Decision-making when data and inferences are not conclusive: risk-benefit and acceptable regret approach.

PubMed

Hozo, Iztok; Schell, Michael J; Djulbegovic, Benjamin

2008-07-01

The absolute truth in research is unobtainable, as no evidence or research hypothesis is ever 100% conclusive. Therefore, all data and inferences can in principle be considered as "inconclusive." Scientific inference and decision-making need to take into account errors, which are unavoidable in the research enterprise. The errors can occur at the level of conclusions that aim to discern the truthfulness of research hypothesis based on the accuracy of research evidence and hypothesis, and decisions, the goal of which is to enable optimal decision-making under present and specific circumstances. To optimize the chance of both correct conclusions and correct decisions, the synthesis of all major statistical approaches to clinical research is needed. The integration of these approaches (frequentist, Bayesian, and decision-analytic) can be accomplished through formal risk:benefit (R:B) analysis. This chapter illustrates the rational choice of a research hypothesis using R:B analysis based on decision-theoretic expected utility theory framework and the concept of "acceptable regret" to calculate the threshold probability of the "truth" above which the benefit of accepting a research hypothesis outweighs its risks.

Development of Decision-Making Automated System for Optimal Placement of Physical Access Control System’s Elements

NASA Astrophysics Data System (ADS)

Danilova, Olga; Semenova, Zinaida

2018-04-01

The objective of this study is a detailed analysis of physical protection systems development for information resources. The optimization theory and decision-making mathematical apparatus is used to formulate correctly and create an algorithm of selection procedure for security systems optimal configuration considering the location of the secured object’s access point and zones. The result of this study is a software implementation scheme of decision-making system for optimal placement of the physical access control system’s elements.

Developing a Corrective Action Simulator to Support Decision Making Research and Training

DTIC Science & Technology

2008-05-01

positions, and any time-based simulation injects (e.g., JSTARS reporting tracks, the Engineer reporting a new aircraft bingo time, a threat being active...future instantiations would benefit from migrating to the IMPRINT Pro version. During the course of this development effort the Army Research...initiating corrective action when a subordinate is observed to make an error (of omission or commission) 58 • Benefits of a Corrective

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

PubMed

Wolf, Lisa

2013-02-01

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

20 CFR 401.70 - Appeals of refusals to correct records or refusals to allow access to records.

Code of Federal Regulations, 2010 CFR

2010-04-01

... explaining the decision on your appeal. The time limit for making our decision after we receive your appeal... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Appeals of refusals to correct records or refusals to allow access to records. 401.70 Section 401.70 Employees' Benefits SOCIAL SECURITY...

A Critical Meta-Analysis of Lens Model Studies in Human Judgment and Decision-Making

PubMed Central

Kaufmann, Esther; Reips, Ulf-Dietrich; Wittmann, Werner W.

2013-01-01

Achieving accurate judgment (‘judgmental achievement’) is of utmost importance in daily life across multiple domains. The lens model and the lens model equation provide useful frameworks for modeling components of judgmental achievement and for creating tools to help decision makers (e.g., physicians, teachers) reach better judgments (e.g., a correct diagnosis, an accurate estimation of intelligence). Previous meta-analyses of judgment and decision-making studies have attempted to evaluate overall judgmental achievement and have provided the basis for evaluating the success of bootstrapping (i.e., replacing judges by linear models that guide decision making). However, previous meta-analyses have failed to appropriately correct for a number of study design artifacts (e.g., measurement error, dichotomization), which may have potentially biased estimations (e.g., of the variability between studies) and led to erroneous interpretations (e.g., with regards to moderator variables). In the current study we therefore conduct the first psychometric meta-analysis of judgmental achievement studies that corrects for a number of study design artifacts. We identified 31 lens model studies (N = 1,151, k = 49) that met our inclusion criteria. We evaluated overall judgmental achievement as well as whether judgmental achievement depended on decision domain (e.g., medicine, education) and/or the level of expertise (expert vs. novice). We also evaluated whether using corrected estimates affected conclusions with regards to the success of bootstrapping with psychometrically-corrected models. Further, we introduce a new psychometric trim-and-fill method to estimate the effect sizes of potentially missing studies correct psychometric meta-analyses for effects of publication bias. Comparison of the results of the psychometric meta-analysis with the results of a traditional meta-analysis (which only corrected for sampling error) indicated that artifact correction leads to a) an increase in values of the lens model components, b) reduced heterogeneity between studies, and c) increases the success of bootstrapping. We argue that psychometric meta-analysis is useful for accurately evaluating human judgment and show the success of bootstrapping. PMID:24391781

A critical meta-analysis of lens model studies in human judgment and decision-making.

PubMed

Kaufmann, Esther; Reips, Ulf-Dietrich; Wittmann, Werner W

2013-01-01

Achieving accurate judgment ('judgmental achievement') is of utmost importance in daily life across multiple domains. The lens model and the lens model equation provide useful frameworks for modeling components of judgmental achievement and for creating tools to help decision makers (e.g., physicians, teachers) reach better judgments (e.g., a correct diagnosis, an accurate estimation of intelligence). Previous meta-analyses of judgment and decision-making studies have attempted to evaluate overall judgmental achievement and have provided the basis for evaluating the success of bootstrapping (i.e., replacing judges by linear models that guide decision making). However, previous meta-analyses have failed to appropriately correct for a number of study design artifacts (e.g., measurement error, dichotomization), which may have potentially biased estimations (e.g., of the variability between studies) and led to erroneous interpretations (e.g., with regards to moderator variables). In the current study we therefore conduct the first psychometric meta-analysis of judgmental achievement studies that corrects for a number of study design artifacts. We identified 31 lens model studies (N = 1,151, k = 49) that met our inclusion criteria. We evaluated overall judgmental achievement as well as whether judgmental achievement depended on decision domain (e.g., medicine, education) and/or the level of expertise (expert vs. novice). We also evaluated whether using corrected estimates affected conclusions with regards to the success of bootstrapping with psychometrically-corrected models. Further, we introduce a new psychometric trim-and-fill method to estimate the effect sizes of potentially missing studies correct psychometric meta-analyses for effects of publication bias. Comparison of the results of the psychometric meta-analysis with the results of a traditional meta-analysis (which only corrected for sampling error) indicated that artifact correction leads to a) an increase in values of the lens model components, b) reduced heterogeneity between studies, and c) increases the success of bootstrapping. We argue that psychometric meta-analysis is useful for accurately evaluating human judgment and show the success of bootstrapping.

32 CFR 806.29 - Administrative processing of Air Force FOIA requests.

Code of Federal Regulations, 2010 CFR

2010-07-01

.../service/a nongovernment source (Exemption 4), records are part of the Air Force's decision-making process... explanation of the decision-making process for intra-agency documents denied under the deliberative process... specific “compelling need” or due process/humanitarian need is true and correct to the best of their...

Analysis of Tactical, Decisional and Executional Behaviour according to the Level of Expertise in Squash

PubMed Central

Catalán-Eslava, María; González-Víllora, Sixto; Pastor-Vicedo, Juan C.; Contreras-Jordán, Onofre R.

2018-01-01

Abstract The objective of this study was to analyse the differences in tactical principles, decision-making and execution of the return shot and drop shot of squash players at different levels of proficiency. The sample was composed of 80 players, divided into four levels of expertise (first national category, second national category, autonomous regional level and provincial level). The Squash Performance Evaluation Tool was used for recording the level of decision-making and execution. The results revealed that reading of the context of the game improved as the level of the player’s expertise of both the return shot and the drop shot increased. The correlation between correct decision-making and better quality execution for both the return shot and the drop shot in squash also improved with the player’s level of expertise. According to these results, improvements in situational tactical principles and the application of tactical principles, correct decision-making and high-quality execution are essential to develop the athletic performance level among squash players. PMID:29599875

Recognition Memory zROC Slopes for Items with Correct versus Incorrect Source Decisions Discriminate the Dual Process and Unequal Variance Signal Detection Models

ERIC Educational Resources Information Center

Starns, Jeffrey J.; Rotello, Caren M.; Hautus, Michael J.

2014-01-01

We tested the dual process and unequal variance signal detection models by jointly modeling recognition and source confidence ratings. The 2 approaches make unique predictions for the slope of the recognition memory zROC function for items with correct versus incorrect source decisions. The standard bivariate Gaussian version of the unequal…

Early Huntington's Disease: Impulse Control Deficits but Correct Judgment Regarding Risky Situations.

PubMed

Galvez, Victor; Fernandez-Ruiz, Juan; Bayliss, Leo; Ochoa-Morales, Adriana; Hernandez-Castillo, Carlos R; Díaz, Rosalinda; Campos-Romo, Aurelio

2017-01-01

Huntington's disease (HD) patients show alterations in decision making tasks. However, it is still uncertain if these deficits are due to poor judgment regarding risky situations, or to impulse control deficits. To elucidate whether decision-making in patients is related to genuine risk behavior or to impulse control deficits. To test between these two alternative possibilities, we evaluated the performance of 19 prodromal HD patients and 19 matched healthy controls in the Cambridge Gambling Task (CGT). This task assesses decision-making while dissociating between genuine risk-taking behaviors (ascending condition) from impulsive behavior (descending condition). The results showed that patients and controls had the same performance during all trials in the ascending condition, reflecting a correct judgment regarding risky situations; however, during the descending condition, patients responded before the controls in all trials, making a significantly larger number of higher bets. Unlike the control group, they did not wait for more optimal subsequent options. These results suggest impulse control deficits in HD gene carriers, but unimpaired risk-taking judgment.

Rationality in the Academy: Why Responsibility Center Budgeting Is a Wrong Step Down the Wrong Road.

ERIC Educational Resources Information Center

Adams, E. M.

1997-01-01

Responsibility Center Budgeting/Management in higher education places at the heart of the university a mode of rationality in decision making that subverts educational policy and weakens the institution's ability for corrective cultural criticism. Academic leaders should make academic and research decisions based on students' and society's…

Decision-making without a brain: how an amoeboid organism solves the two-armed bandit.

PubMed

Reid, Chris R; MacDonald, Hannelore; Mann, Richard P; Marshall, James A R; Latty, Tanya; Garnier, Simon

2016-06-01

Several recent studies hint at shared patterns in decision-making between taxonomically distant organisms, yet few studies demonstrate and dissect mechanisms of decision-making in simpler organisms. We examine decision-making in the unicellular slime mould Physarum polycephalum using a classical decision problem adapted from human and animal decision-making studies: the two-armed bandit problem. This problem has previously only been used to study organisms with brains, yet here we demonstrate that a brainless unicellular organism compares the relative qualities of multiple options, integrates over repeated samplings to perform well in random environments, and combines information on reward frequency and magnitude in order to make correct and adaptive decisions. We extend our inquiry by using Bayesian model selection to determine the most likely algorithm used by the cell when making decisions. We deduce that this algorithm centres around a tendency to exploit environments in proportion to their reward experienced through past sampling. The algorithm is intermediate in computational complexity between simple, reactionary heuristics and calculation-intensive optimal performance algorithms, yet it has very good relative performance. Our study provides insight into ancestral mechanisms of decision-making and suggests that fundamental principles of decision-making, information processing and even cognition are shared among diverse biological systems. © 2016 The Authors.

Cognitive level and health decision-making in children: A preliminary study.

PubMed

Okwumabua, J O; Okwumabua, T M; Hayes, A; Stovall, K

1994-06-01

The study examines children's stage of cognitive development in relation to their patterns of health decision-making, including their cognitive capabilities in integrating the sequential stages of the decision-making process. A sample of 81 male (N=33) and female (N=48) students were drawn from two urban public schools in West Tennessee. All participants in the study were of African-American descent. The Centers for Disease Control Decision-Making Instrument was used to assess students' decision-making as well as their understanding of the decision-making process. The children's cognitive level was determined by their performance on three Piagetian conservation tasks. Findings revealed that both the preoperational and concrete operational children performed significantly below the formal operational children in terms of total correct responses to the decision-making scenarios. Error type analyses indicated that the preoperational children made more errors involving "skipped step" than did either the concrete or formal operational children. There were no significant differences between children's level of cognitive development and any other error type. Implications for health promotion and disease prevention programs among prevention practitioners who work regularly with children are discussed.

Training of perceptual-cognitive skills in offside decision making.

PubMed

Catteeuw, Peter; Gilis, Bart; Jaspers, Arne; Wagemans, Johan; Helsen, Werner

2010-12-01

This study investigates the effect of two off-field training formats to improve offside decision making. One group trained with video simulations and another with computer animations. Feedback after every offside situation allowed assistant referees to compensate for the consequences of the flash-lag effect and to improve their decision-making accuracy. First, response accuracy improved and flag errors decreased for both training groups implying that training interventions with feedback taught assistant referees to better deal with the flash-lag effect. Second, the results demonstrated no effect of format, although assistant referees rated video simulations higher for fidelity than computer animations. This implies that a cognitive correction to a perceptual effect can be learned also when the format does not correspond closely with the original perceptual situation. Off-field offside decision-making training should be considered as part of training because it is a considerable help to gain more experience and to improve overall decision-making performance.

Comprehensible knowledge model creation for cancer treatment decision making.

PubMed

Afzal, Muhammad; Hussain, Maqbool; Ali Khan, Wajahat; Ali, Taqdir; Lee, Sungyoung; Huh, Eui-Nam; Farooq Ahmad, Hafiz; Jamshed, Arif; Iqbal, Hassan; Irfan, Muhammad; Abbas Hydari, Manzar

2017-03-01

A wealth of clinical data exists in clinical documents in the form of electronic health records (EHRs). This data can be used for developing knowledge-based recommendation systems that can assist clinicians in clinical decision making and education. One of the big hurdles in developing such systems is the lack of automated mechanisms for knowledge acquisition to enable and educate clinicians in informed decision making. An automated knowledge acquisition methodology with a comprehensible knowledge model for cancer treatment (CKM-CT) is proposed. With the CKM-CT, clinical data are acquired automatically from documents. Quality of data is ensured by correcting errors and transforming various formats into a standard data format. Data preprocessing involves dimensionality reduction and missing value imputation. Predictive algorithm selection is performed on the basis of the ranking score of the weighted sum model. The knowledge builder prepares knowledge for knowledge-based services: clinical decisions and education support. Data is acquired from 13,788 head and neck cancer (HNC) documents for 3447 patients, including 1526 patients of the oral cavity site. In the data quality task, 160 staging values are corrected. In the preprocessing task, 20 attributes and 106 records are eliminated from the dataset. The Classification and Regression Trees (CRT) algorithm is selected and provides 69.0% classification accuracy in predicting HNC treatment plans, consisting of 11 decision paths that yield 11 decision rules. Our proposed methodology, CKM-CT, is helpful to find hidden knowledge in clinical documents. In CKM-CT, the prediction models are developed to assist and educate clinicians for informed decision making. The proposed methodology is generalizable to apply to data of other domains such as breast cancer with a similar objective to assist clinicians in decision making and education. Copyright © 2017 Elsevier Ltd. All rights reserved.

Impact of a Lung Cancer Screening Counseling and Shared Decision-Making Visit.

PubMed

Mazzone, Peter J; Tenenbaum, Amanda; Seeley, Meredith; Petersen, Hilary; Lyon, Christina; Han, Xiaozhen; Wang, Xiao-Feng

2017-03-01

Lung cancer screening is a complex balance of benefits and harms. A counseling and shared decision-making visit has been mandated to assist patients with the decision about participation in screening. To our knowledge, the impact of this visit on patient understanding and decisions has not been studied. We developed a centralized counseling and shared decision-making visit for our lung cancer screening program. The visit included confirmation of eligibility for screening, education supported by a narrated slide show, individualized risk assessment with a decision aid, time for answering questions, and data collection. We surveyed consecutive patients prior to the visit, immediately after the visit, and 1 month after the visit to determine the impact of the visit on their knowledge. Twenty-three of 423 patients (5.4%) who had a visit did not proceed to the screening CT scan. One hundred twenty-five consecutive patients completed the initial survey, 122 completed the postvisit survey, and 113 completed the 1-month follow-up survey. Prior to the visit, the patients had a poor level of understanding about the age and smoking eligibility criteria (8.8% and 13.6% correct, respectively) and the benefits and harms of screening (55.2% and 38.4% correct, respectively). There was a significant improvement in knowledge noted after the visit for all questions (P = .03 to P < .0001). Knowledge waned by the 1-month follow-up but remained higher than it was before the visit. A centralized counseling and shared decision-making visit impacts the patient's knowledge about the eligibility criteria, benefits, and harms of lung cancer screening with LDCT, helping patients make value-based decisions. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

34 CFR 5b.7 - Procedures for correction or amendment of records.

Code of Federal Regulations, 2010 CFR

2010-07-01

... necessary to accomplish a Department function. A subject individual making a request to amend or correct his... official's decision on the request within that 10 day period. (c) If the responsible Department official... correction, amendment, or deletion and, if accounting was made of prior disclosures of the record, all...

45 CFR 5b.7 - Procedures for correction or amendment of records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... making a request to amend or correct his record shall address his request to the responsible Department... informed of the responsible Department official's decision on the request within that 10 day period. (c) If... individual will be informed in writing of the correction, amendment, or deletion and, if accounting was made...

[Do media reports and public brochures facilitate informed decision making about cervical cancer prevention?].

PubMed

Neumeyer-Gromen, A; Bodemer, N; Müller, S M; Gigerenzer, G

2011-11-01

With the introduction and recommendation of the new HPV (human papillomavirus) vaccination in 2007, cervical cancer prevention has evoked large public interest. Is the public able to make informed decisions on the basis of media reports and brochures? To answer this question, an analysis of media coverage of HPV vaccination (Gardasil®) and Pap (Papanicolaou) screening was conducted from 2007-2009, which investigated the minimum requirement of completeness (pros and cons), transparency (absolute numbers), and correctness (references concerning outcome, uncertainty, magnitude) of the information. As a bench mark, facts boxes with concise data on epidemiology, etiology, benefits, harms, and costs were compiled in advance. Although all vaccination reports and brochures covered the impact of prevention, only 41% provided concrete numbers on effectiveness (90/220) and 2% on absolute risk reductions for the cancer surrogate dysplasia (5/220), whereby none of the latter numbers was correct. The prevention potential was correctly presented once. Only 48% (105/220) mentioned pros and cons. With regard to screening, 20% (4/20) provided explicit data on test quality and one expressed these in absolute numbers, while 25% (5/20) reported the prevention potential; all given numbers were correct. Finally, 25% (5/20) mentioned the possibility of false positive results. Minimum requirements were fulfilled by 1/220 vaccination and 1/20 screening reports. At present, informed decision making based on media coverage is hardly possible.

Role Of Synchrotron Techniques In USEPA Regulatory And Remediation Decisions

EPA Science Inventory

Science provides the foundation for credible decision making. Science is observation followed by an interpretation and understanding of the result of the measurement. Observations may not be correct, complete, or fully descriptive of the phenomena. Interpretation based on avai...

Accuracy of 'My Gut Feeling:' Comparing System 1 to System 2 Decision-Making for Acuity Prediction, Disposition and Diagnosis in an Academic Emergency Department.

PubMed

Cabrera, Daniel; Thomas, Jonathan F; Wiswell, Jeffrey L; Walston, James M; Anderson, Joel R; Hess, Erik P; Bellolio, M Fernanda

2015-09-01

Current cognitive sciences describe decision-making using the dual-process theory, where a System 1 is intuitive and a System 2 decision is hypothetico-deductive. We aim to compare the performance of these systems in determining patient acuity, disposition and diagnosis. Prospective observational study of emergency physicians assessing patients in the emergency department of an academic center. Physicians were provided the patient's chief complaint and vital signs and allowed to observe the patient briefly. They were then asked to predict acuity, final disposition (home, intensive care unit (ICU), non-ICU bed) and diagnosis. A patient was classified as sick by the investigators using previously published objective criteria. We obtained 662 observations from 289 patients. For acuity, the observers had a sensitivity of 73.9% (95% CI [67.7-79.5%]), specificity 83.3% (95% CI [79.5-86.7%]), positive predictive value 70.3% (95% CI [64.1-75.9%]) and negative predictive value 85.7% (95% CI [82.0-88.9%]). For final disposition, the observers made a correct prediction in 80.8% (95% CI [76.1-85.0%]) of the cases. For ICU admission, emergency physicians had a sensitivity of 33.9% (95% CI [22.1-47.4%]) and a specificity of 96.9% (95% CI [94.0-98.7%]). The correct diagnosis was made 54% of the time with the limited data available. System 1 decision-making based on limited information had a sensitivity close to 80% for acuity and disposition prediction, but the performance was lower for predicting ICU admission and diagnosis. System 1 decision-making appears insufficient for final decisions in these domains but likely provides a cognitive framework for System 2 decision-making.

10 CFR 1008.10 - Action in response to a request for correction or amendment of records.

Code of Federal Regulations, 2010 CFR

2010-01-01

... in making any determination about the individual, whether the information is as accurate, relevant... requester of the decision whenever possible. (b) If the decision cannot be reached within 10 working days... expected that the decision will be made. (c) The Privacy Act Officer, consistent with the recommendation of...

Using Covert Response Activation to Test Latent Assumptions of Formal Decision-Making Models in Humans.

PubMed

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

2015-07-15

Most decisions that we make build upon multiple streams of sensory evidence and control mechanisms are needed to filter out irrelevant information. Sequential sampling models of perceptual decision making have recently been enriched by attentional mechanisms that weight sensory evidence in a dynamic and goal-directed way. However, the framework retains the longstanding hypothesis that motor activity is engaged only once a decision threshold is reached. To probe latent assumptions of these models, neurophysiological indices are needed. Therefore, we collected behavioral and EMG data in the flanker task, a standard paradigm to investigate decisions about relevance. Although the models captured response time distributions and accuracy data, EMG analyses of response agonist muscles challenged the assumption of independence between decision and motor processes. Those analyses revealed covert incorrect EMG activity ("partial error") in a fraction of trials in which the correct response was finally given, providing intermediate states of evidence accumulation and response activation at the single-trial level. We extended the models by allowing motor activity to occur before a commitment to a choice and demonstrated that the proposed framework captured the rate, latency, and EMG surface of partial errors, along with the speed of the correction process. In return, EMG data provided strong constraints to discriminate between competing models that made similar behavioral predictions. Our study opens new theoretical and methodological avenues for understanding the links among decision making, cognitive control, and motor execution in humans. Sequential sampling models of perceptual decision making assume that sensory information is accumulated until a criterion quantity of evidence is obtained, from where the decision terminates in a choice and motor activity is engaged. The very existence of covert incorrect EMG activity ("partial error") during the evidence accumulation process challenges this longstanding assumption. In the present work, we use partial errors to better constrain sequential sampling models at the single-trial level. Copyright © 2015 the authors 0270-6474/15/3510371-15$15.00/0.

Simple Statistics: - Summarized!

ERIC Educational Resources Information Center

Blai, Boris, Jr.

Statistics are an essential tool for making proper judgement decisions. It is concerned with probability distribution models, testing of hypotheses, significance tests and other means of determining the correctness of deductions and the most likely outcome of decisions. Measures of central tendency include the mean, median and mode. A second…

Arthroscopy Journal Prizes Are Major Decisions.

