provision affected liberals, moderates, and conservatives similarly, implying that the gap in beliefs between liberals and conservatives is not likely to be bridged by information treatments similar to the one we study. Finally, we conducted a 6-month follow-up with respondents to see if the treatment effect persisted; the results were statistically inconclusive.

Advancing Sustainable Bioenergy: Evolving Stakeholder Interests and the Relevance of Research

NASA Astrophysics Data System (ADS)

Johnson, Timothy Lawrence; Bielicki, Jeffrey M.; Dodder, Rebecca S.; Hilliard, Michael R.; Ozge Kaplan, P.; Andrew Miller, C.

2013-02-01

The sustainability of future bioenergy production rests on more than continual improvements in its environmental, economic, and social impacts. The emergence of new biomass feedstocks, an expanding array of conversion pathways, and expected increases in overall bioenergy production are connecting diverse technical, social, and policy communities. These stakeholder groups have different—and potentially conflicting—values and cultures, and therefore different goals and decision making processes. Our aim is to discuss the implications of this diversity for bioenergy researchers. The paper begins with a discussion of bioenergy stakeholder groups and their varied interests, and illustrates how this diversity complicates efforts to define and promote "sustainable" bioenergy production. We then discuss what this diversity means for research practice. Researchers, we note, should be aware of stakeholder values, information needs, and the factors affecting stakeholder decision making if the knowledge they generate is to reach its widest potential use. We point out how stakeholder participation in research can increase the relevance of its products, and argue that stakeholder values should inform research questions and the choice of analytical assumptions. Finally, we make the case that additional natural science and technical research alone will not advance sustainable bioenergy production, and that important research gaps relate to understanding stakeholder decision making and the need, from a broader social science perspective, to develop processes to identify and accommodate different value systems. While sustainability requires more than improved scientific and technical understanding, the need to understand stakeholder values and manage diversity presents important research opportunities.

Advancing sustainable bioenergy: evolving stakeholder interests and the relevance of research.

PubMed

Johnson, Timothy Lawrence; Bielicki, Jeffrey M; Dodder, Rebecca S; Hilliard, Michael R; Kaplan, P Ozge; Miller, C Andrew

2013-02-01

The sustainability of future bioenergy production rests on more than continual improvements in its environmental, economic, and social impacts. The emergence of new biomass feedstocks, an expanding array of conversion pathways, and expected increases in overall bioenergy production are connecting diverse technical, social, and policy communities. These stakeholder groups have different-and potentially conflicting-values and cultures, and therefore different goals and decision making processes. Our aim is to discuss the implications of this diversity for bioenergy researchers. The paper begins with a discussion of bioenergy stakeholder groups and their varied interests, and illustrates how this diversity complicates efforts to define and promote "sustainable" bioenergy production. We then discuss what this diversity means for research practice. Researchers, we note, should be aware of stakeholder values, information needs, and the factors affecting stakeholder decision making if the knowledge they generate is to reach its widest potential use. We point out how stakeholder participation in research can increase the relevance of its products, and argue that stakeholder values should inform research questions and the choice of analytical assumptions. Finally, we make the case that additional natural science and technical research alone will not advance sustainable bioenergy production, and that important research gaps relate to understanding stakeholder decision making and the need, from a broader social science perspective, to develop processes to identify and accommodate different value systems. While sustainability requires more than improved scientific and technical understanding, the need to understand stakeholder values and manage diversity presents important research opportunities.

Flooding During Drought: Learning from Stakeholder Engagement & Partner Coordination in the California-Nevada Drought Early Warning System (DEWS)

NASA Astrophysics Data System (ADS)

Sheffield, A. M.

2017-12-01

After more than 5 years of drought, extreme precipitation brought drought relief in California and Nevada and presents an opportunity to reflect upon lessons learned while planning for the future. NOAA's National Integrated Drought Information System (NIDIS) California-Nevada Drought Early Warning System (DEWS) in June 2017 convened a regional coordination workshop to provide a forum to discuss and build upon past drought efforts in the region and increase coordination, collaboration and information sharing across the region as a whole. Participants included federal, tribal, state, academic, and local partners who provided a post-mortem on the recent drought and impacts as well as recent innovations in drought monitoring, forecasts, and decision support tools in response to the historic drought. This presentation will highlight lessons learned from stakeholder outreach and engagement around flooding during drought, and pathways for moving forward coordination and collaboration in the region. Additional focus will be on the potential opportunities from examining California decision making calendars from this drought. Identified gaps and challenges will also be shared, such as the need to connect observations with social impacts, capacity building around available tools and resources, and future drought monitoring needs. Drought will continue to impact California and Nevada, and the CA-NV DEWS works to make climate and drought science readily available, easily understandable and usable for decision makers; and to improve the capacity of stakeholders to better monitor, forecast, plan for and cope with the impacts of drought.

Susceptibility to social pressure following ventromedial prefrontal cortex damage

PubMed Central

Rusch, Michelle L.; Dawson, Jeffrey D.; Rizzo, Matthew; Anderson, Steven W.

2015-01-01

Social pressure influences human behavior including risk taking, but the psychological and neural underpinnings of this process are not well understood. We used the human lesion method to probe the role of ventromedial prefrontal cortex (vmPFC) in resisting adverse social pressure in the presence of risk. Thirty-seven participants (11 with vmPFC damage, 12 with brain damage outside the vmPFC and 14 without brain damage) were tested in driving simulator scenarios requiring left-turn decisions across oncoming traffic with varying time gaps between the oncoming vehicles. Social pressure was applied by a virtual driver who honked aggressively from behind. Participants with vmPFC damage were more likely to select smaller and potentially unsafe gaps under social pressure, while gap selection by the comparison groups did not change under social pressure. Participants with vmPFC damage also showed prolonged elevated skin conductance responses (SCR) under social pressure. Comparison groups showed similar initial elevated SCR, which then declined prior to making left-turn decisions. The findings suggest that the vmPFC plays an important role in resisting explicit and immediately present social pressure with potentially negative consequences. The vmPFC appears to contribute to the regulation of emotional responses and the modulation of decision making to optimize long-term outcomes. PMID:25816815

Rationing is a reality in rural physiotherapy: a qualitative exploration of service level decision-making.

