Colorado Public Utility Commission's Xcel Wind Decision

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

Lehr, R. L.; Nielsen, J.; Andrews, S.

2001-09-20

In early 2001 the Colorado Public Utility Commission ordered Xcel Energy to undertake good faith negotiations for a wind plant as part of the utility's integrated resource plan. This paper summarizes the key points of the PUC decision, which addressed the wind plant's projected impact on generation cost and ancillary services. The PUC concluded that the wind plant would cost less than new gas-fired generation under reasonable gas cost projections.

Optimal two-stage dynamic treatment regimes from a classification perspective with censored survival data.

PubMed

Hager, Rebecca; Tsiatis, Anastasios A; Davidian, Marie

2018-05-18

Clinicians often make multiple treatment decisions at key points over the course of a patient's disease. A dynamic treatment regime is a sequence of decision rules, each mapping a patient's observed history to the set of available, feasible treatment options at each decision point, and thus formalizes this process. An optimal regime is one leading to the most beneficial outcome on average if used to select treatment for the patient population. We propose a method for estimation of an optimal regime involving two decision points when the outcome of interest is a censored survival time, which is based on maximizing a locally efficient, doubly robust, augmented inverse probability weighted estimator for average outcome over a class of regimes. By casting this optimization as a classification problem, we exploit well-studied classification techniques such as support vector machines to characterize the class of regimes and facilitate implementation via a backward iterative algorithm. Simulation studies of performance and application of the method to data from a sequential, multiple assignment randomized clinical trial in acute leukemia are presented. © 2018, The International Biometric Society.

Multi-Gaussian fitting for pulse waveform using Weighted Least Squares and multi-criteria decision making method.

PubMed

Wang, Lu; Xu, Lisheng; Feng, Shuting; Meng, Max Q-H; Wang, Kuanquan

2013-11-01

Analysis of pulse waveform is a low cost, non-invasive method for obtaining vital information related to the conditions of the cardiovascular system. In recent years, different Pulse Decomposition Analysis (PDA) methods have been applied to disclose the pathological mechanisms of the pulse waveform. All these methods decompose single-period pulse waveform into a constant number (such as 3, 4 or 5) of individual waves. Furthermore, those methods do not pay much attention to the estimation error of the key points in the pulse waveform. The estimation of human vascular conditions depends on the key points' positions of pulse wave. In this paper, we propose a Multi-Gaussian (MG) model to fit real pulse waveforms using an adaptive number (4 or 5 in our study) of Gaussian waves. The unknown parameters in the MG model are estimated by the Weighted Least Squares (WLS) method and the optimized weight values corresponding to different sampling points are selected by using the Multi-Criteria Decision Making (MCDM) method. Performance of the MG model and the WLS method has been evaluated by fitting 150 real pulse waveforms of five different types. The resulting Normalized Root Mean Square Error (NRMSE) was less than 2.0% and the estimation accuracy for the key points was satisfactory, demonstrating that our proposed method is effective in compressing, synthesizing and analyzing pulse waveforms. Copyright © 2013 Elsevier Ltd. All rights reserved.

Evaluating the substantive effectiveness of SEA: Towards a better understanding

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

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

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

Key Decision Points in the Careers of Geoscientists: The Role of the YES Network in Facilitating Successful Career Transitions for Early Career Geoscientists (Invited)

NASA Astrophysics Data System (ADS)

Venus, J. H.; Gonzales, L. M.; Yes Network

2010-12-01

The external influences on the decisions that geoscientists make pertaining to their careers are often assumed but not quantified. The YES Network is conducting an international study to determine the Key Decision points in the career pathways of early career geoscientists. The study aims to identify factors contributing to individual career decisions and to monitor these over a ten year period. The Initial phase of the study is now underway enabling preliminary conclusions to be drawn and will identify a group of individuals that will be tracked over the 10 year programme. The Survey will highlight reoccurring areas where Early Career Geoscientists are experiencing progression difficulties and, importantly, provide respondents with an opportunity to suggest solutions whilst also allowing general resource needs to be identified from the results as a whole. Early results show an overwhelming majority expressing job satisfaction most or all of the time (only 2 candidates reporting none). Respondents rate job satisfaction and respect highly, returning more responses than good salaries. A general frustration with administration, paper work and bureaucracy is particularly evident in those employed by government organisations. Early Career geoscientists express a frustration concerning a lack of involvement in decision making processes; interestingly several later career respondents also acknowledge a need to properly train, nurture and encourage new recruits to retain good graduates who may otherwise become disillusioned and leave the profession. The role of family in career choices has been highlighted both in survey and general feedback responses particularly by female geoscientists and those working in jobs with high levels of fieldwork; we aim to determine, to some extent, to what point these decisions are controlled by family as opposed to normal career progression. Flexible working conditions and agreed time away from field duty have been independently suggested by a these respondents as a solution that could prevent them from leaving their current sector completely. Comparisons will also be drawn from the 2010 University intake, these participants will provide a continuing insight as the survey follows them through their degrees and career. These results enable determination of key areas where additional resources would significantly improve Geoscientists career progression based on up-to-date data sourced from geoscientists currently progressing through education and early career.

'One also needs a bit of trust in the doctor ... ': a qualitative interview study with pancreatic cancer patients about their perceptions and views on information and treatment decision-making.

PubMed

Schildmann, J; Ritter, P; Salloch, S; Uhl, W; Vollmann, J

2013-09-01

Information about diagnosis, treatment options and prognosis has been emphasized as a key to empower cancer patients to make treatment decisions reflecting their values. However, surveys indicate that patients' preferences regarding information and treatment decision-making differ. In this qualitative interview study, we explored pancreatic cancer patients' perceptions and preferences on information and treatment decision-making. Qualitative in-depth interviews with patients with pancreatic cancer. Purposive sampling and qualitative analysis were carried out. We identified two stages of information and treatment decision-making. Patients initially emphasize trust in their physician and indicate rather limited interest in details about surgical and medical treatment. In the latter stage of disease, patients perceive themselves more active regarding information seeking and treatment decision-making. All patients discuss their poor prognosis. Reflecting on their own situation, all patients interviewed pointed out that hope was an important driver to undergo further treatment also in advanced stages of the disease. Interviewees unanimously emphasized the difficulty of anticipating the time at which stopping cancer treatment would be the right decision. The findings can serve as starting point for reflection on professional decision-making in pancreatic cancer and larger representative surveys on ethical issues in treatment decision-making in pancreatic cancer.

Career Development in Germany.

ERIC Educational Resources Information Center

Hass, Hubert

In Germany, after elementary school, the school system splits into three branches, with students either preparing for an apprenticeship or continuing in school. A second system exists, parallel to this education system, which combines general education with basic professional training. The first key career decision point is in Grade 4, when…

Value Assessment at the Point of Care: Incorporating Patient Values throughout Care Delivery and a Draft Taxonomy of Patient Values.

PubMed

Armstrong, Melissa J; Mullins, C Daniel

2017-02-01

Incorporation of patient values is a key element of patient-centered care, but consistent incorporation of patient values at the point of care is lacking. Shared decision making encourages incorporation of patient values in decision making, but associated tools often lack guidance on value assessment. In addition, focusing on patient values relating only to specific decisions misses an opportunity for a more holistic approach to value assessment that could impact other aspects of clinical encounters, including health care planning, communication, and stakeholder involvement. In this commentary, we propose a taxonomy of values underlying patient decision making and provide examples of how these impact provision of health care. The taxonomy describes four categories of patient values: global, decisional, situational, and external. Global values are personal values impacting decision making at a universal level and can include value traits and life priorities. Decisional values are the values traditionally conceptualized in decision making, including considerations such as efficacy, toxicity, quality of life, convenience, and cost. Situational values are values tied to a specific moment in time that modify patients' existing global and decisional values. Finally, discussion of external values acknowledges that many patients consider values other than their own when making decisions. Recognizing the breadth of values impacting patient decision making has implications for both overall health care delivery and shared decision making because value assessments focusing only on decisional values may miss important patient considerations. This draft taxonomy highlights different values impacting decision making and facilitates a more complete value assessment at the point of care. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

A Health Economics Approach to US Value Assessment Frameworks-Summary and Recommendations of the ISPOR Special Task Force Report [7].

PubMed

Garrison, Louis P; Neumann, Peter J; Willke, Richard J; Basu, Anirban; Danzon, Patricia M; Doshi, Jalpa A; Drummond, Michael F; Lakdawalla, Darius N; Pauly, Mark V; Phelps, Charles E; Ramsey, Scott D; Towse, Adrian; Weinstein, Milton C

2018-02-01

This summary section first lists key points from each of the six sections of the report, followed by six key recommendations. The Special Task Force chose to take a health economics approach to the question of whether a health plan should cover and reimburse a specific technology, beginning with the view that the conventional cost-per-quality-adjusted life-year metric has both strengths as a starting point and recognized limitations. This report calls for the development of a more comprehensive economic evaluation that could include novel elements of value (e.g., insurance value and equity) as part of either an "augmented" cost-effectiveness analysis or a multicriteria decision analysis. Given an aggregation of elements to a measure of value, consistent use of a cost-effectiveness threshold can help ensure the maximization of health gain and well-being for a given budget. These decisions can benefit from the use of deliberative processes. The six recommendations are to: 1) be explicit about decision context and perspective in value assessment frameworks; 2) base health plan coverage and reimbursement decisions on an evaluation of the incremental costs and benefits of health care technologies as is provided by cost-effectiveness analysis; 3) develop value thresholds to serve as one important input to help guide coverage and reimbursement decisions; 4) manage budget constraints and affordability on the basis of cost-effectiveness principles; 5) test and consider using structured deliberative processes for health plan coverage and reimbursement decisions; and 6) explore and test novel elements of benefit to improve value measures that reflect the perspectives of both plan members and patients. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Analyzing the Tactical Risk Decision: Does the Commander Need Help with Versatility?

DTIC Science & Technology

1993-12-17

point forward. 45 Here, too much of Clausewitz’ all important "courage and self confidence" may lead to obstinacy and undermine openmindedness . 46...an unfamiliar operational environment. This is where openmindedness is key, and the biases of conventional combat operations must be left behind. Once

Reflections on Deaf Education: Perspectives of Deaf Senior Citizens

ERIC Educational Resources Information Center

Roberson, Len; Shaw, Sherry

2015-01-01

Parents with deaf children face many challenges in making educational choices, developing language and a sense of belonging. Other key aspects of life including concept development and social competency are also critical decision points faced by parents. Developing language, whether it is through spoken or signed modalities, is of utmost…

Safety, risk and mental health: decision-making processes prescribed by Australian mental health legislation.

PubMed

Smith-Merry, Jennifer; Caple, Andrew

2014-03-01

Adverse events in mental health care occur frequently and cause significant distress for those who experience them, derailing treatment and sometimes leading to death. These events are clustered around particular aspects of care and treatment and are therefore avoidable if practices in these areas are strengthened. The research reported in this article takes as its starting point coronial recommendations made in relation to mental health. We report on those points and processes in treatment and discharge where coronial recommendations are most frequently made. We then examine the legislative requirements around these points and processes in three Australian States. We find that the key areas that need to be strengthened to avoid adverse events are assessment processes, communication and information transfer, documentation, planning and training. We make recommendations for improvements in these key areas.

Analysis of Federal Stimuli to Development of New Technology by Suppliers to Automobile Manufacturers : an Exploratory Study of Barriers and Facilitators.

DOT National Transportation Integrated Search

1978-03-01

The role of suppliers to the auto industry in promoting innovation is explored. Thirty-two innovations are investigated, and information on their success/failure, area of impact, and key decision points is generated. Based on this data base, barriers...

NASA System Engineering Design Process

NASA Technical Reports Server (NTRS)

Roman, Jose

2011-01-01

This slide presentation reviews NASA's use of systems engineering for the complete life cycle of a project. Systems engineering is a methodical, disciplined approach for the design, realization, technical management, operations, and retirement of a system. Each phase of a NASA project is terminated with a Key decision point (KDP), which is supported by major reviews.

Standardized Tests: Purpose Is the Point

ERIC Educational Resources Information Center

Popham, W. James

2016-01-01

"U.S. students are being educated less well these days than they should be," writes W. James Popham. One key contributing factor is that educators often use the wrong tests to make their most important educational decisions. Two recent events have made it a perfect time to change the way we conduct our educational testing: growing…

A brief educational intervention to teach residents shared decision making in the intensive care unit.

PubMed

Yuen, Jacqueline K; Mehta, Sonal S; Roberts, Jordan E; Cooke, Joseph T; Reid, M Carrington

2013-05-01

Effective communication is essential for shared decision making with families of critically ill patients in the intensive care unit (ICU), yet there is limited evidence on effective strategies to teach these skills. The study's objective was to pilot test an educational intervention to teach internal medicine interns skills in discussing goals of care and treatment decisions with families of critically ill patients using the shared decision making framework. The intervention consisted of a PowerPoint online module followed by a four-hour workshop implemented at a retreat for medicine interns training at an urban, academic medical center. Participants (N=33) completed post-intervention questionnaires that included self-assessed skills learned, an open-ended question on the most important learning points from the workshop, and retrospective pre- and post-workshop comfort level with ICU communication skills. Participants rated their satisfaction with the workshop. Twenty-nine interns (88%) completed the questionnaires. Important self-assessed communication skills learned reflect key components of shared decision making, which include assessing the family's understanding of the patient's condition (endorsed by 100%) and obtaining an understanding of the patient/family's perspectives, values, and goals (100%). Interns reported significant improvement in their comfort level with ICU communication skills (pre 3.26, post 3.73 on a five-point scale, p=0.004). Overall satisfaction with the intervention was high (mean 4.45 on a five-point scale). The findings suggest that a brief intervention designed to teach residents communication skills in conducting goals of care and treatment discussions in the ICU is feasible and can improve their comfort level with these conversations.

Recent advances in applying decision science to managing national forests

USGS Publications Warehouse

Marcot, Bruce G.; Thompson, Matthew P.; Runge, Michael C.; Thompson, Frank R.; McNulty, Steven; Cleaves, David; Tomosy, Monica; Fisher, Larry A.; Andrew, Bliss

2012-01-01

Management of federal public forests to meet sustainability goals and multiple use regulations is an immense challenge. To succeed, we suggest use of formal decision science procedures and tools in the context of structured decision making (SDM). SDM entails four stages: problem structuring (framing the problem and defining objectives and evaluation criteria), problem analysis (defining alternatives, evaluating likely consequences, identifying key uncertainties, and analyzing tradeoffs), decision point (identifying the preferred alternative), and implementation and monitoring the preferred alternative with adaptive management feedbacks. We list a wide array of models, techniques, and tools available for each stage, and provide three case studies of their selected use in National Forest land management and project plans. Successful use of SDM involves participation by decision-makers, analysts, scientists, and stakeholders. We suggest specific areas for training and instituting SDM to foster transparency, rigor, clarity, and inclusiveness in formal decision processes regarding management of national forests.

Patient Decision Aids Improve Decision Quality and Patient Experience and Reduce Surgical Rates in Routine Orthopaedic Care: A Prospective Cohort Study.

PubMed

Sepucha, Karen; Atlas, Steven J; Chang, Yuchiao; Dorrwachter, Janet; Freiberg, Andrew; Mangla, Mahima; Rubash, Harry E; Simmons, Leigh H; Cha, Thomas

2017-08-02

Patient decision aids are effective in randomized controlled trials, yet little is known about their impact in routine care. The purpose of this study was to examine whether decision aids increase shared decision-making when used in routine care. A prospective study was designed to evaluate the impact of a quality improvement project to increase the use of decision aids for patients with hip or knee osteoarthritis, lumbar disc herniation, or lumbar spinal stenosis. A usual care cohort was enrolled before the quality improvement project and an intervention cohort was enrolled after the project. Participants were surveyed 1 week after a specialist visit, and surgical status was collected at 6 months. Regression analyses adjusted for clustering of patients within clinicians and examined the impact on knowledge, patient reports of shared decision-making in the visit, and surgical rates. With 550 surveys, the study had 80% to 90% power to detect a difference in these key outcomes. The response rates to the 1-week survey were 70.6% (324 of 459) for the usual care cohort and 70.2% (328 of 467) for the intervention cohort. There was no significant difference (p > 0.05) in any patient characteristic between the 2 cohorts. More patients received decision aids in the intervention cohort at 63.6% compared with the usual care cohort at 27.3% (p = 0.007). Decision aid use was associated with higher knowledge scores, with a mean difference of 18.7 points (95% confidence interval [CI], 11.4 to 26.1 points; p < 0.001) for the usual care cohort and 15.3 points (95% CI, 7.5 to 23.0 points; p = 0.002) for the intervention cohort. Patients reported more shared decision-making (p = 0.009) in the visit with their surgeon in the intervention cohort, with a mean Shared Decision-Making Process score (and standard deviation) of 66.9 ± 27.5 points, compared with the usual care cohort at 62.5 ± 28.6 points. The majority of patients received their preferred treatment, and this did not differ by cohort or decision aid use. Surgical rates were lower in the intervention cohort for those who received the decision aids at 42.3% compared with 58.8% for those who did not receive decision aids (p = 0.023) and in the usual care cohort at 44.3% for those who received decision aids compared with 55.7% for those who did not receive them (p = 0.45). The quality improvement project successfully integrated patient decision aids into a busy orthopaedic clinic. When used in routine care, decision aids are associated with increased knowledge, more shared decision-making, and lower surgical rates. There is increasing pressure to design systems of care that inform and involve patients in decisions about elective surgery. In this study, the authors found that patient decision aids, when used as part of routine orthopaedic care, were associated with increased knowledge, more shared decision-making, higher patient experience ratings, and lower surgical rates.

A unified framework for addiction: Vulnerabilities in the decision process

PubMed Central

Redish, A. David; Jensen, Steve; Johnson, Adam

2013-01-01

The understanding of decision-making systems has come together in recent years to form a unified theory of decision-making in the mammalian brain as arising from multiple, interacting systems (a planning system, a habit system, and a situation-recognition system). This unified decision-making system has multiple potential access points through which it can be driven to make maladaptive choices, particularly choices that entail seeking of certain drugs or behaviors. We identify 10 key vulnerabilities in the system: (1) moving away from homeostasis, (2) changing allostatic set points, (3) euphorigenic “reward-like” signals, (4) overvaluation in the planning system, (5) incorrect search of situation-action-outcome relationships, (6) misclassification of situations, (7) overvaluation in the habit system, (8) a mismatch in the balance of the two decision systems, (9) over-fast discounting processes, and (10) changed learning rates. These vulnerabilities provide a taxonomy of potential problems with decision-making systems. Although each vulnerability can drive an agent to return to the addictive choice, each vulnerability also implies a characteristic symptomology. Different drugs, different behaviors, and different individuals are likely to access different vulnerabilities. This has implications for an individual’s susceptibility to addiction and the transition to addiction, for the potential for relapse, and for the potential for treatment. PMID:18662461

Extending key sharing: how to generate a key tightly coupled to a network security policy

NASA Astrophysics Data System (ADS)

Kazantzidis, Matheos

2006-04-01

Current state of the art security policy technologies, besides the small scale limitation and largely manual nature of accompanied management methods, are lacking a) in real-timeliness of policy implementation and b) vulnerabilities and inflexibility stemming from the centralized policy decision making; even if, for example, a policy description or access control database is distributed, the actual decision is often a centralized action and forms a system single point of failure. In this paper we are presenting a new fundamental concept that allows implement a security policy by a systematic and efficient key distribution procedure. Specifically, we extend the polynomial Shamir key splitting. According to this, a global key is split into n parts, any k of which can re-construct the original key. In this paper we present a method that instead of having "any k parts" be able to re-construct the original key, the latter can only be reconstructed if keys are combined as any access control policy describes. This leads into an easily deployable key generation procedure that results a single key per entity that "knows" its role in the specific access control policy from which it was derived. The system is considered efficient as it may be used to avoid expensive PKI operations or pairwise key distributions as well as provides superior security due to its distributed nature, the fact that the key is tightly coupled to the policy, and that policy change may be implemented easier and faster.

Editorial Commentary: Got Evidence? What We Really Need Is an Algorithm for Treating Symptomatic Bipartite Patella.

PubMed

Fithian, Donald C

2018-05-01

Bipartite patella is an uncommon but potentially troublesome problem for young athletes. Numerous uncontrolled retrospective studies have reported good results after various treatments. What is needed are studies that will guide workup and support treatment decisions based on the condition of the cartilage surfaces of the fragment, presence of pseudoarthrosis, and size and location of the fragment. To support decisions, we need prospective comparative studies, either randomized or, at least, prospective cohort studies that identify patients at the time of presentation, document key decision points, and follow patients to successful resolution of symptoms. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Behind the Headlines: Remembering the Fundamentals about Diversity

ERIC Educational Resources Information Center

Coleman, Arthur L.

2014-01-01

After a decade of silence, the US Supreme Court in two recent cases has spoken on issues of race and ethnicity in higher education--in June 2013, with its "Fisher v. University of Texas" opinion, and in April 2014, with the "Schuette v. BAMN" decision. In "Fisher," the court amplified and elaborated on key points of…

Ability-Based Criteria and the Lower Class Student: The De Facto Screw.

ERIC Educational Resources Information Center

Amato, Josephine; Backman, Carl B.

Social class discrimination in the schooling process is less a product of teachers' attitudes than of the systems by which schools group students. Although class bias has been demonstrated in grading practices and other key decision points, numerous studies have shown that teachers are less to blame for inequitable learning situations than…

Putting the value into biosimilar decision making: the judgment value criteria.

PubMed

Mendes de Abreu, Mirhelen; Strand, Vibeke; Levy, Roger Abramino; Araujo, Denizar Vianna

2014-06-01

Uncertainties remain the key issue surrounding biosimilars, although decisions regarding their use must be made. The challenges for policymakers, doctors, patients and others seeking to navigate in the uncharted waters of biosimilars must be clarified. At the most basic level, scientific understanding of the issue remains limited and when making decisions, policymakers must consider all those affected by health policy decisions, particularly the ultimate recipients of these medicines: the patients. The biosimilar-value chain relies on measurement of comparabilities. The goal is to demonstrate how, from a molecular perspective, closely similar they are or are not and how potential small differences may be relevant to clinical outcomes. To critically understand these points, this conceptual paper will present a knowledge-value chain and discuss each dimension assigning value in the decision making process re-utilization of biosimilars. Copyright © 2014 Elsevier B.V. All rights reserved.

Interventions and assessment tools addressing key concepts people need to know to appraise claims about treatment effects: a systematic mapping review.

PubMed

Austvoll-Dahlgren, Astrid; Nsangi, Allen; Semakula, Daniel

2016-12-29

People's ability to appraise claims about treatment effects is crucial for informed decision-making. Our objective was to systematically map this area of research in order to (a) provide an overview of interventions targeting key concepts that people need to understand to assess treatment claims and (b) to identify assessment tools used to evaluate people's understanding of these concepts. The findings of this review provide a starting point for decisions about which key concepts to address when developing new interventions, and which assessment tools should be considered. We conducted a systematic mapping review of interventions and assessment tools addressing key concepts important for people to be able to assess treatment claims. A systematic literature search was done by a reserach librarian in relevant databases. Judgement about inclusion of studies and data collection was done by at least two researchers. We included all quantitative study designs targeting one or more of the key concepts, and targeting patients, healthy members of the public, and health professionals. The studies were divided into four categories: risk communication and decision aids, evidence-based medicine and critical appraisal, understanding of controlled trials, and science education. Findings were summarised descriptively. We included 415 studies, of which the interventions and assessment tools we identified included only a handful of the key concepts. The most common key concepts in interventions were "Treatments usually have beneficial and harmful effects," "Treatment comparisons should be fair," "Compare like with like," and "Single studies can be misleading." A variety of assessment tools were identified, but only four assessment tools included 10 or more key concepts. There is great potential for developing learning and assessment tools targeting key concepts that people need to understand to assess claims about treatment effects. There is currently no instrument covering assessment of all these key concepts.

Public involvement in research: making sense of the diversity.

PubMed

Oliver, Sandy; Liabo, Kristin; Stewart, Ruth; Rees, Rebecca

2015-01-01

This paper presents a coherent framework for designing and evaluating public involvement in research by drawing on an extensive literature and the authors' experience. The framework consists of three key interrelated dimensions: the drivers for involvement; the processes for involvement and the impact of involvement. The pivotal point in this framework is the opportunity for researchers and others to exchange ideas. This opportunity results from the processes which bring them together and which support their debates and decisions. It is also the point at which research that is in the public interest is open to public influence and the point at which the interaction can also influence anyone directly involved. Judicious choice of methods for bringing people together, and supporting their debate and decisions, depends upon the drivers of those involved; these vary with their characteristics, particularly their degree of enthusiasm and experience, and their motivation. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Temporal competition between differentiation programs determines cell fate choice

NASA Astrophysics Data System (ADS)

Kuchina, Anna; Espinar, Lorena; Cagatay, Tolga; Balbin, Alejandro; Alvarado, Alma; Garcia-Ojalvo, Jordi; Suel, Gurol

2011-03-01

During pluripotent differentiation, cells adopt one of several distinct fates. The dynamics of this decision-making process are poorly understood, since cell fate choice may be governed by interactions between differentiation programs that are active at the same time. We studied the dynamics of decision-making in the model organism Bacillus subtilis by simultaneously measuring the activities of competing differentiation programs (sporulation and competence) in single cells. We discovered a precise switch-like point of cell fate choice previously hidden by cell-cell variability. Engineered artificial crosslinks between competence and sporulation circuits revealed that the precision of this choice is generated by temporal competition between the key players of two differentiation programs. Modeling suggests that variable progression towards a switch-like decision might represent a general strategy to maximize adaptability and robustness of cellular decision-making.

Eating and drinking interventions for people at risk of lacking decision-making capacity: who decides and how?

PubMed

Clarke, Gemma; Galbraith, Sarah; Woodward, Jeremy; Holland, Anthony; Barclay, Stephen

2015-06-11

Some people with progressive neurological diseases find they need additional support with eating and drinking at mealtimes, and may require artificial nutrition and hydration. Decisions concerning artificial nutrition and hydration at the end of life are ethically complex, particularly if the individual lacks decision-making capacity. Decisions may concern issues of life and death: weighing the potential for increasing morbidity and prolonging suffering, with potentially shortening life. When individuals lack decision-making capacity, the standard processes of obtaining informed consent for medical interventions are disrupted. Increasingly multi-professional groups are being utilised to make difficult ethical decisions within healthcare. This paper reports upon a service evaluation which examined decision-making within a UK hospital Feeding Issues Multi-Professional Team. A three month observation of a hospital-based multi-professional team concerning feeding issues, and a one year examination of their records. The key research questions are: a) How are decisions made concerning artificial nutrition for individuals at risk of lacking decision-making capacity? b) What are the key decision-making factors that are balanced? c) Who is involved in the decision-making process? Decision-making was not a singular decision, but rather involved many different steps. Discussions involving relatives and other clinicians, often took place outside of meetings. Topics of discussion varied but the outcome relied upon balancing the information along four interdependent axes: (1) Risks, burdens and benefits; (2) Treatment goals; (3) Normative ethical values; (4) Interested parties. Decision-making was a dynamic ongoing process with many people involved. The multiple points of decision-making, and the number of people involved with the decision-making process, mean the question of 'who decides' cannot be fully answered. There is a potential for anonymity of multiple decision-makers to arise. Decisions in real world clinical practice may not fit precisely into a model of decision-making. The findings from this service evaluation illustrate that within multi-professional team decision-making; decisions may contain elements of both substituted and supported decision-making, and may be better represented as existing upon a continuum.

Constructing inquiry: One school's journey to develop an inquiry-based school for teachers and students

NASA Astrophysics Data System (ADS)

Sisk-Hilton, Stephanie Lee

This study examines the two way relationship between an inquiry-based professional development model and teacher enactors. The two year study follows a group of teachers enacting the emergent Supporting Knowledge Integration for Inquiry Practice (SKIIP) professional development model. This study seeks to: (a) identify activity structures in the model that interact with teachers' underlying assumptions regarding professional development and inquiry learning; (b) explain key decision points during implementation in terms of these underlying assumptions; and (c) examine the impact of key activity structures on individual teachers' stated belief structures regarding inquiry learning. Linn's knowledge integration framework facilitates description and analysis of teacher development. Three sets of tensions emerge as themes that describe and constrain participants' interaction with and learning through the model. These are: learning from the group vs. learning on one's own; choosing and evaluating evidence based on impressions vs. specific criteria; and acquiring new knowledge vs. maintaining feelings of autonomy and efficacy. In each of these tensions, existing group goals and operating assumptions initially fell at one end of the tension, while the professional development goals and forms fell at the other. Changes to the model occurred as participants reacted to and negotiated these points of tension. As the group engaged in and modified the SKIIP model, they had repeated opportunities to articulate goals and to make connections between goals and model activity structures. Over time, decisions to modify the model took into consideration an increasingly complex set of underlying assumptions and goals. Teachers identified and sought to balance these tensions. This led to more complex and nuanced decision making, which reflected growing capacity to consider multiple goals in choosing activity structures to enact. The study identifies key activity structures that scaffolded this process for teachers, and which ultimately promoted knowledge integration at both the group and individual levels. This study is an "extreme case" which examines implementation of the SKIIP model under very favorable conditions. Lessons learned regarding appropriate levels of model responsiveness, likely areas of conflict between model form and teacher underlying assumptions, and activity structures that scaffold knowledge integration provide a starting point for future, larger scale implementation.

Who's afraid of EBM? Medical professionalism from the perspective of evidence-based medicine.

PubMed

Salloch, Sabine

2017-03-01

Evidence-based medicine (EBM) and medical professionalism are two prominent notions in current medical debates. However, proponents of professionalism fear a restriction in doctors' freedom to make their best decisions for individual patients caused by the influence of EBM and highly standardised decision procedures. The challenge which EBM allegedly poses to physicians' discretion forms the starting point for an analysis of the relationship between professionalism, as an inherent value system of medical practice, and EBM, as an approach to optimise the decision-making for individual patients. The analysis starts with a brief conceptual clarification of the ambiguous term "professionalism". It then focuses on three key aspects of medical professionalism which may come into conflict with the basic tenets of EBM. The potential tensions between (a) professional autonomy and clinical practice guidelines, (b) individualised care and standardisation, and (c) esoteric authority and public accountability are analysed and a suggestion for reconcilement regarding each point is made. The article closes with a summary on how a better reflection on medical professionalism may help towards a fuller understanding of EBM and vice versa.

A call to insect scientists: Challenges and opportunities of managing insect communities under climate change

USGS Publications Warehouse

Hellmann, Jessica J.; Grundel, Ralph; Hoving, Chris; Schuurman, Gregor W.

2016-01-01

As climate change moves insect systems into uncharted territory, more knowledge about insect dynamics and the factors that drive them could enable us to better manage and conserve insect communities. Climate change may also require us revisit insect management goals and strategies and lead to a new kind of scientific engagement in management decision-making. Here we make five key points about the role of insect science in aiding and crafting management decisions, and we illustrate those points with the monarch butterfly and the Karner blue butterfly, two species undergoing considerable change and facing new management dilemmas. Insect biology has a strong history of engagement in applied problems, and as the impacts of climate change increase, a reimagined ethic of entomology in service of broader society may emerge. We hope to motivate insect biologists to contribute time and effort toward solving the challenges of climate change.

Drotrecogin alfa (activated)...a sad final fizzle to a roller-coaster party.

PubMed

Angus, Derek C

2012-02-06

Following the failure of PROWESS-SHOCK to demonstrate efficacy, Eli Lilly and Company withdrew drotrecogin alfa (activated) from the worldwide market. Drotrecogin was initially approved after the original trial, PROWESS, was stopped early for overwhelming efficacy. These events prompt consideration of both the initial approval decision and the later decision to withdraw. It is regrettable that the initial decision was made largely on a single trial that was stopped early. However, the decision to approve was within the bounds of normal regulatory practice and was made by many approval bodies around the world. Furthermore, the overall withdrawal rate of approved drugs remains very low. The decision to withdraw was a voluntary decision by Eli Lilly and Company and likely reflected key business considerations. Drotrecogin does have important biologic effects, and it is probable that we do not know how best to select patients who would benefit. Overall, there may still be a small advantage to drotrecogin alfa, even used non-selectively, but the costs of determining such an effect with adequate certainty are likely prohibitive, and the point is now moot. In the future, we should consider ways to make clinical trials easier and quicker so that more information can be available in a timely manner when considering regulatory approval. At the same time, more sophisticated selection of patients seems key if we are to most wisely test agents designed to manipulate the septic host response.

What factors influence physiotherapy service provision in rural communities? A pilot study.

PubMed

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

2014-06-01

To obtain stakeholder perspectives on factors influencing rural physiotherapy service provision and insights into decision making about service provision. Purposive sampling, open-ended survey questions and semi-structured interviews were used in this exploratory, qualitative study. A rural centre and its regional referral centre formed the pilot sites. Nine participant perspectives were obtained on rural physiotherapy services. Stakeholder perspectives on factors influencing rural physiotherapy service provision and service level decision making. Workforce capacity and capability, decision maker's knowledge of the role and scope of physiotherapy, consideration of physiotherapy within resource allocation decisions and proof of practice emerged as key issues. The latter three were particularly reflected in public sector participant comments. Business models and market size were identified factors in influencing private practice. Influencing factors described by participants both align and extend our understanding of issues described in the rural physiotherapy literature. Participant insights add depth and meaning to quantitative data by revealing impacts on local service provision. Available funding and facility priorities were key determinants of public sector physiotherapy service provision, with market size and business model appearing more influential in private practice. The level of self direction or choice about which services to provide, emerged as a point of difference between public and private providers. Decisions by public sector physiotherapists about service provision appear constrained by existing capacity and workload. Further research into service level decision making might provide valuable insights into rural health service delivery. © 2014 National Rural Health Alliance Inc.

Food purchase decision-making typologies of women with non-insulin-dependent diabetes mellitus.

PubMed

Miller, C; Warland, R; Achterberg, C

1997-03-01

Food selection is a key factor in the nutritional management of diabetes mellitus. Since up to 80% of food purchase decisions are made at the supermarket, the purpose of this study was to identify the criteria which influence point-of-purchase decision-making in women with NIDDM aged 40-60 years. A qualitative approach with individual interviews and in-store observations was used. Analysis of the interviews identified four decision-making typologies based on the extent nutrition, price and family needs were emphasized. The four typologies included (1) the Overloaded Shopper, (2) the Budget Shopper, (3) the Nutrition Savvy Shopper, and (4) the Out-of-Touch Shopper. Cluster analysis confirmed the typologies for 71% of the sample. Educators should classify shoppers according to a typology to determine their clients' personal needs and interests. Then, educators can tailor the educational or counseling message to meet those specific needs.

Science for the sustainable use of ecosystem services

PubMed Central

Bennett, Elena M.; Chaplin-Kramer, Rebecca

2016-01-01

Sustainability is a key challenge for humanity in the 21st century. Ecosystem services—the benefits that people derive from nature and natural capital—is a concept often used to help explain human reliance on nature and frame the decisions we make in terms of the ongoing value of nature to human wellbeing. Yet ecosystem service science has not always lived up to the promise of its potential. Despite advances in the scientific literature, ecosystem service science has not yet answered some of the most critical questions posed by decision-makers in the realm of sustainability. Here, we explore the history of ecosystem service science, discuss advances in conceptualization and measurement, and point toward further work needed to improve the use of ecosystem service in decisions about sustainable development. PMID:27853527

Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN): evolution of a content management system for point-of-care clinical decision support.

PubMed

Barwise, Amelia; Garcia-Arguello, Lisbeth; Dong, Yue; Hulyalkar, Manasi; Vukoja, Marija; Schultz, Marcus J; Adhikari, Neill K J; Bonneton, Benjamin; Kilickaya, Oguz; Kashyap, Rahul; Gajic, Ognjen; Schmickl, Christopher N

2016-10-03

The Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN) is an international collaborative project with the overall objective of standardizing the approach to the evaluation and treatment of critically ill patients world-wide, in accordance with best-practice principles. One of CERTAIN's key features is clinical decision support providing point-of-care information about common acute illness syndromes, procedures, and medications in an index card format. This paper describes 1) the process of developing and validating the content for point-of-care decision support, and 2) the content management system that facilitates frequent peer-review and allows rapid updates of content across different platforms (CERTAIN software, mobile apps, pdf-booklet) and different languages. Content was created based on survey results of acute care providers and validated using an open peer-review process. Over a 3 year period, CERTAIN content expanded to include 67 syndrome cards, 30 procedure cards, and 117 medication cards. 127 (59 %) cards have been peer-reviewed so far. Initially MS Word® and Dropbox® were used to create, store, and share content for peer-review. Recently Google Docs® was used to make the peer-review process more efficient. However, neither of these approaches met our security requirements nor has the capacity to instantly update the different CERTAIN platforms. Although we were able to successfully develop and validate a large inventory of clinical decision support cards in a short period of time, commercially available software solutions for content management are suboptimal. Novel custom solutions are necessary for efficient global point of care content system management.

Evaluating supplier quality performance using analytical hierarchy process

NASA Astrophysics Data System (ADS)

Kalimuthu Rajoo, Shanmugam Sundram; Kasim, Maznah Mat; Ahmad, Nazihah

2013-09-01

This paper elaborates the importance of evaluating supplier quality performance to an organization. Supplier quality performance evaluation reflects the actual performance of the supplier exhibited at customer's end. It is critical in enabling the organization to determine the area of improvement and thereafter works with supplier to close the gaps. Success of the customer partly depends on supplier's quality performance. Key criteria as quality, cost, delivery, technology support and customer service are categorized as main factors in contributing to supplier's quality performance. 18 suppliers' who were manufacturing automotive application parts evaluated in year 2010 using weight point system. There were few suppliers with common rating which led to common ranking observed by few suppliers'. Analytical Hierarchy Process (AHP), a user friendly decision making tool for complex and multi criteria problems was used to evaluate the supplier's quality performance challenging the weight point system that was used for 18 suppliers'. The consistency ratio was checked for criteria and sub-criteria. Final results of AHP obtained with no overlap ratings, therefore yielded a better decision making methodology as compared to weight point rating system.

Using Nominal Group Technique to Develop a Consensus Derived Model for Peer Review of Teaching across a Multi-School Faculty

ERIC Educational Resources Information Center

Burrows, Tracy; Findlay, Naomi; Killen, Chloe; Dempsey, Shane E.; Hunter, Sharyn; Chiarelli, Pauline; Snodgrass, Suzanne

2011-01-01

This paper describes the development of a peer review of teaching model for the Faculty of Health at the University of Newcastle, Australia. The process involved using the nominal group technique to engage Faculty academic staff to consider seven key decision points that informed the development of the peer review of teaching model. Use of the…

On formally integrating science and policy: walking the walk

USGS Publications Warehouse

Nichols, James D.; Johnson, Fred A.; Williams, Byron K.; Boomer, G. Scott

2015-01-01

The contribution of science to the development and implementation of policy is typically neither direct nor transparent.  In 1995, the U.S. Fish and Wildlife Service (FWS) made a decision that was unprecedented in natural resource management, turning to an unused and unproven decision process to carry out trust responsibilities mandated by an international treaty.  The decision process was adopted for the establishment of annual sport hunting regulations for the most economically important duck population in North America, the 6 to 11 million mallards Anas platyrhynchos breeding in the mid-continent region of north-central United States and central Canada.  The key idea underlying the adopted decision process was to formally embed within it a scientific process designed to reduce uncertainty (learn) and thus make better decisions in the future.  The scientific process entails use of models to develop predictions of competing hypotheses about system response to the selected action at each decision point.  These prediction not only are used to select the optimal management action, but also are compared with the subsequent estimates of system state variables, providing evidence for modifying degrees of confidence in, and hence relative influence of, these models at the next decision point.  Science and learning in one step are formally and directly incorporated into the next decision, contrasting with the usual ad hoc and indirect use of scientific results in policy development and decision-making.  Application of this approach over the last 20 years has led to a substantial reduction in uncertainty, as well as to an increase in transparency and defensibility of annual decisions and a decrease in the contentiousness of the decision process.  As resource managers are faced with increased uncertainty associated with various components of global change, this approach provides a roadmap for the future scientific management of natural resources.  

Towards data-driven decision-making for sustainable diets in Vietnam: Identifying priority indicators through stakeholder engagement

NASA Astrophysics Data System (ADS)

Mayton, H.; Beal, T.; Rubin, J.; Sanchez, A.; Heller, M.; Hoey, L.; Khoury, C. K.; Jones, A.

2017-12-01

Globally, food systems impact and are impacted by the sustainability of environmental, societal, political, and public health factors. At the center of these systems are human diets, which vary substantially by culture and region, and have significant influence on human health, community livelihoods, climate change, and natural resources. However, rapidly growing and highly diverse lower middle-income countries like Vietnam face challenges in gathering data and defining clear policy intervention points and approaches that will provide a net-positive systemic influence across sectors. A new collaboration, Entry points to Advance Transitions towards Sustainable diets (EATS), between the University of Michigan and the International Center for Tropical Agriculture (CIAT) aims to identify ways that existing data and insights into the policy process can be leveraged to inform decision-making on where and how to intervene to effectively shift multiple axes of food systems to enhance the sustainability of diets. As a first step towards developing a model that other policy communities could follow, researchers aggregated and characterized approximately 50 major existing datasets on food, agriculture, and nutrition in Vietnam. They also created a conceptual framework for evaluating the sustainability of diets and for characterizing existing datasets, including eight domains and over 200 unique, measurable indicators. Figure 1 summarizes these domains and their key relationships, which forms a foundation for identifying leverage points that can positively impact multiple aspects of sustainable diets. Researchers then engaged food system stakeholders through informal interviews, surveys, and collaborative workshops to prioritize indicators and identify additional relevant data sources. Stakeholders included national government, research, NGO, and private sector representatives from across the range of identified domains. The key indicators identified by stakeholders will ultimately be used to create food system data profiles for policymakers, in order to enable more evidence-based decision-making to advance transitions toward sustainable diets.

Decision Vulnerability Analysis (DVA) Program

DTIC Science & Technology

2014-05-01

the external entities. For example, the chief financial officer can say that the organization will be buying back stock to make stockholders more...financial success Reichheld (2001) points out that a key component of success is “doing what you say you are going to do.” This applies to...that run counter to the explicit and implicit expectations expressed by the organization (e.g., do as I say , not as I do). Relevant Research Literature

Cost-Utility Analysis: Current Methodological Issues and Future Perspectives

PubMed Central

Nuijten, Mark J. C.; Dubois, Dominique J.

2011-01-01

The use of cost–effectiveness as final criterion in the reimbursement process for listing of new pharmaceuticals can be questioned from a scientific and policy point of view. There is a lack of consensus on main methodological issues and consequently we may question the appropriateness of the use of cost–effectiveness data in health care decision-making. Another concern is the appropriateness of the selection and use of an incremental cost–effectiveness threshold (Cost/QALY). In this review, we focus mainly on only some key methodological concerns relating to discounting, the utility concept, cost assessment, and modeling methodologies. Finally we will consider the relevance of some other important decision criteria, like social values and equity. PMID:21713127

Decision Trajectories in Dementia Care Networks: Decisions and Related Key Events.

PubMed

Groen-van de Ven, Leontine; Smits, Carolien; Oldewarris, Karen; Span, Marijke; Jukema, Jan; Eefsting, Jan; Vernooij-Dassen, Myrra

2017-10-01

This prospective multiperspective study provides insight into the decision trajectories of people with dementia by studying the decisions made and related key events. This study includes three waves of interviews, conducted between July 2010 and July 2012, with 113 purposefully selected respondents (people with beginning to advanced stages of dementia and their informal and professional caregivers) completed in 12 months (285 interviews). Our multilayered qualitative analysis consists of content analysis, timeline methods, and constant comparison. Four decision themes emerged-managing daily life, arranging support, community living, and preparing for the future. Eight key events delineate the decision trajectories of people with dementia. Decisions and key events differ between people with dementia living alone and living with a caregiver. Our study clarifies that decisions relate not only to the disease but to living with the dementia. Individual differences in decision content and sequence may effect shared decision-making and advance care planning.

Assessing future scenarios for health care waste management using a multi-criteria decision analysis tool: A case study in the Turkish West Black Sea Region.

PubMed

Ciplak, Nesli

2015-08-01

The aim of this paper is to identify the best possible health care waste management option in the West Black Sea Region by taking into account economic, social, environmental, and technical aspects in the concept of multi-criteria decision analysis. In the scope of this research, three different health care waste management scenarios that consist of different technology alternatives were developed and compared using a decision-making computer software, called Right Choice, by identifying various criteria, measuring them, and ranking their relative importance from the point of key stakeholders. The results of the study show that the decentralized autoclave technology option coupled with the disposal through land-filling with energy recovery has potential to be an optimum option for health care waste management system, and an efficient health care waste segregation scheme should be given more attention by the authorities in the region. Furthermore, the discussion of the results points out multidisciplinary approach and the equilibrium between social, environmental, economic, and technical criteria. The methodology used in this research was developed in order to enable the decision makers to gain an increased perception of a decision problem. In general, the results and remarks of this study can be used as a basis of future planning and anticipation of needs for investment in the area of health care waste management in the region and also in developing countries that are dealing with the similar waste management problems.

Miniature near-infrared spectrometer for point-of-use chemical analysis

NASA Astrophysics Data System (ADS)

Friedrich, Donald M.; Hulse, Charles A.; von Gunten, Marc; Williamson, Eric P.; Pederson, Christopher G.; O'Brien, Nada A.

2014-03-01

Point-of-use chemical analysis holds tremendous promise for a number of industries, including agriculture, recycling, pharmaceuticals and homeland security. Near infrared (NIR) spectroscopy is an excellent candidate for these applications, with minimal sample preparation for real-time decision-making. We will detail the development of a golf ball-sized NIR spectrometer developed specifically for this purpose. The instrument is based upon a thin-film dispersive element that is very stable over time and temperature, with less than 2 nm change expected over the operating temperature range and lifetime of the instrument. This filter is coupled with an uncooled InGaAs detector array in a small, rugged, environmentally stable optical bench ideally suited to unpredictable environments. The resulting instrument weighs less than 60 grams, includes onboard illumination and collection optics for diffuse reflectance applications in the 900-1700 nm wavelength range, and is USB-powered. It can be driven in the field by a laptop, tablet or even a smartphone. The software design includes the potential for both on-board and cloud-based storage, analysis and decision-making. The key attributes of the instrument and the underlying design tradeoffs will be discussed, focusing on miniaturization, ruggedization, power consumption and cost. The optical performance of the instrument, as well as its fit-for purpose will be detailed. Finally, we will show that our manufacturing process has enabled us to build instruments with excellent unit-to-unit reproducibility. We will show that this is a key enabler for instrumentindependent chemical analysis models, a requirement for mass point-of-use deployment.

Exploring patient experiences of neo-adjuvant chemotherapy for breast cancer.

PubMed

Beaver, Kinta; Williamson, Susan; Briggs, Jean

2016-02-01

Neo-adjuvant chemotherapy is recommended for 'inoperable' locally advanced and inflammatory breast cancers. For operable breast cancers, trials indicate no survival differences between chemotherapy given pre or post-surgery. Communicating evidence based information to patients is complex and studies examining patient experiences of neo-adjuvant chemotherapy are lacking. This study aims to explore the experiences of women who received neo-adjuvant chemotherapy for breast cancer. A qualitative approach using in-depth interviews with 20 women who had completed neo-adjuvant chemotherapy for breast cancer. Interview data were analysed using thematic analysis. The sample included a relatively young group of women, with caring responsibilities. Five main themes emerged: coping with the rapid transition from 'well' to 'ill', information needs and decision making, needing support and empathy, impact on family, and creating a new 'normal'. More support was needed towards the end of chemotherapy, when side effects were at their most toxic, and decisions about forthcoming surgery were being made. Some women were referred to psychological services, but usually when a crisis point had been reached. Information and support would have been beneficial at key time points. This information is vital in developing services and interventions to meet the complex needs of these patients and potentially prevent late referral to psychological services. Specialist oncology nurses are able to develop empathetic relationships with patients and have the experience, knowledge and skills to inform and support women experiencing neo-adjuvant chemotherapy. Targeting key time points and maintaining relationship throughout neo-adjuvant chemotherapy would be highly beneficial. Copyright © 2015 Elsevier Ltd. All rights reserved.

Clinical, information and business process modeling to promote development of safe and flexible software.

PubMed

Liaw, Siaw-Teng; Deveny, Elizabeth; Morrison, Iain; Lewis, Bryn

2006-09-01

Using a factorial vignette survey and modeling methodology, we developed clinical and information models - incorporating evidence base, key concepts, relevant terms, decision-making and workflow needed to practice safely and effectively - to guide the development of an integrated rule-based knowledge module to support prescribing decisions in asthma. We identified workflows, decision-making factors, factor use, and clinician information requirements. The Unified Modeling Language (UML) and public domain software and knowledge engineering tools (e.g. Protégé) were used, with the Australian GP Data Model as the starting point for expressing information needs. A Web Services service-oriented architecture approach was adopted within which to express functional needs, and clinical processes and workflows were expressed in the Business Process Execution Language (BPEL). This formal analysis and modeling methodology to define and capture the process and logic of prescribing best practice in a reference implementation is fundamental to tackling deficiencies in prescribing decision support software.

Cognitive Control and Individual Differences in Economic Ultimatum Decision-Making

PubMed Central

De Neys, Wim; Novitskiy, Nikolay; Geeraerts, Leen; Ramautar, Jennifer; Wagemans, Johan

2011-01-01

Much publicity has been given to the fact that people's economic decisions often deviate from the rational predictions of standard economic models. In the classic ultimatum game, for example, most people turn down financial gains by rejecting unequal monetary splits. The present study points to neglected individual differences in this debate. After participants played the ultimatum game we tested for individual differences in cognitive control capacity of the most and least economic responders. The key finding was that people who were higher in cognitive control, as measured by behavioral (Go/No-Go performance) and neural (No-Go N2 amplitude) markers, did tend to behave more in line with the standard models and showed increased acceptance of unequal splits. Hence, the cognitively highest scoring decision-makers were more likely to maximize their monetary payoffs and adhere to the standard economic predictions. Findings question popular claims with respect to the rejection of standard economic models and the irrationality of human economic decision-making. PMID:22096522

What are patients' goals and concerns about breast reconstruction after mastectomy?

PubMed

Lee, Clara N; Hultman, Charles Scott; Sepucha, Karen

2010-05-01

Discussions about breast reconstruction should include factual information and consideration of the patient's personal concerns. Providers are familiar with the relevant facts but may not know which personal concerns are important to patients. Experience with breast cancer patients has found that providers frequently do not know their patients' treatment preferences. To help reconstructive surgeons discuss personal preferences with their patients, we sought to identify women's key concerns related to breast reconstruction. We employed a qualitative design and convened a sample of 65 women in 7 focus groups and 15 semi-structured interviews. Women with a recent history of early-stage breast cancer who had a mastectomy with or without reconstruction were included. A variety of backgrounds, including underserved populations, low education levels, and various ages were represented. Qualitative content analysis was performed, and key themes were identified. Five key themes emerged. (1) Magnitude of surgery and recovery. Many women reported that concerns over the number of operations, duration of recovery, and risk of complications strongly affected their decision-making. (2) Using one's own tissue. Several women felt comforted by the notion of using their own tissue for reconstruction. (3) Looking natural in clothing. Many women pointed out the difference between how they look in clothing versus how they look naked. (4) Avoiding an external prosthesis. Several women stressed practical concerns and framed the reconstruction decision in terms of not having to use prosthesis. (5) Considering others' opinions. A few women reported that their partners' opinion strongly influenced their decision. Many women stated that they ultimately followed their doctor's recommendation. Women considering reconstruction have some unmet emotional and physical needs as well as important goals and concerns that can affect their decisions about and experience with reconstruction. In particular, some breast cancer patients are unprepared for the full effect of surgery on their lives and for the recovery process. Discussions about reconstruction would benefit from inclusion of these key concerns.

GAIA - A New Approach To Decision Making on Climate Disruption Issues

NASA Astrophysics Data System (ADS)

Paxton, L. J.; Weiss, M.; Schaefer, R. K.; Swartz, W. H.; Nix, M.; Strong, S. B.; Fountain, G. H.; Babin, S. M.; Pikas, C. K.; Parker, C. L.; Global Assimilation of InformationAction

2011-12-01

GAIA - the Global Assimilation of Information for Action program - provides a broadly extensible framework for enabling the development of a deeper understanding of the issues associated with climate disruption. The key notion of GAIA is that the global climate problem is so complex that a "system engineering" approach is needed in order to make it understandable. The key tenet of system engineering is to focus on requirements and to develop a cost-effective process for satisfying those requirements. To demonstrate this approach we focused first on the impact of climate disruption on public health. GAIA is described in some detail on our website (http://gaia.jhuapl.edu). Climate disruption is not just a scientific problem; one of the key issues that our community has is that of translating scientific results into knowledge that can be used to make informed decisions. In order to support decision makers we have to understand their issues and how to communicate with them. In this talk, we describe how we have built a community of interest that combines subject matter experts from diverse communities (public health, climate change, government, public policy, industry, etc) with policy makers and representatives from industry to develop, on a "level playing field", an understanding of each other's points of view and issues. The first application of this technology was the development of a workshop on Climate, Climate Change and Public Health held April 12-14, 2011. This paper describes our approach to going beyond the workshop environment to continue to engage the decision maker's community in a variety of ways that translate abstract scientific data into actionable information. Key ideas we will discuss include the development of social media, simulations of global/national/local environments affected by climate disruption, and visualizations of the monetary and health impacts of choosing not to address mitigation or adaptation to climate disruption.

Generalizing Automated Assessment of Small Unit Tactical Decision Making

DTIC Science & Technology

2013-12-01

stottlerhenke.com, presnell@stottlerhenke.com James Lunsford Decisive-Point, LLC Kansas City, MO jim@decisive-point.com Marshell G. Cobb US Army...engineer for Electronic Arts and Stormfront Studios. Dr. Marshell G. Cobb. In his current position with the US Army Research Institute (ARI), Dr...Lunsford Decisive-Point, LLC Kansas City, MO jim@decisive-point.com Marshell G. Cobb US Army Research Institute Ft. Benning, GA

21st century neurobehavioral theories of decision making in addiction: Review and evaluation.

PubMed

Bickel, Warren K; Mellis, Alexandra M; Snider, Sarah E; Athamneh, Liqa N; Stein, Jeffrey S; Pope, Derek A

2018-01-01

This review critically examines neurobehavioral theoretical developments in decision making in addiction in the 21st century. We specifically compare each theory reviewed to seven benchmarks of theoretical robustness, based on their ability to address: why some commodities are addictive; developmental trends in addiction; addiction-related anhedonia; self-defeating patterns of behavior in addiction; why addiction co-occurs with other unhealthy behaviors; and, finally, means for the repair of addiction. We have included only self-contained theories or hypotheses which have been developed or extended in the 21st century to address decision making in addiction. We thus review seven distinct theories of decision making in addiction: learning theories, incentive-sensitization theory, dopamine imbalance and systems models, opponent process theory, strength models of self-control failure, the competing neurobehavioral decision systems theory, and the triadic systems theory of addiction. Finally, we have directly compared the performance of each of these theories based on the aforementioned benchmarks, and highlighted key points at which several theories have coalesced. Copyright © 2017 Elsevier Inc. All rights reserved.

Ecological dynamics of continuous and categorical decision-making: the regatta start in sailing.

PubMed

Araújo, Duarte; Davids, Keith; Diniz, Ana; Rocha, Luis; Santos, João Coelho; Dias, Gonçalo; Fernandes, Orlando

2015-01-01

Ecological dynamics of decision-making in the sport of sailing exemplifies emergent, conditionally coupled, co-adaptive behaviours. In this study, observation of the coupling dynamics of paired boats during competitive sailing showed that decision-making can be modelled as a self-sustained, co-adapting system of informationally coupled oscillators (boats). Bytracing the spatial-temporal displacements of the boats, time series analyses (autocorrelations, periodograms and running correlations) revealed that trajectories of match racing boats are coupled more than 88% of the time during a pre-start race, via continuous, competing co-adaptions between boats. Results showed that both the continuously selected trajectories of the sailors (12 years of age) and their categorical starting point locations were examples of emergent decisions. In this dynamical conception of decision-making behaviours, strategic positioning (categorical) and continuous displacement of a boat over the course in match-race sailing emerged as a function of interacting task, personal and environmental constraints. Results suggest how key interacting constraints could be manipulated in practice to enhance sailors' perceptual attunement to them in competition.

Ideas for Improving Retirement Wellness.

PubMed

Rappaport, Anna M

Employers can and should take steps to support retirement and financial wellness. This article provides a framework for retirement wellness informed by research conducted or supported by the Society of Actuaries. Research insights about Americans' finances, planning, decisions, money management, debt, retiree income shocks and other areas point to ways employers can provide retirement wellness support as a vital part of an overall benefit program. The author suggests several key considerations employers should pay attention to in order to improve retirement wellness.

Information Dominance: Why the Army is Interested in Space Control

DTIC Science & Technology

2002-01-01

2002 2. REPORT TYPE 3. DATES COVERED 00-00-2002 to 00-00-2002 4. TITLE AND SUBTITLE Information Dominance : Why the Army is Interested in Space... dominance is a great consideration during all phases of the conflict. It is worth noting that information dominance in itself is not the end-all...goal but rather a key contributor in establishing decision superiority at all points in the conflict time line. The Information Dominance : Why the

Optimization of Water Resources and Agricultural Activities for Economic Benefit in Colorado

NASA Astrophysics Data System (ADS)

LIM, J.; Lall, U.

2017-12-01

The limited water resources available for irrigation are a key constraint for the important agricultural sector of Colorado's economy. As climate change and groundwater depletion reshape these resources, it is essential to understand the economic potential of water resources under different agricultural production practices. This study uses a linear programming optimization at the county spatial scale and annual temporal scales to study the optimal allocation of water withdrawal and crop choices. The model, AWASH, reflects streamflow constraints between different extraction points, six field crops, and a distinct irrigation decision for maize and wheat. The optimized decision variables, under different environmental, social, economic, and physical constraints, provide long-term solutions for ground and surface water distribution and for land use decisions so that the state can generate the maximum net revenue. Colorado, one of the largest agricultural producers, is tested as a case study and the sensitivity on water price and on climate variability is explored.

LDPC decoder with a limited-precision FPGA-based floating-point multiplication coprocessor

NASA Astrophysics Data System (ADS)

Moberly, Raymond; O'Sullivan, Michael; Waheed, Khurram

2007-09-01

Implementing the sum-product algorithm, in an FPGA with an embedded processor, invites us to consider a tradeoff between computational precision and computational speed. The algorithm, known outside of the signal processing community as Pearl's belief propagation, is used for iterative soft-decision decoding of LDPC codes. We determined the feasibility of a coprocessor that will perform product computations. Our FPGA-based coprocessor (design) performs computer algebra with significantly less precision than the standard (e.g. integer, floating-point) operations of general purpose processors. Using synthesis, targeting a 3,168 LUT Xilinx FPGA, we show that key components of a decoder are feasible and that the full single-precision decoder could be constructed using a larger part. Soft-decision decoding by the iterative belief propagation algorithm is impacted both positively and negatively by a reduction in the precision of the computation. Reducing precision reduces the coding gain, but the limited-precision computation can operate faster. A proposed solution offers custom logic to perform computations with less precision, yet uses the floating-point format to interface with the software. Simulation results show the achievable coding gain. Synthesis results help theorize the the full capacity and performance of an FPGA-based coprocessor.

Patient participation in decision-making about cardiovascular preventive drugs - resistance as agency.

PubMed

Hultberg, Josabeth; Rudebeck, Carl Edvard

2017-09-01

The aim of the study was to describe and explore patient agency through resistance in decision-making about cardiovascular preventive drugs in primary care. Six general practitioners from the southeast of Sweden audiorecorded 80 consultations. From these, 28 consultations with proposals from GPs for cardiovascular preventive drug treatments were chosen for theme-oriented discourse analysis. The study shows how patients participate in decision-making about cardiovascular preventive drug treatments through resistance in response to treatment proposals. Passive modes of resistance were withheld responses and minimal unmarked acknowledgements. Active modes were to ask questions, contest the address of an inclusive we, present an identity as a non-drugtaker, disclose non-adherence to drug treatments, and to present counterproposals. The active forms were also found in anticipation to treatment proposals from the GPs. Patients and GPs sometimes displayed mutual renouncement of responsibility for decision-making. The decision-making process appeared to expand both beyond a particular phase in the consultations and beyond the single consultation. The recognition of active and passive resistance from patients as one way of exerting agency may prove valuable when working for patient participation in clinical practice, education and research about patient-doctor communication about cardiovascular preventive medication. We propose particular attentiveness to patient agency through anticipatory resistance, patients' disclosures of non-adherence and presentations of themselves as non-drugtakers. The expansion of the decision-making process beyond single encounters points to the importance of continuity of care. KEY POINTS Guidelines recommend shared decision-making about cardiovascular preventive treatment. We need an understanding of how this is accomplished in actual consultations.This paper describes how patient agency in decision-making is displayed through different forms of resistance to treatment proposals. •The decision-making process expands beyond particular phases in consultations and beyond single encounters, implying the importance of continuity of care. •Attentiveness to patient participation through resistance in treatment negotiations is warranted in clinical practice, research and education about prescribing communication.

Note-taking in the employment interview: effects on recall and judgments.

PubMed

Middendorf, Catherine Houdek; Macan, Therese Hoff

2002-04-01

Although note-taking in the employment interview is highly recommended, little research has examined its effects. This study investigated the effects of note-taking styles, review of the notes, and content of the notes on participants' cued recall of information and decisions made from videotaped employment interviews. Note-taking increased recall accuracy but not judgment accuracy. Being able to review notes resulted in increased judgment accuracy for those taking conventional-style notes. The content of the notes also had important implications for conventional note-takers, suggesting some benefits of recording notes using the key-points style. The findings suggest that the act of note-taking may be more important for memory and legal reasons than for improving the decisions made by interviewers.