PubMed

Lubowitz, James H; Brand, Jefferson C; Provencher, Matthew T; Rossi, Michael J

2016-01-01

According to the Harvard Business Review, the optimal number of people in a decision-making group is no more than 8. Thus, it is no surprise that 18 Arthroscopy journal associate editors had difficulty making a major decision. In the end, 18 editors did successfully select the 2015 winner of the Best Comparative Study Prize. All studies have limitations, but from a statistical standpoint, the editors believe that the conclusions of the winning study are likely correct. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Form and Objective of the Decision Rule in Absolute Identification

NASA Technical Reports Server (NTRS)

Balakrishnan, J. D.

1997-01-01

In several conditions of a line length identification experiment, the subjects' decision making strategies were systematically biased against the responses on the edges of the stimulus range. When the range and number of the stimuli were small, the bias caused the percentage of correct responses to be highest in the center and lowest on the extremes of the range. Two general classes of decision rules that would explain these results are considered. The first class assumes that subjects intend to adopt an optimal decision rule, but systematically misrepresent one or more parameters of the decision making context. The second class assumes that subjects use a different measure of performance than the one assumed by the experimenter: instead of maximizing the chances of a correct response, the subject attempts to minimize the expected size of the response error (a "fidelity criterion"). In a second experiment, extended experience and feedback did not diminish the bias effect, but explicitly penalizing all response errors equally, regardless of their size, did reduce or eliminate it in some subjects. Both results favor the fidelity criterion over the optimal rule.

Judgment and decision making.

PubMed

Mellers, B A; Schwartz, A; Cooke, A D

1998-01-01

For many decades, research in judgment and decision making has examined behavioral violations of rational choice theory. In that framework, rationality is expressed as a single correct decision shared by experimenters and subjects that satisfies internal coherence within a set of preferences and beliefs. Outside of psychology, social scientists are now debating the need to modify rational choice theory with behavioral assumptions. Within psychology, researchers are debating assumptions about errors for many different definitions of rationality. Alternative frameworks are being proposed. These frameworks view decisions as more reasonable and adaptive that previously thought. For example, "rule following." Rule following, which occurs when a rule or norm is applied to a situation, often minimizes effort and provides satisfying solutions that are "good enough," though not necessarily the best. When rules are ambiguous, people look for reasons to guide their decisions. They may also let their emotions take charge. This chapter presents recent research on judgment and decision making from traditional and alternative frameworks.

The Relationship of Decision-Making Styles and Attributional Styles in Addicted and Non-addicted Men.

PubMed

Shaghaghy, Farhad; Saffarinia, Majid; Iranpoor, Mohadeseh; Soltanynejad, Ali

2011-01-01

One of social problems which has affected our society and resulted in problems for different groups of people is drug abuse. This issue indicates a serious psychological, physical and social problem in community. Social skills have positive and successful influences in prevention of substance abuse. This includes the ability to explain events correctly and then appropriate decision making. This study compares decision making styles and attributional styles between addicted and non addicted men to recognize their role in addiction. In this study, 200 addicted and non addicted men were randomly selected. Decision-making style and attributional style questionnaires were used. Data analysis was performed by independent Student's t and Pearson correlation tests. The study population included 81 addicted and 90 non-addicted men. Addicted and non addicted men were significantly different in rational decision-making style (P < 0.05). Negative relationship was found between rational decision making and optimistic attribution style (r = -0.305, P < 0.01) and direct relationship was found between rational decision making and learned helplessness (r = 0.309, P < 0.01). Our study showed that addicts are less rational in decision making and addicts that developed learned helplessness were less rational and did not have optimistic attribution style. These issues show that addiction institutions and therapists have to pay attention to cognitive factors for addiction prevention.

Cognitive reflection vs. calculation in decision making

PubMed Central

Sinayev, Aleksandr; Peters, Ellen

2015-01-01

Scores on the three-item Cognitive Reflection Test (CRT) have been linked with dual-system theory and normative decision making (Frederick, 2005). In particular, the CRT is thought to measure monitoring of System 1 intuitions such that, if cognitive reflection is high enough, intuitive errors will be detected and the problem will be solved. However, CRT items also require numeric ability to be answered correctly and it is unclear how much numeric ability vs. cognitive reflection contributes to better decision making. In two studies, CRT responses were used to calculate Cognitive Reflection and numeric ability; a numeracy scale was also administered. Numeric ability, measured on the CRT or the numeracy scale, accounted for the CRT's ability to predict more normative decisions (a subscale of decision-making competence, incentivized measures of impatient and risk-averse choice, and self-reported financial outcomes); Cognitive Reflection contributed no independent predictive power. Results were similar whether the two abilities were modeled (Study 1) or calculated using proportions (Studies 1 and 2). These findings demonstrate numeric ability as a robust predictor of superior decision making across multiple tasks and outcomes. They also indicate that correlations of decision performance with the CRT are insufficient evidence to implicate overriding intuitions in the decision-making biases and outcomes we examined. Numeric ability appears to be the key mechanism instead. PMID:25999877

Cognitive reflection vs. calculation in decision making.

PubMed

Sinayev, Aleksandr; Peters, Ellen

2015-01-01

Scores on the three-item Cognitive Reflection Test (CRT) have been linked with dual-system theory and normative decision making (Frederick, 2005). In particular, the CRT is thought to measure monitoring of System 1 intuitions such that, if cognitive reflection is high enough, intuitive errors will be detected and the problem will be solved. However, CRT items also require numeric ability to be answered correctly and it is unclear how much numeric ability vs. cognitive reflection contributes to better decision making. In two studies, CRT responses were used to calculate Cognitive Reflection and numeric ability; a numeracy scale was also administered. Numeric ability, measured on the CRT or the numeracy scale, accounted for the CRT's ability to predict more normative decisions (a subscale of decision-making competence, incentivized measures of impatient and risk-averse choice, and self-reported financial outcomes); Cognitive Reflection contributed no independent predictive power. Results were similar whether the two abilities were modeled (Study 1) or calculated using proportions (Studies 1 and 2). These findings demonstrate numeric ability as a robust predictor of superior decision making across multiple tasks and outcomes. They also indicate that correlations of decision performance with the CRT are insufficient evidence to implicate overriding intuitions in the decision-making biases and outcomes we examined. Numeric ability appears to be the key mechanism instead.

Satisficing in split-second decision making is characterized by strategic cue discounting.

PubMed

Oh, Hanna; Beck, Jeffrey M; Zhu, Pingping; Sommer, Marc A; Ferrari, Silvia; Egner, Tobias

2016-12-01

Much of our real-life decision making is bounded by uncertain information, limitations in cognitive resources, and a lack of time to allocate to the decision process. It is thought that humans overcome these limitations through satisficing, fast but "good-enough" heuristic decision making that prioritizes some sources of information (cues) while ignoring others. However, the decision-making strategies we adopt under uncertainty and time pressure, for example during emergencies that demand split-second choices, are presently unknown. To characterize these decision strategies quantitatively, the present study examined how people solve a novel multicue probabilistic classification task under varying time pressure, by tracking shifts in decision strategies using variational Bayesian inference. We found that under low time pressure, participants correctly weighted and integrated all available cues to arrive at near-optimal decisions. With increasingly demanding, subsecond time pressures, however, participants systematically discounted a subset of the cue information by dropping the least informative cue(s) from their decision making process. Thus, the human cognitive apparatus copes with uncertainty and severe time pressure by adopting a "drop-the-worst" cue decision making strategy that minimizes cognitive time and effort investment while preserving the consideration of the most diagnostic cue information, thus maintaining "good-enough" accuracy. This advance in our understanding of satisficing strategies could form the basis of predicting human choices in high time pressure scenarios. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Are multiple-trial experiments appropriate for eyewitness identification studies? Accuracy, choosing, and confidence across trials.

PubMed

Mansour, J K; Beaudry, J L; Lindsay, R C L

2017-12-01

Eyewitness identification experiments typically involve a single trial: A participant views an event and subsequently makes a lineup decision. As compared to this single-trial paradigm, multiple-trial designs are more efficient, but significantly reduce ecological validity and may affect the strategies that participants use to make lineup decisions. We examined the effects of a number of forensically relevant variables (i.e., memory strength, type of disguise, degree of disguise, and lineup type) on eyewitness accuracy, choosing, and confidence across 12 target-present and 12 target-absent lineup trials (N = 349; 8,376 lineup decisions). The rates of correct rejections and choosing (across both target-present and target-absent lineups) did not vary across the 24 trials, as reflected by main effects or interactions with trial number. Trial number had a significant but trivial quadratic effect on correct identifications (OR = 0.99) and interacted significantly, but again trivially, with disguise type (OR = 1.00). Trial number did not significantly influence participants' confidence in correct identifications, confidence in correct rejections, or confidence in target-absent selections. Thus, multiple-trial designs appear to have minimal effects on eyewitness accuracy, choosing, and confidence. Researchers should thus consider using multiple-trial designs for conducting eyewitness identification experiments.

Knowledge of risk factors and the periodontal disease-systemic link in dental students' clinical decisions.

PubMed

Friesen, Lynn Roosa; Walker, Mary P; Kisling, Rebecca E; Liu, Ying; Williams, Karen B

2014-09-01

This study evaluated second-, third-, and fourth-year dental students' ability to identify systemic conditions associated with periodontal disease, risk factors most important for referral, and medications with an effect on the periodontium and their ability to apply this knowledge to make clinical decisions regarding treatment and referral of periodontal patients. A twenty-one question survey was administered at one U.S. dental school in the spring semester of 2012 to elicit the students' knowledge and confidence regarding clinical reasoning. The response rate was 86 percent. Periodontal risk factors were accurately selected by at least 50 percent of students in all three classes; these were poorly controlled diabetes, ≥6 mm pockets posteriorly, and lack of response to previous non-surgical therapy. Confidence in knowledge, knowledge of risk factors, and knowledge of medications with an effect on the periodontium improved with training and were predictive of better referral decision making. The greatest impact of training was seen on the students' ability to make correct decisions about referral and treatment for seven clinical scenarios. Although the study found a large increase in the students' abilities from the second through fourth years, the mean of 4.6 (out of 7) for the fourth-year students shows that, on average, those students missed correct treatment or referral on more than two of seven clinical cases. These results suggest that dental curricula should emphasize more critical decision making with respect to referral and treatment criteria in managing the periodontal patient.

Ethical Decisions in Experience-Based Training and Development Programs.

ERIC Educational Resources Information Center

Gass, Michael A.; Wurdinger, Scott

1993-01-01

Illustrates how principle and virtue ethics can be applied to decision-making processes in experience-based training and development programs. Principle ethics is guided by predetermined rules and assumes that issues being examined are somewhat similar in context, whereas virtue ethics assumes that "correct behavior" is determined from…

Dynamic Computation Offloading for Low-Power Wearable Health Monitoring Systems.

PubMed

Kalantarian, Haik; Sideris, Costas; Mortazavi, Bobak; Alshurafa, Nabil; Sarrafzadeh, Majid

2017-03-01

The objective of this paper is to describe and evaluate an algorithm to reduce power usage and increase battery lifetime for wearable health-monitoring devices. We describe a novel dynamic computation offloading scheme for real-time wearable health monitoring devices that adjusts the partitioning of data processing between the wearable device and mobile application as a function of desired classification accuracy. By making the correct offloading decision based on current system parameters, we show that we are able to reduce system power by as much as 20%. We demonstrate that computation offloading can be applied to real-time monitoring systems, and yields significant power savings. Making correct offloading decisions for health monitoring devices can extend battery life and improve adherence.

"Decision sidestepping: How the motivation for closure prompts individuals to bypass decision making": Correction to Otto et al. (2016).

PubMed

2016-09-01

Reports an error in "Decision sidestepping: How the motivation for closure prompts individuals to bypass decision making" by Ashley S. Otto, Joshua J. Clarkson and Frank R. Kardes ( Journal of Personality and Social Psychology , 2016[Jul], Vol 111[1], 1-16). In the article, the main heading for Experiment 3 was missing due to a production error, and the first sentence of the first paragraph of Experiment 3 should begin as follows: Experiment 2 offered support for the hypothesis that those seeking closure engage in decision sidestepping to reduce the bothersome nature of decision making. (The following abstract of the original article appeared in record 2016-30159-001.) We all too often have to make decisions—from the mundane (e.g., what to eat for breakfast) to the complex (e.g., what to buy a loved one)—and yet there exists a multitude of strategies that allows us to make a decision. This work focuses on a subset of decision strategies that allows individuals to make decisions by bypassing the decision-making process—a phenomenon we term decision sidestepping. Critical to the present manuscript, however, we contend that decision sidestepping stems from the motivation to achieve closure. We link this proposition back to the fundamental nature of closure and how those seeking closure are highly bothered by decision making. As such, we argue that the motivation to achieve closure prompts a reliance on sidestepping strategies (e.g., default bias, choice delegation, status quo bias, inaction inertia, option fixation) to reduce the bothersome nature of decision making. In support of this framework, five experiments demonstrate that (a) those seeking closure are more likely to engage in decision sidestepping, (b) the effect of closure on sidestepping stems from the bothersome nature of decision making, and (c) the reliance on sidestepping results in downstream consequences for subsequent choice. Taken together, these findings offer unique insight into the cognitive motivations stimulating a reliance on decision sidestepping and thus a novel framework by which to understand how individuals make decisions while bypassing the decision-making process. PsycINFO Database Record (c) 2016 APA, all rights reserved

Manipulating memory efficacy affects the behavioral and neural profiles of deterministic learning and decision-making.

PubMed

Tremel, Joshua J; Ortiz, Daniella M; Fiez, Julie A

2018-06-01

When making a decision, we have to identify, collect, and evaluate relevant bits of information to ensure an optimal outcome. How we approach a given choice can be influenced by prior experience. Contextual factors and structural elements of these past decisions can cause a shift in how information is encoded and can in turn influence later decision-making. In this two-experiment study, we sought to manipulate declarative memory efficacy and decision-making in a concurrent discrimination learning task by altering the amount of information to be learned. Subjects learned correct responses to pairs of items across several repetitions of a 50- or 100-pair set and were tested for memory retention. In one experiment, this memory test interrupted learning after an initial encoding experience in order to test for early encoding differences and associate those differences with changes in decision-making. In a second experiment, we used fMRI to probe neural differences between the two list-length groups related to decision-making across learning and assessed subsequent memory retention. We found that a striatum-based system was associated with decision-making patterns when learning a longer list of items, while a medial cortical network was associated with patterns when learning a shorter list. Additionally, the hippocampus was exclusively active for the shorter list group. Altogether, these behavioral, computational, and imaging results provide evidence that multiple types of mnemonic representations contribute to experienced-based decision-making. Moreover, contextual and structural factors of the task and of prior decisions can influence what types of evidence are drawn upon during decision-making. Copyright © 2018 Elsevier Ltd. All rights reserved.

Cost vs. Risk: Determining the Correct Liability Insurance Limit.

ERIC Educational Resources Information Center

Klinksiek, Glenn

1996-01-01

Presents a model for evaluating liability insurance limits and selecting the correct limit for an individual institution. Argues that many colleges and universities may be making overly conservative decisions that lead to the purchase of too much liability insurance. Also discusses the financial consequences of an uninsured large liability loss.…

The Law of Categorical Judgment (Corrected) and the Interpretation of Changes in Psychophysical Performance

ERIC Educational Resources Information Center

Rosner, Burton S.; Kochanski, Greg

2009-01-01

Signal detection theory (SDT) makes the frequently challenged assumption that decision criteria have no variance. An extended model, the Law of Categorical Judgment, relaxes this assumption. The long accepted equation for the law, however, is flawed: It can generate negative probabilities. The correct equation, the Law of Categorical Judgment…

77 FR 22345 - Agency Information Collection Activities: Proposed Collection; Comments Requested; Body Armor in...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-13

... correctional officers, such as the proportion who have body armor, the rate of use, the decision-making factors... Collection; Comments Requested; Body Armor in Correctional Institutions Survey ACTION: 60-day notice of... Collection: Establishment survey and initial approval of collection. (2) Title of Form/Collection: Body Armor...

Adaptive Criterion Setting in Perceptual Decision Making

ERIC Educational Resources Information Center

Stuttgen, Maik C.; Yildiz, Ali; Gunturkun, Onur

2011-01-01

Pigeons responded in a perceptual categorization task with six different stimuli (shades of gray), three of which were to be classified as "light" or "dark", respectively. Reinforcement probability for correct responses was varied from 0.2 to 0.6 across blocks of sessions and was unequal for correct light and dark responses. Introduction of a new…

Effects of Direct and Indirect Instruction on Fostering Decision-Making Competence in Socioscientific Issues

NASA Astrophysics Data System (ADS)

Böttcher, Florian; Meisert, Anke

2013-04-01

In this study the effects of different learning environments on the promotion of decision-making competence for the socioscientific issue of genetically modified crops is investigated. The comparison focuses on direct vs. indirect instructions. Therefore on the one hand a sophisticated decision-making strategy was presented to the directly instructed experimental group (1) and had to be applied correctly. On the other hand indirectly instructed students had to invent an appropriate strategy by themselves (2) based on the given information and the structure of the problem context. Group discussions are analysed qualitatively in order (1) to outline how the given strategy was understood and its results were reflected on by the students and (2) to explore the characteristics of invented strategies and their degree of complexity. Results indicate that the direct instruction of complex decision-making strategies may lead to a lack of understanding of the decision process when the given strategy is applied and therefore may cause rejection of the final decision. Indirectly instructed students were able to invent sophisticated decision-making strategies containing compensatory trade-offs. It is concluded that when directly instructing complex decision-making strategies, essential parts of reflection have to be integrated in order to gain greater transparency. Accordingly, empirical evidence has been found to consider indirect instruction as a possible way to foster decision-making strategies for complex socioscientific issues even if compensatory procedures are considered to be necessary.

Developmental and Gender Related Differences in Response Switches after Nonrepresentative Negative Feedback

ERIC Educational Resources Information Center

Jansen, Brenda R. J.; van Duijvenvoorde, Anna C. K.; Huizenga, Hilde M.

2014-01-01

In many decision making tasks negative feedback is probabilistic and, as a consequence, may be given when the decision is actually correct. This feedback can be referred to as nonrepresentative negative feedback. In the current study, we investigated developmental and gender related differences in such switching after nonrepresentative negative…

Doubly Bayesian Analysis of Confidence in Perceptual Decision-Making.

PubMed

Aitchison, Laurence; Bang, Dan; Bahrami, Bahador; Latham, Peter E

2015-10-01

Humans stand out from other animals in that they are able to explicitly report on the reliability of their internal operations. This ability, which is known as metacognition, is typically studied by asking people to report their confidence in the correctness of some decision. However, the computations underlying confidence reports remain unclear. In this paper, we present a fully Bayesian method for directly comparing models of confidence. Using a visual two-interval forced-choice task, we tested whether confidence reports reflect heuristic computations (e.g. the magnitude of sensory data) or Bayes optimal ones (i.e. how likely a decision is to be correct given the sensory data). In a standard design in which subjects were first asked to make a decision, and only then gave their confidence, subjects were mostly Bayes optimal. In contrast, in a less-commonly used design in which subjects indicated their confidence and decision simultaneously, they were roughly equally likely to use the Bayes optimal strategy or to use a heuristic but suboptimal strategy. Our results suggest that, while people's confidence reports can reflect Bayes optimal computations, even a small unusual twist or additional element of complexity can prevent optimality.

75 FR 26739 - Information Collection Requirement; Defense Federal Acquisition Regulation Supplement; Part 244...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-12

.... Needs and Uses: Administrative contracting officers use this information in making decisions to grant, withhold, or withdraw purchasing system approval at the conclusion of a purchasing system review... for correcting deficiencies or making improvements to its purchasing system. Ynette R. Shelkin, Editor...

Surrogate decision making: do we have to trade off accuracy and procedural satisfaction?

PubMed

Frey, Renato; Hertwig, Ralph; Herzog, Stefan M

2014-02-01

Making surrogate decisions on behalf of incapacitated patients can raise difficult questions for relatives, physicians, and society. Previous research has focused on the accuracy of surrogate decisions (i.e., the proportion of correctly inferred preferences). Less attention has been paid to the procedural satisfaction that patients' surrogates and patients attribute to specific approaches to making surrogate decisions. The objective was to investigate hypothetical patients' and surrogates' procedural satisfaction with specific approaches to making surrogate decisions and whether implementing these preferences would lead to tradeoffs between procedural satisfaction and accuracy. Study 1 investigated procedural satisfaction by assigning participants (618 in a mixed-age but relatively young online sample and 50 in an older offline sample) to the roles of hypothetical surrogates or patients. Study 2 (involving 64 real multigenerational families with a total of 253 participants) investigated accuracy using 24 medical scenarios. Hypothetical patients and surrogates had closely aligned preferences: Procedural satisfaction was highest with a patient-designated surrogate, followed by shared surrogate decision-making approaches and legally assigned surrogates. These approaches did not differ substantially in accuracy. Limitations are that participants' preferences regarding existing and novel approaches to making surrogate decisions can only be elicited under hypothetical conditions. Next to decision making by patient-designated surrogates, shared surrogate decision making is the preferred approach among patients and surrogates alike. This approach appears to impose no tradeoff between procedural satisfaction and accuracy. Therefore, shared decision making should be further studied in representative samples of the general population, and if people's preferences prove to be robust, they deserve to be weighted more strongly in legal frameworks in addition to patient-designated surrogates.

Recognition Decisions From Visual Working Memory Are Mediated by Continuous Latent Strengths.

PubMed

Ricker, Timothy J; Thiele, Jonathan E; Swagman, April R; Rouder, Jeffrey N

2017-08-01

Making recognition decisions often requires us to reference the contents of working memory, the information available for ongoing cognitive processing. As such, understanding how recognition decisions are made when based on the contents of working memory is of critical importance. In this work we examine whether recognition decisions based on the contents of visual working memory follow a continuous decision process of graded information about the correct choice or a discrete decision process reflecting only knowing and guessing. We find a clear pattern in favor of a continuous latent strength model of visual working memory-based decision making, supporting the notion that visual recognition decision processes are impacted by the degree of matching between the contents of working memory and the choices given. Relation to relevant findings and the implications for human information processing more generally are discussed. Copyright © 2016 Cognitive Science Society, Inc.

A patient decision aid regarding antithrombotic therapy for stroke prevention in atrial fibrillation: a randomized controlled trial.