PubMed

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

2015-03-27

Deciding what health services are provided is a key consideration in delivering appropriate and accessible health care for rural and remote populations. Despite residents of rural communities experiencing poorer health outcomes and exhibiting higher health need, workforce shortages and maldistribution mean that rural communities do not have access to the range of services available in metropolitan centres. Where demand exceeds available resources, decisions about resource allocation are required. A qualitative approach enabled the researchers to explore participant perspectives about decisions informing rural physiotherapy service provision. Stakeholder perspectives were obtained through surveys and in-depth interviews. A system theory-case study heuristic provided a framework for exploration across sites within the investigation area: a large area of one Australian state with a mix of rural, regional and remote communities. Thirty-nine surveys were received from participants in eleven communities. Nineteen in-depth interviews were conducted with physiotherapist and key decision-makers. Increasing demand, organisational priorities, fiscal austerity measures and workforce challenges were identified as factors influencing both decision-making and service provision. Rationing of physiotherapy services was common to all sites of this study. Rationing of services, more commonly expressed as service prioritisation, was more evident in responses of public sector physiotherapy participants compared to private physiotherapists. However, private physiotherapists in rural areas reported capacity limits, including expertise, space and affordability that constrained service provision. The imbalance between increasing service demands and limited physiotherapy capacity meant making choices was inevitable. Decreased community access to local physiotherapy services and increased workforce stress, a key determinant of retention, are two results of such choices or decisions. Decreased access was particularly evident for adults and children requiring neurological rehabilitation and for people requiring post-acute physiotherapy. It should not be presumed that rural private physiotherapy providers will cover service gaps that may emerge from changes to public sector service provision. Clinician preference combines with capacity limits and the imperative of financial viability to negate such assumptions. This study provides insight into rural physiotherapy service provision not usually evident and can be used to inform health service planning and decision-making and education of current and future rural physiotherapists.

Understanding decisions Latino students make regarding persistence in the science and math pipeline

NASA Astrophysics Data System (ADS)

Munro, Janet Lynn

This qualitative study focused on the knowledge and perceptions of Latino high school students, as well those of their parents and school personnel, at a southwestern, suburban high school regarding persistence in the math/science pipeline. In the context of the unique school and community setting these students experience, the decision-making process was examined with particular focus on characterizing the relationships that influence the process. While the theoretical framework that informs this study was that of social capital, its primary purpose was to inform the school's processes and policy in support of increased Latino participation in the math and science pipeline. Since course selection may be the most powerful factor affecting school achievement and college-preparedness, and since course selection is influenced by school policy, school personnel, students, parents, and teachers alike, it is important to understand the beliefs and perceptions that characterize the relationships among them. The qualitative research design involved a phenomenological study of nine Latino students, their parents, their teachers and counselors, and certain support personnel from the high school. The school's and community's environment in support of academic intensity served as context for the portrait that developed. Given rapidly changing demographics that bring more and more Latino students to suburban high schools, the persistent achievement gap experienced by Latino students, and the growing dependence of the world economy on a citizenry versed in the math- and science-related fields, a deeper understanding of the decision-making processes Latino 12 students experience can inform school policy as educators struggle to influence those decisions. This study revealed a striking lack of knowledge concerning the college-entrance ramifications of continued course work in math and science beyond that required for graduation, relationships among peers, parents, and school personnel that were markedly lacking in influence over the decision a student makes to continue, or not, course work beyond that required for graduation, and a general dismissal of the value of math- and science-related careers. Also lacking was any evidence of social capital within parental networks that reflected intergenerational closure.

The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: a systematic review.

PubMed

Anderson, Laurie M; Quinn, Toby A; Glanz, Karen; Ramirez, Gilbert; Kahwati, Leila C; Johnson, Donna B; Buchanan, Leigh Ramsey; Archer, W Roodly; Chattopadhyay, Sajal; Kalra, Geetika P; Katz, David L

2009-10-01

This report presents the results of a systematic review of the effectiveness of worksite nutrition and physical activity programs to promote healthy weight among employees. These results form the basis for the recommendation by the Task Force on Community Preventive Services on the use of these interventions. Weight-related outcomes, including weight in pounds or kilograms, BMI, and percentage body fat were used to assess effectiveness of these programs. This review found that worksite nutrition and physical activity programs achieve modest improvements in employee weight status at the 6-12-month follow-up. A pooled effect estimate of -2.8 pounds (95% CI=-4.6, -1.0) was found based on nine RCTs, and a decrease in BMI of -0.5 (95% CI=-0.8, -0.2) was found based on six RCTs. The findings appear to be applicable to both male and female employees, across a range of worksite settings. Most of the studies combined informational and behavioral strategies to influence diet and physical activity; fewer studies modified the work environment (e.g., cafeteria, exercise facilities) to promote healthy choices. Information about other effects, barriers to implementation, cost and cost effectiveness of interventions, and research gaps are also presented in this article. The findings of this systematic review can help inform decisions of employers, planners, researchers, and other public health decision makers.

Structured representation for core elements of common clinical decision support interventions to facilitate knowledge sharing.