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.

An aggregate method to calibrate the reference point of cumulative prospect theory-based route choice model for urban transit network

NASA Astrophysics Data System (ADS)

Zhang, Yufeng; Long, Man; Luo, Sida; Bao, Yu; Shen, Hanxia

2015-12-01

Transit route choice model is the key technology of public transit systems planning and management. Traditional route choice models are mostly based on expected utility theory which has an evident shortcoming that it cannot accurately portray travelers' subjective route choice behavior for their risk preferences are not taken into consideration. Cumulative prospect theory (CPT), a brand new theory, can be used to describe travelers' decision-making process under the condition of uncertainty of transit supply and risk preferences of multi-type travelers. The method to calibrate the reference point, a key parameter to CPT-based transit route choice model, determines the precision of the model to a great extent. In this paper, a new method is put forward to obtain the value of reference point which combines theoretical calculation and field investigation results. Comparing the proposed method with traditional method, it shows that the new method can promote the quality of CPT-based model by improving the accuracy in simulating travelers' route choice behaviors based on transit trip investigation from Nanjing City, China. The proposed method is of great significance to logical transit planning and management, and to some extent makes up the defect that obtaining the reference point is solely based on qualitative analysis.

Guideline Implementation: Hand Hygiene.

PubMed

Goldberg, Judith L

2017-02-01

Performing proper hand hygiene and surgical hand antisepsis is essential to reducing the rates of health care-associated infections, including surgical site infections. The updated AORN "Guideline for hand hygiene" provides guidance on hand hygiene and surgical hand antisepsis, the wearing of fingernail polish and artificial nails, proper skin care to prevent dermatitis, the wearing of jewelry, hand hygiene product selection, and quality assurance and performance improvement considerations. This article focuses on key points of the guideline to help perioperative personnel make informed decisions about hand hygiene and surgical hand antisepsis. The key points address the necessity of keeping fingernails and skin healthy, not wearing jewelry on the hands or wrists in the perioperative area, properly performing hand hygiene and surgical hand antisepsis, and involving patients and visitors in hand hygiene initiatives. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Complex Decision-Making in Heart Failure: A Systematic Review and Thematic Analysis.

PubMed

Hamel, Aimee V; Gaugler, Joseph E; Porta, Carolyn M; Hadidi, Niloufar Niakosari

Heart failure follows a highly variable and difficult course. Patients face complex decisions, including treatment with implantable cardiac defibrillators, mechanical circulatory support, and heart transplantation. The course of decision-making across multiple treatments is unclear yet integral to providing informed and shared decision-making. Recognizing commonalities across treatment decisions could help nurses and physicians to identify opportunities to introduce discussions and support shared decision-making. The specific aims of this review are to examine complex treatment decision-making, specifically implantable cardiac defibrillators, ventricular assist device, and cardiac transplantation, and to recognize commonalities and key points in the decisional process. MEDLINE, CINAHL, PsycINFO, and Web of Science were searched for English-language studies that included qualitative findings reflecting the complexity of heart failure decision-making. Using a 3-step process, findings were synthesized into themes and subthemes. Twelve articles met criteria for inclusion. Participants included patients, caregivers, and clinicians and included decisions to undergo and decline treatment. Emergent themes were "processing the decision," "timing and prognostication," and "considering the future." Subthemes described how participants received and understood information about the therapy, making and changing a treatment decision, timing their decision and gauging health status outcomes in the context of their decision, the influence of a life or death decision, and the future as a factor in their decisional process. Commonalities were present across therapies, which involved the timing of discussions, the delivery of information, and considerations of the future. Exploring this further could help support patient-centered care and optimize shared decision-making interventions.

Classification Model for Damage Localization in a Plate Structure

NASA Astrophysics Data System (ADS)

Janeliukstis, R.; Ruchevskis, S.; Chate, A.

2018-01-01

The present study is devoted to the problem of damage localization by means of data classification. The commercial ANSYS finite-elements program was used to make a model of a cantilevered composite plate equipped with numerous strain sensors. The plate was divided into zones, and, for data classification purposes, each of them housed several points to which a point mass of magnitude 5 and 10% of plate mass was applied. At each of these points, a numerical modal analysis was performed, from which the first few natural frequencies and strain readings were extracted. The strain data for every point were the input for a classification procedure involving k nearest neighbors and decision trees. The classification model was trained and optimized by finetuning the key parameters of both algorithms. Finally, two new query points were simulated and subjected to a classification in terms of assigning a label to one of the zones of the plate, thus localizing these points. Damage localization results were compared for both algorithms and were found to be in good agreement with the actual application positions of point load.

Decision Rules and Group Rationality: Cognitive Gain or Standstill?

PubMed Central

Curşeu, Petru Lucian; Jansen, Rob J. G.; Chappin, Maryse M. H.

2013-01-01

Recent research in group cognition points towards the existence of collective cognitive competencies that transcend individual group members’ cognitive competencies. Since rationality is a key cognitive competence for group decision making, and group cognition emerges from the coordination of individual cognition during social interactions, this study tests the extent to which collaborative and consultative decision rules impact the emergence of group rationality. Using a set of decision tasks adapted from the heuristics and biases literature, we evaluate rationality as the extent to which individual choices are aligned with a normative ideal. We further operationalize group rationality as cognitive synergy (the extent to which collective rationality exceeds average or best individual rationality in the group), and we test the effect of collaborative and consultative decision rules in a sample of 176 groups. Our results show that the collaborative decision rule has superior synergic effects as compared to the consultative decision rule. The ninety one groups working in a collaborative fashion made more rational choices (above and beyond the average rationality of their members) than the eighty five groups working in a consultative fashion. Moreover, the groups using a collaborative decision rule were closer to the rationality of their best member than groups using consultative decision rules. Nevertheless, on average groups did not outperformed their best member. Therefore, our results reveal how decision rules prescribing interpersonal interactions impact on the emergence of collective cognitive competencies. They also open potential venues for further research on the emergence of collective rationality in human decision-making groups. PMID:23451050

Decision rules and group rationality: cognitive gain or standstill?

PubMed

Curşeu, Petru Lucian; Jansen, Rob J G; Chappin, Maryse M H

2013-01-01

Recent research in group cognition points towards the existence of collective cognitive competencies that transcend individual group members' cognitive competencies. Since rationality is a key cognitive competence for group decision making, and group cognition emerges from the coordination of individual cognition during social interactions, this study tests the extent to which collaborative and consultative decision rules impact the emergence of group rationality. Using a set of decision tasks adapted from the heuristics and biases literature, we evaluate rationality as the extent to which individual choices are aligned with a normative ideal. We further operationalize group rationality as cognitive synergy (the extent to which collective rationality exceeds average or best individual rationality in the group), and we test the effect of collaborative and consultative decision rules in a sample of 176 groups. Our results show that the collaborative decision rule has superior synergic effects as compared to the consultative decision rule. The ninety one groups working in a collaborative fashion made more rational choices (above and beyond the average rationality of their members) than the eighty five groups working in a consultative fashion. Moreover, the groups using a collaborative decision rule were closer to the rationality of their best member than groups using consultative decision rules. Nevertheless, on average groups did not outperformed their best member. Therefore, our results reveal how decision rules prescribing interpersonal interactions impact on the emergence of collective cognitive competencies. They also open potential venues for further research on the emergence of collective rationality in human decision-making groups.

Researching Together: A CTSA Partnership of Academicians and Communities for Translation

PubMed Central

Nearing, Kathryn; Felzien, Maret; Green, Larry; Calonge, Ned; Pineda‐Reyes, Fernando; Jones, Grant; Tamez, Montelle; Miller, Sara; Kramer, Andrew

2013-01-01

Abstract Background The Colorado Clinical and Translational Sciences Institute (CCTSI) aims to translate discovery into clinical practice. The Partnership of Academicians and Communities for Translation (PACT) represents a robust campus–community partnership. Methods The CCTSI collected data on all PACT activities including meeting notes, staff activity logs, stakeholder surveys and interviews, and several key component in‐depth evaluations. Data analysis by Evaluation and Community Engagement Core and PACT Council members identified critical shifts that changed the trajectory of community engagement efforts. Results Ten “critical shifts” in six broad rubrics created change in the PACT. Critical shifts were decision points in the development of the PACT that represented quantitative and qualitative changes in the work and trajectory. Critical shifts occurred in PACT management and leadership, financial control and resource allocation, and membership and voice. Discussion The development of a campus–community partnership is not a smooth linear path. Incremental changes lead to major decision points that represent an opportunity for critical shifts in developmental trajectory. We provide an enlightening, yet cautionary, tale to others considering a campus–community partnership so they may prepare for crucial decisions and critical shifts. The PACT serves as a genuine foundational platform for dynamic research efforts aimed at eliminating health disparities. PMID:24127922

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

PubMed

Tan, Amy; Manca, Donna

2013-01-22

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

Improved Modeling of Three-Point Estimates for Decision Making: Going Beyond the Triangle

DTIC Science & Technology

2016-03-01

OF THREE-POINT ESTIMATES FOR DECISION MAKING: GOING BEYOND THE TRIANGLE by Daniel W. Mulligan March 2016 Thesis Advisor: Mark Rhoades...REPORT TYPE AND DATES COVERED Master’s thesis 4. TITLE AND SUBTITLE IMPROVED MODELING OF THREE-POINT ESTIMATES FOR DECISION MAKING: GOING BEYOND...unlimited IMPROVED MODELING OF THREE-POINT ESTIMATES FOR DECISION MAKING: GOING BEYOND THE TRIANGLE Daniel W. Mulligan Civilian, National

Key concepts relevant to quality of complex and shared decision-making in health care: a literature review.

PubMed

Dy, Sydney M; Purnell, Tanjala S

2012-02-01

High-quality provider-patient decision-making is key to quality care for complex conditions. We performed an analysis of key elements relevant to quality and complex, shared medical decision-making. Based on a search of electronic databases, including Medline and the Cochrane Library, as well as relevant articles' reference lists, reviews of tools, and annotated bibliographies, we developed a list of key concepts and applied them to a decision-making example. Key concepts identified included provider competence, trustworthiness, and cultural competence; communication with patients and families; information quality; patient/surrogate competence; and roles and involvement. We applied this concept list to a case example, shared decision-making for live donor kidney transplantation, and identified the likely most important concepts as provider and cultural competence, information quality, and communication with patients and families. This concept list may be useful for conceptualizing the quality of complex shared decision-making and in guiding research in this area. Copyright © 2011 Elsevier Ltd. All rights reserved.

HMIS and decision-making in Zambia: re-thinking information solutions for district health management in decentralized health systems.

PubMed

Mutemwa, Richard I

2006-01-01

At the onset of health system decentralization as a primary health care strategy, which constituted a key feature of health sector reforms across the developing world, efficient and effective health management information systems (HMIS) were widely acknowledged and adopted as a critical element of district health management strengthening programmes. The focal concern was about the performance and long-term sustainability of decentralized district health systems. The underlying logic was that effective and efficient HMIS would provide district health managers with the information required to make effective strategic decisions that are the vehicle for district performance and sustainability in these decentralized health systems. However, this argument is rooted in normative management and decision theory without significant unequivocal empirical corroboration. Indeed, extensive empirical evidence continues to indicate that managers' decision-making behaviour and the existence of other forms of information outside the HMIS, within the organizational environment, suggest a far more tenuous relationship between the presence of organizational management information systems (such as HMIS) and effective strategic decision-making. This qualitative comparative case-study conducted in two districts of Zambia focused on investigating the presence and behaviour of five formally identified, different information forms, including that from HMIS, in the strategic decision-making process. The aim was to determine the validity of current arguments for HMIS, and establish implications for current HMIS policies. Evidence from the eight strategic decision-making processes traced in the study confirmed the existence of different forms of information in the organizational environment, including that provided by the conventional HMIS. These information forms attach themselves to various organizational management processes and key aspects of organizational routine. The study results point to the need for a radical re-think of district health management information solutions in ways that account for the existence of other information forms outside the formal HMIS in the district health system.

Semantics of directly manipulating spatializations.

PubMed

Hu, Xinran; Bradel, Lauren; Maiti, Dipayan; House, Leanna; North, Chris; Leman, Scotland

2013-12-01

When high-dimensional data is visualized in a 2D plane by using parametric projection algorithms, users may wish to manipulate the layout of the data points to better reflect their domain knowledge or to explore alternative structures. However, few users are well-versed in the algorithms behind the visualizations, making parameter tweaking more of a guessing game than a series of decisive interactions. Translating user interactions into algorithmic input is a key component of Visual to Parametric Interaction (V2PI) [13]. Instead of adjusting parameters, users directly move data points on the screen, which then updates the underlying statistical model. However, we have found that some data points that are not moved by the user are just as important in the interactions as the data points that are moved. Users frequently move some data points with respect to some other 'unmoved' data points that they consider as spatially contextual. However, in current V2PI interactions, these points are not explicitly identified when directly manipulating the moved points. We design a richer set of interactions that makes this context more explicit, and a new algorithm and sophisticated weighting scheme that incorporates the importance of these unmoved data points into V2PI.

Unfolding Visual Lexical Decision in Time

PubMed Central

Barca, Laura; Pezzulo, Giovanni

2012-01-01

Visual lexical decision is a classical paradigm in psycholinguistics, and numerous studies have assessed the so-called “lexicality effect" (i.e., better performance with lexical than non-lexical stimuli). Far less is known about the dynamics of choice, because many studies measured overall reaction times, which are not informative about underlying processes. To unfold visual lexical decision in (over) time, we measured participants' hand movements toward one of two item alternatives by recording the streaming x,y coordinates of the computer mouse. Participants categorized four kinds of stimuli as “lexical" or “non-lexical:" high and low frequency words, pseudowords, and letter strings. Spatial attraction toward the opposite category was present for low frequency words and pseudowords. Increasing the ambiguity of the stimuli led to greater movement complexity and trajectory attraction to competitors, whereas no such effect was present for high frequency words and letter strings. Results fit well with dynamic models of perceptual decision-making, which describe the process as a competition between alternatives guided by the continuous accumulation of evidence. More broadly, our results point to a key role of statistical decision theory in studying linguistic processing in terms of dynamic and non-modular mechanisms. PMID:22563419

Moral development and reproductive health decisions.

PubMed

McFadden, E A

1996-01-01

This article reviews the concepts of biomedical ethics, the justice perspective, and the care perspective of moral development and moral decision making; integrates key aspects of each to women's reproductive health nursing practice; and gives examples of application of these models to use as a framework for the assessment of moral development in guiding women in making reproductive health decisions. Emphasis is placed on the need for an integrated approach to assessment of the recognition of and response to what an individual identifies as a moral dilemma. Discussion of two different perspectives, justice and caring, is presented with application to women's health concerns. Nurses are encouraged to assess their moral development and appraisal of issues that constitute moral dilemmas and their ensuing decision making processes and those of clients. Techniques for obtaining information about moral reasoning are suggested. Rather than a traditional framework for the assessment of moral development, the uniqueness of individual women's experiences as they pertain to the case context is recommended to assess the client's appraisal of the circumstances of a perceived moral situation from the client's vantage point.

Subsonic Aircraft Safety Icing Study

NASA Technical Reports Server (NTRS)

Jones, Sharon Monica; Reveley, Mary S.; Evans, Joni K.; Barrientos, Francesca A.

2008-01-01

NASA's Integrated Resilient Aircraft Control (IRAC) Project is one of four projects within the agency s Aviation Safety Program (AvSafe) in the Aeronautics Research Mission Directorate (ARMD). The IRAC Project, which was redesigned in the first half of 2007, conducts research to advance the state of the art in aircraft control design tools and techniques. A "Key Decision Point" was established for fiscal year 2007 with the following expected outcomes: document the most currently available statistical/prognostic data associated with icing for subsonic transport, summarize reports by subject matter experts in icing research on current knowledge of icing effects on control parameters and establish future requirements for icing research for subsonic transports including the appropriate alignment. This study contains: (1) statistical analyses of accident and incident data conducted by NASA researchers for this "Key Decision Point", (2) an examination of icing in other recent statistically based studies, (3) a summary of aviation safety priority lists that have been developed by various subject-matter experts, including the significance of aircraft icing research in these lists and (4) suggested future requirements for NASA icing research. The review of several studies by subject-matter experts was summarized into four high-priority icing research areas. Based on the Integrated Resilient Aircraft Control (IRAC) Project goals and objectives, the IRAC project was encouraged to conduct work in all of the high-priority icing research areas that were identified, with the exception of the developing of methods to sense and document actual icing conditions.

14 CFR 29.77 - Landing Decision Point (LDP): Category A.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Landing Decision Point (LDP): Category A... TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY ROTORCRAFT Flight Performance § 29.77 Landing Decision Point (LDP): Category A. (a) The LDP is the last point in the approach and landing path from which...

A practical guide to assessing clinical decision-making skills using the key features approach.

PubMed

Farmer, Elizabeth A; Page, Gordon

2005-12-01

This paper in the series on professional assessment provides a practical guide to writing key features problems (KFPs). Key features problems test clinical decision-making skills in written or computer-based formats. They are based on the concept of critical steps or 'key features' in decision making and represent an advance on the older, less reliable patient management problem (PMP) formats. The practical steps in writing these problems are discussed and illustrated by examples. Steps include assembling problem-writing groups, selecting a suitable clinical scenario or problem and defining its key features, writing the questions, selecting question response formats, preparing scoring keys, reviewing item quality and item banking. The KFP format provides educators with a flexible approach to testing clinical decision-making skills with demonstrated validity and reliability when constructed according to the guidelines provided.

Health technology assessment in Switzerland: a descriptive analysis of “Coverage with Evidence Development” decisions from 1996 to 2013

PubMed Central

Brügger, Urs; Horisberger, Bruno; Ruckstuhl, Alexander; Plessow, Rafael; Eichler, Klaus; Gratwohl, Alois

2015-01-01

Objectives To identify factors associated with the decisions of the Federal Department of Home Affairs concerning coverage with evidence development (CED) for contested novel medical technologies in Switzerland. Design Quantitative, retrospective, descriptive analysis of publicly available material and prospective, structured, qualitative interviews with key stakeholders. Setting All 152 controversial medical services decided on by the Federal Commission on Health Insurance Benefits within the framework of the new federal law on health insurance in Switzerland from 1997 to 2013, with focus on 33 technologies assigned initially to CED and 33 to evidence development without coverage. Main outcome measures Factors associated with numbers and type of contested services assigned to CED per year, the duration and final outcome of the evaluations and perceptions of key stakeholders. Results The rate of CED decisions (82 total; median 1.5/year; range 0–9/year), the time to final decision (4.5 years median; 0.75 to +11 years) and the probability of a final ‘yes’ varied over time. In logistic regression models, the change of office of the commission provided the best explanation for the observed outcomes. Good intentions but absence of scientific criteria for decisions were reported as major comments by the stakeholders. Conclusions The introduction of CED enabled access to some promising technologies early in their life cycle, and might have triggered establishment of registries and research. Impact on patients’ outcome and costs remain unknown. The primary association of institutional changes with measured end points illustrates the need for evaluation of the current health technology assessment (HTA) system. PMID:25818273

Key Decision Record Creation and Approval Module

NASA Technical Reports Server (NTRS)

Hebert, Barrt; Messer, Elizabeth A.; Albasini, Colby; Le, Thang; ORourke, William, Sr.; Stiglets, Tim; Strain, Ted

2012-01-01

Retaining good key decision records is critical to ensuring the success of a project or operation. Having adequately documented decisions with supporting documents and rationale can greatly reduce the amount of rework or reinvention over a project's, vehicle's, or facility's lifecycle. Stennis Space Center developed and uses a software tool that automates the Key Decision Record (KDR) process for its engineering and test projects. It provides the ability for a user to log key decisions that are made during the course of a project. By customizing Parametric Technology Corporation's (PTC) Windchill product, the team was able to log all information about a decision, and electronically route that information for approval. Customizing the Windchill product allowed the team to directly connect these decisions to the engineering data that it might affect and notify data owners of the decision. The user interface was created in JSP and Javascript, within the OOTB (Out of the Box) Windchill product, allowing users to create KDRs. Not only does this interface allow users to create and track KDRs, but it also plugs directly into the OOTB ability to associate these decision records with other relevant engineering data such as drawings, designs, models, requirements, or specifications

Affordability Engineering: Bridging the Gap Between Design and Cost

NASA Technical Reports Server (NTRS)

Reeves, J. D.; DePasquale, Dominic; Lim, Evan

2010-01-01

Affordability is a commonly used term that takes on numerous meanings depending on the context used. Within conceptual design of complex systems, the term generally implies comparisons between expected costs and expected resources. This characterization is largely correct, but does not convey the many nuances and considerations that are frequently misunderstood and underappreciated. In the most fundamental sense, affordability and cost directly relate to engineering and programmatic decisions made throughout development programs. Systems engineering texts point out that there is a temporal aspect to this relationship, for decisions made earlier in a program dictate design implications much more so than those made during latter phases. This paper explores affordability engineering and its many sub-disciplines by discussing how it can be considered an additional engineering discipline to be balanced throughout the systems engineering and systems analysis processes. Example methods of multidisciplinary design analysis with affordability as a key driver will be discussed, as will example methods of data visualization, probabilistic analysis, and other ways of relating design decisions to affordability results.

A Machine-Checked Proof of A State-Space Construction Algorithm

NASA Technical Reports Server (NTRS)

Catano, Nestor; Siminiceanu, Radu I.

2010-01-01

This paper presents the correctness proof of Saturation, an algorithm for generating state spaces of concurrent systems, implemented in the SMART tool. Unlike the Breadth First Search exploration algorithm, which is easy to understand and formalise, Saturation is a complex algorithm, employing a mutually-recursive pair of procedures that compute a series of non-trivial, nested local fixed points, corresponding to a chaotic fixed point strategy. A pencil-and-paper proof of Saturation exists, but a machine checked proof had never been attempted. The key element of the proof is the characterisation theorem of saturated nodes in decision diagrams, stating that a saturated node represents a set of states encoding a local fixed-point with respect to firing all events affecting only the node s level and levels below. For our purpose, we have employed the Prototype Verification System (PVS) for formalising the Saturation algorithm, its data structures, and for conducting the proofs.

Patient participation in decision-making about cardiovascular preventive drugs – resistance as agency

PubMed Central

Hultberg, Josabeth; Rudebeck, Carl Edvard

2017-01-01

Objective The aim of the study was to describe and explore patient agency through resistance in decision-making about cardiovascular preventive drugs in primary care. Design Six general practitioners from the southeast of Sweden audiorecorded 80 consultations. From these, 28 consultations with proposals from GPs for cardiovascular preventive drug treatments were chosen for theme-oriented discourse analysis. Results The study shows how patients participate in decision-making about cardiovascular preventive drug treatments through resistance in response to treatment proposals. Passive modes of resistance were withheld responses and minimal unmarked acknowledgements. Active modes were to ask questions, contest the address of an inclusive we, present an identity as a non-drugtaker, disclose non-adherence to drug treatments, and to present counterproposals. The active forms were also found in anticipation to treatment proposals from the GPs. Patients and GPs sometimes displayed mutual renouncement of responsibility for decision-making. The decision-making process appeared to expand both beyond a particular phase in the consultations and beyond the single consultation. Conclusions The recognition of active and passive resistance from patients as one way of exerting agency may prove valuable when working for patient participation in clinical practice, education and research about patient–doctor communication about cardiovascular preventive medication. We propose particular attentiveness to patient agency through anticipatory resistance, patients’ disclosures of non-adherence and presentations of themselves as non-drugtakers. The expansion of the decision-making process beyond single encounters points to the importance of continuity of care. KEY POINTS Guidelines recommend shared decision-making about cardiovascular preventive treatment. We need an understanding of how this is accomplished in actual consultations.This paper describes how patient agency in decision-making is displayed through different forms of resistance to treatment proposals. •The decision-making process expands beyond particular phases in consultations and beyond single encounters, implying the importance of continuity of care. •Attentiveness to patient participation through resistance in treatment negotiations is warranted in clinical practice, research and education about prescribing communication. PMID:28277056

Johnson Space Center Health and Medical Technical Authority

NASA Technical Reports Server (NTRS)

Fogarty, Jennifer A.

2010-01-01

1.HMTA responsibilities: a) Assure program/project compliance with Agency health and medical requirements at identified key decision points. b) Certify that programs/projects comply with Agency health and medical requirements prior to spaceflight missions. c) Assure technical excellence. 2. Designation of applicable NASA Centers for HMTA implementation and Chief Medical Officer (CMO) appointment. 3. Center CMO responsible for HMTA implementation for programs and projects at the center. JSC HMTA captured in "JSC HMTA Implementation Plan". 4. Establishes specifics of dissenting opinion process consistent with NASA procedural requirements.

Using cognitive task analysis to identify critical decisions in the laparoscopic environment.

PubMed

Craig, Curtis; Klein, Martina I; Griswold, John; Gaitonde, Krishnanath; McGill, Thomas; Halldorsson, Ari

2012-12-01

The aim of this study was to identify the critical decisions surgeons need to make regarding laparoscopic surgery, the information these decisions are based on, the strategies employed by surgeons to reach their objectives, and the difficulties experienced by novices. Laparoscopic training focuses on the development of technical skills. However, successful surgical outcomes are also dependent on appropriate decisions made during surgery, which are influenced by critical cues and the use of appropriate strategies. Novices might not be as adept at cue detection and strategy use. Participants were eight attending surgeons. The authors employed task-analytic techniques to identify critical decisions inherent in laparoscopy and the cues, strategies, and novice traps associated with these decisions. The authors used decision requirements tables to organize the data into the key decisions made during the preoperative, operative, and postoperative phases as well as the cues, strategies, and novice traps associated with these decisions. Key decisions identified for the preoperative phase included but were not limited to the decision of performing a laparoscopic versus open surgery, necessity to review the literature, practicing the procedure, and trocar placement. Some key decisions identified for the operative phase included converting to open surgery, performing angiograms, cutting tissue or organs, and reevaluation of the approach. Only one key decision was identified for the postoperative phrase: whether the surgeon's technique needs to be evaluated and revised. The laparoscopic environment requires complex decision making, and novices are prone to errors in their decisions. The information elicited in this study is applicable to laparoscopic training.

Managing healthcare budgets in times of austerity: the role of program budgeting and marginal analysis.

PubMed

Mitton, Craig; Dionne, Francois; Donaldson, Cam

2014-04-01

Given limited resources, priority setting or choice making will remain a reality at all levels of publicly funded healthcare across countries for many years to come. The pressures may well be even more acute as the impact of the economic crisis of 2008 continues to play out but, even as economies begin to turn around, resources within healthcare will be limited, thus some form of rationing will be required. Over the last few decades, research on healthcare priority setting has focused on methods of implementation as well as on the development of approaches related to fairness and legitimacy and on more technical aspects of decision making including the use of multi-criteria decision analysis. Recently, research has led to better understanding of evaluating priority setting activity including defining 'success' and articulating key elements for high performance. This body of research, however, often goes untapped by those charged with making challenging decisions and as such, in line with prevailing public sector incentives, decisions are often reliant on historical allocation patterns and/or political negotiation. These archaic and ineffective approaches not only lead to poor decisions in terms of value for money but further do not reflect basic ethical conditions that can lead to fairness in the decision-making process. The purpose of this paper is to outline a comprehensive approach to priority setting and resource allocation that has been used in different contexts across countries. This will provide decision makers with a single point of access for a basic understanding of relevant tools when faced with having to make difficult decisions about what healthcare services to fund and what not to fund. The paper also addresses several key issues related to priority setting including how health technology assessments can be used, how performance can be improved at a practical level, and what ongoing resource management practice should look like. In terms of future research, one of the most important areas of priority setting that needs further attention is how best to engage public members.

Game Related Statistics Which Discriminate Between Winning and Losing Under-16 Male Basketball Games

PubMed Central

Lorenzo, Alberto; Gómez, Miguel Ángel; Ortega, Enrique; Ibáñez, Sergio José; Sampaio, Jaime

2010-01-01

The aim of the present study was to identify the game-related statistics which discriminate between winning and losing teams in under-16 years old male basketball games. The sample gathered all 122 games in the 2004 and 2005 Under-16 European Championships. The game-related statistics analysed were the free-throws (both successful and unsuccessful), 2- and 3-points field-goals (both successful and unsuccessful) offensive and defensive rebounds, blocks, assists, fouls, turnovers and steals. The winning teams exhibited lower ball possessions per game and better offensive and defensive efficacy coefficients than the losing teams. Results from discriminant analysis were statistically significant and allowed to emphasize several structure coefficients (SC). In close games (final score differences below 9 points), the discriminant variables were the turnovers (SC = -0.47) and the assists (SC = 0.33). In balanced games (final score differences between 10 and 29 points), the variables that discriminated between the groups were the successful 2-point field-goals (SC = -0.34) and defensive rebounds (SC = -0. 36); and in unbalanced games (final score differences above 30 points) the variables that best discriminated both groups were the successful 2-point field-goals (SC = 0.37). These results allowed understanding that these players' specific characteristics result in a different game-related statistical profile and helped to point out the importance of the perceptive and decision making process in practice and in competition. Key points The players' game-related statistical profile varied according to game type, game outcome and in formative categories in basketball. The results of this work help to point out the different player's performance described in U-16 men's basketball teams compared with senior and professional men's basketball teams. The results obtained enhance the importance of the perceptive and decision making process in practice and in competition. PMID:24149794

Key recovery factors for the August 24, 2014, South Napa Earthquake

USGS Publications Warehouse

Hudnut, Kenneth W.; Brocher, Thomas M.; Prentice, Carol S.; Boatwright, John; Brooks, Benjamin A.; Aagaard, Brad T.; Blair, James Luke; Fletcher, Jon Peter B.; Erdem, Jemile; Wicks, Chuck; Murray, Jessica R.; Pollitz, Fred F.; Langbein, John O.; Svarc, Jerry L.; Schwartz, David P.; Ponti, Daniel J.; Hecker, Suzanne; DeLong, Stephen B.; Rosa, Carla M.; Jones, Brenda; Lamb, Rynn M.; Rosinski, Anne M.; McCrink, Timothy P.; Dawson, Timothy E.; Seitz, Gordon G.; Glennie, Craig; Hauser, Darren; Ericksen, Todd; Mardock, Dan; Hoirup, Don F.; Bray, Jonathan D.; Rubin, Ron S.

2014-01-01

Through discussions between the Federal Emergency Management Agency (FEMA) and the U.S. Geological Survey (USGS) following the South Napa earthquake, it was determined that several key decision points would be faced by FEMA for which additional information should be sought and provided by USGS and its partners. This report addresses the four tasks that were agreed to. These tasks are (1) assessment of ongoing fault movement (called afterslip) especially in the Browns Valley residential neighborhood, (2) assessment of the shaking pattern in the downtown area of the City of Napa, (3) improvement of information on the fault hazards posed by the West Napa Fault System (record of past earthquakes and slip rate, for example), and (4) imagery acquisition and data processing to provide overall geospatial information support to FEMA.

Enhancing Collaborative Learning through Group Intelligence Software

NASA Astrophysics Data System (ADS)

Tan, Yin Leng; Macaulay, Linda A.

Employers increasingly demand not only academic excellence from graduates but also excellent interpersonal skills and the ability to work collaboratively in teams. This paper discusses the role of Group Intelligence software in helping to develop these higher order skills in the context of an enquiry based learning (EBL) project. The software supports teams in generating ideas, categorizing, prioritizing, voting and multi-criteria decision making and automatically generates a report of each team session. Students worked in a Group Intelligence lab designed to support both face to face and computer-mediated communication and employers provided feedback at two key points in the year long team project. Evaluation of the effectiveness of Group Intelligence software in collaborative learning was based on five key concepts of creativity, participation, productivity, engagement and understanding.

The use of color infrared photography for wetlands assessment

NASA Technical Reports Server (NTRS)

Enslin, W. R.; Sullivan, M. C.

1974-01-01

A study was undertaken of Pointe Mouillee Marsh, located on Lake Erie, to assess shoreline erosion and to inventory and evaluate adjacent land as potential replacement for areas lost to erosion, and to provide better data sources for management decisions. The results of the study were: (1) Evaluation of low altitude oblique photography was useful in determining specifications of operational mission requirements; (2) Accurate base map revisions, reflecting shoreline erosion, were made using aerial photography and a Zoom Transfer Scope; (3) An aerial land cover inventory provided data necessary for the selection of adjacent lands suitable for marshland development; (4) A detailed inventory of vegetative communities (mapped from CIR), was made for management decisions; and (5) A carefully selected and well laid-out transect was a key asset to photo interpretation and analysis of vegetation.

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

PubMed Central

2013-01-01

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

Establishing the effectiveness of patient decision aids: key constructs and measurement instruments

PubMed Central

2013-01-01

Background Establishing the effectiveness of patient decision aids (PtDA) requires evidence that PtDAs improve the quality of the decision-making process and the quality of the choice made, or decision quality. The aim of this paper is to review the theoretical and empirical evidence for PtDA effectiveness and discuss emerging practical and research issues in the measurement of effectiveness. Methods This updated overview incorporates: a) an examination of the instruments used to measure five key decision-making process constructs (i.e., recognize decision, feel informed about options and outcomes, feel clear about goals and preferences, discuss goals and preferences with health care provider, and be involved in decisions) and decision quality constructs (i.e., knowledge, realistic expectations, values-choice agreement) within the 86 trials in the Cochrane review; and b) a summary of the 2011 Cochrane Collaboration’s review of PtDAs for these key constructs. Data on the constructs and instruments used were extracted independently by two authors from the 86 trials and any disagreements were resolved by discussion, with adjudication by a third party where required. Results The 86 studies provide considerable evidence that PtDAs improve the decision-making process and decision quality. A majority of the studies (76/86; 88%) measured at least one of the key decision-making process or decision quality constructs. Seventeen different measurement instruments were used to measure decision-making process constructs, but no single instrument covered all five constructs. The Decisional Conflict Scale was most commonly used (n = 47), followed by the Control Preference Scale (n = 9). Many studies reported one or more constructs of decision quality, including knowledge (n = 59), realistic expectation of risks and benefits (n = 21), and values-choice agreement (n = 13). There was considerable variability in how values-choice agreement was defined and determined. No study reported on all key decision-making process and decision quality constructs. Conclusions Evidence of PtDA effectiveness in improving the quality of the decision-making process and decision quality is strong and growing. There is not, however, consensus or standardization of measurement for either the decision-making process or decision quality. Additional work is needed to develop and evaluate measurement instruments and further explore theoretical issues to advance future research on PtDA effectiveness. PMID:24625035

Establishing the effectiveness of patient decision aids: key constructs and measurement instruments.

PubMed

Sepucha, Karen R; Borkhoff, Cornelia M; Lally, Joanne; Levin, Carrie A; Matlock, Daniel D; Ng, Chirk Jenn; Ropka, Mary E; Stacey, Dawn; Joseph-Williams, Natalie; Wills, Celia E; Thomson, Richard

2013-01-01

Establishing the effectiveness of patient decision aids (PtDA) requires evidence that PtDAs improve the quality of the decision-making process and the quality of the choice made, or decision quality. The aim of this paper is to review the theoretical and empirical evidence for PtDA effectiveness and discuss emerging practical and research issues in the measurement of effectiveness. This updated overview incorporates: a) an examination of the instruments used to measure five key decision-making process constructs (i.e., recognize decision, feel informed about options and outcomes, feel clear about goals and preferences, discuss goals and preferences with health care provider, and be involved in decisions) and decision quality constructs (i.e., knowledge, realistic expectations, values-choice agreement) within the 86 trials in the Cochrane review; and b) a summary of the 2011 Cochrane Collaboration's review of PtDAs for these key constructs. Data on the constructs and instruments used were extracted independently by two authors from the 86 trials and any disagreements were resolved by discussion, with adjudication by a third party where required. The 86 studies provide considerable evidence that PtDAs improve the decision-making process and decision quality. A majority of the studies (76/86; 88%) measured at least one of the key decision-making process or decision quality constructs. Seventeen different measurement instruments were used to measure decision-making process constructs, but no single instrument covered all five constructs. The Decisional Conflict Scale was most commonly used (n = 47), followed by the Control Preference Scale (n = 9). Many studies reported one or more constructs of decision quality, including knowledge (n = 59), realistic expectation of risks and benefits (n = 21), and values-choice agreement (n = 13). There was considerable variability in how values-choice agreement was defined and determined. No study reported on all key decision-making process and decision quality constructs. Evidence of PtDA effectiveness in improving the quality of the decision-making process and decision quality is strong and growing. There is not, however, consensus or standardization of measurement for either the decision-making process or decision quality. Additional work is needed to develop and evaluate measurement instruments and further explore theoretical issues to advance future research on PtDA effectiveness.

36 CFR 1010.5 - Major decision points.

Code of Federal Regulations, 2010 CFR

2010-07-01

...-making process. Most Trust projects have three distinct stages in the decision-making process: (1... stage. (b) Environmental review will be integrated into the decision-making process of the Trust as... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Major decision points. 1010.5...

36 CFR 907.6 - Major decision points.

Code of Federal Regulations, 2010 CFR

2010-07-01

... decisionmaking process. For most Corporation projects there are three distinct stages in the decision making...) Implementation stage. (b) Environmental review will be integrated into the decision making process of the... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Major decision points. 907.6...

Making the business case for telemedicine: an interactive spreadsheet.

PubMed

McCue, Michael J; Palsbo, Susan E

2006-04-01

The objective of this study was to demonstrate the business case for telemedicine in nonrural areas. We developed an interactive spreadsheet to conduct multiple financial analyses under different capital investment, revenue, and expense scenarios. We applied the spreadsheet to the specific case of poststroke rehabilitation in urban settings. The setting involved outpatient clinics associated with a freestanding rehabilitation hospital in Oklahoma. Our baseline scenario used historical financial data from face-to-face encounters as the baseline for payer and volume mix. We assumed a cost of capital of 10% to finance the project. The outcome measures were financial breakeven points and internal rate of return. A total of 340 telemedicine visits will generate a positive net cash flow each year. The project is expected to recoup the initial investment by the fourth year, produce a positive present value dollar return of more than $2,000, and earn rate of return of 20%, which exceeds the hospital's cost of capital. The business case is demonstrated for this scenario. Urban telemedicine programs can be financially self-sustaining without accounting for reductions in travel time by providers or patients. Urban telemedicine programs can be a sound business investment and not depend on grants or subsidies for start-up funding. There are several key decision points that affect breakeven points and return on investment. The best business strategy is to approach the decision as whether or not to build a new clinic.

UK and Italian EIA systems: A comparative study on management practice and performance in the construction industry

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

Bassi, Andrea, E-mail: ab395@bath.co.uk; Howard, Robert, E-mail: robhoward@constcom.demon.co.uk; Geneletti, Davide, E-mail: davide.geneletti@ing.unitn.it

This study evaluates and contrasts the management practice and the performance that characterise Environmental Impact Assessments (EIA) in Italy and in the UK. The methodology relies on the investigation of six carefully selected case studies, critically reviewed by referring to EIA and project design information, as well as collecting the opinion of key project participants. The study focuses on the construction industry and on specific key sectors like infrastructure for transport and renewable energy and commercial and tourism development. A main term of reference for the analyses has been established by critically reviewing international literature so as to outline commonmore » good practice, requirements for the enhancement of sustainability principles and typically incurred drawbacks. The proposed approach enhances transfer of knowledge and of experiences between the analyzed contexts and allows the provision of guidelines for practitioners. Distinctive differences between the UK and the Italian EIA systems have been detected for pivotal phases and elements of EIA, like screening, scoping, analysis of alternatives and of potential impacts, definition of mitigation strategies, review, decision making, public participation and follow up. - Highlights: Black-Right-Pointing-Pointer The Italian and the UK Environmental Impact Assessment systems are compared. Black-Right-Pointing-Pointer The research is centred on the construction industry. Black-Right-Pointing-Pointer Issues and shortcomings are analysed by investigating six case studies. Black-Right-Pointing-Pointer Integration of EIA with sustainability principles is appraised. Black-Right-Pointing-Pointer General guidelines are provided to assist practitioners in the two national contexts.« less

Surveillance system for air pollutants by combination of the decision support system COMPAS and optical remote sensing systems

NASA Astrophysics Data System (ADS)

Flassak, Thomas; de Witt, Helmut; Hahnfeld, Peter; Knaup, Andreas; Kramer, Lothar

1995-09-01

COMPAS is a decision support system designed to assist in the assessment of the consequences of accidental releases of toxic and flammable substances. One of the key elements of COMPAS is a feedback algorithm which allows us to calculate the source term with the aid of concentration measurements. Up to now the feedback technique is applied to concentration measurements done with test tubes or conventional point sensors. In this paper the extension of the actual method is presented which is the combination of COMPAS and an optical remote sensing system like the KAYSER-THREDE K300 FTIR system. Active remote sensing methods based on FTIR are, among other applications, ideal for the so-called fence line monitoring of the diffuse emissions and accidental releases from industrial facilities, since from the FTIR spectra averaged concentration levels along the measurement path can be achieved. The line-averaged concentrations are ideally suited as on-line input for COMPAS' feedback technique. Uncertainties in the assessment of the source term related with both shortcomings of the dispersion model itself and also problems of a feedback strategy based on point measurements are reduced.

Local dynamics in decision making: The evolution of preference within and across decisions

NASA Astrophysics Data System (ADS)

O'Hora, Denis; Dale, Rick; Piiroinen, Petri T.; Connolly, Fionnuala

2013-07-01

Within decisions, perceived alternatives compete until one is preferred. Across decisions, the playing field on which these alternatives compete evolves to favor certain alternatives. Mouse cursor trajectories provide rich continuous information related to such cognitive processes during decision making. In three experiments, participants learned to choose symbols to earn points in a discrimination learning paradigm and the cursor trajectories of their responses were recorded. Decisions between two choices that earned equally high-point rewards exhibited far less competition than decisions between choices that earned equally low-point rewards. Using positional coordinates in the trajectories, it was possible to infer a potential field in which the choice locations occupied areas of minimal potential. These decision spaces evolved through the experiments, as participants learned which options to choose. This visualisation approach provides a potential framework for the analysis of local dynamics in decision-making that could help mitigate both theoretical disputes and disparate empirical results.

Misinterpretation of statistical distance in security of quantum key distribution shown by simulation

NASA Astrophysics Data System (ADS)

Iwakoshi, Takehisa; Hirota, Osamu

2014-10-01

This study will test an interpretation in quantum key distribution (QKD) that trace distance between the distributed quantum state and the ideal mixed state is a maximum failure probability of the protocol. Around 2004, this interpretation was proposed and standardized to satisfy both of the key uniformity in the context of universal composability and operational meaning of the failure probability of the key extraction. However, this proposal has not been verified concretely yet for many years while H. P. Yuen and O. Hirota have thrown doubt on this interpretation since 2009. To ascertain this interpretation, a physical random number generator was employed to evaluate key uniformity in QKD. In this way, we calculated statistical distance which correspond to trace distance in quantum theory after a quantum measurement is done, then we compared it with the failure probability whether universal composability was obtained. As a result, the degree of statistical distance of the probability distribution of the physical random numbers and the ideal uniformity was very large. It is also explained why trace distance is not suitable to guarantee the security in QKD from the view point of quantum binary decision theory.

A research protocol for developing a Point-Of-Care Key Evidence Tool 'POCKET': a checklist for multidimensional evidence reporting on point-of-care in vitro diagnostics.

PubMed

Huddy, Jeremy R; Ni, Melody; Mavroveli, Stella; Barlow, James; Williams, Doris-Ann; Hanna, George B

2015-07-10

Point-of-care in vitro diagnostics (POC-IVD) are increasingly becoming widespread as an acceptable means of providing rapid diagnostic results to facilitate decision-making in many clinical pathways. Evidence in utility, usability and cost-effectiveness is currently provided in a fragmented and detached manner that is fraught with methodological challenges given the disruptive nature these tests have on the clinical pathway. The Point-of-care Key Evidence Tool (POCKET) checklist aims to provide an integrated evidence-based framework that incorporates all required evidence to guide the evaluation of POC-IVD to meet the needs of policy and decisionmakers in the National Health Service (NHS). A multimethod approach will be applied in order to develop the POCKET. A thorough literature review has formed the basis of a robust Delphi process and validation study. Semistructured interviews are being undertaken with POC-IVD stakeholders, including industry, regulators, commissioners, clinicians and patients to understand what evidence is required to facilitate decision-making. Emergent themes will be translated into a series of statements to form a survey questionnaire that aims to reach a consensus in each stakeholder group to what needs to be included in the tool. Results will be presented to a workshop to discuss the statements brought forward and the optimal format for the tool. Once assembled, the tool will be field-tested through case studies to ensure validity and usability and inform refinement, if required. The final version will be published online with a call for comments. Limitations include unpredictable sample representation, development of compromise position rather than consensus, and absence of blinding in validation exercise. The Imperial College Joint Research Compliance Office and the Imperial College Hospitals NHS Trust R&D department have approved the protocol. The checklist tool will be disseminated through a PhD thesis, a website, peer-reviewed publication, academic conferences and formal presentations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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

PubMed

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

2011-08-01

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

Tips and Tricks of Incorporating Industry Standards into a Library Collection

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

Abbott, Jennifer; Sandberg, Tami

Professional literature on the incorporation of industry standards into a library collection is somewhat limited. The objective of this presentation is to discuss the intricate details of acquiring, managing, and delivering electronic industry standards to library patrons in a seamless manner. Lessons learned regarding vendor selection and license agreements will also be discussed. Results from a survey administer at the National Renewable Energy Laboratory will be used to analyze how collection policies can properly be developed to incorporate industry standards into a library setting. The key points of acquisition decisions, avoidance of liability issues, and cost will be addressed.

What to do now? How women with breast cancer make fertility preservation decisions.

PubMed

Snyder, Karrie Ann; Tate, Alexandra Lee

2013-07-01

There has been increased attention paid to cancer-related infertility and fertility preservation. However, how cancer patients decide whether or not to pursue fertility preservation has not been fully examined. The data come from 34 interviews with women in the USA diagnosed with breast cancer prior to 40 years of age who contemplated fertility preservation prior to cancer treatment. Fully transcribed interviews were coded through a three-staged inductive process. Three sets of factors that shaped the decision-making process of the respondents regarding fertility preservation treatment options were identified: perceived benefits (e.g. ability to use 'younger' eggs in the future), inhibiting concerns (e.g. success rates) and influential relationships (e.g. physicians, parents and partners). Respondents saw their main fertility preservation decision as choosing whether or not to pursue egg/embryo banking. The decision-making process was complicated and included both health-related and personal considerations, with many respondents reporting a lack of support services for fertility issues. Findings suggest that greater attention needs to be placed on presenting patients with a wider range of options. Those who counsel patients regarding fertility preservation decisions should be aware of the influence of relationship dynamics, broader health care concerns, and fertility histories on these decisions. KEY MESSAGE POINTS: While fertility preservation has garnered greater attention, less is known about how cancer patients make fertility preservation decisions. Despite the range of choices for fertility preservation, respondents identified egg/embryo banking as their primary option. Many factors outside of cancer concerns inhibit and facilitate fertility preservation decisions including fertility history and family relationship dynamics.

Project Delivery System Mode Decision Based on Uncertain AHP and Fuzzy Sets

NASA Astrophysics Data System (ADS)

Kaishan, Liu; Huimin, Li

2017-12-01

The project delivery system mode determines the contract pricing type, project management mode and the risk allocation among all participants. Different project delivery system modes have different characteristics and applicable scope. For the owners, the selection of the delivery mode is the key point to decide whether the project can achieve the expected benefits, it relates to the success or failure of project construction. Under the precondition of comprehensively considering the influence factors of the delivery mode, the model of project delivery system mode decision was set up on the basis of uncertain AHP and fuzzy sets, which can well consider the uncertainty and fuzziness when conducting the index evaluation and weight confirmation, so as to rapidly and effectively identify the most suitable delivery mode according to project characteristics. The effectiveness of the model has been verified via the actual case analysis in order to provide reference for the construction project delivery system mode.

[Consumer knowledge about dietary fibre -- Results of a national questionnaire survey].

PubMed

Szűcs, Viktória; Harangozó, Júlia; Guiné, Raquel P F

2016-02-21

Dietary fibres are key elements of healthy and balanced diet. The aim of the present study was to explore consumers' knowledge considering fibre, their role in the purchasing decisions, and the cognition of the currently used as well as the possible information sources to encourage the fibre consumption. A questionnaire survey was conducted with 303 respondents. Knowledge about the fibre sources has showed a kind of uncertainty of the respondents, while knowledge about their possible health effects was relatively profound. Internet appeared as a remarkable information source in the topic; however, results pointed out the importance of education, too. Participants more often consuming foodstuffs rich in fibre, women and respondents over 45 years old showed conscious attitudes regarding fibres. Guidelines and education containing authentic information and practical elements are essential, and as a result, consumers' latent knowledge will appear in their conscious food choice decisions.

Wind Turbine Contingency Control Through Generator De-Rating

NASA Technical Reports Server (NTRS)

Frost, Susan; Goebel, Kai; Balas, Mark

2013-01-01

Maximizing turbine up-time and reducing maintenance costs are key technology drivers for wind turbine operators. Components within wind turbines are subject to considerable stresses due to unpredictable environmental conditions resulting from rapidly changing local dynamics. In that context, systems health management has the aim to assess the state-of-health of components within a wind turbine, to estimate remaining life, and to aid in autonomous decision-making to minimize damage to the turbine. Advanced contingency control is one way to enable autonomous decision-making by providing the mechanism to enable safe and efficient turbine operation. The work reported herein explores the integration of condition monitoring of wind turbines with contingency control to balance the trade-offs between maintaining system health and energy capture. The contingency control involves de-rating the generator operating point to achieve reduced loads on the wind turbine. Results are demonstrated using a high fidelity simulator of a utility-scale wind turbine.

Decision-making patterns for dietary supplement purchases among women aged 25 to 45 years.

PubMed

Miller, Carla K; Russell, Teri; Kissling, Grace

2003-11-01

Women frequently consume dietary supplements but the criteria used to select supplements have received little investigation. This research identified the decision-making criteria used for dietary supplements among women aged 25 to 45 years who consumed a supplement at least four times per week. Participants (N=51) completed an in-store shopping interview that was audiotaped, transcribed, and analyzed qualitatively for the criteria used to make supplement selections. Qualitative analysis revealed 10 key criteria and the number of times each person used each criterion was quantified. Cluster analysis identified five homogeneous subgroups of participants based on the criteria used. These included brand shopper, bargain shopper, quality shopper, convenience shopper, and information gatherer. Supplement users vary in the criteria used to make point-of-purchase supplement selections. Dietetics professionals can classify supplement users according to the criteria used to tailor their nutrition counseling and better meet the educational needs of consumers.

Extending the boundaries of the Declaration of Helsinki: a case study of an unethical experiment in a non-medical setting

PubMed Central

Richter, E.; Barach, P.; Berman, T.; Ben-David, G; Weinberger, Z.

2001-01-01

To examine the ethical issues involved in governmental decisions with potential health risks, we review the history of the decision to raise the interurban speed limit in Israel in light of its impact on road death and injury. In 1993, the Israeli Ministry of Transportation initiated an "experiment" to raise the interurban speed limit from 90 to 100 kph. The "experiment" did not include a protocol and did not specify cut-off points for early termination in the case of adverse results. After the raise in the speed limit, the death toll on interurban roads rose as a result of a sudden increase in speeds and case fatality rates. The committee's decision is a case study in unfettered human experimentation and public health risks when the setting is non-medical and lacks a defined ethical framework. The case study states the case for extending Helsinki type safeguards to experimentation in non-medical settings. Key Words: Declaration of Helsinki • human experimentation • speed limit PMID:11314157

You Can't Think and Hit at the Same Time: Neural Correlates of Baseball Pitch Classification.

PubMed

Sherwin, Jason; Muraskin, Jordan; Sajda, Paul

2012-01-01

Hitting a baseball is often described as the most difficult thing to do in sports. A key aptitude of a good hitter is the ability to determine which pitch is coming. This rapid decision requires the batter to make a judgment in a fraction of a second based largely on the trajectory and spin of the ball. When does this decision occur relative to the ball's trajectory and is it possible to identify neural correlates that represent how the decision evolves over a split second? Using single-trial analysis of electroencephalography (EEG) we address this question within the context of subjects discriminating three types of pitches (fastball, curveball, slider) based on pitch trajectories. We find clear neural signatures of pitch classification and, using signal detection theory, we identify the times of discrimination on a trial-to-trial basis. Based on these neural signatures we estimate neural discrimination distributions as a function of the distance the ball is from the plate. We find all three pitches yield unique distributions, namely the timing of the discriminating neural signatures relative to the position of the ball in its trajectory. For instance, fastballs are discriminated at the earliest points in their trajectory, relative to the two other pitches, which is consistent with the need for some constant time to generate and execute the motor plan for the swing (or inhibition of the swing). We also find incorrect discrimination of a pitch (errors) yields neural sources in Brodmann Area 10, which has been implicated in prospective memory, recall, and task difficulty. In summary, we show that single-trial analysis of EEG yields informative distributions of the relative point in a baseball's trajectory when the batter makes a decision on which pitch is coming.

Countermeasure development using a formalised metric-based process

NASA Astrophysics Data System (ADS)

Barker, Laurence

2008-10-01

Guided weapons, are a potent threat to both air and surface platforms; to protect the platform, Countermeasures are often used to disrupt the operation of the tracking system. Development of effective techniques to defeat the guidance sensors is a complex activity. The countermeasure often responds to the behaviour of a responsive sensor system, creating a "closed loop" interaction. Performance assessment is difficult, and determining that enough knowledge exists to make a case that a platform is adequately protected is challenging. A set of metrics known as Countermeasure Confidence Levels (CCL) is described. These set out a measure of confidence in prediction of Countermeasure performance. The CCL scale provides, for the first time, a method to determine whether enough evidence exists to support development activity and introduction to operational service. Application of the CCL scale to development of a hypothetical countermeasure is described. This tracks how the countermeasure is matured from initial concept to in-service application. The purpose of each stage is described, together with a description of what work is likely to be needed. This will involve timely use of analysis, simulation, laboratory work and field testing. The use of the CCL scale at key decision points is described. These include procurement decision points, and entry-to-service decisions. Each stage requires collection of evidence of effectiveness. Completeness of the available evidence can be assessed, and duplication can be avoided. Read-across between concepts, weapon systems and platforms can be addressed and the impact of technology insertion can be assessed.

Return of the JITAI: Applying a Just-in-Time Adaptive Intervention Framework to the Development of m-Health Solutions for Addictive Behaviors

PubMed Central

Evans, Brittney C.; Flack, Daniel; Juarascio, Adrienne; Manasse, Stephanie; Zhang, Fengqing; Forman, Evan M.

2018-01-01

Purpose Lapses are strong indicators of later relapse among individuals with addictive disorders, and thus are an important intervention target. However, lapse behavior has proven resistant to change due to the complex interplay of lapse triggers that are present in everyday life. It could be possible to prevent lapses before they occur by using m-Health solutions to deliver interventions in real-time. Method Just-in-time adaptive intervention (JITAI) is an intervention design framework that could be delivered via mobile app to facilitate in-the-moment monitoring of triggers for lapsing, and deliver personalized coping strategies to the user to prevent lapses from occurring. An organized framework is key for successful development of a JITAI. Results Nahum-Shani and colleagues (2014) set forth six core elements of a JITAI and guidelines for designing each: distal outcomes, proximal outcomes, tailoring variables, decision points, decision rules, and intervention options. The primary aim of this paper is to illustrate the use of this framework as it pertains to developing a JITAI that targets lapse behavior among individuals following a weight control diet. Conclusion We will detail our approach to various decision points during the development phases, report on preliminary findings where applicable, identify problems that arose during development, and provide recommendations for researchers who are currently undertaking their own JITAI development efforts. Issues such as missing data, the rarity of lapses, advantages/disadvantages of machine learning, and user engagement are discussed. PMID:28083725

Return of the JITAI: Applying a Just-in-Time Adaptive Intervention Framework to the Development of m-Health Solutions for Addictive Behaviors.

PubMed

Goldstein, Stephanie P; Evans, Brittney C; Flack, Daniel; Juarascio, Adrienne; Manasse, Stephanie; Zhang, Fengqing; Forman, Evan M

2017-10-01

Lapses are strong indicators of later relapse among individuals with addictive disorders, and thus are an important intervention target. However, lapse behavior has proven resistant to change due to the complex interplay of lapse triggers that are present in everyday life. It could be possible to prevent lapses before they occur by using m-Health solutions to deliver interventions in real-time. Just-in-time adaptive intervention (JITAI) is an intervention design framework that could be delivered via mobile app to facilitate in-the-moment monitoring of triggers for lapsing, and deliver personalized coping strategies to the user to prevent lapses from occurring. An organized framework is key for successful development of a JITAI. Nahum-Shani and colleagues (2014) set forth six core elements of a JITAI and guidelines for designing each: distal outcomes, proximal outcomes, tailoring variables, decision points, decision rules, and intervention options. The primary aim of this paper is to illustrate the use of this framework as it pertains to developing a JITAI that targets lapse behavior among individuals following a weight control diet. We will detail our approach to various decision points during the development phases, report on preliminary findings where applicable, identify problems that arose during development, and provide recommendations for researchers who are currently undertaking their own JITAI development efforts. Issues such as missing data, the rarity of lapses, advantages/disadvantages of machine learning, and user engagement are discussed.

Medical technology as a key driver of rising health expenditure: disentangling the relationship

PubMed Central

Sorenson, Corinna; Drummond, Michael; Bhuiyan Khan, Beena

2013-01-01

Health care spending has risen steadily in most countries, becoming a concern for decision-makers worldwide. Commentators often point to new medical technology as the key driver for burgeoning expenditures. This paper critically appraises this conjecture, based on an analysis of the existing literature, with the aim of offering a more detailed and considered analysis of this relationship. Several databases were searched to identify relevant literature. Various categories of studies (eg, multivariate and cost-effectiveness analyses) were included to cover different perspectives, methodological approaches, and issues regarding the link between medical technology and costs. Selected articles were reviewed and relevant information was extracted into a standardized template and analyzed for key cross-cutting themes, ie, impact of technology on costs, factors influencing this relationship, and methodological challenges in measuring such linkages. A total of 86 studies were reviewed. The analysis suggests that the relationship between medical technology and spending is complex and often conflicting. Findings were frequently contingent on varying factors, such as the availability of other interventions, patient population, and the methodological approach employed. Moreover, the impact of technology on costs differed across technologies, in that some (eg, cancer drugs, invasive medical devices) had significant financial implications, while others were cost-neutral or cost-saving. In light of these issues, we argue that decision-makers and other commentators should extend their focus beyond costs solely to include consideration of whether medical technology results in better value in health care and broader socioeconomic benefits. PMID:23807855

Funding Decisions for Newborn Screening: A Comparative Review of 22 Decision Processes in Europe

PubMed Central

Fischer, Katharina Elisabeth; Rogowski, Wolf Henning

2014-01-01

Decision-makers need to make choices to improve public health. Population-based newborn screening (NBS) is considered as one strategy to prevent adverse health outcomes and address rare disease patients’ needs. The aim of this study was to describe key characteristics of decisions for funding new NBS programmes in Europe. We analysed past decisions using a conceptual framework. It incorporates indicators that capture the steps of decision processes by health care payers. Based on an internet survey, we compared 22 decisions for which answers among two respondents were validated for each observation. The frequencies of indicators were calculated to elicit key characteristics. All decisions resulted in positive, mostly unrestricted funding. Stakeholder participation was diverse focusing on information provision or voting. Often, decisions were not fully transparent. Assessment of NBS technologies concentrated on expert opinion, literature review and rough cost estimates. Most important appraisal criteria were effectiveness (i.e., health gain from testing for the children being screened), disease severity and availability of treatments. Some common and diverging key characteristics were identified. Although no evidence of explicit healthcare rationing was found, processes may be improved in respect of transparency and scientific rigour of assessment. PMID:24852389

Information Needs of Older Women With Early-Stage Breast Cancer When Making Radiation Therapy Decisions.

PubMed

Wang, Shi-Yi; Kelly, Gabrielle; Gross, Cary; Killelea, Brigid K; Mougalian, Sarah; Presley, Carolyn; Fraenkel, Liana; Evans, Suzanne B

2017-07-15

To identify the information older women with early-stage breast cancer need when making radiation therapy decisions, and who patients identify as the main decision maker. We surveyed (through face-to-face interview, telephone, or mail) women aged ≥65 years who received lumpectomy and were considering or receiving adjuvant radiation therapy for early-stage breast cancer. The survey instrument was constructed with input from patient and professional advisory committees, including breast cancer survivors, advocates of breast cancer care and aging, clinicians, and researchers. Participants rated the importance (on a 4-point scale) of 24 statements describing the benefits, side effects, impact on daily life, and other issues of radiation therapy in relation to radiation therapy decision making. Participants also designated who was considered the key decision maker. The response rate was 56.4% (93 of 165). Mean age was 72.5 years, ranging from 65 to 93 years. More than 96% of participants indicated they were the main decision maker on receiving radiation therapy. There was wide variation in information needs regarding radiation therapy decision making. Participants rated a mean of 18 (range, 3-24) items as "essential." Participants rated items related to benefits highest, followed by side effects. Participants who were older than 75 years rated 13.9 questions as essential, whereas participants aged ≤74 years rated 18.7 as essential (P=.018). Older women desire information and have more agency and input in the decision-making process than prior literature would suggest. The variation in information needs indicates that future decision support tools should provide options to select what information would be of interest to the participants. Copyright © 2017 Elsevier Inc. All rights reserved.

Right choice, right time: Evaluation of an online decision aid for youth depression.