PubMed

Man-Son-Hing, M; Laupacis, A; O'Connor, A M; Biggs, J; Drake, E; Yetisir, E; Hart, R G

1999-08-25

Decision aids are tools designed to help patients participate in the clinical decision-making process. To determine whether use of an audiobooklet (AB) decision aid explaining the results of a clinical trial affected the decision-making process of study participants. Randomized controlled trial conducted from May 1997 to April 1998. Fourteen centers that participated in the Stroke Prevention in Atrial Fibrillation (SPAF) III trial. A total of 287 patients from the SPAF III aspirin cohort study, in which patients with atrial fibrillation and a relatively low risk of stroke received 325 mg/d of aspirin and were followed up for a mean of 2 years. At the end of SPAF III, participants were randomized to be informed of the study results with usual care plus use of an AB (AB group) vs usual care alone (control group). The AB included pertinent information to help patients decide whether to continue taking aspirin or switch to warfarin. Patients' ability to make choices regarding antithrombotic therapy, and 6-month adherence to these decisions. Their knowledge, expectations, decisional conflict (the amount of uncertainty about the course of action to take), and satisfaction with the decision-making process were also measured. More patients in the AB group made a choice about antithrombotic therapy than in the control group (99% vs 94%; P = .02). Patients in the AB group were more knowledgeable and had more realistic expectations about the risk of stroke and hemorrhage (in the AB group, 53%-80% correctly estimated different risks; in the control group, 16%-28% gave correct estimates). Decisional conflict and satisfaction were similar for the 2 groups. After 6 months, a similar percentage of patients were still taking their initial choice of antithrombotic therapy (95% vs 93%; P = .44). For patients with atrial fibrillation who had participated in a major clinical trial, the use of an AB decision aid improved their understanding of the benefits and risks associated with different treatment options and helped them make definitive choices about which therapy to take. Further studies are necessary to evaluate the acceptability and impact of decision aids in other clinical settings.

Reasons for family involvement in elective surgical decision-making in Taiwan: a qualitative study.

PubMed

Lin, Mei-Ling; Huang, Chuen-Teng; Chen, Ching-Huey

2017-07-01

To inquire into the reasons for family involvement in adult patients' surgical decision-making processes from the point of view of the patients' family. Making a patient the centre of medical decision-making is essential for respecting individual's autonomy. However, in a Chinese society, family members are often deeply involved in a patient's medical decision-making. Although family involvement has long been viewed as an aspect of the Chinese culture, empirical evidence of the reasons for family involvement in medical decision-making has been lacking. A qualitative study. In order to record and examine reasons for family involvement in adult patients' surgical decision-making, 12 different family members of 12 elective surgery patients were interviewed for collecting and analysing data. Three major reasons for family involvement emerged from the data analyses: (1) to share responsibility; (2) to ensure the correctness of medical information; and (3) to safeguard the patient's well-being. These findings also reveal that culture is not the only reason for family involvement. Making decision to undergo a surgery is a tough and stressful process for a patient. Family may provide the patient with timely psychological support to assist the patient to communicate with his or her physician(s) and other medical personnel to ensure their rights. It is also found that due to the imbalanced doctor-patient power relationship, a patient may be unable, unwilling to, or even dare not, tell the whole truth about his or her illness or feelings to the medical personnel. Thus, a patient would expect his or her family to undertake such a mission during the informed consent and decision-making processes. The results of this study may provide medical professionals with relevant insights into family involvement in adult patients' surgical decision-making. © 2016 John Wiley & Sons Ltd.

On the value of endangered and other species

NASA Astrophysics Data System (ADS)

Sagoff, Mark

1996-11-01

This paper describes two frameworks—utilitarian and Kantian—society uses to make decisions concerning environmental management and, in particular, species protection. The utilitarian framework emphasizes the consequences of choices for prior preferences. A perfectly competitive market, on this model, correctly values environmental resources. The Kantian approach identifies rules appropriate to recognized situations given the identity of the decision maker. It relies on democratic political processes and institutions to provide the means by which citizens determine the identity of their community—its moral character and aspirations—and match appropriate rules to recognized situations. This paper argues that markets do not fail in any general way in measuring the economic value of plants and animals. Market prices, in general, correctly represent the marginal or exchange value of species. If society legislates against extinction, this must be understood as an exercise in Kantian decision making in view of the moral value of species, not as an attempt to “correct” a market failure or to promote social welfare or utility.

[Decision making and executive function in severe traumatic brain injured patients: validation of a decision-making task and correlated features].

PubMed

Wiederkehr, S; Barat, M; Dehail, P; de Sèze, M; Lozes-Boudillon, S; Giroire, J-M

2005-02-01

At the chronic stage, severe traumatic brain injured (TBI) patients experience difficulty in making decisions. Several studies have demonstrated the involvement of the prefrontal cortex, in particular the orbitofrontal region, in decision-making. The aim of the present study was to validate a decision-making task in this population and to ascertain whether the components of their dysexecutive syndrome may affect their decision-making and lead to difficulties for social rehabilitation. Fifteen TBI patients and 15 controlled subjects matched for age, sex and years of education were assessed by a battery of executive tests (GREFEX) and by the gambling task (GT). The TBI subjects performed significantly worse than the controlled group in five out of six GREFEX tests. The TBI choices are significantly more disadvantageous than the choices of the control group when considering the three last blocks of 20 cards of the GT. The GT total score correlated significantly with execution time of the Stroop interference condition and the Trail Making Task B, as well as with the two measures (correct sequence span and number of crossed boxes) of the double condition of Baddeley's task. We postulate that executive functioning (supervisory attentional system) influence performance in the gambling task through mechanisms of inhibitory control, divided attention and working memory. Thus, this task seems to be determined by multiple factors; the process of decision-making may depend on frontal integrity.

Toward Online Measurement of Decision State

NASA Technical Reports Server (NTRS)

Lachter, Joel; Johnston, James C.; Corrado, Greg S.; McClelland, James L.

2009-01-01

In traditional perceptual decision-making experiments, two pieces of data are collected on each trial: response time and accuracy. But how confident were participants and how did their decision state evolve over time? We asked participants to provide a continuous readout of their decision state by moving a cursor along a sliding scale between a 100% certain left response and a 100% certain right response. Subjects did not terminate the trials; rather, trials were timed out at random and subjects were scored based on the cursor position at that time. Higher rewards for correct responses and higher penalties for errors were associated with extreme responses so that the response with the highest expected value was that which accurately reflected the participant's odds of being correct. This procedure encourages participants to expose the time-course of their evolving decision state. Evidence on how well they can do this will be presented.

Toward Online Measurement of Decision State

NASA Technical Reports Server (NTRS)

Lachter, Joel; Johnston, James C.; Corrado, Greg S.; McClelland, James L.

2009-01-01

In traditional perceptual decision-making experiments, two pieces of data recollected on each trial: response time and accuracy. But how confident were participants and how did their decision state evolve over time? We asked participants to provide a continuous readout of their decision state by moving a cursor along a sliding scale between a 100% certain left response and a 100% certain right response. Subjects did not terminate the trials; rather, trials were timed out at random and subjects were scored based on the cursor position at the time. Higher rewards for correct responses and higher penalties for errors were associated with extreme responses so that the response with the highest ex[pected value was that which accurately reflected the participant's odds of being correct. This procedure encourages participants to expose the time-course of their evolving decision state. Evidence on how well they can do this will be presented.

First-degree relatives of suicide completers may have impaired decision-making but functional cognitive control.

PubMed

Hoehne, A; Richard-Devantoy, S; Ding, Y; Turecki, G; Jollant, F

2015-09-01

The heritability of suicide is well established. Transmission of risk appears to follow traits more than disorders like depression. In the present project, we aimed at investigating the potential for transmission of cognitive deficits previously observed in suicide attempters, specifically impaired decision-making and cognitive control. Seventeen healthy first-degree relatives of suicide completers with no personal history of suicidal act were compared to 18 first-degree relatives of individuals with major depressive disorder but no family history of suicidal act, and 19 healthy controls. Decision-making was assessed with the Iowa Gambling Task, and cognitive control with the Stroop Task, the Hayling Sentence Completion Test, and the Trail-Making Test. Both suicide and depressed relatives showed lower gambling task net scores than healthy controls. However, there were trends toward lower learning abilities in suicide than depressed relatives (interaction: p = 0.07), with more risky choices at the end of the test. Suicide relatives also showed a higher number of self-corrected errors relative to the total number of errors in the Stroop colour test compared to both control groups, with no difference in interference scores. There was no group-difference for any other cognitive tests. Our findings suggest that decision-making impairment may be found in healthy relatives of suicides and represent a cognitive endophenotype of suicidal behaviour. Normal cognitive control (or self-corrected deficits) may protect relatives against suicidal acts. Impairments in value-based and control processes may, therefore, be part of the suicide vulnerability and represent potential targets of preventative interventions. Copyright © 2015 Elsevier Ltd. All rights reserved.

16 CFR 1014.8 - Appeal of initial denial of access, correction or amendment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... a record is denied, in whole or in part, may appeal that decision within 30 working days to the... and shall: (1) Name the individual making the appeal; (2) Identify the record to which access is... decision thereon. However, for good cause shown, the Chairman of the Commission may extend the 30-day...

A fuzzy gear shifting strategy for manual transmissions

NASA Astrophysics Data System (ADS)

Mashadi, B.; Kazemkhani, A.

2005-12-01

Governing parameters in decision making for gear changing of an automated manual transmission are discussed based on two different criteria, namely engine working conditions and driver's intention. By taking into consideration the effects of these parameters, gear shifting strategy is designed with the application of Fuzzy control method. The controller structure is formed in two layers. In the first layer two fuzzy inference modules are used to determine necessary outputs. In second layer a fuzzy inference module makes the decision of shifting by up-shift, downshift or maintain commands. The quality of Fuzzy controller behavior is examined by making use of ADVISOR software. It is shown that at different driving conditions the controller makes correct decisions for gear shifting accounting for dynamical requirements of vehicle. It is also shown that the controller based on both engine state and driver's intention eliminates unnecessary shiftings that are present when the intention is ignored. A micro-trip is designed in which a required speed in the form of a step function is demanded for the vehicle. Starting from rest both strategies change the gear to reach maximum speed more or less in a similar fashion. In deceleration phase, however, large differences are observed between the two strategies. The engine-state strategy is less sensitive to downshift, taking even unnecessary up shift decisions. The state-intention strategy, however, correctly interprets the driver's intention for decreasing speed and utilizes engine brake torque to reduce vehicle speed in a shorter time.

Discriminating talent-identified junior Australian football players using a video decision-making task.

PubMed

Woods, Carl T; Raynor, Annette J; Bruce, Lyndell; McDonald, Zane

2016-01-01

This study examined if a video decision-making task could discriminate talent-identified junior Australian football players from their non-talent-identified counterparts. Participants were recruited from the 2013 under 18 (U18) West Australian Football League competition and classified into two groups: talent-identified (State U18 Academy representatives; n = 25; 17.8 ± 0.5 years) and non-talent-identified (non-State U18 Academy selection; n = 25; 17.3 ± 0.6 years). Participants completed a video decision-making task consisting of 26 clips sourced from the Australian Football League game-day footage, recording responses on a sheet provided. A score of "1" was given for correct and "0" for incorrect responses, with the participants total score used as the criterion value. One-way analysis of variance tested the main effect of "status" on the task criterion, whilst a bootstrapped receiver operating characteristic (ROC) curve assessed the discriminant ability of the task. An area under the curve (AUC) of 1 (100%) represented perfect discrimination. Between-group differences were evident (P < 0.05) and the ROC curve was maximised with a score of 15.5/26 (60%) (AUC = 89.0%), correctly classifying 92% and 76% of the talent-identified and non-talent-identified participants, respectively. Future research should investigate the mechanisms leading to the superior decision-making observed in the talent-identified group.

Correcting the bias against interdisciplinary research.

PubMed

Shapiro, Ehud

2014-04-01

When making decisions about funding and jobs the scientific community should recognise that most of the tools used to evaluate scientific excellence are biased in favour of established disciplines and against interdisciplinary research.

The use of a cognitive task analysis-based multimedia program to teach surgical decision making in flexor tendon repair.

PubMed

Luker, Kali R; Sullivan, Maura E; Peyre, Sarah E; Sherman, Randy; Grunwald, Tiffany

2008-01-01

The aim of this study was to compare the surgical knowledge of residents before and after receiving a cognitive task analysis-based multimedia teaching module. Ten plastic surgery residents were evaluated performing flexor tendon repair on 3 occasions. Traditional learning occurred between the first and second trial and served as the control. A teaching module was introduced as an intervention between the second and third trial using cognitive task analysis to illustrate decision-making skills. All residents showed improvement in their decision-making ability when performing flexor tendon repair after each surgical procedure. The group improved through traditional methods as well as exposure to our talk-aloud protocol (P > .01). After being trained using the cognitive task analysis curriculum the group displayed a statistically significant knowledge expansion (P < .01). Residents receiving cognitive task analysis-based multimedia surgical curriculum instruction achieved greater command of problem solving and are better equipped to make correct decisions in flexor tendon repair.

Consistency of the Relations of Cognitive Ability and Personality Traits to Pilot Training Performance

DTIC Science & Technology

2014-08-22

MAB-II scores. The univariate Case II correction ( Thorndike , 1949) was used for the NEO-PI-R scores due to a lack of sufficient data to apply the...pilot training, AFRL-RH-WP-TR-2013-0081. Wright-Patterson AFB, OH: Air Force Research Laboratory, Decision Making Division. Thorndike , R. L...NEO domain scores were corrected using the univariate Case 2 ( Thorndike , 1949) method. Correlations in the column labeled rfc were corrected for both

Correction to: Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset.

PubMed

Roehle, Robert; Wieske, Viktoria; Schuetz, Georg M; Gueret, Pascal; Andreini, Daniele; Meijboom, Willem Bob; Pontone, Gianluca; Garcia, Mario; Alkadhi, Hatem; Honoris, Lily; Hausleiter, Jörg; Bettencourt, Nuno; Zimmermann, Elke; Leschka, Sebastian; Gerber, Bernhard; Rochitte, Carlos; Schoepf, U Joseph; Shabestari, Abbas Arjmand; Nørgaard, Bjarne; Sato, Akira; Knuuti, Juhani; Meijs, Matthijs F L; Brodoefel, Harald; Jenkins, Shona M M; Øvrehus, Kristian Altern; Diederichsen, Axel Cosmus Pyndt; Hamdan, Ashraf; Halvorsen, Bjørn Arild; Rodriguez, Vladimir Mendoza; Wan, Yung Liang; Rixe, Johannes; Sheikh, Mehraj; Langer, Christoph; Ghostine, Said; Martuscelli, Eugenio; Niinuma, Hiroyuki; Scholte, Arthur; Nikolaou, Konstantin; Ulimoen, Geir; Zhang, Zhaoqi; Mickley, Hans; Nieman, Koen; Kaufmann, Philipp A; Buechel, Ronny Ralf; Herzog, Bernhard A; Clouse, Melvin; Halon, David A; Leipsic, Jonathan; Bush, David; Jakamy, Reda; Sun, Kai; Yang, Lin; Johnson, Thorsten; Laissy, Jean-Pierre; Marcus, Roy; Muraglia, Simone; Tardif, Jean-Claude; Chow, Benjamin; Paul, Narinder; Maintz, David; Hoe, John; de Roos, Albert; Haase, Robert; Laule, Michael; Schlattmann, Peter; Dewey, Marc

2018-06-01

The original version of this article, published on 19 March 2018, unfortunately contained a mistake. The following correction has therefore been made in the original: The names of the authors Philipp A. Kaufmann, Ronny Ralf Buechel and Bernhard A. Herzog were presented incorrectly.

Using Research to Make Informed Decisions about the Spelling Curriculum

ERIC Educational Resources Information Center

Putman, Rebecca

2017-01-01

Learning how to spell is important. Most people would agree that the ability to spell correctly is an essential trait of literate people, and that students must be taught how to spell correctly; however, there is still debate among parents, educators, and the public as to how spelling should be taught in the schools. This paper reexamines and…

Parents' and Physicians' Perceptions of Children's Participation in Decision-making in Paediatric Oncology: A Quantitative Study.

PubMed

Rost, Michael; Wangmo, Tenzin; Niggli, Felix; Hartmann, Karin; Hengartner, Heinz; Ansari, Marc; Brazzola, Pierluigi; Rischewski, Johannes; Beck-Popovic, Maja; Kühne, Thomas; Elger, Bernice S

2017-12-01

The goal is to present how shared decision-making in paediatric oncology occurs from the viewpoints of parents and physicians. Eight Swiss Pediatric Oncology Group centres participated in this prospective study. The sample comprised a parent and physician of the minor patient (<18 years). Surveys were statistically analysed by comparing physicians' and parents' perspectives and by evaluating factors associated with children's actual involvement. Perspectives of ninety-one parents and twenty physicians were obtained for 151 children. Results indicate that for six aspects of information provision examined, parents' and physicians' perceptions differed. Moreover, parents felt that the children were more competent to understand diagnosis and prognosis, assessed the disease of the children as worse, and reported higher satisfaction with decision-making on the part of the children. A patient's age and gender predicted involvement. Older children and girls were more likely to be involved. In the decision-making process, parents held a less active role than they actually wanted. Physicians should take measures to ensure that provided information is understood correctly. Furthermore, they should work towards creating awareness for systematic differences between parents and physicians with respect to the perception of the child, the disease, and shared decision-making.

Evidence based policy making in the European Union: the role of the scientific community.

PubMed

Majcen, Špela

2017-03-01

In the times when the acquis of the European Union (EU) has developed so far as to reach a high level of technical complexity, in particular in certain policy fields such as environmental legislation, it is important to look at what kind of information and data policy decisions are based on. This position paper looks at the extent to which evidence-based decision-making process is being considered in the EU institutions when it comes to adopting legislation in the field of environment at the EU level. The paper calls for closer collaboration between scientists and decision-makers in view of ensuring that correct data is understood and taken into consideration when drafting, amending, negotiating and adopting new legal texts at all levels of the EU decision-making process. It concludes that better awareness of the need for such collaboration among the decision-makers as well as the scientific community would benefit the process and quality of the final outcomes (legislation).

Relation between Belief and Performance in Perceptual Decision Making

PubMed Central

Drugowitsch, Jan; Moreno-Bote, Rubén; Pouget, Alexandre

2014-01-01

In an uncertain and ambiguous world, effective decision making requires that subjects form and maintain a belief about the correctness of their choices, a process called meta-cognition. Prediction of future outcomes and self-monitoring are only effective if belief closely matches behavioral performance. Equality between belief and performance is also critical for experimentalists to gain insight into the subjects' belief by simply measuring their performance. Assuming that the decision maker holds the correct model of the world, one might indeed expect that belief and performance should go hand in hand. Unfortunately, we show here that this is rarely the case when performance is defined as the percentage of correct responses for a fixed stimulus, a standard definition in psychophysics. In this case, belief equals performance only for a very narrow family of tasks, whereas in others they will only be very weakly correlated. As we will see it is possible to restore this equality in specific circumstances but this remedy is only effective for a decision-maker, not for an experimenter. We furthermore show that belief and performance do not match when conditioned on task difficulty – as is common practice when plotting the psychometric curve – highlighting common pitfalls in previous neuroscience work. Finally, we demonstrate that miscalibration and the hard-easy effect observed in humans' and other animals' certainty judgments could be explained by a mismatch between the experimenter's and decision maker's expected distribution of task difficulties. These results have important implications for experimental design and are of relevance for theories that aim to unravel the nature of meta-cognition. PMID:24816801

Relation between belief and performance in perceptual decision making.

PubMed

Drugowitsch, Jan; Moreno-Bote, Rubén; Pouget, Alexandre

2014-01-01

In an uncertain and ambiguous world, effective decision making requires that subjects form and maintain a belief about the correctness of their choices, a process called meta-cognition. Prediction of future outcomes and self-monitoring are only effective if belief closely matches behavioral performance. Equality between belief and performance is also critical for experimentalists to gain insight into the subjects' belief by simply measuring their performance. Assuming that the decision maker holds the correct model of the world, one might indeed expect that belief and performance should go hand in hand. Unfortunately, we show here that this is rarely the case when performance is defined as the percentage of correct responses for a fixed stimulus, a standard definition in psychophysics. In this case, belief equals performance only for a very narrow family of tasks, whereas in others they will only be very weakly correlated. As we will see it is possible to restore this equality in specific circumstances but this remedy is only effective for a decision-maker, not for an experimenter. We furthermore show that belief and performance do not match when conditioned on task difficulty--as is common practice when plotting the psychometric curve--highlighting common pitfalls in previous neuroscience work. Finally, we demonstrate that miscalibration and the hard-easy effect observed in humans' and other animals' certainty judgments could be explained by a mismatch between the experimenter's and decision maker's expected distribution of task difficulties. These results have important implications for experimental design and are of relevance for theories that aim to unravel the nature of meta-cognition.

Three-class ROC analysis--the equal error utility assumption and the optimality of three-class ROC surface using the ideal observer.

PubMed

He, Xin; Frey, Eric C

2006-08-01

Previously, we have developed a decision model for three-class receiver operating characteristic (ROC) analysis based on decision theory. The proposed decision model maximizes the expected decision utility under the assumption that incorrect decisions have equal utilities under the same hypothesis (equal error utility assumption). This assumption reduced the dimensionality of the "general" three-class ROC analysis and provided a practical figure-of-merit to evaluate the three-class task performance. However, it also limits the generality of the resulting model because the equal error utility assumption will not apply for all clinical three-class decision tasks. The goal of this study was to investigate the optimality of the proposed three-class decision model with respect to several other decision criteria. In particular, besides the maximum expected utility (MEU) criterion used in the previous study, we investigated the maximum-correctness (MC) (or minimum-error), maximum likelihood (ML), and Nyman-Pearson (N-P) criteria. We found that by making assumptions for both MEU and N-P criteria, all decision criteria lead to the previously-proposed three-class decision model. As a result, this model maximizes the expected utility under the equal error utility assumption, maximizes the probability of making correct decisions, satisfies the N-P criterion in the sense that it maximizes the sensitivity of one class given the sensitivities of the other two classes, and the resulting ROC surface contains the maximum likelihood decision operating point. While the proposed three-class ROC analysis model is not optimal in the general sense due to the use of the equal error utility assumption, the range of criteria for which it is optimal increases its applicability for evaluating and comparing a range of diagnostic systems.

Decision-making and referral processes for patients with motor neurone disease: a qualitative study of GP experiences and evaluation of a new decision-support tool.

PubMed

Baxter, Susan; McDermott, Christopher J

2017-05-08

The diagnosis of motor neurone disease (MND) is known to be challenging and there may be delay in patients receiving a correct diagnosis. This study investigated the referral process for patients who had been diagnosed with MND, and whether a newly-developed tool (The Red Flags checklist) might help General Practitioners (GPs) in making referral decisions. We carried out interviews with GPs who had recently referred a patient diagnosed with MND, and interviews/surveys with GPs who had not recently referred a patient with suspected MND. We collected data before the Red Flags checklist was introduced; and again one year later. We analysed the data to identify key recurring themes. Forty two GPs took part in the study. The presence of fasciculation was the clinical feature that most commonly led to consideration of a potential MND diagnosis. GPs perceived that their role was to make onward referrals rather than attempting to make a diagnosis, and delays in correct diagnosis tended to occur at the specialist level. A quarter of participants had some awareness of the newly-developed tool; most considered it useful, if incorporated into existing systems. While fasciculation is the most common symptom associated with MND, other bulbar, limb or respiratory features, together with progression should be considered. There is a need for further research into how decision-support tools should be designed and provided, in order to best assist GPs with referral decisions. There is also a need for further work at the level of secondary care, in order that referrals made are re-directed appropriately.