PubMed

Zhou, Li; Hongsermeier, Tonya; Boxwala, Aziz; Lewis, Janet; Kawamoto, Kensaku; Maviglia, Saverio; Gentile, Douglas; Teich, Jonathan M; Rocha, Roberto; Bell, Douglas; Middleton, Blackford

2013-01-01

At present, there are no widely accepted, standard approaches for representing computer-based clinical decision support (CDS) intervention types and their structural components. This study aimed to identify key requirements for the representation of five widely utilized CDS intervention types: alerts and reminders, order sets, infobuttons, documentation templates/forms, and relevant data presentation. An XML schema was proposed for representing these interventions and their core structural elements (e.g., general metadata, applicable clinical scenarios, CDS inputs, CDS outputs, and CDS logic) in a shareable manner. The schema was validated by building CDS artifacts for 22 different interventions, targeted toward guidelines and clinical conditions called for in the 2011 Meaningful Use criteria. Custom style sheets were developed to render the XML files in human-readable form. The CDS knowledge artifacts were shared via a public web portal. Our experience also identifies gaps in existing standards and informs future development of standards for CDS knowledge representation and sharing.

Merging Air Quality and Public Health Decision Support Systems

NASA Astrophysics Data System (ADS)

Hudspeth, W. B.; Bales, C. L.

2003-12-01

The New Mexico Air Quality Mapper (NMAQM) is a Web-based, open source GIS prototype application that Earth Data Analysis Center is developing under a NASA Cooperative Agreement. NMAQM enhances and extends existing data and imagery delivery systems with an existing Public Health system called the Rapid Syndrome Validation Project (RSVP). RSVP is a decision support system operating in several medical and public health arenas. It is evolving to ingest remote sensing data as input to provide early warning of human health threats, especially those related to anthropogenic atmospheric pollutants and airborne pathogens. The NMAQM project applies measurements of these atmospheric pollutants, derived from both remotely sensed data as well as from in-situ air quality networks, to both forecasting and retrospective analyses that influence human respiratory health. NMAQM provides a user-friendly interface for visualizing and interpreting environmentally-linked epidemiological phenomena. The results, and the systems made to provide the information, will be applicable not only to decision-makers in the public health realm, but also to air quality organizations, demographers, community planners, and other professionals in information technology, and social and engineering sciences. As an accessible and interactive mapping and analysis application, it allows environment and health personnel to study historic data for hypothesis generation and trend analysis, and then, potentially, to predict air quality conditions from daily data acquisitions. Additional spin off benefits to such users include the identification of gaps in the distribution of in-situ monitoring stations, the dissemination of air quality data to the public, and the discrimination of local vs. more regional sources of air pollutants that may bear on decisions relating to public health and public policy.

Incapacity in Canada: review of laws and policies on research involving decisionally impaired adults.

PubMed

Wildeman, Sheila; Dunn, Laura B; Onyemelukwe, Cheluchi

2013-04-01

In Canada, as in the United States, the legal frameworks governing research involving adults incapable of providing informed consent are beset by gaps and ambiguities. In both countries, federal laws and policies relevant to the regulation of research involving decisionally incapable adults interact in complex ways with provincial or state laws. To alert researchers to these complexities and to urge law reform, this review provides a comprehensive account of the federal and provincial/ territorial legal frameworks relevant to research involving decisionally incapable adults in Canada. We identified the federal and provincial/territorial laws and policies pertinent to this review by updating previous work on substitute decision-making about research in Canada and then performing keyword searches on a Canadian legal information database (CanLii) to identify further laws of relevance. Our analysis of identified laws focused on three questions: 1) What (if any) preconditions-including permissible risk and/or benefit thresholds-are imposed on research involving persons who lack capacity to consent? 2) What provisions (if any) are in place for identification of the legally authorized representative for research decision making? and 3) What factors, if any, are stipulated as mandatory relevant considerations for the legally authorized representative's decision-making process? Across Canada, laws relating to substitute decision-making are highly variable, and often ambiguous or uncertain, on each of the matters targeted in our analysis. Researchers and research institutions should be aware of federal and provincial/territorial legal requirements for research involving persons who lack capacity to consent in Canada. The relevant governments should undertake coordinated efforts at law reform to clarify, and potentially harmonize, these requirements. Copyright © 2013 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Designing Observation and Modeling Systems to Inform Decisions and Policies on Freshwater Objectives in New Zealand

NASA Astrophysics Data System (ADS)

Baisden, W. T.; Ellis, T.; Rissman, C.; Moore, C.; Matthews, A.

2016-12-01

Declines in New Zealand's freshwater quality have led to legislation - the 2014 National Policy Statement on Freshwater Management (NPS-FM) - which requires regional governments to set "objectives" and design policies accordingly. In most regions, increases in freshwater contaminants are derived largely from intensifying agriculture and come as nitrogen, phosphorous or sediment, or a combination thereof. Here, the development and application of N and O isotopes as natural tracers for nitrate is examined as a case study, in the context of a wider hierarchy of observations such as N concentrations, flow and broader hydrochemistry used for NPS-FM implementation. The analysis of N and O isotopes in nitrate provides specific information on sources and removal processes that cannot be obtained by other measurements. Yet, despite considerable development of the technical methodology and environment-specific interpretation, application of measurements has faced barriers. Many may be typical of science in a small advanced nation with a population of 4.5 million, but others are unique due to New Zealand's limited rural population base and large diversity in physical geography, as well as a unique economic reliance on highly productive pastoral agricultural systems. Seventeen different regional governments are empowered to regulate in ways consistent with local consultation and democracy within their catchment boundaries, but with limited resources to align highly technical observational data to policies and decisions, as well as supporting models. The resulting gaps in communication and technical capability combine with a diversity of approaches to pose both challenges and opportunities for development and application of hierarchical observation systems. Success appears to lie in ensuring decision frameworks can be `mapped', so that different frameworks can be compared, and the benefits of sophisticated observations understood directly in relation to influence on regional policy and on-farm management decisions.