PubMed

Simmons, Magenta B; Elmes, Aurora; McKenzie, Joanne E; Trevena, Lyndal; Hetrick, Sarah E

2017-08-01

Appropriate treatment for youth depression is an important public health priority. Shared decision making has been recommended, yet no decision aids exist to facilitate this. The main objective of this study was to evaluate an online decision aid for youth depression. An uncontrolled cohort study with pre-decision, immediately post-decision and follow-up measurements. Young people (n=66) aged 12-25 years with mild, mild-moderate or moderate-severe depression were recruited from two enhanced primary care services. Online decision aid with evidence communication, preference elicitation and decision support components. The main outcome measures were ability to make a decision; whether the decision was in line with clinical practice guidelines, personal preferences and values; decisional conflict; perceived involvement; satisfaction with decision; adherence; and depression scores at follow-up. After using the decision aid, clients were more likely to make a decision in line with guideline recommendations (93% vs 70%; P=.004), were more able to make a decision (97% vs 79%; P=.022), had significantly reduced decisional conflict (17.8 points lower (95% CI: 13.3-22.9 points lower) on the Decisional Conflict Scale (range 0-100)) and felt involved and satisfied with their decision. At follow-up, clients had significantly reduced depression symptoms (2.7 points lower (95% CI: 1.3-4.0 points lower) on the Patient Health Questionnaire nine-item scale (range 0-27)) and were adherent to 88% (95% CI: 82%-94%) of treatment courses. A decision aid for youth depression can help ensure evidence-based, client-centred care, promoting collaboration in this often difficult to engage population. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Biological, developmental, and neurobehavioral factors relevant to adolescent driving risks.

PubMed

Dahl, Ronald E

2008-09-01

This article reviews emerging knowledge about key aspects of neurobehavioral development, with an emphasis on the development of self-regulation over behavior and emotions and its relevance to driving risks among youth. It begins with a brief overview of recent advances in understanding adolescent brain maturation and presents a heuristic model focusing on brain-behavior-social-context interactions during adolescent development. The article considers the relatively slow neurobehavioral maturation of cognitive control and emphasizes the importance of affective influences on decision making. It points to several questions about programs and policies that may help to protect high-risk youth during this important maturational period. The heuristic model is then used to examine a specific neuroregulatory system during adolescence--the regulation of sleep and arousal. This focus on sleep illustrates key points about brain-behavior-social-context interactions by looking at both biological and social influences on sleep in teens. Moreover, sleep has direct relevance to understanding a specific dimension of driving risk in youth. Sleep deprivation is rampant among adolescents, and the consequences of insufficient sleep (sleepiness, lapses in attention, susceptibility to aggression, and negative synergy with alcohol) appear to contribute significantly to driving risks in teens.

Assessing the teaching of procedural skills: can cognitive task analysis add to our traditional teaching methods?

PubMed

Sullivan, Maura E; Ortega, Adrian; Wasserberg, Nir; Kaufman, Howard; Nyquist, Julie; Clark, Richard

2008-01-01

The purpose of this study was to determine if a cognitive task analysis (CTA) could capture steps and decision points that were not articulated during traditional teaching of a colonoscopy. Three expert colorectal surgeons were videotaped performing a colonoscopy. After the videotapes were transcribed, the experts participated in a CTA. A 26-step procedural checklist and a 16-step cognitive demands table was created by using information obtained in the CTA. The videotape transcriptions were transposed onto the procedural checklist and cognitive demands table to identify steps and decision points that were omitted during traditional teaching. Surgeon A described 50% of "how-to" steps and 43% of decision points. Surgeon B described 30% of steps and 25% of decisions. Surgeon C described 26% of steps and 38% of cognitive decisions. By using CTA, we were able to identify relevant steps and decision points that were omitted during traditional teaching by all 3 experts.

The STARTEC Decision Support Tool for Better Tradeoffs between Food Safety, Quality, Nutrition, and Costs in Production of Advanced Ready-to-Eat Foods.

PubMed

Skjerdal, Taran; Gefferth, Andras; Spajic, Miroslav; Estanga, Edurne Gaston; de Cecare, Alessandra; Vitali, Silvia; Pasquali, Frederique; Bovo, Federica; Manfreda, Gerardo; Mancusi, Rocco; Trevisiani, Marcello; Tessema, Girum Tadesse; Fagereng, Tone; Moen, Lena Haugland; Lyshaug, Lars; Koidis, Anastasios; Delgado-Pando, Gonzalo; Stratakos, Alexandros Ch; Boeri, Marco; From, Cecilie; Syed, Hyat; Muccioli, Mirko; Mulazzani, Roberto; Halbert, Catherine

2017-01-01

A prototype decision support IT-tool for the food industry was developed in the STARTEC project. Typical processes and decision steps were mapped using real life production scenarios of participating food companies manufacturing complex ready-to-eat foods. Companies looked for a more integrated approach when making food safety decisions that would align with existing HACCP systems. The tool was designed with shelf life assessments and data on safety, quality, and costs, using a pasta salad meal as a case product. The process flow chart was used as starting point, with simulation options at each process step. Key parameters like pH, water activity, costs of ingredients and salaries, and default models for calculations of Listeria monocytogenes , quality scores, and vitamin C, were placed in an interactive database. Customization of the models and settings was possible on the user-interface. The simulation module outputs were provided as detailed curves or categorized as "good"; "sufficient"; or "corrective action needed" based on threshold limit values set by the user. Possible corrective actions were suggested by the system. The tool was tested and approved by end-users based on selected ready-to-eat food products. Compared to other decision support tools, the STARTEC-tool is product-specific and multidisciplinary and includes interpretation and targeted recommendations for end-users.

The STARTEC Decision Support Tool for Better Tradeoffs between Food Safety, Quality, Nutrition, and Costs in Production of Advanced Ready-to-Eat Foods

PubMed Central

Gefferth, Andras; Spajic, Miroslav; Estanga, Edurne Gaston; Vitali, Silvia; Pasquali, Frederique; Bovo, Federica; Manfreda, Gerardo; Mancusi, Rocco; Tessema, Girum Tadesse; Fagereng, Tone; Moen, Lena Haugland; Lyshaug, Lars; Koidis, Anastasios; Delgado-Pando, Gonzalo; Stratakos, Alexandros Ch.; Boeri, Marco; From, Cecilie; Syed, Hyat; Muccioli, Mirko; Mulazzani, Roberto; Halbert, Catherine

2017-01-01

A prototype decision support IT-tool for the food industry was developed in the STARTEC project. Typical processes and decision steps were mapped using real life production scenarios of participating food companies manufacturing complex ready-to-eat foods. Companies looked for a more integrated approach when making food safety decisions that would align with existing HACCP systems. The tool was designed with shelf life assessments and data on safety, quality, and costs, using a pasta salad meal as a case product. The process flow chart was used as starting point, with simulation options at each process step. Key parameters like pH, water activity, costs of ingredients and salaries, and default models for calculations of Listeria monocytogenes, quality scores, and vitamin C, were placed in an interactive database. Customization of the models and settings was possible on the user-interface. The simulation module outputs were provided as detailed curves or categorized as “good”; “sufficient”; or “corrective action needed” based on threshold limit values set by the user. Possible corrective actions were suggested by the system. The tool was tested and approved by end-users based on selected ready-to-eat food products. Compared to other decision support tools, the STARTEC-tool is product-specific and multidisciplinary and includes interpretation and targeted recommendations for end-users. PMID:29457031

Decision making and effort in the self-regulation of hypertension: testing two competing theories.

PubMed

Taylor, Stephanie D; Bagozzi, Richard P; Gaither, Caroline A

2005-11-01

We compare the ability of two social psychological models to explain self-regulation decisions to control hypertension by 208 patients at a hospital clinic: the theory of planned behaviour (TPB) and the model of goal-directed behaviour (MGB). The sample was drawn from patients at a large research hospital in North America. The findings show that the MGB not only explains significantly more variance in decision making than the TPB, but it provides an account for how reasons for acting become integrated and transformed into intentions to act, which the TPB does not address. The MGB does this in part by introducing the variable, desire, as an essential mediator between reasons for acting and intentions. The MGB also incorporates the effects of anticipated emotions on decision making, which are forms of forward-looking counterfactual thinking with respect to goals. In addition, the present study reconceptualized instrumental behaviour to encompass how hard one tries to act in the senses of (1) devoting time to planning with respect to reducing/maintaining blood pressure, (2) expending mental/physical energy to reduce/maintain blood pressure, (3) maintaining will power to reduce/maintain blood pressure, and (4) sustaining self-discipline (e.g. in overcoming obstacles) to reduce/maintain blood pressure. Key differences, as well as commonalities, in decision making are pointed-out between men and women and between people whose goal is to reduce versus maintain blood pressure.

Deciding Where to Turn: A Qualitative Investigation of College Students' Helpseeking Decisions After Sexual Assault.

PubMed

DeLoveh, Heidi L M; Cattaneo, Lauren Bennett

2017-03-01

Sexual assault is a widespread problem on college campuses that has been the subject of substantial attention in recent years (Ali, 2011; Krebs, Lindquist, Berzofsky, Shook-Sa, & Peterson, 2016). Resources designed to address the problem exist, but there is evidence that they are underutilized by survivors (Campbell, 2008). The current study used grounded theory to explore how sexual assault survivors make decisions about helpseeking. In-depth interviews were conducted with 14 college sexual assault survivors to develop a theoretical model for their decision-making process. The resulting model, Deciding Where to Turn, suggests that survivors engage in three key decision points: determining if there is a problem related to the sexual assault (Do I Need Help), considering options (What Can I Do), and weighing the consequences of these options (What Will I Do). This process results in one of four behavioral choices: cope on one's own, seek support from friends/family, seek support from formal resources, or covert helpseeking, where needs are met without disclosure. Deciding Where to Turn contributes to the literature by providing a framework for understanding helpseeking decisions after sexual assault, highlighting the need to match reactions to survivor perceptions. The concept of covert helpseeking in particular adds to the way researchers and practitioners think about helpseeking. Research and practice implications are discussed. © Society for Community Research and Action 2017.

[Mechanisms for allocating financial resources after decentralization in the state of Jalisco].

PubMed

Pérez-Núñez, Ricardo; Arredondo-López, Armando; Pelcastre, Blanca

2006-01-01

To analyze, from the decision maker's perspective, the financial resource allocation process of the health services of the state of Jalisco (SSJ, per its abbreviation in spanish), within the context of decentralization. Through a qualitative approximation using semi-structured individual interviews of key personnel in managerial positions as the method for compiling information, the experience of the SSJ in financial resource allocation was documented. From September to November 2003, the perception of managers and administrators regarding their level of autonomy in decision-making was explored as well as the process they follow for the allocation of financial resources, in order to identify the criteria they use and their justifications. From the point of view of decision-makers, autonomy of the SSJ has increased considerably since decentralization was implemented, although the degree of decision-making freedom remains limited due mainly to high adminstrative costs associated with salaries. In this sense, the implications attributable to labor situations that are still centralized are evident. Some innovative systems for financial resource allocation have been established in the SSJ for the sanitary regions and hospitals based upon administrative-managerial and productivity incentives. Adjustments were also made for degree of marginalization and population lag, under the equity criterion. General work conditions and decision-making autonomy of the sanitary regions constitute outstanding aspects pending decentralization. Although decentralization has granted more autonomy to the SSJ, the level of decision-making freedom for allocating financial resources has been held within the highest hierarchical levels.

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

PubMed Central

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

2017-01-01

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

Systematic review of interventions to improve appropriate use and outcomes associated with do-not-attempt-cardiopulmonary-resuscitation decisions.

PubMed

Field, Richard A; Fritz, Zoë; Baker, Annalie; Grove, Amy; Perkins, Gavin D

2014-11-01

The treatment for a cardiac arrest, cardiopulmonary resuscitation (CPR), may be lifesaving following an acute, potentially reversible illness. Yet this treatment is unlikely to be effective if cardiac arrest occurs as part of the dying process towards the end of a person's natural life. Do not attempt CPR (DNACPR) decisions allow resuscitation to be withheld when it has little chance of success, or where the patient, or those close to the patient, indicate the burdens of CPR outweigh the benefits. This review sought to identify evidence for systems that improve the appropriate use of DNACPR decisions. Electronic databases were searched (Medline, CINAHL and Embase) for English language articles from 2001 to 2014. 4090 citations were identified of which 37 studies were relevant. The overall quality of evidence was moderate to poor. Thematic synthesis identified key interventions which may improve DNACPR decision making. The most promising interventions involved structured discussion at the time of acute admission to hospital and review by specialist teams at the point of an acute deterioration. Linking DNACPR decisions to discussions about overall treatment plans provided greater clarity about goals of care, aided communication between clinicians and reduced harms. Standardised documentation proved helpful for improving the frequency and quality of recording DNACPR decisions. Patient and clinician education in isolation were associated with limited or no effects. Relatively simple process changes may enhance the appropriate use of and outcomes associated with DNACPR decisions. Systematic review registration number: PROSPERO2012:CRD42012002669. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Misconceptions and biases in German students' perception of multiple energy sources: implications for science education

NASA Astrophysics Data System (ADS)

Lee, Roh Pin

2016-04-01

Misconceptions and biases in energy perception could influence people's support for developments integral to the success of restructuring a nation's energy system. Science education, in equipping young adults with the cognitive skills and knowledge necessary to navigate in the confusing energy environment, could play a key role in paving the way for informed decision-making. This study examined German students' knowledge of the contribution of diverse energy sources to their nation's energy mix as well as their affective energy responses so as to identify implications for science education. Specifically, the study investigated whether and to what extent students hold mistaken beliefs about the role of multiple energy sources in their nation's energy mix, and assessed how misconceptions could act as self-generated reference points to underpin support/resistance of proposed developments. An in-depth analysis of spontaneous affective associations with five key energy sources also enabled the identification of underlying concerns driving people's energy responses and facilitated an examination of how affective perception, in acting as a heuristic, could lead to biases in energy judgment and decision-making. Finally, subgroup analysis differentiated by education and gender supported insights into a 'two culture' effect on energy perception and the challenge it poses to science education.

Knowledge Management Implementation and the Tools Utilized in Healthcare for Evidence-Based Decision Making: A Systematic Review.

PubMed

Shahmoradi, Leila; Safadari, Reza; Jimma, Worku

2017-09-01

Healthcare is a knowledge driven process and thus knowledge management and the tools to manage knowledge in healthcare sector are gaining attention. The aim of this systematic review is to investigate knowledge management implementation and knowledge management tools used in healthcare for informed decision making. Three databases, two journals websites and Google Scholar were used as sources for the review. The key terms used to search relevant articles include: "Healthcare and Knowledge Management"; "Knowledge Management Tools in Healthcare" and "Community of Practices in healthcare". It was found that utilization of knowledge management in healthcare is encouraging. There exist numbers of opportunities for knowledge management implementation, though there are some barriers as well. Some of the opportunities that can transform healthcare are advances in health information and communication technology, clinical decision support systems, electronic health record systems, communities of practice and advanced care planning. Providing the right knowledge at the right time, i.e., at the point of decision making by implementing knowledge management in healthcare is paramount. To do so, it is very important to use appropriate tools for knowledge management and user-friendly system because it can significantly improve the quality and safety of care provided for patients both at hospital and home settings.

Decision PBL: A 4-year retrospective case study of the use of virtual patients in problem-based learning.

PubMed

Ellaway, Rachel H; Poulton, Terry; Jivram, Trupti

2015-01-01

In 2009, St George's University of London (SGUL) replaced their paper-based problem-based learning (PBL) cases with virtual patients for intermediate-level undergraduate students. This involved the development of Decision-Problem-Based Learning (D-PBL), a variation on progressive-release PBL that uses virtual patients instead of paper cases, and focuses on patient management decisions and their consequences. Using a case study method, this paper describes four years of developing and running D-PBL at SGUL from individual activities up to the ways in which D-PBL functioned as an educational system. A number of broad issues were identified: the importance of debates and decision-making in making D-PBL activities engaging and rewarding; the complexities of managing small group dynamics; the time taken to complete D-PBL activities; the changing role of the facilitator; and the erosion of the D-PBL process over time. A key point in understanding this work is the construction and execution of the D-PBL activity, as much of the value of this approach arises from the actions and interactions of students, their facilitators and the virtual patients rather than from the design of the virtual patients alone. At a systems level D-PBL needs to be periodically refreshed to retain its effectiveness.

Prefrontal cortical BDNF: A regulatory key in cocaine- and food-reinforced behaviors

PubMed Central

Pitts, Elizabeth G.; Taylor, Jane R.; Gourley, Shannon L.

2016-01-01

Brain-derived neurotrophic factor (BDNF) affects synaptic plasticity and neural structure and plays key roles in learning and memory processes. Recent evidence also points to important, yet complex, roles for BDNF in rodent models of cocaine abuse and addiction. Here we examine the role of prefrontal cortical (PFC) BDNF in reward-related decision making and behavioral sensitivity to, and responding for, cocaine. We focus on BDNF within the medial and orbital PFC, its regulation by cocaine during early postnatal development and in adulthood, and how BDNF in turn influences responding for drug reinforcement, including in reinstatement models. When relevant, we draw comparisons and contrasts with experiments using natural (food) reinforcers. We also summarize findings supporting, or refuting, the possibility that BDNF in the medial and orbital PFC regulate the development and maintenance of stimulus-response habits. Further investigation could assist in the development of novel treatment approaches for cocaine use disorders. PMID:26923993

Practical Communication Guidance to Improve Phase I Informed Consent Conversations and Decision-Making in Pediatric Oncology

PubMed Central

Johnson, Liza-Marie; Leek, Angela C.; Drotar, Dennis; Noll, Robert B.; Rheingold, Susan R.; Kodish, Eric D.; Baker, Justin N.

2015-01-01

Background It can be difficult to explain pediatric Phase I oncology trials to families of children with refractory cancer. Parents may misunderstand the information presented to them, and physicians may assume that certain topics are covered in the informed consent document and need not be discussed. Communication models can help to ensure effective discussions. Methods Suggestions for improving the informed consent process were first solicited from Phase I study clinicians via questionnaire. Eight parents who had enrolled their child on a Phase I pediatric oncology trial were recruited for an advisory group designed to assess the clinicians’ suggestions and make additional recommendations for improving informed consent for pediatric Phase I trials. Results A Phase I Communication Model was designed to incorporate the suggestions of clinicians and families. It focuses on education of parents/families about Phase I trials at specific time points during a child’s illness, but specifically at the point of relapse. We also present an informative Phase I fact sheet that can be distributed to families. Conclusions Families who will be offered information about a Phase I clinical trial can first receive a standardized fact sheet explaining the general purpose of these early-phase clinical trials. Parental understanding may be further enhanced when oncologists address key themes, beginning at diagnosis and continuing through important decision points during the child’s illness. This model should be prospectively evaluated. PMID:25873253

Solving multi-objective optimization problems in conservation with the reference point method

PubMed Central

Dujardin, Yann; Chadès, Iadine

2018-01-01

Managing the biodiversity extinction crisis requires wise decision-making processes able to account for the limited resources available. In most decision problems in conservation biology, several conflicting objectives have to be taken into account. Most methods used in conservation either provide suboptimal solutions or use strong assumptions about the decision-maker’s preferences. Our paper reviews some of the existing approaches to solve multi-objective decision problems and presents new multi-objective linear programming formulations of two multi-objective optimization problems in conservation, allowing the use of a reference point approach. Reference point approaches solve multi-objective optimization problems by interactively representing the preferences of the decision-maker with a point in the criteria (objectives) space, called the reference point. We modelled and solved the following two problems in conservation: a dynamic multi-species management problem under uncertainty and a spatial allocation resource management problem. Results show that the reference point method outperforms classic methods while illustrating the use of an interactive methodology for solving combinatorial problems with multiple objectives. The method is general and can be adapted to a wide range of ecological combinatorial problems. PMID:29293650

12 CFR 1815.105 - Major decision points.

Code of Federal Regulations, 2012 CFR

2012-01-01

... ENVIRONMENTAL QUALITY § 1815.105 Major decision points. (a) The possible environmental effects of an Application... decisionmaking process: (1) Preliminary approval stage, at which point applications are selected for funding; and (2) Final approval and funding stage. (b) Environmental review shall be integrated into the...

12 CFR 1815.105 - Major decision points.

Code of Federal Regulations, 2010 CFR

2010-01-01

... ENVIRONMENTAL QUALITY § 1815.105 Major decision points. (a) The possible environmental effects of an Application... decisionmaking process: (1) Preliminary approval stage, at which point applications are selected for funding; and (2) Final approval and funding stage. (b) Environmental review shall be integrated into the...

12 CFR 1815.105 - Major decision points.

Code of Federal Regulations, 2014 CFR

2014-01-01

... ENVIRONMENTAL QUALITY § 1815.105 Major decision points. (a) The possible environmental effects of an Application... decisionmaking process: (1) Preliminary approval stage, at which point applications are selected for funding; and (2) Final approval and funding stage. (b) Environmental review shall be integrated into the...

The effect of a decision aid intervention on decision making about coronary heart disease risk reduction: secondary analyses of a randomized trial

PubMed Central

2014-01-01

Background Decision aids offer promise as a practical solution to improve patient decision making about coronary heart disease (CHD) prevention medications and help patients choose medications to which they are likely to adhere. However, little data is available on decision aids designed to promote adherence. Methods In this paper, we report on secondary analyses of a randomized trial of a CHD adherence intervention (second generation decision aid plus tailored messages) versus usual care in an effort to understand how the decision aid facilitates adherence. We focus on data collected from the primary study visit, when intervention participants presented 45 minutes early to a previously scheduled provider visit; viewed the decision aid, indicating their intent for CHD risk reduction after each decision aid component (individualized risk assessment and education, values clarification, and coaching); and filled out a post-decision aid survey assessing their knowledge, perceived risk, decisional conflict, and intent for CHD risk reduction. Control participants did not present early and received usual care from their provider. Following the provider visit, participants in both groups completed post-visit surveys assessing the number and quality of CHD discussions with their provider, their intent for CHD risk reduction, and their feelings about the decision aid. Results We enrolled 160 patients into our study (81 intervention, 79 control). Within the decision aid group, the decision aid significantly increased knowledge of effective CHD prevention strategies (+21 percentage points; adjusted p<.0001) and the accuracy of perceived CHD risk (+33 percentage points; adjusted p<.0001), and significantly decreased decisional conflict (-0.63; adjusted p<.0001). Comparing between study groups, the decision aid also significantly increased CHD prevention discussions with providers (+31 percentage points; adjusted p<.0001) and improved perceptions of some features of patient-provider interactions. Further, it increased participants’ intentions for any effective CHD risk reducing strategies (+21 percentage points; 95% CI 5 to 37 percentage points), with a majority of the effect from the educational component of the decision aid. Ninety-nine percent of participants found the decision aid easy to understand and 93% felt it easy to use. Conclusions Decision aids can play an important role in improving decisions about CHD prevention and increasing patient-provider discussions and intent to reduce CHD risk. PMID:24575882

Health technology assessment to optimize health technology utilization: using implementation initiatives and monitoring processes.

PubMed

Frønsdal, Katrine B; Facey, Karen; Klemp, Marianne; Norderhaug, Inger Natvig; Mørland, Berit; Røttingen, John-Arne

2010-07-01

The way in which a health technology is used in any particular health system depends on the decisions and actions of a variety of stakeholders, the local culture, and context. In 2009, the HTAi Policy Forum considered how health technology assessment (HTA) could be improved to optimize the use of technologies (in terms of uptake, change in use, or disinvestment) in such complex systems. In scoping, it was agreed to focus on initiatives to implement evidence-based guidance and monitoring activities. A review identified systematic reviews of implementation initiatives and monitoring activities. A two-day deliberative workshop was held to discuss key papers, members' experiences, and collectively address key questions. This consensus paper was developed by email and finalized at a postworkshop meeting. Evidence suggests that the impact and use of HTA could be increased by ensuring timely delivery of relevant reports to clearly determined policy receptor (decision-making) points. To achieve this, the breadth of assessment, implementation initiatives such as incentives and targeted, intelligent dissemination of HTA result, needs to be considered. HTA stakeholders undertake a variety of monitoring activities, which could inform optimal use of a technology. However, the quality of these data varies and is often not submitted to an HTA. Monitoring data should be sufficiently robust so that they can be used in HTA to inform optimal use of technology. Evidence-based implementation initiatives should be developed for HTA, to better inform decision makers at all levels in a health system about the optimal use of technology.

DOD Financial Management: Effect of Continuing Weaknesses on Management and Operations and Status of Key Challenges

DTIC Science & Technology

2014-05-13

the information needed to effectively (1) manage its assets, (2) assess program performance and make budget decisions , (3) make cost- effective ... decision making, including the information needed to effectively (1) manage its assets, (2) assess program performance and make budget decisions , (3...incorporating key elements of a comprehensive management approach , such as a complete analysis of the return on investment, quantitatively -defined goals

Impact of data transparency: Scientific publications

PubMed Central

Joshi, Mohit; Bhardwaj, Payal

2018-01-01

Data transparency has been an important aspect of medical research as it helps in enabling evidence-based decisions in medicine which leads to foster trust among the patients and research community alike. Currently, it is one of the key talking points owing to a number of initiatives taken by the pharmaceutical organizations, regulatory bodies, and the other decision enablers of the industry. Thanks to this, there are a number of ways by which a single piece of datum is available through multiple access points, namely, clinical trial disclosures (CTDs), clinical study reports (CSRs), plain language summaries, and scientific publications including abstracts, posters, and manuscripts, to name a few. This may pose a burden of documentation on the pharmaceutical organizations, demanding downsizing of medical writing documents. Since CTDs, CSRs, and other regulatory document are more or less template driven; there may not be much scope to interfere with their structure and submission timings. Scientific publications, on the other hand, provide the flexibility of presenting the clinical data that is typically not dependent on a particular format and timelines. The present paper discusses how the upcoming data transparency initiatives could affect the publication practices across the pharmaceutical industry and what could pharmaceutical companies do to get the maximum benefit out of the data transparency initiatives. PMID:29430415

Impact of data transparency: Scientific publications.

PubMed

Joshi, Mohit; Bhardwaj, Payal

2018-01-01

Data transparency has been an important aspect of medical research as it helps in enabling evidence-based decisions in medicine which leads to foster trust among the patients and research community alike. Currently, it is one of the key talking points owing to a number of initiatives taken by the pharmaceutical organizations, regulatory bodies, and the other decision enablers of the industry. Thanks to this, there are a number of ways by which a single piece of datum is available through multiple access points, namely, clinical trial disclosures (CTDs), clinical study reports (CSRs), plain language summaries, and scientific publications including abstracts, posters, and manuscripts, to name a few. This may pose a burden of documentation on the pharmaceutical organizations, demanding downsizing of medical writing documents. Since CTDs, CSRs, and other regulatory document are more or less template driven; there may not be much scope to interfere with their structure and submission timings. Scientific publications, on the other hand, provide the flexibility of presenting the clinical data that is typically not dependent on a particular format and timelines. The present paper discusses how the upcoming data transparency initiatives could affect the publication practices across the pharmaceutical industry and what could pharmaceutical companies do to get the maximum benefit out of the data transparency initiatives.

Cognitive systems at the point of care: The CREDO program.

PubMed

Fox, John

2017-04-01

CREDO is a framework for understanding human expertise and for designing and deploying systems that support cognitive tasks like situation and risk assessment, decision-making, therapy planning and workflow management. The framework has evolved through an extensive program of research on human decision-making and clinical practice. It draws on concepts from cognitive science, and has contributed new results to cognitive theory and understanding of human expertise and knowledge-based AI. These results are exploited in a suite of technologies for designing, implementing and deploying clinical services, early versions of which were reported by Das et al. (1997) [9] and Fox and Das (2000) [26]. A practical outcome of the CREDO program is a technology stack, a key element of which is an agent specification language (PROforma: Sutton and Fox (2003) [55]) which has proved to be a versatile tool for designing point of care applications in many clinical specialties and settings. Since software became available for implementing and deploying PROforma applications many kinds of services have been successfully built and trialed, some of which are in large-scale routine use. This retrospective describes the foundations of the CREDO model, summarizes the main theoretical, technical and clinical contributions, and discusses benefits of the cognitive approach. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Winning and Losing: Effects on Impulsive Action

PubMed Central

2016-01-01

In the present study, we examined the effect of wins and losses on impulsive action in gambling (Experiments 1–3) and nongambling tasks (Experiments 4–5). In each experiment, subjects performed a simple task in which they had to win points. On each trial, they had to choose between a gamble and a nongamble. The gamble was always associated with a higher amount but a lower probability of winning than the nongamble. After subjects indicated their choice (i.e., gamble or not), feedback was presented. They had to press a key to start the next trial. Experiments 1–3 showed that, compared to the nongambling baseline, subjects were faster to initiate the next trial after a gambled loss, indicating that losses can induce impulsive actions. In Experiments 4 and 5, subjects alternated between the gambling task and a neutral decision-making task in which they could not win or lose points. Subjects were faster in the neutral decision-making task if they had just lost in the gambling task, suggesting that losses have a general effect on action. Our results challenge the dominant idea that humans become more cautious after suboptimal outcomes. Instead, they indicate that losses in the context of potential rewards are emotional events that increase impulsivity. PMID:27808548

The thinking doctor: clinical decision making in contemporary medicine.

PubMed

Trimble, Michael; Hamilton, Paul

2016-08-01

Diagnostic errors are responsible for a significant number of adverse events. Logical reasoning and good decision-making skills are key factors in reducing such errors, but little emphasis has traditionally been placed on how these thought processes occur, and how errors could be minimised. In this article, we explore key cognitive ideas that underpin clinical decision making and suggest that by employing some simple strategies, physicians might be better able to understand how they make decisions and how the process might be optimised. © 2016 Royal College of Physicians.

Threat evaluation for impact assessment in situation analysis systems

NASA Astrophysics Data System (ADS)

Roy, Jean; Paradis, Stephane; Allouche, Mohamad

2002-07-01

Situation analysis is defined as a process, the examination of a situation, its elements, and their relations, to provide and maintain a product, i.e., a state of situation awareness, for the decision maker. Data fusion is a key enabler to meeting the demanding requirements of military situation analysis support systems. According to the data fusion model maintained by the Joint Directors of Laboratories' Data Fusion Group, impact assessment estimates the effects on situations of planned or estimated/predicted actions by the participants, including interactions between action plans of multiple players. In this framework, the appraisal of actual or potential threats is a necessary capability for impact assessment. This paper reviews and discusses in details the fundamental concepts of threat analysis. In particular, threat analysis generally attempts to compute some threat value, for the individual tracks, that estimates the degree of severity with which engagement events will potentially occur. Presenting relevant tracks to the decision maker in some threat list, sorted from the most threatening to the least, is clearly in-line with the cognitive demands associated with threat evaluation. A key parameter in many threat value evaluation techniques is the Closest Point of Approach (CPA). Along this line of thought, threatening tracks are often prioritized based upon which ones will reach their CPA first. Hence, the Time-to-CPA (TCPA), i.e., the time it will take for a track to reach its CPA, is also a key factor. Unfortunately, a typical assumption for the computation of the CPA/TCPA parameters is that the track velocity will remain constant. When a track is maneuvering, the CPA/TCPA values will change accordingly. These changes will in turn impact the threat value computations and, ultimately, the resulting threat list. This is clearly undesirable from a command decision-making perspective. In this regard, the paper briefly discusses threat value stabilization approaches based on neural networks and other mathematical techniques.

Lung Cancer Screening with Low-Dose Computed Tomography for Primary Care Providers

PubMed Central

Richards, Thomas B.; White, Mary C.; Caraballo, Ralph S.

2015-01-01

This review provides an update on lung cancer screening with low-dose computed tomography (LDCT) and its implications for primary care providers. One of the unique features of lung cancer screening is the potential complexity in patient management if an LDCT scan reveals a small pulmonary nodule. Additional tests, consultation with multiple specialists, and follow-up evaluations may be needed to evaluate whether lung cancer is present. Primary care providers should know the resources available in their communities for lung cancer screening with LDCT and smoking cessation, and the key points to be addressed in informed and shared decision-making discussions with patients. PMID:24830610

A Study to Determine if Ethics Committees Should be a Decision-Making and Review Mechanism for Matters Relating to No-Code Orders in the Continental United States Army Medical Department Hospitals with over One Hundred Total Operating Beds

DTIC Science & Technology

1984-08-01

their role in the hospital. The book Megatrends points out that there are six States which set the pace for national trends. One of these is California...care hospitals but two. Again, one must recall what the book Megatrends says about California and national trends. Another key according to this study...Catholic Hospitals," Ethics Committees Newsletter, Vol 1, No. 2, November 1983, p. 2. 7. R. Veatch, Death, PyiLn and the Biological Revolution, New Haven

China's emergence and the prospects for global sustainability

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

Grumbine, R.E.

2007-03-15

China's rapid development is influencing global patterns of resource use and their associated environmental and geopolitical impacts. Trend projections suggest that China's rise will have unprecedented impacts on the rest of the world. I examine three key drivers affecting China's emergence (scale of development, government policy decisions, and globalization), along with four factors that may constrain development (environmental degradation, political instability, coal and oil consumption, and carbon dioxide emissions). China's rise represents a tipping point between fossil fuel-based economies and still emergent sustainable alternatives. Policy precedents between the United States and China over the next decade may well determine themore » future course of global sustainability.« less

Optimizing empiric therapy for Gram-negative bloodstream infections in children.

PubMed

Chao, Y; Reuter, C; Kociolek, L K; Patel, R; Zheng, X; Patel, S J

2018-06-01

Antimicrobial stewardship can be challenging in children with bloodstream infections (BSIs) caused by Gram-negative bacilli (GNB). This retrospective cohort study explored how data elements in the electronic health record could potentially optimize empiric antibiotic therapy for BSIs caused by GNB, via the construction of customized antibiograms for categorical GNB infections and identification of opportunities to minimize organism-drug mismatch and decrease time to effective therapy. Our results suggest potential strategies that could be implemented at key decision points in prescribing at initiation, modification, and targeting of therapy. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

[The willingness-to-pay concept in question].

PubMed

Mould Quevedo, Joaquín F; Contreras Hernández, Iris; Garduño Espinosa, Juan; Salinas Escudero, Guillermo

2009-04-01

The adequacy of the concept of willingness to pay within health economics evaluations is reviewed. A considerable number of researchers in the literature have pointed out multiple methodological issues involving willingness-to-pay estimates. On the other hand, the theoretical discussion about the aggregation of individual preferences within an aggregate demand remains open. However, over the last 20 years, willingness-to-pay estimates alongside health economics research significantly increased and in many cases they are one of the key factors for decision making on issues of health policies. The article describes some limitations of this approach as well as the potential distorting effect that it might have on health economics evaluations.

HOSPITAL-BASED HEALTH TECHNOLOGY ASSESSMENT IN IRAN.

PubMed

Mohtasham, Farideh; Majdzadeh, Reza; Jamshidi, Ensiyeh

2017-01-01

Hospitals with health technology assessment (HTA) programs have reported its positive effects on the management of resources and costs. This study aimed to identify the barriers faced by hospital-based HTA (HBHTA) in Iran by inductive content analysis of stakeholders' and decision-makers' points of view. The key individuals and organizations that could provide rich, relevant, and diverse data in response to the research question were purposively selected for the interviews and focus group discussion. Twelve stakeholders from seven public hospitals participated in the interviews. Another eighteen stakeholders from twelve HBHTA-related organizations took part in the focus group discussion. Most of the hospitals' senior management team did not feel the need for HBHTA and believed that in Iran a systematic process like HTA faces many challenges. The stakeholders participating in this study highlighted the significance of certain points that needed to be addressed before establishing HBHTA in Iran.

Risky decision-making in children with and without ADHD: A prospective study.

PubMed

Humphreys, Kathryn L; Tottenham, Nim; Lee, Steve S

2018-02-01

Learning from past decisions can enhance successful decision-making. It is unclear whether difficulties in learning from experience may contribute to risky decision-making, which may be altered among individuals with attention-deficit/hyperactivity disorder (ADHD). This study follows 192 children with and without ADHD aged 5 to 10 years for approximately 2.5 years and examines their risky decision-making using the Balloon Emotional Learning Task (BELT), a computerized assessment of sequential risky decision-making in which participants pump up a series of virtual balloons for points. The BELT contains three task conditions: one with a variable explosion point, one with a stable and early explosion point, and one with a stable and late explosion point. These conditions may be learned via experience on the task. Contrary to expectations, ADHD status was not found to be related to greater risk-taking on the BELT, and among younger children ADHD status is in fact associated with reduced risk-taking. In addition, the typically-developing children without ADHD showed significant learning-related gains on both stable task conditions. However, the children with ADHD demonstrated learning on the condition with a stable and early explosion point, but not on the condition with the stable and late explosion point, in which more pumps are required before learning when the balloon will explode. Learning during decision-making may be more difficult for children with ADHD. Because adapting to changing environmental demands requires the use of feedback to guide future behavior, negative outcomes associated with childhood ADHD may partially reflect difficulties in learning from experience.

Strategies in Forecasting Outcomes in Ethical Decision-making: Identifying and Analyzing the Causes of the Problem

PubMed Central

Beeler, Cheryl K.; Antes, Alison L.; Wang, Xiaoqian; Caughron, Jared J.; Thiel, Chase E.; Mumford, Michael D.

2010-01-01

This study examined the role of key causal analysis strategies in forecasting and ethical decision-making. Undergraduate participants took on the role of the key actor in several ethical problems and were asked to identify and analyze the causes, forecast potential outcomes, and make a decision about each problem. Time pressure and analytic mindset were manipulated while participants worked through these problems. The results indicated that forecast quality was associated with decision ethicality, and the identification of the critical causes of the problem was associated with both higher quality forecasts and higher ethicality of decisions. Neither time pressure nor analytic mindset impacted forecasts or ethicality of decisions. Theoretical and practical implications of these findings are discussed. PMID:20352056

ECOLOGICAL RISK ASSESSMENT IN THE CONTEXT OF GLOBAL CLIMATE CHANGE

PubMed Central

Landis, Wayne G; Durda, Judi L; Brooks, Marjorie L; Chapman, Peter M; Menzie, Charles A; Stahl, Ralph G; Stauber, Jennifer L

2013-01-01

Changes to sources, stressors, habitats, and geographic ranges; toxicological effects; end points; and uncertainty estimation require significant changes in the implementation of ecological risk assessment (ERA). Because of the lack of analog systems and circumstances in historically studied sites, there is a likelihood of type III error. As a first step, the authors propose a decision key to aid managers and risk assessors in determining when and to what extent climate change should be incorporated. Next, when global climate change is an important factor, the authors recommend seven critical changes to ERA. First, develop conceptual cause–effect diagrams that consider relevant management decisions as well as appropriate spatial and temporal scales to include both direct and indirect effects of climate change and the stressor of management interest. Second, develop assessment end points that are expressed as ecosystem services. Third, evaluate multiple stressors and nonlinear responses—include the chemicals and the stressors related to climate change. Fourth, estimate how climate change will affect or modify management options as the impacts become manifest. Fifth, consider the direction and rate of change relative to management objectives, recognizing that both positive and negative outcomes can occur. Sixth, determine the major drivers of uncertainty, estimating and bounding stochastic uncertainty spatially, temporally, and progressively. Seventh, plan for adaptive management to account for changing environmental conditions and consequent changes to ecosystem services. Good communication is essential for making risk-related information understandable and useful for managers and stakeholders to implement a successful risk-assessment and decision-making process. Environ. Toxicol. Chem. 2013;32:79–92. © 2012 SETAC PMID:23161373

Vicious circles in inflammatory bowel disease.

PubMed

Sonnenberg, Amnon; Collins, Judith F

2006-10-01

Inflammatory bowel disease can present with a bewildering array of disease manifestations whose overall impact on patient health is difficult to disentangle. The multitude of disease complications and therapeutic side effects result in conflicting ideas on how to best manage a patient. The aim of the study is to test the usefulness of influence diagrams in resolving conflicts centered on managing complex disease processes. The influences of a disease process and the ensuing medical interventions on the health of a patient with inflammatory bowel disease are modeled by an influence diagram. Patient health is the focal point of multiple influences affecting its overall strength. Any downstream influence represents the focal point of other preceding upstream influences. The mathematics underlying the influence diagram is similar to that of a decision tree. Its formalism allows one to consider additive and inhibitory influences and include in the same analysis qualitatively different types of parameters, such as diagnoses, complications, side effects, and therapeutic outcomes. Three exemplary cases are presented to illustrate the potential use of influence diagrams. In all three case scenarios, Crohn's disease resulted in disease manifestations that seemingly interfered with its own therapy. The presence of negative feedback loops rendered the management of each case particularly challenging. The analyses by influence diagrams revealed subtle interactions among the multiple influences and their joint contributions to the patient's overall health that would have been difficult to appreciate by verbal reasoning alone. Influence diagrams represent a decision tool that is particularly suited to improve decision-making in inflammatory bowel disease. They highlight key factors of a complex disease process and help to assess their quantitative interactions.

Ventriculogram segmentation using boosted decision trees

NASA Astrophysics Data System (ADS)

McDonald, John A.; Sheehan, Florence H.

2004-05-01

Left ventricular status, reflected in ejection fraction or end systolic volume, is a powerful prognostic indicator in heart disease. Quantitative analysis of these and other parameters from ventriculograms (cine xrays of the left ventricle) is infrequently performed due to the labor required for manual segmentation. None of the many methods developed for automated segmentation has achieved clinical acceptance. We present a method for semi-automatic segmentation of ventriculograms based on a very accurate two-stage boosted decision-tree pixel classifier. The classifier determines which pixels are inside the ventricle at key ED (end-diastole) and ES (end-systole) frames. The test misclassification rate is about 1%. The classifier is semi-automatic, requiring a user to select 3 points in each frame: the endpoints of the aortic valve and the apex. The first classifier stage is 2 boosted decision-trees, trained using features such as gray-level statistics (e.g. median brightness) and image geometry (e.g. coordinates relative to user supplied 3 points). Second stage classifiers are trained using the same features as the first, plus the output of the first stage. Border pixels are determined from the segmented images using dilation and erosion. A curve is then fit to the border pixels, minimizing a penalty function that trades off fidelity to the border pixels with smoothness. ED and ES volumes, and ejection fraction are estimated from border curves using standard area-length formulas. On independent test data, the differences between automatic and manual volumes (and ejection fractions) are similar in size to the differences between two human observers.

Ecological risk assessment in the context of global climate change.

PubMed

Landis, Wayne G; Durda, Judi L; Brooks, Marjorie L; Chapman, Peter M; Menzie, Charles A; Stahl, Ralph G; Stauber, Jennifer L

2013-01-01

Changes to sources, stressors, habitats, and geographic ranges; toxicological effects; end points; and uncertainty estimation require significant changes in the implementation of ecological risk assessment (ERA). Because of the lack of analog systems and circumstances in historically studied sites, there is a likelihood of type III error. As a first step, the authors propose a decision key to aid managers and risk assessors in determining when and to what extent climate change should be incorporated. Next, when global climate change is an important factor, the authors recommend seven critical changes to ERA. First, develop conceptual cause-effect diagrams that consider relevant management decisions as well as appropriate spatial and temporal scales to include both direct and indirect effects of climate change and the stressor of management interest. Second, develop assessment end points that are expressed as ecosystem services. Third, evaluate multiple stressors and nonlinear responses-include the chemicals and the stressors related to climate change. Fourth, estimate how climate change will affect or modify management options as the impacts become manifest. Fifth, consider the direction and rate of change relative to management objectives, recognizing that both positive and negative outcomes can occur. Sixth, determine the major drivers of uncertainty, estimating and bounding stochastic uncertainty spatially, temporally, and progressively. Seventh, plan for adaptive management to account for changing environmental conditions and consequent changes to ecosystem services. Good communication is essential for making risk-related information understandable and useful for managers and stakeholders to implement a successful risk-assessment and decision-making process. Copyright © 2012 SETAC.

Distributed decision making in action: diagnostic imaging investigations within the bigger picture.

PubMed

Makanjee, Chandra R; Bergh, Anne-Marie; Hoffmann, Willem A

2018-03-01

Decision making in the health care system - specifically with regard to diagnostic imaging investigations - occurs at multiple levels. Professional role players from various backgrounds are involved in making these decisions, from the point of referral to the outcomes of the imaging investigation. The aim of this study was to map the decision-making processes and pathways involved when patients are referred for diagnostic imaging investigations and to explore distributed decision-making events at the points of contact with patients within a health care system. A two-phased qualitative study was conducted in an academic public health complex with the district hospital as entry point. The first phase included case studies of 24 conveniently selected patients, and the second phase involved 12 focus group interviews with health care providers. Data analysis was based on Rapley's interpretation of decision making as being distributed across time, situations and actions, and including different role players and technologies. Clinical decisions incorporating imaging investigations are distributed across the three vital points of contact or decision-making events, namely the initial patient consultation, the diagnostic imaging investigation and the post-investigation consultation. Each of these decision-making events is made up of a sequence of discrete decision-making moments based on the transfer of retrospective, current and prospective information and its transformation into knowledge. This paper contributes to the understanding of the microstructural processes (the 'when' and 'where') involved in the distribution of decisions related to imaging investigations. It also highlights the interdependency in decision-making events of medical and non-medical providers within a single medical encounter. © 2017 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.

The Concept of Strategic Decisionmaking.

ERIC Educational Resources Information Center

Collier, Douglas J.

Strategic decision-making literature is reviewed, and applications to colleges and universities are made. The key requirement for strategic decision-making is that decisions affect the entire organization. While strategic decision-making can occur at different levels within the organization, the specific strategic decisions available to the…

Using science soundly: The Yucca Mountain standard

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

Fri, R.W.

1995-09-01

Using sound science to shape government regulation is one of the most hotly argued topics in the ongoing debate about regulatory reform. Even though no one advaocates using unsound science, the belief that even the best science will sweep away regulatory controversy is equally foolish. As chair of a National Research Council (NRC) committee that studied the scientific basis for regulating high-level nuclear waste disposal, the author learned that science alone could resolve few of the key regulatory questions. Developing a standard that specifies a socially acceptable limit on the human health effects of nuclear waste releases involves many decisions.more » As the NRC committee learned in evaluating the scientific basis for the Yucca Mountain standard, a scientifically best decision rarely exists. More often, science can only offer a useful framework and starting point for policy debates. And sometimes, science`s most helpful contribution is to admit that it has nothing to say. The Yucca mountain study clearly illustrates that excessive faith in the power of science is more likely to produce messy frustration than crisp decisions. A better goal for regulatory reform is the sound use of science to clarify and contain the inevitable policy controversy.« less

Hepatocellular carcinoma: Western and Eastern surgeons' points of view.

PubMed

Vibert, E; Ishizawa, T

2012-10-01

Hepatocellular carcinoma (HCC) is the third leading cause of cancer mortality worldwide. Developed on a pathological liver in 90% of cases, theoretically liver transplantation (LT) is its best treatment because it cures both malignancy and cause of malignancy, the underlying pathological liver. Cadaveric donors are the main source of liver in Western countries as France and living donors are the rules in Eastern countries as Japan. Because organ shortage could impact choices in HCC treatments, it was interesting to compare a Western and Eastern surgeon's points of view about treatment of HCC to assess if the source of organs has modified therapeutic strategies. Hence, aim of this work was to compare points of view of two hepatobiliary and transplant surgeons specialized in the treatment of HCC in France and Japan concerning five keys points that are decisive to choose one of the two curative treatments in HCC on pathological liver: liver resection or LT. These questions included the definition of an oncological treatment of HCC, the assessment of liver function, the treatment of HCC recurrences, the incidence of pathological information on therapeutic strategy and potential future therapeutics strategies. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Optimal production lot size and reorder point of a two-stage supply chain while random demand is sensitive with sales teams' initiatives

NASA Astrophysics Data System (ADS)

Sankar Sana, Shib

2016-01-01

The paper develops a production-inventory model of a two-stage supply chain consisting of one manufacturer and one retailer to study production lot size/order quantity, reorder point sales teams' initiatives where demand of the end customers is dependent on random variable and sales teams' initiatives simultaneously. The manufacturer produces the order quantity of the retailer at one lot in which the procurement cost per unit quantity follows a realistic convex function of production lot size. In the chain, the cost of sales team's initiatives/promotion efforts and wholesale price of the manufacturer are negotiated at the points such that their optimum profits reached nearer to their target profits. This study suggests to the management of firms to determine the optimal order quantity/production quantity, reorder point and sales teams' initiatives/promotional effort in order to achieve their maximum profits. An analytical method is applied to determine the optimal values of the decision variables. Finally, numerical examples with its graphical presentation and sensitivity analysis of the key parameters are presented to illustrate more insights of the model.

Frontal, Striatal, and Medial Temporal Sensitivity to Value Distinguishes Risk-Taking from Risk-Aversive Older Adults during Decision Making.

PubMed

Goh, Joshua O S; Su, Yu-Shiang; Tang, Yong-Jheng; McCarrey, Anna C; Tereshchenko, Alexander; Elkins, Wendy; Resnick, Susan M

2016-12-07

Aging compromises the frontal, striatal, and medial temporal areas of the reward system, impeding accurate value representation and feedback processing critical for decision making. However, substantial variability characterizes age-related effects on the brain so that some older individuals evince clear neurocognitive declines whereas others are spared. Moreover, the functional correlates of normative individual differences in older-adult value-based decision making remain unclear. We performed a functional magnetic resonance imaging study in 173 human older adults during a lottery choice task in which costly to more desirable stakes were depicted using low to high expected values (EVs) of points. Across trials that varied in EVs, participants decided to accept or decline the offered stakes to maximize total accumulated points. We found that greater age was associated with less optimal decisions, accepting stakes when losses were likely and declining stakes when gains were likely, and was associated with increased frontal activity for costlier stakes. Critically, risk preferences varied substantially across older adults and neural sensitivity to EVs in the frontal, striatal, and medial temporal areas dissociated risk-aversive from risk-taking individuals. Specifically, risk-averters increased neural responses to increasing EVs as stakes became more desirable, whereas risk-takers increased neural responses with decreasing EV as stakes became more costly. Risk preference also modulated striatal responses during feedback with risk-takers showing more positive responses to gains compared with risk-averters. Our findings highlight the frontal, striatal, and medial temporal areas as key neural loci in which individual differences differentially affect value-based decision-making ability in older adults. Frontal, striatal, and medial temporal functions implicated in value-based decision processing of rewards and costs undergo substantial age-related changes. However, age effects on brain function and cognition differ across individuals. How this normative variation relates to older-adult value-based decision making is unclear. We found that although the ability make optimal decisions declines with age, there is still much individual variability in how this deterioration occurs. Critically, whereas risk-averters showed increased neural activity to increasingly valuable stakes in frontal, striatal, and medial temporal areas, risk-takers instead increased activity as stakes became more costly. Such distinct functional decision-making processing in these brain regions across normative older adults may reflect individual differences in susceptibility to age-related brain changes associated with incipient cognitive impairment. Copyright © 2016 the authors 0270-6474/16/3612498-12$15.00/0.

Reunifying abused or neglected children: Decision-making and outcomes.

PubMed

Biehal, Nina; Sinclair, Ian; Wade, Jim

2015-11-01

Little is known about decision-making regarding the reunification of children in care, or about the consequences of these decisions for the children concerned. This study compared decision-making and outcomes for 149 maltreated children in seven English authorities (68 reunified, 81 who remained in care). Children were followed up six months after their return home or, for those who were not reunified, six months after the 'effective decision' that they should remain in care. They were followed up again four years (on average) after the return or effective decision. Data were extracted from case files at baseline and six month follow-up and were gathered from surveys of social workers and teachers at final follow-up. The two key predictors of reunification were assessments that parental problems had improved and that risks to the child were not unacceptably high. Two-thirds returned to improved family circumstances, sometimes due to a change in the household they returned to, but others were reunified despite persisting concerns. However 35% re-entered care within six months and 63% re-entered at some point during the four-year follow-up period, often due to recurring abuse or neglect. At final follow-up remaining in care was the strongest predictor of positive outcomes on a range of dimensions, even once children's characteristics and histories were taken into account. Outcomes were especially poor for neglected children who were reunified, irrespective of whether reunification was stable or unstable. Results show the potential of the care system to produce positive outcomes for maltreated children. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Decision Support Framework for Science-Based, Multi-Stakeholder Deliberation: A Coral Reef Example

NASA Astrophysics Data System (ADS)

Rehr, Amanda P.; Small, Mitchell J.; Bradley, Patricia; Fisher, William S.; Vega, Ann; Black, Kelly; Stockton, Tom

2012-12-01

We present a decision support framework for science-based assessment and multi-stakeholder deliberation. The framework consists of two parts: a DPSIR (Drivers-Pressures-States-Impacts-Responses) analysis to identify the important causal relationships among anthropogenic environmental stressors, processes, and outcomes; and a Decision Landscape analysis to depict the legal, social, and institutional dimensions of environmental decisions. The Decision Landscape incorporates interactions among government agencies, regulated businesses, non-government organizations, and other stakeholders. It also identifies where scientific information regarding environmental processes is collected and transmitted to improve knowledge about elements of the DPSIR and to improve the scientific basis for decisions. Our application of the decision support framework to coral reef protection and restoration in the Florida Keys focusing on anthropogenic stressors, such as wastewater, proved to be successful and offered several insights. Using information from a management plan, it was possible to capture the current state of the science with a DPSIR analysis as well as important decision options, decision makers and applicable laws with a the Decision Landscape analysis. A structured elicitation of values and beliefs conducted at a coral reef management workshop held in Key West, Florida provided a diversity of opinion and also indicated a prioritization of several environmental stressors affecting coral reef health. The integrated DPSIR/Decision landscape framework for the Florida Keys developed based on the elicited opinion and the DPSIR analysis can be used to inform management decisions, to reveal the role that further scientific information and research might play to populate the framework, and to facilitate better-informed agreement among participants.

Using wind plant data to increase reliability.

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

Peters, Valerie A.; Ogilvie, Alistair B.; McKenney, Bridget L.

2011-01-01

Operators interested in improving reliability should begin with a focus on the performance of the wind plant as a whole. To then understand the factors which drive individual turbine performance, which together comprise the plant performance, it is necessary to track a number of key indicators. Analysis of these key indicators can reveal the type, frequency, and cause of failures and will also identify their contributions to overall plant performance. The ideal approach to using data to drive good decisions includes first determining which critical decisions can be based on data. When those required decisions are understood, then the analysismore » required to inform those decisions can be identified, and finally the data to be collected in support of those analyses can be determined. Once equipped with high-quality data and analysis capabilities, the key steps to data-based decision making for reliability improvements are to isolate possible improvements, select the improvements with largest return on investment (ROI), implement the selected improvements, and finally to track their impact.« less

An Iterative Information-Reduced Quadriphase-Shift-Keyed Carrier Synchronization Scheme Using Decision Feedback for Low Signal-to-Noise Ratio Applications

NASA Technical Reports Server (NTRS)

Simon, M.; Tkacenko, A.

2006-01-01

In a previous publication [1], an iterative closed-loop carrier synchronization scheme for binary phase-shift keyed (BPSK) modulation was proposed that was based on feeding back data decisions to the input of the loop, the purpose being to remove the modulation prior to carrier synchronization as opposed to the more conventional decision-feedback schemes that incorporate such feedback inside the loop. The idea there was that, with sufficient independence between the received data and the decisions on it that are fed back (as would occur in an error-correction coding environment with sufficient decoding delay), a pure tone in the presence of noise would ultimately be produced (after sufficient iteration and low enough error probability) and thus could be tracked without any squaring loss. This article demonstrates that, with some modification, the same idea of iterative information reduction through decision feedback can be applied to quadrature phase-shift keyed (QPSK) modulation, something that was mentioned in the previous publication but never pursued.

Myopic Loss Aversion: Demystifying the Key Factors Influencing Decision Problem Framing

ERIC Educational Resources Information Center

Hardin, Andrew M.; Looney, Clayton Arlen

2012-01-01

Advancement of myopic loss aversion theory has been hamstrung by conflicting results, methodological inconsistencies, and a piecemeal approach toward understanding the key factors influencing decision problem framing. A series of controlled experiments provides a more holistic view of the variables promoting myopia. Extending the information…

The Key Decision Log: Facilitating high reliability and organizational learning

Treesearch

Anne E. Black

2009-01-01

If you were involved in the 2008 fire season in the West, you may have heard the term "Key Decision Log" or "KDL." This article describes the KDL concept, it's intent (past and present), how it was applied in 2008, and where the practice is heading.

Concluding comments: maximizing good patient care and minimizing potential liability when considering complementary and alternative medicine.

PubMed

Gilmour, Joan; Harrison, Christine; Vohra, Sunita

2011-11-01

Our goal for this supplemental issue of Pediatrics was to consider what practitioners, parents, patients, institutions, and policy-makers need to take into account to make good decisions about using complementary and alternative medicine (CAM) to treat children and to develop guidelines for appropriate use. We began by explaining underlying concepts and principles in ethical, legal, and clinical reasoning and then used case scenarios to explore how they apply and identify gaps that remain in practice and policy. In this concluding article, we review our major findings, summarize our recommendations, and suggest further research. We focus on several key areas: practitioner and patient/parent relationships; decision-making; dispute resolution; standards of practice; hospital/health facility policies; patient safety; education; and research. Ethical principles, standards, and rules applicable when making decisions about conventional care for children apply to decision-making about CAM as well. The same is true of legal reasoning. Although CAM use has seldom led to litigation, general legal principles relied on in cases involving conventional medical care provide the starting point for analysis. Similarly, with respect to clinical decision-making, clinicians are guided by clinical judgment and the best interests of their patient. Whether a therapy is CAM or conventional, clinicians must weigh the relative risks and benefits of therapeutic options and take into account their patient's values, beliefs, and preferences. Consequently, many of our observations apply to conventional and CAM care and to both adult and pediatric patients.

Masculine interest behind high prevalence of female contraceptive methods in rural Nepal.

PubMed

Chapagain, Matrika

2005-02-01

This article explores the nexus between intraspousal power relations and couples' participation in contraceptive decision-making. Further, it discloses whether perceived gender roles and privilege influence couples' contraceptive behaviour in rural Nepal. Two hundred and twenty-three couples from 197 randomly selected households from two rural population clusters in eastern Nepal were interviewed. Additionally, 40 key informants were included to collect in-depth qualitative information. The conclusion provides the essence of the results from quantitative and qualitative analyses. Out of 10 independent variables regarding the social power status of the wives and husbands (education, age, occupation, personal income, household headship, political participation, social participation, access to mass media, exposure to psychological assault and physical assault from husband), four variables, namely education, personal income, exposure to psychological assault and physical assault demonstrated significant influence on wives' participation, while no one variable showed association with husbands' participation in contraceptive decision-making. Despite the husband's domination, husband-wife joint involvement in making contraceptive decisions was common. However, stereotyped gender roles and privilege appeared to be influential in deciding the types of methods to use, to shift the methods, and to terminate using contraception. As an unequal conjugal relationship is one of the factors responsible for the husband's domination in the decision-making process, women's empowerment should be an entry-point for the transformation of gender discriminatory attitudes and behaviour. Women's empowerment enhances an equal conjugal relationship, and thereby helps in achieving equal partnership in reproductive health decision-making.

Decisions without blinders.

PubMed

Bazerman, Max H; Chugh, Dolly

2006-01-01

By the time Merck withdrew its pain relief drug Vioxx from the market in 2004, more than 100 million prescriptions had been filled in the United States alone. Yet researchers now estimate that Vioxx may have been associated with as many as 25,000 heart attacks and strokes. Evidence of the drug's risks was available as early as 2000, so why did so many doctors keep prescribing it? The answer, say the authors, involves the phenomenon of bounded awareness--when cognitive blinders prevent a person from seeing, seeking, using, or sharing highly relevant, easily accessible, and readily perceivable information during the decision-making process. Doctors prescribing Vioxx, for instance, more often than not received positive feedback from patients. So, despite having access to information about the risks, physicians may have been blinded to the actual extent of the risks. Bounded awareness can occur at three points in the decision-making process. First, executives may fail to see or seek out the important information needed to make a sound decision. Second, they may fail to use the information that they do see because they aren't aware of its relevance. Third, executives may fail to share information with others, thereby bounding the organization's awareness. Drawing on examples such as the Challenger disaster and Citibank's failures in Japan, this article examines what prevents executives from seeing what's right in front of them and offers advice on how to increase awareness. Of course, not every decision requires executives to consciously broaden their focus. Collecting too much information for every decision would waste time and other valuable resources. The key is being mindful. If executives think an error could generate almost irrecoverable damage, then they should insist on getting all the information they need to make a wise decision.

Neuromodulation of group prejudice and religious belief

PubMed Central

Izuma, Keise; Deblieck, Choi; Fessler, Daniel M. T.; Iacoboni, Marco

2016-01-01

People cleave to ideological convictions with greater intensity in the aftermath of threat. The posterior medial frontal cortex (pMFC) plays a key role in both detecting discrepancies between desired and current conditions and adjusting subsequent behavior to resolve such conflicts. Building on prior literature examining the role of the pMFC in shifts in relatively low-level decision processes, we demonstrate that the pMFC mediates adjustments in adherence to political and religious ideologies. We presented participants with a reminder of death and a critique of their in-group ostensibly written by a member of an out-group, then experimentally decreased both avowed belief in God and out-group derogation by downregulating pMFC activity via transcranial magnetic stimulation. The results provide the first evidence that group prejudice and religious belief are susceptible to targeted neuromodulation, and point to a shared cognitive mechanism underlying concrete and abstract decision processes. We discuss the implications of these findings for further research characterizing the cognitive and affective mechanisms at play. PMID:26341901

Cognitive Bias in Systems Verification

NASA Technical Reports Server (NTRS)

Larson, Steve

2012-01-01

Working definition of cognitive bias: Patterns by which information is sought and interpreted that can lead to systematic errors in decisions. Cognitive bias is used in diverse fields: Economics, Politics, Intelligence, Marketing, to name a few. Attempts to ground cognitive science in physical characteristics of the cognitive apparatus exceed our knowledge. Studies based on correlations; strict cause and effect is difficult to pinpoint. Effects cited in the paper and discussed here have been replicated many times over, and appear sound. Many biases have been described, but it is still unclear whether they are all distinct. There may only be a handful of fundamental biases, which manifest in various ways. Bias can effect system verification in many ways . Overconfidence -> Questionable decisions to deploy. Availability -> Inability to conceive critical tests. Representativeness -> Overinterpretation of results. Positive Test Strategies -> Confirmation bias. Debiasing at individual level very difficult. The potential effect of bias on the verification process can be managed, but not eliminated. Worth considering at key points in the process.