Ethical evaluation of decision-making for distribution of health resources in China.

PubMed

Guo-Ping, Wang

2007-06-01

Since distribution of health resources involves various aspects of ethics, the evaluation of ethical problems should be emphasised in health decisions using criteria of fairness and fundamental principles of ethics correctly understood and chosen in order to solve the real conflicts evident in the distribution of health resources and to enable fair and reasonable distribution of health resources.

The conscious mind and its emergent properties; an analysis based on decision theory.

PubMed

Morris, James A

2011-08-01

The process of conscious and unconscious decision making is analyzed using decision theory. An essential part of an optimum decision strategy is the assessment of values and costs associated with correct and incorrect decisions. In the case of unconscious decisions this involves an automatic process akin to computation using numerical values. But for conscious decisions the conscious mind must experience the outcome of the decision as pleasure or pain. It is suggested that the rules of behavior are programmed in our genes but modified by experience of the society in which we are reared. Our unconscious then uses the rules to reward or punish our conscious mind for the decisions it makes. This is relevant to concepts of altruism and religion in society. It is consistent with the observation that we prefer beauty to utility. The decision theory equations also explain the paradox that a single index of happiness can be applied in society. The symptoms of mental illness can be due to appropriate or inappropriate action by the unconscious. The former indicates a psychological conflict between conscious and unconscious decision making. Inappropriate action indicates that a pathological process has switched on genetic networks that should be switched off. Copyright © 2011 Elsevier Ltd. All rights reserved.

Empirical Evaluation of a Decision-Analytic Aid.

DTIC Science & Technology

1980-05-01

scenarios may be attributable to the use of the Baye- sian revision model by the latter group . In the A scenarios, as well as in the NA scenarios, aided...inten- tions and to make a decision by recommending one of four prespecified courses of action. The use of the aiding package significantly increased...courses of action. The use of the aiding package significantly in- I creased the number of correct decisions under the attack version of the scenarios

A targeted decision aid for the elderly to decide whether to undergo colorectal cancer screening: development and results of an uncontrolled trial

PubMed Central

2010-01-01

Background Competing causes of mortality in the elderly decrease the potential net benefit from colorectal cancer screening and increase the likelihood of potential harms. Individualized decision making has been recommended, so that the elderly can decide whether or not to undergo colorectal cancer (CRC) screening. The objective is to develop and test a decision aid designed to promote individualized colorectal cancer screening decision making for adults age 75 and over. Methods We used formative research and cognitive testing to develop and refine the decision aid. We then tested the decision aid in an uncontrolled trial. The primary outcome was the proportion of patients who were prepared to make an individualized decision, defined a priori as having adequate knowledge (10/15 questions correct) and clear values (25 or less on values clarity subscale of decisional conflict scale). Secondary outcomes included overall score on the decisional conflict scale, and preferences for undergoing screening. Results We enrolled 46 adults in the trial. The decision aid increased the proportion of participants with adequate knowledge from 4% to 52% (p < 0.01) and the proportion prepared to make an individualized decision from 4% to 41% (p < 0.01). The proportion that preferred to undergo CRC screening decreased from 67% to 61% (p = 0. 76); 7 participants (15%) changed screening preference (5 against screening, 2 in favor of screening) Conclusion In an uncontrolled trial, the elderly participants appeared better prepared to make an individualized decision about whether or not to undergo CRC screening after using the decision aid. PMID:20849625

Evaluating team decision-making as an emergent phenomenon.

PubMed

Kinnear, John; Wilson, Nick; O'Dwyer, Anthony

2018-04-01

The complexity of modern clinical practice has highlighted the fallibility of individual clinicians' decision-making, with effective teamwork emerging as a key to patient safety. Dual process theory is widely accepted as a framework for individual decision-making, with type 1 processes responsible for fast, intuitive and automatic decisions and type 2 processes for slow, analytical decisions. However, dual process theory does not explain cognition at the group level, when individuals act in teams. Team cognition resulting from dynamic interaction of individuals is said to be more resilient to decision-making error and greater than simply aggregated cognition. Clinicians were paired as teams and asked to solve a cognitive puzzle constructed as a drug calculation. The frequency at which the teams made incorrect decisions was compared with that of individual clinicians answering the same question. When clinicians acted in pairs, 63% answered the cognitive puzzle correctly, compared with 33% of clinicians as individuals, showing a statistically significant difference in performance (χ 2 (1, n=116)=24.329, P<0.001). Based on the predicted performance of teams made up of the random pairing of individuals who had the same propensity to answer as previously, there was no statistical difference in the actual and predicted teams' performance. Teams are less prone to making errors of decision-making than individuals. However, the improved performance is likely to be owing to the effect of aggregated cognition rather than any improved decision-making as a result of the interaction. There is no evidence of team cognition as an emergent and distinct entity. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Evaluation of a Decision-Making Curriculum for Teaching Adolescents with Disabilities to Resist Negative Peer Pressure.

PubMed

Khemka, Ishita; Hickson, Linda; Mallory, Sarah B

2016-07-01

This study was designed to assess the impact of a decision-making curriculum (PEER-DM) on the social peer relationship knowledge and self-protective decision-making skills of adolescents with disabilities in hypothetical situations involving negative peer pressure. A randomized design was used to assign students with disabilities from self-contained special education classes to an intervention group (n = 22) or a wait-list control group (n = 20). ANCOVA analyses, using pretest scores as covariates, indicated that students who were trained on PEER-DM had significantly higher effective decision-making action and correct risk perception scores, relative to participants in the control group. This study provides supporting evidence that PEER-DM is a promising intervention for students with disabilities, including those with identified autism spectrum disorders, during transition years to help them develop a better understanding of positive and negative peer relationships and learn systematic decision-making skills for improved handling of social situations in the school and community, especially situations involving negative peer pressure. The study adds credence to using systematic, strategy-based decision making interventions designed to address the cognitive, emotional and motivational processes underlying adolescent decision making in sensitive interpersonal situations involving peer pressure. The study points to the lack of preparedness to handle situations of negative peer pressure as a serious social and health risk for adolescents with disabilities that deserves urgent and concerted attention in transition services programming. Implications for future curriculum-development efforts and replication of treatment findings are discussed. Future research examining disability-specific patterns of decision-making in peer situations and comparisons with typically developing populations is recommended.

Selecting Nonpharmaceutical Strategies to Minimize Influenza Spread: The 2009 Influenza A (H1N1) Pandemic and Beyond

PubMed Central

Koonin, Lisa M.; Kohl, Katrin S.; Cetron, Martin

2012-01-01

Shortly after the influenza A (H1N1) 2009 pandemic began, the U.S. government provided guidance to state and local authorities to assist decision-making for the use of nonpharmaceutical strategies to minimize influenza spread. This guidance included recommendations for flexible decision-making based on outbreak severity, and it allowed for uncertainty and course correction as the pandemic progressed. These recommendations build on a foundation of local, collaborative planning and posit a series of questions regarding epidemiology, the impact on the health-care system, and locally determined feasibility and acceptability of nonpharmaceutical strategies. This article describes -recommendations and key questions for decision makers. PMID:23115381

Effects of stress on decisions under uncertainty: A meta-analysis.

PubMed

Starcke, Katrin; Brand, Matthias

2016-09-01

[Correction Notice: An Erratum for this article was reported in Vol 142(9) of Psychological Bulletin (see record 2016-39486-001). It should have been reported that the inverted u-shaped relationship between cortisol stress responses and decision-making performance was only observed in female, but not in male participants as suggested by the study by van den Bos, Harteveld, and Stoop (2009). Corrected versions of the affected sentences are provided.] The purpose of the present meta-analysis was to quantify the effects that stress has on decisions made under uncertainty. We hypothesized that stress increases reward seeking and risk taking through alterations of dopamine firing rates and reduces executive control by hindering optimal prefrontal cortex functioning. In certain decision situations, increased reward seeking and risk taking is dysfunctional, whereas in others, this is not the case. We also assumed that the type of stressor plays a role. In addition, moderating variables are analyzed, such as the hormonal stress response, the time between stress onset and decisions, and the participants' age and gender. We included studies in the meta-analysis that investigated decision making after a laboratory stress-induction versus a control condition (k = 32 datasets, N = 1829 participants). A random-effects model revealed that overall, stress conditions lead to decisions that can be described as more disadvantageous, more reward seeking, and more risk taking than nonstress conditions (d = .17). In those situations in which increased reward seeking and risk taking is disadvantageous, stress had significant effects (d = .26), whereas in other situations, no effects were observed (d = .01). Effects were observed under processive stressors (d = .19), but not under systemic ones (d = .09). Moderation analyses did not reveal any significant results. We concluded that stress deteriorates overall decision-making performance through the mechanisms proposed. The effects differ, depending on the decision situation and the type of stressor, but not on the characteristics of the individuals. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Use of statistical and pharmacokinetic-pharmacodynamic modeling and simulation to improve decision-making: A section summary report of the trends and innovations in clinical trial statistics conference.

PubMed

Kimko, Holly; Berry, Seth; O'Kelly, Michael; Mehrotra, Nitin; Hutmacher, Matthew; Sethuraman, Venkat

2017-01-01

The application of modeling and simulation (M&S) methods to improve decision-making was discussed during the Trends & Innovations in Clinical Trial Statistics Conference held in Durham, North Carolina, USA on May 1-4, 2016. Uses of both pharmacometric and statistical M&S were presented during the conference, highlighting the diversity of the methods employed by pharmacometricians and statisticians to address a broad range of quantitative issues in drug development. Five presentations are summarized herein, which cover the development strategy of employing M&S to drive decision-making; European initiatives on best practice in M&S; case studies of pharmacokinetic/pharmacodynamics modeling in regulatory decisions; estimation of exposure-response relationships in the presence of confounding; and the utility of estimating the probability of a correct decision for dose selection when prior information is limited. While M&S has been widely used during the last few decades, it is expected to play an essential role as more quantitative assessments are employed in the decision-making process. By integrating M&S as a tool to compile the totality of evidence collected throughout the drug development program, more informed decisions will be made.

Maternal psychological distress and child decision-making.

PubMed

Flouri, Eirini; Ioakeimidi, Sofia; Midouhas, Emily; Ploubidis, George B

2017-08-15

There is much research to suggest that maternal psychological distress is associated with many adverse outcomes in children. This study examined, for the first time, if it is related to children's affective decision-making. Using data from 12,080 families of the Millennium Cohort Study, we modelled the effect of trajectories of maternal psychological distress in early-to-middle childhood (3-11 years) on child affective decision-making, measured with a gambling task at age 11. Latent class analysis showed four longitudinal types of maternal psychological distress (chronically high, consistently low, moderate-accelerating and moderate-decelerating). Maternal distress typology predicted decision-making but only in girls. Specifically, compared to girls growing up in families with never-distressed mothers, those exposed to chronically high maternal psychological distress showed more risk-taking, bet more and exhibited poorer risk-adjustment, even after correction for confounding. Most of these effects on girls' decision-making were not robust to additional controls for concurrent internalising and externalising problems, but chronically high maternal psychological distress was associated positively with risk-taking even after this adjustment. Importantly, this association was similar for those who had reached puberty and those who had not. Given the study design, causality cannot be inferred. Therefore, we cannot propose that treating chronic maternal psychological distress will reduce decision-making pathology in young females. Our study suggests that young daughters of chronically distressed mothers tend to be particularly reckless decision-makers. Copyright © 2017. Published by Elsevier B.V.

Toward detecting deception in intelligent systems

NASA Astrophysics Data System (ADS)

Santos, Eugene, Jr.; Johnson, Gregory, Jr.

2004-08-01

Contemporary decision makers often must choose a course of action using knowledge from several sources. Knowledge may be provided from many diverse sources including electronic sources such as knowledge-based diagnostic or decision support systems or through data mining techniques. As the decision maker becomes more dependent on these electronic information sources, detecting deceptive information from these sources becomes vital to making a correct, or at least more informed, decision. This applies to unintentional disinformation as well as intentional misinformation. Our ongoing research focuses on employing models of deception and deception detection from the fields of psychology and cognitive science to these systems as well as implementing deception detection algorithms for probabilistic intelligent systems. The deception detection algorithms are used to detect, classify and correct attempts at deception. Algorithms for detecting unexpected information rely upon a prediction algorithm from the collaborative filtering domain to predict agent responses in a multi-agent system.

Neural signatures of experience-based improvements in deterministic decision-making.

PubMed

Tremel, Joshua J; Laurent, Patryk A; Wolk, David A; Wheeler, Mark E; Fiez, Julie A

2016-12-15

Feedback about our choices is a crucial part of how we gather information and learn from our environment. It provides key information about decision experiences that can be used to optimize future choices. However, our understanding of the processes through which feedback translates into improved decision-making is lacking. Using neuroimaging (fMRI) and cognitive models of decision-making and learning, we examined the influence of feedback on multiple aspects of decision processes across learning. Subjects learned correct choices to a set of 50 word pairs across eight repetitions of a concurrent discrimination task. Behavioral measures were then analyzed with both a drift-diffusion model and a reinforcement learning model. Parameter values from each were then used as fMRI regressors to identify regions whose activity fluctuates with specific cognitive processes described by the models. The patterns of intersecting neural effects across models support two main inferences about the influence of feedback on decision-making. First, frontal, anterior insular, fusiform, and caudate nucleus regions behave like performance monitors, reflecting errors in performance predictions that signal the need for changes in control over decision-making. Second, temporoparietal, supplementary motor, and putamen regions behave like mnemonic storage sites, reflecting differences in learned item values that inform optimal decision choices. As information about optimal choices is accrued, these neural systems dynamically adjust, likely shifting the burden of decision processing from controlled performance monitoring to bottom-up, stimulus-driven choice selection. Collectively, the results provide a detailed perspective on the fundamental ability to use past experiences to improve future decisions. Copyright © 2016 Elsevier B.V. All rights reserved.

Spatial attention during saccade decisions.

PubMed

Jonikaitis, Donatas; Klapetek, Anna; Deubel, Heiner

2017-07-01

Behavioral measures of decision making are usually limited to observations of decision outcomes. In the present study, we made use of the fact that oculomotor and sensory selection are closely linked to track oculomotor decision making before oculomotor responses are made. We asked participants to make a saccadic eye movement to one of two memorized target locations and observed that visual sensitivity increased at both the chosen and the nonchosen saccade target locations, with a clear bias toward the chosen target. The time course of changes in visual sensitivity was related to saccadic latency, with the competition between the chosen and nonchosen targets resolved faster before short-latency saccades. On error trials, we observed an increased competition between the chosen and nonchosen targets. Moreover, oculomotor selection and visual sensitivity were influenced by top-down and bottom-up factors as well as by selection history and predicted the direction of saccades. Our findings demonstrate that saccade decisions have direct visual consequences and show that decision making can be traced in the human oculomotor system well before choices are made. Our results also indicate a strong association between decision making, saccade target selection, and visual sensitivity. NEW & NOTEWORTHY We show that saccadic decisions can be tracked by measuring spatial attention. Spatial attention is allocated in parallel to the two competing saccade targets, and the time course of spatial attention differs for fast-slow and for correct-erroneous decisions. Saccade decisions take the form of a competition between potential saccade goals, which is associated with spatial attention allocation to those locations. Copyright © 2017 the American Physiological Society.

Neural signatures of experience-based improvements in deterministic decision-making

PubMed Central

Tremel, Joshua J.; Laurent, Patryk A.; Wolk, David A.; Wheeler, Mark E.; Fiez, Julie A.

2016-01-01

Feedback about our choices is a crucial part of how we gather information and learn from our environment. It provides key information about decision experiences that can be used to optimize future choices. However, our understanding of the processes through which feedback translates into improved decision-making is lacking. Using neuroimaging (fMRI) and cognitive models of decision-making and learning, we examined the influence of feedback on multiple aspects of decision processes across learning. Subjects learned correct choices to a set of 50 word pairs across eight repetitions of a concurrent discrimination task. Behavioral measures were then analyzed with both a drift-diffusion model and a reinforcement learning model. Parameter values from each were then used as fMRI regressors to identify regions whose activity fluctuates with specific cognitive processes described by the models. The patterns of intersecting neural effects across models support two main inferences about the influence of feedback on decision-making. First, frontal, anterior insular, fusiform, and caudate nucleus regions behave like performance monitors, reflecting errors in performance predictions that signal the need for changes in control over decision-making. Second, temporoparietal, supplementary motor, and putamen regions behave like mnemonic storage sites, reflecting differences in learned item values that inform optimal decision choices. As information about optimal choices is accrued, these neural systems dynamically adjust, likely shifting the burden of decision processing from controlled performance monitoring to bottom-up, stimulus-driven choice selection. Collectively, the results provide a detailed perspective on the fundamental ability to use past experiences to improve future decisions. PMID:27523644

Hippocampal SWR Activity Predicts Correct Decisions during the Initial Learning of an Alternation Task

PubMed Central

Singer, Annabelle C.; Carr, Margaret F.; Karlsson, Mattias P.; Frank, Loren M.

2013-01-01

SUMMARY The hippocampus frequently replays memories of past experiences during sharp-wave ripple (SWR) events. These events can represent spatial trajectories extending from the animal’s current location to distant locations, suggesting a role in the evaluation of upcoming choices. While SWRs have been linked to learning and memory, the specific role of awake replay remains unclear. Here we show that there is greater coordinated neural activity during SWRs preceding correct, as compared to incorrect, trials in a spatial alternation task. As a result, the proportion of cell pairs coactive during SWRs was predictive of subsequent correct or incorrect responses on a trial-by-trial basis. This effect was seen specifically during early learning, when the hippocampus is essential for task performance. SWR activity preceding correct trials represented multiple trajectories that included both correct and incorrect options. These results suggest that reactivation during awake SWRs contributes to the evaluation of possible choices during memory-guided decision making. PMID:23522050

Supporting Neonatal Intensive Care Unit Parents Through Social Media.

PubMed

Dzubaty, Dolores R

2016-01-01

Parents of infants in the neonatal intensive care unit may often find themselves seeking healthcare information from online and social media sources. Social media applications are available to healthcare consumers and their families, as well as healthcare providers, in a variety of formats. Information that parents gather on their own, and information that is explained by providers, is then used when parents make healthcare decisions regarding their infants. Parents also seek support from peers and family while making healthcare decisions. The combination of knowledge obtained and social support given may empower the parent to feel more confident in their decision making. Healthcare professionals can guide parents to credible resources. The exchange of information between providers and parents can occur using a variety of communication methods. Misperceptions can be corrected, support given, open sharing of information occurs, and parent empowerment may result.

Misremembrance of options past: source monitoring and choice.

PubMed

Mather, M; Shafir, E; Johnson, M K

2000-03-01

This study reveals that when remembering past decisions, people engage in choice-supportive memory distortion. When asked to make memory attributions of options' features, participants made source-monitoring errors that supported their decisions. They tended to attribute, both correctly and incorrectly, more positive features to the option they had selected than to its competitor. In addition, they sometimes attributed, both correctly and incorrectly, more negative features to the nonselected option. This pattern of distortion may be beneficial to people's general well-being, reducing regret for options not taken. At the same time, it is problematic for memory accuracy, for accountability, and for learning from past experience.

Decision making in family medicine

PubMed Central

Labrecque, Michel; Ratté, Stéphane; Frémont, Pierre; Cauchon, Michel; Ouellet, Jérôme; Hogg, William; McGowan, Jessie; Gagnon, Marie-Pierre; Njoya, Merlin; Légaré, France

2013-01-01

Abstract Objective To compare the ability of users of 2 medical search engines, InfoClinique and the Trip database, to provide correct answers to clinical questions and to explore the perceived effects of the tools on the clinical decision-making process. Design Randomized trial. Setting Three family medicine units of the family medicine program of the Faculty of Medicine at Laval University in Quebec city, Que. Participants Fifteen second-year family medicine residents. Intervention Residents generated 30 structured questions about therapy or preventive treatment (2 questions per resident) based on clinical encounters. Using an Internet platform designed for the trial, each resident answered 20 of these questions (their own 2, plus 18 of the questions formulated by other residents, selected randomly) before and after searching for information with 1 of the 2 search engines. For each question, 5 residents were randomly assigned to begin their search with InfoClinique and 5 with the Trip database. Main outcome measures The ability of residents to provide correct answers to clinical questions using the search engines, as determined by third-party evaluation. After answering each question, participants completed a questionnaire to assess their perception of the engine’s effect on the decision-making process in clinical practice. Results Of 300 possible pairs of answers (1 answer before and 1 after the initial search), 254 (85%) were produced by 14 residents. Of these, 132 (52%) and 122 (48%) pairs of answers concerned questions that had been assigned an initial search with InfoClinique and the Trip database, respectively. Both engines produced an important and similar absolute increase in the proportion of correct answers after searching (26% to 62% for InfoClinique, for an increase of 36%; 24% to 63% for the Trip database, for an increase of 39%; P = .68). For all 30 clinical questions, at least 1 resident produced the correct answer after searching with either search engine. The mean (SD) time of the initial search for each question was 23.5 (7.6) minutes with InfoClinique and 22.3 (7.8) minutes with the Trip database (P = .30). Participants’ perceptions of each engine’s effect on the decision-making process were very positive and similar for both search engines. Conclusion Family medicine residents’ ability to provide correct answers to clinical questions increased dramatically and similarly with the use of both InfoClinique and the Trip database. These tools have strong potential to increase the quality of medical care. PMID:24130286

Decision making in family medicine: randomized trial of the effects of the InfoClinique and Trip database search engines.

PubMed

Labrecque, Michel; Ratté, Stéphane; Frémont, Pierre; Cauchon, Michel; Ouellet, Jérôme; Hogg, William; McGowan, Jessie; Gagnon, Marie-Pierre; Njoya, Merlin; Légaré, France

2013-10-01

To compare the ability of users of 2 medical search engines, InfoClinique and the Trip database, to provide correct answers to clinical questions and to explore the perceived effects of the tools on the clinical decision-making process. Randomized trial. Three family medicine units of the family medicine program of the Faculty of Medicine at Laval University in Quebec city, Que. Fifteen second-year family medicine residents. Residents generated 30 structured questions about therapy or preventive treatment (2 questions per resident) based on clinical encounters. Using an Internet platform designed for the trial, each resident answered 20 of these questions (their own 2, plus 18 of the questions formulated by other residents, selected randomly) before and after searching for information with 1 of the 2 search engines. For each question, 5 residents were randomly assigned to begin their search with InfoClinique and 5 with the Trip database. The ability of residents to provide correct answers to clinical questions using the search engines, as determined by third-party evaluation. After answering each question, participants completed a questionnaire to assess their perception of the engine's effect on the decision-making process in clinical practice. Of 300 possible pairs of answers (1 answer before and 1 after the initial search), 254 (85%) were produced by 14 residents. Of these, 132 (52%) and 122 (48%) pairs of answers concerned questions that had been assigned an initial search with InfoClinique and the Trip database, respectively. Both engines produced an important and similar absolute increase in the proportion of correct answers after searching (26% to 62% for InfoClinique, for an increase of 36%; 24% to 63% for the Trip database, for an increase of 39%; P = .68). For all 30 clinical questions, at least 1 resident produced the correct answer after searching with either search engine. The mean (SD) time of the initial search for each question was 23.5 (7.6) minutes with InfoClinique and 22.3 (7.8) minutes with the Trip database (P = .30). Participants' perceptions of each engine's effect on the decision-making process were very positive and similar for both search engines. Family medicine residents' ability to provide correct answers to clinical questions increased dramatically and similarly with the use of both InfoClinique and the Trip database. These tools have strong potential to increase the quality of medical care.