Estimating the incidence, prevalence and true cost of asthma in the UK: secondary analysis of national stand-alone and linked databases in England, Northern Ireland, Scotland and Wales—a study protocol

PubMed Central

Mukherjee, Mome; Gupta, Ramyani; Farr, Angela; Heaven, Martin; Stoddart, Andrew; Nwaru, Bright I; Fitzsimmons, Deborah; Chamberlain, George; Bandyopadhyay, Amrita; Fischbacher, Colin; Dibben, Christopher; Shields, Michael; Phillips, Ceri; Strachan, David; Davies, Gwyneth; McKinstry, Brian; Sheikh, Aziz

2014-01-01

Introduction Asthma is now one of the most common long-term conditions in the UK. It is therefore important to develop a comprehensive appreciation of the healthcare and societal costs in order to inform decisions on care provision and planning. We plan to build on our earlier estimates of national prevalence and costs from asthma by filling the data gaps previously identified in relation to healthcare and broadening the field of enquiry to include societal costs. This work will provide the first UK-wide estimates of the costs of asthma. In the context of asthma for the UK and its member countries (ie, England, Northern Ireland, Scotland and Wales), we seek to: (1) produce a detailed overview of estimates of incidence, prevalence and healthcare utilisation; (2) estimate health and societal costs; (3) identify any remaining information gaps and explore the feasibility of filling these and (4) provide insights into future research that has the potential to inform changes in policy leading to the provision of more cost-effective care. Methods and analysis Secondary analyses of data from national health surveys, primary care, prescribing, emergency care, hospital, mortality and administrative data sources will be undertaken to estimate prevalence, healthcare utilisation and outcomes from asthma. Data linkages and economic modelling will be undertaken in an attempt to populate data gaps and estimate costs. Separate prevalence and cost estimates will be calculated for each of the UK-member countries and these will then be aggregated to generate UK-wide estimates. Ethics and dissemination Approvals have been obtained from the NHS Scotland Information Services Division's Privacy Advisory Committee, the Secure Anonymised Information Linkage Collaboration Review System, the NHS South-East Scotland Research Ethics Service and The University of Edinburgh's Centre for Population Health Sciences Research Ethics Committee. We will produce a report for Asthma-UK, submit papers to peer-reviewed journals and construct an interactive map. PMID:25371419

Estimating the incidence, prevalence and true cost of asthma in the UK: secondary analysis of national stand-alone and linked databases in England, Northern Ireland, Scotland and Wales-a study protocol.

PubMed

Mukherjee, Mome; Gupta, Ramyani; Farr, Angela; Heaven, Martin; Stoddart, Andrew; Nwaru, Bright I; Fitzsimmons, Deborah; Chamberlain, George; Bandyopadhyay, Amrita; Fischbacher, Colin; Dibben, Christopher; Shields, Michael; Phillips, Ceri; Strachan, David; Davies, Gwyneth; McKinstry, Brian; Sheikh, Aziz

2014-11-04

Asthma is now one of the most common long-term conditions in the UK. It is therefore important to develop a comprehensive appreciation of the healthcare and societal costs in order to inform decisions on care provision and planning. We plan to build on our earlier estimates of national prevalence and costs from asthma by filling the data gaps previously identified in relation to healthcare and broadening the field of enquiry to include societal costs. This work will provide the first UK-wide estimates of the costs of asthma. In the context of asthma for the UK and its member countries (ie, England, Northern Ireland, Scotland and Wales), we seek to: (1) produce a detailed overview of estimates of incidence, prevalence and healthcare utilisation; (2) estimate health and societal costs; (3) identify any remaining information gaps and explore the feasibility of filling these and (4) provide insights into future research that has the potential to inform changes in policy leading to the provision of more cost-effective care. Secondary analyses of data from national health surveys, primary care, prescribing, emergency care, hospital, mortality and administrative data sources will be undertaken to estimate prevalence, healthcare utilisation and outcomes from asthma. Data linkages and economic modelling will be undertaken in an attempt to populate data gaps and estimate costs. Separate prevalence and cost estimates will be calculated for each of the UK-member countries and these will then be aggregated to generate UK-wide estimates. Approvals have been obtained from the NHS Scotland Information Services Division's Privacy Advisory Committee, the Secure Anonymised Information Linkage Collaboration Review System, the NHS South-East Scotland Research Ethics Service and The University of Edinburgh's Centre for Population Health Sciences Research Ethics Committee. We will produce a report for Asthma-UK, submit papers to peer-reviewed journals and construct an interactive map. 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.

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

PubMed

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

2016-01-01

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

Research-informed Outreach informs Research: Using games to inform and understand farmer decisions in Sri Lanka

NASA Astrophysics Data System (ADS)

Gunda, T.; Yeung, K.; Hornberger, G. M.

2016-12-01

Researchers from the Agricultural Decision Making and Adaptation to Precipitation Trends in Sri Lanka (ADAPT-SL) team have been working for the past six years to understand Sri Lanka's agricultural vulnerability to climate change and how farmers and policy makers can adapt to and mitigate the variety of threats and uncertainties that climate change brings. In addition to academic publications, the compiled and developed knowledge from the ADAPT-SL research efforts are shared routinely with Sri Lankan stakeholders directly. While presentations are the norm for academic and government stakeholder outreach, we decided that an interactive component would increase farmers' learning. Drawing on teaching pedagogies, we designed a place-based, hands-on game that incorporated local climate and market characteristics to convey the impact of climate change on crop water needs for the Sri Lanka farmers. The process of developing the game, however, revealed gaps in our research knowledge, specifically regarding how farmers balance uncertainties associated with weather and market conditions. So we took advantage of the opportunity offered by the outreach effort to collect data; findings from the game led to the development of a system dynamics model. The game was well received by farmers and other Sri Lankan stakeholders in January 2016, with the former expressing that they played the game as if it was emulating actual farming decisions. The farmers also expressed a desire for more outreach efforts to be designed in such an interactive way. The game has since been used to engage U.S. students (from 5th grade to college seniors majoring in Sociology) regarding the complexities of tackling climate change issues.