Implementation Pearls from a New Guidebook on Improving Medication Use and Outcomes with Clinical Decision Support

PubMed Central

Sirajuddin, Anwar M; Osheroff, Jerome A.; Sittig, Dean F.; Chuo, John; Velasco, Ferdinand; Collins, David A.

2012-01-01

Effective clinical decision support (CDS) is essential for addressing healthcare performance improvement imperatives, but care delivery organizations (CDO) typically struggle with CDS deployment. Ensuring safe and effective medication delivery to patients is a central focus of CDO performance improvement efforts, and this article provides an overview of best-practice strategies for applying CDS to these goals. The strategies discussed are drawn from a new guidebook, co-published and co-sponsored by more than a dozen leading organizations. Developed by scores of CDS implementers and experts, the guidebook outlines key steps and success factors for applying CDS to medication management. A central thesis is that improving outcomes with CDS interventions requires that the CDS five rights be addressed successfully. That is, the interventions must deliver the right information, to the right person, in the right format, through the right channel, at the right point in workflow. This paper provides further details about these CDS five rights, and highlights other important strategies for successful CDS programs. PMID:19894486

Recovery and Resilience After a Nuclear Power Plant Disaster: A Medical Decision model for Managing an Effective, Timely, and Balanced Response

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

Coleman, C. Norman; Blumenthal, Daniel J.

2013-05-01

Based on experiences in Tokyo responding to the Fukushima Daiichi nuclear power plant crisis, a real-time, medical decision model is presented by which to make key health-related decisions given the central role of health and medical issues in such disasters. Focus is on response and recovery activities that are safe, timely, effective, and well-organized. This approach empowers on-site decision makers to make interim decisions without undue delay using readily available and high-level scientific, medical, communication, and policy expertise. Key features of this approach include ongoing assessment, consultation, information, and adaption to the changing conditions. This medical decision model presented ismore » compatible with the existing US National Response Framework structure.« less

Abortion Decision and Ambivalence: Insights via an Abortion Decision Balance Sheet

ERIC Educational Resources Information Center

Allanson, Susie

2007-01-01

Decision ambivalence is a key concept in abortion literature, but has been poorly operationalised. This study explored the concept of decision ambivalence via an Abortion Decision Balance Sheet (ADBS) articulating reasons both for and against terminating an unintended pregnancy. Ninety-six women undergoing an early abortion for psychosocial…

Interventionist and participatory approaches to flood risk mitigation decisions: two case studies in the Italian Alps

NASA Astrophysics Data System (ADS)

Bianchizza, C.; Del Bianco, D.; Pellizzoni, L.; Scolobig, A.

2012-04-01

Flood risk mitigation decisions pose key challenges not only from a technical but also from a social, economic and political viewpoint. There is an increasing demand for improving the quality of these processes by including different stakeholders - and especially by involving the local residents in the decision making process - and by guaranteeing the actual improvement of local social capacities during and after the decision making. In this paper we analyse two case studies of flood risk mitigation decisions, Malborghetto-Valbruna and Vipiteno-Sterzing, in the Italian Alps. In both of them, mitigation works have been completed or planned, yet following completely different approaches especially in terms of responses of residents and involvement of local authorities. In Malborghetto-Valbruna an 'interventionist' approach (i.e. leaning towards a top down/technocratic decision process) was used to make decisions after the flood event that affected the municipality in the year 2003. In Vipiteno-Sterzing, a 'participatory' approach (i.e. leaning towards a bottom-up/inclusive decision process) was applied: decisions about risk mitigation measures were made by submitting different projects to the local citizens and by involving them in the decision making process. The analysis of the two case studies presented in the paper is grounded on the results of two research projects. Structured and in-depth interviews, as well as questionnaire surveys were used to explore residents' and local authorities' orientations toward flood risk mitigation. Also a SWOT analysis (Strengths, Weaknesses, Opportunities and Threats) involving key stakeholders was used to better understand the characteristics of the communities and their perception of flood risk mitigation issues. The results highlight some key differences between interventionist and participatory approaches, together with some implications of their adoption in the local context. Strengths and weaknesses of the two approaches, as well as key challenges for the future are also discussed.

The value of forecasting key-decision variables for rain-fed farming

NASA Astrophysics Data System (ADS)

Winsemius, Hessel; Werner, Micha

2013-04-01

Rain-fed farmers are highly vulnerable to variability in rainfall. Timely knowledge of the onset of the rainy season, the expected amount of rainfall and the occurrence of dry spells can help rain-fed farmers to plan the cropping season. Seasonal probabilistic weather forecasts may provide such information to farmers, but need to provide reliable forecasts of key variables with which farmers can make decisions. In this contribution, we present a new method to evaluate the value of meteorological forecasts in predicting these key variables. The proposed method measures skill by assessing whether a forecast was useful to this decision. This is done by taking into account the required accuracy of timing of the event to make the decision useful. The method progresses the estimate of forecast skill to forecast value by taking into account the required accuracy that is needed to make the decision valuable, based on the cost/loss ratio of possible decisions. The method is applied over the Limpopo region in Southern Africa. We demonstrate the method using the example of temporary water harvesting techniques. Such techniques require time to construct and must be ready long enough before the occurrence of a dry spell to be effective. The value of the forecasts to the decision used as an example is shown to be highly sensitive to the accuracy in the timing of forecasted dry spells, and the tolerance in the decision to timing error. The skill with which dry spells can be predicted is shown to be higher in some parts of the basin, indicating that these forecasts have higher value for the decision in those parts than in others. Through assessing the skill of forecasting key decision variables to the farmers we show that it is easier to understand if the forecasts have value in reducing risk, or if other adaptation strategies should be implemented.

Organic Versus Contractor Logistics Support For Depot-Level Repair: Factors That Drive Sub-Optimal Decisions

DTIC Science & Technology

2016-02-16

Considerations in Using CLS or Organic Support Break-Even Analysis in the Decision Process When a business decision is made in an ideal environment, all costs...Line B). The break-even point (Point C) is the production quantity where the advantage moves to a different cost curve. For a business decision...the Services to provide regular reporting to them on contractor versus organic workload and money .1415 In sum, there are laws that mandate 50/50

A Decade of Molecular Understanding of Withanolide Biosynthesis and In vitro Studies in Withania somnifera (L.) Dunal: Prospects and Perspectives for Pathway Engineering

PubMed Central

Dhar, Niha; Razdan, Sumeer; Rana, Satiander; Bhat, Wajid W.; Vishwakarma, Ram; Lattoo, Surrinder K.

2015-01-01

Withania somnifera, a multipurpose medicinal plant is a rich reservoir of pharmaceutically active triterpenoids that are steroidal lactones known as withanolides. Though the plant has been well-characterized in terms of phytochemical profiles as well as pharmaceutical activities, limited attempts have been made to decipher the biosynthetic route and identification of key regulatory genes involved in withanolide biosynthesis. This scenario limits biotechnological interventions for enhanced production of bioactive compounds. Nevertheless, recent emergent trends vis-à-vis, the exploration of genomic, transcriptomic, proteomic, metabolomics, and in vitro studies have opened new vistas regarding pathway engineering of withanolide production. During recent years, various strategic pathway genes have been characterized with significant amount of regulatory studies which allude toward development of molecular circuitries for production of key intermediates or end products in heterologous hosts. Another pivotal aspect covering redirection of metabolic flux for channelizing the precursor pool toward enhanced withanolide production has also been attained by deciphering decisive branch point(s) as robust targets for pathway modulation. With these perspectives, the current review provides a detailed overview of various studies undertaken by the authors and collated literature related to molecular and in vitro approaches employed in W. somnifera for understanding various molecular network interactions in entirety. PMID:26640469

Canada-United States oil and gas relations, 1958 to 1974

NASA Astrophysics Data System (ADS)

Nemeth, Tammy Lynn

While there were overtures from each country to develop a more formal accord to govern the trade of oil and natural gas at different times since 1958, Canada rejected that option in 1974 when it decided to phase out oil exports to the U.S. The main purpose of this research is to trace the development and evolution of Canada-U.S. oil and gas relations from the beginning of the informal continental relationship in 1959, through attempts to formalize a continental oil and gas agreement in the late 1960s, to the initial reversal of continentalism by Canada in 1974. This study examines and compares the changing influence of the explanatory variables of interest groups, international forces, national security, economics, ideas, and personalities on the energy decision- and policy-making processes of Canada and the U.S. between 1958 and 1974. Four key decisions or events that can be considered turning points in the Canada-U.S. oil and gas relationship are analysed and include: Canada's exemption to the American Mandatory Oil Import Program (MOIP); Canada's National Oil Policy (NOP); the near revocation of Canada's MOIP exemption; and Canada's decision to phase out oil exports. These events and relationships are situated in the larger context of interdependence, intergovernmental and transgovernmental relations, and the altered bureaucratic structures of governments in both countries over this period of time. Although decisions concerning Canada-U.S. oil and gas relations, and the pursuit and reversal of continentalist policies, were influenced by concerns regarding the pressure of various interest groups, international forces, national security, and changing economic and ideological circumstances; in the period examined here, the personalities of and personal relationships between Presidents and Prime Ministers, and the actions of key officials, as well as their transgovernmental networks across the border, often made the difference in determining what policy or approach was chosen when and why.

Benchmarking to the world's best in mathematics. Quality control in curriculum and instruction among the top performers in the TIMSS.

PubMed

Phelps, R P

2001-08-01

This article describes the education quality control systems (for mathematics) used by those countries that performed best on the Third International Mathematics and Science Study (TIMSS). Enforced quality control measures are defined as "decision points"--where adherence to the curriculum and instruction system can be reinforced. Most decision points involve stakes for the student, teacher, or school. They involve potential consequences for failure to adhere to the system and to follow the program at a reasonable pace. Generally, countries with more decision points perform better on the TIMSS. When the number of decision points and TIMSS test scores are adjusted for country wealth, the relationship between the degree of (enforced) quality control and student achievement appears to be positive and exponential. The more (enforced) quality control measures employed in an education system, the greater is students' academic achievement.

Science For Decision-Makers: Climate Change Indicators For The North-Central California Coast And Ocean

NASA Astrophysics Data System (ADS)

Duncan, B.; Higgason, K.; Suchanek, T.; Stachowicz, J.; Largier, J. L.; Cayan, D. R.

2013-12-01

Resource managers and decision-makers in North-central California recognize a need for increased information about the impacts of climate change on the region's coast and ocean to ensure that adaptation and conservation decisions are grounded in sound science. To help meet this need, ocean climate indicators were developed in a project based at NOAA's Gulf of the Farallones National Marine Sanctuary for the North-central California coast and ocean, from Año Nuevo to Point Arena, including the Pacific coastline of the San Francisco Bay Area. These represent the first regional ocean climate indicators in the National Marine Sanctuary System. The indicators were developed in collaboration with over 50 regional research scientists and resource managers representing federal and state agencies, research universities and institutions, and non-governmental organizations. Following the indicator development process, an interdisciplinary working group incorporated the indicators into a regional indicators monitoring inventory and plan that will be used by scientists, natural resource managers, and state and municipal planners to monitor, track, and develop adaptation strategies for the impacts of climate change on the region. The working group collaborated extensively to co-identify key measurements and data sources for the indicators, and to ensure that the monitoring plan was accessible and convenient for decision-makers while still providing a valuable resource for research scientists.

Section-Based Tree Species Identification Using Airborne LIDAR Point Cloud

NASA Astrophysics Data System (ADS)

Yao, C.; Zhang, X.; Liu, H.

2017-09-01

The application of LiDAR data in forestry initially focused on mapping forest community, particularly and primarily intended for largescale forest management and planning. Then with the smaller footprint and higher sampling density LiDAR data available, detecting individual tree overstory, estimating crowns parameters and identifying tree species are demonstrated practicable. This paper proposes a section-based protocol of tree species identification taking palm tree as an example. Section-based method is to detect objects through certain profile among different direction, basically along X-axis or Y-axis. And this method improve the utilization of spatial information to generate accurate results. Firstly, separate the tree points from manmade-object points by decision-tree-based rules, and create Crown Height Mode (CHM) by subtracting the Digital Terrain Model (DTM) from the digital surface model (DSM). Then calculate and extract key points to locate individual trees, thus estimate specific tree parameters related to species information, such as crown height, crown radius, and cross point etc. Finally, with parameters we are able to identify certain tree species. Comparing to species information measured on ground, the portion correctly identified trees on all plots could reach up to 90.65 %. The identification result in this research demonstrate the ability to distinguish palm tree using LiDAR point cloud. Furthermore, with more prior knowledge, section-based method enable the process to classify trees into different classes.

Examining key design decisions involved in developing a serious game for child sexual abuse prevention.

PubMed

Stieler-Hunt, Colleen; Jones, Christian M; Rolfe, Ben; Pozzebon, Kay

2014-01-01

This paper presents a case study of the key decisions made in the design of Orbit, a child sexual abuse prevention computer game targeted at school students between 8 and 10 years of age. Key decisions include providing supported delivery for the target age group, featuring adults in the program, not over-sanitizing game content, having a focus on building healthy self-concept of players, making the game engaging and relatable for all players and evaluating the program. This case study has implications for the design of Serious Games more generally, including that research should underpin game design decisions, game designers should consider ways of bridging the game to real life, the learning that arises from the game should go beyond rote-learning, designers should consider how the player can make the game-world their own and comprehensive evaluations of Serious Games should be undertaken.

Examining key design decisions involved in developing a serious game for child sexual abuse prevention

PubMed Central

Stieler-Hunt, Colleen; Jones, Christian M.; Rolfe, Ben; Pozzebon, Kay

2014-01-01

This paper presents a case study of the key decisions made in the design of Orbit, a child sexual abuse prevention computer game targeted at school students between 8 and 10 years of age. Key decisions include providing supported delivery for the target age group, featuring adults in the program, not over-sanitizing game content, having a focus on building healthy self-concept of players, making the game engaging and relatable for all players and evaluating the program. This case study has implications for the design of Serious Games more generally, including that research should underpin game design decisions, game designers should consider ways of bridging the game to real life, the learning that arises from the game should go beyond rote-learning, designers should consider how the player can make the game-world their own and comprehensive evaluations of Serious Games should be undertaken. PMID:24550880

Improving the care pathway for women who request Caesarean section: an experience-based co-design study.

PubMed

Kenyon, Sara L; Johns, Nina; Duggal, Sandhya; Hewston, Ruth; Gale, Nicola

2016-11-09

Maternal request for Caesarean section is controversial and yet the NICE Caesarean section Guideline recommends that that if this is requested, following discussion of the risks and benefits, women should be supported in their choice. There was a desire to improve the pathway at Birmingham Women's NHS Foundation Trust. Experience-based co-design methodology uses service user and clinicians experiences collected using qualitative methods to jointly re-design services. Firstly semi-structured interviews were conducted to elicit the views and experiences of health care professionals and women who requested Caesarean section (with and without medical indication). Analysis identified key themes arising from the health care professionals' interviews and 'touch points' (key moments or events related to the experience of care) arising from the interviews with women.. Separate workshops were then held with each group to ensure these resonated and to identify key areas for service improvement. At the first joint workshop a pathway using 'audio clips' demonstrating women's agreed 'touch points' prompted discussion and joint working began to change the pathway. A final second workshop was held to agree changes to the pathway. Interviews were conducted with health care professionals (n = 22, 10 consultant obstetricians and 12 midwives) and women (n = 15). The women's 'touch points' included repetition of request, delay in the decision for Caesarean section to be made, feeling judged, and that information was poor with similar findings identified from the health care professionals. Joint working resulted in a revised pathway for women who request Caesarean section. Changes to the pathway for women as a result of the work include written information about 'The way your baby may be born' which is given to the woman followed by a discussion about mode of birth around the 16 week appointment. If the woman wishes to have a Caesarean section, referral is made to appropriate health care professionals (e.g., Consultant Midwife, counsellor) only if support and information would be useful. If Caesarean section is requested, woman is referred to a consultant obstetrician for an appointment at 20/40, with a decision by 28/40. Recording this in the notes minimises repeated challenge described by women. Final consent and timing of Caesarean section remain as recommended. This has resulted in changes to the pathway agreed by a co-design process and which are acceptable to both health care professionals and women. Use of such methodologies should be considered more frequently when implementing service change.

History of the Spitzer Mission

NASA Astrophysics Data System (ADS)

Rieke, George

2006-12-01

The Spitzer Telescope was launched more than 20 years after the original announcement of opportunity was released. During this long gestation period, the mission took a wide variety of forms and had to survive many political and managerial environments within NASA and in the US Government generally. Finally, approval to build the telescope was won at the height of the faster-better-cheaper era, but completing it extended beyond this phase. This poster shows the key steps in preserving the mission and why decision makers viewed it positively at critical points when it might have been killed. In the end, the scope of the mission was reduced by a factor of about five while still preserving much of its science capabilities. This reduction required a new way to streamline the science objectives by adopting a limited number of key programs and requiring that all features be justified in terms of those programs. This philosophy provided decision rules to carry out necessary descopes while preserving a coherent set of capabilities. In addition, the faster-better-cheaper guidelines requires use of a small launch vehicle, which was only possible by the invention of a new “warm launch” telescope concept, in which the telescope would cool primarily by radiation into space after launch. Both of these concepts are critical to the approach to future missions such as JWST. This work is partially supported by contract 1255094 from JPL/Caltech to the University of Arizona.

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

PubMed

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

2017-03-01

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

Changing Times, Complex Decisions: Presidential Values and Decision Making

ERIC Educational Resources Information Center

Hornak, Anne M.; Garza Mitchell, Regina L.

2016-01-01

Objective: The objective of this article is to delve more deeply into the thought processes of the key decision makers at community colleges and understand how they make decisions. Specifically, this article focuses on the role of the community college president's personal values in decision making. Method: We conducted interviews with 13…

How much should we know about energy to better implement climate change education?

NASA Astrophysics Data System (ADS)

Silva-Send, N.; Anders, S.

2011-12-01

Anthropogenic climate change requires us to understand complex and multidisciplinary aspects of climate science. But without also grasping the connection between our lifestyles, behavior, and energy use, it will be difficult for many of us to make changes to contribute to climate change mitigation and energy conservation. A deeper understanding of the energy-climate relationship related to our behavior is thus warranted because, as the internet-based EnergyLiteracy.org points out, albeit within a different but related context of national security and development, "The vast majority of Americans simply don't adequately understand the magnitude and urgency of our national energy crisis ..." and "That lack of understanding deprives our democracy of the political will that must be generated in order to adequately address...." these issues. Our NSF Climate Change Education Program Project, the San Diego Regional Climate Education Partnership (SDRCEP), has as its overarching aim to inform citizens to make balanced decisions based on climate change and energy literacy. The project targets a selected group of 30 key influential persons in the region, and their audiences, representing, for example, the banking sector, the construction industry, the health sector, and commercial real estate. Interviews carried out so far suggest that the connection between climate change and energy use is not easily made. On the other hand, the interviews indicate that a connection is easily made, in this region, between climate change and water availability. Therefore, the purpose of this presentation is to discuss what specific knowledge about personal and societal energy use might be useful to (a) inform and empower key decision-makers responsible for energy-use decisions that significantly affect our lives in the next decades, and (b) empower people to contribute to reducing the impacts of climate change through behavioral or even life-style changes.

Creating an advance-care-planning decision aid for high-risk surgery: a qualitative study

PubMed Central

2014-01-01

Background High-risk surgery patients may lose decision-making capacity as a result of surgical complications. Advance care planning prior to surgery may be beneficial, but remains controversial and is hindered by a lack of appropriate decision aids. This study sought to examine stakeholders’ views on the appropriateness of using decision aids, in general, to support advance care planning among high-risk surgery populations and the design of such a decision aid. Methods Key informants were recruited through purposive and snowball sampling. Semi-structured interviews were conducted by phone until data collected reached theoretical saturation. Key informants were asked to discuss their thoughts about advance care planning and interventions to support advance care planning, particularly for this population. Researchers took de-identified notes that were analyzed for emerging concordant, discordant, and recurrent themes using interpretative phenomenological analysis. Results Key informants described the importance of initiating advance care planning preoperatively, despite potential challenges present in surgical settings. In general, decision aids were viewed as an appropriate approach to support advance care planning for this population. A recipe emerged from the data that outlines tools, ingredients, and tips for success that are needed to design an advance care planning decision aid for high-risk surgical settings. Conclusions Stakeholders supported incorporating advance care planning in high-risk surgical settings and endorsed the appropriateness of using decision aids to do so. Findings will inform the next stages of developing the first advance care planning decision aid for high-risk surgery patients. PMID:25067908

Creating an advance-care-planning decision aid for high-risk surgery: a qualitative study.

PubMed

Schuster, Anne Lr; Aslakson, Rebecca A; Bridges, John Fp

2014-01-01

High-risk surgery patients may lose decision-making capacity as a result of surgical complications. Advance care planning prior to surgery may be beneficial, but remains controversial and is hindered by a lack of appropriate decision aids. This study sought to examine stakeholders' views on the appropriateness of using decision aids, in general, to support advance care planning among high-risk surgery populations and the design of such a decision aid. Key informants were recruited through purposive and snowball sampling. Semi-structured interviews were conducted by phone until data collected reached theoretical saturation. Key informants were asked to discuss their thoughts about advance care planning and interventions to support advance care planning, particularly for this population. Researchers took de-identified notes that were analyzed for emerging concordant, discordant, and recurrent themes using interpretative phenomenological analysis. Key informants described the importance of initiating advance care planning preoperatively, despite potential challenges present in surgical settings. In general, decision aids were viewed as an appropriate approach to support advance care planning for this population. A recipe emerged from the data that outlines tools, ingredients, and tips for success that are needed to design an advance care planning decision aid for high-risk surgical settings. Stakeholders supported incorporating advance care planning in high-risk surgical settings and endorsed the appropriateness of using decision aids to do so. Findings will inform the next stages of developing the first advance care planning decision aid for high-risk surgery patients.

Strategies to support drug discovery through integration of systems and data.

PubMed

Waller, Chris L; Shah, Ajay; Nolte, Matthias

2007-08-01

Much progress has been made over the past several years to provide technologies for the integration of drug discovery software applications and the underlying data bits. Integration at the application layer has focused primarily on developing and delivering applications that support specific workflows within the drug discovery arena. A fine balance between creating behemoth applications and providing business value must be maintained. Heterogeneous data sources have typically been integrated at the data level in an effort to provide a more holistic view of the data packages supporting key decision points. This review will highlight past attempts, current status, and potential future directions for systems and data integration strategies in support of drug discovery efforts.

Development of a structured observational method for the systematic assessment of school food-choice architecture.

PubMed

Ozturk, Orgul D; McInnes, Melayne M; Blake, Christine E; Frongillo, Edward A; Jones, Sonya J

2016-01-01

The objective of this study is to develop a structured observational method for the systematic assessment of the food-choice architecture that can be used to identify key points for behavioral economic intervention intended to improve the health quality of children's diets. We use an ethnographic approach with observations at twelve elementary schools to construct our survey instrument. Elements of the structured observational method include decision environment, salience, accessibility/convenience, defaults/verbal prompts, number of choices, serving ware/method/packaging, and social/physical eating environment. Our survey reveals important "nudgeable" components of the elementary school food-choice architecture, including precommitment and default options on the lunch line.

Interdisciplinary shared governance: a partnership model for high performance in a managed care environment.

PubMed

Anderson, D A; Bankston, K; Stindt, J L; Weybright, D W

2000-09-01

Today's managed care environment is forcing hospitals to seek new and innovative ways to deliver a seamless continuum of high-quality care and services to defined populations at lower costs. Many are striving to achieve this goal through the implementation of shared governance models that support point-of-service decision making, interdisciplinary partnerships, and the integration of work across clinical settings and along the service delivery continuum. The authors describe the key processes and strategies used to facilitate the design and successful implementation of an interdisciplinary shared governance model at The University Hospital, Cincinnati, Ohio. Implementation costs and initial benefits obtained over a 2-year period also are identified.

A Tri-Reference Point Theory of Decision Making under Risk

ERIC Educational Resources Information Center

Wang, X. T.; Johnson, Joseph G.

2012-01-01

The tri-reference point (TRP) theory takes into account minimum requirements (MR), the status quo (SQ), and goals (G) in decision making under risk. The 3 reference points demarcate risky outcomes and risk perception into 4 functional regions: success (expected value of x greater than or equal to G), gain (SQ less than x less than G), loss (MR…

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

PubMed

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

2017-03-06

Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system. While there is considerable evidence of implementation initiatives in direct care context, there is limited investigation of implementation initiatives in decision-making context as it relates to program planning, service delivery and developing policies. Research has also shown a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs) at decision-making points in primary healthcare (PHC) based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI) a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs) was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to include value-based (customer driven quality and experience of care) perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainability. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The marketing activities of hospitals: environmental, organizational, and managerial influences.

PubMed

Myrtle, R C; Martinez, C F

1991-03-01

This article reports the results of a study designed to examine the relationship of environmental, organizational and structural factors, perceptions of key decision makers about competitive conditions, and changes in operational performance with the level of the marketing activities engaged in by 145 California hospitals. Measures assessing the impact of environmental conditions and the perception of the key decision makers were found to be related to the marketing activities of the organization. However, the relationship between measures which examined the structural and performance impacts on the marketing activities did not demonstrate the same predictive ability. The results suggest that marketing activities were affected by the key decision maker's assessment of the competitive nature of the environment, influence of key stakeholders, and tangible changes in the organization's task environment. Performance and other measures were not found to be as influential in determining these activities.

Perspectives of self-direction: a systematic review of key areas contributing to service users' engagement and choice-making in self-directed disability services and supports.

PubMed

Lakhani, Ali; McDonald, Donna; Zeeman, Heidi

2018-05-01

Self-directed disability support policies aim to encourage greater choice and control for service users in terms of the health and social care they receive. The proliferation of self-directed disability support policies throughout the developed world has resulted in a growing amount of research exploring the outcomes for service users, and their families and carers. Our understanding of the issues faced by people with disabilities, particularly how they make health and social care decisions and the key areas that determine their engagement with service providers within a self-directed environment is limited. A synthesis of research is timely and can provide knowledge for service users and health and social care support providers to ensure their successful participation. A systematic review guided by the PRISMA approach explored (i) the key areas determining service users' engagement with self-directed disability services and supports, and (ii) how service users make informed decisions about providers. In October 2014 and April 2016, three databases - MEDLINE, CINAHL and Web of Science - were searched for research and review articles. Eighteen sources met the search criteria. Findings were mapped into either: key areas determining service user engagement, or service users' informed decision-making. Findings concerning key areas determining engagement fell into three themes - personal responsibility for budgeting, personalised approaches, and a cultural shift in practice and delivery among service providers. Findings about decision-making yielded two themes - supporting informed decision-making and inhibiting informed decision-making. Literature suggests that self-directed models of care may provide service users with increased control over the services that they receive. Increased control for some service users and their families requires independent external decision-making support, particularly around the domains of budgeting, planning and hiring. Future research must continue to investigate the perspectives of service users pertaining to their engagement, as their participation is central to the effectiveness of the approach. © 2016 John Wiley & Sons Ltd.

Promotion of Physical Activity Using Point-of-Decision Prompts in Berlin Underground Stations

PubMed Central

Müller-Riemenschneider, Falk; Nocon, Marc; Reinhold, Thomas; Willich, Stefan N.

2010-01-01

To evaluate point-of-decision prompts in the promotion of stair use in Germany, motivational posters were placed at three underground stations in Berlin. The proportion of passengers using stairs or stairways was counted before, during installation, and two weeks after removal of posters. In total, 5,467 passersby were counted. Stair use increased significantly in women, but not in men. The present pilot study thereby shows that the use of point-of-decision prompts is also feasible in Germany and it provides some evidence of effectiveness. Methodologically rigorous studies are warranted to confirm these findings. PMID:20948947

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

PubMed

Doran, Diane M; Sidani, Souraya

2007-01-01

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

38 CFR 26.7 - VA environmental decision making and documents.

Code of Federal Regulations, 2010 CFR

2010-07-01

... environmental decision making and documents. (a) Relevant environmental documents shall accompany other decision documents as they proceed through the decision-making process. (b) The major decision points for VA actions... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false VA environmental decision...

Operationalizing Semantic Medline for meeting the information needs at point of care.

PubMed

Rastegar-Mojarad, Majid; Li, Dingcheng; Liu, Hongfang

2015-01-01

Scientific literature is one of the popular resources for providing decision support at point of care. It is highly desirable to bring the most relevant literature to support the evidence-based clinical decision making process. Motivated by the recent advance in semantically enhanced information retrieval, we have developed a system, which aims to bring semantically enriched literature, Semantic Medline, to meet the information needs at point of care. This study reports our work towards operationalizing the system for real time use. We demonstrate that the migration of a relational database implementation to a NoSQL (Not only SQL) implementation significantly improves the performance and makes the use of Semantic Medline at point of care decision support possible.

Operationalizing Semantic Medline for meeting the information needs at point of care

PubMed Central

Rastegar-Mojarad, Majid; Li, Dingcheng; Liu, Hongfang

2015-01-01

Scientific literature is one of the popular resources for providing decision support at point of care. It is highly desirable to bring the most relevant literature to support the evidence-based clinical decision making process. Motivated by the recent advance in semantically enhanced information retrieval, we have developed a system, which aims to bring semantically enriched literature, Semantic Medline, to meet the information needs at point of care. This study reports our work towards operationalizing the system for real time use. We demonstrate that the migration of a relational database implementation to a NoSQL (Not only SQL) implementation significantly improves the performance and makes the use of Semantic Medline at point of care decision support possible. PMID:26306259

Teaching Behavioral Ethics: Overcoming the Key Impediments to Ethical Behavior

ERIC Educational Resources Information Center

Schwartz, Mark S.

2017-01-01

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

A 2-Year Integrated Agriculture and Nutrition Program Targeted to Mothers of Young Children in Burkina Faso Reduces Underweight among Mothers and Increases Their Empowerment: A Cluster-Randomized Controlled Trial.

PubMed

Olney, Deanna K; Bliznashka, Lilia; Pedehombga, Abdoulaye; Dillon, Andrew; Ruel, Marie T; Heckert, Jessica

2016-05-01

Recent evidence demonstrates the benefits of integrated agriculture and nutrition programs for children's health and nutrition outcomes. These programs may also improve mothers' nutrition and empowerment outcomes. However, evidence from rigorous evaluations is scarce. We examined impacts of Helen Keller International's 2-y enhanced-homestead food production (E-HFP) program in Burkina Faso on the secondary impact measures of mothers' nutrition and empowerment. We used a cluster-randomized controlled trial whereby 55 villages with 1767 mothers of young children were randomly assigned to 3 groups: 1) control, 2) E-HFP with the behavior change communication (BCC) strategy implemented by older women leaders, or 3) E-HFP with BCC implemented by health committee members. Data for the treatment groups were pooled for this analysis because no differences were found between the 2 groups in key mothers' outcomes. We used difference-in-differences (DID) estimates to assess impacts on mothers' dietary intake, diversity, body mass index (BMI; in kg/m(2)), prevalence of underweight (BMI <18.5), and empowerment. The E-HFP program significantly increased mothers' intake of fruit (DID = 15.8 percentage points; P = 0.02) and marginally increased their intake of meat/poultry (DID = 7.5 percentage points; P = 0.08) and dietary diversity (DID = 0.3 points; P = 0.08). The prevalence of underweight was significantly reduced among mothers in treatment compared with control villages by 8.7 percentage points (P < 0.01). Although the changes in BMI did not differ between mothers in treatment and control villages, there was a marginally significant interaction (baseline underweight × change in BMI; P-interaction = 0.07), indicating that underweight mothers had a greater increase in BMI than did mothers who were not underweight. The E-HFP program also positively affected mothers' overall empowerment score (DID = 3.13 points out of 37 possible points; P < 0.01) and 3 components of empowerment: meeting with women (DID = 1.21 points out of 5 possible points; P < 0.01), purchasing decisions (DID = 0.86 points out of 8 possible points; P = 0.01), and health care decisions (DID = 0.24 points out of 2 possible points; P = 0.05). Helen Keller International's E-HFP program in Burkina Faso substantially improved mothers' nutrition and empowerment outcomes. These positive impacts benefit the mothers themselves and may also improve their ability to care for their children. This trial was registered at clinicaltrials.gov as NCT01825226. © 2016 American Society for Nutrition.

How can point-of-care HbA1c testing be integrated into UK primary care consultations? - A feasibility study.

PubMed

Hirst, J A; Stevens, R J; Smith, I; James, T; Gudgin, B C; Farmer, A J

2017-08-01

Point-of-care (POC) HbA1c testing gives a rapid result, allowing testing and treatment decisions to take place in a single appointment. Trials of POC testing have not been shown to improve HbA1c, possibly because of how testing was implemented. This study aimed to identify key components of POC HbA1c testing and determine strategies to optimise implementation in UK primary care. This cohort feasibility study recruited thirty patients with type 2 diabetes and HbA1c>7.5% (58mmol/mol) into three primary care clinics. Patients' clinical care included two POC HbA1c tests over six months. Data were collected on appointment duration, clinical decisions, technical performance and patient behaviour. Fifty-three POC HbA1c consultations took place during the study; clinical decisions were made in 30 consultations. Five POC consultations with a family doctor lasted on average 11min and 48 consultations with nurses took on average 24min. Five POC study visits did not take place in one clinic. POC results were uploaded to hospital records from two clinics. In total, sixty-three POC tests were performed, and there were 11 cartridge failures. No changes in HbA1c or patient behaviour were observed. HbA1c measurement with POC devices can be effectively implemented in primary care. This work has identified when these technologies might work best, as well as potential challenges. The findings can be used to inform the design of a pragmatic trial to implement POC HbA1c testing. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Leadership Style, Decision Context, and the Poliheuristic Theory of Decision Making: An Experimental Analysis

ERIC Educational Resources Information Center

Keller, Jonathan W.; Yang, Yi Edward

2008-01-01

The poliheuristic (PH) theory of decision making has made important contributions to our understanding of political decision making but remains silent about certain key aspects of the decision process. Specifically, PH theory contends that leaders screen out politically unacceptable options, but it provides no guidance on (1) the crucial threshold…

Roles, processes, and outcomes of interprofessional shared decision-making in a neonatal intensive care unit: A qualitative study.

PubMed

Dunn, Sandra I; Cragg, Betty; Graham, Ian D; Medves, Jennifer; Gaboury, Isabelle

2018-05-01

Shared decision-making provides an opportunity for the knowledge and skills of care providers to synergistically influence patient care. Little is known about interprofessional shared decision-making processes in critical care settings. The aim of this study was to explore interprofessional team members' perspectives about the nature of interprofessional shared decision-making in a neonatal intensive care unit (NICU) and to determine if there are any differences in perspectives across professional groups. An exploratory qualitative approach was used consisting of semi-structured interviews with 22 members of an interprofessional team working in a tertiary care NICU in Canada. Participants identified four key roles involved in interprofessional shared decision-making: leader, clinical experts, parents, and synthesizer. Participants perceived that interprofessional shared decision-making happens through collaboration, sharing, and weighing the options, the evidence and the credibility of opinions put forward. The process of interprofessional shared decision-making leads to a well-informed decision and participants feeling valued. Findings from this study identified key concepts of interprofessional shared decision-making, increased awareness of differing professional perspectives about this process of shared decision-making, and clarified understanding of the different roles involved in the decision-making process in an NICU.

The use of a policy dialogue to facilitate evidence-informed policy development for improved access to care: the case of the Winnipeg Central Intake Service (WCIS).

PubMed

Damani, Zaheed; MacKean, Gail; Bohm, Eric; DeMone, Brie; Wright, Brock; Noseworthy, Tom; Holroyd-Leduc, Jayna; Marshall, Deborah A

2016-10-18

Policy dialogues are critical for developing responsive, effective, sustainable, evidence-informed policy. Our multidisciplinary team, including researchers, physicians and senior decision-makers, comprehensively evaluated The Winnipeg Central Intake Service, a single-entry model in Winnipeg, Manitoba, to improve patient access to hip/knee replacement surgery. We used the evaluation findings to develop five evidence-informed policy directions to help improve access to scheduled clinical services across Manitoba. Using guiding principles of public participation processes, we hosted a policy roundtable meeting to engage stakeholders and use their input to refine the policy directions. Here, we report on the use and input of a policy roundtable meeting and its role in contributing to the development of evidence-informed policy. Our evidence-informed policy directions focused on formal measurement/monitoring of quality, central intake as a preferred model for service delivery, provincial scope, transparent processes/performance indicators, and patient choice of provider. We held a policy roundtable meeting and used outcomes of facilitated discussions to refine these directions. Individuals from our team and six stakeholder groups across Manitoba participated (n = 44), including patients, family physicians, orthopaedic surgeons, surgical office assistants, Winnipeg Central Intake team, and administrators/managers. We developed evaluation forms to assess the meeting process, and collected decision-maker partners' perspectives on the value of the policy roundtable meeting and use of policy directions to improve access to scheduled clinical services after the meeting, and again 15 months later. We analyzed roundtable and evaluation data using thematic analysis to identify key themes. Four key findings emerged. First, participants supported all policy directions, with revisions and key implementation considerations identified. Second, participants felt the policy roundtable meeting achieved its purpose (to engage stakeholders, elicit feedback, refine policy directions). Third, our decision-maker partners' expectations of the policy roundtable meeting were exceeded; they re-affirmed its value and described the refined policy directions as foundational to establishing the vocabulary, vision and framework for improving access to scheduled clinical services in Manitoba. Finally, our adaptation of key design elements was conducive to discussion of issues surrounding access to care. Our policy roundtable process was an effective tool for acquiring broad input from stakeholders, refining policy directions and forming the necessary consensus starting points to move towards evidence-informed policy.

Consensus Building: A Key to School Transformation

ERIC Educational Resources Information Center

Baron, Daniel

2008-01-01

Consensus-based decision making can turn faculty meetings into meaningful and productive work sessions in which faculty members know that their input is respected and valued and important decisions are made. Reaching consensus has different meanings in different contexts. Decisions are made "by consensus" when the decision affects the entire…

Keys to success for data-driven decision making: Lessons from participatory monitoring and collaborative adaptive management

USDA-ARS?s Scientific Manuscript database

Recent years have witnessed a call for evidence-based decisions in conservation and natural resource management, including data-driven decision-making. Adaptive management (AM) is one prevalent model for integrating scientific data into decision-making, yet AM has faced numerous challenges and limit...

What Learning Environments Help Improve Decision-Making?

ERIC Educational Resources Information Center

O'Connor, Donna; Larkin, Paul; Williams, A. Mark

2017-01-01

Background: Decision-making is a key component of performance in sport. However, there has been minimal investigation of how coaches may adapt practice sessions to specifically develop decision-making. Purpose: The aim in this exploratory study was to investigate the pedagogical approaches coaches use to develop decision-making in soccer. Method:…

Offset quadrature communications with decision-feedback carrier synchronization

NASA Technical Reports Server (NTRS)

Simon, M. K.; Smith, J. G.

1974-01-01

In order to accommodate a quadrature amplitude-shift-keyed (QASK) signal, Simon and Smith (1974) have modified the decision-feedback loop which tracks a quadrature phase-shift-keyed (QPSK). In the investigation reported approaches are considered to modify the loops in such a way that offset QASK signals can be tracked, giving attention to the special case of an offset QPSK. The development of the stochastic integro-differential equation of operation for a decision-feedback offset QASK loop is discussed along with the probability density function of the phase error process.

Use of structured decision-making to explicitly incorporate environmental process understanding in management of coastal restoration projects: Case study on barrier islands of the northern Gulf of Mexico.

PubMed

Dalyander, P Soupy; Meyers, Michelle; Mattsson, Brady; Steyer, Gregory; Godsey, Elizabeth; McDonald, Justin; Byrnes, Mark; Ford, Mark

2016-12-01

Coastal ecosystem management typically relies on subjective interpretation of scientific understanding, with limited methods for explicitly incorporating process knowledge into decisions that must meet multiple, potentially competing stakeholder objectives. Conversely, the scientific community lacks methods for identifying which advancements in system understanding would have the highest value to decision-makers. A case in point is barrier island restoration, where decision-makers lack tools to objectively use system understanding to determine how to optimally use limited contingency funds when project construction in this dynamic environment does not proceed as expected. In this study, collaborative structured decision-making (SDM) was evaluated as an approach to incorporate process understanding into mid-construction decisions and to identify priority gaps in knowledge from a management perspective. The focus was a barrier island restoration project at Ship Island, Mississippi, where sand will be used to close an extensive breach that currently divides the island. SDM was used to estimate damage that may occur during construction, and guide repair decisions within the confines of limited availability of sand and funding to minimize adverse impacts to project objectives. Sand was identified as more limiting than funds, and unrepaired major breaching would negatively impact objectives. Repairing minor damage immediately was determined to be generally more cost effective (depending on the longshore extent) than risking more damage to a weakened project. Key gaps in process-understanding relative to project management were identified as the relationship of island width to breach formation; the amounts of sand lost during breaching, lowering, or narrowing of the berm; the potential for minor breaches to self-heal versus developing into a major breach; and the relationship between upstream nourishment and resiliency of the berm to storms. This application is a prototype for using structured decision-making in support of engineering projects in dynamic environments where mid-construction decisions may arise; highlights uncertainty about barrier island physical processes that limit the ability to make robust decisions; and demonstrates the potential for direct incorporation of process-based models in a formal adaptive management decision framework. Published by Elsevier Ltd.

The information value of early career productivity in mathematics: a ROC analysis of prediction errors in bibliometricly informed decision making.

PubMed

Lindahl, Jonas; Danell, Rickard

The aim of this study was to provide a framework to evaluate bibliometric indicators as decision support tools from a decision making perspective and to examine the information value of early career publication rate as a predictor of future productivity. We used ROC analysis to evaluate a bibliometric indicator as a tool for binary decision making. The dataset consisted of 451 early career researchers in the mathematical sub-field of number theory. We investigated the effect of three different definitions of top performance groups-top 10, top 25, and top 50 %; the consequences of using different thresholds in the prediction models; and the added prediction value of information on early career research collaboration and publications in prestige journals. We conclude that early career performance productivity has an information value in all tested decision scenarios, but future performance is more predictable if the definition of a high performance group is more exclusive. Estimated optimal decision thresholds using the Youden index indicated that the top 10 % decision scenario should use 7 articles, the top 25 % scenario should use 7 articles, and the top 50 % should use 5 articles to minimize prediction errors. A comparative analysis between the decision thresholds provided by the Youden index which take consequences into consideration and a method commonly used in evaluative bibliometrics which do not take consequences into consideration when determining decision thresholds, indicated that differences are trivial for the top 25 and the 50 % groups. However, a statistically significant difference between the methods was found for the top 10 % group. Information on early career collaboration and publication strategies did not add any prediction value to the bibliometric indicator publication rate in any of the models. The key contributions of this research is the focus on consequences in terms of prediction errors and the notion of transforming uncertainty into risk when we are choosing decision thresholds in bibliometricly informed decision making. The significance of our results are discussed from the point of view of a science policy and management.

Use of structured decision-making to explicitly incorporate environmental process understanding in management of coastal restoration projects: Case study on barrier islands of the northern Gulf of Mexico

USGS Publications Warehouse

Dalyander, P. Soupy; Meyers, Michelle B.; Mattsson, Brady; Steyer, Gregory; Godsey, Elizabeth; McDonald, Justin; Byrnes, Mark R.; Ford, Mark

2016-01-01

Coastal ecosystem management typically relies on subjective interpretation of scientific understanding, with limited methods for explicitly incorporating process knowledge into decisions that must meet multiple, potentially competing stakeholder objectives. Conversely, the scientific community lacks methods for identifying which advancements in system understanding would have the highest value to decision-makers. A case in point is barrier island restoration, where decision-makers lack tools to objectively use system understanding to determine how to optimally use limited contingency funds when project construction in this dynamic environment does not proceed as expected. In this study, collaborative structured decision-making (SDM) was evaluated as an approach to incorporate process understanding into mid-construction decisions and to identify priority gaps in knowledge from a management perspective. The focus was a barrier island restoration project at Ship Island, Mississippi, where sand will be used to close an extensive breach that currently divides the island. SDM was used to estimate damage that may occur during construction, and guide repair decisions within the confines of limited availability of sand and funding to minimize adverse impacts to project objectives. Sand was identified as more limiting than funds, and unrepaired major breaching would negatively impact objectives. Repairing minor damage immediately was determined to be generally more cost effective (depending on the longshore extent) than risking more damage to a weakened project. Key gaps in process-understanding relative to project management were identified as the relationship of island width to breach formation; the amounts of sand lost during breaching, lowering, or narrowing of the berm; the potential for minor breaches to self-heal versus developing into a major breach; and the relationship between upstream nourishment and resiliency of the berm to storms. This application is a prototype for using structured decision-making in support of engineering projects in dynamic environments where mid-construction decisions may arise; highlights uncertainty about barrier island physical processes that limit the ability to make robust decisions; and demonstrates the potential for direct incorporation of process-based models in a formal adaptive management decision framework.

Cost analysis of open radical cystectomy versus robot-assisted radical cystectomy.

PubMed

Bansal, Sukhchain S; Dogra, Tara; Smith, Peter W; Amran, Maisarah; Auluck, Ishna; Bhambra, Maninder; Sura, Manraj S; Rowe, Edward; Koupparis, Anthony

2018-03-01

To perform a cost analysis comparing the cost of robot-assisted radical cystectomy (RARC) with open RC (ORC) in a UK tertiary referral centre and to identify the key cost drivers. Data on hospital length of stay (LOS), operative time (OT), transfusion rate, and volume and complication rate were obtained from a prospectively updated institutional database for patients undergoing RARC or ORC. A cost decision tree model was created. Sensitivity analysis was performed to find key drivers of overall cost and to find breakeven points with ORC. Monte Carlo analysis was performed to quantify the variability in the dataset. One RARC procedure costs £12 449.87, or £12 106.12 if the robot was donated via charitable funds. In comparison, one ORC procedure costs £10 474.54. RARC is 18.9% more expensive than ORC. The key cost drivers were OT, LOS, and the number of cases performed per annum. High ongoing equipment costs remain a large barrier to the cost of RARC falling. However, minimal improvements in patient quality of life would be required to offset this difference. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Stakeholders’ Perspectives on Strategies for the Recruitment and Retention of Primary Health Care Employees in Qatar: A Qualitative Approach

PubMed Central

Alameddine, Mohamad; Yassoub, Rami; Mourad, Yara; Khodr, Hiba

2017-01-01

This study explores the recruitment and retention conditions influencing primary health care (PHC) human resources for health (HRH) in Qatar and suggests strategies for their improvement. A qualitative design employing semistructured key informant interviews with PHC stakeholders in Qatar was utilized. Key interviewees were originally recognized, and snowball sampling was used to identify additional interviewees until reaching saturation point. Interview scripts were transcribed and then analyzed thematically using the Nvivo software package. Thematic analysis precipitated a number of themes. Under recruitment, the centrality of enhancing collaboration with academic institutions, enhancing extrinsic benefits, and strengthening human resources recruitment and management practices. Dedicated support needs to be provided to expatriate HRH especially in regard to housing services, children schooling, and streamlining administrative processes for relocation. Findings revealed that job security, continuous professional development, objective performance appraisal systems, enhanced job transparency, and remuneration are key retention concerns. The study provides a number of recommendations for the proper recruitment and retention of HRH. Health planners and decision makers must take these recommendations into consideration to ensure the presence of a competent and sustainable HRH in the PHC sector in the future. PMID:28853314

Stakeholders' Perspectives on Strategies for the Recruitment and Retention of Primary Health Care Employees in Qatar: A Qualitative Approach.

PubMed

Alameddine, Mohamad; Yassoub, Rami; Mourad, Yara; Khodr, Hiba

2017-01-01

This study explores the recruitment and retention conditions influencing primary health care (PHC) human resources for health (HRH) in Qatar and suggests strategies for their improvement. A qualitative design employing semistructured key informant interviews with PHC stakeholders in Qatar was utilized. Key interviewees were originally recognized, and snowball sampling was used to identify additional interviewees until reaching saturation point. Interview scripts were transcribed and then analyzed thematically using the Nvivo software package. Thematic analysis precipitated a number of themes. Under recruitment, the centrality of enhancing collaboration with academic institutions, enhancing extrinsic benefits, and strengthening human resources recruitment and management practices. Dedicated support needs to be provided to expatriate HRH especially in regard to housing services, children schooling, and streamlining administrative processes for relocation. Findings revealed that job security, continuous professional development, objective performance appraisal systems, enhanced job transparency, and remuneration are key retention concerns. The study provides a number of recommendations for the proper recruitment and retention of HRH. Health planners and decision makers must take these recommendations into consideration to ensure the presence of a competent and sustainable HRH in the PHC sector in the future.

The Use of Research Evidence in Public Health Decision Making Processes: Systematic Review

PubMed Central

Orton, Lois; Lloyd-Williams, Ffion; Taylor-Robinson, David; O'Flaherty, Martin; Capewell, Simon

2011-01-01

Background The use of research evidence to underpin public health policy is strongly promoted. However, its implementation has not been straightforward. The objectives of this systematic review were to synthesise empirical evidence on the use of research evidence by public health decision makers in settings with universal health care systems. Methods To locate eligible studies, 13 bibliographic databases were screened, organisational websites were scanned, key informants were contacted and bibliographies of included studies were scrutinised. Two reviewers independently assessed studies for inclusion, extracted data and assessed methodological quality. Data were synthesised as a narrative review. Findings 18 studies were included: 15 qualitative studies, and three surveys. Their methodological quality was mixed. They were set in a range of country and decision making settings. Study participants included 1063 public health decision makers, 72 researchers, and 174 with overlapping roles. Decision making processes varied widely between settings, and were viewed differently by key players. A range of research evidence was accessed. However, there was no reliable evidence on the extent of its use. Its impact was often indirect, competing with other influences. Barriers to the use of research evidence included: decision makers' perceptions of research evidence; the gulf between researchers and decision makers; the culture of decision making; competing influences on decision making; and practical constraints. Suggested (but largely untested) ways of overcoming these barriers included: research targeted at the needs of decision makers; research clearly highlighting key messages; and capacity building. There was little evidence on the role of research evidence in decision making to reduce inequalities. Conclusions To more effectively implement research informed public health policy, action is required by decision makers and researchers to address the barriers identified in this systematic review. There is an urgent need for evidence to support the use of research evidence to inform public health decision making to reduce inequalities. PMID:21818262

36 CFR 907.14 - Corporation decision making procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Corporation decision making... CORPORATION ENVIRONMENTAL QUALITY § 907.14 Corporation decision making procedures. To ensure that at major decision making points all relevant environmental concerns are considered by the Decision Maker, the...

Collaborating with Youth to Inform and Develop Tools for Psychotropic Decision Making

PubMed Central

Murphy, Andrea; Gardner, David; Kutcher, Stan; Davidson, Simon; Manion, Ian

2010-01-01

Introduction: Youth oriented and informed resources designed to support psychopharmacotherapeutic decision-making are essentially unavailable. This article outlines the approach taken to design such resources, the product that resulted from the approach taken, and the lessons learned from the process. Methods: A project team with psychopharmacology expertise was assembled. The project team reviewed best practices regarding medication educational materials and related tools to support decisions. Collaboration with key stakeholders who were thought of as primary end-users and target groups occurred. A graphic designer and a plain language consultant were also retained. Results: Through an iterative and collaborative process over approximately 6 months, Med Ed and Med Ed Passport were developed. Literature and input from key stakeholders, in particular youth, was instrumental to the development of the tools and materials within Med Ed. A training program utilizing a train-the-trainer model was developed to facilitate the implementation of Med Ed in Ontario, which is currently ongoing. Conclusion: An evidence-informed process that includes youth and key stakeholder engagement is required for developing tools to support in psychopharmacotherapeutic decision-making. The development process fostered an environment of reciprocity between the project team and key stakeholders. PMID:21037916

Identification of design features to enhance utilization and acceptance of systems for Internet-based decision support at the point of care.

PubMed

Gadd, C S; Baskaran, P; Lobach, D F

1998-01-01

Extensive utilization of point-of-care decision support systems will be largely dependent on the development of user interaction capabilities that make them effective clinical tools in patient care settings. This research identified critical design features of point-of-care decision support systems that are preferred by physicians, through a multi-method formative evaluation of an evolving prototype of an Internet-based clinical decision support system. Clinicians used four versions of the system--each highlighting a different functionality. Surveys and qualitative evaluation methodologies assessed clinicians' perceptions regarding system usability and usefulness. Our analyses identified features that improve perceived usability, such as telegraphic representations of guideline-related information, facile navigation, and a forgiving, flexible interface. Users also preferred features that enhance usefulness and motivate use, such as an encounter documentation tool and the availability of physician instruction and patient education materials. In addition to identifying design features that are relevant to efforts to develop clinical systems for point-of-care decision support, this study demonstrates the value of combining quantitative and qualitative methods of formative evaluation with an iterative system development strategy to implement new information technology in complex clinical settings.

CFHT's SkyProbe: a real-time sky-transparency monitor

NASA Astrophysics Data System (ADS)

Cuillandre, Jean-Charles; Magnier, Eugene A.; Isani, Sidik; Sabin, Daniel; Knight, Wiley; Kras, Simon; Lai, Kamson

2002-12-01

We have developed a system at the Canada-France-Hawaii Telescope (CFHT), SkyProbe, which allows for the direct measurement of the true attenuation by clouds once per minute, within a percent, directly on the field pointed by the telescope. It has been possible to make this system relatively inexpensively due to the low-cost CCD cameras from the amateur market. A crucial addition to this hardware is the quite recent availability of a full-sky photometry catalog at the appropriate depth: the Tycho catalog, from the Hipparcos mission. The central element is the automatic data analysis pipeline developed at CFHT, Elixir, for the improved operation of the CFHT wide-field imagers, CFH12K and MegaCam. SkyProbe"s FITS images are processed in real-time and the pipeline output (a zero point attenuation) provides the current sky transmission to the observers and helps immediate decision making. These measurements are also attached to the archived data, adding a key criteria for future use by other astronomers.

Aptamers as the Agent in Decontamination Assays (Apta-Decontamination Assays): From the Environment to the Potential Application In Vivo

PubMed Central

Bilibana, Mawethu Pascoe; Yeoh, Tzi Shien; Tang, Thean-Hock

2017-01-01

The binding specificity and affinity of aptamers have long been harnessed as the key elements in the development of aptamer-based assays, particularly aptasensing application. One promising avenue that is currently explored based on the specificity and affinity of aptamers is the application of aptamers in the decontamination assays. Aptamers have been successfully harnessed as the decontamination agents to remove contaminants from the environment and to decontaminate infectious elements. The reversible denaturation property inherent in aptamers enables the repeated usage of aptamers, which can immensely save the cost of decontamination. Analogous to the point-of-care diagnostics, there is no doubt that aptamers can also be deployed in the point-of-care aptamer-based decontamination assay, whereby decontamination can be performed anywhere and anytime for instantaneous decision-making. It is also prophesied that aptamers can also serve more than as a decontaminant, probably as a tool to capture and kill hazardous elements, particularly pathogenic agents. PMID:29225967

Caregiving and, Decision-Making For Seniors: How You Can Help

MedlinePlus

... Issue Past Issues Feature: Senior Living Caregiving and Decision-Making For Seniors: How You Can Help Past Issues / ... key resources and suggestions for effective care and decision-making for seniors. —The Editors To Find Out More ...

Early warning systems for the management of chronic heart failure: a systematic literature review of cost-effectiveness models.

PubMed

Albuquerque De Almeida, Fernando; Al, Maiwenn; Koymans, Ron; Caliskan, Kadir; Kerstens, Ankie; Severens, Johan L

2018-04-01

Describing the general and methodological characteristics of decision-analytical models used in the economic evaluation of early warning systems for the management of chronic heart failure patients and performing a quality assessment of their methodological characteristics is expected to provide concise and useful insight to inform the future development of decision-analytical models in the field of heart failure management. Areas covered: The literature on decision-analytical models for the economic evaluation of early warning systems for the management of chronic heart failure patients was systematically reviewed. Nine electronic databases were searched through the combination of synonyms for heart failure and sensitive filters for cost-effectiveness and early warning systems. Expert commentary: The retrieved models show some variability with regards to their general study characteristics. Overall, they display satisfactory methodological quality, even though some points could be improved, namely on the consideration and discussion of any competing theories regarding model structure and disease progression, identification of key parameters and the use of expert opinion, and uncertainty analyses. A comprehensive definition of early warning systems and further research under this label should be pursued. To improve the transparency of economic evaluation publications, authors should make available detailed technical information regarding the published models.

Estimating and communicating prognosis in advanced neurologic disease

PubMed Central

Gramling, Robert; Kelly, Adam G.

2013-01-01

Prognosis can no longer be relegated behind diagnosis and therapy in high-quality neurologic care. High-stakes decisions that patients (or their surrogates) make often rest upon perceptions and beliefs about prognosis, many of which are poorly informed. The new science of prognostication—the estimating and communication “what to expect”—is in its infancy and the evidence base to support “best practices” is lacking. We propose a framework for formulating a prediction and communicating “what to expect” with patients, families, and surrogates in the context of common neurologic illnesses. Because neurologic disease affects function as much as survival, we specifically address 2 important prognostic questions: “How long?” and “How well?” We provide a summary of prognostic information and highlight key points when tailoring a prognosis for common neurologic diseases. We discuss the challenges of managing prognostic uncertainty, balancing hope and realism, and ways to effectively engage surrogate decision-makers. We also describe what is known about the nocebo effects and the self-fulfilling prophecy when communicating prognoses. There is an urgent need to establish research and educational priorities to build a credible evidence base to support best practices, improve communication skills, and optimize decision-making. Confronting the challenges of prognosis is necessary to fulfill the promise of delivering high-quality, patient-centered care. PMID:23420894

Science-based HRA: experimental comparison of operator performance to IDAC (Information-Decision-Action Crew) simulations

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

Shirley, Rachel; Smidts, Carol; Boring, Ronald

Information-Decision-Action Crew (IDAC) operator model simulations of a Steam Generator Tube Rupture are compared to student operator performance in studies conducted in the Ohio State University’s Nuclear Power Plant Simulator Facility. This study is presented as a prototype for conducting simulator studies to validate key aspects of Human Reliability Analysis (HRA) methods. Seven student operator crews are compared to simulation results for crews designed to demonstrate three different decision-making strategies. The IDAC model used in the simulations is modified slightly to capture novice behavior rather that expert operators. Operator actions and scenario pacing are compared. A preliminary review of availablemore » performance shaping factors (PSFs) is presented. After the scenario in the NPP Simulator Facility, student operators review a video of the scenario and evaluate six PSFs at pre-determined points in the scenario. This provides a dynamic record of the PSFs experienced by the OSU student operators. In this preliminary analysis, Time Constraint Load (TCL) calculated in the IDAC simulations is compared to TCL reported by student operators. We identify potential modifications to the IDAC model to develop an “IDAC Student Operator Model.” This analysis provides insights into how similar experiments could be conducted using expert operators to improve the fidelity of IDAC simulations.« less

Using histograms to introduce randomization in the generation of ensembles of decision trees

DOEpatents

Kamath, Chandrika; Cantu-Paz, Erick; Littau, David

2005-02-22

A system for decision tree ensembles that includes a module to read the data, a module to create a histogram, a module to evaluate a potential split according to some criterion using the histogram, a module to select a split point randomly in an interval around the best split, a module to split the data, and a module to combine multiple decision trees in ensembles. The decision tree method includes the steps of reading the data; creating a histogram; evaluating a potential split according to some criterion using the histogram, selecting a split point randomly in an interval around the best split, splitting the data, and combining multiple decision trees in ensembles.

A fast image matching algorithm based on key points

NASA Astrophysics Data System (ADS)

Wang, Huilin; Wang, Ying; An, Ru; Yan, Peng

2014-05-01

Image matching is a very important technique in image processing. It has been widely used for object recognition and tracking, image retrieval, three-dimensional vision, change detection, aircraft position estimation, and multi-image registration. Based on the requirements of matching algorithm for craft navigation, such as speed, accuracy and adaptability, a fast key point image matching method is investigated and developed. The main research tasks includes: (1) Developing an improved celerity key point detection approach using self-adapting threshold of Features from Accelerated Segment Test (FAST). A method of calculating self-adapting threshold was introduced for images with different contrast. Hessian matrix was adopted to eliminate insecure edge points in order to obtain key points with higher stability. This approach in detecting key points has characteristics of small amount of computation, high positioning accuracy and strong anti-noise ability; (2) PCA-SIFT is utilized to describe key point. 128 dimensional vector are formed based on the SIFT method for the key points extracted. A low dimensional feature space was established by eigenvectors of all the key points, and each eigenvector was projected onto the feature space to form a low dimensional eigenvector. These key points were re-described by dimension-reduced eigenvectors. After reducing the dimension by the PCA, the descriptor was reduced to 20 dimensions from the original 128. This method can reduce dimensions of searching approximately near neighbors thereby increasing overall speed; (3) Distance ratio between the nearest neighbour and second nearest neighbour searching is regarded as the measurement criterion for initial matching points from which the original point pairs matched are obtained. Based on the analysis of the common methods (e.g. RANSAC (random sample consensus) and Hough transform cluster) used for elimination false matching point pairs, a heuristic local geometric restriction strategy is adopted to discard false matched point pairs further; and (4) Affine transformation model is introduced to correct coordinate difference between real-time image and reference image. This resulted in the matching of the two images. SPOT5 Remote sensing images captured at different date and airborne images captured with different flight attitude were used to test the performance of the method from matching accuracy, operation time and ability to overcome rotation. Results show the effectiveness of the approach.