Mice learn to avoid regret.

PubMed

Sweis, Brian M; Thomas, Mark J; Redish, A David

2018-06-01

Regret can be defined as the subjective experience of recognizing that one has made a mistake and that a better alternative could have been selected. The experience of regret is thought to carry negative utility. This typically takes two distinct forms: augmenting immediate postregret valuations to make up for losses, and augmenting long-term changes in decision-making strategies to avoid future instances of regret altogether. While the short-term changes in valuation have been studied in human psychology, economics, neuroscience, and even recently in nonhuman-primate and rodent neurophysiology, the latter long-term process has received far less attention, with no reports of regret avoidance in nonhuman decision-making paradigms. We trained 31 mice in a novel variant of the Restaurant Row economic decision-making task, in which mice make decisions of whether to spend time from a limited budget to achieve food rewards of varying costs (delays). Importantly, we tested mice longitudinally for 70 consecutive days, during which the task provided their only source of food. Thus, decision strategies were interdependent across both trials and days. We separated principal commitment decisions from secondary reevaluation decisions across space and time and found evidence for regret-like behaviors following change-of-mind decisions that corrected prior economically disadvantageous choices. Immediately following change-of-mind events, subsequent decisions appeared to make up for lost effort by altering willingness to wait, decision speed, and pellet consumption speed, consistent with past reports of regret in rodents. As mice were exposed to an increasingly reward-scarce environment, we found they adapted and refined distinct economic decision-making strategies over the course of weeks to maximize reinforcement rate. However, we also found that even without changes in reinforcement rate, mice transitioned from an early strategy rooted in foraging to a strategy rooted in deliberation and planning that prevented future regret-inducing change-of-mind episodes from occurring. These data suggest that mice are learning to avoid future regret, independent of and separate from reinforcement rate maximization.

Research implications of science-informed, value-based decision making.

PubMed

Dowie, Jack

2004-01-01

In 'Hard' science, scientists correctly operate as the 'guardians of certainty', using hypothesis testing formulations and value judgements about error rates and time discounting that make classical inferential methods appropriate. But these methods can neither generate most of the inputs needed by decision makers in their time frame, nor generate them in a form that allows them to be integrated into the decision in an analytically coherent and transparent way. The need for transparent accountability in public decision making under uncertainty and value conflict means the analytical coherence provided by the stochastic Bayesian decision analytic approach, drawing on the outputs of Bayesian science, is needed. If scientific researchers are to play the role they should be playing in informing value-based decision making, they need to see themselves also as 'guardians of uncertainty', ensuring that the best possible current posterior distributions on relevant parameters are made available for decision making, irrespective of the state of the certainty-seeking research. The paper distinguishes the actors employing different technologies in terms of the focus of the technology (knowledge, values, choice); the 'home base' mode of their activity on the cognitive continuum of varying analysis-to-intuition ratios; and the underlying value judgements of the activity (especially error loss functions and time discount rates). Those who propose any principle of decision making other than the banal 'Best Principle', including the 'Precautionary Principle', are properly interpreted as advocates seeking to have their own value judgements and preferences regarding mode location apply. The task for accountable decision makers, and their supporting technologists, is to determine the best course of action under the universal conditions of uncertainty and value difference/conflict.

The Impact of Health and Financial Literacy on Decision Making in Community-Based Older Adults

PubMed Central

James, Bryan D.; Boyle, Patricia A.; Bennett, Jarred S.; Bennett, David A.

2012-01-01

Background Health and financial literacy have been linked to the health and well-being of older adults, yet there are few data on how health and financial literacy actually impact decision making regarding healthcare and economic choices in advanced age. Objective To examine the association of health and financial literacy with decision making in older adults. Method Data came from 525 community-dwelling older persons without dementia from the Rush Memory and Aging Project, an ongoing longitudinal study of aging. Health and financial literacy were assessed via a series of questions designed to measure comprehension of health and financial information and concepts. The two scores were averaged to yield a total literacy score. A modified, 12-item version of the Decision-Making Competence Assessment Tool was used to measure financial and healthcare decision making (6 items each), using materials designed to approximate those used in real world settings. All 12 items were summed to yield a total decision-making score. Associations were tested via linear regression models adjusted for age, sex and education. Secondary models adjusted for global cognitive function, income, depression and chronic medical conditions. Results On average, participants correctly answered 67% of the literacy questions (health literacy = 61.6%, SD = 18.8% and financial literacy = 72.5%, SD = 16.0%). After adjustment for cognitive function, the total literacy score was positively associated with the decision-making total score (estimate = 0.64, SE = 0.08, p < 0.001), as well as healthcare (estimate = 0.37, SE = 0.5, p < 0.001) and financial decision making (estimate = 0.28, SE = 0.05, p < 0.001). Further, total literacy, health and financial literacy all were independently associated with decision making in models adjusted for covariates including income, depression, and chronic medical conditions (all p values < 0.001). Finally, there was evidence of effect modification such that the beneficial association between literacy and healthcare decision making was stronger among older persons, poorer persons and persons at the lower ranges of cognitive ability. Conclusion Among community based older persons without dementia, higher levels of health and financial literacy were associated with better decision making, suggesting that improvements in literacy could facilitate better decision making and lead to better health and quality of life in later years. PMID:22739454

The impact of health and financial literacy on decision making in community-based older adults.

PubMed

James, Bryan D; Boyle, Patricia A; Bennett, Jarred S; Bennett, David A

2012-01-01

Health and financial literacy have been linked to the health and well-being of older adults, yet there are few data on how health and financial literacy actually impact decision making regarding healthcare and economic choices in advanced age. To examine the association of health and financial literacy with decision making in older adults. Data came from 525 community-dwelling older persons without dementia from the Rush Memory and Aging Project, an ongoing longitudinal study of aging. Health and financial literacy were assessed via a series of questions designed to measure comprehension of health and financial information and concepts. The two scores were averaged to yield a total literacy score. A modified, 12-item version of the Decision-Making Competence Assessment Tool was used to measure financial and healthcare decision making (6 items each), using materials designed to approximate those used in real world settings. All 12 items were summed to yield a total decision-making score. Associations were tested via linear regression models adjusted for age, sex and education. Secondary models adjusted for global cognitive function, income, depression and chronic medical conditions. On average, participants correctly answered 67% of the literacy questions (health literacy = 61.6%, SD = 18.8% and financial literacy = 72.5%, SD = 16.0%). After adjustment for cognitive function, the total literacy score was positively associated with the decision-making total score (estimate = 0.64, SE = 0.08, p < 0.001), as well as healthcare (estimate = 0.37, SE = 0.5, p < 0.001) and financial decision making (estimate = 0.28, SE = 0.05, p < 0.001). Further, total literacy, health and financial literacy all were independently associated with decision making in models adjusted for covariates including income, depression, and chronic medical conditions (all p values < 0.001). Finally, there was evidence of effect modification such that the beneficial association between literacy and healthcare decision making was stronger among older persons, poorer persons and persons at the lower ranges of cognitive ability. Among community based older persons without dementia, higher levels of health and financial literacy were associated with better decision making, suggesting that improvements in literacy could facilitate better decision making and lead to better health and quality of life in later years. Copyright © 2012 S. Karger AG, Basel.

How attention influences perceptual decision making: Single-trial EEG correlates of drift-diffusion model parameters

PubMed Central

Nunez, Michael D.; Vandekerckhove, Joachim; Srinivasan, Ramesh

2016-01-01

Perceptual decision making can be accounted for by drift-diffusion models, a class of decision-making models that assume a stochastic accumulation of evidence on each trial. Fitting response time and accuracy to a drift-diffusion model produces evidence accumulation rate and non-decision time parameter estimates that reflect cognitive processes. Our goal is to elucidate the effect of attention on visual decision making. In this study, we show that measures of attention obtained from simultaneous EEG recordings can explain per-trial evidence accumulation rates and perceptual preprocessing times during a visual decision making task. Models assuming linear relationships between diffusion model parameters and EEG measures as external inputs were fit in a single step in a hierarchical Bayesian framework. The EEG measures were features of the evoked potential (EP) to the onset of a masking noise and the onset of a task-relevant signal stimulus. Single-trial evoked EEG responses, P200s to the onsets of visual noise and N200s to the onsets of visual signal, explain single-trial evidence accumulation and preprocessing times. Within-trial evidence accumulation variance was not found to be influenced by attention to the signal or noise. Single-trial measures of attention lead to better out-of-sample predictions of accuracy and correct reaction time distributions for individual subjects. PMID:28435173

How attention influences perceptual decision making: Single-trial EEG correlates of drift-diffusion model parameters.

PubMed

Nunez, Michael D; Vandekerckhove, Joachim; Srinivasan, Ramesh

2017-02-01

Perceptual decision making can be accounted for by drift-diffusion models, a class of decision-making models that assume a stochastic accumulation of evidence on each trial. Fitting response time and accuracy to a drift-diffusion model produces evidence accumulation rate and non-decision time parameter estimates that reflect cognitive processes. Our goal is to elucidate the effect of attention on visual decision making. In this study, we show that measures of attention obtained from simultaneous EEG recordings can explain per-trial evidence accumulation rates and perceptual preprocessing times during a visual decision making task. Models assuming linear relationships between diffusion model parameters and EEG measures as external inputs were fit in a single step in a hierarchical Bayesian framework. The EEG measures were features of the evoked potential (EP) to the onset of a masking noise and the onset of a task-relevant signal stimulus. Single-trial evoked EEG responses, P200s to the onsets of visual noise and N200s to the onsets of visual signal, explain single-trial evidence accumulation and preprocessing times. Within-trial evidence accumulation variance was not found to be influenced by attention to the signal or noise. Single-trial measures of attention lead to better out-of-sample predictions of accuracy and correct reaction time distributions for individual subjects.

Erratum To: Indigenous Frameworks for Observing and Responding to Climate Change in Alaska

NASA Technical Reports Server (NTRS)

Cochran, Patricia; Huntington, Orville H.; Pungowiyi, Caleb; Tom, Stanley; Chapin, F. Stuart, III; Huntington, Henry P.; Maynard, Nancy G.; Trainor, Sarah F.

2014-01-01

In section 5, item 1 of this article it is stated that: A recent shift in decision-making authority from the politically appointed Board of Game to the Subsistence Division of the Alaska Department of Fish and Game should make these decisions about hunting regulations more responsive to local observations and needs. We now recognize that this shift in regulatory authority to ADF&G never occurred. We hereby correct this error so that wildlife users in Alaska do not come to ADF&G with expectations that this agency has authority to adjust hunting regulations to accommodate climate change.

The ethics of end-of-life decisions in the elderly: deliberations from the ECOPE study.

PubMed

Reiter-Theil, Stella

2003-06-01

Is age a factor underlying clinical decision-making? Should age be a criterion in the allocation of health care resources? Is it correct to criticize this approach as 'ageism'? What role does 'paternalism' play? These questions are the focus of this chapter which takes an interdisciplinary perspective of clinical ethics in order to provide an ethical evaluation of the situation of the elderly in health care. First, the text of the chapter is based on the descriptive level referring to (a) clinical ethics consultation, (b) the ECOPE study on 'Ethical Conditions of Passive Euthanasia' focusing on decision-making, and studies about age as a factor in clinical decisions, such as the American SUPPORT study. Second, at the normative level, ethical deliberations are discussed for and against age as a criterion for allocating health care resources. Finally, it is suggested that the differences in evidence to be found about the role of age as a factor in clinical decision-making may be due to the different national health policies as well as to the insufficient awareness of ethical principles violated by covert 'ageist' attitudes.

Evidence accumulation in decision making: unifying the "take the best" and the "rational" models.

PubMed

Lee, Michael D; Cummins, Tarrant D R

2004-04-01

An evidence accumulation model of forced-choice decision making is proposed to unify the fast and frugal take the best (TTB) model and the alternative rational (RAT) model with which it is usually contrasted. The basic idea is to treat the TTB model as a sequential-sampling process that terminates as soon as any evidence in favor of a decision is found and the rational approach as a sequential-sampling process that terminates only when all available information has been assessed. The unified TTB and RAT models were tested in an experiment in which participants learned to make correct judgments for a set of real-world stimuli on the basis of feedback, and were then asked to make additional judgments without feedback for cases in which the TTB and the rational models made different predictions. The results show that, in both experiments, there was strong intraparticipant consistency in the use of either the TTB or the rational model but large interparticipant differences in which model was used. The unified model is shown to be able to capture the differences in decision making across participants in an interpretable way and is preferred by the minimum description length model selection criterion.

Effects of outcome on the covariance between risk level and brain activity in adolescents with internet gaming disorder.

PubMed

Qi, Xin; Yang, Yongxin; Dai, Shouping; Gao, Peihong; Du, Xin; Zhang, Yang; Du, Guijin; Li, Xiaodong; Zhang, Quan

2016-01-01

Individuals with internet gaming disorder (IGD) often have impaired risky decision-making abilities, and IGD-related functional changes have been observed during neuroimaging studies of decision-making tasks. However, it is still unclear how feedback (outcomes of decision-making) affects the subsequent risky decision-making in individuals with IGD. In this study, twenty-four adolescents with IGD and 24 healthy controls (HCs) were recruited and underwent functional magnetic resonance imaging while performing the balloon analog risk task (BART) to evaluate the effects of prior outcomes on brain activity during subsequent risky decision-making in adolescents with IGD. The covariance between risk level and activation of the bilateral ventral medial prefrontal cortex, left inferior frontal cortex, right ventral striatum (VS), left hippocampus/parahippocampus, right inferior occipital gyrus/fusiform gyrus and right inferior temporal gyrus demonstrated interaction effects of group by outcome ( P  < 0.05, AlphaSim correction). The regions with interactive effects were defined as ROI, and ROI-based intergroup comparisons showed that the covariance between risk level and brain activation was significantly greater in adolescents with IGD compared with HCs after a negative outcome occurred ( P  < 0.05). Our results indicated that negative outcomes affected the covariance between risk level and activation of the brain regions related to value estimation (prefrontal cortex), anticipation of rewards (VS), and emotional-related learning (hippocampus/parahippocampus), which may be one of the underlying neural mechanisms of disadvantageous risky decision-making in adolescents with IGD.

Decision Support in Diabetes Care: The Challenge of Supporting Patients in Their Daily Living Using a Mobile Glucose Predictor.

PubMed

Pérez-Gandía, Carmen; García-Sáez, Gema; Subías, David; Rodríguez-Herrero, Agustín; Gómez, Enrique J; Rigla, Mercedes; Hernando, M Elena

2018-03-01

In type 1 diabetes mellitus (T1DM), patients play an active role in their own care and need to have the knowledge to adapt decisions to their daily living conditions. Artificial intelligence applications can help people with type 1 diabetes in decision making and allow them to react at time scales shorter than the scheduled face-to-face visits. This work presents a decision support system (DSS), based on glucose prediction, to assist patients in a mobile environment. The system's impact on therapeutic corrective actions has been evaluated in a randomized crossover pilot study focused on interprandial periods. Twelve people with type 1 diabetes treated with insulin pump participated in two phases: In the experimental phase (EP) patients used the DSS to modify initial corrective decisions in presence of hypoglycemia or hyperglycemia events. In the control phase (CP) patients were asked to follow decisions without knowing the glucose prediction. A telemedicine platform allowed participants to register monitoring data and decisions and allowed endocrinologists to supervise data at the hospital. The study period was defined as a postprediction (PP) time window. After knowing the glucose prediction, participants modified the initial decision in 20% of the situations. No statistically significant differences were found in the PP Kovatchev's risk index change (-1.23 ± 11.85 in EP vs -0.56 ± 6.06 in CP). Participants had a positive opinion about the DSS with an average score higher than 7 in a usability questionnaire. The DSS had a relevant impact in the participants' decision making while dealing with T1DM and showed a high confidence of patients in the use of glucose prediction.

Military Service and Decision Quality in the Management of Knee Osteoarthritis.

PubMed

Henderson, Eric R; Titus, Alexander J; Keeney, Benjamin J; Goodney, Philip P; Lurie, Jon D; Ibrahim, Said A

2018-05-18

Decision quality measures the degree to which care decisions are knowledge-based and value-aligned. Because military service emphasizes hierarchy, command, and mandates some healthcare decisions, military service may attenuate patient autonomy in healthcare decisions and lower decision quality. VA is the nation's largest provider of orthopedic care. We compared decision quality in a sample of VA and non-VA patients seeking care for knee osteoarthritis. Our study sample consisted of patients newly referred to our orthopedic clinic for the management of knee osteoarthritis. None of the study patients were exposed to a knee osteoarthritis decision aid. Consenting patients were administered the Hip/Knee Decision Quality Instrument (HK-DQI). In addition, they were surveyed about decision-making preferences and demographics. We compared results to a non-VA cohort from our academic institution's arthroplasty database. The HK-DQI Knowledge Score was lower in the VA cohort (45%, SD = 22, n = 25) compared with the non-VA cohort (53%, SD = 21, n = 177) (p = 0.04). The Concordance Score was lower in the VA cohort (36%, SD = 49%) compared with the control cohort (70%, SD 46%) (p = 0.003). Non-VA patients were more likely to make a high-quality decision (p = 0.05). Non-VA patients were more likely to favor a shared decision-making process (p = 0.002). Decision quality is lower in Veterans with knee osteoarthritis compared with civilians, placing them at risk for lower treatment satisfaction and possibly unwarranted surgical utilization. Our future work will examine if this difference is from conditioned military service behaviors or confounding demographic factors, and if conventional shared decision-making techniques will correct this deficiency.

Rubus fruit myths vs. reality

USDA-ARS?s Scientific Manuscript database

This factsheet corrects several popular media inaccuracies about Rubus fruit. Supplying the public with scientific facts is part of our continued efforts to assist consumers in making sound health conscious decisions. This project was partially funded by a Specialty Crop Research Initiative grant fr...

Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity.

PubMed

Bridwell, Keith H

2006-09-01

Author experience and literature review. To investigate and discuss decision-making on when to perform a Smith-Petersen osteotomy as opposed to a pedicle subtraction procedure and/or a vertebral column resection. Articles have been published regarding Smith-Petersen osteotomies, pedicle subtraction procedures, and vertebral column resections. Expectations and complications have been reviewed. However, decision-making regarding which of the 3 procedures is most useful for a particular spinal deformity case is not clearly investigated. Discussed in this manuscript is the author's experience and the literature regarding the operative options for a fixed coronal or sagittal deformity. There are roles for Smith-Petersen osteotomy, pedicle subtraction, and vertebral column resection. Each has specific applications and potential complications. As the magnitude of resection increases, the ability to correct deformity improves, but also the risk of complication increases. Therein, an understanding of potential applications and complications is helpful.

Treatment decision making and adjustment to breast cancer: a longitudinal study.

PubMed

Stanton, A L; Estes, M A; Estes, N C; Cameron, C L; Danoff-Burg, S; Irving, L M

1998-04-01

This study monitored women (N = 76) with breast cancer from diagnosis through 1 year, and tested constructs from subjective expected utility theory with regard to their ability to predict patients' choice of surgical treatment as well as psychological distress and well-being over time. Women's positive expectancies for the consequences of treatment generally were maintained in favorable perceptions of outcome in several realms (i.e., physician agreement, likelihood of cancer cure or recurrence, self-evaluation, likelihood of additional treatment, partner support for option, attractiveness to partner). Assessed before the surgical decision-making appointment, women's expectancies for consequences of the treatment options, along with age, correctly classified 94% of the sample with regard to election of mastectomy versus breast-conserving procedures. Calculated from the point of decision making to 3 months later, expectancy disconfirmations and value discrepancies concerning particular treatment consequences predicted psychological adjustment 3 months and 1 year after diagnosis.

Decision Accuracy in Computer-Mediated versus Face-to-Face Decision-Making Teams.

PubMed

Hedlund; Ilgen; Hollenbeck

1998-10-01

Changes in the way organizations are structured and advances in communication technologies are two factors that have altered the conditions under which group decisions are made. Decisions are increasingly made by teams that have a hierarchical structure and whose members have different areas of expertise. In addition, many decisions are no longer made via strictly face-to-face interaction. The present study examines the effects of two modes of communication (face-to-face or computer-mediated) on the accuracy of teams' decisions. The teams are characterized by a hierarchical structure and their members differ in expertise consistent with the framework outlined in the Multilevel Theory of team decision making presented by Hollenbeck, Ilgen, Sego, Hedlund, Major, and Phillips (1995). Sixty-four four-person teams worked for 3 h on a computer simulation interacting either face-to-face (FtF) or over a computer network. The communication mode had mixed effects on team processes in that members of FtF teams were better informed and made recommendations that were more predictive of the correct team decision, but leaders of CM teams were better able to differentiate staff members on the quality of their decisions. Controlling for the negative impact of FtF communication on staff member differentiation increased the beneficial effect of the FtF mode on overall decision making accuracy. Copyright 1998 Academic Press.

"Effects of Stress on Decisions Under Uncertainty: A Meta-Analysis": Correction to Starcke and Brand (2016).

PubMed

2016-09-01

Reports an error in "Effects of Stress on Decisions Under Uncertainty: A Meta-Analysis" by Katrin Starcke and Matthias Brand ( Psychological Bulletin , Advanced Online Publication, May 23, 2016, np). It should have been reported that the inverted u-shaped relationship between cortisol stress responses and decision-making performance was only observed in female, but not in male participants as suggested by the study by van den Bos, Harteveld, and Stoop (2009). Corrected versions of the affected sentences are provided. (The following abstract of the original article appeared in record 2016-25465-001.) The purpose of the present meta-analysis was to quantify the effects that stress has on decisions made under uncertainty. We hypothesized that stress increases reward seeking and risk taking through alterations of dopamine firing rates and reduces executive control by hindering optimal prefrontal cortex functioning. In certain decision situations, increased reward seeking and risk taking is dysfunctional, whereas in others, this is not the case. We also assumed that the type of stressor plays a role. In addition, moderating variables are analyzed, such as the hormonal stress response, the time between stress onset and decisions, and the participants' age and gender. We included studies in the meta-analysis that investigated decision making after a laboratory stress-induction versus a control condition (k = 32 datasets, N = 1829 participants). A random-effects model revealed that overall, stress conditions lead to decisions that can be described as more disadvantageous, more reward seeking, and more risk taking than nonstress conditions (d = .17). In those situations in which increased reward seeking and risk taking is disadvantageous, stress had significant effects (d = .26), whereas in other situations, no effects were observed (d = .01). Effects were observed under processive stressors (d = .19), but not under systemic ones (d = .09). Moderation analyses did not reveal any significant results. We concluded that stress deteriorates overall decision-making performance through the mechanisms proposed. The effects differ, depending on the decision situation and the type of stressor, but not on the characteristics of the individuals. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Refining a brief decision aid in stable CAD: cognitive interviews.