Rapid Molecular Diagnostics, Antibiotic Treatment Decisions, and Developing Approaches to Inform Empiric Therapy: PRIMERS I and II.

PubMed

Evans, Scott R; Hujer, Andrea M; Jiang, Hongyu; Hujer, Kristine M; Hall, Thomas; Marzan, Christine; Jacobs, Michael R; Sampath, Rangarajan; Ecker, David J; Manca, Claudia; Chavda, Kalyan; Zhang, Pan; Fernandez, Helen; Chen, Liang; Mediavilla, Jose R; Hill, Carol B; Perez, Federico; Caliendo, Angela M; Fowler, Vance G; Chambers, Henry F; Kreiswirth, Barry N; Bonomo, Robert A

2016-01-15

Rapid molecular diagnostic (RMD) platforms may lead to better antibiotic use. Our objective was to develop analytical strategies to enhance the interpretation of RMDs for clinicians. We compared the performance characteristics of 4 RMD platforms for detecting resistance against β-lactams in 72 highly resistant isolates of Escherichia coli and Klebsiella pneumoniae (PRIMERS I). Subsequently, 2 platforms were used in a blinded study in which a heterogeneous collection of 196 isolates of E. coli and K. pneumoniae (PRIMERS II) were examined. We evaluated the genotypic results as predictors of resistance or susceptibility against β-lactam antibiotics. We designed analytical strategies and graphical representations of platform performance, including discrimination summary plots and susceptibility and resistance predictive values, that are readily interpretable by practitioners to inform decision-making. In PRIMERS I, the 4 RMD platforms detected β-lactamase (bla) genes and identified susceptibility or resistance in >95% of cases. In PRIMERS II, the 2 platforms identified susceptibility against extended-spectrum cephalosporins and carbapenems in >90% of cases; however, against piperacillin/tazobactam, susceptibility was identified in <80% of cases. Applying the analytical strategies to a population with 15% prevalence of ceftazidime-resistance and 5% imipenem-resistance, RMD platforms predicted susceptibility in >95% of cases, while prediction of resistance was 69%-73% for ceftazidime and 41%-50% for imipenem. RMD platforms can help inform empiric β-lactam therapy in cases where bla genes are not detected and the prevalence of resistance is known. Our analysis is a first step in bridging the gap between RMDs and empiric treatment decisions. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Analytic and heuristic processing influences on adolescent reasoning and decision-making.

PubMed

Klaczynski, P A

2001-01-01

The normative/descriptive gap is the discrepancy between actual reasoning and traditional standards for reasoning. The relationship between age and the normative/descriptive gap was examined by presenting adolescents with a battery of reasoning and decision-making tasks. Middle adolescents (N = 76) performed closer to normative ideals than early adolescents (N = 66), although the normative/descriptive gap was large for both groups. Correlational analyses revealed that (1) normative responses correlated positively with each other, (2) nonnormative responses were positively interrelated, and (3) normative and nonnormative responses were largely independent. Factor analyses suggested that performance was based on two processing systems. The "analytic" system operates on "decontextualized" task representations and underlies conscious, computational reasoning. The "heuristic" system operates on "contextualized," content-laden representations and produces "cognitively cheap" responses that sometimes conflict with traditional norms. Analytic processing was more clearly linked to age and to intelligence than heuristic processing. Implications for cognitive development, the competence/performance issue, and rationality are discussed.

Characteristics of knowledge content in a curated online evidence library.

PubMed

Varada, Sowmya; Lacson, Ronilda; Raja, Ali S; Ip, Ivan K; Schneider, Louise; Osterbur, David; Bain, Paul; Vetrano, Nicole; Cellini, Jacqueline; Mita, Carol; Coletti, Margaret; Whelan, Julia; Khorasani, Ramin

2018-05-01

To describe types of recommendations represented in a curated online evidence library, report on the quality of evidence-based recommendations pertaining to diagnostic imaging exams, and assess underlying knowledge representation. The evidence library is populated with clinical decision rules, professional society guidelines, and locally developed best practice guidelines. Individual recommendations were graded based on a standard methodology and compared using chi-square test. Strength of evidence ranged from grade 1 (systematic review) through grade 5 (recommendations based on expert opinion). Finally, variations in the underlying representation of these recommendations were identified. The library contains 546 individual imaging-related recommendations. Only 15% (16/106) of recommendations from clinical decision rules were grade 5 vs 83% (526/636) from professional society practice guidelines and local best practice guidelines that cited grade 5 studies (P < .0001). Minor head trauma, pulmonary embolism, and appendicitis were topic areas supported by the highest quality of evidence. Three main variations in underlying representations of recommendations were "single-decision," "branching," and "score-based." Most recommendations were grade 5, largely because studies to test and validate many recommendations were absent. Recommendation types vary in amount and complexity and, accordingly, the structure and syntax of statements they generate. However, they can be represented in single-decision, branching, and score-based representations. In a curated evidence library with graded imaging-based recommendations, evidence quality varied widely, with decision rules providing the highest-quality recommendations. The library may be helpful in highlighting evidence gaps, comparing recommendations from varied sources on similar clinical topics, and prioritizing imaging recommendations to inform clinical decision support implementation.