Use of modified Delphi to plan knowledge translation for decision makers: an application in the field of advanced practice nursing.

PubMed

Carter, Nancy; Lavis, John N; MacDonald-Rencz, Sandra

2014-01-01

Disseminating research to decision makers is difficult. Interaction between researchers and decision makers can identify key messages and processes for dissemination. To gain agreement on the key findings from a synthesis on the integration of advanced practice nurses, we used a modified Delphi process. Nursing decision makers contributed ideas via e-mail, discussed and clarified ideas face to face, and then prioritized statements. Sixteen (89%) participated and 14 (77%) completed the final phase. Priority key messages were around access to care and outcomes. The majority identified "NPs increase access to care" and "NPs and CNSs improve patient and system outcomes" as priority messaging statements. Participants agreed policy makers and the public were target audiences for messages. Consulting with policy makers provided the necessary context to develop tailored policy messages and is a helpful approach for research dissemination. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Obtaining Reimbursement in France and Italy for New Diabetes Products

PubMed Central

Schaefer, Elmar; Sonsalla, Jessica

2015-01-01

Manufacturers launching next-generation or innovative medical devices in Europe face a very heterogeneous reimbursement landscape, with each country having its own pathways, timing, requirements and success factors. We selected 2 markets for a deeper look into the reimbursement landscape: France, representing a country with central decision making with defined processes, and Italy, which delegates reimbursement decisions to the regional level, resulting in a less transparent approach to reimbursement. Based on our experience in working on various new product launches and analyzing recent reimbursement decisions, we found that payers in both countries do not reward improved next-generation products with incremental reimbursement. Looking at innovations, we observe that manufacturers face a challenging and lengthy process to obtain reimbursement. In addition, requirements and key success factors differ by country: In France, comparative clinical evidence and budget impact very much drive reimbursement decisions in terms of pricing and restrictions, whereas in Italy, regional key opinion leader (KOL) support and additional local observational data are key. PMID:25550411

Obtaining reimbursement in France and Italy for new diabetes products.

PubMed

Schaefer, Elmar; Schnell, Gerald; Sonsalla, Jessica

2015-01-01

Manufacturers launching next-generation or innovative medical devices in Europe face a very heterogeneous reimbursement landscape, with each country having its own pathways, timing, requirements and success factors. We selected 2 markets for a deeper look into the reimbursement landscape: France, representing a country with central decision making with defined processes, and Italy, which delegates reimbursement decisions to the regional level, resulting in a less transparent approach to reimbursement. Based on our experience in working on various new product launches and analyzing recent reimbursement decisions, we found that payers in both countries do not reward improved next-generation products with incremental reimbursement. Looking at innovations, we observe that manufacturers face a challenging and lengthy process to obtain reimbursement. In addition, requirements and key success factors differ by country: In France, comparative clinical evidence and budget impact very much drive reimbursement decisions in terms of pricing and restrictions, whereas in Italy, regional key opinion leader (KOL) support and additional local observational data are key. © 2015 Diabetes Technology Society.

Disciplinary and Academic Decisions Pertaining to Students: A Review of the 1997 Judicial Decisions.

ERIC Educational Resources Information Center

Stoner, Edward N.; Schupansky, Susan P.

1998-01-01

Reviews key cases concerning disciplinary and academic decisions in higher education handed down by courts in 1997. Cases touched on procedural due process (for medical residents, academic versus disciplinary decisions, other notable issues), double jeopardy, breach of contract, student discipline records under the Family Education Rights and…

The Elementary School Principal's Influence on Teachers' Curricular and Instructional Decisions.

ERIC Educational Resources Information Center

Larsen, Marci L.; Malen, Betty

Within the research on teacher planning and decision making the principal is seldom mentioned as a key shaper of teachers' curricular and instructional decision making. This paper presents findings of a case study of two elementary school principals. The study examined the congruence between principals' aims and teachers' decisions; the statements…

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

PubMed

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

2007-01-01

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

Exploring evidence-policy linkages in health research plans: A case study from six countries

PubMed Central

Syed, Shamsuzzoha B; Hyder, Adnan A; Bloom, Gerald; Sundaram, Sandhya; Bhuiya, Abbas; Zhenzhong, Zhang; Kanjilal, Barun; Oladepo, Oladimeji; Pariyo, George; Peters, David H

2008-01-01

The complex evidence-policy interface in low and middle income country settings is receiving increasing attention. Future Health Systems (FHS): Innovations for Equity, is a research consortium conducting health systems explorations in six Asian and African countries: Bangladesh, India, China, Afghanistan, Uganda, and Nigeria. The cross-country research consortium provides a unique opportunity to explore the research-policy interface. Three key activities were undertaken during the initial phase of this five-year project. First, key considerations in strengthening evidence-policy linkages in health system research were developed by FHS researchers through workshops and electronic communications. Four key considerations in strengthening evidence-policy linkages are postulated: development context; research characteristics; decision-making processes; and stakeholder engagement. Second, these four considerations were applied to research proposals in each of the six countries to highlight features in the research plans that potentially strengthen the research-policy interface and opportunities for improvement. Finally, the utility of the approach for setting research priorities in health policy and systems research was reflected upon. These three activities yielded interesting findings. First, developmental consideration with four dimensions – poverty, vulnerabilities, capabilities, and health shocks – provides an entry point in examining research-policy interfaces in the six settings. Second, research plans focused upon on the ground realities in specific countries strengthens the interface. Third, focusing on research prioritized by decision-makers, within a politicized health arena, enhances chances of research influencing action. Lastly, early and continued engagement of multiple stakeholders, from local to national levels, is conducive to enhanced communication at the interface. The approach described has four main utilities: first, systematic analyses of research proposals using key considerations ensure such issues are incorporated into research proposals; second, the exact meaning, significance, and inter-relatedness of these considerations can be explored within the research itself; third, cross-country learning can be enhanced; and finally, translation of evidence into action may be facilitated. Health systems research proposals in low and middle income countries should include reflection on transferring research findings into policy. Such deliberations may be informed by employing the four key considerations suggested in this paper in analyzing research proposals. PMID:18331651

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

PubMed

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

2018-05-01

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

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

PubMed

Lanzer, Peter; Prechelt, Lutz

2011-02-15

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

Accuracy and reliability of forensic latent fingerprint decisions

PubMed Central

Ulery, Bradford T.; Hicklin, R. Austin; Buscaglia, JoAnn; Roberts, Maria Antonia

2011-01-01

The interpretation of forensic fingerprint evidence relies on the expertise of latent print examiners. The National Research Council of the National Academies and the legal and forensic sciences communities have called for research to measure the accuracy and reliability of latent print examiners’ decisions, a challenging and complex problem in need of systematic analysis. Our research is focused on the development of empirical approaches to studying this problem. Here, we report on the first large-scale study of the accuracy and reliability of latent print examiners’ decisions, in which 169 latent print examiners each compared approximately 100 pairs of latent and exemplar fingerprints from a pool of 744 pairs. The fingerprints were selected to include a range of attributes and quality encountered in forensic casework, and to be comparable to searches of an automated fingerprint identification system containing more than 58 million subjects. This study evaluated examiners on key decision points in the fingerprint examination process; procedures used operationally include additional safeguards designed to minimize errors. Five examiners made false positive errors for an overall false positive rate of 0.1%. Eighty-five percent of examiners made at least one false negative error for an overall false negative rate of 7.5%. Independent examination of the same comparisons by different participants (analogous to blind verification) was found to detect all false positive errors and the majority of false negative errors in this study. Examiners frequently differed on whether fingerprints were suitable for reaching a conclusion. PMID:21518906

Accuracy and reliability of forensic latent fingerprint decisions.

PubMed

Ulery, Bradford T; Hicklin, R Austin; Buscaglia, Joann; Roberts, Maria Antonia

2011-05-10

The interpretation of forensic fingerprint evidence relies on the expertise of latent print examiners. The National Research Council of the National Academies and the legal and forensic sciences communities have called for research to measure the accuracy and reliability of latent print examiners' decisions, a challenging and complex problem in need of systematic analysis. Our research is focused on the development of empirical approaches to studying this problem. Here, we report on the first large-scale study of the accuracy and reliability of latent print examiners' decisions, in which 169 latent print examiners each compared approximately 100 pairs of latent and exemplar fingerprints from a pool of 744 pairs. The fingerprints were selected to include a range of attributes and quality encountered in forensic casework, and to be comparable to searches of an automated fingerprint identification system containing more than 58 million subjects. This study evaluated examiners on key decision points in the fingerprint examination process; procedures used operationally include additional safeguards designed to minimize errors. Five examiners made false positive errors for an overall false positive rate of 0.1%. Eighty-five percent of examiners made at least one false negative error for an overall false negative rate of 7.5%. Independent examination of the same comparisons by different participants (analogous to blind verification) was found to detect all false positive errors and the majority of false negative errors in this study. Examiners frequently differed on whether fingerprints were suitable for reaching a conclusion.

Technology to improve quality and accountability.

PubMed

Kay, Jonathan

2006-01-01

A body of evidence has been accumulated to demonstrate that current practice is not sufficiently safe for several stages of central laboratory testing. In particular, while analytical and perianalytical steps that take place within the laboratory are subjected to quality control procedures, this is not the case for several pre- and post-analytical steps. The ubiquitous application of auto-identification technology seems to represent a valuable tool for reducing error rates. A series of projects in Oxford has attempted to improve processes which support several areas of laboratory medicine, including point-of-care testing, blood transfusion, delivery and interpretation of reports, and support of decision-making by clinicians. The key tools are auto-identification, Internet communication technology, process re-engineering, and knowledge management.

Environmental Assessment of Packaging: The Consumer Point of View

PubMed

Van Dam YK

1996-09-01

When marketing environmentally responsible packaged products, the producer is confronted with consumer beliefs concerning the environmental friendliness of packaging materials. When making environmentally conscious packaging decisions, these consumer beliefs should be taken into account alongside the technical guidelines. Dutch consumer perceptions of the environmental friendliness of packaged products are reported and compared with the results of a life-cycle analysis assessment. It is shown that consumers judge environmental friendliness mainly from material and returnability. Furthermore, the consumer perception of the environmental friendliness of packaging material is based on the postconsumption waste, whereas the environmental effects of production are ignored. From the consumer beliefs concerning environmental friendliness implications are deduced for packaging policy and for environmental policy.KEY WORDS: Consumer behavior; Environment; Food; Packaging; Perception; Waste

The habenula.

PubMed

Namboodiri, Vijay Mohan K; Rodriguez-Romaguera, Jose; Stuber, Garret D

2016-10-10

The habenula is a tiny brain region the size of a pea in humans. This region is highly conserved across vertebrates and has been traditionally overlooked by neuroscientists. The name habenula is derived from the Latin word habena, meaning "little rein", because of its elongated shape. Originally its function was thought to be related to the regulation of the nearby pineal gland (which Rene Descartes described as the "principal seat of the soul"). More recent evidence, however, demonstrates that the habenula acts as a critical neuroanatomical hub that connects and regulates brain regions important for divergent motivational states and cognition. In this Primer, we will discuss the recent and converging evidence that points to the habenula as a key brain region for motivation and decision-making. Copyright © 2016. Published by Elsevier Ltd.

Space Launch System milestone on This Week @NASA - August 29, 2014

NASA Image and Video Library

2014-08-29

On August 27, NASA announced a milestone in development of the Space Launch System heavy-lift rocket. The completion of a rigorous review known as Key Decision Point C, or KDP-C, means NASA can transition from formulation to development of the rocket that will send humans beyond Earth orbit and to Mars. KDP-C outlines a conservative development cost baseline and a launch readiness schedule based on an initial SLS flight no later than November 2018. This marks the country's first commitment to building an exploration class launch vehicle since the Space Shuttle Program. Also, 3-D printed rocket injector test, SLS scale model test, Composite fuel tank tests, Crossing Neptune’s orbit, New Horizons: Continuing Voyager’s legacy and more!

Energy taxation: an analysis of selected taxes

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

Not Available

1980-01-01

Taxation is a key instrument by which governments affect economic decision making and outcomes. Not surprisingly, energy taxation has received considerable attention in recent years with the mounting concern over national energy policy. As with other policy instruments, the taxation of energy production and use spans a wide array of topics. It also cuts across other instruments because it affects the entire spectrum of economic variables - prices, outputs, investments, uses, and so on. As a result, the subject of energy taxation constitutes a highly complex set of issues for public policy. This report examines the principal components of thatmore » set of issues. In the process, it points out the most-important interrelations among the various taxes and between taxation and other policy instruments.« less

Participatory Decision Making.

ERIC Educational Resources Information Center

King, M. Bruce; And Others

Shifting from traditional, hierarchical bureaucracies to participatory governance and decision making is a major theme in school restructuring. This paper focuses on the involvement of teachers in key aspects of school decision making. Specifically, the paper describes how changes in power relations supported teachers' focus on improving the…

Registration algorithm of point clouds based on multiscale normal features

NASA Astrophysics Data System (ADS)

Lu, Jun; Peng, Zhongtao; Su, Hang; Xia, GuiHua

2015-01-01

The point cloud registration technology for obtaining a three-dimensional digital model is widely applied in many areas. To improve the accuracy and speed of point cloud registration, a registration method based on multiscale normal vectors is proposed. The proposed registration method mainly includes three parts: the selection of key points, the calculation of feature descriptors, and the determining and optimization of correspondences. First, key points are selected from the point cloud based on the changes of magnitude of multiscale curvatures obtained by using principal components analysis. Then the feature descriptor of each key point is proposed, which consists of 21 elements based on multiscale normal vectors and curvatures. The correspondences in a pair of two point clouds are determined according to the descriptor's similarity of key points in the source point cloud and target point cloud. Correspondences are optimized by using a random sampling consistency algorithm and clustering technology. Finally, singular value decomposition is applied to optimized correspondences so that the rigid transformation matrix between two point clouds is obtained. Experimental results show that the proposed point cloud registration algorithm has a faster calculation speed, higher registration accuracy, and better antinoise performance.

Neuromodulation of group prejudice and religious belief.

PubMed

Holbrook, Colin; Izuma, Keise; Deblieck, Choi; Fessler, Daniel M T; Iacoboni, Marco

2016-03-01

People cleave to ideological convictions with greater intensity in the aftermath of threat. The posterior medial frontal cortex (pMFC) plays a key role in both detecting discrepancies between desired and current conditions and adjusting subsequent behavior to resolve such conflicts. Building on prior literature examining the role of the pMFC in shifts in relatively low-level decision processes, we demonstrate that the pMFC mediates adjustments in adherence to political and religious ideologies. We presented participants with a reminder of death and a critique of their in-group ostensibly written by a member of an out-group, then experimentally decreased both avowed belief in God and out-group derogation by downregulating pMFC activity via transcranial magnetic stimulation. The results provide the first evidence that group prejudice and religious belief are susceptible to targeted neuromodulation, and point to a shared cognitive mechanism underlying concrete and abstract decision processes. We discuss the implications of these findings for further research characterizing the cognitive and affective mechanisms at play. © The Author (2015). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Cost-effectiveness analysis: what it really means for transfusion medicine decision making.

PubMed

Custer, Brian; Hoch, Jeffrey S

2009-01-01

Some have suggested that "blood is different," and the role for cost-effectiveness is thus circumscribed. In this article, the authors start by reviewing key concepts in health economics and economic analysis methods. Examples are drawn from published blood safety studies. After explaining the underlying reasoning behind cost-effectiveness analysis, the authors point out how economic thinking is evident in some aspects of transfusion medicine. Some cost-effectiveness study results for blood safety are discussed to provide context, followed by consideration of prominent decisions that have been made in transfusion medicine field. In the last section, the authors conjecture as to why in some cases cost-effectiveness analysis appears to have greater impact than in others, noting the terrible price that is paid in mortality and morbidity when cost-effectiveness analysis is ignored. In this context, the implications of opportunity cost are discussed, and it is noted that opportunity cost should not be viewed as benefits forgone by concentrating on one aspect of blood safety and instead should be viewed as our societal willingness to misallocate resources to achieve less health for the same cost.

Implant Rehabilitation Planning Protocol for the Edentulous Patient According to Denture Space, Lip Support, and Smile Line.

PubMed

Lago, Laura; Rilo, Benito; Fernández-Formoso, Noelia; DaSilva, Luis

2017-08-01

Rehabilitation with implants is a challenge. Having previous evaluation criteria is key to establishing the best treatment for the patient. In addition to clinical and radiological aspects, the prosthetic parameters must be taken into account in the initial workup, since they allow discrimination between fixed and removable rehabilitation. We present a study protocol that analyzes three basic prosthetic aspects. First, denture space defines the need to replace teeth, tissue, or both. Second, lip support focuses on whether or not to include a flange. Third, the smile line warns of potential risks in esthetic rehabilitation. Combining these parameters allows us to make a decision as to the most suitable type of prosthesis. The proposed protocol is useful for assessing the prosthetic parameters that influence decision making as to the best-suited type of restoration. From this point of view, we think it is appropriate for the initial approach to the patient. In any case, other considerations of study may amend the proposal. © 2016 by the American College of Prosthodontists.

Searching for the right fit: development of applicant person-organization fit perceptions during the recruitment process.

PubMed

Swider, Brian W; Zimmerman, Ryan D; Barrick, Murray R

2015-05-01

Numerous studies link applicant fit perceptions measured at a single point in time to recruitment outcomes. Expanding upon this prior research by incorporating decision-making theory, this study examines how applicants develop these fit perceptions over the duration of the recruitment process, showing meaningful changes in fit perceptions across and within organizations overtime. To assess the development of applicant fit perceptions, eight assessments of person-organization (PO) fit with up to four different organizations across 169 applicants for 403 job choice decisions were analyzed. Results showed the presence of initial levels and changes in differentiation of applicant PO fit perceptions across organizations, which significantly predicted future job choice. In addition, changes in within-organizational PO fit perceptions across two stages of recruitment predicted applicant job choices among multiple employers. The implications of these results for accurately understanding the development of fit perceptions, relationships between fit perceptions and key recruiting outcomes, and possible limitations of past meta-analytically derived estimates of these relationships are discussed. (c) 2015 APA, all rights reserved.

Intuition, subjectivity, and Le bricoleur: cancer patients' accounts of negotiating a plurality of therapeutic options.

PubMed

Broom, Alex

2009-08-01

Cancer patients are now combining complementary and alternative medicine (CAM) with biomedical cancer treatments, reflecting an increasingly pluralistic health care environment. However, there has been little research done on the ways in which cancer patients juggle multiplicity in claims to expertise, models of disease, and therapeutic practice. Drawing on the accounts of cancer patients who use CAM, in this article I develop a conceptualization of therapeutic decision making, utilizing the notion of bricolage as a key point of departure. The patient accounts illustrate the "piecing together" (or bricolage) of therapeutic trajectories, drawing on intuitive, embodied knowledge, as well as formalized "objective" scientific expertise. Le bricoleur, as characterized here, actively mediates, rather than accepts or rejects CAM or biomedicine, and utilizes a combination of scientific expertise, embodied physicality, and social knowledge to make decisions and assess therapeutic effectiveness. Although these "border crossings" are potentially subversive of established biomedical expertise, the analysis also illustrates the structural constraints (and penalties) associated with bricolage, and furthermore, the interplay of a repositioning of responsibility with neoliberal forms of self-governance.

Application of Graph Theory to Cost-Effective Fire Protection of Chemical Plants During Domino Effects.

PubMed

Khakzad, Nima; Landucci, Gabriele; Reniers, Genserik

2017-09-01

In the present study, we have introduced a methodology based on graph theory and multicriteria decision analysis for cost-effective fire protection of chemical plants subject to fire-induced domino effects. By modeling domino effects in chemical plants as a directed graph, the graph centrality measures such as out-closeness and betweenness scores can be used to identify the installations playing a key role in initiating and propagating potential domino effects. It is demonstrated that active fire protection of installations with the highest out-closeness score and passive fire protection of installations with the highest betweenness score are the most effective strategies for reducing the vulnerability of chemical plants to fire-induced domino effects. We have employed a dynamic graph analysis to investigate the impact of both the availability and the degradation of fire protection measures over time on the vulnerability of chemical plants. The results obtained from the graph analysis can further be prioritized using multicriteria decision analysis techniques such as the method of reference point to find the most cost-effective fire protection strategy. © 2016 Society for Risk Analysis.

PM₂.₅ opened a door to public participation addressing environmental challenges in China.

PubMed

Huang, Ganlin

2015-02-01

China has long been regarded as a centralized society where the public has little influence on decision-making. Such a top-down management scheme is perceived as a major obstacle to address complicated environment issues. The recent public campaign in China to urge creation of a nationwide PM₂.₅ monitoring network and mitigation plan provides an unprecedented case of how the public participated and influenced policy-making in a centralized society. This paper reviews key incidents in the campaign chronologically. Here we identify information technology, public awareness of air quality's health impacts and the fact air quality affects everyone as public goods as the major factors promoting public participation. This case demonstrates that public participation can happen in a centralized, top-down society such as China. Continued environmental deterioration may stimulate similar campaigns for other issues. We anticipate this essay to be a starting point for more studies on how environmental issues stimulate incremental social change by making people involved in decision-making process, especially in societies where they are rarely able to do so. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

EPA Science Inventory

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

A study exploring factors which influence the decision to commence nurse-led weaning.

PubMed

Gelsthorpe, Tony; Crocker, Cheryl

2004-01-01

Nurse-led weaning can improve patient outcome. Exploration of the factors that influence the commencement of weaning. Themes of decision-making, pathophysiological and multidisciplinary team factors emerged. Experience was a key factor in the decision to wean. The use of protocol-led weaning may not be useful in the decision to wean.

The use of predictive models to optimize risk of decisions.

PubMed

Baranyi, József; Buss da Silva, Nathália

2017-01-02

The purpose of this paper is to set up a mathematical framework that risk assessors and regulators could use to quantify the "riskiness" of a particular recommendation (choice/decision). The mathematical theory introduced here can be used for decision support systems. We point out that efficient use of predictive models in decision making for food microbiology needs to consider three major points: (1) the uncertainty and variability of the used information based on which the decision is to be made; (2) the validity of the predictive models aiding the assessor; and (3) the cost generated by the difference between the a-priory choice and the a-posteriori outcome. Copyright © 2016 Elsevier B.V. All rights reserved.

Chinese immigrant parents' vaccination decision making for children: a qualitative analysis.

PubMed

Wang, Linda D L; Lam, Wendy W T; Wu, Joseph T; Liao, Qiuyan; Fielding, Richard

2014-02-07

While immunization coverage rates for childhood routine vaccines in Hong Kong are almost 100%, the uptake rates of optional vaccines remain suboptimal. Understanding parental decision-making for children's vaccination is important, particularly among minority groups who are most vulnerable and underserved. This study explored how a subsample of new immigrant mothers from mainland China, a rapidly-growing subpopulation in Hong Kong, made decisions on various childhood and adolescent vaccines for their offspring, and identified key influences affecting their decision making. Semi-structured in-depth interviews were conducted with 23 Chinese new immigrant mothers recruited by purposive sampling. All interviews were audio-taped, transcribed and analyzed using a Grounded Theory approach. Participants' conversation revealed five underlying themes which influenced parents' vaccination decision-making: (1) Institutional factors, (2) Insufficient vaccination knowledge and advice, (3) Affective impacts on motivation, (4) Vaccination barriers, and (5) Social influences. The role of social norms appeared overwhelmingly salient influencing parents' vaccination decision making. Institutional factors shaped parent's perceptions of vaccination necessity. Fear of vaccine-targeted diseases was a key motivating factor for parents adopting vaccination. Insufficient knowledge about vaccines and targeted diseases, lack of advice from health professionals and, if provided, suspicions regarding the motivations for such advice were common issues. Vaccination cost was a major barrier for many new immigrant parents. Social norms play a key role influencing parental vaccination decision-making. Insight gained from this study will help inform healthcare providers in vaccination communication and policymakers in future vaccination programme.

Research on investment decisions model of trans-regional transmission network based on the theory of NPV

NASA Astrophysics Data System (ADS)

Zai, Wenjiao; Wang, Bo; Liu, Jichun; Shi, Haobo; Zeng, Pingliang

2018-02-01

The investment decision model of trans-regional transmission network in the context of Global Energy Internet was studied in this paper. The key factors affecting the trans-regional transmission network investment income: the income tax rate, the loan interest rate, the expected return on investment of the investment subject, the per capita GDP and so on were considered in the transmission network investment income model. First, according to the principle of system dynamics, the causality diagram of key factors was constructed. Then, the dynamic model of transmission investment decision was established. A case study of the power transmission network between China and Mongolia, through the simulation of the system dynamic model, the influence of the above key factors on the investment returns was analyzed, and the feasibility and effectiveness of the model was proved.

Investigating the Heart Pump Implant Decision Process: Opportunities for Decision Support Tools to Help

PubMed Central

Yang, Qian; Zimmerman, John; Steinfeld, Aaron; Carey, Lisa; Antaki, James F.

2016-01-01

Clinical decision support tools (DSTs) are computational systems that aid healthcare decision-making. While effective in labs, almost all these systems failed when they moved into clinical practice. Healthcare researchers speculated it is most likely due to a lack of user-centered HCI considerations in the design of these systems. This paper describes a field study investigating how clinicians make a heart pump implant decision with a focus on how to best integrate an intelligent DST into their work process. Our findings reveal a lack of perceived need for and trust of machine intelligence, as well as many barriers to computer use at the point of clinical decision-making. These findings suggest an alternative perspective to the traditional use models, in which clinicians engage with DSTs at the point of making a decision. We identify situations across patients’ healthcare trajectories when decision supports would help, and we discuss new forms it might take in these situations. PMID:27833397

41 CFR Appendix A to Subpart D of... - 3-Key Points and Principles

Code of Federal Regulations, 2010 CFR

2010-07-01

... Principles A Appendix A to Subpart D of Part 102 Public Contracts and Property Management Federal Property... Subpart D of Part 102-3—Key Points and Principles This appendix provides additional guidance in the form of answers to frequently asked questions and identifies key points and principles that may be applied...

41 CFR Appendix A to Subpart C of... - 3-Key Points and Principles

Code of Federal Regulations, 2010 CFR

2010-07-01

... Principles A Appendix A to Subpart C of Part 102 Public Contracts and Property Management Federal Property... 102-3—Key Points and Principles This appendix provides additional guidance in the form of answers to frequently asked questions and identifies key points and principles that may be applied to situations not...

The "Make or Buy" Decision: Five Main Points to Consider

ERIC Educational Resources Information Center

Archer, Mary Ann E.

1978-01-01

Five points which should be considered when making decisions about whether to purchase magnetic tapes for in-hours searching by batch processing, purchase terminals and contract with on-line vendors, or contract with information brokers for retrospective searching or SDI are availability of information in the most useful form, hardware and…

77 FR 23432 - Radio Broadcasting Services; Asbury and Maquoketa, IA, and Mineral Point, WI

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-19

... this decision also may be purchased from the Commission's duplicating contractor, Best Copy and... making filed by KM Radio of Independence, LLC, proposing the allotment of Channel 238A at Mineral Point... Commission decision is available for inspection and copying during normal business hours in the FCC...

Cultural influences on the physician-patient encounter: The case of shared treatment decision-making.

PubMed

Charles, Cathy; Gafni, Amiram; Whelan, Tim; O'Brien, Mary Ann

2006-11-01

In this paper we discuss the influence of culture on the process of treatment decision-making, and in particular, shared treatment decision-making in the physician-patient encounter. We explore two key issues: (1) the meaning of culture and the ways that it can affect treatment decision-making; (2) cultural issues and assumptions underlying the development and use of treatment decision aids. This is a conceptual paper. Based on our knowledge and reading of the key literature in the treatment decision-making field, we looked for written examples where cultural influences were taken into account when discussing the physician-patient encounter and when designing instruments (decision aids) to help patients participate in making decisions. Our assessment of the situation is that to date, and with some recent exceptions, research in the above areas has not been culturally sensitive. We suggest that more research attention should be focused on exploring potential cultural variations in the meaning of and preferences for shared decision-making as well as on the applicability across cultural groups of decision aids developed to facilitate patient participation in treatment decision-making with physicians. Both patients and physicians need to be aware of the cultural assumptions underlying the development and use of decision aids and assess their cultural sensitivity to the needs and preferences of patients in diverse cultural groups.

Decision Tree Approach for Soil Liquefaction Assessment

PubMed Central

Gandomi, Amir H.; Fridline, Mark M.; Roke, David A.

2013-01-01

In the current study, the performances of some decision tree (DT) techniques are evaluated for postearthquake soil liquefaction assessment. A database containing 620 records of seismic parameters and soil properties is used in this study. Three decision tree techniques are used here in two different ways, considering statistical and engineering points of view, to develop decision rules. The DT results are compared to the logistic regression (LR) model. The results of this study indicate that the DTs not only successfully predict liquefaction but they can also outperform the LR model. The best DT models are interpreted and evaluated based on an engineering point of view. PMID:24489498

Decision tree approach for soil liquefaction assessment.

PubMed

Gandomi, Amir H; Fridline, Mark M; Roke, David A

2013-01-01

In the current study, the performances of some decision tree (DT) techniques are evaluated for postearthquake soil liquefaction assessment. A database containing 620 records of seismic parameters and soil properties is used in this study. Three decision tree techniques are used here in two different ways, considering statistical and engineering points of view, to develop decision rules. The DT results are compared to the logistic regression (LR) model. The results of this study indicate that the DTs not only successfully predict liquefaction but they can also outperform the LR model. The best DT models are interpreted and evaluated based on an engineering point of view.

Identification of design features to enhance utilization and acceptance of systems for Internet-based decision support at the point of care.

PubMed Central

Gadd, C. S.; Baskaran, P.; Lobach, D. F.

1998-01-01

Extensive utilization of point-of-care decision support systems will be largely dependent on the development of user interaction capabilities that make them effective clinical tools in patient care settings. This research identified critical design features of point-of-care decision support systems that are preferred by physicians, through a multi-method formative evaluation of an evolving prototype of an Internet-based clinical decision support system. Clinicians used four versions of the system--each highlighting a different functionality. Surveys and qualitative evaluation methodologies assessed clinicians' perceptions regarding system usability and usefulness. Our analyses identified features that improve perceived usability, such as telegraphic representations of guideline-related information, facile navigation, and a forgiving, flexible interface. Users also preferred features that enhance usefulness and motivate use, such as an encounter documentation tool and the availability of physician instruction and patient education materials. In addition to identifying design features that are relevant to efforts to develop clinical systems for point-of-care decision support, this study demonstrates the value of combining quantitative and qualitative methods of formative evaluation with an iterative system development strategy to implement new information technology in complex clinical settings. Images Figure 1 PMID:9929188

Human/Automation Trade Methodology for the Moon, Mars and Beyond

NASA Technical Reports Server (NTRS)

Korsmeyer, David J.

2009-01-01

It is possible to create a consistent trade methodology that can characterize operations model alternatives for crewed exploration missions. For example, a trade-space that is organized around the objective of maximizing Crew Exploration Vehicle (CEV) independence would have the input as a classification of the category of analysis to be conducted or decision to be made, and a commitment to a detailed point in a mission profile during which the analysis or decision is to be made. For example, does the decision have to do with crew activity planning, or life support? Is the mission phase trans-Earth injection, cruise, or lunar descent? Different kinds of decision analysis of the trade-space between human and automated decisions will occurs at different points in a mission's profile. The necessary objectives at a given point in time during a mission will call for different kinds of response with respect to where and how computers and automation are expected to help provide an accurate, safe, and timely response. In this paper, a consistent methodology for assessing the trades between human and automated decisions on-board will be presented and various examples discussed.

Acquisition Program Transition Workshops: An Element of the DSMC Program Manager Mission Assistance Capability

DTIC Science & Technology

2011-10-01

specific modules as needed. The term “startup” is inclusive of any point in a DoD acquisition program. As noted above, methodology for conducting...Acquisition Sustainment =Decision Point =Milestone Review =Decision Point if PDR is not conducted before Milestone B ProgramA B Initiation) C IOC FOC...start a new program 2.2 Background Conclusions flowing from these observations led the Office of the Secretary of Defense, the De - fense Acquisition

The Degree to Which Students and Teachers Are Involved in Second-Level School Processes and Participation in Decision-Making: An Irish Case Study

ERIC Educational Resources Information Center

Harrison, Kathy; Taysum, Alison; McNamara, Gerry; O'Hara, Joe

2016-01-01

The Education Act (1998) is a key policy document in Irish education, emphasising the rights, roles and responsibilities of key stakeholders, including parents, teachers and pupils in schools. Since 1998 the Department of Education and Skills (DES) has stressed the need to introduce an increased role for teachers and pupils in decision-making. It…

Recovery and resilience after a nuclear power plant disaster: a medical decision model for managing an effective, timely, and balanced response.

PubMed

Coleman, C Norman; Blumenthal, Daniel J; Casto, Charles A; Alfant, Michael; Simon, Steven L; Remick, Alan L; Gepford, Heather J; Bowman, Thomas; Telfer, Jana L; Blumenthal, Pamela M; Noska, Michael A

2013-04-01

Resilience after a nuclear power plant or other radiation emergency requires response and recovery activities that are appropriately safe, timely, effective, and well organized. Timely informed decisions must be made, and the logic behind them communicated during the evolution of the incident before the final outcome is known. Based on our experiences in Tokyo responding to the Fukushima Daiichi nuclear power plant crisis, we propose a real-time, medical decision model by which to make key health-related decisions that are central drivers to the overall incident management. Using this approach, on-site decision makers empowered to make interim decisions can act without undue delay using readily available and high-level scientific, medical, communication, and policy expertise. Ongoing assessment, consultation, and adaption to the changing conditions and additional information are additional key features. Given the central role of health and medical issues in all disasters, we propose that this medical decision model, which is compatible with the existing US National Response Framework structure, be considered for effective management of complex, large-scale, and large-consequence incidents.

Multiplicity: discussion points from the Statisticians in the Pharmaceutical Industry multiplicity expert group.

PubMed

Phillips, Alan; Fletcher, Chrissie; Atkinson, Gary; Channon, Eddie; Douiri, Abdel; Jaki, Thomas; Maca, Jeff; Morgan, David; Roger, James Henry; Terrill, Paul

2013-01-01

In May 2012, the Committee of Health and Medicinal Products issued a concept paper on the need to review the points to consider document on multiplicity issues in clinical trials. In preparation for the release of the updated guidance document, Statisticians in the Pharmaceutical Industry held a one-day expert group meeting in January 2013. Topics debated included multiplicity and the drug development process, the usefulness and limitations of newly developed strategies to deal with multiplicity, multiplicity issues arising from interim decisions and multiregional development, and the need for simultaneous confidence intervals (CIs) corresponding to multiple test procedures. A clear message from the meeting was that multiplicity adjustments need to be considered when the intention is to make a formal statement about efficacy or safety based on hypothesis tests. Statisticians have a key role when designing studies to assess what adjustment really means in the context of the research being conducted. More thought during the planning phase needs to be given to multiplicity adjustments for secondary endpoints given these are increasing in importance in differentiating products in the market place. No consensus was reached on the role of simultaneous CIs in the context of superiority trials. It was argued that unadjusted intervals should be employed as the primary purpose of the intervals is estimation, while the purpose of hypothesis testing is to formally establish an effect. The opposing view was that CIs should correspond to the test decision whenever possible. Copyright © 2013 John Wiley & Sons, Ltd.

Decision Making: Rational, Nonrational, and Irrational.

ERIC Educational Resources Information Center

Simon, Herbert A.

1993-01-01

Describes the current state of knowledge about human decision-making and problem-solving processes, explaining recent developments and their implications for management and management training. Rational goal-setting is the key to effective decision making and accomplishment. Bounded rationality is a realistic orientation, because the world is too…

Risky Group Decision-Making Method for Distribution Grid Planning

NASA Astrophysics Data System (ADS)

Li, Cunbin; Yuan, Jiahang; Qi, Zhiqiang

2015-12-01

With rapid speed on electricity using and increasing in renewable energy, more and more research pay attention on distribution grid planning. For the drawbacks of existing research, this paper proposes a new risky group decision-making method for distribution grid planning. Firstly, a mixing index system with qualitative and quantitative indices is built. On the basis of considering the fuzziness of language evaluation, choose cloud model to realize "quantitative to qualitative" transformation and construct interval numbers decision matrices according to the "3En" principle. An m-dimensional interval numbers decision vector is regarded as super cuboids in m-dimensional attributes space, using two-level orthogonal experiment to arrange points uniformly and dispersedly. The numbers of points are assured by testing numbers of two-level orthogonal arrays and these points compose of distribution points set to stand for decision-making project. In order to eliminate the influence of correlation among indices, Mahalanobis distance is used to calculate the distance from each solutions to others which means that dynamic solutions are viewed as the reference. Secondly, due to the decision-maker's attitude can affect the results, this paper defines the prospect value function based on SNR which is from Mahalanobis-Taguchi system and attains the comprehensive prospect value of each program as well as the order. At last, the validity and reliability of this method is illustrated by examples which prove the method is more valuable and superiority than the other.

Channelling information flows from observation to decision; or how to increase certainty

NASA Astrophysics Data System (ADS)

Weijs, S. V.

2015-12-01

To make adequate decisions in an uncertain world, information needs to reach the decision problem, to enable overseeing the full consequences of each possible decision.On its way from the physical world to a decision problem, information is transferred through the physical processes that influence the sensor, then through processes that happen in the sensor, through wires or electromagnetic waves. For the last decade, most information becomes digitized at some point. From moment of digitization, information can in principle be transferred losslessly. Information about the physical world is often also stored, sometimes in compressed form, such as physical laws, concepts, or models of specific hydrological systems. It is important to note, however, that all information about a physical system eventually has to originate from observation (although inevitably coloured by some prior assumptions). This colouring makes the compression lossy, but is effectively the only way to make use of similarities in time and space that enable predictions while measuring only a a few macro-states of a complex hydrological system.Adding physical process knowledge to a hydrological model can thus be seen as a convenient way to transfer information from observations from a different time or place, to make predictions about another situation, assuming the same dynamics are at work.The key challenge to achieve more certainty in hydrological prediction can therefore be formulated as a challenge to tap and channel information flows from the environment. For tapping more information flows, new measurement techniques, large scale campaigns, historical data sets, and large sample hydrology and regionalization efforts can bring progress. For channelling the information flows with minimum loss, model calibration, and model formulation techniques should be critically investigated. Some experience from research in a Swiss high alpine catchment are used as an illustration.

A contemporary approach to validity arguments: a practical guide to Kane's framework.

PubMed

Cook, David A; Brydges, Ryan; Ginsburg, Shiphra; Hatala, Rose

2015-06-01

Assessment is central to medical education and the validation of assessments is vital to their use. Earlier validity frameworks suffer from a multiplicity of types of validity or failure to prioritise among sources of validity evidence. Kane's framework addresses both concerns by emphasising key inferences as the assessment progresses from a single observation to a final decision. Evidence evaluating these inferences is planned and presented as a validity argument. We aim to offer a practical introduction to the key concepts of Kane's framework that educators will find accessible and applicable to a wide range of assessment tools and activities. All assessments are ultimately intended to facilitate a defensible decision about the person being assessed. Validation is the process of collecting and interpreting evidence to support that decision. Rigorous validation involves articulating the claims and assumptions associated with the proposed decision (the interpretation/use argument), empirically testing these assumptions, and organising evidence into a coherent validity argument. Kane identifies four inferences in the validity argument: Scoring (translating an observation into one or more scores); Generalisation (using the score[s] as a reflection of performance in a test setting); Extrapolation (using the score[s] as a reflection of real-world performance), and Implications (applying the score[s] to inform a decision or action). Evidence should be collected to support each of these inferences and should focus on the most questionable assumptions in the chain of inference. Key assumptions (and needed evidence) vary depending on the assessment's intended use or associated decision. Kane's framework applies to quantitative and qualitative assessments, and to individual tests and programmes of assessment. Validation focuses on evaluating the key claims, assumptions and inferences that link assessment scores with their intended interpretations and uses. The Implications and associated decisions are the most important inferences in the validity argument. © 2015 John Wiley & Sons Ltd.

Introduction of New Vaccines: Decision-making Process in Bangladesh

PubMed Central

Sarma, Haribondhu; Bari, Tajul I.; Koehlmoos, Tracey P.

2013-01-01

The understanding of the decision-making process in the introduction of new vaccines helps establish why vaccines are adopted or not. It also contributes to building a sustainable demand for vaccines in a country. The purpose of the study was to map and analyze the formal decision-making process in relation to the introduction of new vaccines within the context of health policy and health systems and identify the ways of making decisions to introduce new vaccines in Bangladesh. During February-April 2011, a qualitative assessment was made at the national level to evaluate the decision-making process around the adoption of new vaccines in Bangladesh. The study population included: policy-level people, programme heads or associates, and key decision-makers of the Government, private sector, non-governmental organizations, and international agencies at the national level. In total, 13 key informants were purposively selected. Data were collected by interviewing key informants and reviewing documents. Data were analyzed thematically. The findings revealed that the actors from different sectors at the policy level were involved in the decision-making process in the introduction of new vaccines. They included policy-makers from the ministries of health and family welfare, finance, and local government and rural development; academicians; researchers; representatives from professional associations; development partners; and members of different committees on EPI. They contributed to the introduction of new vaccines in their own capacity. The burden of disease, research findings on vaccine-preventable diseases, political issues relating to outbreaks of certain diseases, initiatives of international and local stakeholders, pressure of development partners, the Global Alliance for Vaccines and Immunization (GAVI) support, and financial matters were the key factors in the introduction of new vaccines in Bangladesh. The slow introduction and uptake of new vaccines is a concern in the country. Rapid action on the application of GAVI support and less time taken by the Government in processing the implementation and administrative work may expedite the introduction of new vaccines in future in this country. PMID:23930339

Introduction of new vaccines: decision-making process in Bangladesh.

PubMed

Uddin, Jasim; Sarma, Haribondhu; Bari, Tajul I; Koehlmoos, Tracey P

2013-06-01

The understanding of the decision-making process in the introduction of new vaccines helps establish why vaccines are adopted or not. It also contributes to building a sustainable demand for vaccines in a country. The purpose of the study was to map and analyze the formal decision-making process in relation to the introduction of new vaccines within the context of health policy and health systems and identify the ways of making decisions to introduce new vaccines in Bangladesh. During February-April 2011, a qualitative assessment was made at the national level to evaluate the decision-making process around the adoption of new vaccines in Bangladesh. The study population included: policy-level people, programme heads or associates, and key decision-makers of the Government, private sector, non-governmental organizations, and international agencies at the national level. In total, 13 key informants were purposively selected. Data were collected by interviewing key informants and reviewing documents. Data were analyzed thematically. The findings revealed that the actors from different sectors at the policy level were involved in the decision-making process in the introduction of new vaccines. They included policy-makers from the ministries of health and family welfare, finance, and local government and rural development; academicians; researchers; representatives from professional associations; development partners; and members of different committees on EPI. They contributed to the introduction of new vaccines in their own capacity. The burden of disease, research findings on vaccine-preventable diseases, political issues relating to outbreaks of certain diseases, initiatives of international and local stakeholders, pressure of development partners, the Global Alliance for Vaccines and Immunization (GAVI) support, and financial matters were the key factors in the introduction of new vaccines in Bangladesh. The slow introduction and uptake of new vaccines is a concern in the country. Rapid action on the application of GAVI support and less time taken by the Government in processing the implementation and administrative work may expedite the introduction of new vaccines in future in this country.

Identification of the Key Fields and Their Key Technical Points of Oncology by Patent Analysis

PubMed Central

Zhang, Ting; Chen, Juan; Jia, Xiaofeng

2015-01-01

Background This paper aims to identify the key fields and their key technical points of oncology by patent analysis. Methodology/Principal Findings Patents of oncology applied from 2006 to 2012 were searched in the Thomson Innovation database. The key fields and their key technical points were determined by analyzing the Derwent Classification (DC) and the International Patent Classification (IPC), respectively. Patent applications in the top ten DC occupied 80% of all the patent applications of oncology, which were the ten fields of oncology to be analyzed. The number of patent applications in these ten fields of oncology was standardized based on patent applications of oncology from 2006 to 2012. For each field, standardization was conducted separately for each of the seven years (2006–2012) and the mean of the seven standardized values was calculated to reflect the relative amount of patent applications in that field; meanwhile, regression analysis using time (year) and the standardized values of patent applications in seven years (2006–2012) was conducted so as to evaluate the trend of patent applications in each field. Two-dimensional quadrant analysis, together with the professional knowledge of oncology, was taken into consideration in determining the key fields of oncology. The fields located in the quadrant with high relative amount or increasing trend of patent applications are identified as key ones. By using the same method, the key technical points in each key field were identified. Altogether 116,820 patents of oncology applied from 2006 to 2012 were retrieved, and four key fields with twenty-nine key technical points were identified, including “natural products and polymers” with nine key technical points, “fermentation industry” with twelve ones, “electrical medical equipment” with four ones, and “diagnosis, surgery” with four ones. Conclusions/Significance The results of this study could provide guidance on the development direction of oncology, and also help researchers broaden innovative ideas and discover new technological opportunities. PMID:26599967

Identification of the Key Fields and Their Key Technical Points of Oncology by Patent Analysis.

PubMed

Zhang, Ting; Chen, Juan; Jia, Xiaofeng

2015-01-01

This paper aims to identify the key fields and their key technical points of oncology by patent analysis. Patents of oncology applied from 2006 to 2012 were searched in the Thomson Innovation database. The key fields and their key technical points were determined by analyzing the Derwent Classification (DC) and the International Patent Classification (IPC), respectively. Patent applications in the top ten DC occupied 80% of all the patent applications of oncology, which were the ten fields of oncology to be analyzed. The number of patent applications in these ten fields of oncology was standardized based on patent applications of oncology from 2006 to 2012. For each field, standardization was conducted separately for each of the seven years (2006-2012) and the mean of the seven standardized values was calculated to reflect the relative amount of patent applications in that field; meanwhile, regression analysis using time (year) and the standardized values of patent applications in seven years (2006-2012) was conducted so as to evaluate the trend of patent applications in each field. Two-dimensional quadrant analysis, together with the professional knowledge of oncology, was taken into consideration in determining the key fields of oncology. The fields located in the quadrant with high relative amount or increasing trend of patent applications are identified as key ones. By using the same method, the key technical points in each key field were identified. Altogether 116,820 patents of oncology applied from 2006 to 2012 were retrieved, and four key fields with twenty-nine key technical points were identified, including "natural products and polymers" with nine key technical points, "fermentation industry" with twelve ones, "electrical medical equipment" with four ones, and "diagnosis, surgery" with four ones. The results of this study could provide guidance on the development direction of oncology, and also help researchers broaden innovative ideas and discover new technological opportunities.

36 CFR 1010.13 - Trust decision-making procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Trust decision-making procedures. 1010.13 Section 1010.13 Parks, Forests, and Public Property PRESIDIO TRUST ENVIRONMENTAL QUALITY § 1010.13 Trust decision-making procedures. To ensure that at major decision-making points all relevant...

Visualization support for risk-informed decision making when planning and managing software developments

NASA Technical Reports Server (NTRS)

Feather, Martin S.; Kiper, James D.; Menzies, Tim

2005-01-01

Key decisions are made in the early stages of planning and management of software developments. The information basis for these decisions is often a mix of analogy with past developments, and the best judgments of domain experts. Visualization of this information can support to such decision making by clarifying the status of the information and yielding insights into the ramifications of that information vis-a-vis decision alternatives.

Using Modern Digital Photography Tools to Guide Management Decisions on Forested Land

ERIC Educational Resources Information Center

Craft, Brandon; Barlow, Rebecca; Kush, John; Hemard, Charles

2016-01-01

Forestland management depends on assessing changes that occur over time. Long-term photo point monitoring is a low-cost method for documenting these changes. Using forestry as an example, this article highlights the idea that long-term photo point monitoring can be used to improve many types of land management decision making. Guidance on…

Quality of life in active surveillance and the associations with decision-making-a literature review.

PubMed

Menichetti, Julia; Valdagni, Riccardo; Bellardita, Lara

2018-02-01

Several studies have been conducted on the quality of life (QoL) in men with low risk prostate cancer (PCa) who choose active surveillance (AS). While recent reviews have shown a lack of consistency among the available QoL-studies, a few key points have been identified, including decision-making (DM)-related issues and their potential effect on QoL. The importance of this theme has also been recently highlighted by the international task force of the European School of Oncology. However, to our knowledge, there are no studies that have specifically marshalled scientific knowledge on the association between DM and QoL among men with low-risk PCa undergoing AS. We performed a literature review to fill this gap, taking a systematic approach to retrieving and selecting articles that included both DM and QoL measures. Among the 272 articles retrieved, we selected nine observational, quantitative articles with both DM and QoL measures. The most considered DM aspects within these studies were decisional conflict and preference for the patient's role in the DM process, as well as health-related QoL aspects. The studies included 42 assessments of the relationship between an empirical measure of DM and an empirical measure of QoL. Among these assessments, 23 (55%) were both positive and significant. They mostly concerned the relationship between patient-related (decisional self-efficacy, decisional control and knowledge) and external (presence of social support, collaborative role within the DM process, and influence of different physicians) DM aspects, as well as the QoL after choice. The findings of these studies revealed key challenges to research and clinical practice related to DM and QoL in AS. These include adopting a person-centred perspective where clinicians, caregivers and their interactions are also included in evaluations and where the psychosocial existential experience of individuals within the DM and AS journey is considered. Much more attention needs to be paid to the DM process after diagnosis, as well as to all the other moments where patients may have to or want to review their decision. Healthcare professionals play a key role in enabling men to make informed decisions and to take care of their health and well-being during AS. There is still work that needs to be done in training healthcare professionals from different disciplines to work together in a model of shared DM and AS tailored to the needs of low-risk PCa patients and their family members.

Key Decisions of a First-Year "Turnaround" Principal

ERIC Educational Resources Information Center

Duke, Daniel; Salmonowicz, Michael

2010-01-01

This article examines the decisions made by one principal in her first year as a school turnaround specialist in a low-performing urban elementary school. Researchers focused on decisions related to the principal's three high-priority concerns: (1) elimination of an ineffective instructional program; (2) creation of a culture of teacher…

DASEES: A Tripartite Decision Analysis Framework to Achieve Sustainable Environment, Economy & Society Growth and Management Goals

EPA Science Inventory

Many of Societies management and growth decisions are often made without a balanced consideration of pertinent factors from environmental, economic and societal perspectives. All three of these areas are key players in many of the decisions facing societies as they strive to ope...

"What Should I Do?" How Consultants Impact Adolescents' Risky Decisions

ERIC Educational Resources Information Center

Finken, Laura

2009-01-01

Consultation plays a key role in adolescents' risky decisions and influences what options and consequences are considered, how potential consequences are valued, and even what choices adolescents make. Even with impulsive decisions, informal consultation affects how likely an adolescent is to engage in risky behaviors. Unfortunately several…

Chinese immigrant parents’ vaccination decision making for children: a qualitative analysis

PubMed Central

2014-01-01

Background While immunization coverage rates for childhood routine vaccines in Hong Kong are almost 100%, the uptake rates of optional vaccines remain suboptimal. Understanding parental decision-making for children’s vaccination is important, particularly among minority groups who are most vulnerable and underserved. This study explored how a subsample of new immigrant mothers from mainland China, a rapidly-growing subpopulation in Hong Kong, made decisions on various childhood and adolescent vaccines for their offspring, and identified key influences affecting their decision making. Methods Semi-structured in-depth interviews were conducted with 23 Chinese new immigrant mothers recruited by purposive sampling. All interviews were audio-taped, transcribed and analyzed using a Grounded Theory approach. Results Participants’ conversation revealed five underlying themes which influenced parents’ vaccination decision-making: (1) Institutional factors, (2) Insufficient vaccination knowledge and advice, (3) Affective impacts on motivation, (4) Vaccination barriers, and (5) Social influences. The role of social norms appeared overwhelmingly salient influencing parents’ vaccination decision making. Institutional factors shaped parent’s perceptions of vaccination necessity. Fear of vaccine-targeted diseases was a key motivating factor for parents adopting vaccination. Insufficient knowledge about vaccines and targeted diseases, lack of advice from health professionals and, if provided, suspicions regarding the motivations for such advice were common issues. Vaccination cost was a major barrier for many new immigrant parents. Conclusions Social norms play a key role influencing parental vaccination decision-making. Insight gained from this study will help inform healthcare providers in vaccination communication and policymakers in future vaccination programme. PMID:24507384

Point-of-care testing (POCT) and evidence-based laboratory medicine (EBLM) - does it leverage any advantage in clinical decision making?

PubMed

Florkowski, Christopher; Don-Wauchope, Andrew; Gimenez, Nuria; Rodriguez-Capote, Karina; Wils, Julien; Zemlin, Annalise

Point-of-care testing (POCT) is the analysis of patient specimens outside the clinical laboratory, near or at the site of patient care, usually performed by clinical staff without laboratory training, although it also encompasses patient self-monitoring. It is able to provide a rapid result near the patient and which can be acted upon immediately. The key driver is the concept that clinical decision making may be delayed when samples are sent to the clinical laboratory. Balanced against this are considerations of increased costs for purchase and maintenance of equipment, staff training, connectivity to the laboratory information system (LIS), quality control (QC) and external quality assurance (EQA) procedures, all required for accreditation under ISO 22870. The justification for POCT depends upon being able to demonstrate that a more timely result (shorter turnaround times (TATs)) is able to leverage a clinically important advantage in decision making compared with the central laboratory (CL). In the four decades since POCT was adapted for the self-monitoring of blood glucose levels by subjects with diabetes, numerous new POCT methodologies have become available, enabling the clinician to receive results and initiate treatment more rapidly. However, these instruments are often operated by staff not trained in laboratory medicine and hence are prone to errors in the analytical phase (as opposed to laboratory testing where the analytical phase has the least errors). In some environments, particularly remote rural settings, the CL may be at a considerable distance and timely availability of cardiac troponins and other analytes can triage referrals to the main centers, thus avoiding expensive unnecessary patient transportation costs. However, in the Emergency Department, availability of more rapid results with POCT does not always translate into shorter stays due to other barriers to implementation of care. In this review, we apply the principles of evidence-based laboratory medicine (EBLM) looking for high quality systematic reviews and meta-analyses, ideally underpinned by randomized controlled trials (RCTs), looking for evidence of whether POCT confers any advantage in clinical decision making in different scenarios.

Optimising qualitative longitudinal analysis: Insights from a study of traumatic brain injury recovery and adaptation.

PubMed

Fadyl, Joanna K; Channon, Alexis; Theadom, Alice; McPherson, Kathryn M

2017-04-01

Knowledge about aspects that influence recovery and adaptation in the postacute phase of disabling health events is key to understanding how best to provide appropriate rehabilitation and health services. Qualitative longitudinal research makes it possible to look for patterns, key time points and critical moments that could be vital for interventions and supports. However, strategies that support robust data management and analysis for longitudinal qualitative research in health-care are not well documented in the literature. This article reviews three challenges encountered in a large longitudinal qualitative descriptive study about experiences of recovery and adaptation after traumatic brain injury in New Zealand, and the strategies and technologies used to address them. These were (i) tracking coding and analysis decisions during an extended analysis period; (ii) navigating interpretations over time and in response to new data; and (iii) exploiting data volume and complexity. Concept mapping during coding review, a considered combination of information technologies, employing both cross-sectional and narrative analysis, and an expectation that subanalyses would be required for key topics helped us manage the study in a way that facilitated useful and novel insights. These strategies could be applied in other qualitative longitudinal studies in healthcare inquiry to optimise data analysis and stimulate important insights. © 2016 John Wiley & Sons Ltd.

Application of Bayesian techniques to model the burden of human salmonellosis attributable to U.S. food commodities at the point of processing: adaptation of a Danish model.

PubMed

Guo, Chuanfa; Hoekstra, Robert M; Schroeder, Carl M; Pires, Sara Monteiro; Ong, Kanyin Liane; Hartnett, Emma; Naugle, Alecia; Harman, Jane; Bennett, Patricia; Cieslak, Paul; Scallan, Elaine; Rose, Bonnie; Holt, Kristin G; Kissler, Bonnie; Mbandi, Evelyne; Roodsari, Reza; Angulo, Frederick J; Cole, Dana

2011-04-01

Mathematical models that estimate the proportion of foodborne illnesses attributable to food commodities at specific points in the food chain may be useful to risk managers and policy makers to formulate public health goals, prioritize interventions, and document the effectiveness of mitigations aimed at reducing illness. Using human surveillance data on laboratory-confirmed Salmonella infections from the Centers for Disease Control and Prevention and Salmonella testing data from U.S. Department of Agriculture Food Safety and Inspection Service's regulatory programs, we developed a point-of-processing foodborne illness attribution model by adapting the Hald Salmonella Bayesian source attribution model. Key model outputs include estimates of the relative proportions of domestically acquired sporadic human Salmonella infections resulting from contamination of raw meat, poultry, and egg products processed in the United States from 1998 through 2003. The current model estimates the relative contribution of chicken (48%), ground beef (28%), turkey (17%), egg products (6%), intact beef (1%), and pork (<1%) across 109 Salmonella serotypes found in food commodities at point of processing. While interpretation of the attribution estimates is constrained by data inputs, the adapted model shows promise and may serve as a basis for a common approach to attribution of human salmonellosis and food safety decision-making in more than one country. © Mary Ann Liebert, Inc.

Application of Bayesian Techniques to Model the Burden of Human Salmonellosis Attributable to U.S. Food Commodities at the Point of Processing: Adaptation of a Danish Model

PubMed Central

Guo, Chuanfa; Hoekstra, Robert M.; Schroeder, Carl M.; Pires, Sara Monteiro; Ong, Kanyin Liane; Hartnett, Emma; Naugle, Alecia; Harman, Jane; Bennett, Patricia; Cieslak, Paul; Scallan, Elaine; Rose, Bonnie; Holt, Kristin G.; Kissler, Bonnie; Mbandi, Evelyne; Roodsari, Reza; Angulo, Frederick J.

2011-01-01

Abstract Mathematical models that estimate the proportion of foodborne illnesses attributable to food commodities at specific points in the food chain may be useful to risk managers and policy makers to formulate public health goals, prioritize interventions, and document the effectiveness of mitigations aimed at reducing illness. Using human surveillance data on laboratory-confirmed Salmonella infections from the Centers for Disease Control and Prevention and Salmonella testing data from U.S. Department of Agriculture Food Safety and Inspection Service's regulatory programs, we developed a point-of-processing foodborne illness attribution model by adapting the Hald Salmonella Bayesian source attribution model. Key model outputs include estimates of the relative proportions of domestically acquired sporadic human Salmonella infections resulting from contamination of raw meat, poultry, and egg products processed in the United States from 1998 through 2003. The current model estimates the relative contribution of chicken (48%), ground beef (28%), turkey (17%), egg products (6%), intact beef (1%), and pork (<1%) across 109 Salmonella serotypes found in food commodities at point of processing. While interpretation of the attribution estimates is constrained by data inputs, the adapted model shows promise and may serve as a basis for a common approach to attribution of human salmonellosis and food safety decision-making in more than one country. PMID:21235394

Designing Integrated Approaches to Support People with Multimorbidity: Key Messages from Systematic Reviews, Health System Leaders and Citizens.

PubMed

Wilson, Michael G; Lavis, John N; Gauvin, Francois-Pierre

2016-11-01

Living with multiple chronic conditions (multimorbidity) - and facing complex, uncoordinated and fragmented care - is part of the daily life of a growing number of Canadians. We undertook: a knowledge synthesis; a "gap analysis" of existing systematic reviews; an issue brief that synthesized the available evidence about the problem, three options for addressing it and implementation considerations; a stakeholder dialogue involving key health-system leaders; and a citizen panel. We identified several recommendations for actions that can be taken, including: developing evidence-based guidance that providers can use to help achieve goals set by patients; embracing approaches to supporting self-management; supporting greater communication and collaboration across healthcare providers as well as between healthcare providers and patients; and investing more efforts in health promotion and disease prevention. Our results point to the need for health system decision-makers to support bottom-up, person-centred approaches to developing models of care that are tailored for people with multimorbidity and support a research agenda to address the identified priorities. Copyright © 2016 Longwoods Publishing.

Resolving Environmental Effects of Wind Energy

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

Sinclair, Karin C; DeGeorge, Elise M; Copping, Andrea E.

Concerns for potential wildlife impacts resulting from land-based and offshore wind energy have created challenges for wind project development. Research is not always adequately supported, results are neither always readily accessible nor are they satisfactorily disseminated, and so decisions are often made based on the best available information, which may be missing key findings. The potential for high impacts to avian and bat species and marine mammals have been used by wind project opponents to stop, downsize, or severely delay project development. The global nature of the wind industry - combined with the understanding that many affected species cross-national boundaries,more » and in many cases migrate between continents - also points to the need to collaborate on an international level. The International Energy Agency (IEA) Wind Technology Collaborative Programs facilitates coordination on key research issues. IEA Wind Task 34 - WREN: Working Together to Resolve Environmental Effects of Wind Energy-is a collaborative forum to share lessons gained from field research and modeling, including management methods, wildlife monitoring methods, best practices, study results, and successful approaches to mitigating impacts and addressing the cumulative effects of wind energy on wildlife.« less

A teacher-developed inquiry model to teach the molecular basis of hyperbolic kinetics in biological membrane transport.