PubMed

Kelly-Blake, Karen; Clark, Stacie; Dontje, Katherine; Olomu, Adesuwa; Henry, Rebecca C; Rovner, David R; Rothert, Marilyn L; Holmes-Rovner, Margaret

2014-02-13

We describe the results of cognitive interviews to refine the "Making Choices©" Decision Aid (DA) for shared decision-making (SDM) about stress testing in patients with stable coronary artery disease (CAD). We conducted a systematic development process to design a DA consistent with International Patient Decision Aid Standards (IPDAS) focused on Alpha testing criteria. Cognitive interviews were conducted with ten stable CAD patients using the "think aloud" interview technique to assess the clarity, usefulness, and design of each page of the DA. Participants identified three main messages: 1) patients have multiple options based on stress tests and they should be discussed with a physician, 2) take care of yourself, 3) the stress test is the gold standard for determining the severity of your heart disease. Revisions corrected the inaccurate assumption of item number three. Cognitive interviews proved critical for engaging patients in the development process and highlighted the necessity of clear message development and use of design principles that make decision materials easy to read and easy to use. Cognitive interviews appear to contribute critical information from the patient perspective to the overall systematic development process for designing decision aids.

Trait anxiety affects decision-making differently in healthy men and women: towards gender-specific endophenotypes of anxiety.

PubMed

de Visser, L; van der Knaap, L J; van de Loo, A J A E; van der Weerd, C M M; Ohl, F; van den Bos, R

2010-05-01

Excessive levels of trait anxiety are a risk factor for psychiatric conditions, including anxiety disorders and substance abuse. High trait anxiety has been associated with altered cognitive functioning, in particular with an attentional bias towards aversive stimuli. Decision-making is a crucial aspect of cognitive functioning that relies on the correct processing and control of emotional stimuli. Interestingly, anxiety and decision-making share underlying neural substrates, involving cortico-limbic pathways, including the amygdala, striatum and medial and dorsolateral prefrontal cortices. In the present study, we investigated the relationship between trait anxiety, measured by the State-Trait Anxiety Inventory, and complex decision-making, measured by the Iowa Gambling Task, in healthy male and female volunteers. The main focus of this study was the inclusion of gender as a discriminative factor. Indeed, we found distinct gender-specific effects of trait anxiety: in men, both low and high anxiety groups showed impaired decision-making compared to medium anxiety individuals, whereas in women only high anxiety individuals performed poorly. Furthermore, anxiety affected decision-making in men early in the task, i.e. the exploration phase, as opposed to an effect on performance in women during the second part of the test, i.e. the exploitation phase. These findings were related to different profiles of trait anxiety in men and women, and were independent of performance in the Wisconsin Card Sorting Test and cortisol levels. Our data show gender-specific effects of trait anxiety on emotional decision-making. We suggest gender-specific endophenotypes of anxiety to exist, that differentially affect cognitive functioning. 2010 Elsevier Ltd. All rights reserved.

A video to improve patient and surrogate understanding of cardiopulmonary resuscitation choices in the ICU: a randomized controlled trial.

PubMed

Wilson, Michael E; Krupa, Artur; Hinds, Richard F; Litell, John M; Swetz, Keith M; Akhoundi, Abbasali; Kashyap, Rahul; Gajic, Ognjen; Kashani, Kianoush

2015-03-01

To determine if a video depicting cardiopulmonary resuscitation and resuscitation preference options would improve knowledge and decision making among patients and surrogates in the ICU. Randomized, unblinded trial. Single medical ICU. Patients and surrogate decision makers in the ICU. The usual care group received a standard pamphlet about cardiopulmonary resuscitation and cardiopulmonary resuscitation preference options plus routine code status discussions with clinicians. The video group received usual care plus an 8-minute video that depicted cardiopulmonary resuscitation, showed a simulated hospital code, and explained resuscitation preference options. One hundred three patients and surrogates were randomized to usual care. One hundred five patients and surrogates were randomized to video plus usual care. Median total knowledge scores (0-15 points possible for correct answers) in the video group were 13 compared with 10 in the usual care group, p value of less than 0.0001. Video group participants had higher rates of understanding the purpose of cardiopulmonary resuscitation and resuscitation options and terminology and could correctly name components of cardiopulmonary resuscitation. No statistically significant differences in documented resuscitation preferences following the interventions were found between the two groups, although the trial was underpowered to detect such differences. A majority of participants felt that the video was helpful in cardiopulmonary resuscitation decision making (98%) and would recommend the video to others (99%). A video depicting cardiopulmonary resuscitation and explaining resuscitation preference options was associated with improved knowledge of in-hospital cardiopulmonary resuscitation options and cardiopulmonary resuscitation terminology among patients and surrogate decision makers in the ICU, compared with receiving a pamphlet on cardiopulmonary resuscitation. Patients and surrogates found the video helpful in decision making and would recommend the video to others.

What are parents' perspectives on psychological empowerment in the MMR vaccination decision? A focus group study

PubMed Central

Fadda, Marta; Galimberti, Elisa; Carraro, Valter; Schulz, Peter J

2016-01-01

Objectives Most developed countries do not have compulsory immunisation requirements, but instead issue recommendations. Although parents are expected to make an informed, autonomous (ie, empowered) decision regarding their children's vaccinations, there is no evidence about how parents' interpret this demand nor on the latitude of their decision-making. The goal of this study is to gain insights from parents residing in a low measles-mumps-rubella (MMR) uptake area on what constitutes feelings of empowerment in the decision they have to make on their child's MMR vaccination. Design A qualitative study employing focus group interviews. Setting 11 vaccination centres and hospitals in the Province of Trento, Italy. Participants 24 mothers and 4 fathers of children for whom the MMR vaccination decision was still pending participated in 6 focus groups. Results Autonomy and competence were salient themes in relation to empowerment, and were further connected with beliefs regarding legal responsibility and ethics of freedom concerning the decision, parents' relationship with the paediatrician (trust), feelings of relevance of the decision and related stress, and seeking, avoidance, or fear of vaccination-related information. Competence was interpreted as medical knowledge and information-seeking skills, but it was also related to the extent parents perceived the paediatrician to be competent. Conclusions Since parents' interpretation of empowerment goes beyond mere perceptions of being informed and autonomous and differs across individuals, it is important that this construct be correctly interpreted and implemented by best practice, for instance by explicitly adopting a relational conception of autonomy. Knowing whether parents want to make an empowered decision and what their information and autonomy needs are might help health professionals adapt their communication about immunisation, and promote parental perception of making an informed, autonomous decision. PMID:27084284

The effect of four user interface concepts on visual scan pattern similarity and information foraging in a complex decision making task.

PubMed

Starke, Sandra D; Baber, Chris

2018-07-01

User interface (UI) design can affect the quality of decision making, where decisions based on digitally presented content are commonly informed by visually sampling information through eye movements. Analysis of the resulting scan patterns - the order in which people visually attend to different regions of interest (ROIs) - gives an insight into information foraging strategies. In this study, we quantified scan pattern characteristics for participants engaging with conceptually different user interface designs. Four interfaces were modified along two dimensions relating to effort in accessing information: data presentation (either alpha-numerical data or colour blocks), and information access time (all information sources readily available or sequential revealing of information required). The aim of the study was to investigate whether a) people develop repeatable scan patterns and b) different UI concepts affect information foraging and task performance. Thirty-two participants (eight for each UI concept) were given the task to correctly classify 100 credit card transactions as normal or fraudulent based on nine transaction attributes. Attributes varied in their usefulness of predicting the correct outcome. Conventional and more recent (network analysis- and bioinformatics-based) eye tracking metrics were used to quantify visual search. Empirical findings were evaluated in context of random data and possible accuracy for theoretical decision making strategies. Results showed short repeating sequence fragments within longer scan patterns across participants and conditions, comprising a systematic and a random search component. The UI design concept showing alpha-numerical data in full view resulted in most complete data foraging, while the design concept showing colour blocks in full view resulted in the fastest task completion time. Decision accuracy was not significantly affected by UI design. Theoretical calculations showed that the difference in achievable accuracy between very complex and simple decision making strategies was small. We conclude that goal-directed search of familiar information results in repeatable scan pattern fragments (often corresponding to information sources considered particularly important), but no repeatable complete scan pattern. The underlying concept of the UI affects how visual search is performed, and a decision making strategy develops. This should be taken in consideration when designing for applied domains. Copyright © 2018 Elsevier Ltd. All rights reserved.

Willed action, free will, and the stochastic neurodynamics of decision-making

PubMed Central

Rolls, Edmund T.

2012-01-01

It is shown that the randomness of the firing times of neurons in decision-making attractor neuronal networks that is present before the decision cues are applied can cause statistical fluctuations that influence the decision that will be taken. In this rigorous sense, it is possible to partially predict decisions before they are made. This raises issues about free will and determinism. There are many decision-making networks in the brain. Some decision systems operate to choose between gene-specified rewards such as taste, touch, and beauty (in for example the peacock's tail). Other processes capable of planning ahead with multiple steps held in working memory may require correction by higher order thoughts that may involve explicit, conscious, processing. The explicit system can allow the gene-specified rewards not to be selected or deferred. The decisions between the selfish gene-specified rewards, and the explicitly calculated rewards that are in the interests of the individual, the phenotype, may themselves be influenced by noise in the brain. When the explicit planning system does take the decision, it can report on its decision-making, and can provide a causal account rather than a confabulation about the decision process. We might use the terms “willed action” and “free will” to refer to the operation of the planning system that can think ahead over several steps held in working memory with which it can take explicit decisions. Reduced connectivity in some of the default mode cortical regions including the precuneus that are active during self-initiated action appears to be related to the reduction in the sense of self and agency, of causing willed actions, that can be present in schizophrenia. PMID:22973205

Simply criminal: predicting burglars' occupancy decisions with a simple heuristic.

PubMed

Snook, Brent; Dhami, Mandeep K; Kavanagh, Jennifer M

2011-08-01

Rational choice theories of criminal decision making assume that offenders weight and integrate multiple cues when making decisions (i.e., are compensatory). We tested this assumption by comparing how well a compensatory strategy called Franklin's Rule captured burglars' decision policies regarding residence occupancy compared to a non-compensatory strategy (i.e., Matching Heuristic). Forty burglars each decided on the occupancy of 20 randomly selected photographs of residences (for which actual occupancy was known when the photo was taken). Participants also provided open-ended reports on the cues that influenced their decisions in each case, and then rated the importance of eight cues (e.g., deadbolt visible) over all decisions. Burglars predicted occupancy beyond chance levels. The Matching Heuristic was a significantly better predictor of burglars' decisions than Franklin's Rule, and cue use in the Matching Heuristic better corresponded to the cue ecological validities in the environment than cue use in Franklin's Rule. The most important cue in burglars' models was also the most ecologically valid or predictive of actual occupancy (i.e., vehicle present). The majority of burglars correctly identified the most important cue in their models, and the open-ended technique showed greater correspondence between self-reported and captured cue use than the rating over decision technique. Our findings support a limited rationality perspective to understanding criminal decision making, and have implications for crime prevention.

Enhancing Medical Decision-Making Evaluations: Introduction of Normative Data for the Capacity to Consent to Treatment Instrument.

PubMed

Gerstenecker, Adam; Niccolai, Lindsay; Marson, Daniel; Triebel, Kristen L

2016-04-01

A number of measures have been developed to assess medical decision-making capacity (MDC) in adults. However, their clinical utility is limited by a lack of available normative data. In the current study, we introduce age-independent and age-adjusted normative data for a measure of MDC: the Capacity to Consent to Treatment Instrument. The sample consisted of 308 cognitively normal, community-dwelling adults ranging in age from 19 to 86 years. For age-adjusted norms, individual raw scores were first converted to age-corrected scaled scores based on position within a cumulative frequency distribution and then grouped according to empirically supported age ranges. For age-independent norms, the same method was utilized but without age-corrections being applied or participants being grouped into age ranges. This study has the potential to enhance MDC evaluations by allowing clinicians to compare a patient's performance on the Capacity to Consent to Treatment Instrument with that of adults regardless of age as well as to same age peers. Tables containing normative corrections are supplementary material available online at http://asm.sagepub.com/supplemental. © The Author(s) 2015.

Deciding on PSA-screening - Quality of current consumer information on the Internet.

PubMed

Korfage, Ida J; van den Bergh, Roderick C N; Essink-Bot, Marie-Louise

2010-11-01

Given that screening for prostate cancer has the potential to reduce prostate cancer mortality at the expense of considerable overdiagnosis and overtreatment, the availability of core consumer information - correct, balanced and supportive of autonomous decision-making - is a must. We assessed the quality of consumer information available through the Internet per November 2009 and its possible contribution to informed decision-making by potential screenees. Consumer information on PSA-screening was sought through the Internet in November 2009. Materials had to be targeted at potential consumers, offered by not-for-profit organisations, released in 2005 or after, in English or Dutch. Per material 2 of the authors assessed independently from each other whether standardised pre-defined topics were addressed, whether the content was correct and which approach was taken towards the decision-making process about uptake. Twenty-three materials were included, of which 11 were released (shortly) after the results of 2 large randomized-controlled trials (RCTs) that evaluated the effectiveness of screening for prostate cancer had been published in March 2009. That a PSA-test result can be abnormal because of non-cancerous conditions (false positive) and that it may miss prostate cancer (false negative) was not addressed in 2/23 and 8/23 materials, respectively. The risk of overdiagnosis and overtreatment was not mentioned in 6 out of 23. PSA-screening was presented as a usual thing to do in some materials, whereas other materials emphasised the voluntary nature of PSA-screening ('it is your decision'). The content of 19/23 materials was considered sufficiently informative according to the pre-defined criteria, 12/23 materials were considered supportive of informed decision-making by men. Most materials of not-for-profit organizations supplied adequate information about PSA-screening, whilst the degree of persuasion towards uptake reflected variations in opinions on men's autonomy regarding their own health. Copyright © 2010 Elsevier Ltd. All rights reserved.

"An integrative formal model of motivation and decision making: The MGPM*": Correction to Ballard et al. (2016).

PubMed

2017-02-01

Reports an error in "An integrative formal model of motivation and decision making: The MGPM*" by Timothy Ballard, Gillian Yeo, Shayne Loft, Jeffrey B. Vancouver and Andrew Neal ( Journal of Applied Psychology , 2016[Sep], Vol 101[9], 1240-1265). Equation A3 contained an error. This correct equation is provided in the erratum. (The following abstract of the original article appeared in record 2016-28692-001.) We develop and test an integrative formal model of motivation and decision making. The model, referred to as the extended multiple-goal pursuit model (MGPM*), is an integration of the multiple-goal pursuit model (Vancouver, Weinhardt, & Schmidt, 2010) and decision field theory (Busemeyer & Townsend, 1993). Simulations of the model generated predictions regarding the effects of goal type (approach vs. avoidance), risk, and time sensitivity on prioritization. We tested these predictions in an experiment in which participants pursued different combinations of approach and avoidance goals under different levels of risk. The empirical results were consistent with the predictions of the MGPM*. Specifically, participants pursuing 1 approach and 1 avoidance goal shifted priority from the approach to the avoidance goal over time. Among participants pursuing 2 approach goals, those with low time sensitivity prioritized the goal with the larger discrepancy, whereas those with high time sensitivity prioritized the goal with the smaller discrepancy. Participants pursuing 2 avoidance goals generally prioritized the goal with the smaller discrepancy. Finally, all of these effects became weaker as the level of risk increased. We used quantitative model comparison to show that the MGPM* explained the data better than the original multiple-goal pursuit model, and that the major extensions from the original model were justified. The MGPM* represents a step forward in the development of a general theory of decision making during multiple-goal pursuit. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Two sides of the same coin: Monetary incentives concurrently improve and bias confidence judgments.

PubMed

Lebreton, Maël; Langdon, Shari; Slieker, Matthijs J; Nooitgedacht, Jip S; Goudriaan, Anna E; Denys, Damiaan; van Holst, Ruth J; Luigjes, Judy

2018-05-01

Decisions are accompanied by a feeling of confidence, that is, a belief about the decision being correct. Confidence accuracy is critical, notably in high-stakes situations such as medical or financial decision-making. We investigated how incentive motivation influences confidence accuracy by combining a perceptual task with a confidence incentivization mechanism. By varying the magnitude and valence (gains or losses) of monetary incentives, we orthogonalized their motivational and affective components. Corroborating theories of rational decision-making and motivation, our results first reveal that the motivational value of incentives improves aspects of confidence accuracy. However, in line with a value-confidence interaction hypothesis, we further show that the affective value of incentives concurrently biases confidence reports, thus degrading confidence accuracy. Finally, we demonstrate that the motivational and affective effects of incentives differentially affect how confidence builds on perceptual evidence. Together, these findings may provide new hints about confidence miscalibration in healthy or pathological contexts.

Probabilistic vs. non-probabilistic approaches to the neurobiology of perceptual decision-making

PubMed Central

Drugowitsch, Jan; Pouget, Alexandre

2012-01-01

Optimal binary perceptual decision making requires accumulation of evidence in the form of a probability distribution that specifies the probability of the choices being correct given the evidence so far. Reward rates can then be maximized by stopping the accumulation when the confidence about either option reaches a threshold. Behavioral and neuronal evidence suggests that humans and animals follow such a probabilitistic decision strategy, although its neural implementation has yet to be fully characterized. Here we show that that diffusion decision models and attractor network models provide an approximation to the optimal strategy only under certain circumstances. In particular, neither model type is sufficiently flexible to encode the reliability of both the momentary and the accumulated evidence, which is a pre-requisite to accumulate evidence of time-varying reliability. Probabilistic population codes, in contrast, can encode these quantities and, as a consequence, have the potential to implement the optimal strategy accurately. PMID:22884815

Application of majority voting and consensus voting algorithms in N-version software

NASA Astrophysics Data System (ADS)

Tsarev, R. Yu; Durmuş, M. S.; Üstoglu, I.; Morozov, V. A.

2018-05-01

N-version programming is one of the most common techniques which is used to improve the reliability of software by building in fault tolerance, redundancy and decreasing common cause failures. N different equivalent software versions are developed by N different and isolated workgroups by considering the same software specifications. The versions solve the same task and return results that have to be compared to determine the correct result. Decisions of N different versions are evaluated by a voting algorithm or the so-called voter. In this paper, two of the most commonly used software voting algorithms such as the majority voting algorithm and the consensus voting algorithm are studied. The distinctive features of Nversion programming with majority voting and N-version programming with consensus voting are described. These two algorithms make a decision about the correct result on the base of the agreement matrix. However, if the equivalence relation on the agreement matrix is not satisfied it is impossible to make a decision. It is shown that the agreement matrix can be transformed into an appropriate form by using the Boolean compositions when the equivalence relation is satisfied.

Influence of clinical knowledge, organizational context, and practice style on transfusion decision making. Implications for practice change strategies.

PubMed

Salem-Schatz, S R; Avorn, J; Soumerai, S B

1990-07-25

Evidence shows that blood products, like other health care resources, are often used inappropriately, but the reasons for this have not been well studied. We conducted a face-to-face survey of 122 general surgeons, orthopedic surgeons, and anesthesiologists in three hospitals to evaluate the influence of several clinical and nonclinical factors on transfusion decision making. We found widespread deficiencies in physicians' knowledge of transfusion risks and indications. Each transfusion risk was estimated correctly by fewer than half of the physicians surveyed, and only 31% responded correctly to a set of four questions regarding transfusion indications. Attending physicians routinely had lower knowledge scores than did residents, yet they exhibited more confidence in their knowledge. Residents' transfusion decisions, however, were strongly influenced by the desires of their attending physicians, resulting in their ordering potentially inappropriate transfusions. Of the residents surveyed, 61% indicated that they ordered transfusions that they judged unnecessary at least once a month because a more senior physician suggested that they do so. These findings provide insights for the development of strategies to improve transfusion practices, which would address the dual concerns of quality of care and cost containment.

Heuristic Reasoning in Chemistry: Making decisions about acid strength

NASA Astrophysics Data System (ADS)

McClary, LaKeisha; Talanquer, Vicente

2011-07-01

The characterization of students' reasoning strategies is of central importance in the development of instructional strategies that foster meaningful learning. In particular, the identification of shortcut reasoning procedures (heuristics) used by students to reduce cognitive load can help us devise strategies to facilitate the development of more analytical ways of thinking. The central goal of this qualitative study was thus to investigate heuristic reasoning as used by organic chemistry college students, focusing our attention on their ability to predict the relative acid strength of chemical compounds represented using explicit composition and structural features (i.e., structural formulas). Our results indicated that many study participants relied heavily on one or more of the following heuristics to make most of their decisions: reduction, representativeness, and lexicographic. Despite having visual access to reach structural information about the substances included in each ranking task, many students relied on isolated composition features to make their decisions. However, the specific characteristics of the tasks seemed to trigger heuristic reasoning in different ways. Although the use of heuristics allowed students to simplify some components of the ranking tasks and generate correct responses, it often led them astray. Very few study participants predicted the correct trends based on scientifically acceptable arguments. Our results suggest the need for instructional interventions that explicitly develop college chemistry students' abilities to monitor their thinking and evaluate the effectiveness of analytical versus heuristic reasoning strategies in different contexts.

Shared decision-making to improve attention-deficit hyperactivity disorder care.

PubMed

Brinkman, William B; Hartl Majcher, Jessica; Poling, Lauren M; Shi, Gaoyan; Zender, Mike; Sucharew, Heidi; Britto, Maria T; Epstein, Jeffery N

2013-10-01

To examine the effect of a shared decision-making intervention with parents of children newly diagnosed with attention-deficit/hyperactivity disorder. Seven pediatricians participated in a pre/post open trial of decision aids for use before and during the office visit to discuss diagnosis and develop a treatment plan. Encounters pre- (n=21, control group) and post-intervention implementation (n=33, intervention group) were compared. We video-recorded encounters and surveyed parents. Compared to controls, intervention group parents were more involved in shared decision-making (31.2 vs. 43.8 on OPTION score, p<0.01), more knowledgeable (6.4 vs. 8.1 questions correct, p<0.01), and less conflicted about treatment options (16.2 vs. 10.7 on decisional conflict total score, p=0.06). Visit duration was unchanged (41.0 vs. 41.6min, p=0.75). There were no significant differences in the median number of follow-up visits (0 vs. 1 visits, p=0.08), or the proportion of children with medication titration (62% vs. 76%, p=0.28), or parent-completed behavior rating scale to assess treatment response (24% vs. 39%, p=0.36). Our intervention increased shared decision-making with parents. Parents were better informed about treatment options without increasing visit duration. Interventions are available to prepare parents for visits and enable physicians to elicit parent preferences and involvement in decision-making. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Of mental models, assumptions and heuristics: The case of acids and acid strength

NASA Astrophysics Data System (ADS)

McClary, Lakeisha Michelle

This study explored what cognitive resources (i.e., units of knowledge necessary to learn) first-semester organic chemistry students used to make decisions about acid strength and how those resources guided the prediction, explanation and justification of trends in acid strength. We were specifically interested in the identifying and characterizing the mental models, assumptions and heuristics that students relied upon to make their decisions, in most cases under time constraints. The views about acids and acid strength were investigated for twenty undergraduate students. Data sources for this study included written responses and individual interviews. The data was analyzed using a qualitative methodology to answer five research questions. Data analysis regarding these research questions was based on existing theoretical frameworks: problem representation (Chi, Feltovich & Glaser, 1981), mental models (Johnson-Laird, 1983); intuitive assumptions (Talanquer, 2006), and heuristics (Evans, 2008). These frameworks were combined to develop the framework from which our data were analyzed. Results indicated that first-semester organic chemistry students' use of cognitive resources was complex and dependent on their understanding of the behavior of acids. Expressed mental models were generated using prior knowledge and assumptions about acids and acid strength; these models were then employed to make decisions. Explicit and implicit features of the compounds in each task mediated participants' attention, which triggered the use of a very limited number of heuristics, or shortcut reasoning strategies. Many students, however, were able to apply more effortful analytic reasoning, though correct trends were predicted infrequently. Most students continued to use their mental models, assumptions and heuristics to explain a given trend in acid strength and to justify their predicted trends, but the tasks influenced a few students to shift from one model to another model. An emergent finding from this project was that the problem representation greatly influenced students' ability to make correct predictions in acid strength. Many students, however, were able to apply more effortful analytic reasoning, though correct trends were predicted infrequently. Most students continued to use their mental models, assumptions and heuristics to explain a given trend in acid strength and to justify their predicted trends, but the tasks influenced a few students to shift from one model to another model. An emergent finding from this project was that the problem representation greatly influenced students' ability to make correct predictions in acid strength.