Consumer Decision-Making of Older People: A 45-Year Review.

PubMed

Hettich, Dominik; Hattula, Stefan; Bornemann, Torsten

2017-03-15

Aging is one of the key future challenges for global life. Of particular interest is the consumption-related decision-making of older people, as its better understanding would enable the effective influence of behavior, which would help to secure the economic well-being and ensure a better quality of life for this population. This article explores the respective literature and identifies gaps for future research. We conducted a holistic review of peer-reviewed literature that examined the decision-making of older consumers. Using a structured approach based on the consumer decision process model, we present the findings of 45 years of research (a total of 42 articles) and identify further research areas. The review reveals that the literature on older consumers' decision-making is fragmented, and that the findings are mixed. In particular, results on the role of emotions are controversial. While emotions have been shown to be better controlled by older individuals, emotions are also found to be highly influential in commercial advertisements. Similarly, the literature contains a lively debate on the relevance of price, service and store quality, and provider choice. These results call for a more holistic view of the decision-making of older consumers, and the review highlights numerous opportunities for future research. For instance, little is known about how older consumers deal with need recognition and the reasons they search for particular information. Moreover, understanding is lacking with respect to online purchase and feedback behavior. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Health Technology Assessment and Private Payers' Coverage of Personalized Medicine

PubMed Central

Trosman, Julia R.; Van Bebber, Stephanie L.; Phillips, Kathryn A.

2011-01-01

Purpose: Health technology assessment (HTA) plays an increasing role in translating emerging technologies into clinical practice and policy. Private payers are important users of HTA whose decisions impact adoption and use of new technologies. We examine the current use of HTA by private payers in coverage decisions for personalized medicine, a field that is increasingly impacting oncology practice. Study Design: Literature review and semistructured interviews. Methods: We reviewed seven HTA organizations used by private payers in decision making and explored how HTA is used by major US private payers (n = 11) for coverage of personalized medicine. Results: All payers used HTA in coverage decisions, but the number of HTA organizations used by an individual payer ranged from one (n = 1) to all seven (n = 1), with the majority of payers (n = 8) using three or more. Payers relied more extensively on HTAs for reviews of personalized medicine (64%) than for other technologies. Most payers (82%) equally valued expertise of reviewers and rigor of evaluation as HTA strengths, whereas genomic-specific methodology was less important. Key reported shortcomings were limited availability of reviews (73%) and limited inclusion of nonclinical factors (91%), such as cost-effectiveness or adoption of technology in clinical practice. Conclusion: Payers use a range of HTAs in their coverage decisions related to personalized medicine, but the current state of HTA to comprehensively guide those decisions is limited. HTA organizations should address current gaps to improve their relevance to payers and clinicians. Current HTA shortcomings may also inform the national HTA agenda. PMID:21886515

Opportunities and challenges in conducting secondary analysis of HIV programmes using data from routine health information systems and personal health information.

PubMed

Gloyd, Stephen; Wagenaar, Bradley H; Woelk, Godfrey B; Kalibala, Samuel

2016-01-01

HIV programme data from routine health information systems (RHIS) and personal health information (PHI) provide ample opportunities for secondary data analysis. However, these data pose unique opportunities and challenges for use in health system monitoring, along with process and impact evaluations. Analyses focused on retrospective case reviews of four of the HIV-related studies published in this JIAS supplement. We identify specific opportunities and challenges with respect to the secondary analysis of RHIS and PHI data. Challenges working with both HIV-related RHIS and PHI included missing, inconsistent and implausible data; rapidly changing indicators; systematic differences in the utilization of services; and patient linkages over time and different data sources. Specific challenges among RHIS data included numerous registries and indicators, inconsistent data entry, gaps in data transmission, duplicate registry of information, numerator-denominator incompatibility and infrequent use of data for decision-making. Challenges specific to PHI included the time burden for busy providers, the culture of lax charting, overflowing archives for paper charts and infrequent chart review. Many of the challenges that undermine effective use of RHIS and PHI data for analyses are related to the processes and context of collecting the data, excessive data requirements, lack of knowledge of the purpose of data and the limited use of data among those generating the data. Recommendations include simplifying data sources, analysis and reporting; conducting systematic data quality audits; enhancing the use of data for decision-making; promoting routine chart review linked with simple patient tracking systems; and encouraging open access to RHIS and PHI data for increased use.

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

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

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

2016-11-04

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

A Grounded Theory Study of Aircraft Maintenance Technician Decision-Making

NASA Astrophysics Data System (ADS)

Norcross, Robert

Aircraft maintenance technician decision-making and actions have resulted in aircraft system errors causing aircraft incidents and accidents. Aircraft accident investigators and researchers examined the factors that influence aircraft maintenance technician errors and categorized the types of errors in an attempt to prevent similar occurrences. New aircraft technology introduced to improve aviation safety and efficiency incur failures that have no information contained in the aircraft maintenance manuals. According to the Federal Aviation Administration, aircraft maintenance technicians must use only approved aircraft maintenance documents to repair, modify, and service aircraft. This qualitative research used a grounded theory approach to explore the decision-making processes and actions taken by aircraft maintenance technicians when confronted with an aircraft problem not contained in the aircraft maintenance manuals. The target population for the research was Federal Aviation Administration licensed aircraft and power plant mechanics from across the United States. Nonprobability purposeful sampling was used to obtain aircraft maintenance technicians with the experience sought in the study problem. The sample population recruitment yielded 19 participants for eight focus group sessions to obtain opinions, perceptions, and experiences related to the study problem. All data collected was entered into the Atlas ti qualitative analysis software. The emergence of Aircraft Maintenance Technician decision-making themes regarding Aircraft Maintenance Manual content, Aircraft Maintenance Technician experience, and legal implications of not following Aircraft Maintenance Manuals surfaced. Conclusions from this study suggest Aircraft Maintenance Technician decision-making were influenced by experience, gaps in the Aircraft Maintenance Manuals, reliance on others, realizing the impact of decisions concerning aircraft airworthiness, management pressures, and legal concerns related to decision-making. Recommendations included an in-depth systematic review of the Aircraft Maintenance Manuals, development of a Federal Aviation Administration approved standardized Aircraft Maintenance Technician decision-making flow diagram, and implementation of risk based decision-making training. The benefit of this study is to save the airline industry revenue by preventing poor decision-making practices that result in inefficient maintenance actions and aircraft incidents and accidents.