PubMed

Marcus, Leanne; Plumeri, Julia; Baker, Gary M; Miller, Jon S

2013-06-01

A previously published classroom teaching method for helping students visualize and understand Michaelis-Menten kinetics (19) was used as an anticipatory set with high school and middle school science teachers in an Illinois Math and Science Partnership Program. As part of the activity, the teachers were asked to collect data by replicating the method and to analyze and report the data. All concluded that the rate data they had collected were hyperbolic. As part of a guided inquiry plan, teachers were then prompted to reexamine the method and evaluate its efficacy as a teaching strategy for developing specific kinetic concepts. After further data collection and analysis, the teachers discovered that their data trends were not, in fact, hyperbolic, which led to several teacher-developed revisions aimed at obtaining a true hyperbolic outcome. This article outlines the inquiry process that led to these revisions and illustrates their alignment with several key concepts, such as rapid equilibrium kinetics. Instructional decisions were necessary at several key points, and these are discussed.

A decision-making framework for total ownership cost management of complex systems: A Delphi study

NASA Astrophysics Data System (ADS)

King, Russel J.

This qualitative study, using a modified Delphi method, was conducted to develop a decision-making framework for the total ownership cost management of complex systems in the aerospace industry. The primary focus of total ownership cost is to look beyond the purchase price when evaluating complex system life cycle alternatives. A thorough literature review and the opinions of a group of qualified experts resulted in a compilation of total ownership cost best practices, cost drivers, key performance factors, applicable assessment methods, practitioner credentials and potential barriers to effective implementation. The expert panel provided responses to the study questions using a 5-point Likert-type scale. Data were analyzed and provided to the panel members for review and discussion with the intent to achieve group consensus. As a result of the study, the experts agreed that a total ownership cost analysis should (a) be as simple as possible using historical data; (b) establish cost targets, metrics, and penalties early in the program; (c) monitor the targets throughout the product lifecycle and revise them as applicable historical data becomes available; and (d) directly link total ownership cost elements with other success factors during program development. The resultant study framework provides the business leader with incentives and methods to develop and implement strategies for controlling and reducing total ownership cost over the entire product life cycle when balancing cost, schedule, and performance decisions.

Emerging Role of Quality Indicators in Physical Therapist Practice and Health Service Delivery

PubMed Central

Klemm, Alexandria; Li, Linda C.; Jones, C. Allyson

2016-01-01

Quality-based care is a hallmark of physical therapy. Treatment effectiveness must be evident to patients, managers, employers, and funders. Quality indicators (QIs) are tools that specify the minimum acceptable standard of practice. They are used to measure health care processes, organizational structures, and outcomes that relate to aspects of high-quality care of patients. Physical therapists can use QIs to guide clinical decision making, implement guideline recommendations, and evaluate and report treatment effectiveness to key stakeholders, including third-party payers and patients. Rehabilitation managers and senior decision makers can use QIs to assess care gaps and achievement of benchmarks as well as to guide quality improvement initiatives and strategic planning. This article introduces the value and use of QIs to guide clinical practice and health service delivery specific to physical therapy. A framework to develop, select, report, and implement QIs is outlined, with total joint arthroplasty rehabilitation as an example. Current initiatives of Canadian and American physical therapy associations to develop tools to help clinicians report and access point-of-care data on patient progress, treatment effectiveness, and practice strengths for the purpose of demonstrating the value of physical therapy to patients, decision makers, and payers are discussed. Suggestions on how physical therapists can participate in QI initiatives and integrate a quality-of-care approach in clinical practice are made. PMID:26089040

Police officer response to the injured officer: a survey-based analysis of medical care decisions.

PubMed

Sztajnkrycer, Matthew D; Callaway, David W; Baez, Amado Alejandro

2007-01-01

No widely accepted, specialized medical training exists for police officers confronted with medical emergencies while under conditions of active threat. The purpose of this study was to assess medical decision-making capabilities of law enforcement personnel under these circumstances. Web-based surveys were administered to all sworn officers within the county jurisdiction. Thirty-eight key actions were predetermined for nine injured officer scenarios, with each correct action worth one point. Descriptive statistics and t-tests were used to analyze results. Ninety-seven officers (65.1% response rate) responded to the survey. The majority of officers (68.0%) were trained to the first-responder level. Overall mean score for the scenarios was 15.5 +/- 3.6 (range 7-25). A higher level of medical training (EMT-B/P versus first responder) was associated with a higher mean score (16.6 +/- 3.4, p = 0.05 vs. 15.0 +/- 3.6, p = 0.05). Tactical unit assignment was associated with a lower score compared with non-assigned officers (13.5 +/- 2.9 vs. 16.0 +/- 3.6, p = 0.0085). No difference was noted based upon previous military experience. Ninety-two percent of respondents expressed interest in a law enforcement-oriented advanced first-aid course. Tactical medical decision-making capability, as assessed through the nine scenarios, was sub-optimal. In this post 9/11 era, development of law enforcement-specific medical training appears appropriate.

Cooperation, psychological game theory, and limitations of rationality in social interaction.

PubMed

Colman, Andrew M

2003-04-01

Rational choice theory enjoys unprecedented popularity and influence in the behavioral and social sciences, but it generates intractable problems when applied to socially interactive decisions. In individual decisions, instrumental rationality is defined in terms of expected utility maximization. This becomes problematic in interactive decisions, when individuals have only partial control over the outcomes, because expected utility maximization is undefined in the absence of assumptions about how the other participants will behave. Game theory therefore incorporates not only rationality but also common knowledge assumptions, enabling players to anticipate their co-players' strategies. Under these assumptions, disparate anomalies emerge. Instrumental rationality, conventionally interpreted, fails to explain intuitively obvious features of human interaction, yields predictions starkly at variance with experimental findings, and breaks down completely in certain cases. In particular, focal point selection in pure coordination games is inexplicable, though it is easily achieved in practice; the intuitively compelling payoff-dominance principle lacks rational justification; rationality in social dilemmas is self-defeating; a key solution concept for cooperative coalition games is frequently inapplicable; and rational choice in certain sequential games generates contradictions. In experiments, human players behave more cooperatively and receive higher payoffs than strict rationality would permit. Orthodox conceptions of rationality are evidently internally deficient and inadequate for explaining human interaction. Psychological game theory, based on nonstandard assumptions, is required to solve these problems, and some suggestions along these lines have already been put forward.

Recognition method of construction conflict based on driver's eye movement.

PubMed

Xu, Yi; Li, Shiwu; Gao, Song; Tan, Derong; Guo, Dong; Wang, Yuqiong

2018-04-01

Drivers eye movement data in simulated construction conflicts at different speeds were collected and analyzed to find the relationship between the drivers' eye movement and the construction conflict. On the basis of the relationship between the drivers' eye movement and the construction conflict, the peak point of wavelet processed pupil diameter, the first point on the left side of the peak point and the first blink point after the peak point are selected as key points for locating construction conflict periods. On the basis of the key points and the GSA, a construction conflict recognition method so called the CCFRM is proposed. And the construction conflict recognition speed and location accuracy of the CCFRM are verified. The good performance of the CCFRM verified the feasibility of proposed key points in construction conflict recognition. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Mental Capacity Act 1: advance decisions.

PubMed

Lynch, Teresa

This is the first of a two-part unit on the Mental Capacity Act 2005. Part 1 outlines the act's key principles and implications. Healthcare professionals' responsibilities are examined in relation to advance decisions.

Semi-automated quantitative Drosophila wings measurements.

PubMed

Loh, Sheng Yang Michael; Ogawa, Yoshitaka; Kawana, Sara; Tamura, Koichiro; Lee, Hwee Kuan

2017-06-28

Drosophila melanogaster is an important organism used in many fields of biological research such as genetics and developmental biology. Drosophila wings have been widely used to study the genetics of development, morphometrics and evolution. Therefore there is much interest in quantifying wing structures of Drosophila. Advancement in technology has increased the ease in which images of Drosophila can be acquired. However such studies have been limited by the slow and tedious process of acquiring phenotypic data. We have developed a system that automatically detects and measures key points and vein segments on a Drosophila wing. Key points are detected by performing image transformations and template matching on Drosophila wing images while vein segments are detected using an Active Contour algorithm. The accuracy of our key point detection was compared against key point annotations of users. We also performed key point detection using different training data sets of Drosophila wing images. We compared our software with an existing automated image analysis system for Drosophila wings and showed that our system performs better than the state of the art. Vein segments were manually measured and compared against the measurements obtained from our system. Our system was able to detect specific key points and vein segments from Drosophila wing images with high accuracy.

A collaborative approach to supporting communication in the assessment of decision-making capacity.

PubMed

Zuscak, Simon John; Peisah, Carmelle; Ferguson, Alison

2016-01-01

This paper explores the clinical implications of acquired communication disorders in decisional capacity. Discipline-specific contributions are discussed in a multidisciplinary context, with a specific focus on the role of speech and language pathologists (SLPs). Key rehabilitation issues in determining decisional capacity are identified. The impact of communication impairment on capacity is discussed in light of the research literature relating to supportive communication and collaborative practice that respects human rights. Guidelines are presented for professionals involved in the assessment of the decisional capacity of individuals with communication disorders of neurological origin. They guide an assessor through: assessing cognition, language and speech; determining preferred communication domains; and practical strategies and considerations for maximising communication. There is a dearth of guidelines available that deal with augmenting and supporting communication of individuals with acquired communication disorders of neurological origin when it comes to assessing legal decision-making capacity. Capacity assessment is a multidisciplinary realm, and the involvement of SLPs is key to maximising the decision-making capacity of these individuals. All clinicians have an obligation to maximise client autonomy and participation in decision-making. Assessments of capacity should involve a general cognitive ability assessment, followed by a decision-specific assessment tool or question set for the decision facing the patient. The involvement of speech and language pathologists (SLPs) is key to assess and facilitate capacity determinations in instances of cognitive-communication disorder. Impairments in different aspects of auditory comprehension require different accommodations.

Analysing causal structures with entropy

PubMed Central

Weilenmann, Mirjam

2017-01-01

A central question for causal inference is to decide whether a set of correlations fits a given causal structure. In general, this decision problem is computationally infeasible and hence several approaches have emerged that look for certificates of compatibility. Here, we review several such approaches based on entropy. We bring together the key aspects of these entropic techniques with unified terminology, filling several gaps and establishing new connections, all illustrated with examples. We consider cases where unobserved causes are classical, quantum and post-quantum, and discuss what entropic analyses tell us about the difference. This difference has applications to quantum cryptography, where it can be crucial to eliminate the possibility of classical causes. We discuss the achievements and limitations of the entropic approach in comparison to other techniques and point out the main open problems. PMID:29225499

A Collaborative Reasoning Maintenance System for a Reliable Application of Legislations

NASA Astrophysics Data System (ADS)

Tamisier, Thomas; Didry, Yoann; Parisot, Olivier; Feltz, Fernand

Decision support systems are nowadays used to disentangle all kinds of intricate situations and perform sophisticated analysis. Moreover, they are applied in areas where the knowledge can be heterogeneous, partially un-formalized, implicit, or diffuse. The representation and management of this knowledge become the key point to ensure the proper functioning of the system and keep an intuitive view upon its expected behavior. This paper presents a generic architecture for implementing knowledge-base systems used in collaborative business, where the knowledge is organized into different databases, according to the usage, persistence and quality of the information. This approach is illustrated with Cadral, a customizable automated tool built on this architecture and used for processing family benefits applications at the National Family Benefits Fund of the Grand-Duchy of Luxembourg.

Study of pollution effect on water quality of Grogol River, DKI Jakarta

NASA Astrophysics Data System (ADS)

Amira, S.; Astono, W.; Hendrawan, D.

2018-01-01

A study has been conducted to identify the incoming pollutants and assess the water quality in Grogol River, DKI Jakarta, Indonesia, which has a length of 13.35 km and consists of two segments. The water quality assessment is determined by pollution index method, referring to Minister of Environment Decree No. 15/2013 on The Guidelines of Water Quality Status. The samples were taken both in rainy and dry seasons at 7 sampling points. Based on the analyses of 10 key parameters and the calculation of pollution index value, it can be concluded that Grogol River is low polluted in rainy season and moderate polluted in dry season. The information obtained from this research can be used for decision making to improve the water quality of Grogol River.

Analysing causal structures with entropy

NASA Astrophysics Data System (ADS)

Weilenmann, Mirjam; Colbeck, Roger

2017-11-01

A central question for causal inference is to decide whether a set of correlations fits a given causal structure. In general, this decision problem is computationally infeasible and hence several approaches have emerged that look for certificates of compatibility. Here, we review several such approaches based on entropy. We bring together the key aspects of these entropic techniques with unified terminology, filling several gaps and establishing new connections, all illustrated with examples. We consider cases where unobserved causes are classical, quantum and post-quantum, and discuss what entropic analyses tell us about the difference. This difference has applications to quantum cryptography, where it can be crucial to eliminate the possibility of classical causes. We discuss the achievements and limitations of the entropic approach in comparison to other techniques and point out the main open problems.

Key beliefs related to decisions for physical activity engagement among first-in-family students transitioning to university.

PubMed

Cowie, Eloise; Hamilton, Kyra

2014-08-01

The current study investigated key beliefs related to decisions for physical activity (PA) engagement among first-in-family (FIF) students transitioning to university. FIF students (n = 157) completed an online questionnaire assessing standard theory of planned behaviour constructs and belief-based items. One week later, participants completed a follow-up questionnaire assessing self-reported PA during the previous week. Results identified a range of behavioural, normative, and control beliefs that were significantly correlated with both PA intention and behaviour. Various key beliefs were also identified in relation to FIF students' decisions to be regularly physically active, with behavioural beliefs such as "take up too much time", normative beliefs including "friends outside of university", and control beliefs such as "cost", identified. Finally, frequencies of those who strongly or fully accepted these beliefs were analysed, demonstrating that typically, a large number of FIF students did not hold the beliefs, and as such, these are relevant to target in resultant interventions. The current study effectively highlights a number of key beliefs that can be targeted in programs aimed at encouraging FIF students' PA. Further, the study addresses a gap in the literature of targeting FIF students, a cohort at risk for inactivity, and utilises a sound theoretical framework to identify the unique set of beliefs guiding decisions for PA for this at-risk community group.

Turning Points in the Lives of Youth of With/Without ADHD: Are They Linked to Changes in Substance Use?

PubMed

Jensen, Peter S; Yuki, Kumi; Murray, Desiree; Mitchell, John T; Weisner, Thomas; Hinshaw, Steven; Molina, Brooke; Swanson, James; Arnold, L Eugene; Hechtman, Lily; Wells, Karen

2017-04-01

This study examines the behavior beliefs, social supports, and turning points in individuals with/without ADHD related to their substance use/abuse (SU/A) decisions. The coded interviews from 60 participants with/without ADHD were compared for their SU/A decisions and precipitants with these decisions among abstainers, persisters, and desisters. ADHD participants reported fewer social advantages to avoid SU/A than non-ADHD participants. Desisters and persisters reported more social advantages of using drugs than abstainers. Persisters reported both more negative and positive psychological/physiological effects of SU/A. ADHD participants reported fewer positive role models in their lives. Non-ADHD patients reported more positive turning points than ADHD participants, regardless of SU/A status. ADHD individuals face challenges in making healthy decisions about SU/A due to lack of positive role models. Reinforcing accurate behavioral beliefs may be important to change behaviors in individuals with SU/A or to prevent SU/A initiation in ADHD individuals.

Message survival and decision dynamics in a class of reactive complex systems subject to external fields

NASA Astrophysics Data System (ADS)

Rodriguez Lucatero, C.; Schaum, A.; Alarcon Ramos, L.; Bernal-Jaquez, R.

2014-07-01

In this study, the dynamics of decisions in complex networks subject to external fields are studied within a Markov process framework using nonlinear dynamical systems theory. A mathematical discrete-time model is derived using a set of basic assumptions regarding the convincement mechanisms associated with two competing opinions. The model is analyzed with respect to the multiplicity of critical points and the stability of extinction states. Sufficient conditions for extinction are derived in terms of the convincement probabilities and the maximum eigenvalues of the associated connectivity matrices. The influences of exogenous (e.g., mass media-based) effects on decision behavior are analyzed qualitatively. The current analysis predicts: (i) the presence of fixed-point multiplicity (with a maximum number of four different fixed points), multi-stability, and sensitivity with respect to the process parameters; and (ii) the bounded but significant impact of exogenous perturbations on the decision behavior. These predictions were verified using a set of numerical simulations based on a scale-free network topology.

The Differences in Preference for Truth-telling of Patients With Cancer of Different Genders.

PubMed

Chen, Shih-Ying; Wang, Hung-Ming; Tang, Woung-Ru

Patients' personality traits, especially age, gender, and cancer stage, tend to affect doctors' truth-telling methods. However, there is a lack of studies investigating the influence of patients' gender on truth-telling, especially for Asian cultures. The aims of this study were to qualitatively investigate the differences in preferences for truth-telling for patients with cancer of different genders and explore patients' preferences for decision making. For this descriptive qualitative study, in-depth interviews were conducted with 20 patients with cancer (10 men and 10 women) using a semistructured interview guide. All interviews were audiotaped and transcribed verbatim. Data collection and analysis occurred concurrently; content analysis developed categories and themes. Data analysis revealed 2 themes: (1) similar gender preferences for truth-telling and decision making: knowledge of their medical condition, direct and frank truthfulness, and assistance in decision making for subsequent treatment programs, and (2) preferences in truth-telling that differed by gender: women wanted family members present for confirmation of diagnosis, whereas men did not; men preferred truth-telling for only key points of their cancer, whereas women wanted detailed information; and men did not want to know their survival period, whereas women wanted this information. Our study revealed similar gender preferences for truth-telling regarding knowledge and decision making; however, preferences differed for family support, scope of information, and survival time. These findings can serve as a reference for nurses and other healthcare personnel when implementing truth-telling for patients given a diagnosis of cancer. Strategies can be targeted for specific preferences of men and women.

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

PubMed

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

2015-09-01

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

"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.

Experience as knowledge: Disability, distillation and (reprogenetic) decision-making.

PubMed

Boardman, Felicity K

2017-10-01

'Experiential knowledge' is increasingly recognised as an important influence on reproductive decision-making. 'Experiential knowledge of disability' in particular is a significant resource within prenatal testing/screening contexts, enabling prospective parents to imagine and appraise future lives affected by disability. However, the concept of 'experiential knowledge' has been widely critiqued for its idiosyncrasy, its impermanence and consequently its perceived inferiority to (medical) knowledge. This paper explores some of these key critiques of experiential knowledge through an analysis of its constitution and uses in the context of reproductive decision-making. Seventeen UK-resident women with Spinal Muscular Atrophy (SMA), or with SMA in their family, took part in two in-depth interviews: one in 2007-9 and the other in 2013-4. By comparing and contrasting these women's accounts at two time points, this paper demonstrates the stark contrast between 'lived experience' of SMA (the visceral everyday realities of life with the condition) and the various way(s) this experience was transformed into, and presented as, 'knowledge' through the processes of making, and accounting, for reproductive decisions. The analysis highlights that multiple, distinct and sometimes competing experiential frameworks are used to conceptualise SMA across time and context. However, rather than evidence of its fallibility, this finding highlights that 'knowledge' is an inappropriate vessel with which to capture and transfer 'experiential knowledge'. Rather, we need to consider how to value such insight in ways that harnesses its inherent strength without leaving it vulnerable to the epistemological critiques attracted by labelling it 'knowledge'. Copyright © 2017 The Author. Published by Elsevier Ltd.. All rights reserved.

Pilot study of a point-of-use decision support tool for cancer clinical trials eligibility.

PubMed

Breitfeld, P P; Weisburd, M; Overhage, J M; Sledge, G; Tierney, W M

1999-01-01

Many adults with cancer are not enrolled in clinical trials because caregivers do not have the time to match the patient's clinical findings with varying eligibility criteria associated with multiple trials for which the patient might be eligible. The authors developed a point-of-use portable decision support tool (DS-TRIEL) to automate this matching process. The support tool consists of a hand-held computer with a programmable relational database. A two-level hierarchic decision framework was used for the identification of eligible subjects for two open breast cancer clinical trials. The hand-held computer also provides protocol consent forms and schemas to further help the busy oncologist. This decision support tool and the decision framework on which it is based could be used for multiple trials and different cancer sites.

Pilot Study of a Point-of-use Decision Support Tool for Cancer Clinical Trials Eligibility

PubMed Central

Breitfeld, Philip P.; Weisburd, Marina; Overhage, J. Marc; Sledge, George; Tierney, William M.

1999-01-01

Many adults with cancer are not enrolled in clinical trials because caregivers do not have the time to match the patient's clinical findings with varying eligibility criteria associated with multiple trials for which the patient might be eligible. The authors developed a point-of-use portable decision support tool (DS-TRIEL) to automate this matching process. The support tool consists of a hand-held computer with a programmable relational database. A two-level hierarchic decision framework was used for the identification of eligible subjects for two open breast cancer clinical trials. The hand-held computer also provides protocol consent forms and schemas to further help the busy oncologist. This decision support tool and the decision framework on which it is based could be used for multiple trials and different cancer sites. PMID:10579605

Practitioners' Views on Involving Young Children in Decision Making: Challenges for the Children's Rights Agenda

ERIC Educational Resources Information Center

Hudson, Kim

2012-01-01

This article presents the key findings and discussion from a research project and subsequent report: "Involving young children in decision making: An exploration of practitioners' views". This research explored early childhood practitioners'--childcare workers, kindergarten, pre-primary and grade 1-2 teachers--views on decision making…

A Web-Based Tool to Support Data-Based Early Intervention Decision Making

ERIC Educational Resources Information Center

Buzhardt, Jay; Greenwood, Charles; Walker, Dale; Carta, Judith; Terry, Barbara; Garrett, Matthew

2010-01-01

Progress monitoring and data-based intervention decision making have become key components of providing evidence-based early childhood special education services. Unfortunately, there is a lack of tools to support early childhood service providers' decision-making efforts. The authors describe a Web-based system that guides service providers…

Decision support systems for plant disease and insect management in commercial nurseries in the Midwest: A perspective review

USDA-ARS?s Scientific Manuscript database

Decision-support systems (DDSs) are techniques that help decision makers utilize models to solve problems under complex and uncertain conditions. Predicting conditions that warrant intervention is a key tenet of the concept of integrated pest management (IPM) with the use of expert systems and pest ...

The Effect of Shared Decision-Making on the Improvement in Teachers' Job Development

ERIC Educational Resources Information Center

Chi Keung, Cheng

2008-01-01

Background: Teacher Participation in decision-making is one of the recommendations of school-based management and one of the key characteristics of an effective school. Although teacher participation in decision making is claimed to be correlated with their affective outcome, few researchers have been attempted to verify the predictive…

Modeling as a Decision-Making Process

ERIC Educational Resources Information Center

Bleiler-Baxter, Sarah K.; Stephens, D. Christopher; Baxter, Wesley A.; Barlow, Angela T.

2017-01-01

The goal in this article is to support teachers in better understanding what it means to model with mathematics by focusing on three key decision-making processes: Simplification, Relationship Mapping, and Situation Analysis. The authors use the Theme Park task to help teachers develop a vision of how students engage in these three decision-making…

Parental Influence on Exploratory Students' College Choice, Major, and Career Decision Making

ERIC Educational Resources Information Center

Workman, Jamie L.

2015-01-01

This article explores parental influence on exploratory students' college choice, major, and career decision making. The research began with examination of a first year academic advising model and Living Learning Community. Parental influence emerged as a key theme in student decision making processes. The project was conducted using grounded…

Child Protection Decision Making: A Factorial Analysis Using Case Vignettes

ERIC Educational Resources Information Center

Stokes, Jacqueline; Schmidt, Glen

2012-01-01

This study explored decision making by child protection social workers in the province of British Columbia, Canada. A factorial survey method was used in which case vignettes were constructed by randomly assigning a number of key characteristics associated with decision making in child protection. Child protection social workers (n = 118) assessed…

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

PubMed

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

2017-01-01

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

Shared decision making in the United States: policy and implementation activity on multiple fronts.

PubMed

Frosch, Dominick L; Moulton, Benjamin W; Wexler, Richard M; Holmes-Rovner, Margaret; Volk, Robert J; Levin, Carrie A

2011-01-01

Shared decision making in the United States has become an important element in health policy debates. The recently passed federal health care reform legislation includes several key provisions related to shared decision making (SDM) and patient decision support. Several states have passed or are considering legislation that incorporates SDM as a key component of improved health care provision. Research on SDM is funded by a range of public and private organizations. Non-profit, for-profit, academic and government organizations are developing decision support interventions for numerous conditions. Some interventions are publicly available; others are distributed to patients through health insurance and healthcare providers. A significant number of clinical implementation projects are underway to test and evaluate different ways of incorporating SDM and patient decision support into routine clinical care. Numerous professional organizations are advocating for SDM and social networking efforts are increasing their advocacy as well. Policy makers are intrigued by the potential of SDM to improve health care provision and potentially lower costs. The role of shared decision making in policy and practice will be part of the larger health care reform debate. 2011. Published by Elsevier GmbH.

Focus of attention in an activity-based scheduler

NASA Technical Reports Server (NTRS)

Sadeh, Norman; Fox, Mark S.

1989-01-01

Earlier research in job shop scheduling has demonstrated the advantages of opportunistically combining order-based and resource-based scheduling techniques. An even more flexible approach is investigated where each activity is considered a decision point by itself. Heuristics to opportunistically select the next decision point on which to focus attention (i.e., variable ordering heuristics) and the next decision to be tried at this point (i.e., value ordering heuristics) are described that probabilistically account for both activity precedence and resource requirement interactions. Preliminary experimental results indicate that the variable ordering heuristic greatly increases search efficiency. While least constraining value ordering heuristics have been advocated in the literature, the experimental results suggest that other value ordering heuristics combined with our variable-ordering heuristic can produce much better schedules without significantly increasing search.

The development of a decision aid for tinnitus.

PubMed

Pryce, Helen; Durand, Marie-Anne; Hall, Amanda; Shaw, Rachel; Culhane, Beth-Anne; Swift, Sarah; Straus, Jean; Marks, Elizabeth; Ward, Melanie; Chilvers, Katie

2018-05-09

To develop a decision aid for tinnitus care that would meet international consensus for decision aid quality. A mixed methods design that included qualitative in-depth interviews, literature review, focus groups, user testing and readability checking. Patients and clinicians who have clinical experience of tinnitus. A decision aid for tinnitus care was developed. This incorporates key evidence of efficacy for the most frequently used tinnitus care options, together with information derived from patient priorities when deciding which choice to make. The decision aid has potential to enable shared decision making between clinicians and patients in audiology. The decision aid meets consensus standards.

Logics of pre-merger decision-making processes: the case of Karolinska University Hospital.

PubMed

Choi, Soki; Brommels, Mats

2009-01-01

The purpose of this paper is to examine how and why a decision to merge two university hospitals in a public context might occur by using an in-depth case study of the pre-merger process of Karolinska University Hospital. Based on extensive document analysis and 35 key informant interviews the paper reconstructed the pre-merger process, searched for empirical patterns, and interpreted those by applying neo-institutional theory. Spanning nearly a decade, the pre-merger process goes from idea generation through transition to decision, and took place on two arenas, political, and scientific. Both research excellence and economic efficiency are stated merger motives. By applying a neo-institutional perspective, the paper finds that the two initial phases are driven by decision rationality, which is typical for political organizations and that the final phase demonstrated action rationality, which is typical for private firms. Critical factors behind this radical change of decision logic are means convergence, uniting key stakeholder groups, and an economic and political crisis, triggering critical incidents, which ultimately legitimized the formal decision. It is evident from the paper that merger decisions in the public sector might not necessarily result from stated and/or economic drivers only. This paper suggests that a change of decision logic from decision to action rationality might promote effective decision making on large and complex issues in a public context. This is the first systematic in-depth study of a university hospital merger employing a decision-making perspective.

How do the EMA and FDA decide which anticancer drugs make it to the market? A comparative qualitative study on decision makers' views.

PubMed

Tafuri, G; Stolk, P; Trotta, F; Putzeist, M; Leufkens, H G; Laing, R O; De Allegri, M

2014-01-01

The process leading to a regulatory outcome is guided by factors both related and unrelated to the data package, defined in this analysis as 'formal and informal factors', respectively. The aim of this qualitative study was to analyse which formal and informal factors drive the decision-making process of the European Medicines Agency (EMA) and Food and Drug Administration (FDA) regulators with regard to anticancer drugs, using in-depth semi-structured interviews with regulators of the two agencies. In line with the theory and practice of qualitative research, no set sample size was defined a priori. Respondent enrolment continued until saturation and redundancy were reached. Data were collected through means of in-depth semi-structured interviews conducted either in a face-to-face setting or via Skype(®) with each regulator. The interviews were audio-recorded and verbatim transcribed. The analysis was manually carried out on the transcribed text. Data were independently coded and categorized by two researchers. Interpretation of the findings emerged through a process of triangulation between the two. Seven EMA and six FDA regulators, who had extensive experience with making decisions about anticancer medicines, were interviewed between April and June 2012. There is an open dialogue between the FDA and EMA, with the two moving closer and exchanging information, not opinions. Differences in decision-making between the agencies may be due to a different evaluation of end points. Different interaction modalities with industry and patients represent an additional source of divergence with a potential impact on decision-making. The key message of our respondents was that the agencies manage uncertainty in a different way: unlike the EMA, the FDA has a prevailing attitude to take risks in order to guarantee quicker access to new treatments. Although formal factors are the main drivers for regulatory decisions, the influence of informal factors plays an important role in the drug evaluation process.

Untangling the psychosocial predictors of HPV vaccination decision-making among parents of boys.

PubMed

Perez, Samara; Tatar, Ovidiu; Gilca, Vladimir; Shapiro, Gilla K; Ogilvie, Gina; Guichon, Juliet; Naz, Anila; Rosberger, Zeev

2017-08-24

HPV vaccination uptake in boys is suboptimal in many jurisdictions, particularly in the absence of publicly funded HPV vaccination programs. Parents represent key decision-makers of HPV vaccination and their HPV vaccine decision-making stage is influenced by multiple psychosocial determinants. Our objective was to assess the relationship between a broad range of psychosocial factors and parents of boys' HPV vaccine decision-making stage. Data were collected through an online survey from a nationally representative sample of Canadian parents of boys in February (T1) and November 2014 (T2). We assessed a broad number of psychosocial factors including: socio-demographics, health behaviours and validated scales for assessing HPV knowledge, attitudes and beliefs. Parents selected their HPV vaccination adoption stage based on the Precaution Adoption Process Model (PAPM). Multinomial logistic regression was used to test the association between predictors and PAPM stage at T1 and T2. Discussion with a healthcare provider about the HPV vaccine and increased HPV knowledge was associated with increased odds of being in the more advanced PAPM stages. Increased perception of risks in the absence of HPV vaccination, increased perception that others endorse HPV vaccination and positive attitudes related to vaccines in general were associated with increased odds of being in the decided to vaccinate stage. Believing that HPV vaccination is harmful increased, and perceiving the benefits of HPV vaccination decreased the odds of deciding not to vaccinate. This study highlights the psychosocial predictors of the decision-making stage reported by parents regarding HPV vaccination of their sons, that were significant at two time-points. Targeted interventions that consider the impact of the health care provider and address knowledge gaps as well as individual beliefs about benefits, risks, and harms of the HPV vaccine and vaccines in general should be implemented to help parents make better informed decisions that is, to move closer to actual vaccination adoption. Copyright © 2017 Elsevier Ltd. All rights reserved.

Before you make that big decision...

PubMed

Kahneman, Daniel; Lovallo, Dan; Sibony, Olivier

2011-06-01

When an executive makes a big bet, he or she typically relies on the judgment of a team that has put together a proposal for a strategic course of action. After all, the team will have delved into the pros and cons much more deeply than the executive has time to do. The problem is, biases invariably creep into any team's reasoning-and often dangerously distort its thinking. A team that has fallen in love with its recommendation, for instance, may subconsciously dismiss evidence that contradicts its theories, give far too much weight to one piece of data, or make faulty comparisons to another business case. That's why, with important decisions, executives need to conduct a careful review not only of the content of recommendations but of the recommendation process. To that end, the authors-Kahneman, who won a Nobel Prize in economics for his work on cognitive biases; Lovallo of the University of Sydney; and Sibony of McKinsey-have put together a 12-question checklist intended to unearth and neutralize defects in teams' thinking. These questions help leaders examine whether a team has explored alternatives appropriately, gathered all the right information, and used well-grounded numbers to support its case. They also highlight considerations such as whether the team might be unduly influenced by self-interest, overconfidence, or attachment to past decisions. By using this practical tool, executives will build decision processes over time that reduce the effects of biases and upgrade the quality of decisions their organizations make. The payoffs can be significant: A recent McKinsey study of more than 1,000 business investments, for instance, showed that when companies worked to reduce the effects of bias, they raised their returns on investment by seven percentage points. Executives need to realize that the judgment of even highly experienced, superbly competent managers can be fallible. A disciplined decision-making process, not individual genius, is the key to good strategy.

Decision feedback loop for tracking a polyphase modulated carrier

NASA Technical Reports Server (NTRS)

Simon, M. K. (Inventor)

1974-01-01

A multiple phase modulated carrier tracking loop for use in a frequency shift keying system is described in which carrier tracking efficiency is improved by making use of the decision signals made on the data phase transmitted in each T-second interval. The decision signal is used to produce a pair of decision-feedback quadrature signals for enhancing the loop's performance in developing a loop phase error signal.

Audio-video decision support for patients: the documentary genré as a basis for decision aids.

PubMed

Volandes, Angelo E; Barry, Michael J; Wood, Fiona; Elwyn, Glyn

2013-09-01

Decision support tools are increasingly using audio-visual materials. However, disagreement exists about the use of audio-visual materials as they may be subjective and biased. This is a literature review of the major texts for documentary film studies to extrapolate issues of objectivity and bias from film to decision support tools. The key features of documentary films are that they attempt to portray real events and that the attempted reality is always filtered through the lens of the filmmaker. The same key features can be said of decision support tools that use audio-visual materials. Three concerns arising from documentary film studies as they apply to the use of audio-visual materials in decision support tools include whose perspective matters (stakeholder bias), how to choose among audio-visual materials (selection bias) and how to ensure objectivity (editorial bias). Decision science needs to start a debate about how audio-visual materials are to be used in decision support tools. Simply because audio-visual materials may be subjective and open to bias does not mean that we should not use them. Methods need to be found to ensure consensus around balance and editorial control, such that audio-visual materials can be used. © 2011 John Wiley & Sons Ltd.

Audio‐video decision support for patients: the documentary genré as a basis for decision aids

PubMed Central

Volandes, Angelo E.; Barry, Michael J.; Wood, Fiona; Elwyn, Glyn

2011-01-01

Abstract Objective  Decision support tools are increasingly using audio‐visual materials. However, disagreement exists about the use of audio‐visual materials as they may be subjective and biased. Methods  This is a literature review of the major texts for documentary film studies to extrapolate issues of objectivity and bias from film to decision support tools. Results  The key features of documentary films are that they attempt to portray real events and that the attempted reality is always filtered through the lens of the filmmaker. The same key features can be said of decision support tools that use audio‐visual materials. Three concerns arising from documentary film studies as they apply to the use of audio‐visual materials in decision support tools include whose perspective matters (stakeholder bias), how to choose among audio‐visual materials (selection bias) and how to ensure objectivity (editorial bias). Discussion  Decision science needs to start a debate about how audio‐visual materials are to be used in decision support tools. Simply because audio‐visual materials may be subjective and open to bias does not mean that we should not use them. Conclusion  Methods need to be found to ensure consensus around balance and editorial control, such that audio‐visual materials can be used. PMID:22032516

Strategies for single-point diamond machining a large format germanium blazed immersion grating

NASA Astrophysics Data System (ADS)

Montesanti, R. C.; Little, S. L.; Kuzmenko, P. J.; Bixler, J. V.; Jackson, J. L.; Lown, J. G.; Priest, R. E.; Yoxall, B. E.

2016-07-01

A large format germanium immersion grating was flycut with a single-point diamond tool on the Precision Engineering Research Lathe (PERL) at the Lawrence Livermore National Laboratory (LLNL) in November - December 2015. The grating, referred to as 002u, has an area of 59 mm x 67 mm (along-groove and cross-groove directions), line pitch of 88 line/mm, and blaze angle of 32 degree. Based on total groove length, the 002u grating is five times larger than the previous largest grating (ZnSe) cut on PERL, and forty-five times larger than the previous largest germanium grating cut on PERL. The key risks associated with cutting the 002u grating were tool wear and keeping the PERL machine running uninterrupted in a stable machining environment. This paper presents the strategies employed to mitigate these risks, introduces pre-machining of the as-etched grating substrate to produce a smooth, flat, damage-free surface into which the grooves are cut, and reports on trade-offs that drove decisions and experimental results.

United States Air Force 611th Air Support Group/Civil Engineering Squadron, Elmendorf AFB, Alaska. Decision document for no further response action planned Oliktok Point Radar Installation, Alaska. Final report

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

Karmi, S.

1996-06-03

This Decision Document discusses the selection of no further action as the recommended action for four sites located at the Oliktok Point radar installation. The United States Air Force (Air Force) completed a Remedial Investigation/Feasibility Study and a Risk Assessment for the eight sites located at the Oliktok Point installation (U.S. Air Force 1996a,b). Based on the findings of these activities, four sites are recommended for no further action.

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

Hoogmartens, Rob, E-mail: rob.hoogmartens@uhasselt.be; Van Passel, Steven, E-mail: steven.vanpassel@uhasselt.be; Van Acker, Karel, E-mail: karel.vanacker@lrd.kuleuven.be

Increasing interest in sustainability has led to the development of sustainability assessment tools such as Life Cycle Analysis (LCA), Life Cycle Costing (LCC) and Cost–Benefit Analysis (CBA). Due to methodological disparity of these three tools, conflicting assessment results generate confusion for many policy and business decisions. In order to interpret and integrate assessment results, the paper provides a framework that clarifies the connections and coherence between the included assessment methodologies. Building on this framework, the paper further focuses on key aspects to adapt any of the methodologies to full sustainability assessments. Aspects dealt with in the review are for examplemore » the reported metrics, the scope, data requirements, discounting, product- or project-related and approaches with respect to scarcity and labor requirements. In addition to these key aspects, the review shows that important connections exist: (i) the three tools can cope with social inequality, (ii) processes such as valuation techniques for LCC and CBA are common, (iii) Environmental Impact Assessment (EIA) is used as input in both LCA and CBA and (iv) LCA can be used in parallel with LCC. Furthermore, the most integrated sustainability approach combines elements of LCA and LCC to achieve the Life Cycle Sustainability Assessment (LCSA). The key aspects and the connections referred to in the review are illustrated with a case study on the treatment of end-of-life automotive glass. - Highlights: • Proliferation of assessment tools creates ambiguity and confusion. • The developed assessment framework clarifies connections between assessment tools. • Broadening LCA, key aspects are metric and data requirements. • Broadening LCC, key aspects are scope, time frame and discounting. • Broadening CBA, focus point, timespan, references, labor and scarcity are key.« less

A fuzzy rumor spreading model based on transmission capacity

NASA Astrophysics Data System (ADS)

Zhang, Yi; Xu, Jiuping; Wu, Yue

This paper proposes a rumor spreading model that considers three main factors: the event importance, event ambiguity, and the publics critical sense, each of which are defined by decision makers using linguistic descriptions and then transformed into triangular fuzzy numbers. To calculate the resultant force of these three factors, the transmission capacity and a new parameter category with fuzzy variables are determined. A rumor spreading model is then proposed which has fuzzy parameters rather than the fixed parameters in traditional models. As the proposed model considers the comprehensive factors affecting rumors from three aspects rather than examining special factors from a particular aspect. The proposed rumor spreading model is tested using different parameters for several different conditions on BA networks and three special cases are simulated. The simulation results for all three cases suggested that events of low importance, those that are only clarifying facts, and those that are strongly critical do not result in rumors. Therefore, the model assessment results were proven to be in agreement with reality. Parameters for the model were then determined and applied to an analysis of the 7.23 Yong-Wen line major transportation accident (YWMTA). When the simulated data were compared with the real data from this accident, the results demonstrated that the interval for the rumor spreading key point in the model was accurate, and that the key point for the YWMTA rumor spread fell into the range estimated by the model.

Decision making.

PubMed

Chambers, David W

2011-01-01

A decision is a commitment of resources under conditions of risk in expectation of the best future outcome. The smart decision is always the strategy with the best overall expected value-the best combination of facts and values. Some of the special circumstances involved in decision making are discussed, including decisions where there are multiple goals, those where more than one person is involved in making the decision, using trigger points, framing decisions correctly, commitments to lost causes, and expert decision makers. A complex example of deciding about removal of asymptomatic third molars, with and without an EBD search, is discussed.

Clean Energy Financing Programs: A Decision Resource for States and Communities

EPA Pesticide Factsheets

Describes financing-program options, key components of financing programs, and factors for states and communities to consider as they make decisions about getting started or updating their clean energy financing programs.

Patient‐focussed decision‐making in early‐stage prostate cancer: insights from a cognitively based decision aid

PubMed Central

Feldman‐Stewart, Deb; Brundage, Michael D; Manen, Lori Van; Svenson, Ola

2004-01-01

Abstract Purpose  To study the cognitive processes of early‐stage prostate cancer patients as they determined which treatment they preferred, using our cognitively based decision aid. Method  The aid was a one‐to‐one interview that included the structured presentation of information, listing exercises in which the patient identified attributes important to his decision, and trade‐off exercises to help him weigh and integrate those attributes together. At various points of the interview, patients identified the attributes they felt were important to their decision, rated their treatment options and completed standardized assessments relating to their decision. In addition, patients participated in a follow‐up interview at the time they made their actual treatment decision and again 3 months later. Results  Sixty of 70 (86%) of the invited patients participated in the study. Participating patients identified a median of four important attributes (range 1–10); 36 different attributes were identified at some point in the interview by the group. During the interview, 78% of patients changed which attributes they considered important, and 72% changed their treatment ratings. Stability of treatment choice after the interview and lack of regret after the decision were each positively associated with increasing differentiation between treatment options over time. Conclusions  The decision process appears to be dynamic for the patients with great variability across patients in what is important to the decision. Increasing stability of choice and lack of regret appear to be related positively to increasing difference over time in how attractive the preferred option is over its closest competitor, rather than to the size of the difference at any one point in time. PMID:15117387

Role-based access control permissions

DOEpatents

Staggs, Kevin P.; Markham, Thomas R.; Hull Roskos, Julie J.; Chernoguzov, Alexander

2017-04-25

Devices, systems, and methods for role-based access control permissions are disclosed. One method includes a policy decision point that receives up-to-date security context information from one or more outside sources to determine whether to grant access for a data client to a portion of the system and creates an access vector including the determination; receiving, via a policy agent, a request by the data client for access to the portion of the computing system by the data client, wherein the policy agent checks to ensure there is a session established with communications and user/application enforcement points; receiving, via communications policy enforcement point, the request from the policy agent, wherein the communications policy enforcement point determines whether the data client is an authorized node, based upon the access vector received from the policy decision point; and receiving, via the user/application policy enforcement point, the request from the communications policy enforcement point.

Reducing NPR 7120.5D to Practice: Preparing for a Life-Cycle Review

NASA Technical Reports Server (NTRS)

Taylor, Randall L.

2008-01-01

In March 2007, NASA issued revised rules for space flight project management, NPR 7120.5D, 'NASA Space Flight Program and Project Management Requirements.' Central to the new rules was the construct of Key Decision Points, maturity gates that the project team must pass in order to continue development. In order that the KDP decision be fully informed, the NPR required, as entrance criteria for the gate, the generation and delivery of specified planning, technical, and cost/schedule documents (gate products) and a life-cycle review, the Preliminary Design Review. Building on JPL experience on the Prometheus and Juno projects, the team successfully organized for and conducted these reviews on an aggressive schedule. Key actions were taken to proactively interact with the SRB, produce high-quality gate products with stakeholder review, generate review presentation materials, and handle a myriad of supporting logistical functions. A review preparation team was established, including a Review Captain and leads for documentation, information systems, and logistics, and their roles, responsibilities and task assignments were identified. Aids were produced, including a detailed review preparation schedule and a comprehensive gate products production table. Institutional support was leveraged early and often. Implementation strategy reflected the needs of a nationally-distributed team, as well as applicable export control and IT security requirements. This paper gives a brief overview of the GRAIL mission and its project management challenges, provides a detailed description of project PMSR and PDR preparation and execution activities, including positive and negative lessons learned, and identifies recommendations for future NASA (and non-NASA) project teams.

Quantum Uncertainty and Decision-Making in Game Theory

NASA Astrophysics Data System (ADS)

Asano, M.; Ohya, M.; Tanaka, Y.; Khrennikov, A.; Basieva, I.

2011-01-01

Recently a few authors pointed to a possibility to apply the mathematical formalism of quantum mechanics to cognitive psychology, in particular, to games of the Prisoners Dilemma (PD) type.6_18 In this paper, we discuss the problem of rationality in game theory and point out that the quantum uncertainty is similar to the uncertainty of knowledge, which a player feels subjectively in his decision-making.

Shared Decision Making in Common Chronic Conditions: Impact of a Resident Training Workshop.

PubMed

Simmons, Leigh; Leavitt, Lauren; Ray, Alaka; Fosburgh, Blair; Sepucha, Karen

2016-01-01

Physicians must be competent in several different kinds of communication skills in order to implement shared decision making; however, these skills are not part of routine medical student education, nor are they formally taught during residency training. We developed a 1- and 2-hour workshop curriculum for internal medicine residents to promote shared decision making in treatment decisions for four common chronic conditions: diabetes, depression, hypertension, and hyperlipidemia. The workshops included a written case exercise, a short didactic presentation on shared decision-making concepts and strategies for risk communication, and two role-playing exercises focused on decision making for depression and hyperlipidemia treatment. We delivered the workshop as a required component of the resident curriculum in ambulatory medicine. To evaluate the impact of the workshop, we used written course evaluations, tracked the use of the newly introduced Decision Worksheets, and asked preceptors to perform direct observation of treatment decision conversations. Residents were involved in the development of the workshop and helped identify key content, suggested framing for difficult topics, and confirmed the need for the skills workshop. One hundred thirty internal medicine and medicine-pediatrics residents attended 8 workshops over a 4-month period. In written cases completed before the workshop, the majority of residents indicated that they would discuss medications, but few mentioned other treatment options or documented patients' goals and preferences in a sample encounter note with a patient with new depression symptoms. Overall, most participants (89.7%) rated the workshop as excellent or very good, and 93.5% said that they would change their practice based on what they learned. Decision Worksheets addressing diabetes, depression, hyperlipidemia, and hypertension were available on a primary care-focused intranet site and were downloaded almost 1,200 times in the first 8 months following the workshops. Preceptors were able to observe only one consult during which one of the four topics was discussed. Internal medicine residents had considerable gaps in shared decision-making skills as measured in a baseline written exercise. Residents provided valuable contributions to the development of a Decision Worksheet to be used at the point of care. Participants rated the skills workshop highly, though interns rated the exercise more useful than PGY-2 and PGY-3 residents did. The Decision Worksheets were accessed often following the sessions; however, observing the Decision Worksheets in use in real time was a challenge in the resident-faculty clinic. Additional studies are warranted to examine whether the workshop was successful in increasing residents' ability to implement skills in practice.

Data key to quest for quality.

PubMed

Chang, Florence S; Nielsen, Jon; Macias, Charles

2013-11-01

Late-binding data warehousing reduces the time it takes to obtain data needed to make crucial decisions. Late binding refers to when and how tightly data from the source applications are bound to the rules and vocabularies that make it useful. In some cases, data can be seen in real time. In historically paper-driven environments where data-driven decisions may be a new concept, buy-in from clinicians, physicians, and hospital leaders is key to success in using data to improve outcomes.

Combining statistical inference and decisions in ecology

USGS Publications Warehouse

Williams, Perry J.; Hooten, Mevin B.

2016-01-01

Statistical decision theory (SDT) is a sub-field of decision theory that formally incorporates statistical investigation into a decision-theoretic framework to account for uncertainties in a decision problem. SDT provides a unifying analysis of three types of information: statistical results from a data set, knowledge of the consequences of potential choices (i.e., loss), and prior beliefs about a system. SDT links the theoretical development of a large body of statistical methods including point estimation, hypothesis testing, and confidence interval estimation. The theory and application of SDT have mainly been developed and published in the fields of mathematics, statistics, operations research, and other decision sciences, but have had limited exposure in ecology. Thus, we provide an introduction to SDT for ecologists and describe its utility for linking the conventionally separate tasks of statistical investigation and decision making in a single framework. We describe the basic framework of both Bayesian and frequentist SDT, its traditional use in statistics, and discuss its application to decision problems that occur in ecology. We demonstrate SDT with two types of decisions: Bayesian point estimation, and an applied management problem of selecting a prescribed fire rotation for managing a grassland bird species. Central to SDT, and decision theory in general, are loss functions. Thus, we also provide basic guidance and references for constructing loss functions for an SDT problem.

The database search problem: a question of rational decision making.

PubMed

Gittelson, S; Biedermann, A; Bozza, S; Taroni, F

2012-10-10

This paper applies probability and decision theory in the graphical interface of an influence diagram to study the formal requirements of rationality which justify the individualization of a person found through a database search. The decision-theoretic part of the analysis studies the parameters that a rational decision maker would use to individualize the selected person. The modeling part (in the form of an influence diagram) clarifies the relationships between this decision and the ingredients that make up the database search problem, i.e., the results of the database search and the different pairs of propositions describing whether an individual is at the source of the crime stain. These analyses evaluate the desirability associated with the decision of 'individualizing' (and 'not individualizing'). They point out that this decision is a function of (i) the probability that the individual in question is, in fact, at the source of the crime stain (i.e., the state of nature), and (ii) the decision maker's preferences among the possible consequences of the decision (i.e., the decision maker's loss function). We discuss the relevance and argumentative implications of these insights with respect to recent comments in specialized literature, which suggest points of view that are opposed to the results of our study. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

The Assisted Decision-Making (Capacity) Act 2015: what it is and why it matters.

PubMed

Kelly, B D

2017-05-01

Ireland's Assisted Decision-Making (Capacity) Act 2015 was signed by President Higgins in December 2015 and scheduled for commencement in 2016. To explore the content and implications of the 2015 Act. Review of the 2015 Act and related literature. The 2015 Act places the "will and preferences" of persons with impaired mental capacity at the heart of decision-making relating to "personal welfare" (including healthcare) and "property and affairs". Capacity is to be "construed functionally" and interventions must be "for the benefit of the relevant person". The Act outlines three levels of decision-making assistance: "decision-making assistant", "co-decision-maker" (joint decision-maker) and "decision-making representative" (substitute decision-maker). There are procedures relating to "enduring power of attorney" and "advance healthcare directives"; in the case of the latter, a "refusal of treatment" can be legally binding, while a "request for a specific treatment" must "be taken into consideration". The 2015 Act is considerably more workable than the 2013 Bill that preceded it. Key challenges include the subtle decision-making required by patients, healthcare staff, Circuit Court judges and the director of the Decision Support Service; implementation of "advance healthcare directives", especially if they do not form part of a broader model of advance care planning (incorporating the flexibility required for unpredictable future circumstances); and the over-arching issue of logistics, as very many healthcare decisions are currently made in situations where the patient's capacity is impaired. A key challenge will lie in balancing the emphasis on autonomy with principles of beneficence, mutuality and care.

Collective Leadership: Principals' Decision Influence and the Supportive or Inhibiting Decision Influence of Other Stakeholders

ERIC Educational Resources Information Center

Ni, Yongmei; Yan, Rui; Pounder, Diana

2018-01-01

Purpose: Using the collective leadership framework, this study examines (a) how principals perceive their own influence and that of other key stakeholders in various school decisions and (b) how principals' perceived influences of other stakeholders are associated with their own influence. Research Method/Approach: This study uses the nationally…

Education Leaders' Decision-Making Processes about Educational Facilities in a University Multiple Stakeholder Environment

ERIC Educational Resources Information Center

Kelting, Scott

2011-01-01

This research is a retrospective case study designed to document and analyze the process of decision-making by educational leaders and stakeholders at a four-year university. For this study, educational leaders and key stakeholders agreed to extensive interviews about the decisions made during the design, construction, and post-occupancy phases of…

20 CFR 416.1453 - The decision of an administrative law judge.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the findings of fact and the reasons for the decision. The administrative law judge must base the... document that sets forth the key data, findings of fact, and narrative rationale for the decision. If the... instance may be extended by the total number of days of the delays. The delays include delays in submitting...

Prescribing regeneration treatments for mixed-oak forests in the Mid-Atlantic region

Treesearch

Patrick H. Brose; Kurt W. Gottschalk; Stephen B. Horsley; Peter D. Knopp; James N. Kochenderfer; Barbara J. McGuinness; Gary W. Miller; Todd E. Ristau; Scott H. Stoleson; Susan L. Stout

2008-01-01

Includes guidelines for using the SILVAH decision-support system to perpetuate oak forests in the Mid-Atlantic region. Six chapters provide information on values of oak forests, inventory methods, key decision variables, decision charts, and silvicultural prescriptions, as well as guidance on fostering young stands. Sample tally sheets and SILVAH computer printouts are...

Decision modeling for fire incident analysis

Treesearch

Donald G. MacGregor; Armando González-Cabán

2009-01-01

This paper reports on methods for representing and modeling fire incidents based on concepts and models from the decision and risk sciences. A set of modeling techniques are used to characterize key fire management decision processes and provide a basis for incident analysis. The results of these methods can be used to provide insights into the structure of fire...

Design Decisions in Developing Learning Trajectories-Based Assessments in Mathematics: A Case Study

ERIC Educational Resources Information Center

Penuel, William R.; Confrey, Jere; Maloney, Alan; Rupp, André A.

2014-01-01

This article analyzes the design decisions of a team developing diagnostic assessments for a learning trajectory focused on rational number reasoning. The analysis focuses on the design rationale for key decisions about how to develop the cognitive assessments and related validity arguments within a fluid state and national policy context. The…

Field test of classical symmetric encryption with continuous variables quantum key distribution.

PubMed

Jouguet, Paul; Kunz-Jacques, Sébastien; Debuisschert, Thierry; Fossier, Simon; Diamanti, Eleni; Alléaume, Romain; Tualle-Brouri, Rosa; Grangier, Philippe; Leverrier, Anthony; Pache, Philippe; Painchault, Philippe

2012-06-18

We report on the design and performance of a point-to-point classical symmetric encryption link with fast key renewal provided by a Continuous Variable Quantum Key Distribution (CVQKD) system. Our system was operational and able to encrypt point-to-point communications during more than six months, from the end of July 2010 until the beginning of February 2011. This field test was the first demonstration of the reliability of a CVQKD system over a long period of time in a server room environment. This strengthens the potential of CVQKD for information technology security infrastructure deployments.

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

PubMed

Safarnejad, Ali; Groot, Wim; Pavlova, Milena

2018-01-30

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

Hypothesis generation using network structures on community health center cancer-screening performance.

PubMed

Carney, Timothy Jay; Morgan, Geoffrey P; Jones, Josette; McDaniel, Anna M; Weaver, Michael T; Weiner, Bryan; Haggstrom, David A

2015-10-01

Nationally sponsored cancer-care quality-improvement efforts have been deployed in community health centers to increase breast, cervical, and colorectal cancer-screening rates among vulnerable populations. Despite several immediate and short-term gains, screening rates remain below national benchmark objectives. Overall improvement has been both difficult to sustain over time in some organizational settings and/or challenging to diffuse to other settings as repeatable best practices. Reasons for this include facility-level changes, which typically occur in dynamic organizational environments that are complex, adaptive, and unpredictable. This study seeks to understand the factors that shape community health center facility-level cancer-screening performance over time. This study applies a computational-modeling approach, combining principles of health-services research, health informatics, network theory, and systems science. To investigate the roles of knowledge acquisition, retention, and sharing within the setting of the community health center and to examine their effects on the relationship between clinical decision support capabilities and improvement in cancer-screening rate improvement, we employed Construct-TM to create simulated community health centers using previously collected point-in-time survey data. Construct-TM is a multi-agent model of network evolution. Because social, knowledge, and belief networks co-evolve, groups and organizations are treated as complex systems to capture the variability of human and organizational factors. In Construct-TM, individuals and groups interact by communicating, learning, and making decisions in a continuous cycle. Data from the survey was used to differentiate high-performing simulated community health centers from low-performing ones based on computer-based decision support usage and self-reported cancer-screening improvement. This virtual experiment revealed that patterns of overall network symmetry, agent cohesion, and connectedness varied by community health center performance level. Visual assessment of both the agent-to-agent knowledge sharing network and agent-to-resource knowledge use network diagrams demonstrated that community health centers labeled as high performers typically showed higher levels of collaboration and cohesiveness among agent classes, faster knowledge-absorption rates, and fewer agents that were unconnected to key knowledge resources. Conclusions and research implications: Using the point-in-time survey data outlining community health center cancer-screening practices, our computational model successfully distinguished between high and low performers. Results indicated that high-performance environments displayed distinctive network characteristics in patterns of interaction among agents, as well as in the access and utilization of key knowledge resources. Our study demonstrated how non-network-specific data obtained from a point-in-time survey can be employed to forecast community health center performance over time, thereby enhancing the sustainability of long-term strategic-improvement efforts. Our results revealed a strategic profile for community health center cancer-screening improvement via simulation over a projected 10-year period. The use of computational modeling allows additional inferential knowledge to be drawn from existing data when examining organizational performance in increasingly complex environments. Copyright © 2015 Elsevier Inc. All rights reserved.

Analysis of complex decisionmaking processes. [with application to jet engine development

NASA Technical Reports Server (NTRS)

Hill, J. D.; Ollila, R. G.

1978-01-01

The analysis of corporate decisionmaking processes related to major system developments is unusually difficult because of the number of decisionmakers involved in the process and the long development cycle. A method for analyzing such decision processes is developed and illustrated through its application to the analysis of the commercial jet engine development process. The method uses interaction matrices as the key tool for structuring the problem, recording data, and analyzing the data to establish the rank order of the major factors affecting development decisions. In the example, the use of interaction matrices permitted analysts to collect and analyze approximately 50 factors that influenced decisions during the four phases of the development cycle, and to determine the key influencers of decisions at each development phase. The results of this study indicate that the cost of new technology installed on an aircraft is the prime concern of the engine manufacturer.

[Modeling in value-based medicine].

PubMed

Neubauer, A S; Hirneiss, C; Kampik, A

2010-03-01

Modeling plays an important role in value-based medicine (VBM). It allows decision support by predicting potential clinical and economic consequences, frequently combining different sources of evidence. Based on relevant publications and examples focusing on ophthalmology the key economic modeling methods are explained and definitions are given. The most frequently applied model types are decision trees, Markov models, and discrete event simulation (DES) models. Model validation includes besides verifying internal validity comparison with other models (external validity) and ideally validation of its predictive properties. The existing uncertainty with any modeling should be clearly stated. This is true for economic modeling in VBM as well as when using disease risk models to support clinical decisions. In economic modeling uni- and multivariate sensitivity analyses are usually applied; the key concepts here are tornado plots and cost-effectiveness acceptability curves. Given the existing uncertainty, modeling helps to make better informed decisions than without this additional information.

ClinicalKey 2.0: Upgrades in a Point-of-Care Search Engine.

PubMed

Huslig, Mary Ann; Vardell, Emily

2015-01-01

ClinicalKey 2.0, launched September 23, 2014, offers a mobile-friendly design with a search history feature for targeting point-of-care resources for health care professionals. Browsing is improved with searchable, filterable listings of sources highlighting new resources. ClinicalKey 2.0 improvements include more than 1,400 new Topic Pages for quick access to point-of-care content. A sample search details some of the upgrades and content options.

Evaluation of Image Segmentation and Object Recognition Algorithms for Image Parsing

DTIC Science & Technology

2013-09-01

generation of the features from the key points. OpenCV uses Euclidean distance to match the key points and has the option to use Manhattan distance...feature vector includes polarity and intensity information. Final step is matching the key points. In OpenCV , Euclidean distance or Manhattan...the code below is one way and OpenCV offers the function radiusMatch (a pair must have a distance less than a given maximum distance). OpenCV’s

Risky decision making from childhood through adulthood: Contributions of learning and sensitivity to negative feedback.

PubMed

Humphreys, Kathryn L; Telzer, Eva H; Flannery, Jessica; Goff, Bonnie; Gabard-Durnam, Laurel; Gee, Dylan G; Lee, Steve S; Tottenham, Nim

2016-02-01

Decision making in the context of risk is a complex and dynamic process that changes across development. Here, we assessed the influence of sensitivity to negative feedback (e.g., loss) and learning on age-related changes in risky decision making, both of which show unique developmental trajectories. In the present study, we examined risky decision making in 216 individuals, ranging in age from 3-26 years, using the balloon emotional learning task (BELT), a computerized task in which participants pump up a series of virtual balloons to earn points, but risk balloon explosion on each trial, which results in no points. It is important to note that there were 3 balloon conditions, signified by different balloon colors, ranging from quick- to slow-to-explode, and participants could learn the color-condition pairings through task experience. Overall, we found age-related increases in pumps made and points earned. However, in the quick-to-explode condition, there was a nonlinear adolescent peak for points earned. Follow-up analyses indicated that this adolescent phenotype occurred at the developmental intersection of linear age-related increases in learning and decreases in sensitivity to negative feedback. Adolescence was marked by intermediate values on both these processes. These findings show that a combination of linearly changing processes can result in nonlinear changes in risky decision making, the adolescent-specific nature of which is associated with developmental improvements in learning and reduced sensitivity to negative feedback. (c) 2016 APA, all rights reserved).

Reflecting on the efficacy of cognitive mapping for decision-making in intellectual disability care: a case study.