Exploring the effect of sexual empowerment on sexual decision making in female adolescents.

PubMed

Hsu, Hsiu-Yueh; Lien, Yu-Fen; Lou, Jiunn-Horng; Chen, Sheng-Hwang; Wang, Ruey-Hsia

2010-03-01

Traditional health education may not provide adequate sexual information to female adolescents. Sexual health education for female adolescents broadens opportunities for nurses to help female adolescents adopt appropriate sexual attitudes and make appropriate decisions. The purpose of this study was to understand the effect of sexual empowerment on sexual decision making in female adolescents. Twenty-nine female students with steady boyfriends were invited to participate in a sexual empowerment course. Course activities specifically related to sexual empowerment were audio-tape-recorded. Dialogue content was analyzed, and content provided by each study participant was reconfirmed in face-to-face interviews to understand the entire empowerment process in terms of how such may affect responses and to assess the possibility of correctly reinterpreting findings during the member check process. This study also took into consideration degrees of reliability and rigorousness. The four themes found to underlie participant perceptions of their sexual empowerment to make sex-related decisions were as follows: (a) proactively seeking sexual knowledge, (b) reexamining relationships with boyfriends, (c) the right to say "no" and to engage in self-protection, and (d) the need to change sexual attitudes and behaviors. Using the peer group intervention in sexual empowerment may positively impact sexual health decision making in adolescent girls. Nursing professionals may consider peer group intervention as a sexual empowering method in healthcare.

Participants' recall and understanding of genomic research and large-scale data sharing.

PubMed

Robinson, Jill Oliver; Slashinski, Melody J; Wang, Tao; Hilsenbeck, Susan G; McGuire, Amy L

2013-10-01

As genomic researchers are urged to openly share generated sequence data with other researchers, it is important to examine the utility of informed consent documents and processes, particularly as these relate to participants' engagement with and recall of the information presented to them, their objective or subjective understanding of the key elements of genomic research (e.g., data sharing), as well as how these factors influence or mediate the decisions they make. We conducted a randomized trial of three experimental informed consent documents (ICDs) with participants (n = 229) being recruited to genomic research studies; each document afforded varying control over breadth of release of genetic information. Recall and understanding, their impact on data sharing decisions, and comfort in decision making were assessed in a follow-up structured interview. Over 25% did not remember signing an ICD to participate in a genomic study, and the majority (54%) could not correctly identify with whom they had agreed to share their genomic data. However, participants felt that they understood enough to make an informed decision, and lack of recall did not impact final data sharing decisions or satisfaction with participation. These findings raise questions about the types of information participants need in order to provide valid informed consent, and whether subjective understanding and comfort with decision making are sufficient to satisfy the ethical principle of respect for persons.

The idiosyncratic nature of confidence

PubMed Central

Navajas, Joaquin; Hindocha, Chandni; Foda, Hebah; Keramati, Mehdi; Latham, Peter E; Bahrami, Bahador

2017-01-01

Confidence is the ‘feeling of knowing’ that accompanies decision making. Bayesian theory proposes that confidence is a function solely of the perceived probability of being correct. Empirical research has suggested, however, that different individuals may perform different computations to estimate confidence from uncertain evidence. To test this hypothesis, we collected confidence reports in a task where subjects made categorical decisions about the mean of a sequence. We found that for most individuals, confidence did indeed reflect the perceived probability of being correct. However, in approximately half of them, confidence also reflected a different probabilistic quantity: the perceived uncertainty in the estimated variable. We found that the contribution of both quantities was stable over weeks. We also observed that the influence of the perceived probability of being correct was stable across two tasks, one perceptual and one cognitive. Overall, our findings provide a computational interpretation of individual differences in human confidence. PMID:29152591

Smart strategies for doctors and doctors-in-training: heuristics in medicine.

PubMed

Wegwarth, Odette; Gaissmaier, Wolfgang; Gigerenzer, Gerd

2009-08-01

How do doctors make sound decisions when confronted with probabilistic data, time pressures and a heavy workload? One theory that has been embraced by many researchers is based on optimisation, which emphasises the need to integrate all information in order to arrive at sound decisions. This notion makes heuristics, which use less than complete information, appear as second-best strategies. In this article, we challenge this pessimistic view of heuristics. We introduce two medical problems that involve decision making to the reader: one concerns coronary care issues and the other macrolide prescriptions. In both settings, decision-making tools grounded in the principles of optimisation and heuristics, respectively, have been developed to assist doctors in making decisions. We explain the structure of each of these tools and compare their performance in terms of their facilitation of correct predictions. For decisions concerning both the coronary care unit and the prescribing of macrolides, we demonstrate that sacrificing information does not necessarily imply a forfeiting of predictive accuracy, but can sometimes even lead to better decisions. Subsequently, we discuss common misconceptions about heuristics and explain when and why ignoring parts of the available information can lead to the making of more robust predictions. Heuristics are neither good nor bad per se, but, if applied in situations to which they have been adapted, can be helpful companions for doctors and doctors-in-training. This, however, requires that heuristics in medicine be openly discussed, criticised, refined and then taught to doctors-in-training rather than being simply dismissed as harmful or irrelevant. A more uniform use of explicit and accepted heuristics has the potential to reduce variations in diagnoses and to improve medical care for patients.

76 FR 40229 - Psychiatric Evaluation and Treatment

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-08

... qualified to make decisions about the administration of psychopharmacologic medications and that, when... practitioner (Physician's Assistant or Nurse Practitioner), it must be signed by a licensed physician before it... advance practice nurses as part of the treatment team in correctional facilities.'' While the Bureau does...

Four Conceptions of Linguistic Disadvantage

ERIC Educational Resources Information Center

Shorten, Andrew

2017-01-01

Policymakers need a conception of linguistic disadvantage to supply guidance about the relative priority of inequalities with a linguistic dimension and to inform decisions about whether such inequalities require correction or compensation. A satisfactory conception of linguistic disadvantage will make it possible to compare the situations of…

Categorization and decision-making in a neurobiologically plausible spiking network using a STDP-like learning rule.

PubMed

Beyeler, Michael; Dutt, Nikil D; Krichmar, Jeffrey L

2013-12-01

Understanding how the human brain is able to efficiently perceive and understand a visual scene is still a field of ongoing research. Although many studies have focused on the design and optimization of neural networks to solve visual recognition tasks, most of them either lack neurobiologically plausible learning rules or decision-making processes. Here we present a large-scale model of a hierarchical spiking neural network (SNN) that integrates a low-level memory encoding mechanism with a higher-level decision process to perform a visual classification task in real-time. The model consists of Izhikevich neurons and conductance-based synapses for realistic approximation of neuronal dynamics, a spike-timing-dependent plasticity (STDP) synaptic learning rule with additional synaptic dynamics for memory encoding, and an accumulator model for memory retrieval and categorization. The full network, which comprised 71,026 neurons and approximately 133 million synapses, ran in real-time on a single off-the-shelf graphics processing unit (GPU). The network was constructed on a publicly available SNN simulator that supports general-purpose neuromorphic computer chips. The network achieved 92% correct classifications on MNIST in 100 rounds of random sub-sampling, which is comparable to other SNN approaches and provides a conservative and reliable performance metric. Additionally, the model correctly predicted reaction times from psychophysical experiments. Because of the scalability of the approach and its neurobiological fidelity, the current model can be extended to an efficient neuromorphic implementation that supports more generalized object recognition and decision-making architectures found in the brain. Copyright © 2013 Elsevier Ltd. All rights reserved.

Consistency of the Relations of Cognitive Ability and Personality Traits to Pilot Training Performance

DTIC Science & Technology

2014-08-22

MAB–II scores. The univariate Case II correction ( Thorndike , 1949) was used for the NEO PI–R scores due to a lack of sufficient data to apply the...multivariate method (Lawley, 1943), whereas the NEO domain scores were corrected using the univariate Case 2 ( Thorndike , 1949) method. VIQ = verbal IQ; PIQ...Air Force Research Laboratory, Decision Making Division. Thorndike , R. L. (1949). Personnel selection. New York, NY: Wiley. U.S. Air Force. (2011

The more the merrier? Increasing group size may be detrimental to decision-making performance in nominal groups.

PubMed

Amir, Ofra; Amir, Dor; Shahar, Yuval; Hart, Yuval; Gal, Kobi

2018-01-01

Demonstrability-the extent to which group members can recognize a correct solution to a problem-has a significant effect on group performance. However, the interplay between group size, demonstrability and performance is not well understood. This paper addresses these gaps by studying the joint effect of two factors-the difficulty of solving a problem and the difficulty of verifying the correctness of a solution-on the ability of groups of varying sizes to converge to correct solutions. Our empirical investigations use problem instances from different computational complexity classes, NP-Complete (NPC) and PSPACE-complete (PSC), that exhibit similar solution difficulty but differ in verification difficulty. Our study focuses on nominal groups to isolate the effect of problem complexity on performance. We show that NPC problems have higher demonstrability than PSC problems: participants were significantly more likely to recognize correct and incorrect solutions for NPC problems than for PSC problems. We further show that increasing the group size can actually decrease group performance for some problems of low demonstrability. We analytically derive the boundary that distinguishes these problems from others for which group performance monotonically improves with group size. These findings increase our understanding of the mechanisms that underlie group problem-solving processes, and can inform the design of systems and processes that would better facilitate collective decision-making.

Clinical and genetic correlates of decision making in anorexia nervosa.

PubMed

Tenconi, Elena; Degortes, Daniela; Clementi, Maurizio; Collantoni, Enrico; Pinato, Claudia; Forzan, Monica; Cassina, Matteo; Santonastaso, Paolo; Favaro, Angela

2016-01-01

Decision-making (DM) abilities have been found to be impaired in anorexia nervosa (AN), but few data are available about the characteristics and correlates of this cognitive function. The aim of the present study was to provide data on DM functioning in AN using both veridical and adaptive paradigms. While in veridical DM tasks, the individual's ability to predict a true/false response is measured, adaptive DM is the ability to consider both internal and external demands in order to make a good choice, in the absence of a single true "correct" answer. The participants were 189 women, of whom 91 were eating-disordered patients with a lifetime diagnosis of anorexia nervosa, and 98 were healthy women. All the participants underwent clinical, neuropsychological, and genetic assessment. The cognitive evaluation included a set of neuropsychological tasks and two decision-making tests: The Iowa Gambling Task and the Cognitive Bias Task. Anorexia nervosa patients showed significantly poorer performances on both decision-making tasks than healthy women. The Cognitive Bias Task revealed that anorexia nervosa patients employed significantly more context-independent decision-making strategies, which were independent from diagnostic subtype, handedness, education, and psychopathology. In the whole sample (patients and controls), Cognitive Bias Task performance was independently predicted by lifetime anorexia nervosa diagnosis, body mass index at assessment, and 5-HTTLPR genotype. Patients displayed poor decision-making functioning in both veridical and adaptive situations. The difficulties detected in anorexia nervosa individuals may affect not only the ability to consider the future outcomes of their actions (leading to "myopia for the future"), but also the capacity to update and review one's own mindset according to new environmental stimuli.

Blocking serotonin but not dopamine reuptake alters neural processing during perceptual decision making.

PubMed

Costa, Vincent D; Kakalios, Laura C; Averbeck, Bruno B

2016-10-01

Dopamine and serotonin have opponent interactions on aspects of impulsivity. Therefore we wanted to test the hypothesis that dopamine and serotonin would have opposing effects on speed-accuracy trade offs in a perceptual decision making task. Unlike other behavioral measures of impulsivity, perceptual decision making allows us to determine whether decreasing premature responses, often interpreted as decreased impulsivity, corresponds to increased behavioral performance. We administered GBR-12909 (a dopamine transporter blocker), escitalopram (a serotonin transporter blocker), or saline in separate sessions to 3 rhesus macaques. We found that animals had slower reaction times (RTs) on escitalopram than on GBR-12909 or saline. However, they were also least accurate on escitalopram. Animals were faster, although nonsignificantly, on GBR than saline and had equivalent accuracy. Administration of GBR-12909 did cause animals to be faster in error trials than correct trials. Therefore, from the point of view of RTs the animals were less impulsive on escitalopram. However, the decreased accuracy of the monkeys shows that they were not able to make use of their slower response times to make more accurate decisions. Therefore, impulsivity was reduced on escitalopram, but at the expense of a slower information-processing rate in the perceptual inference task. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

78 FR 58897 - Pipeline Safety: Administrative Procedures; Updates and Technical Corrections

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-25

... incorporate increased transparency into the decision making process, the regulations must explicitly recognize... certainty, and due process. II. Discussion of Comments The comments received from the trade organizations... assistance through these processes by assisting OPS in the development of written responses to requests for...

Use of the AHP methodology in system dynamics: Modelling and simulation for health technology assessments to determine the correct prosthesis choice for hernia diseases.

PubMed

Improta, Giovanni; Russo, Mario Alessandro; Triassi, Maria; Converso, Giuseppe; Murino, Teresa; Santillo, Liberatina Carmela

2018-05-01

Health technology assessments (HTAs) are often difficult to conduct because of the decisive procedures of the HTA algorithm, which are often complex and not easy to apply. Thus, their use is not always convenient or possible for the assessment of technical requests requiring a multidisciplinary approach. This paper aims to address this issue through a multi-criteria analysis focusing on the analytic hierarchy process (AHP). This methodology allows the decision maker to analyse and evaluate different alternatives and monitor their impact on different actors during the decision-making process. However, the multi-criteria analysis is implemented through a simulation model to overcome the limitations of the AHP methodology. Simulations help decision-makers to make an appropriate decision and avoid unnecessary and costly attempts. Finally, a decision problem regarding the evaluation of two health technologies, namely, the evaluation of two biological prostheses for incisional infected hernias, will be analysed to assess the effectiveness of the model. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Meta-analysis in evidence-based healthcare: a paradigm shift away from random effects is overdue.

PubMed

Doi, Suhail A R; Furuya-Kanamori, Luis; Thalib, Lukman; Barendregt, Jan J

2017-12-01

Each year up to 20 000 systematic reviews and meta-analyses are published whose results influence healthcare decisions, thus making the robustness and reliability of meta-analytic methods one of the world's top clinical and public health priorities. The evidence synthesis makes use of either fixed-effect or random-effects statistical methods. The fixed-effect method has largely been replaced by the random-effects method as heterogeneity of study effects led to poor error estimation. However, despite the widespread use and acceptance of the random-effects method to correct this, it too remains unsatisfactory and continues to suffer from defective error estimation, posing a serious threat to decision-making in evidence-based clinical and public health practice. We discuss here the problem with the random-effects approach and demonstrate that there exist better estimators under the fixed-effect model framework that can achieve optimal error estimation. We argue for an urgent return to the earlier framework with updates that address these problems and conclude that doing so can markedly improve the reliability of meta-analytical findings and thus decision-making in healthcare.

Mass Deacidification Systems: Planning and Managerial Decision Making.

ERIC Educational Resources Information Center

Turko, Karen

Library administrators, faced with the problems of acid-paper deterioration, are examining mass deacidification procedures. Mass deacidification of acidic books while they are still physically sound and not yet brittle is the most cost-effective corrective action to extend the life of the paper. There are currently at least five mass…

A Model Assessment and Classification System for Men and Women in Correctional Institutions.

ERIC Educational Resources Information Center

Hellervik, Lowell W.; And Others

The report describes a manpower assessment and classification system for criminal offenders directed towards making practical training and job classification decisions. The model is not concerned with custody classifications except as they affect occupational/training possibilities. The model combines traditional procedures of vocational…

Don't Just Do the Math--Type It!

ERIC Educational Resources Information Center

Stephens, Greg

2016-01-01

Most word processors, including Google Docs™ and Microsoft® Word, include an equation editor. These are great tools for the occasional homework problem or project assignment. Getting the mathematics to display correctly means making decisions about exactly which elements of an expression go where. The feedback is immediate: Students can see…

77 FR 24878 - Privacy Act of 1974; Implementation

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-26

... accounting be made available to the named subject of a record, because this system is exempt from the access provisions of subsection (d). Also, because making available to a record subject the accounting of... correctional management decisions. (6) From subsections (e)(3) because in view of BOP's operational...

A multiple-scenario assessment of the effect of a continuous-care, guideline-based decision support system on clinicians' compliance to clinical guidelines.

PubMed

Shalom, Erez; Shahar, Yuval; Parmet, Yisrael; Lunenfeld, Eitan

2015-04-01

To quantify the effect of a new continuous-care guideline (GL)-application engine, the Picard decision support system (DSS) engine, on the correctness and completeness of clinicians' decisions relative to an established clinical GL, and to assess the clinicians' attitudes towards a specific DSS. Thirty-six clinicians, including residents at different training levels and board-certified specialists at an academic OB/GYN department that handles around 15,000 deliveries annually, agreed to evaluate our continuous-care guideline-based DSS and to perform a cross-over assessment of the effects of using our guideline-based DSS. We generated electronic patient records that realistically simulated the longitudinal course of six different clinical scenarios of the preeclampsia/eclampsia/toxemia (PET) GL, encompassing 60 different decision points in total. Each clinician managed three scenarios manually without the Picard DSS engine (Non-DSS mode) and three scenarios when assisted by the Picard DSS engine (DSS mode). The main measures in both modes were correctness and completeness of actions relative to the PET GL. Correctness was further decomposed into necessary and redundant actions, relative to the guideline and the actual patient data. At the end of the assessment, a questionnaire was administered to the clinicians to assess their perceptions regarding use of the DSS. With respect to completeness, the clinicians applied approximately 41% of the GL's recommended actions in the non-DSS mode. Completeness increased to the performance of approximately 93% of the guideline's recommended actions, when using the DSS mode. With respect to correctness, approximately 94.5% of the clinicians' decisions in the non-DSS mode were correct. However, these included 68% of the actions that were correct but redundant, given the patient's data (e.g., repeating tests that had been performed), and 27% of the actions, which were necessary in the context of the GL and of the given scenario. Only 5.5% of the decisions were definite errors. In the DSS mode, 94% of the clinicians' decisions were correct, which included 3% that were correct but redundant, and 91% of the actions that were correct and necessary in the context of the GL and of the given scenario. Only 6% of the DSS-mode decisions were erroneous. The DSS was assessed by the clinicians as potentially useful. Support from the GL-based DSS led to uniformity in the quality of the decisions, regardless of the particular clinician, any particular clinical scenario, any particular decision point, or any decision type within the scenarios. Using the DSS dramatically enhances completeness (i.e., performance of guideline-based recommendations) and seems to prevent the performance of most of the redundant actions, but does not seem to affect the rate of performance of incorrect actions. The redundancy rate is enhanced by similar recent findings in recent studies. Clinicians mostly find this support to be potentially useful for their daily practice. A continuous-care GL-based DSS, such as the Picard DSS engine, has the potential to prevent most errors of omission by ensuring uniformly high quality of clinical decision making (relative to a GL-based norm), due to the increased adherence (i.e., completeness) to the GL, and most of the errors of commission that increase therapy costs, by reducing the rate of redundant actions. However, to prevent clinical errors of commission, the DSS needs to be accompanied by additional modules, such as automated control of the quality of the physician's actual actions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Environmental change challenges decision-making during post-market environmental monitoring of transgenic crops.

PubMed

Sanvido, Olivier; Romeis, Jörg; Bigler, Franz

2011-12-01

The ability to decide what kind of environmental changes observed during post-market environmental monitoring of genetically modified (GM) crops represent environmental harm is an essential part of most legal frameworks regulating the commercial release of GM crops into the environment. Among others, such decisions are necessary to initiate remedial measures or to sustain claims of redress linked to environmental liability. Given that consensus on criteria to evaluate 'environmental harm' has not yet been found, there are a number of challenges for risk managers when interpreting GM crop monitoring data for environmental decision-making. In the present paper, we argue that the challenges in decision-making have four main causes. The first three causes relate to scientific data collection and analysis, which have methodological limits. The forth cause concerns scientific data evaluation, which is controversial among the different stakeholders involved in the debate on potential impacts of GM crops on the environment. This results in controversy how the effects of GM crops should be valued and what constitutes environmental harm. This controversy may influence decision-making about triggering corrective actions by regulators. We analyse all four challenges and propose potential strategies for addressing them. We conclude that environmental monitoring has its limits in reducing uncertainties remaining from the environmental risk assessment prior to market approval. We argue that remaining uncertainties related to adverse environmental effects of GM crops would probably be assessed in a more efficient and rigorous way during pre-market risk assessment. Risk managers should acknowledge the limits of environmental monitoring programmes as a tool for decision-making.

Impaired decision-making and selective cortical frontal thinning in Cushing's syndrome.

PubMed

Crespo, Iris; Esther, Granell-Moreno; Santos, Alicia; Valassi, Elena; Yolanda, Vives-Gilabert; De Juan-Delago, Manel; Webb, Susan M; Gómez-Ansón, Beatriz; Resmini, Eugenia

2014-12-01

Cushing's syndrome (CS) is caused by a glucocorticoid excess. This hypercortisolism can damage the prefrontal cortex, known to be important in decision-making. Our aim was to evaluate decision-making in CS and to explore cortical thickness. Thirty-five patients with CS (27 cured, eight medically treated) and thirty-five matched controls were evaluated using Iowa gambling task (IGT) and 3 Tesla magnetic resonance imaging (MRI) to assess cortical thickness. The IGT evaluates decision-making, including strategy and learning during the test. Cortical thickness was determined on MRI using freesurfer software tools, including a whole-brain analysis. There were no differences between medically treated and cured CS patients. They presented an altered decision-making strategy compared to controls, choosing a lower number of the safer cards (P < 0·05). They showed more difficulties than controls to learn the correct profiles of wins and losses for each card group (P < 0·05). In whole-brain analysis, patients with CS showed decreased cortical thickness in the left superior frontal cortex, left precentral cortex, left insular cortex, left and right rostral anterior cingulate cortex, and right caudal middle frontal cortex compared to controls (P < 0·001). Patients with CS failed to learn advantageous strategies and their behaviour was driven by short-term reward and long-term punishment, indicating learning problems because they did not use previous experience as a feedback factor to regulate their choices. These alterations in decision-making and the decreased cortical thickness in frontal areas suggest that chronic hypercortisolism promotes brain changes which are not completely reversible after endocrine remission. © 2014 John Wiley & Sons Ltd.