Flood Damage and Loss Estimation for Iowa on Web-based Systems using HAZUS

NASA Astrophysics Data System (ADS)

Yildirim, E.; Sermet, M. Y.; Demir, I.

2016-12-01

Importance of decision support systems for flood emergency response and loss estimation increases with its social and economic impacts. To estimate the damage of the flood, there are several software systems available to researchers and decision makers. HAZUS-MH is one of the most widely used desktop program, developed by FEMA (Federal Emergency Management Agency), to estimate economic loss and social impacts of disasters such as earthquake, hurricane and flooding (riverine and coastal). HAZUS used loss estimation methodology and implements through geographic information system (GIS). HAZUS contains structural, demographic, and vehicle information across United States. Thus, it allows decision makers to understand and predict possible casualties and damage of the floods by running flood simulations through GIS application. However, it doesn't represent real time conditions because of using static data. To close this gap, an overview of a web-based infrastructure coupling HAZUS and real time data provided by IFIS (Iowa Flood Information System) is presented by this research. IFIS is developed by the Iowa Flood Center, and a one-stop web-platform to access community-based flood conditions, forecasts, visualizations, inundation maps and flood-related data, information, and applications. Large volume of real-time observational data from a variety of sensors and remote sensing resources (radars, rain gauges, stream sensors, etc.) and flood inundation models are staged on a user-friendly maps environment that is accessible to the general public. Providing cross sectional analyses between HAZUS-MH and IFIS datasets, emergency managers are able to evaluate flood damage during flood events easier and more accessible in real time conditions. With matching data from HAZUS-MH census tract layer and IFC gauges, economical effects of flooding can be observed and evaluated by decision makers. The system will also provide visualization of the data by using augmented reality for see-through displays. Emergency management experts can take advantage of this visualization mode to manage flood response activities in real time. Also, forecast system developed by the Iowa Flood Center will be used to predict probable damage of the flood.

The Multifold Relationship between Memory and Decision Making: An Individual-Differences Study

ERIC Educational Resources Information Center

Del Missier, Fabio; Mäntylä, Timo; Hansson, Patrik; Bruine de Bruin, Wändi; Parker, Andrew M.; Nilsson, Lars-Göran

2013-01-01

Several judgment and decision-making tasks are assumed to involve memory functions, but significant knowledge gaps on the memory processes underlying these tasks remain. In a study on 568 adults between 25 and 80 years of age, hypotheses were tested on the specific relationships between individual differences in working memory, episodic memory,…

76 FR 5820 - Record of Decision for the General Management Plan for the Cumberland Gap National Historical...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-02

...: Pursuant to the National Environmental Policy Act of 1969, the National Park Service (NPS) announces the... Historical Park in Kentucky, Tennessee, and Virginia. On September 13, 2010, the Regional Director, Southeast....F.R. 1506.6. The responsible official for this Record of Decision is the Regional Director...

Decision Making behind the Use of Metacognitive Pedagogy within Education Methodology Coursework: An Exploratory Case Study

ERIC Educational Resources Information Center

Stokes, Andria Hilvitz

2011-01-01

Recent Department of Education Reports identify a need for changes in pre-service teacher education to help close the continuance of the achievement gap. The purpose of this qualitative study is to identify the professor decision making about metacognitive pedagogical theory within preparation of preservice education programs. The study included…

Factors that Influence STEM-Promising Females' Decision to Attend a Non Research-Intensive Undergraduate Institution

ERIC Educational Resources Information Center

Miller, Roxanne Greitz; Hurlock, Ashley J.

2017-01-01

Non research-intensive institutions of higher education are effective at narrowing STEM gender gaps in major selection and persistence to degree completion, yet the decision to attend such a setting is likely seen as counterintuitive when such institutions typically have lower levels of research, financial resources, and total student enrollments…

Collating science-based evidence to inform public opinion on the environmental effects of marine drilling platforms in the Mediterranean Sea.

PubMed

Mangano, M C; Sarà, G

2017-03-01

The use of rigorous methodologies to assess environmental, social and health impacts of specific interventions is crucial to disentangle the various components of environmental questions and to inform public opinion. The power of systematic maps relies on the capacity to summarise and organise the areas or relationships most studied, and to highlight key gaps in the evidence base. The recent Italian technical referendum (2016) - a public consultation inviting people to express their opinion by voting to change the rules on the length of licence duration and the decommissioning of offshore oil and gas platform drilling licences - inspired the creation of a systematic map of evidence to scope and quantify the effects of off-shore extraction platforms on Mediterranean marine ecosystems. The map was aimed as a useful model to standardise a "minimal informational threshold", which can inform public opinion at the beginning of any public consultation. Produced by synthesising scientific information, the map represents a reliable layer for any future sustainable strategy in the Mediterranean basin by: (i) providing a summary of the effects of marine gas and oil platforms on the Mediterranean marine ecosystem, (ii) describing the best known affected components on which the biggest monitoring efforts have been focused, and (iii) strengthening the science-policy nexus by offering a credible, salient and legitimate knowledge baseline to both public opinion and decision-makers. The map exercise highlights the knowledge gaps that need filling and taking into due consideration before future transnational and cross-border monitoring and management plans and activities can be addressed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Identifying and Assessing Gaps in Subseasonal to Seasonal Prediction Skill using the North American Multi-model Ensemble

NASA Astrophysics Data System (ADS)

Pegion, K.; DelSole, T. M.; Becker, E.; Cicerone, T.