PubMed

Duryan, Meri; Nikolik, Dragan; van Merode, Godefridus; Curfs, Leopold M G

2015-01-01

The central aspect of this study is a set of reflections on the efficacy of soft operational research techniques in understanding the dynamics of a complex system such as intellectual disability (ID) care providers. Organizations providing services to ID patients are complex and have many interacting stakeholders with often different and competing interests. Understanding the causes for failures in complex systems is crucial for appreciating the multiple perspectives of the key stakeholders of the system. Knowing the factors that adversely affect delivery of a patient-centred care by ID provider organizations offers the potential for identifying more effective resource-allocation solutions. The authors suggest cognitive mapping as a starting point for system dynamics modelling of optimal resource-allocation projects in ID care. The application of the method is illustrated via a case study in one of the ID care providers in the Netherlands. The paper discusses some of the practical implications of applying problem-structuring methods that support gathering feedback from vulnerable service users and front-line workers. The authors concluded that cognitive mapping technique can assist the management of healthcare organizations in strategic decision-making. Copyright © 2013 John Wiley & Sons, Ltd.

Strategic targeting of advance care planning interventions: the Goldilocks phenomenon.

PubMed

Billings, J Andrew; Bernacki, Rachelle

2014-04-01

Strategically selecting patients for discussions and documentation about limiting life-sustaining treatments-choosing the right time along the end-of-life trajectory for such an intervention and identifying patients at high risk of facing end-of-life decisions-can have a profound impact on the value of advance care planning (ACP) efforts. Timing is important because the completion of an advance directive (AD) too far from or too close to the time of death can lead to end-of-life decisions that do not optimally reflect the patient's values, goals, and preferences: a poorly chosen target patient population that is unlikely to need an AD in the near future may lead to patients making unrealistic, hypothetical choices, while assessing preferences in the emergency department or hospital in the face of a calamity is notoriously inadequate. Because much of the currently studied ACP efforts have led to a disappointingly small proportion of patients eventually benefitting from an AD, careful targeting of the intervention should also improve the efficacy of such projects. A key to optimal timing and strategic selection of target patients for an ACP program is prognostication, and we briefly highlight prognostication tools and studies that may point us toward high-value AD interventions.

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.

Information and redundancy: key concepts in understanding the genetic control of health and intelligence.

PubMed

Morris, J A

1999-08-01

A model is proposed in which information from the environment is analysed by complex biological decision-making systems which are highly redundant. A correct response is intelligent behaviour which preserves health; incorrect responses lead to disease. Mutations in genes which code for the redundant systems will accumulate in the genome and impair decision-making. The number of mutant genes will depend upon a balance between the new mutation rate per generation and systems of elimination based on synergistic interaction in redundant systems. This leads to a polygenic pattern of inheritance for intelligence and the common diseases. The model also gives a simple explanation for some of the hitherto puzzling aspects of work on the genetic basis of intelligence including the recorded rise in IQ this century. There is a prediction that health, intelligence and socio-economic position will be correlated generating a health differential in the social hierarchy. Furthermore, highly competitive societies will place those least able to cope in the harshest environment and this will impair health overall. The model points to a need for population monitoring of somatic mutation in order to preserve the health and intelligence of future generations.

The Selection of Test Items for Decision Making with a Computer Adaptive Test.

ERIC Educational Resources Information Center

Spray, Judith A.; Reckase, Mark D.

The issue of test-item selection in support of decision making in adaptive testing is considered. The number of items needed to make a decision is compared for two approaches: selecting items from an item pool that are most informative at the decision point or selecting items that are most informative at the examinee's ability level. The first…

Measuring coverage in MNCH: total survey error and the interpretation of intervention coverage estimates from household surveys.

PubMed

Eisele, Thomas P; Rhoda, Dale A; Cutts, Felicity T; Keating, Joseph; Ren, Ruilin; Barros, Aluisio J D; Arnold, Fred

2013-01-01

Nationally representative household surveys are increasingly relied upon to measure maternal, newborn, and child health (MNCH) intervention coverage at the population level in low- and middle-income countries. Surveys are the best tool we have for this purpose and are central to national and global decision making. However, all survey point estimates have a certain level of error (total survey error) comprising sampling and non-sampling error, both of which must be considered when interpreting survey results for decision making. In this review, we discuss the importance of considering these errors when interpreting MNCH intervention coverage estimates derived from household surveys, using relevant examples from national surveys to provide context. Sampling error is usually thought of as the precision of a point estimate and is represented by 95% confidence intervals, which are measurable. Confidence intervals can inform judgments about whether estimated parameters are likely to be different from the real value of a parameter. We recommend, therefore, that confidence intervals for key coverage indicators should always be provided in survey reports. By contrast, the direction and magnitude of non-sampling error is almost always unmeasurable, and therefore unknown. Information error and bias are the most common sources of non-sampling error in household survey estimates and we recommend that they should always be carefully considered when interpreting MNCH intervention coverage based on survey data. Overall, we recommend that future research on measuring MNCH intervention coverage should focus on refining and improving survey-based coverage estimates to develop a better understanding of how results should be interpreted and used.

Measuring Coverage in MNCH: Total Survey Error and the Interpretation of Intervention Coverage Estimates from Household Surveys

PubMed Central

Eisele, Thomas P.; Rhoda, Dale A.; Cutts, Felicity T.; Keating, Joseph; Ren, Ruilin; Barros, Aluisio J. D.; Arnold, Fred

2013-01-01

Nationally representative household surveys are increasingly relied upon to measure maternal, newborn, and child health (MNCH) intervention coverage at the population level in low- and middle-income countries. Surveys are the best tool we have for this purpose and are central to national and global decision making. However, all survey point estimates have a certain level of error (total survey error) comprising sampling and non-sampling error, both of which must be considered when interpreting survey results for decision making. In this review, we discuss the importance of considering these errors when interpreting MNCH intervention coverage estimates derived from household surveys, using relevant examples from national surveys to provide context. Sampling error is usually thought of as the precision of a point estimate and is represented by 95% confidence intervals, which are measurable. Confidence intervals can inform judgments about whether estimated parameters are likely to be different from the real value of a parameter. We recommend, therefore, that confidence intervals for key coverage indicators should always be provided in survey reports. By contrast, the direction and magnitude of non-sampling error is almost always unmeasurable, and therefore unknown. Information error and bias are the most common sources of non-sampling error in household survey estimates and we recommend that they should always be carefully considered when interpreting MNCH intervention coverage based on survey data. Overall, we recommend that future research on measuring MNCH intervention coverage should focus on refining and improving survey-based coverage estimates to develop a better understanding of how results should be interpreted and used. PMID:23667331

Obesity and health-related decisions: An empirical model of the determinants of weight status across the transition from adolescence to young adulthood.

PubMed

Morales, Leonardo Fabio; Gordon-Larsen, Penny; Guilkey, David

2016-12-01

We estimate a structural dynamic model of the determinants of obesity. In addition to including many of the well-recognized endogenous factors mentioned in the literature as obesity determinants, we also model the individual's residential location as a choice variable, which is the main contribution of this paper to the literature. This allows us to control for an individual's self-selection into communities that possess the types of amenities in the built environment, which in turn affect their obesity-related behaviors such as physical activity (PA) and fast food consumption. We specify reduced form equations for a set of endogenous demand decisions, together with an obesity structural equation. The whole system of equations is jointly estimated by a semi-parametric full information log-likelihood method that allows for a general pattern of correlation in the errors across equations. Our model predicts a reduction in adult obesity of 7 percentage points as a result of a continued high level PA from adolescence into adulthood; a reduction of 0.7 (3) percentage points in adult obesity as a result of one standard deviation reduction in weekly fast food consumption for women (men); and a reduction of 0.02 (0.05) in adult obesity as a result of one standard deviation change in several neighborhood amenities for women (men). Another key finding is that controlling for residential self-selection has substantive implications. To our knowledge, this has not been yet documented within a full information maximum likelihood framework. Copyright © 2016 Elsevier B.V. All rights reserved.

Social marketing campaign promoting the use of respiratory protection devices among farmers.

PubMed

Pounds, Lea; Duysen, Ellen; Romberger, Debra; Cramer, Mary E; Wendl, Mary; Rautiainen, Risto

2014-01-01

This article describes the formal use of marketing concepts in a systematic approach to influence farmers to voluntarily increase respiratory protective device (RPD) use. The planning process for the project incorporated six key decision or action points, each informed by formative research or health behavior theory. The planning process included developing behavior change strategies based on a 4P model (product, price, place, and promotion). The resulting campaign elements included print and e-mail messages that leveraged motivators related to family and health in order to increase farmers' knowledge about the risks of exposure to dusty environments, four instructional videos related to the primary barriers identified in using RPDs, and a brightly colored storage bag to address barriers to using RPDs related to mask storage. Campaign implementation included a series of e-mails using a bulk e-mail subscription service, use of social media in the form of posting instructional videos on a YouTube channel, and in-person interactions with members of the target audience at farm shows throughout the Central States Center for Agricultural Safety and Health seven-state region. Evaluation of the e-mail campaigns indicated increased knowledge about RPD use and intent to use RPDs in dusty conditions. YouTube analytic data indicated continuing exposure of the instructional videos beyond the life of the campaign. The project demonstrates the efficacy of a planning process that incorporates formative research and clear decision points throughout. This process could be used to plan health behavior change interventions to address other agriculture-related health and safety issues.

Clinical relevance is associated with allergen-specific wheal size in skin prick testing.

PubMed

Haahtela, T; Burbach, G J; Bachert, C; Bindslev-Jensen, C; Bonini, S; Bousquet, J; Bousquet-Rouanet, L; Bousquet, P J; Bresciani, M; Bruno, A; Canonica, G W; Darsow, U; Demoly, P; Durham, S R; Fokkens, W J; Giavi, S; Gjomarkaj, M; Gramiccioni, C; Kowalski, M L; Losonczy, G; Orosz, M; Papadopoulos, N G; Stingl, G; Todo-Bom, A; von Mutius, E; Köhli, A; Wöhrl, S; Järvenpää, S; Kautiainen, H; Petman, L; Selroos, O; Zuberbier, T; Heinzerling, L M

2014-03-01

Within a large prospective study, the Global Asthma and Allergy European Network (GA(2) LEN) has collected skin prick test (SPT) data throughout Europe to make recommendations for SPT in clinical settings. To improve clinical interpretation of SPT results for inhalant allergens by providing quantitative decision points. The GA(2) LEN SPT study with 3068 valid data sets was used to investigate the relationship between SPT results and patient-reported clinical relevance for each of the 18 inhalant allergens as well as SPT wheal size and physician-diagnosed allergy (rhinitis, asthma, atopic dermatitis, food allergy). The effects of age, gender, and geographical area on SPT results were assessed. For each allergen, the wheal size in mm with an 80% positive predictive value (PPV) for being clinically relevant was calculated. Depending on the allergen, from 40% (blatella) to 87-89% (grass, mites) of the positive SPT reactions (wheal size ≥ 3 mm) were associated with patient-reported clinical symptoms when exposed to the respective allergen. The risk of allergic symptoms increased significantly with larger wheal sizes for 17 of the 18 allergens tested. Children with positive SPT reactions had a smaller risk of sensitizations being clinically relevant compared with adults. The 80% PPV varied from 3 to 10 mm depending on the allergen. These 'reading keys' for 18 inhalant allergens can help interpret SPT results with respect to their clinical significance. A SPT form with the standard allergens including mm decision points for each allergen is offered for clinical use. © 2013 The Authors. Clinical & Experimental Allergy published by John Wiley & Sons Ltd.

Obesity and Health-Related Decisions: An Empirical Model of the Determinants of Weight Status across the Transition from Adolescence to Young Adulthood*

PubMed Central

Morales, Leonardo Fabio; Gordon-Larsen, Penny; Guilkey, David

2017-01-01

We estimate a structural dynamic model of the determinants of obesity. In addition to including many of the well-recognized endogenous factors mentioned in the literature as obesity determinants, we also model the individual’s residential location as a choice variable, which is the main contribution of this paper to the literature. This allows us to control for an individual's self-selection into communities that possess the types of amenities in the built environment, which in turn affect their obesity-related behaviors such as physical activity (PA) and fast food consumption. We specify reduced form equations for a set of endogenous demand decisions, together with an obesity structural equation. The whole system of equations is jointly estimated by a semi-parametric full information log-likelihood method that allows for a general pattern of correlation in the errors across equations. Our model predicts a reduction in adult obesity of 7 percentage points as a result of a continued high level PA from adolescence into adulthood; a reduction of 0.7 (3) percentage points in adult obesity as a result of one standard deviation reduction in weekly fast food consumption for women (men); and a reduction of 0.02 (0.05) in adult obesity as a result of one standard deviation change in several neighborhood amenities for women (men). Another key finding is that controlling for residential self-selection has substantive implications. To our knowledge, this has not been yet documented within a full information maximum likelihood framework. PMID:27459276

OnEarth: An Open Source Solution for Efficiently Serving High-Resolution Mapped Image Products

NASA Astrophysics Data System (ADS)

Thompson, C. K.; Plesea, L.; Hall, J. R.; Roberts, J. T.; Cechini, M. F.; Schmaltz, J. E.; Alarcon, C.; Huang, T.; McGann, J. M.; Chang, G.; Boller, R. A.; Ilavajhala, S.; Murphy, K. J.; Bingham, A. W.

2013-12-01

This presentation introduces OnEarth, a server side software package originally developed at the Jet Propulsion Laboratory (JPL), that facilitates network-based, minimum-latency geolocated image access independent of image size or spatial resolution. The key component in this package is the Meta Raster Format (MRF), a specialized raster file extension to the Geospatial Data Abstraction Library (GDAL) consisting of an internal indexed pyramid of image tiles. Imagery to be served is converted to the MRF format and made accessible online via an expandable set of server modules handling requests in several common protocols, including the Open Geospatial Consortium (OGC) compliant Web Map Tile Service (WMTS) as well as Tiled WMS and Keyhole Markup Language (KML). OnEarth has recently transitioned to open source status and is maintained and actively developed as part of GIBS (Global Imagery Browse Services), a collaborative project between JPL and Goddard Space Flight Center (GSFC). The primary function of GIBS is to enhance and streamline the data discovery process and to support near real-time (NRT) applications via the expeditious ingestion and serving of full-resolution imagery representing science products from across the NASA Earth Science spectrum. Open source software solutions are leveraged where possible in order to utilize existing available technologies, reduce development time, and enlist wider community participation. We will discuss some of the factors and decision points in transitioning OnEarth to a suitable open source paradigm, including repository and licensing agreement decision points, institutional hurdles, and perceived benefits. We will also provide examples illustrating how OnEarth is integrated within GIBS and other applications.

Multimedia education increases elder knowledge of emergency department care.

PubMed

Terndrup, Thomas E; Ali, Sameer; Hulse, Steve; Shaffer, Michele; Lloyd, Tom

2013-03-01

Elders who utilize the emergency department (ED) may have little prospective knowledge of appropriate expectations during an ED encounter. Improving elder orientation to ED expectations is important for satisfaction and health education. The purpose of this study was to evaluate a multi-media education intervention as a method for informing independently living elders about ED care. The program delivered messages categorically as, the number of tests, providers, decisions and disposition decision making. Interventional trial of representative elders over 59 years of age comparing pre and post multimedia program exposure. A brief (0.3 hour) video that chronicled the key events after a hypothetical 911 call for chest pain was shown. The video used a clinical narrator, 15 ED health care providers, and 2 professional actors for the patient and spouse. Pre- and post-video tests results were obtained with audience response technology (ART) assessed learning using a 4 point Likert scale. Valid data from 142 participants were analyzed pre to post rankings (Wilcoxon signed-rank tests). The following four learning objectives showed significant improvements: number of tests expected [median differences on a 4-point Likert scale with 95% confidence intervals: 0.50 (0.00, 1.00)]; number of providers expected 1.0 (1.00, 1.50); communications 1.0 (1.00, 1.50); and pre-hospital medical treatment 0.50 (0.00, 1.00). Elders (96%) judged the intervention as improving their ability to cope with an ED encounter. A short video with graphic side-bar information is an effective educational strategy to improve elder understanding of expectations during a hypothetical ED encounter following calling 911.

Gender roles and relationships: Implications for water management

NASA Astrophysics Data System (ADS)

Peter, G.

This study mainstreams gender at household level by showing how the gendered roles and relations between women and men influence access, allocation and use of resources in a rural community, Makhosini, in Swaziland. Implications of the identified gender roles and relationships for water management in Swaziland are highlighted. The working hypotheses of this study are (i) that gender-neutral development initiatives will benefit equally women and men at household level; and (ii) in Swaziland the trend toward irrigated agriculture for food security will have unequal impacts on men and women as access, allocation and use of key resources is highly gendered, privileging men as the value of the resource increases. In this study, a questionnaire was administered to sampled male and female heads of household as well as women under male heads. The heads were asked to indicate the roles they play and key decisions they make in resource use as heads of households. The women under male heads were also asked to indicate their roles and key decision responsibilities. The key resources considered were land and crops produced. Comparative analysis on roles and decisions made as well as access and use of resources and production was done by gender and between the women groups. The results show marked gender differences within households and across resources. Men were overwhelmingly involved in productive roles, giving low priority to reproductive roles. In contrast, priority of women’s roles were reproductive in nature. The key findings are that there were no significant differences in the roles of men and women as heads of households. Women as heads of households assume the same roles as those of men heads suggesting relative gender-neutrality. Also all women played “double-day” roles. However, the data reveals that men dominate decisions on crops to be grown, inputs to be used, disposal of the products and use of income obtained. Only a small percentage of women claimed influence over decisions on high-income generating crops such as sugarcane. A majority of women did demonstrate influence in the areas of key rainfed crops such as sweet potatoes and maize. The only area where women had full control was on grass used for making handicrafts. The implications for water resources management are that gender-blind decisions regarding the importance of irrigated crop production for household security may in fact remove decision-making capacity out of the hands of women so increasing the gendered-nature of food insecurity. At the same time, however, women household heads do show some influence in irrigated crop production and in high-value rainfed crop production. This suggests possibilities for in-building gender-neutral practices where high value crops are concerned.

Achieving a Risk-Informed Decision-Making Environment at NASA: The Emphasis of NASA's Risk Management Policy

NASA Technical Reports Server (NTRS)

Dezfuli, Homayoon

2010-01-01

This slide presentation reviews the evolution of risk management (RM) at NASA. The aim of the RM approach at NASA is to promote an approach that is heuristic, proactive, and coherent across all of NASA. Risk Informed Decision Making (RIDM) is a decision making process that uses a diverse set of performance measures along with other considerations within a deliberative process to inform decision making. RIDM is invoked for key decisions such as architecture and design decisions, make-buy decisions, and budget reallocation. The RIDM process and how it relates to the continuous Risk Management (CRM) process is reviewed.

The Worst Disaster: The Decisive Point and the Fall of Singapore

DTIC Science & Technology

2007-11-06

British territory of Malaya includes Singapore. In 1957, Malaysia became an independent state. In 1965, ore seceded from Malaysia . A.J Kennedy, A...repulsed? Per the leisurely pace of Singapore’s defense planning to date, it would certainly have been uncharacteristic of the entire Singapore... leisurely pace, Britain’s pre-WWII operational commanders were unable to compensate for a newly identified decisive point. Conversely, today’s

Formal Process Modeling to Improve Human Decision-Making in Test and Evaluation Acoustic Range Control

DTIC Science & Technology

2017-09-01

AVAILABILITY STATEMENT Approved for public release. Distribution is unlimited. 12b. DISTRIBUTION CODE 13. ABSTRACT (maximum 200 words) Test and...ambiguities and identify high -value decision points? This thesis explores how formalization of these experience-based decisions as a process model...representing a T&E event may reveal high -value decision nodes where certain decisions carry more weight or potential for impacts to a successful test. The

Passive and active adaptive management: Approaches and an example

USGS Publications Warehouse

Williams, B.K.

2011-01-01

Adaptive management is a framework for resource conservation that promotes iterative learning-based decision making. Yet there remains considerable confusion about what adaptive management entails, and how to actually make resource decisions adaptively. A key but somewhat ambiguous distinction in adaptive management is between active and passive forms of adaptive decision making. The objective of this paper is to illustrate some approaches to active and passive adaptive management with a simple example involving the drawdown of water impoundments on a wildlife refuge. The approaches are illustrated for the drawdown example, and contrasted in terms of objectives, costs, and potential learning rates. Some key challenges to the actual practice of AM are discussed, and tradeoffs between implementation costs and long-term benefits are highlighted. ?? 2010 Elsevier Ltd.

Understanding Meta-Decisions: The Key To Effecting Organizational Change. A Model for Analyzing Decision Making Within Organizations

ERIC Educational Resources Information Center

Billings, Charles R.

1974-01-01

Proposes a behavioral model for analyzing the decisionmaking process within organizations. The model is designed to facilitate the impact of members on those organizations. Examples and illustrations are cited. (WM)

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

PubMed Central

Menychtas, Andreas; Tsanakas, Panayiotis

2016-01-01

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

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

PubMed

Menychtas, Andreas; Tsanakas, Panayiotis; Maglogiannis, Ilias

2016-03-01

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

Role-players in abortion decision-making in the Accra Metropolis, Ghana.

PubMed

Kumi-Kyereme, Akwasi; Gbagbo, Fred Yao; Amo-Adjei, Joshua

2014-09-16

Making the final decision to terminate a pregnancy can be influenced by different circumstances involving various individuals. This paper describes the key players involved in the decision-making process regarding abortions among women who elected to undergo an induced abortion in a cosmopolitan urban setting in Ghana. A retrospective cross-sectional mixed method study was conducted between January and December 2011. A total of 401 women with records in abortion logbooks were selected for an interviewer-administered questionnaire and an in-depth interview. Descriptive and multinomial logistic regression analyses were used to assess the quantitative data, and a thematic analysis was applied to the qualitative data. The findings of the study reveal that pregnant individuals, mothers of abortion-seekers, male partners, and "Others" (for example, friends, employers) were instrumental in making a decision to terminate unplanned/unwanted pregnancies. Several key factors influenced the decision-making processes, including aversion from the men responsible for the pregnancy, concerns about abnormalities/deformities in future births due to unprofessionally conducted abortions, and economic considerations. A number of individuals, such as friends, mothers, and male partners, influence the decision-making process regarding abortion among the participants of the study. Various targeted messages are needed for the various participants in the decision.

Styles of Career Decision-Making

ERIC Educational Resources Information Center

Bimrose, Jenny; Barnes, Sally-Anne

2007-01-01

Distinctive styles of client decision-making have emerged from case study research into the effectiveness of career guidance. This paper explores some findings from the third year of a longitudinal study currently underway in England, which relate to the ways clients approach transition points in their careers and make the decisions that move them…

A Method to Assess Climate-Relevant Decisions: Application in the Chesapeake Bay (2010 External Review Draft)

EPA Science Inventory

The goal of this study is to formalize an approach to inventory and analyze management decisions in order to produce useful information targeted toward effective adaptation to climate change. The approach uses as its starting point ongoing planning processes and decisions geared ...

Social work and end-of-life decisions: self-determination and the common good.

PubMed

Wesley, C A

1996-05-01

Client self-determination is the key element of NASW's policy statement about social work intervention in end-of-life decisions. However, both self-determination and the common good must be respected in social work practice and policy regarding end-of-life decisions. This article discusses self-determination in end-of-life decision making, ethical decision making and the NASW Code of Ethics, and professional ethics based on a balanced view of both self-determination and the common good. Recommendations for professional practice and social policy are offered.

78 FR 101 - Guidance for Industry and Food and Drug Administration Staff; Acceptance and Filing Reviews for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-02

... element(s). In order to enhance the consistency of our acceptance and filing decisions and to help..., thereby assuring the consistency of our acceptance and filing decisions. This guidance is applicable to... issues that need to be addressed in a PMA and the key decisions to be made during the filing process. The...

An Effective and Novel Neural Network Ensemble for Shift Pattern Detection in Control Charts.

PubMed

Barghash, Mahmoud

2015-01-01

Pattern recognition in control charts is critical to make a balance between discovering faults as early as possible and reducing the number of false alarms. This work is devoted to designing a multistage neural network ensemble that achieves this balance which reduces rework and scrape without reducing productivity. The ensemble under focus is composed of a series of neural network stages and a series of decision points. Initially, this work compared using multidecision points and single-decision point on the performance of the ANN which showed that multidecision points are highly preferable to single-decision points. This work also tested the effect of population percentages on the ANN and used this to optimize the ANN's performance. Also this work used optimized and nonoptimized ANNs in an ensemble and proved that using nonoptimized ANN may reduce the performance of the ensemble. The ensemble that used only optimized ANNs has improved performance over individual ANNs and three-sigma level rule. In that respect using the designed ensemble can help in reducing the number of false stops and increasing productivity. It also can be used to discover even small shifts in the mean as early as possible.

Introducing high-cost health care to patients: dentists' accounts of offering dental implant treatment.

PubMed

Vernazza, Christopher R; Rousseau, Nikki; Steele, Jimmy G; Ellis, Janice S; Thomason, John Mark; Eastham, Jane; Exley, Catherine

2015-02-01

The decision-making process within health care has been widely researched, with shared decision-making, where both patients and clinicians share technical and personal information, often being cited as the ideal model. To date, much of this research has focused on systems where patients receive their care and treatment free at the point of contact (either in government-funded schemes or in insurance-based schemes). Oral health care often involves patients making direct payments for their care and treatment, and less is known about how this payment affects the decision-making process. It is clear that patient characteristics influence decision-making, but previous evidence suggests that clinicians may assume characteristics rather than eliciting them directly. The aim was to explore the influences on how dentists' engaged in the decision-making process surrounding a high-cost item of health care, dental implant treatments (DITs). A qualitative study using semi-structured interviews was undertaken using a purposive sample of primary care dentists (n = 25). Thematic analysis was undertaken to reveal emerging key themes. There were differences in how dentists discussed and offered implants. Dentists made decisions about whether to offer implants based on business factors, professional and legal obligations and whether they perceived the patient to be motivated to have treatment and their ability to pay. There was evidence that assessment of these characteristics was often based on assumptions derived from elements such as the appearance of the patient, the state of the patient's mouth and demographic details. The data suggest that there is a conflict between three elements of acting as a healthcare professional: minimizing provision of unneeded treatment, trying to fully involve patients in shared decisions and acting as a business person with the potential for financial gain. It might be expected that in the context of a high-cost healthcare intervention for which patients pay the bill themselves, that decision-making would be closer to an informed than a paternalistic model. Our research suggests that paternalistic decision-making is still practised and is influenced by assumptions about patient characteristics. Better tools and training may be required to support clinicians in this area of practice. © 2014 The Authors. Community Dentistry and Oral Epidemiology Published by John Wiley & Sons Ltd.

Points of attention in designing tools for regional brownfield prioritization.

PubMed

Limasset, Elsa; Pizzol, Lisa; Merly, Corinne; Gatchett, Annette M; Le Guern, Cécile; Martinát, Stanislav; Klusáček, Petr; Bartke, Stephan

2018-05-01

The regeneration of brownfields has been increasingly recognized as a key instrument in sustainable land management, since free developable land (or so called "greenfields") has become a scare and more expensive resource, especially in densely populated areas. However, the complexity of these sites requires considerable efforts to successfully complete their revitalization projects, thus requiring the development and application of appropriate tools to support decision makers in the selection of promising sites where efficiently allocate the limited financial resources. The design of effective prioritization tools is a complex process, which requires the analysis and consideration of critical points of attention (PoAs) which has been identified considering the state of the art in literature, and lessons learned from previous developments of regional brownfield (BF) prioritization processes, frameworks and tools. Accordingly, we identified 5 PoAs, namely 1) Assessing end user needs and orientation discussions, 2) Availability and quality of the data needed for the BF prioritization tool, 3) Communication and stakeholder engagement 4) Drivers of regeneration success, and 5) Financing and application costs. To deepen and collate the most recent knowledge on the topics from scientists and practitioners, we organized a focus group discussion within a special session at the AquaConSoil (ACS) conference 2017, where participants were asked to add their experience and thoughts to the discussion in order to identify the most significant and urgent points of attention in BF prioritization tool design. The result of this assessment is a comprehensive table (Table 2), which can support problem owners, investors, service providers, regulators, public and private land managers, decision makers etc. in the identification of the main aspects (sub-topics) to be considered and their relative influences and in the comprehension of the general patterns and challenges to be faced when dealing with the development of BF prioritization tools. Copyright © 2017 Elsevier B.V. All rights reserved.

Facilitating surgeon understanding of complex anatomy using a three-dimensional printed model.

PubMed

Cromeens, Barrett P; Ray, William C; Hoehne, Brad; Abayneh, Fikir; Adler, Brent; Besner, Gail E

2017-08-01

3-dimensional prints (3DP) anecdotally facilitate surgeon understanding of anatomy and decision-making. However, the actual benefit to surgeons or patients has not been quantified. This study investigates how surgeon understanding of complex anatomy is altered by a 3DP compared to computed tomography (CT) scan or CT + digital reconstruction (CT + DR). Key anatomic features were segmented from a CT-abdomen/pelvis of pygopagus twins to build a DR and printed in color on a 3D printer. Pediatric surgery trainees and attendings (n = 21) were tested regarding anatomy identification and their understanding of point-to-point distances, scale, and shape. There was no difference between media regarding point-to-point distances. The 3DP led to an increased number of correct answers for questions of scale and shape compared to CT (P < 0.05). CT + DR performance was intermediate but not statistically different from 3DP or CT. Identification of anatomy was inconsistent between media; however, answers were significantly closer to correct when using the 3DP. Participants completed the test faster with the 3DP (6.6 ± 0.5 min) (P < 0.05) than with CT (18.9 ± 2.5 min) or CT + 3DR (14.9 ± 1.5 min). Although point-to-point measurements were not different, 3DP increased the understanding of shape, scale, and anatomy. It enabled understanding significantly faster than other media. In difficult surgical cases with complex anatomy and a need for efficient multidisciplinary coordination, 3D printed models should be considered for surgical planning. Copyright © 2017 Elsevier Inc. All rights reserved.

Modeling hard clinical end-point data in economic analyses.

PubMed

Kansal, Anuraag R; Zheng, Ying; Palencia, Roberto; Ruffolo, Antonio; Hass, Bastian; Sorensen, Sonja V

2013-11-01

The availability of hard clinical end-point data, such as that on cardiovascular (CV) events among patients with type 2 diabetes mellitus, is increasing, and as a result there is growing interest in using hard end-point data of this type in economic analyses. This study investigated published approaches for modeling hard end-points from clinical trials and evaluated their applicability in health economic models with different disease features. A review of cost-effectiveness models of interventions in clinically significant therapeutic areas (CV diseases, cancer, and chronic lower respiratory diseases) was conducted in PubMed and Embase using a defined search strategy. Only studies integrating hard end-point data from randomized clinical trials were considered. For each study included, clinical input characteristics and modeling approach were summarized and evaluated. A total of 33 articles (23 CV, eight cancer, two respiratory) were accepted for detailed analysis. Decision trees, Markov models, discrete event simulations, and hybrids were used. Event rates were incorporated either as constant rates, time-dependent risks, or risk equations based on patient characteristics. Risks dependent on time and/or patient characteristics were used where major event rates were >1%/year in models with fewer health states (<7). Models of infrequent events or with numerous health states generally preferred constant event rates. The detailed modeling information and terminology varied, sometimes requiring interpretation. Key considerations for cost-effectiveness models incorporating hard end-point data include the frequency and characteristics of the relevant clinical events and how the trial data is reported. When event risk is low, simplification of both the model structure and event rate modeling is recommended. When event risk is common, such as in high risk populations, more detailed modeling approaches, including individual simulations or explicitly time-dependent event rates, are more appropriate to accurately reflect the trial data.

Issues in Distance Education: A Primer for Higher Education Decision Makers

ERIC Educational Resources Information Center

Beaudoin, Michael

2016-01-01

This chapter presents an overview of current issues related to distance learning in higher education. It identifies central questions, issues, challenges, and opportunities that must be addressed by decision makers, as well as key attributes of effective leaders.

Managing the Risks of Climate Change and Terrorism

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

Rosa, Eugene; Dietz, Tom; Moss, Richard H.

2012-04-07

The article describes challenges to comparative risk assessment, a key approach for managing uncertainty in decision making, across diverse threats such as terrorism and climate change and argues new approaches will be particularly important in addressing decisions related to sustainability.

Understanding the Science behind EPA’s Pesticide Decisions

EPA Pesticide Factsheets

Science is key to EPA’s decision-making. EPA scientists review these data to determine whether to register a pesticide product or use and any need for specific restrictions. EPA maintains a transparent, public process in assessing potential human health ri

Decision-Making Alignment: Respecting Natural Consequences

ERIC Educational Resources Information Center

Quinby, Lee

2016-01-01

Many organizations have a tendency toward misalignment of "authority," "responsibility," and "accountability" that causes poor decision-making. There are natural consequences that result, similar to touching fire and getting burned. When those key elements are not properly aligned, the organization can experience…

Fail-safe transcription termination: Because one is never enough.

PubMed

Lemay, Jean-François; Bachand, François

2015-01-01

Termination of RNA polymerase II (RNAPII) transcription is a fundamental step of gene expression that involves the release of the nascent transcript and dissociation of RNAPII from the DNA template. As transcription termination is intimately linked to RNA 3' end processing, termination pathways have a key decisive influence on the fate of the transcribed RNA. Quite remarkably, when reaching the 3' end of genes, a substantial fraction of RNAPII fail to terminate transcription, requiring the contribution of alternative or "fail-safe" mechanisms of termination to release the polymerase. This point of view covers redundant mechanisms of transcription termination and how they relate to conventional termination models. In particular, we expand on recent findings that propose a reverse torpedo model of termination, in which the 3'5' exonucleolytic activity of the RNA exosome targets transcription events associated with paused and backtracked RNAPII.

HESS Opinions "On forecast (in)consistency in a hydro-meteorological chain: curse or blessing?"

NASA Astrophysics Data System (ADS)

Pappenberger, F.; Cloke, H. L.; Persson, A.; Demeritt, D.

2011-07-01

Flood forecasting increasingly relies on numerical weather prediction forecasts to achieve longer lead times. One of the key difficulties that is emerging in constructing a decision framework for these flood forecasts is what to dowhen consecutive forecasts are so different that they lead to different conclusions regarding the issuing of warnings or triggering other action. In this opinion paper we explore some of the issues surrounding such forecast inconsistency (also known as "Jumpiness", "Turning points", "Continuity" or number of "Swings"). In thsi opinion paper we define forecast inconsistency; discuss the reasons why forecasts might be inconsistent; how we should analyse inconsistency; and what we should do about it; how we should communicate it and whether it is a totally undesirable property. The property of consistency is increasingly emerging as a hot topic in many forecasting environments.

Capturing structured, pulmonary disease-specific data elements in electronic health records.

PubMed

Gronkiewicz, Cynthia; Diamond, Edward J; French, Kim D; Christodouleas, John; Gabriel, Peter E

2015-04-01

Electronic health records (EHRs) have the potential to improve health-care quality by allowing providers to make better decisions at the point of care based on electronically aggregated data and by facilitating clinical research. These goals are easier to achieve when key, disease-specific clinical information is documented as structured data elements (SDEs) that computers can understand and process, rather than as free-text/natural-language narrative. This article reviews the benefits of capturing disease-specific SDEs. It highlights several design and implementation considerations, including the impact on efficiency and expressivity of clinical documentation and the importance of adhering to data standards when available. Pulmonary disease-specific examples of collection instruments are provided from two commonly used commercial EHRs. Future developments that can leverage SDEs to improve clinical quality and research are discussed.

Analysis of sheltering and evacuation strategies for a Chicago nuclear detonation scenario.

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

Yoshimura, Ann S.; Brandt, Larry D.

2011-09-01

Development of an effective strategy for shelter and evacuation is among the most important planning tasks in preparation for response to a low yield, nuclear detonation in an urban area. Extensive studies have been performed and guidance published that highlight the key principles for saving lives following such an event. However, region-specific data are important in the planning process as well. This study examines some of the unique regional factors that impact planning for a 10 kt detonation in Chicago. The work utilizes a single scenario to examine regional impacts as well as the shelter-evacuate decision alternatives at selected exemplarymore » points. For many Chicago neighborhoods, the excellent assessed shelter quality available make shelter-in-place or selective transit to a nearby shelter a compelling post-detonation strategy.« less

Dissociable Neural Processes Underlying Risky Decisions for Self Versus Other

PubMed Central

Jung, Daehyun; Sul, Sunhae; Kim, Hackjin

2013-01-01

Previous neuroimaging studies on decision making have mainly focused on decisions on behalf of oneself. Considering that people often make decisions on behalf of others, it is intriguing that there is little neurobiological evidence on how decisions for others differ from those for oneself. The present study directly compared risky decisions for self with those for another person using functional magnetic resonance imaging (fMRI). Participants were asked to perform a gambling task on behalf of themselves (decision-for-self condition) or another person (decision-for-other condition) while in the scanner. Their task was to choose between a low-risk option (i.e., win or lose 10 points) and a high-risk option (i.e., win or lose 90 points) with variable levels of winning probability. Compared with choices regarding others, those regarding oneself were more risk-averse at lower winning probabilities and more risk-seeking at higher winning probabilities, perhaps due to stronger affective process during risky decisions for oneself compared with those for other. The brain-activation pattern changed according to the target, such that reward-related regions were more active in the decision-for-self condition than in the decision-for-other condition, whereas brain regions related to the theory of mind (ToM) showed greater activation in the decision-for-other condition than in the decision-for-self condition. Parametric modulation analysis using individual decision models revealed that activation of the amygdala and the dorsomedial prefrontal cortex (DMPFC) were associated with value computations for oneself and for another, respectively, during risky financial decisions. The results of the present study suggest that decisions for oneself and for other may recruit fundamentally distinct neural processes, which can be mainly characterized as dominant affective/impulsive and cognitive/regulatory processes, respectively. PMID:23519016

Combining statistical inference and decisions in ecology.

PubMed

Williams, Perry J; Hooten, Mevin B

2016-09-01

Statistical decision theory (SDT) is a sub-field of decision theory that formally incorporates statistical investigation into a decision-theoretic framework to account for uncertainties in a decision problem. SDT provides a unifying analysis of three types of information: statistical results from a data set, knowledge of the consequences of potential choices (i.e., loss), and prior beliefs about a system. SDT links the theoretical development of a large body of statistical methods, including point estimation, hypothesis testing, and confidence interval estimation. The theory and application of SDT have mainly been developed and published in the fields of mathematics, statistics, operations research, and other decision sciences, but have had limited exposure in ecology. Thus, we provide an introduction to SDT for ecologists and describe its utility for linking the conventionally separate tasks of statistical investigation and decision making in a single framework. We describe the basic framework of both Bayesian and frequentist SDT, its traditional use in statistics, and discuss its application to decision problems that occur in ecology. We demonstrate SDT with two types of decisions: Bayesian point estimation and an applied management problem of selecting a prescribed fire rotation for managing a grassland bird species. Central to SDT, and decision theory in general, are loss functions. Thus, we also provide basic guidance and references for constructing loss functions for an SDT problem. © 2016 by the Ecological Society of America.

A key for the Forest Service hardwood tree grades

Treesearch

Gary W. Miller; Leland F. Hanks; Harry V., Jr. Wiant

1986-01-01

A dichotomous key organizes the USDA Forest Service hardwood tree grade specifications into a stepwise procedure for those learning to grade hardwood sawtimber. The key addresses the major grade factors, tree size, surface characteristics, and allowable cull deductions in a series of paried choices that lead the user to a decision regarding tree grade.

Leveraging human decision making through the optimal management of centralized resources

NASA Astrophysics Data System (ADS)

Hyden, Paul; McGrath, Richard G.

2016-05-01

Combining results from mixed integer optimization, stochastic modeling and queuing theory, we will advance the interdisciplinary problem of efficiently and effectively allocating centrally managed resources. Academia currently fails to address this, as the esoteric demands of each of these large research areas limits work across traditional boundaries. The commercial space does not currently address these challenges due to the absence of a profit metric. By constructing algorithms that explicitly use inputs across boundaries, we are able to incorporate the advantages of using human decision makers. Key improvements in the underlying algorithms are made possible by aligning decision maker goals with the feedback loops introduced between the core optimization step and the modeling of the overall stochastic process of supply and demand. A key observation is that human decision-makers must be explicitly included in the analysis for these approaches to be ultimately successful. Transformative access gives warfighters and mission owners greater understanding of global needs and allows for relationships to guide optimal resource allocation decisions. Mastery of demand processes and optimization bottlenecks reveals long term maximum marginal utility gaps in capabilities.

Interdisciplinary cognitive task analysis: a strategy to develop a comprehensive endoscopic retrograde cholangiopancreatography protocol for use in fellowship training.

PubMed

Canopy, Erin; Evans, Matt; Boehler, Margaret; Roberts, Nicole; Sanfey, Hilary; Mellinger, John

2015-10-01

Endoscopic retrograde cholangiopancreatography is a challenging procedure performed by surgeons and gastroenterologists. We employed cognitive task analysis to identify steps and decision points for this procedure. Standardized interviews were conducted with expert gastroenterologists (7) and surgeons (4) from 4 institutions. A procedural step and cognitive decision point protocol was created from audio-taped transcriptions and was refined by 5 additional surgeons. Conceptual elements, sequential actions, and decision points were iterated for 5 tasks: patient preparation, duodenal intubation, selective cannulation, imaging interpretation with related therapeutic intervention, and complication management. A total of 180 steps were identified. Gastroenterologists identified 34 steps not identified by surgeons, and surgeons identified 20 steps not identified by gastroenterologists. The findings suggest that for complex procedures performed by diverse practitioners, more experts may help delineate distinctive emphases differentiated by training background and type of practice. Copyright © 2015 Elsevier Inc. All rights reserved.

Identifying management and disease priorities of Canadian dairy industry stakeholders.

PubMed

Bauman, C A; Barkema, H W; Dubuc, J; Keefe, G P; Kelton, D F

2016-12-01

The objective of this study was to identify the key management and disease issues affecting the Canadian dairy industry. An online questionnaire (FluidSurveys, http://fluidsurveys.com/) was conducted between March 1 and May 31, 2014. A total of 1,025 responses were received from across Canada of which 68% (n=698) of respondents were dairy producers, and the remaining respondents represented veterinarians, university researchers, government personnel, and other allied industries. Participants were asked to identify their top 3 management and disease priorities from 2 lists offered. Topics were subsequently ranked from highest to lowest using 3 different ranking methods based on points: 5-3-1 (5 points for first priority, 3 for second, and 1 for first), 3-2-1, and 1-1-1 (equal ranking). The 5-3-1 point system was selected because it minimized the number of duplicate point scores. Stakeholder groups showed general agreement with the top management issue identified as animal welfare and the number one health concern as lameness. Other areas identified as priorities were reproductive health, antibiotic use, bovine viral diarrhea, and Staphylococcus aureus mastitis with these rankings influenced by region, herd size, and stakeholder group. This is the first national comprehensive assessment of priorities undertaken in the Canadian dairy industry and will assist researchers, policymakers, program developers, and funding agencies make future decisions based on direct industry feedback. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Human body motion tracking based on quantum-inspired immune cloning algorithm

NASA Astrophysics Data System (ADS)

Han, Hong; Yue, Lichuan; Jiao, Licheng; Wu, Xing

2009-10-01

In a static monocular camera system, to gain a perfect 3D human body posture is a great challenge for Computer Vision technology now. This paper presented human postures recognition from video sequences using the Quantum-Inspired Immune Cloning Algorithm (QICA). The algorithm included three parts. Firstly, prior knowledge of human beings was used, the key joint points of human could be detected automatically from the human contours and skeletons which could be thinning from the contours; And due to the complexity of human movement, a forecasting mechanism of occlusion joint points was addressed to get optimum 2D key joint points of human body; And then pose estimation recovered by optimizing between the 2D projection of 3D human key joint points and 2D detection key joint points using QICA, which recovered the movement of human body perfectly, because this algorithm could acquire not only the global optimal solution, but the local optimal solution.

An evaluation of several different classification schemes - Their parameters and performance. [maximum likelihood decision for crop identification

NASA Technical Reports Server (NTRS)

Scholz, D.; Fuhs, N.; Hixson, M.

1979-01-01

The overall objective of this study was to apply and evaluate several of the currently available classification schemes for crop identification. The approaches examined were: (1) a per point Gaussian maximum likelihood classifier, (2) a per point sum of normal densities classifier, (3) a per point linear classifier, (4) a per point Gaussian maximum likelihood decision tree classifier, and (5) a texture sensitive per field Gaussian maximum likelihood classifier. Three agricultural data sets were used in the study: areas from Fayette County, Illinois, and Pottawattamie and Shelby Counties in Iowa. The segments were located in two distinct regions of the Corn Belt to sample variability in soils, climate, and agricultural practices.

United States Air Force 611th Air Support Group/Civil Engineering Squadron Elmendorf AFB, Alaska. Decision document for no further response action planned: Bullen Point Radar Installation, Alaska. Final report

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

Karmi, S.

1996-05-24

This Decision Document discusses the selection of no further action as the recommended action for two sites located at the Bullen Point radar installation. The United States Air Force (Air Force) completed a Remedial Investigation/Feasibility Study and a Risk Assessment for the five sites located at the Bullen Point installation (U.S. Air Force 1996a,b). Based on the findings of these activities, two sites are recommended for no further action. Sites at the Bullen Point radar installation recommended for no further action are: Old Landfill/Dump Site East (LF06) and Drum Storage Area (SS10).

Balancing ecosystem services with energy and food security - assessing trade-offs for reservoir operation and irrigation investment in Kenya's Tana basin

NASA Astrophysics Data System (ADS)

Hurford, A. P.; Harou, J. J.

2014-01-01

Competition for water between key economic sectors and the environment means agreeing on allocation is challenging. Managing releases from the three major dams in Kenya's Tana River basin with its 4.4 million inhabitants, 567 MW of installed hydropower capacity, 33 000 ha of irrigation and ecologically important wetlands and forests is a pertinent example. This research seeks to identify and help decision-makers visualise reservoir management strategies which result in the best possible (Pareto-optimal) allocation of benefits between sectors. Secondly we seek to show how trade-offs between achievable benefits shift with the implementation of new proposed rice, cotton and biofuel irrigation projects. To identify the Pareto-optimal trade-offs we link a water resources management model to a multi-criteria search algorithm. The decisions or "levers" of the management problem are volume dependent release rules for the three major dams and extent of investment in new irrigation schemes. These decisions are optimised for objectives covering provision of water supply and irrigation, energy generation and maintenance of ecosystem services which underpin tourism and local livelihoods. Visual analytic plots allow decision makers to assess multi-reservoir rule-sets by understanding their impacts on different beneficiaries. Results quantify how economic gains from proposed irrigation schemes trade-off against disturbance of the flow regime which supports ecosystem services. Full implementation of the proposed schemes is shown to be Pareto-optimal, but at high environmental and social cost. The clarity and comprehensiveness of "best-case" trade-off analysis is a useful vantage point from which to tackle the interdependence and complexity of water-energy-food "nexus" challenges.

Balancing ecosystem services with energy and food security - Assessing trade-offs from reservoir operation and irrigation investments in Kenya's Tana Basin

NASA Astrophysics Data System (ADS)

Hurford, A. P.; Harou, J. J.

2014-08-01

Competition for water between key economic sectors and the environment means agreeing allocations is challenging. Managing releases from the three major dams in Kenya's Tana River basin with its 4.4 million inhabitants, 567 MW of installed hydropower capacity, 33 000 ha of irrigation and ecologically important wetlands and forests is a pertinent example. This research seeks firstly to identify and help decision-makers visualise reservoir management strategies which result in the best possible (Pareto-optimal) allocation of benefits between sectors. Secondly, it seeks to show how trade-offs between achievable benefits shift with the implementation of proposed new rice, cotton and biofuel irrigation projects. To approximate the Pareto-optimal trade-offs we link a water resources management simulation model to a multi-criteria search algorithm. The decisions or "levers" of the management problem are volume-dependent release rules for the three major dams and extent of investment in new irrigation schemes. These decisions are optimised for eight objectives covering the provision of water supply and irrigation, energy generation and maintenance of ecosystem services. Trade-off plots allow decision-makers to assess multi-reservoir rule-sets and irrigation investment options by visualising their impacts on different beneficiaries. Results quantify how economic gains from proposed irrigation schemes trade-off against the disturbance of ecosystems and local livelihoods that depend on them. Full implementation of the proposed schemes is shown to come at a high environmental and social cost. The clarity and comprehensiveness of "best-case" trade-off analysis is a useful vantage point from which to tackle the interdependence and complexity of "water-energy-food nexus" resource security issues.

Affective decision-making deficits, linked to a dysfunctional ventromedial prefrontal cortex, revealed in 10th grade Chinese adolescent binge drinkers

PubMed Central

Johnson, C. Anderson; Xiao, Lin; Palmer, Paula; Sun, Ping; Wang, Qiong; Wei, Yonglan; Jia, Yong; Grenard, Jerry L.; Stacy, Alan W.; Bechara, Antoine

2011-01-01

The primary aim of this study was to test the hypothesis that adolescent binge drinkers, but not lighter drinkers, would show signs of impairment on tasks of affective decision-making as measured by the Iowa Gambling Test (IGT), when compared to adolescents who never drank. We tested 207 10th grade adolescents in Chengdu City, China, using two versions of the IGT, the original and a variant, in which the reward/punishment contingencies were reversed. This enables one to distinguish among different possibilities of impaired decision-making, such as insensitivity to long-term consequences, or hypersensitivity to reward. Furthermore, we tested working memory capacity using the Self-ordered Pointing Test (SOPT). Paper and pencil questionnaires were used to assess drinking behaviors and school academic performance. Results indicated that relative to never-drinkers, adolescent binge drinkers, but not other (ever, past 30-day) drinkers, showed significantly lower net scores on the original version of the IGT especially in the latter trials. Furthermore, the profiles of behavioral performance from the original and variant versions of the IGT were consistent with a decision-making impairment attributed to hypersensitivity to reward. In addition, working memory and school academic performance revealed no differences between drinkers (at all levels) and never-drinkers. Logistic regression analysis showed that after controlling for demographic variables, working memory, and school academic performance, the IGT significantly predicted binge-drinking. These findings suggest that a “myopia” for future consequences linked to hypersensitivity to reward is a key characteristic of adolescents with binge-drinking behavior, and that underlying neural mechanisms for this “myopia” for future consequences may serve as a predisposing factor that renders some adolescents more susceptible to future addictive behaviors. PMID:17996909

A Diagnostics Tool to detect ensemble forecast system anomaly and guide operational decisions

NASA Astrophysics Data System (ADS)

Park, G. H.; Srivastava, A.; Shrestha, E.; Thiemann, M.; Day, G. N.; Draijer, S.

2017-12-01

The hydrologic community is moving toward using ensemble forecasts to take uncertainty into account during the decision-making process. The New York City Department of Environmental Protection (DEP) implements several types of ensemble forecasts in their decision-making process: ensemble products for a statistical model (Hirsch and enhanced Hirsch); the National Weather Service (NWS) Advanced Hydrologic Prediction Service (AHPS) forecasts based on the classical Ensemble Streamflow Prediction (ESP) technique; and the new NWS Hydrologic Ensemble Forecasting Service (HEFS) forecasts. To remove structural error and apply the forecasts to additional forecast points, the DEP post processes both the AHPS and the HEFS forecasts. These ensemble forecasts provide mass quantities of complex data, and drawing conclusions from these forecasts is time-consuming and difficult. The complexity of these forecasts also makes it difficult to identify system failures resulting from poor data, missing forecasts, and server breakdowns. To address these issues, we developed a diagnostic tool that summarizes ensemble forecasts and provides additional information such as historical forecast statistics, forecast skill, and model forcing statistics. This additional information highlights the key information that enables operators to evaluate the forecast in real-time, dynamically interact with the data, and review additional statistics, if needed, to make better decisions. We used Bokeh, a Python interactive visualization library, and a multi-database management system to create this interactive tool. This tool compiles and stores data into HTML pages that allows operators to readily analyze the data with built-in user interaction features. This paper will present a brief description of the ensemble forecasts, forecast verification results, and the intended applications for the diagnostic tool.

Evidence-Based Diabetes Prevention and Control Programs and Policies in Local Health Departments.

PubMed

Zwald, Marissa; Elliott, Lindsay; Brownson, Ross C; Skala, Mahree

2015-12-01

The purpose of this study is to: (1) assess implementation of evidence-based programs and policies (EBPPs) related to diabetes prevention and control in local health departments, (2) assess feasibility of non-implemented diabetes prevention and control EBPPs, and (3) examine individual- and organizational-level factors associated with implementation of diabetes prevention and control EBPPs. An online survey was administered in January 2015 to key representatives of all local health departments in Missouri. Descriptive statistics were used to describe implementation and perceived feasibility of 20 diabetes prevention and control EBPPs. Logistic regression was used to examine the association between individual and organizational factors and diabetes prevention and control EBPP implementation. One hundred local health departments participated (89% response rate) in the online survey. Most frequently implemented diabetes-related EBPPs in local health departments included: nutrition education for agency or community members, increased fruit and vegetable access in community settings, and community-wide campaigns to promote physical activity. Increased encouragement to others in the department to use evidence-based decision making and agency incentives to help employees use evidence-based decision making were positively associated with implementation of diabetes prevention and control EBPPs. Local health departments are on the "front line" of public health, and this study demonstrates the important role these organizations play in implementing diabetes prevention and control EBPPs. Potential leverage points for more widespread adoption of diabetes-related EBPPs in local health departments include education about and encouragement of evidence-based decision making and organizational incentives for employees to integrate evidence-based decision making into their diabetes prevention and control activities. © 2015 The Author(s).

Evidence-based diabetes prevention and control programs and policies in local health departments

PubMed Central

Zwald, Marissa; Elliott, Lindsay; Brownson, Ross C.; Skala, Mahree

2016-01-01

Purpose The purpose of this study is to: (1) assess implementation of evidence-based programs and policies (EBPPs) related to diabetes prevention and control in local health departments; (2) assess feasibility of non-implemented diabetes prevention and control EBPPs; and (3) examine individual- and organizational-level factors associated with implementation of diabetes prevention and control EBPPs. Methods An online survey was administered in January 2015 to key representatives of all local health departments in Missouri. Descriptive statistics were used to describe implementation and perceived feasibility of 20 diabetes prevention and control EBPPs. Logistic regression was used to examine the association between individual and organizational factors and diabetes prevention and control EBPP implementation. Results One hundred local health departments participated (89% response rate) in the online survey. Most frequently implemented diabetes-related EBPPs in local health departments included: nutrition education for agency or community members; increased fruit and vegetable access in community settings; and community-wide campaigns to promote physical activity. Increased encouragement to others in the department to use evidence-based decision making and agency incentives to help employees use evidence-based decision making were positively associated with implementation of diabetes prevention and control EBPPs. Conclusions Local health departments are the “front line” of public health and this study demonstrates the important role these organizations play in implementing diabetes prevention and control EBPPs. Potential leverage points for more widespread adoption of diabetes-related EBPPs in local health departments include education about and encouragement of evidence-based decision making and organizational incentives for employees to integrate evidence-based decision making into their diabetes prevention and control activities. PMID:26297714

Podium: Ranking Data Using Mixed-Initiative Visual Analytics.

PubMed

Wall, Emily; Das, Subhajit; Chawla, Ravish; Kalidindi, Bharath; Brown, Eli T; Endert, Alex

2018-01-01

People often rank and order data points as a vital part of making decisions. Multi-attribute ranking systems are a common tool used to make these data-driven decisions. Such systems often take the form of a table-based visualization in which users assign weights to the attributes representing the quantifiable importance of each attribute to a decision, which the system then uses to compute a ranking of the data. However, these systems assume that users are able to quantify their conceptual understanding of how important particular attributes are to a decision. This is not always easy or even possible for users to do. Rather, people often have a more holistic understanding of the data. They form opinions that data point A is better than data point B but do not necessarily know which attributes are important. To address these challenges, we present a visual analytic application to help people rank multi-variate data points. We developed a prototype system, Podium, that allows users to drag rows in the table to rank order data points based on their perception of the relative value of the data. Podium then infers a weighting model using Ranking SVM that satisfies the user's data preferences as closely as possible. Whereas past systems help users understand the relationships between data points based on changes to attribute weights, our approach helps users to understand the attributes that might inform their understanding of the data. We present two usage scenarios to describe some of the potential uses of our proposed technique: (1) understanding which attributes contribute to a user's subjective preferences for data, and (2) deconstructing attributes of importance for existing rankings. Our proposed approach makes powerful machine learning techniques more usable to those who may not have expertise in these areas.

Boosting medical diagnostics by pooling independent judgments

PubMed Central

Kurvers, Ralf H. J. M.; Herzog, Stefan M.; Hertwig, Ralph; Krause, Jens; Carney, Patricia A.; Bogart, Andy; Argenziano, Giuseppe; Zalaudek, Iris; Wolf, Max

2016-01-01

Collective intelligence refers to the ability of groups to outperform individual decision makers when solving complex cognitive problems. Despite its potential to revolutionize decision making in a wide range of domains, including medical, economic, and political decision making, at present, little is known about the conditions underlying collective intelligence in real-world contexts. We here focus on two key areas of medical diagnostics, breast and skin cancer detection. Using a simulation study that draws on large real-world datasets, involving more than 140 doctors making more than 20,000 diagnoses, we investigate when combining the independent judgments of multiple doctors outperforms the best doctor in a group. We find that similarity in diagnostic accuracy is a key condition for collective intelligence: Aggregating the independent judgments of doctors outperforms the best doctor in a group whenever the diagnostic accuracy of doctors is relatively similar, but not when doctors’ diagnostic accuracy differs too much. This intriguingly simple result is highly robust and holds across different group sizes, performance levels of the best doctor, and collective intelligence rules. The enabling role of similarity, in turn, is explained by its systematic effects on the number of correct and incorrect decisions of the best doctor that are overruled by the collective. By identifying a key factor underlying collective intelligence in two important real-world contexts, our findings pave the way for innovative and more effective approaches to complex real-world decision making, and to the scientific analyses of those approaches. PMID:27432950

Collective strategy for obstacle navigation during cooperative transport by ants.

PubMed

McCreery, Helen F; Dix, Zachary A; Breed, Michael D; Nagpal, Radhika

2016-11-01

Group cohesion and consensus have primarily been studied in the context of discrete decisions, but some group tasks require making serial decisions that build on one another. We examine such collective problem solving by studying obstacle navigation during cooperative transport in ants. In cooperative transport, ants work together to move a large object back to their nest. We blocked cooperative transport groups of Paratrechina longicornis with obstacles of varying complexity, analyzing groups' trajectories to infer what kind of strategy the ants employed. Simple strategies require little information, but more challenging, robust strategies succeed with a wider range of obstacles. We found that transport groups use a stochastic strategy that leads to efficient navigation around simple obstacles, and still succeeds at difficult obstacles. While groups navigating obstacles preferentially move directly toward the nest, they change their behavior over time; the longer the ants are obstructed, the more likely they are to move away from the nest. This increases the chance of finding a path around the obstacle. Groups rapidly changed directions and rarely stalled during navigation, indicating that these ants maintain consensus even when the nest direction is blocked. Although some decisions were aided by the arrival of new ants, at many key points, direction changes were initiated within the group, with no apparent external cause. This ant species is highly effective at navigating complex environments, and implements a flexible strategy that works for both simple and more complex obstacles. © 2016. Published by The Company of Biologists Ltd.

The utility of decision support, clinical guidelines, and financial incentives as tools to achieve improved clinical performance.

PubMed

Goldfarb, S

1999-03-01

Whether one seeks to reduce inappropriate utilization of resources, improve diagnostic accuracy, increase utilization of effective therapies, or reduce the incidence of complications, the key to change is physician involvement in change. Unfortunately, a simple approach to the problem of inducing change in physician behavior is not available. There is a generally accepted view that expert, best-practice guidelines will improve clinical performance. However, there may be a bias to report positive results and a lack of careful analysis of guideline usage in routine practice in a "postmarketing" study akin to that seen in the pharmaceutical industry. Systems that allow the reliable assessment of quality of outcomes, efficiency of resource utilization, and accurate assessment of the risks associated with the care of given patient populations must be widely available before deciding whether an incentive-based system for providing the full range of medical care is feasible. Decision support focuses on providing information, ideally at the "point of service" and in the context of a particular clinical situation. Rules are self-imposed by physicians and are therefore much more likely to be adopted. As health care becomes corporatized, with increasing numbers of physicians employed by large organizations with the capacity to provide detailed information on the nature and quality of clinical care, it is possible that properly constructed guidelines, appropriate financial incentives, and robust forms of decision support will lead to a physician-led, process improvement approach to more rational and affordable health care.

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.

41 CFR Appendix A to Subpart B of... - 3-Key Points and Principles

Code of Federal Regulations, 2010 CFR

2010-07-01

... Principles A Appendix A to Subpart B of Part 102 Public Contracts and Property Management Federal Property.... B, App. A Appendix A to Subpart B of Part 102-3—Key Points and Principles This appendix provides... principles that may be applied to situations not covered elsewhere in this subpart. The guidance follows: Key...

ClinicalKey: a point-of-care search engine.

PubMed

Vardell, Emily

2013-01-01

ClinicalKey is a new point-of-care resource for health care professionals. Through controlled vocabulary, ClinicalKey offers a cross section of resources on diseases and procedures, from journals to e-books and practice guidelines to patient education. A sample search was conducted to demonstrate the features of the database, and a comparison with similar tools is presented.