2016-12-01

Predictability represents the upper limit of prediction skill if we had an infinite member ensemble and a perfect model. It is an intrinsic limit of the climate system associated with the chaotic nature of the atmosphere. Producing a forecast system that can make predictions very near to this limit is the ultimate goal of forecast system development. Estimates of predictability together with calculations of current prediction skill are often used to define the gaps in our prediction capabilities on subseasonal to seasonal timescales and to inform the scientific issues that must be addressed to build the next forecast system. Quantification of the predictability is also important for providing a scientific basis for relaying to stakeholders what kind of climate information can be provided to inform decision-making and what kind of information is not possible given the intrinsic predictability of the climate system. One challenge with predictability estimates is that different prediction systems can give different estimates of the upper limit of skill. How do we know which estimate of predictability is most representative of the true predictability of the climate system? Previous studies have used the spread-error relationship and the autocorrelation to evaluate the fidelity of the signal and noise estimates. Using a multi-model ensemble prediction system, we can quantify whether these metrics accurately indicate an individual model's ability to properly estimate the signal, noise, and predictability. We use this information to identify the best estimates of predictability for 2-meter temperature, precipitation, and sea surface temperature from the North American Multi-model Ensemble and compare with current skill to indicate the regions with potential for improving skill.

Gaps, disconnections, and discontinuities--the role of information exchange in the delivery of quality long-term care.

PubMed

Georgiou, Andrew; Marks, Anne; Braithwaite, Jeffrey; Westbrook, Johanna Irene

2013-10-01

The smart use of information and communication technologies (ICT) is widely seen as a means of enhancing the quality of aged care services. One of the barriers to ICT diffusion in aged care is the failure to cater for the complex and interdisciplinary requirements of the aged care environment. The aim of this qualitative study was to identify the layers of information exchange and communication and produce a conceptual model that can help to inform decisions related to the design, implementation, and sustainability of ICT. A qualitative study conducted in 2010 within seven Australian residential aged care facilities. It included 11 focus groups involving 47 staff and 54 individual interviews and observation sessions. The analysis of work processes identified key information exchange components related to the type of information (residential, clinical, and administrative) that is collected, stored, and communicated. This information relies on a diverse number of internal and external communication channels that are important for the organization of care. The findings highlight potential areas of communication dysfunction as a consequence of structural holes, fragmentation, or disconnections that can adversely affect the continuity and coordination of care, its safety, and quality.

Medical Data Architecture (MDA) Project Status

NASA Technical Reports Server (NTRS)

Krihak, M.; Middour, C.; Gurram, M.; Wolfe, S.; Marker, N.; Winther, S.; Ronzano, K.; Bolles, D.; Toscano, W.; Shaw, T.

2018-01-01

The Medical Data Architecture (MDA) project supports the Exploration Medical Capability (ExMC) risk to minimize or reduce the risk of adverse health outcomes and decrements in performance due to in-flight medical capabilities on human exploration missions. To mitigate this risk, the ExMC MDA project addresses the technical limitations identified in ExMC Gap Med 07: We do not have the capability to comprehensively process medically-relevant information to support medical operations during exploration missions. This gap identifies that the current in-flight medical data management includes a combination of data collection and distribution methods that are minimally integrated with on-board medical devices and systems. Furthermore, there are a variety of data sources and methods of data collection. For an exploration mission, the seamless management of such data will enable a more medically autonomous crew than the current paradigm. The medical system requirements are being developed in parallel with the exploration mission architecture and vehicle design. ExMC has recognized that in order to make informed decisions about a medical data architecture framework, current methods for medical data management must not only be understood, but an architecture must also be identified that provides the crew with actionable insight to medical conditions. This medical data architecture will provide the necessary functionality to address the challenges of executing a self-contained medical system that approaches crew health care delivery without assistance from ground support. Hence, the products supported by current prototype development will directly inform exploration medical system requirements.

Boundary Layer Transition Results From STS-114

NASA Technical Reports Server (NTRS)

Berry, Scott A.; Horvath, Thomas J.; Cassady, Amy M.; Kirk, Benjamin S.; Wang, K. C.; Hyatt, Andrew J.

2006-01-01

The tool for predicting the onset of boundary layer transition from damage to and/or repair of the thermal protection system developed in support of Shuttle Return to Flight is compared to the STS-114 flight results. The Boundary Layer Transition (BLT) Tool is part of a suite of tools that analyze the aerothermodynamic environment of the local thermal protection system to allow informed disposition of damage for making recommendations to fly as is or to repair. Using mission specific trajectory information and details of each damage site or repair, the expected time of transition onset is predicted to help determine the proper aerothermodynamic environment to use in the subsequent thermal and stress analysis of the local structure. The boundary layer transition criteria utilized for the tool was developed from ground-based measurements to account for the effect of both protuberances and cavities and has been calibrated against flight data. Computed local boundary layer edge conditions provided the means to correlate the experimental results and then to extrapolate to flight. During STS-114, the BLT Tool was utilized and was part of the decision making process to perform an extravehicular activity to remove the large gap fillers. The role of the BLT Tool during this mission, along with the supporting information that was acquired for the on-orbit analysis, is reviewed. Once the large gap fillers were removed, all remaining damage sites were cleared for reentry as is. Post-flight analysis of the transition onset time revealed excellent agreement with BLT Tool predictions.