Conceptualising and managing trade-offs in sustainability assessment

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

Morrison-Saunders, Angus, E-mail: A.Morrison-Saunders@murdoch.edu.au; School of Environmental Science, Murdoch University; Pope, Jenny

One of the defining characteristics of sustainability assessment as a form of impact assessment is that it provides a forum for the explicit consideration of the trade-offs that are inherent in complex decision-making processes. Few sustainability assessments have achieved this goal though, and none has considered trade-offs in a holistic fashion throughout the process. Recent contributions such as the Gibson trade-off rules have significantly progressed thinking in this area by suggesting appropriate acceptability criteria for evaluating substantive trade-offs arising from proposed development, as well as process rules for how evaluations of acceptability should occur. However, there has been negligible uptakemore » of these rules in practice. Overall, we argue that there is inadequate consideration of trade-offs, both process and substantive, throughout the sustainability assessment process, and insufficient considerations of how process decisions and compromises influence substantive outcomes. This paper presents a framework for understanding and managing both process and substantive trade-offs within each step of a typical sustainability assessment process. The framework draws together previously published literature and offers case studies that illustrate aspects of the practical application of the framework. The framing and design of sustainability assessment are vitally important, as process compromises or trade-offs can have substantive consequences in terms of sustainability outcomes delivered, with the choice of alternatives considered being a particularly significant determinant of substantive outcomes. The demarcation of acceptable from unacceptable impacts is a key aspect of managing trade-offs. Offsets can be considered as a form of trade-off within a category of sustainability that are utilised to enhance preferred alternatives once conditions of impact acceptability have been met. In this way they may enable net gains to be delivered; another imperative for progress to sustainability. Understanding the nature and implications of trade-offs within sustainability assessment is essential to improving practice. - Highlights: Black-Right-Pointing-Pointer A framework for understanding trade-offs in sustainability assessment is presented. Black-Right-Pointing-Pointer Trade-offs should be considered as early as possible in any sustainability assessment process. Black-Right-Pointing-Pointer Demarcation of acceptable from unacceptable impacts is needed for effective trade-off management. Black-Right-Pointing-Pointer Offsets in place, time or kind can ensure and attain a net benefit outcome overall. Black-Right-Pointing-Pointer Gibson's trade-off rules provide useful acceptability criteria and process guidance.« less

16 CFR Appendix to Part 1213 - Findings Under the Consumer Product Safety Act

Code of Federal Regulations, 2010 CFR

2010-01-01

... at the point of purchase and make their purchase decisions with this safety information in mind. This... the Commission's decision focus on the specific facts of this rulemaking and are stated below. iii... inform the Commission's decision regarding whether a certain level of conformance with a voluntary...

Arousal, working memory capacity, and sexual decision-making in men.

PubMed

Spokes, Tara; Hine, Donald W; Marks, Anthony D G; Quain, Peter; Lykins, Amy D

2014-08-01

This study investigated whether working memory capacity (WMC) moderated the relationship between physiological arousal and sexual decision making. A total of 59 men viewed 20 consensual and 20 non-consensual images of heterosexual interaction while their physiological arousal levels were recorded using skin conductance response. Participants also completed an assessment of WMC and a date-rape analogue task for which they had to identify the point at which an average Australian male would cease all sexual advances in response to verbal and/or physical resistance from a female partner. Participants who were more physiologically aroused by and spent more time viewing the non-consensual sexual imagery nominated significantly later stopping points on the date-rape analogue task. Consistent with our predictions, the relationship between physiological arousal and nominated stopping point was strongest for participants with lower levels of WMC. For participants with high WMC, physiological arousal was unrelated to nominated stopping point. Thus, executive functioning ability (and WMC in particular) appears to play an important role in moderating men's decision making with regard to sexually aggressive behavior.

48 CFR 6104.407 - Reconsideration of Board decision [Rule 407].

Code of Federal Regulations, 2010 CFR

2010-10-01

... CONTRACT APPEALS, GENERAL SERVICES ADMINISTRATION TRAVEL AND RELOCATION EXPENSES CASES 6104.407... disagreement with a decision or re-argument of points already made is not a sufficient ground for seeking...

Planning in subsumption architectures

NASA Technical Reports Server (NTRS)

Chalfant, Eugene C.

1994-01-01

A subsumption planner using a parallel distributed computational paradigm based on the subsumption architecture for control of real-world capable robots is described. Virtual sensor state space is used as a planning tool to visualize the robot's anticipated effect on its environment. Decision sequences are generated based on the environmental situation expected at the time the robot must commit to a decision. Between decision points, the robot performs in a preprogrammed manner. A rudimentary, domain-specific partial world model contains enough information to extrapolate the end results of the rote behavior between decision points. A collective network of predictors operates in parallel with the reactive network forming a recurrrent network which generates plans as a hierarchy. Details of a plan segment are generated only when its execution is imminent. The use of the subsumption planner is demonstrated by a simple maze navigation problem.

HOW DOES PEER PRESSURE AFFECT EDUCATIONAL INVESTMENTS?

PubMed

Bursztyn, Leonardo; Jensen, Robert

When effort is observable to peers, students may try to avoid social penalties by conforming to prevailing norms. To test this hypothesis, we first consider a natural experiment that introduced a performance leaderboard into computer-based high school courses. The result was a 24 percent performance decline. The decline appears to be driven by a desire to avoid the leaderboard; top performing students prior to the change, those most at risk of appearing on the leaderboard, had a 40 percent performance decline, while poor performing students improved slightly. We next consider a field experiment that offered students complimentary access to an online SAT preparatory course. Sign-up forms differed randomly across students only in whether they said the decision would be kept private from classmates. In nonhonors classes, sign-up was 11 percentage points lower when decisions were public rather than private. Honors class sign-up was unaffected. For students taking honors and nonhonors classes, the response depended on which peers they were with at the time of the offer, and thus to whom their decision would be revealed. When offered the course in a nonhonors class (where peer sign-up rates are low), they were 15 percentage points less likely to sign up if the decision was public. But when offered the course in an honors class (where peer sign-up rates are high), they were 8 percentage points more likely to sign up if the decision was public. Thus, students are highly responsive to their peers are the prevailing norm when they make decisions.

A point-of-care chemistry test for reduction of turnaround and clinical decision time.

PubMed

Lee, Eui Jung; Shin, Sang Do; Song, Kyoung Jun; Kim, Seong Chun; Cho, Jin Seong; Lee, Seung Chul; Park, Ju Ok; Cha, Won Chul

2011-06-01

Our study compared clinical decision time between patients managed with a point-of-care chemistry test (POCT) and patients managed with the traditional central laboratory test (CLT). This was a randomized controlled multicenter trial in the emergency departments (EDs) of 5 academic teaching hospitals. We randomly assigned patients to POCT or CLT stratified by the Emergency Severity Index. A POCT chemistry analyzer (Piccolo; Abaxis, Inc, Union City, Calif), which is able to test liver panel, renal panel, pancreas enzymes, lipid panel, electrolytes, and blood gases, was set up in each ED. Primary and secondary end point was turnaround time and door-to-clinical-decision time. The total 2323 patients were randomly assigned to the POCT group (n = 1167) or to the CLT group (n = 1156). All of the basic characteristics were similar in the 2 groups. The turnaround time (median, interquartile range [IQR]) of the POCT group was shorter than that of the CLT group (14, 12-19 versus 55, 45-69 minutes; P < .0001). The median (IQR) door-to-clinical-decision time was also shorter in the POCT compared with the CLT group (46, 33-61 versus 86, 68-107 minutes; P < .0001). The proportion of patients who had new decisions within 60 minutes was 72.8% for the POCT group and 12.5% for the CLT group (P < .0001). A POCT chemistry analyzer in the ED shortens the test turnaround and ED clinical decision times compared with CLT. Copyright © 2011 Elsevier Inc. All rights reserved.

Stopping decisions: information order effects on nonfocal evaluations.

PubMed

Yu, Michael; Gonzalez, Cleotilde

2013-08-01

We investigated how the order in which information is presented affects when a person decides to stop performing a task. A stopping decision is a decision to stop performing a task on the basis of a sequence of cues. Previous order-effects models do not account for how these contexts limit available working memory for making such decisions. Participants decided how long to perform a task known as the Work Hazard Game that began by rewarding points but later cost points if work continued after an unannounced "emergency." An additive sequence of cues indicated the probability of an emergency. Study I involved a three-group design with cue sequences that indicated the same risk at each decision point but whose final cue presented a high, medium, or low probability. Study 2 had a 2 x 2 design with high or low final cues and an easy or a challenging task. In Study I, participants stopped sooner when the most recent cue presented a high rather than low probability (p = .09), despite the same emergency risk. In Study 2, participants stopped sooner when the most recent cue presented a high rather than low probability for the challenging task but not for the easy task (p = .08). Stopping decisions appear sensitive to the most recent cue observed while experiencing task load. Participants responded to the same risks differently only on the basis of a change in presentation. Findings may be relevant for research and training for hazardous jobs, such as subsurface coal mining, fishing, and trucking.

Integrating Decision Making and Mental Health Interventions Research: Research Directions

PubMed Central

Wills, Celia E.; Holmes-Rovner, Margaret

2006-01-01

The importance of incorporating patient and provider decision-making processes is in the forefront of the National Institute of Mental Health (NIMH) agenda for improving mental health interventions and services. Key concepts in patient decision making are highlighted within a simplified model of patient decision making that links patient-level/“micro” variables to services-level/“macro” variables via the decision-making process that is a target for interventions. The prospective agenda for incorporating decision-making concepts in mental health research includes (a) improved measures for characterizing decision-making processes that are matched to study populations, complexity, and types of decision making; (b) testing decision aids in effectiveness research for diverse populations and clinical settings; and (c) improving the understanding and incorporation of preference concepts in enhanced intervention designs. PMID:16724158

Fit for purpose: perspectives on rapid reviews from end-user interviews.

PubMed

Hartling, Lisa; Guise, Jeanne-Marie; Hempel, Susanne; Featherstone, Robin; Mitchell, Matthew D; Motu'apuaka, Makalapua L; Robinson, Karen A; Schoelles, Karen; Totten, Annette; Whitlock, Evelyn; Wilt, Timothy J; Anderson, Johanna; Berliner, Elise; Gozu, Aysegul; Kato, Elisabeth; Paynter, Robin; Umscheid, Craig A

2017-02-17

There is increasing demand for rapid reviews and timely evidence synthesis. The goal of this project was to understand end-user perspectives on the utility and limitations of rapid products including evidence inventories, rapid responses, and rapid reviews. Interviews were conducted with key informants representing: guideline developers (n = 3), health care providers/health system organizations (n = 3), research funders (n = 1), and payers/health insurers (n = 1). We elicited perspectives on important characteristics of systematic reviews, acceptable methods to streamline reviews, and uses of rapid products. We analyzed content of the interview transcripts and identified themes and subthemes. Key informants identified the following as critical features of evidence reviews: (1) originating from a reliable source (i.e., conducted by experienced reviewers from an established research organization), (2) addressing clinically relevant questions, and (3) trusted relationship between the user and producer. Key informants expressed strong preference for the following review methods and characteristics: use of evidence tables, quality rating of studies, assessments of total evidence quality/strength, and use of summary tables for results and conclusions. Most acceptable trade-offs to increase efficiencies were limiting the literature search (e.g., limiting search dates or language) and performing single screening of citations and full texts for relevance. Key informants perceived rapid products (particularly evidence inventories and rapid responses) as useful interim products to inform downstream investigation (e.g., whether to proceed with a full review or guideline, direction for future research). Most key informants indicated that evidence analysis/synthesis and quality/strength of evidence assessments were important for decision-making. They reported that rapid reviews in particular were useful for guideline development on narrow topics, policy decisions when a quick turn-around is needed, decision-making for practicing clinicians in nuanced clinical settings, and decisions about coverage by payers/health insurers. Rapid reviews may be more relevant within specific clinical settings or health systems; whereas, broad/national guidelines often need a traditional systematic review. Key informants interviewed in our study indicated that evidence inventories, rapid responses, and rapid reviews have utility in specific decisions and contexts. They indicated that the credibility of the review producer, relevance of key questions, and close working relationship between the end-user and producer are critical for any rapid product. Our findings are limited by the sample size which may have been too small to reach saturation for the themes described.

Key External Influences Affecting Consumers’ Decisions Regarding Food

PubMed Central

Martínez-Ruiz, María Pilar; Gómez-Cantó, Carmen María

2016-01-01

Among the numerous internal and external forces that compete for consumers’ attention in the context in which they buy their food, this paper will seek to provide a review of the most important external influences, such as the variables related to food itself. To this end, in addition to the food attributes traditionally identified in fields such as consumer behavior, it will give special consideration to the classification of food values. Although the influence of these variables on consumer decisions depends on the individual, analyzing them will undoubtedly increase understanding of consumers’ decisions. Additionally, identifying and describing these variables will enable subsequent research on how they influence both consumer behavior and other key outcomes for producers, manufacturers, and retailers in the food industry, such as satisfaction, trust, and loyalty. PMID:27803686

A streamlined sustainability assessment tool for improved decision making in the urban water industry.

PubMed

Schulz, Matthias; Short, Michael D; Peters, Gregory M

2012-01-01

Water supply is a key consideration in sustainable urban planning. Ideally, detailed quantitative sustainability assessments are undertaken during the planning stage to inform the decision-making process. In reality, however, the significant time and cost associated with undertaking such detailed environmental and economic assessments is often cited as a barrier to wider implementation of these key decision support tools, particularly for decisions made at the local or regional government level. In an attempt to overcome this barrier of complexity, 4 water service providers in Melbourne, Australia, funded the development of a publicly available streamlined Environmental Sustainability Assessment Tool, which is aimed at a wide range of decision makers to assist them in broadening the type and number of water servicing options that can be considered for greenfield or backlog developments. The Environmental Sustainability Assessment Tool consists of a simple user interface and draws on life cycle inventory data to allow for rapid estimation of the environmental and economic performance of different water servicing scenarios. Scenario options can then be further prioritized by means of an interactive multicriteria analysis. The intent of this article is to identify the key issues to be considered in a streamlined sustainability assessment tool for the urban water industry, and to demonstrate the feasibility of generating accurate life cycle assessments and life cycle costings, using such a tool. We use a real-life case study example consisting of 3 separate scenarios for a planned urban development to show that this kind of tool can emulate life cycle assessments and life cycle costings outcomes obtained through more detailed studies. This simplified approach is aimed at supporting "sustainability thinking" early in the decision-making process, thereby encouraging more sustainable water and sewerage infrastructure solutions. Copyright © 2011 SETAC.

Key stakeholders' perceptions of the acceptability and usefulness of a tablet-based tool to improve communication and shared decision making in ICUs.

PubMed

Ernecoff, Natalie C; Witteman, Holly O; Chon, Kristen; Chen, Yanquan Iris; Buddadhumaruk, Praewpannarai; Chiarchiaro, Jared; Shotsberger, Kaitlin J; Shields, Anne-Marie; Myers, Brad A; Hough, Catherine L; Carson, Shannon S; Lo, Bernard; Matthay, Michael A; Anderson, Wendy G; Peterson, Michael W; Steingrub, Jay S; Arnold, Robert M; White, Douglas B

2016-06-01

Although barriers to shared decision making in intensive care units are well documented, there are currently no easily scaled interventions to overcome these problems. We sought to assess stakeholders' perceptions of the acceptability, usefulness, and design suggestions for a tablet-based tool to support communication and shared decision making in ICUs. We conducted in-depth semi-structured interviews with 58 key stakeholders (30 surrogates and 28 ICU care providers). Interviews explored stakeholders' perceptions about the acceptability of a tablet-based tool to support communication and shared decision making, including the usefulness of modules focused on orienting families to the ICU, educating them about the surrogate's role, completing a question prompt list, eliciting patient values, educating about treatment options, eliciting perceptions about prognosis, and providing psychosocial support resources. The interviewer also elicited stakeholders' design suggestions for such a tool. We used constant comparative methods to identify key themes that arose during the interviews. Overall, 95% (55/58) of participants perceived the proposed tool to be acceptable, with 98% (57/58) of interviewees finding six or more of the seven content domains acceptable. Stakeholders identified several potential benefits of the tool including that it would help families prepare for the surrogate role and for family meetings as well as give surrogates time and a framework to think about the patient's values and treatment options. Key design suggestions included: conceptualize the tool as a supplement to rather than a substitute for surrogate-clinician communication; make the tool flexible with respect to how, where, and when surrogates can access the tool; incorporate interactive exercises; use video and narration to minimize the cognitive load of the intervention; and build an extremely simple user interface to maximize usefulness for individuals with low computer literacy. There is broad support among stakeholders for the use of a tablet-based tool to improve communication and shared decision making in ICUs. Eliciting the perspectives of key stakeholders early in the design process yielded important insights to create a tool tailored to the needs of surrogates and care providers in ICUs. Copyright © 2016 Elsevier Inc. All rights reserved.

Cognitive Bias in Ambiguity Judgements: Using Computational Models to Dissect the Effects of Mild Mood Manipulation in Humans.

PubMed

Iigaya, Kiyohito; Jolivald, Aurelie; Jitkrittum, Wittawat; Gilchrist, Iain D; Dayan, Peter; Paul, Elizabeth; Mendl, Michael

2016-01-01

Positive and negative moods can be treated as prior expectations over future delivery of rewards and punishments. This provides an inferential foundation for the cognitive (judgement) bias task, now widely-used for assessing affective states in non-human animals. In the task, information about affect is extracted from the optimistic or pessimistic manner in which participants resolve ambiguities in sensory input. Here, we report a novel variant of the task aimed at dissecting the effects of affect manipulations on perceptual and value computations for decision-making under ambiguity in humans. Participants were instructed to judge which way a Gabor patch (250ms presentation) was leaning. If the stimulus leant one way (e.g. left), pressing the REWard key yielded a monetary WIN whilst pressing the SAFE key failed to acquire the WIN. If it leant the other way (e.g. right), pressing the SAFE key avoided a LOSS whilst pressing the REWard key incurred the LOSS. The size (0-100 UK pence) of the offered WIN and threatened LOSS, and the ambiguity of the stimulus (vertical being completely ambiguous) were varied on a trial-by-trial basis, allowing us to investigate how decisions were affected by differing combinations of these factors. Half the subjects performed the task in a 'Pleasantly' decorated room and were given a gift (bag of sweets) prior to starting, whilst the other half were in a bare 'Unpleasant' room and were not given anything. Although these treatments had little effect on self-reported mood, they did lead to differences in decision-making. All subjects were risk averse under ambiguity, consistent with the notion of loss aversion. Analysis using a Bayesian decision model indicated that Unpleasant Room subjects were ('pessimistically') biased towards choosing the SAFE key under ambiguity, but also weighed WINS more heavily than LOSSes compared to Pleasant Room subjects. These apparently contradictory findings may be explained by the influence of affect on different processes underlying decision-making, and the task presented here offers opportunities for further dissecting such processes.

Cognitive Bias in Ambiguity Judgements: Using Computational Models to Dissect the Effects of Mild Mood Manipulation in Humans

PubMed Central

Jitkrittum, Wittawat; Gilchrist, Iain D.; Dayan, Peter; Paul, Elizabeth

2016-01-01

Positive and negative moods can be treated as prior expectations over future delivery of rewards and punishments. This provides an inferential foundation for the cognitive (judgement) bias task, now widely-used for assessing affective states in non-human animals. In the task, information about affect is extracted from the optimistic or pessimistic manner in which participants resolve ambiguities in sensory input. Here, we report a novel variant of the task aimed at dissecting the effects of affect manipulations on perceptual and value computations for decision-making under ambiguity in humans. Participants were instructed to judge which way a Gabor patch (250ms presentation) was leaning. If the stimulus leant one way (e.g. left), pressing the REWard key yielded a monetary WIN whilst pressing the SAFE key failed to acquire the WIN. If it leant the other way (e.g. right), pressing the SAFE key avoided a LOSS whilst pressing the REWard key incurred the LOSS. The size (0–100 UK pence) of the offered WIN and threatened LOSS, and the ambiguity of the stimulus (vertical being completely ambiguous) were varied on a trial-by-trial basis, allowing us to investigate how decisions were affected by differing combinations of these factors. Half the subjects performed the task in a ‘Pleasantly’ decorated room and were given a gift (bag of sweets) prior to starting, whilst the other half were in a bare ‘Unpleasant’ room and were not given anything. Although these treatments had little effect on self-reported mood, they did lead to differences in decision-making. All subjects were risk averse under ambiguity, consistent with the notion of loss aversion. Analysis using a Bayesian decision model indicated that Unpleasant Room subjects were (‘pessimistically’) biased towards choosing the SAFE key under ambiguity, but also weighed WINS more heavily than LOSSes compared to Pleasant Room subjects. These apparently contradictory findings may be explained by the influence of affect on different processes underlying decision-making, and the task presented here offers opportunities for further dissecting such processes. PMID:27829041

The role of decision analysis in informed consent: choosing between intuition and systematicity.

PubMed

Ubel, P A; Loewenstein, G

1997-03-01

An important goal of informed consent is to present information to patients so that they can decide which medical option is best for them, according to their values. Research in cognitive psychology has shown that people are rapidly overwhelmed by having to consider more than a few options in making choices. Decision analysis provides a quantifiable way to assess patients' values, and it eliminates the burden of integrating these values with probabilistic information. In this paper we evaluate the relative importance of intuition and systematicity in informed consent. We point out that there is no gold standard for optimal decision making in decisions that hinge on patient values. We also point out that in some such situations it is too early to assume that the benefits of systematicity outweigh the benefits of intuition. Research is needed to address the question of which situations favor the use of intuitive approaches of decision making and which call for a more systematic approach.

Optimizing Disaster Relief: Real-Time Operational and Tactical Decision Support

DTIC Science & Technology

1993-01-01

efficiencies in completing the tAsks. Allocations recognize task priorities and the logistica l effects of geographic prox- imity, In addition...as if they ar~ collocated. Arcs connect loc-•I J>airs of zones to represent feasible dTrect point-to-point transportation and bear cost> ror...data to thl.’ de >~red level of aggregation. We have tested ARES manuall)’ ;mtl by replacins tbc deci~ion maker wrlh the decision simulator which

Superfund Record of Decision (EPA Region 4): Agriculture and Nutrition (Montgomery), Operable Unit 2, Montgomery, AL, September 28, 1998

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

NONE

This decision document presents the selected remedial action for the T.H. Agriculture and Nutrition (THAN) Site, Montgomery, Alabama. Operable Unit Two (OU2) encompasses the remediation of the contaminated soils and sediments on the Site, and also establishes the performance standards for the groundwater remedy. Upon reaching the cleanup standards for groundwater at an established point(s) of compliance, the groundwater pumping system will be shut down.

The evaluation and enhancement of quality, environmental protection and seaport safety by using FAHP

NASA Astrophysics Data System (ADS)

Tadic, Danijela; Aleksic, Aleksandar; Popovic, Pavle; Arsovski, Slavko; Castelli, Ana; Joksimovic, Danijela; Stefanovic, Miladin

2017-02-01

The evaluation and enhancement of business processes in any organization in an uncertain environment presents one of the main requirements of ISO 9000:2008 and has a key effect on competitive advantage and long-term sustainability. The aim of this paper can be defined as the identification and discussion of some of the most important business processes of seaports and the performances of business processes and their key performance indicators (KPIs). The complexity and importance of the treated problem call for analytic methods rather than intuitive decisions. The existing decision variables of the considered problem are described by linguistic expressions which are modelled by triangular fuzzy numbers (TFNs). In this paper, the modified fuzzy extended analytic hierarchy process (FAHP) is proposed. The assessment of the relative importance of each pair of performances and their key performance indicators are stated as a fuzzy group decision-making problem. By using the modified fuzzy extended analytic hierarchy process, the fuzzy rank of business processes of a seaport is obtained. The model is tested through an illustrative example with real-life data, where the obtained data suggest measures which should enhance business strategy and improve key performance indicators. The future improvement is based on benchmark and knowledge sharing.

Research review of nongovernmental organizations' security policies for humanitarian programs in war, conflict, and postconflict environments.

PubMed

Rowley, Elizabeth; Burns, Lauren; Burnham, Gilbert

2013-06-01

To identify the most and least commonly cited security management messages that nongovernmental organizations (NGOs) are communicating to their field staff, to determine the types of documentation that NGOs most often use to communicate key security messages, and to distinguish the points of commonality and divergence across organizations in the content of key security messages. The authors undertook a systematic review of available security policies, manuals, and training materials from 20 international humanitarian NGOs using the InterAction Minimum Operating Security Standards as the basis for a review framework. The most commonly cited standards include analytical security issues such as threat and risk assessment processes and guidance on acceptance, protection, and deterrence approaches. Among the least commonly cited standards were considering security threats to national staff during staffing decision processes, incorporating security awareness into job descriptions, and ensuring that national staff security issues are addressed in trainings. NGO staff receive security-related messages through multiple document types, but only 12 of the 20 organizations have a distinct security policy document. Points of convergence across organizations in the content of commonly cited standards were found in many areas, but differences in security risk and threat assessment guidance may undermine communication between aid workers about changes in local security environments. Although the humanitarian community has experienced significant progress in the development of practical staff security guidance during the past 10 years, gaps remain that can hinder efforts to garner needed resources, clarify security responsibilities, and ensure that the distinct needs of national staff are recognized and addressed.

Use of historical control data for assessing treatment effects in clinical trials.

PubMed

Viele, Kert; Berry, Scott; Neuenschwander, Beat; Amzal, Billy; Chen, Fang; Enas, Nathan; Hobbs, Brian; Ibrahim, Joseph G; Kinnersley, Nelson; Lindborg, Stacy; Micallef, Sandrine; Roychoudhury, Satrajit; Thompson, Laura

2014-01-01

Clinical trials rarely, if ever, occur in a vacuum. Generally, large amounts of clinical data are available prior to the start of a study, particularly on the current study's control arm. There is obvious appeal in using (i.e., 'borrowing') this information. With historical data providing information on the control arm, more trial resources can be devoted to the novel treatment while retaining accurate estimates of the current control arm parameters. This can result in more accurate point estimates, increased power, and reduced type I error in clinical trials, provided the historical information is sufficiently similar to the current control data. If this assumption of similarity is not satisfied, however, one can acquire increased mean square error of point estimates due to bias and either reduced power or increased type I error depending on the direction of the bias. In this manuscript, we review several methods for historical borrowing, illustrating how key parameters in each method affect borrowing behavior, and then, we compare these methods on the basis of mean square error, power and type I error. We emphasize two main themes. First, we discuss the idea of 'dynamic' (versus 'static') borrowing. Second, we emphasize the decision process involved in determining whether or not to include historical borrowing in terms of the perceived likelihood that the current control arm is sufficiently similar to the historical data. Our goal is to provide a clear review of the key issues involved in historical borrowing and provide a comparison of several methods useful for practitioners. Copyright © 2013 John Wiley & Sons, Ltd.

Use of historical control data for assessing treatment effects in clinical trials

PubMed Central

Viele, Kert; Berry, Scott; Neuenschwander, Beat; Amzal, Billy; Chen, Fang; Enas, Nathan; Hobbs, Brian; Ibrahim, Joseph G.; Kinnersley, Nelson; Lindborg, Stacy; Micallef, Sandrine; Roychoudhury, Satrajit; Thompson, Laura

2014-01-01

Clinical trials rarely, if ever, occur in a vacuum. Generally, large amounts of clinical data are available prior to the start of a study, particularly on the current study’s control arm. There is obvious appeal in using (i.e., ‘borrowing’) this information. With historical data providing information on the control arm, more trial resources can be devoted to the novel treatment while retaining accurate estimates of the current control arm parameters. This can result in more accurate point estimates, increased power, and reduced type I error in clinical trials, provided the historical information is sufficiently similar to the current control data. If this assumption of similarity is not satisfied, however, one can acquire increased mean square error of point estimates due to bias and either reduced power or increased type I error depending on the direction of the bias. In this manuscript, we review several methods for historical borrowing, illustrating how key parameters in each method affect borrowing behavior, and then, we compare these methods on the basis of mean square error, power and type I error. We emphasize two main themes. First, we discuss the idea of ‘dynamic’ (versus ‘static’) borrowing. Second, we emphasize the decision process involved in determining whether or not to include historical borrowing in terms of the perceived likelihood that the current control arm is sufficiently similar to the historical data. Our goal is to provide a clear review of the key issues involved in historical borrowing and provide a comparison of several methods useful for practitioners. PMID:23913901

The Quest for Quality

ERIC Educational Resources Information Center

Chappuis, Stephen; Chappuis, Jan; Stiggins, Rick

2009-01-01

Instructional decisions based on quality assessments and a balanced assessment system most effectively promote student learning. To inform sound decisions, assessments need to satisfy five key standards of quality: (1) clear purpose; (2) clear learning targets; (3) sound assessment design; (4) effective communication of results; and (5) student…

Selecting optimal second-generation antihistamines for allergic rhinitis and urticaria in Asia.

PubMed

Recto, Marysia Tiongco; Gabriel, Ma Teresita; Kulthanan, Kanokvalai; Tantilipikorn, Pongsakorn; Aw, Derrick Chen-Wee; Lee, Tak Hong; Chwen, Ch'ng Chin; Mutusamy, Somasundran; Hao, Nguyen Trong; Quang, Vo Thanh; Canonica, Giorgio Walter

2017-01-01

Allergic diseases are on the rise in many parts of the world, including the Asia-Pacific (APAC) region. Second-generation antihistamines are the first-line treatment option in the management of allergic rhinitis and urticaria. International guidelines describe the management of these conditions; however, clinicians perceive the additional need to tailor treatment according to patient profiles. This study serves as a consensus of experts from several countries in APAC (Hong Kong, Malaysia, the Philippines, Singapore, Thailand, Vietnam), which aims to describe the unmet needs, practical considerations, challenges, and key decision factors when determining optimal second-generation antihistamines for patients with allergic rhinitis and/or urticaria. Specialists from allergology, dermatology, and otorhinolaryngology were surveyed on practical considerations and key decision points when treating patients with allergic rhinitis and/or urticaria. Clinicians felt the need for additional tools for diagnosis of these diseases and a single drug with all preferred features of an antihistamine. Challenges in treatment include lack of clinician and patient awareness and compliance, financial constraints, and treatment for special patient populations such as those with concomitant disease. Selection of optimal second-generation antihistamines depends on many factors, particularly drug safety and efficacy, impact on psychomotor abilities, and sedation. Country-specific considerations include drug availability and cost-effectiveness. Survey results reveal bilastine as a preferred choice due to its high efficacy and safety, suitability for special patient populations, and the lack of sedative effects. Compliance to the international guidelines is present among allergists, dermatologists and otorhinolaryngologists; however, this is lower amongst general practitioners (GPs). To increase awareness, allergy education programs targeted at GPs and patients may be beneficial. Updates to the existing international guidelines are suggested in APAC to reflect appropriate management for different patient profiles and varying symptoms of allergic rhinitis and urticaria.

Implementing communication and decision-making interventions directed at goals of care: a theory-led scoping review

PubMed Central

Cummings, Amanda; Lund, Susi; Campling, Natasha; May, Carl; Richardson, Alison; Myall, Michelle

2017-01-01

Objectives To identify the factors that promote and inhibit the implementation of interventions that improve communication and decision-making directed at goals of care in the event of acute clinical deterioration. Design and methods A scoping review was undertaken based on the methodological framework of Arksey and O’Malley for conducting this type of review. Searches were carried out in Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL) to identify peer-reviewed papers and in Google to identify grey literature. Searches were limited to those published in the English language from 2000 onwards. Inclusion and exclusion criteria were applied, and only papers that had a specific focus on implementation in practice were selected. Data extracted were treated as qualitative and subjected to directed content analysis. A theory-informed coding framework using Normalisation Process Theory (NPT) was applied to characterise and explain implementation processes. Results Searches identified 2619 citations, 43 of which met the inclusion criteria. Analysis generated six themes fundamental to successful implementation of goals of care interventions: (1) input into development; (2) key clinical proponents; (3) training and education; (4) intervention workability and functionality; (5) setting and context; and (6) perceived value and appraisal. Conclusions A broad and diverse literature focusing on implementation of goals of care interventions was identified. Our review recognised these interventions as both complex and contentious in nature, making their incorporation into routine clinical practice dependent on a number of factors. Implementing such interventions presents challenges at individual, organisational and systems levels, which make them difficult to introduce and embed. We have identified a series of factors that influence successful implementation and our analysis has distilled key learning points, conceptualised as a set of propositions, we consider relevant to implementing other complex and contentious interventions. PMID:28988176

Evaluation of a novel electronic genetic screening and clinical decision support tool in prenatal clinical settings.

PubMed

Edelman, Emily A; Lin, Bruce K; Doksum, Teresa; Drohan, Brian; Edelson, Vaughn; Dolan, Siobhan M; Hughes, Kevin; O'Leary, James; Vasquez, Lisa; Copeland, Sara; Galvin, Shelley L; DeGroat, Nicole; Pardanani, Setul; Gregory Feero, W; Adams, Claire; Jones, Renee; Scott, Joan

2014-07-01

"The Pregnancy and Health Profile" (PHP) is a free prenatal genetic screening and clinical decision support (CDS) software tool for prenatal providers. PHP collects family health history (FHH) during intake and provides point-of-care risk assessment for providers and education for patients. This pilot study evaluated patient and provider responses to PHP and effects of using PHP in practice. PHP was implemented in four clinics. Surveys assessed provider confidence and knowledge and patient and provider satisfaction with PHP. Data on the implementation process were obtained through semi-structured interviews with administrators. Quantitative survey data were analyzed using Chi square test, Fisher's exact test, paired t tests, and multivariate logistic regression. Open-ended survey questions and interviews were analyzed using qualitative thematic analysis. Of the 83% (513/618) of patients that provided feedback, 97% felt PHP was easy to use and 98% easy to understand. Thirty percent (21/71) of participating physicians completed both pre- and post-implementation feedback surveys [13 obstetricians (OBs) and 8 family medicine physicians (FPs)]. Confidence in managing genetic risks significantly improved for OBs on 2/6 measures (p values ≤0.001) but not for FPs. Physician knowledge did not significantly change. Providers reported value in added patient engagement and reported mixed feedback about the CDS report. We identified key steps, resources, and staff support required to implement PHP in a clinical setting. To our knowledge, this study is the first to report on the integration of patient-completed, electronically captured and CDS-enabled FHH software into primary prenatal practice. PHP is acceptable to patients and providers. Key to successful implementation in the future will be customization options and interoperability with electronic health records.

2016 guideline strategies for the use of antifungal agents in patients with hematological malignancies or hematopoietic stem cell transplantation recipients in Taiwan.

PubMed

Ko, Bor-Sheng; Chen, Wei-Ting; Kung, Hsiang-Chi; Wu, Un-In; Tang, Jih-Luh; Yao, Ming; Chen, Yee-Chun; Tien, Hwei-Fang; Chang, Shan-Chwen; Chuang, Yin-Ching; Lin, Dong-Tsamn

2017-07-25

The Infectious Diseases Society of Taiwan (IDST), the Hematology Society of Taiwan, the Taiwan Society of Blood and Marrow Transplantation, Medical Foundation in Memory of Dr. Deh-Lin Cheng, Foundation of Professor Wei-Chuan Hsieh for Infectious Diseases Research and Education, and CY Lee's Research Foundation for Pediatric Infectious Diseases and Vaccines cooperatively published this guideline for the use of antifungal agents in hematological patients with invasive fungal diseases (IFDs) in Taiwan. The guideline is the first one endorsed by IDST focusing on selection of antifungal strategies, including prophylaxis, empirical (or symptom-driven) and pre-emptive (or diagnostic-driven) strategy. We suggest a risk-adapted dynamic strategy and provide an algorithm to facilitate decision making in population level as well as for individual patient. Risk assessment and management accordingly is explicitly emphasized. In addition, we highlight the importance of diagnosis in each antifungal strategy among five elements of the antimicrobial stewardship (diagnosis, drug, dose, de-escalation and duration). The rationale, purpose, and key recommendations for the choice of antifungal strategy are summarized, with concise review of international guidelines or recommendation, key original articles and local epidemiology reports. We point out the interaction and influence between elements of recommendations and limitation of and gap between evidences and daily practice. The guideline balances the quality of evidence and feasibility of recommendation in clinical practice. Finally, this version introduces the concept of health economics and provides data translated from local disease burdens. All these contents hopefully facilitate transparency and accountability in medical decision-making, improvements in clinical care and health outcomes, and appropriateness of medical resource allocation. Copyright © 2017. Published by Elsevier B.V.

Assessing dengue vaccination impact: Model challenges and future directions.

PubMed

Recker, Mario; Vannice, Kirsten; Hombach, Joachim; Jit, Mark; Simmons, Cameron P

2016-08-31

In response to the sharp rise in the global burden caused by dengue virus (DENV) over the last few decades, the WHO has set out three specific key objectives in its disease control strategy: (i) to estimate the true burden of dengue by 2015; (ii) a reduction in dengue mortality by at least 50% by 2020 (used as a baseline); and (iii) a reduction in dengue morbidity by at least 25% by 2020. Although various elements will all play crucial parts in achieving this goal, from diagnosis and case management to integrated surveillance and outbreak response, sustainable vector control, vaccine implementation and finally operational and implementation research, it seems clear that new tools (e.g. a safe and effective vaccine and/or effective vector control) are key to success. The first dengue vaccine was licensed in December 2015, Dengvaxia® (CYD-TDV) developed by Sanofi Pasteur. The WHO has provided guidance on the use of CYD-TDV in endemic countries, for which there are a variety of considerations beyond the risk-benefit evaluation done by regulatory authorities, including public health impact and cost-effectiveness. Population-level vaccine impact and economic and financial aspects are two issues that can potentially be considered by means of mathematical modelling, especially for new products for which empirical data are still lacking. In December 2014 a meeting was convened by the WHO in order to revisit the current status of dengue transmission models and their utility for public health decision-making. Here, we report on the main points of discussion and the conclusions of this meeting, as well as next steps for maximising the use of mathematical models for vaccine decision-making. Copyright © 2016.

The case for values as a basis for organizational culture.

PubMed

Brinkley, Ruth W

2013-01-01

At a time when almost every aspect of healthcare is rapidly and dramatically changing, it is important for healthcare leaders to maintain a moral compass--a clear sense of the morals or virtues that guide their decisions. A firmly rooted moral compass inspires, leads, guides, and provides a solid foundation--and some sense of security--for organizations navigating massive or significant transformational changes, such as those required by the Affordable Care Act. In addition, "smaller" changes, such as consolidation, rationalization, and relocation of services, have a strong chance of succeeding in organizations that operate within a moral framework from which the organization can shape its future strategies and make important decisions. Finally, an organization's moral compass guides actions, reactions, and behaviors when unexpected or devastating events occur in the lives of consumers, employees, physicians, business partners, patients, families, and members of the community. The direction toward which its moral compass is pointing determines the types and quality of relationships it has with those key stakeholders, and those individuals and groups come to depend on what they have observed and know to be true about how the organization behaves in certain circumstances. While no organization can predict the future and all of the implications of change, key stakeholder groups need and want to know how they will be treated in the face of such change-whether expected or unexpected. In this sense, every organization must establish ways to evaluate the validity of its moral compass and develop--and adhere to--guidelines that determine how its members will behave, whether in ordinary circumstances; in the face of extraordinary, high-impact situations; or in times of massive transformational change. Above all, executive leaders must always be mindful that their own personal moral compass becomes their organization's moral compass.

A tri-reference point theory of decision making under risk.

PubMed

Wang, X T; Johnson, Joseph G

2012-11-01

The tri-reference point (TRP) theory takes into account minimum requirements (MR), the status quo (SQ), and goals (G) in decision making under risk. The 3 reference points demarcate risky outcomes and risk perception into 4 functional regions: success (expected value of x ≥ G), gain (SQ < × < G), loss (MR ≤ x < SQ), and failure (x < MR). The psychological impact of achieving or failing to achieve these reference points is rank ordered as MR > G > SQ. We present TRP assumptions and value functions and a mathematical formalization of the theory. We conducted empirical tests of crucial TRP predictions using both explicit and implicit reference points. We show that decision makers consider both G and MR and give greater weight to MR than G, indicating failure aversion (i.e., the disutility of a failure is greater than the utility of a success in the same task) in addition to loss aversion (i.e., the disutility of a loss is greater than the utility of the same amount of gain). Captured by a double-S shaped value function with 3 inflection points, risk preferences switched between risk seeking and risk aversion when the distribution of a gamble straddled a different reference point. The existence of MR (not G) significantly shifted choice preference toward risk aversion even when the outcome distribution of a gamble was well above the MR. Single reference point based models such as prospect theory cannot consistently account for these findings. The TRP theory provides simple guidelines for evaluating risky choices for individuals and organizational management. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Proposed RCRA Permit Decision for CNMI Remedial Action Plan

EPA Pesticide Factsheets

EPA requesting public comment on its proposed Remedial Action Plan permit decision for the detonation unit and storage cave located at Marpi Point, Saipan, approximately 1 mile north of the new Marpi Landfill.

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

PubMed

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

2015-01-01

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

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

PubMed Central

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

2016-01-01

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

What is a good medical decision? A research agenda guided by perspectives from multiple stakeholders.

PubMed

Hamilton, Jada G; Lillie, Sarah E; Alden, Dana L; Scherer, Laura; Oser, Megan; Rini, Christine; Tanaka, Miho; Baleix, John; Brewster, Mikki; Craddock Lee, Simon; Goldstein, Mary K; Jacobson, Robert M; Myers, Ronald E; Zikmund-Fisher, Brian J; Waters, Erika A

2017-02-01

Informed and shared decision making are critical aspects of patient-centered care, which has contributed to an emphasis on decision support interventions to promote good medical decision making. However, researchers and healthcare providers have not reached a consensus on what defines a good decision, nor how to evaluate it. This position paper, informed by conference sessions featuring diverse stakeholders held at the 2015 Society of Behavioral Medicine and Society for Medical Decision Making annual meetings, describes key concepts that influence the decision making process itself and that may change what it means to make a good decision: interpersonal factors, structural constraints, affective influences, and values clarification methods. This paper also proposes specific research questions within each of these priority areas, with the goal of moving medical decision making research to a more comprehensive definition of a good medical decision, and enhancing the ability to measure and improve the decision making process.

What makes health impact assessments successful? Factors contributing to effectiveness in Australia and New Zealand.

PubMed

Haigh, Fiona; Harris, Elizabeth; Harris-Roxas, Ben; Baum, Fran; Dannenberg, Andrew L; Harris, Mark F; Keleher, Helen; Kemp, Lynn; Morgan, Richard; Ng Chok, Harrison; Spickett, Jeff

2015-10-03

While many guidelines explain how to conduct Health Impact Assessments (HIAs), less is known about the factors that determine the extent to which HIAs affect health considerations in the decision making process. We investigated which factors are associated with increased or reduced effectiveness of HIAs in changing decisions and in the implementation of policies, programs or projects. This study builds on and tests the Harris and Harris-Roxas' conceptual framework for evaluating HIA effectiveness, which emphasises context, process and output as key domains. We reviewed 55 HIA reports in Australia and New Zealand from 2005 to 2009 and conducted surveys and interviews for 48 of these HIAs. Eleven detailed case studies were undertaken using document review and stakeholder interviews. Case study participants were selected through purposeful and snowball sampling. The data were analysed by thematic content analysis. Findings were synthesised and mapped against the conceptual framework. A stakeholder forum was utilised to test face validity and practical adequacy of the findings. We found that some features of HIA are essential, such as the stepwise but flexible process, and evidence based approach. Non-essential features that can enhance the impact of HIAs include capacity and experience; 'right person right level'; involvement of decision-makers and communities; and relationships and partnerships. There are contextual factors outside of HIA such as fit with planning and decision making context, broader global context and unanticipated events, and shared values and goals that may influence a HIA. Crosscutting factors include proactive positioning, and time and timeliness. These all operate within complex open systems, involving multiple decision-makers, levels of decision-making, and points of influence. The Harris and Harris-Roxas framework was generally supported. We have confirmed previously identified factors influencing effectiveness of HIA and identified new factors such as proactive positioning. Our findings challenge some presumptions about 'right' timing for HIA and the rationality and linearity of decision-making processes. The influence of right timing on decision making needs to be seen within the context of other factors such as proactive positioning. This research can help HIA practitioners and researchers understand and identify what can be enhanced within the HIA process. Practitioners can adapt the flexible HIA process to accommodate the external contextual factors identified in this report.

Exploring how different modes of governance act across health system levels to influence primary healthcare facility managers' use of information in decision-making: experience from Cape Town, South Africa.

PubMed

Scott, Vera; Gilson, Lucy

2017-09-15

Governance, which includes decision-making at all levels of the health system, and information have been identified as key, interacting levers of health system strengthening. However there is an extensive literature detailing the challenges of supporting health managers to use formal information from health information systems (HISs) in their decision-making. While health information needs differ across levels of the health system there has been surprisingly little empirical work considering what information is actually used by primary healthcare facility managers in managing, and making decisions about, service delivery. This paper, therefore, specifically examines experience from Cape Town, South Africa, asking the question: How is primary healthcare facility managers' use of information for decision-making influenced by governance across levels of the health system? The research is novel in that it both explores what information these facility managers actually use in decision-making, and considers how wider governance processes influence this information use. An academic researcher and four facility managers worked as co-researchers in a multi-case study in which three areas of management were served as the cases. There were iterative cycles of data collection and collaborative analysis with individual and peer reflective learning over a period of three years. Central governance shaped what information and knowledge was valued - and, therefore, generated and used at lower system levels. The central level valued formal health information generated in the district-based HIS which therefore attracted management attention across the levels of the health system in terms of design, funding and implementation. This information was useful in the top-down practices of planning and management of the public health system. However, in facilities at the frontline of service delivery, there was a strong requirement for local, disaggregated information and experiential knowledge to make locally-appropriate and responsive decisions, and to perform the people management tasks required. Despite central level influences, modes of governance operating at the subdistrict level had influence over what information was valued, generated and used locally. Strengthening local level managers' ability to create enabling environments is an important leverage point in supporting informed local decision-making, and, in turn, translating national policies and priorities, including equity goals, into appropriate service delivery practices.

Adaptation Planning for Water Resources Management in the Context of Scientific Uncertainty

NASA Astrophysics Data System (ADS)

Lowrey, J.; Kenney, D.

2008-12-01

Several municipalities are beginning to create policies and plans in order to adapt to potential impacts from climate change. A 2007 report from the Heinz Center for Science, Economics, and the Environment, 'A Survey of Climate Change Adaptation Planning,' surveyed fourteen cities or counties across the U.S. and Canada that have created or are working towards creating climate change adaptation plans. Informal interactions with water managers in the Intermountain West indicate an eagerness to learn from those who have already begun adapting to potential climate change. Many of those without plans do not feel comfortable making potentially expensive long-term policy decisions based on impacts derived from uncertain climate change projections. This research identifies how decision makers currently consider climate change in adaptation planning despite imperfect information about climate change impacts, particularly in the water sector. Insights are offered into how best to provide information on climate change projections to regional decision makers so that they can begin adaptation planning for a changing climate. This research analyzes how a subset of the fourteen municipalities justified adaptive planning in the face of scientific uncertainty, paying particular attention to water resource adaptation, using the adaptation approaches studied in the 2007 Heinz Center Report. Interviews will be conducted with decision makers to learn how policies will be implemented and evaluated, and to explore resulting changes in policy or planning. Adaptation strategies are not assessed, but are used to identify how the decision makers plan to evaluate their own adaptation policies. In addition to looking at information use in adaptation plans, we compare how the plans orient themselves (adapting to projected impacts vs. increasing resiliency to current climate variability), how they address barriers and opportunities for adaptation, and whether they follow some key steps for successful adaptation as outlined in the literature. This part of the study will identify any consensus among the municipalities already adapting, and see of the decision makers tend to agree with the points of views expressed in the literature. The conclusions here will not only help decision makers trying to adapt, but it will help researchers orient future research to the informational needs of the decision makers. The work is intended to provide useful information for the Western Water Assessment, a NOAA-funded research boundary organization, which provides climate information to water resource managers in the Intermountain West, including the Colorado River Basin.

Decision Tree Phytoremediation

DTIC Science & Technology

1999-12-01

aromatic hydrocarbons, and landfill leachates . Phytoremediation has been used for point and nonpoint source hazardous waste control. 1.2 Types of... Phytoremediation Prepared by Interstate Technology and Regulatory Cooperation Work Group Phytoremediation Work Team December 1999 Decision Tree...1999 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE Phytoremediation Decision Tree 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c

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

PubMed

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

2017-05-01

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

Foster Parents' Rights to Share in Decision-Making for the Foster Child: Some Issues That Foster Parents Should Be Aware Of.

ERIC Educational Resources Information Center

Hardin, Mark; Tazzara, Patricia

This brief paper is intended, not to provide legal advice, but to alert foster parents to some of the key legal issues affecting their role in decision-making for the foster child. Contents discuss foster parents' access to adequate information concerning their foster children and their right to pursue grievances, resist agency decisions to remove…

Group assessment of key indicators of sustainable waste management in developing countries.

PubMed

Tot, Bojana; Vujić, Goran; Srđević, Zorica; Ubavin, Dejan; Russo, Mário Augusto Tavares

2017-09-01

Decision makers in developing countries are struggling to solve the present problems of solid waste management. Prioritisation and ranking of the most important indicators that influence the waste management system is very useful for any decision maker for the future planning and implementation of a sustainable waste management system. The aim of this study is to evaluate key indicators and their related sub-indicators in a group decision-making environment. In order to gain insight into the subject it was necessary to obtain the qualified opinions of decision makers from different countries who understand the situation in the sector of waste management in developing countries. An assessment is performed by 43 decision makers from both developed and developing countries, and the applied methodology is based on a combined use of the analytic hierarchy process, from the multi-criteria decision-making set of tools, and the preferential voting method known as Borda Count, which belongs to social choice theory. Pairwise comparison of indicators is performed with the analytic hierarchy process, and the ranking of indicators once obtained is assessed with Borda Count. Detailed analysis of the final results showed that the Institutional-Administrative indicator was the most important one, with the maximum weight as derived by both groups of decision makers. The results also showed that the combined use of the analytic hierarchy process and Borda Count contributes to the credibility and objectivity of the decision-making process, allowing its use in more complex waste management group decision-making problems to be recommended.

Structuring decisions for managing threatened and endangered species in a changing climate.

PubMed

Gregory, Robin; Arvai, Joseph; Gerber, Leah R

2013-12-01

The management of endangered species under climate change is a challenging and often controversial task that incorporates input from a variety of different environmental, economic, social, and political interests. Yet many listing and recovery decisions for endangered species unfold on an ad hoc basis without reference to decision-aiding approaches that can improve the quality of management choices. Unlike many treatments of this issue, which consider endangered species management a science-based problem, we suggest that a clear decision-making process is equally necessary. In the face of new threats due to climate change, managers' choices about endangered species require closely linked analyses and deliberations that identify key objectives and develop measurable attributes, generate and compare management alternatives, estimate expected consequences and key sources of uncertainty, and clarify trade-offs across different dimensions of value. Several recent cases of endangered species conservation decisions illustrate our proposed decision-focused approach, including Gulf of Maine Atlantic salmon (Salmo salar) recovery framework development, Cultus Lake sockeye salmon (Oncorhynchus nerka) management, and Upper Columbia River white sturgeon (Acipenser transmontanus) recovery planning. Estructuración de Decisiones para Manejar Especies Amenazadas y en Peligro en un Clima Cambiante. © 2013 Society for Conservation Biology No claim to original US government works.

Relative effectiveness assessments of oncology medicines for pricing and reimbursement decisions in European countries.

PubMed

Kleijnen, S; Lipska, I; Leonardo Alves, T; Meijboom, K; Elsada, A; Vervölgyi, V; d'Andon, A; Timoney, A; Leufkens, H G; De Boer, A; Goettsch, W G

2016-09-01

There is a debate on the added clinical value of new, expensive, anticancer treatments. Among European decision makers, the relevance of commonly used end points in trials, especially overall survival (OS), progression-free survival (PFS) and quality of life (QoL), varies, leading to the available evidence being valued differently. This research studies the extent to which the value of end points for cancer medicines differs among European decision makers. We compared guidelines and relative effectiveness assessments (REAs) of medicines for pricing or reimbursement decisions in England, France, Germany, The Netherlands, Poland, and Scotland. Anticancer medicines that received marketing authorization in Europe between 2011 and 2013 with at least four available national REAs were evaluated. A total of 79 REAs were included. Health technology assessment (HTA) guidelines indicate a preference for clinically and patient relevant end points such as OS and QoL above surrogate end points. Most guidelines do not specify whether PFS is considered a surrogate or patient-relevant end point. The number of REAs included per jurisdiction varied between 7 (The Netherlands) and 18 (Germany). OS data were included in all REAs and were the preferred end point by HTA agencies, but these data were not always mature or robust. QoL data are included in only 54% of the REAs, with a limited impact on the recommendations. PFS data are included in 70% of the REAs, but the extent to which HTA agencies find PFS relevant varies. European decision-making on relative effectiveness of anticancer medicines is affected by a gap in requested versus available clinical evidence, mainly because the regulator is willing to accept some degree of clinical uncertainty. A multi-stakeholder debate would be essential to align concrete robust evidence requirements in oncology and a collectively shared definition for relevant clinical benefit, which will benefit patients and society in general. © The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

The Hidden Dimension of Strategic Planning: Explorations in the Formation of Perspectives

DTIC Science & Technology

1991-09-01

13 2. Laws--Or Points Of Reference?.........18 B. THE HORIZONTAL LEVEL OF DECISION - MAKING . . . . 23 1. KNOWLEDGE, RATIONALITY , AND... decision - making is a horizontal level ranging from logic and rationalism to subjective emotionalism. This is the dimension of decision - making with which...the process of decision - making . The basis of game theory is the dual premises of rationality and maximization of utility.6 "It [game theory] is

Missed opportunities for diagnosis: lessons learned from diagnostic errors in primary care.

PubMed

Goyder, Clare R; Jones, Caroline H D; Heneghan, Carl J; Thompson, Matthew J

2015-12-01

Because of the difficulties inherent in diagnosis in primary care, it is inevitable that diagnostic errors will occur. However, despite the important consequences associated with diagnostic errors and their estimated high prevalence, teaching and research on diagnostic error is a neglected area. To ascertain the key learning points from GPs' experiences of diagnostic errors and approaches to clinical decision making associated with these. Secondary analysis of 36 qualitative interviews with GPs in Oxfordshire, UK. Two datasets of semi-structured interviews were combined. Questions focused on GPs' experiences of diagnosis and diagnostic errors (or near misses) in routine primary care and out of hours. Interviews were audiorecorded, transcribed verbatim, and analysed thematically. Learning points include GPs' reliance on 'pattern recognition' and the failure of this strategy to identify atypical presentations; the importance of considering all potentially serious conditions using a 'restricted rule out' approach; and identifying and acting on a sense of unease. Strategies to help manage uncertainty in primary care were also discussed. Learning from previous examples of diagnostic errors is essential if these events are to be reduced in the future and this should be incorporated into GP training. At a practice level, learning points from experiences of diagnostic errors should be discussed more frequently; and more should be done to integrate these lessons nationally to understand and characterise diagnostic errors. © British Journal of General Practice 2015.

C-learning: A new classification framework to estimate optimal dynamic treatment regimes.

PubMed

Zhang, Baqun; Zhang, Min

2017-12-11

A dynamic treatment regime is a sequence of decision rules, each corresponding to a decision point, that determine that next treatment based on each individual's own available characteristics and treatment history up to that point. We show that identifying the optimal dynamic treatment regime can be recast as a sequential optimization problem and propose a direct sequential optimization method to estimate the optimal treatment regimes. In particular, at each decision point, the optimization is equivalent to sequentially minimizing a weighted expected misclassification error. Based on this classification perspective, we propose a powerful and flexible C-learning algorithm to learn the optimal dynamic treatment regimes backward sequentially from the last stage until the first stage. C-learning is a direct optimization method that directly targets optimizing decision rules by exploiting powerful optimization/classification techniques and it allows incorporation of patient's characteristics and treatment history to improve performance, hence enjoying advantages of both the traditional outcome regression-based methods (Q- and A-learning) and the more recent direct optimization methods. The superior performance and flexibility of the proposed methods are illustrated through extensive simulation studies. © 2017, The International Biometric Society.

Molecular regulation of the mitosis/meiosis decision in multicellular organisms.

PubMed

Kimble, Judith

2011-08-01

A major step in the journey from germline stem cell to differentiated gamete is the decision to leave the mitotic cell cycle and begin progression through the meiotic cell cycle. Over the past decade, molecular regulators of the mitosis/meiosis decision have been discovered in most of the major model multicellular organisms. Historically, the mitosis/meiosis decision has been closely linked with controls of germline self-renewal and the sperm/egg decision, especially in nematodes and mice. Molecular explanations of those linkages clarify our understanding of this fundamental germ cell decision, and unifying themes have begun to emerge. Although the complete circuitry of the decision is not known in any organism, the recent advances promise to impact key issues in human reproduction and agriculture.

Intercity passenger rail : decisions on the future of Amtrak and intercity passenger rail are approaching

DOT National Transportation Integrated Search

2000-09-26

Key decisions will soon have to be made regarding the future of Amtrak, the nation's intercity passenger rail operator. If Amtrak does not reach operational self-sufficiency within the next 2 years, federal law requires that the Amtrak Reform Council...

Participatory monitoring and evaluation approaches that influence decision-making: lessons from a maternal and newborn study in Eastern Uganda.

PubMed

Kananura, Rornald Muhumuza; Ekirapa-Kiracho, Elizabeth; Paina, Ligia; Bumba, Ahmed; Mulekwa, Godfrey; Nakiganda-Busiku, Dinah; Oo, Htet Nay Lin; Kiwanuka, Suzanne Namusoke; George, Asha; Peters, David H

2017-12-28

The use of participatory monitoring and evaluation (M&E) approaches is important for guiding local decision-making, promoting the implementation of effective interventions and addressing emerging issues in the course of implementation. In this article, we explore how participatory M&E approaches helped to identify key design and implementation issues and how they influenced stakeholders' decision-making in eastern Uganda. The data for this paper is drawn from a retrospective reflection of various M&E approaches used in a maternal and newborn health project that was implemented in three districts in eastern Uganda. The methods included qualitative and quantitative M&E techniques such as  key informant interviews, formal surveys and supportive supervision, as well as participatory approaches, notably participatory impact pathway analysis. At the design stage, the M&E approaches were useful for identifying key local problems and feasible local solutions and informing the activities that were subsequently implemented. During the implementation phase, the M&E approaches provided evidence that informed decision-making and helped identify emerging issues, such as weak implementation by some village health teams, health facility constraints such as poor use of standard guidelines, lack of placenta disposal pits, inadequate fuel for the ambulance at some facilities, and poor care for low birth weight infants. Sharing this information with key stakeholders prompted them to take appropriate actions. For example, the sub-county leadership constructed placenta disposal pits, the district health officer provided fuel for ambulances, and health workers received refresher training and mentorship on how to care for newborns. Diverse sources of information and perspectives can help researchers and decision-makers understand and adapt evidence to contexts for more effective interventions. Supporting districts to have crosscutting, routine information generating and sharing platforms that bring together stakeholders from different sectors is therefore crucial for the successful implementation of complex development interventions.

[Participation in health: systematization of the articles published in Brazilian journals--1988/2005].

PubMed

Cavalcanti, Maria de Lourdes Tavares; Cabral, Marta Henriques de Pina; Antunes, Ludmila Rodrigues

2012-07-01

This is a study involving the revision of 107 papers on participation in health, published in 25 Public Health journals, with a view to systematize its main focus points and identify the options for the participation of society in the health system. Bibliographic research was conducted using key words, and the reading of abstracts of articles published in national public health journals linked to the CAPES portal between 1988 and 2005. The articles selected were read and categorized according to methodological and thematic aspects. Three dimensions were identified: the main dimension emphasizes participation as a strategy for the enhancing of citizenship and recognition of the right to health; the second refers to participation as a strategy for democratization of the State and strengthening of the health system, including participation in political, managerial and inspection decisions; in the third dimension of community participation, individuals, families and the community share the responsibility for health with the State. In the works examined the participation in the health system is still in progress and highlights its importance as an incentive for social capital; however, some authors point to difficulties for effective participation in accordance with legal propositions.

Debates, divisions, and decisions: recombinant DNA advisory committee (RAC) authorization of the first human gene transfer experiments.

PubMed Central

Carmen, I H

1992-01-01

Possibly the most far-reaching, controversial research currently being conducted in the international biological science community involves human gene therapy experimentation. In this paper, I report the dynamics of the political process which ultimately found the Recombinant DNA Advisory Committee (RAC) of the National Institutes of Health approving for the first time protocols of this genre. A full appreciation of the policy-making dialogue shows that significant participants perceived the process from very different vantage points regarding the way in which the American political system works and the way in which it ought to work. I argue that, if we are to understand how the RAC should proceed in orchestrating a human gene therapy policy agenda, then we must flesh out and critically analyze these competing vantage points. To that end, I postulate seven possible "action models" for characterizing how protocol assessments of the type at issue might be developed given the nature of our politics, reaching the conclusion that one of these models holds out the most promise for synthesizing efficaciously the key factors involved. In conclusion, I discuss how the RAC might profitably employ this preferred strategy in these and other cases. PMID:1734711

Enzyme Sequestration as a Tuning Point in Controlling Response Dynamics of Signalling Networks

PubMed Central

Ollivier, Julien F.; Soyer, Orkun S.

2016-01-01

Signalling networks result from combinatorial interactions among many enzymes and scaffolding proteins. These complex systems generate response dynamics that are often essential for correct decision-making in cells. Uncovering biochemical design principles that underpin such response dynamics is a prerequisite to understand evolved signalling networks and to design synthetic ones. Here, we use in silico evolution to explore the possible biochemical design space for signalling networks displaying ultrasensitive and adaptive response dynamics. By running evolutionary simulations mimicking different biochemical scenarios, we find that enzyme sequestration emerges as a key mechanism for enabling such dynamics. Inspired by these findings, and to test the role of sequestration, we design a generic, minimalist model of a signalling cycle, featuring two enzymes and a single scaffolding protein. We show that this simple system is capable of displaying both ultrasensitive and adaptive response dynamics. Furthermore, we find that tuning the concentration or kinetics of the sequestering protein can shift system dynamics between these two response types. These empirical results suggest that enzyme sequestration through scaffolding proteins is exploited by evolution to generate diverse response dynamics in signalling networks and could provide an engineering point in synthetic biology applications. PMID:27163612