Interpatch foraging in honeybees-rational decision making at secondary hubs based upon time and motivation.

PubMed

Najera, Daniel A; McCullough, Erin L; Jander, Rudolf

2012-11-01

For honeybees, Apis mellifera, the hive has been well known to function as a primary decision-making hub, a place from which foragers decide among various directions, distances, and times of day to forage efficiently. Whether foraging honeybees can make similarly complex navigational decisions from locations away from the hive is unknown. To examine whether or not such secondary decision-making hubs exist, we trained bees to forage at four different locations. Specifically, we trained honeybees to first forage to a distal site "CT" 100 m away from the hive; if food was present, they fed and then chose to go home. If food was not present, the honeybees were trained to forage to three auxiliary sites, each at a different time of the day: A in the morning, B at noon, and C in the afternoon. The foragers learned to check site CT for food first and then efficiently depart to the correct location based upon the time of day if there was no food at site CT. Thus, the honeybees were able to cognitively map motivation, time, and five different locations (Hive, CT, A, B, and C) in two spatial dimensions; these are the contents of the cognitive map used by the honeybees here. While at site CT, we verified that the honeybees could choose between 4 different directions (to A, B, C, and the Hive) and thus label it as a secondary decision-making hub. The observed decision making uncovered here is inferred to constitute genuine logical operations, involving a branched structure, based upon the premises of motivational state, and spatiotemporal knowledge.

The roles of the anterior cingulate cortex and its dopamine receptors in self-paced cost-benefit decision making in rats.

PubMed

Wang, Shuai; Hu, Shan-Hu; Shi, Yi; Li, Bao-Ming

2017-03-01

It has been shown that the anterior cingulate cortex (ACC) and its dopamine system are crucial for decision making that requires physical/emotional effort, but not for all forms of cost-benefit decision making. Previous studies had mostly employed behavioral tasks with two competing cost-reward options that were preset by the experimenters. However, few studies have been conducted using scenarios in which the subjects have full control over the energy/time expenditure required to obtain a proportional reward. Here, we assessed the roles of the ACC and its dopamine system in cost-benefit decision making by utilizing a "do more get more" (DMGM) task and a time-reward trade-off (TRTO) task, wherein the animals were able to self-determine how much effort or time to expend at a nosepoke operandum for a proportional reward. Our results showed that (1) ACC inactivation severely impaired DMGM task performance, with a reduction in the rate of correct responses and a decrease in the effort expended, but did not affect the TRTO task; and (2) blocking ACC D2 receptors had no impact on DMGM task performance in the baseline cost-benefit scenario, but it significantly reduced the attempts to invest increased effort for a large reward when the benefit-cost ratio was reduced by half. In contrast, blocking ACC D1 receptors had no effect on DMGM task performance. These findings suggest that the ACC is required for self-paced effort-based but not for time-reward trade-off decision making. Furthermore, ACC dopamine D2 but not D1 receptors are involved in DMGM decision making.

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

Matthews, Patrick K.

This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 550: Smoky Contamination Area, Nevada National Security Site, Nevada. CAU 550 includes 19 corrective action sites (CASs), which consist of one weapons-related atmospheric test (Smoky), three safety experiments (Ceres, Oberon, Titania), and 15 debris sites (Table ES-1). The CASs were sorted into the following study groups based on release potential and technical similarities: • Study Group 1, Atmospheric Test • Study Group 2, Safety Experiments • Study Group 3, Washes • Study Group 4, Debris The purpose of this document is to provide justificationmore » and documentation supporting the conclusion that no further corrective action is needed for CAU 550 based on implementation of the corrective actions listed in Table ES-1. Corrective action investigation (CAI) activities were performed between August 2012 and October 2013 as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 550: Smoky Contamination Area; and in accordance with the Soils Activity Quality Assurance Plan. The approach for the CAI was to investigate and make data quality objective (DQO) decisions based on the types of releases present. The purpose of the CAI was to fulfill data needs as defined during the DQO process. The CAU 550 dataset of investigation results was evaluated based on a data quality assessment. This assessment demonstrated the dataset is complete and acceptable for use in fulfilling the DQO data needs.« less

Towards good practice for health statistics: lessons from the Millennium Development Goal health indicators.

PubMed

Murray, Christopher J L

2007-03-10

Health statistics are at the centre of an increasing number of worldwide health controversies. Several factors are sharpening the tension between the supply and demand for high quality health information, and the health-related Millennium Development Goals (MDGs) provide a high-profile example. With thousands of indicators recommended but few measured well, the worldwide health community needs to focus its efforts on improving measurement of a small set of priority areas. Priority indicators should be selected on the basis of public-health significance and several dimensions of measurability. Health statistics can be divided into three types: crude, corrected, and predicted. Health statistics are necessary inputs to planning and strategic decision making, programme implementation, monitoring progress towards targets, and assessment of what works and what does not. Crude statistics that are biased have no role in any of these steps; corrected statistics are preferred. For strategic decision making, when corrected statistics are unavailable, predicted statistics can play an important part. For monitoring progress towards agreed targets and assessment of what works and what does not, however, predicted statistics should not be used. Perhaps the most effective method to decrease controversy over health statistics and to encourage better primary data collection and the development of better analytical methods is a strong commitment to provision of an explicit data audit trail. This initiative would make available the primary data, all post-data collection adjustments, models including covariates used for farcasting and forecasting, and necessary documentation to the public.

The role of noise in self-organized decision making by the true slime mold Physarum polycephalum.

PubMed

Meyer, Bernd; Ansorge, Cedrick; Nakagaki, Toshiyuki

2017-01-01

Self-organized mechanisms are frequently encountered in nature and known to achieve flexible, adaptive control and decision-making. Noise plays a crucial role in such systems: It can enable a self-organized system to reliably adapt to short-term changes in the environment while maintaining a generally stable behavior. This is fundamental in biological systems because they must strike a delicate balance between stable and flexible behavior. In the present paper we analyse the role of noise in the decision-making of the true slime mold Physarum polycephalum, an important model species for the investigation of computational abilities in simple organisms. We propose a simple biological experiment to investigate the reaction of P. polycephalum to time-variant risk factors and present a stochastic extension of an established mathematical model for P. polycephalum to analyze this experiment. It predicts that-due to the mechanism of stochastic resonance-noise can enable P. polycephalum to correctly assess time-variant risk factors, while the corresponding noise-free system fails to do so. Beyond the study of P. polycephalum we demonstrate that the influence of noise on self-organized decision-making is not tied to a specific organism. Rather it is a general property of the underlying process dynamics, which appears to be universal across a wide range of systems. Our study thus provides further evidence that stochastic resonance is a fundamental component of the decision-making in self-organized macroscopic and microscopic groups and organisms.

The role of noise in self-organized decision making by the true slime mold Physarum polycephalum

PubMed Central

Ansorge, Cedrick; Nakagaki, Toshiyuki

2017-01-01

Self-organized mechanisms are frequently encountered in nature and known to achieve flexible, adaptive control and decision-making. Noise plays a crucial role in such systems: It can enable a self-organized system to reliably adapt to short-term changes in the environment while maintaining a generally stable behavior. This is fundamental in biological systems because they must strike a delicate balance between stable and flexible behavior. In the present paper we analyse the role of noise in the decision-making of the true slime mold Physarum polycephalum, an important model species for the investigation of computational abilities in simple organisms. We propose a simple biological experiment to investigate the reaction of P. polycephalum to time-variant risk factors and present a stochastic extension of an established mathematical model for P. polycephalum to analyze this experiment. It predicts that—due to the mechanism of stochastic resonance—noise can enable P. polycephalum to correctly assess time-variant risk factors, while the corresponding noise-free system fails to do so. Beyond the study of P. polycephalum we demonstrate that the influence of noise on self-organized decision-making is not tied to a specific organism. Rather it is a general property of the underlying process dynamics, which appears to be universal across a wide range of systems. Our study thus provides further evidence that stochastic resonance is a fundamental component of the decision-making in self-organized macroscopic and microscopic groups and organisms. PMID:28355213

Uncertainty and the difficulty of thinking through disjunctions.

PubMed

Shafir, E

1994-01-01

This paper considers the relationship between decision under uncertainty and thinking through disjunctions. Decision situations that lead to violations of Savage's sure-thing principle are examined, and a variety of simple reasoning problems that often generate confusion and error are reviewed. The common difficulty is attributed to people's reluctance to think through disjunctions. Instead of hypothetically traveling through the branches of a decision tree, it is suggested, people suspend judgement and remain at the node. This interpretation is applied to instances of decision making, information search, deductive and inductive reasoning, probabilistic judgement, games, puzzles and paradoxes. Some implications of the reluctance to think through disjunctions, as well as potential corrective procedures, are discussed.

A systematic approach to embedded biomedical decision making.

PubMed

Song, Zhe; Ji, Zhongkai; Ma, Jian-Guo; Sputh, Bernhard; Acharya, U Rajendra; Faust, Oliver

2012-11-01

An embedded decision making is a key feature for many biomedical systems. In most cases human life directly depends on correct decisions made by these systems, therefore they have to work reliably. This paper describes how we applied systems engineering principles to design a high performance embedded classification system in a systematic and well structured way. We introduce the structured design approach by discussing requirements capturing, specifications refinement, implementation and testing. Thereby, we follow systems engineering principles and execute each of these processes as formal as possible. The requirements, which motivate the system design, describe an automated decision making system for diagnostic support. These requirements are refined into the implementation of a support vector machine (SVM) algorithm which enables us to integrate automated decision making in embedded systems. With a formal model we establish functionality, stability and reliability of the system. Furthermore, we investigated different parallel processing configurations of this computationally complex algorithm. We found that, by adding SVM processes, an almost linear speedup is possible. Once we established these system properties, we translated the formal model into an implementation. The resulting implementation was tested using XMOS processors with both normal and failure cases, to build up trust in the implementation. Finally, we demonstrated that our parallel implementation achieves the speedup, predicted by the formal model. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Group Augmentation in Realistic Visual-Search Decisions via a Hybrid Brain-Computer Interface.

PubMed

Valeriani, Davide; Cinel, Caterina; Poli, Riccardo

2017-08-10

Groups have increased sensing and cognition capabilities that typically allow them to make better decisions. However, factors such as communication biases and time constraints can lead to less-than-optimal group decisions. In this study, we use a hybrid Brain-Computer Interface (hBCI) to improve the performance of groups undertaking a realistic visual-search task. Our hBCI extracts neural information from EEG signals and combines it with response times to build an estimate of the decision confidence. This is used to weigh individual responses, resulting in improved group decisions. We compare the performance of hBCI-assisted groups with the performance of non-BCI groups using standard majority voting, and non-BCI groups using weighted voting based on reported decision confidence. We also investigate the impact on group performance of a computer-mediated form of communication between members. Results across three experiments suggest that the hBCI provides significant advantages over non-BCI decision methods in all cases. We also found that our form of communication increases individual error rates by almost 50% compared to non-communicating observers, which also results in worse group performance. Communication also makes reported confidence uncorrelated with the decision correctness, thereby nullifying its value in weighing votes. In summary, best decisions are achieved by hBCI-assisted, non-communicating groups.

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

NASA Technical Reports Server (NTRS)

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

2003-01-01

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

What are parents' perspectives on psychological empowerment in the MMR vaccination decision? A focus group study.

PubMed

Fadda, Marta; Galimberti, Elisa; Carraro, Valter; Schulz, Peter J

2016-04-15

Most developed countries do not have compulsory immunisation requirements, but instead issue recommendations. Although parents are expected to make an informed, autonomous (ie, empowered) decision regarding their children's vaccinations, there is no evidence about how parents' interpret this demand nor on the latitude of their decision-making. The goal of this study is to gain insights from parents residing in a low measles-mumps-rubella (MMR) uptake area on what constitutes feelings of empowerment in the decision they have to make on their child's MMR vaccination. A qualitative study employing focus group interviews. 11 vaccination centres and hospitals in the Province of Trento, Italy. 24 mothers and 4 fathers of children for whom the MMR vaccination decision was still pending participated in 6 focus groups. Autonomy and competence were salient themes in relation to empowerment, and were further connected with beliefs regarding legal responsibility and ethics of freedom concerning the decision, parents' relationship with the paediatrician (trust), feelings of relevance of the decision and related stress, and seeking, avoidance, or fear of vaccination-related information. Competence was interpreted as medical knowledge and information-seeking skills, but it was also related to the extent parents perceived the paediatrician to be competent. Since parents' interpretation of empowerment goes beyond mere perceptions of being informed and autonomous and differs across individuals, it is important that this construct be correctly interpreted and implemented by best practice, for instance by explicitly adopting a relational conception of autonomy. Knowing whether parents want to make an empowered decision and what their information and autonomy needs are might help health professionals adapt their communication about immunisation, and promote parental perception of making an informed, autonomous decision. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Two sides of the same coin: Monetary incentives concurrently improve and bias confidence judgments

PubMed Central

Lebreton, Maël; Slieker, Matthijs J.; Nooitgedacht, Jip S.; van Holst, Ruth J.; Luigjes, Judy

2018-01-01

Decisions are accompanied by a feeling of confidence, that is, a belief about the decision being correct. Confidence accuracy is critical, notably in high-stakes situations such as medical or financial decision-making. We investigated how incentive motivation influences confidence accuracy by combining a perceptual task with a confidence incentivization mechanism. By varying the magnitude and valence (gains or losses) of monetary incentives, we orthogonalized their motivational and affective components. Corroborating theories of rational decision-making and motivation, our results first reveal that the motivational value of incentives improves aspects of confidence accuracy. However, in line with a value-confidence interaction hypothesis, we further show that the affective value of incentives concurrently biases confidence reports, thus degrading confidence accuracy. Finally, we demonstrate that the motivational and affective effects of incentives differentially affect how confidence builds on perceptual evidence. Together, these findings may provide new hints about confidence miscalibration in healthy or pathological contexts. PMID:29854944

Temporal characteristics of the influence of punishment on perceptual decision making in the human brain.

PubMed

Blank, Helen; Biele, Guido; Heekeren, Hauke R; Philiastides, Marios G

2013-02-27

Perceptual decision making is the process by which information from sensory systems is combined and used to influence our behavior. In addition to the sensory input, this process can be affected by other factors, such as reward and punishment for correct and incorrect responses. To investigate the temporal dynamics of how monetary punishment influences perceptual decision making in humans, we collected electroencephalography (EEG) data during a perceptual categorization task whereby the punishment level for incorrect responses was parametrically manipulated across blocks of trials. Behaviorally, we observed improved accuracy for high relative to low punishment levels. Using multivariate linear discriminant analysis of the EEG, we identified multiple punishment-induced discriminating components with spatially distinct scalp topographies. Compared with components related to sensory evidence, components discriminating punishment levels appeared later in the trial, suggesting that punishment affects primarily late postsensory, decision-related processing. Crucially, the amplitude of these punishment components across participants was predictive of the size of the behavioral improvements induced by punishment. Finally, trial-by-trial changes in prestimulus oscillatory activity in the alpha and gamma bands were good predictors of the amplitude of these components. We discuss these findings in the context of increased motivation/attention, resulting from increases in punishment, which in turn yields improved decision-related processing.

Cognitive Reflection, Decision Biases, and Response Times

PubMed Central

Alós-Ferrer, Carlos; Garagnani, Michele; Hügelschäfer, Sabine

2016-01-01

We present novel evidence on response times and personality traits in standard questions from the decision-making literature where responses are relatively slow (medians around half a minute or above). To this end, we measured response times in a number of incentivized, framed items (decisions from description) including the Cognitive Reflection Test, two additional questions following the same logic, and a number of classic questions used to study decision biases in probability judgments (base-rate neglect, the conjunction fallacy, and the ratio bias). All questions create a conflict between an intuitive process and more deliberative thinking. For each item, we then created a non-conflict version by either making the intuitive impulse correct (resulting in an alignment question), shutting it down (creating a neutral question), or making it dominant (creating a heuristic question). For CRT questions, the differences in response times are as predicted by dual-process theories, with alignment and heuristic variants leading to faster responses and neutral questions to slower responses than the original, conflict questions. For decision biases (where responses are slower), evidence is mixed. To explore the possible influence of personality factors on both choices and response times, we used standard personality scales including the Rational-Experiential Inventory and the Big Five, and used them as controls in regression analysis. PMID:27713710

Cognitive Reflection, Decision Biases, and Response Times.

PubMed

Alós-Ferrer, Carlos; Garagnani, Michele; Hügelschäfer, Sabine

2016-01-01

We present novel evidence on response times and personality traits in standard questions from the decision-making literature where responses are relatively slow (medians around half a minute or above). To this end, we measured response times in a number of incentivized, framed items (decisions from description) including the Cognitive Reflection Test, two additional questions following the same logic, and a number of classic questions used to study decision biases in probability judgments (base-rate neglect, the conjunction fallacy, and the ratio bias). All questions create a conflict between an intuitive process and more deliberative thinking. For each item, we then created a non-conflict version by either making the intuitive impulse correct (resulting in an alignment question), shutting it down (creating a neutral question), or making it dominant (creating a heuristic question). For CRT questions, the differences in response times are as predicted by dual-process theories, with alignment and heuristic variants leading to faster responses and neutral questions to slower responses than the original, conflict questions. For decision biases (where responses are slower), evidence is mixed. To explore the possible influence of personality factors on both choices and response times, we used standard personality scales including the Rational-Experiential Inventory and the Big Five, and used them as controls in regression analysis.

Cynefin as Reference Framework to Facilitate Insight and Decision-Making in Complex Contexts of Biomedical Research.

PubMed

Kempermann, Gerd

2017-01-01

The Cynefin scheme is a concept of knowledge management, originally devised to support decision making in management, but more generally applicable to situations, in which complexity challenges the quality of insight, prediction, and decision. Despite the fact that life itself, and especially the brain and its diseases, are complex to the extent that complexity could be considered their cardinal feature, complex problems in biomedicine are often treated as if they were actually not more than the complicated sum of solvable sub-problems. Because of the emergent properties of complex contexts this is not correct. With a set of clear criteria Cynefin helps to set apart complex problems from "simple/obvious," "complicated," "chaotic," and "disordered" contexts in order to avoid misinterpreting the relevant causality structures. The distinction comes with the insight, which specific kind of knowledge is possible in each of these categories and what are the consequences for resulting decisions and actions. From student's theses over the publication and grant writing process to research politics, misinterpretation of complexity can have problematic or even dangerous consequences, especially in clinical contexts. Conceptualization of problems within a straightforward reference language like Cynefin improves clarity and stringency within projects and facilitates communication and decision-making about them.

The Gulf of Maine in the Classroom.

ERIC Educational Resources Information Center

Brody, Michael J.

This paper describes some of the correct, missing, and alternative conceptions which students possess related to the Gulf of Maine. Students (N=226) from grades 4, 8, and 11 were interviewed on 15 major concepts involving geology, physical and chemical oceanography, natural resources, ecology, and decision-making. The mean interview scores of the…

Comparison of Three Instructional Approaches to Enhance Tactical Knowledge in Volleyball among University Students

ERIC Educational Resources Information Center

Vande Broek, Gert; Boen, Filip; Claessens, Manu; Feys, Jos; Ceux, Tanja

2011-01-01

This study investigated the decision-making process of three instructional groups (i.e., teacher-centered, student-centered with tactical questioning and student-centered without tactical questioning) in practical courses in volleyball among university students. All students (N = 122) performed a Tactical Awareness task on the correctness of the…

Consider the Source: A Commentary on Incest and Parental Contact

ERIC Educational Resources Information Center

Boat, Barbara W.; Forman, Sarah B.

2008-01-01

According to these authors, it is correct to assume that mental health professionals, including psychologists, may not have adequate literature that provides an evidence-informed basis for making decisions about a parent's contact with a child whom he/she has sexually molested. Indeed, there are several sources of information that may negatively…

Jail Management. Book 3. Jail and Community Corrections Programs.

ERIC Educational Resources Information Center

Blumer, Alice Howard

The course is for independent study by jail officers who must learn that, in addition to their routine tasks, they must be prepared to be well-trained, responsible professionals, making important decisions and avoiding the mistakes and disproven beliefs of the past. The jail administrator must continually wrestle with the problems of conflicting…

An Affirmative Action Prophecy

ERIC Educational Resources Information Center

Prindle, David F.

2004-01-01

The present-day Supreme Court ruling that skin color is a valid basis upon which to rest academic decision-making sets us on a course toward a world minutely regulated by identity-group politics. David F. Prindle's reverie of a subsequent majority opinion by Sandra Day O'Connor, ten years hence, mandating correct racial proportionality in GPAs and…

Effects of an Uncertain Literature on All Facets of Clinical Decision Making

ERIC Educational Resources Information Center

Sammons, Morgan T.; Newman, Russ

2010-01-01

Greenberg (2010) is correct in his assertion that the investigational heuristic used to measure the efficacy of antidepressants is flawed. Robust placebo effects are endemic in the psychiatric literature, particularly in studies of antidepressants, and estimates of placebo responding have increased over time (Rief et al., 2009). In the case of…

Statistical Literacy: Data Tell a Story

ERIC Educational Resources Information Center

Sole, Marla A.

2016-01-01

Every day, students collect, organize, and analyze data to make decisions. In this data-driven world, people need to assess how much trust they can place in summary statistics. The results of every survey and the safety of every drug that undergoes a clinical trial depend on the correct application of appropriate statistics. Recognizing the…

12 CFR 792.59 - Appeal of initial determination.

Code of Federal Regulations, 2010 CFR

2010-01-01

... General Counsel shall either advise the individual of a decision to amend or correct the record, or advise... accounting made as required by the Privacy Act of 1974 or any other accounting previously made, of the... concise statement of the reasons for not making the requested amendment may also be provided if deemed...

“I Want Her to Make Correct Decisions on Her Own:” Former Soviet Union Mothers' Beliefs about Autonomy Development

PubMed Central

Komolova, Masha; Lipnitsky, Jane Y.

2018-01-01

This qualitative study examined Former Soviet Union (FSU) mothers' explicit and implicit attitudes and parenting practices around adolescents' autonomy development. Interviews were conducted with 10 mothers who had immigrated from the FSU to the US between 10 and 25 years ago, and who had daughters between the ages of 13 and 17 years. Mothers predominantly defined autonomy in terms of adolescents' ability to carry out instrumental tasks, make correct decisions, and financially provide for themselves, but rarely mentioned psychological or emotional independence. Mothers reflected on the various aspects of autonomy emphasized in their country of origin and America, and balancing the two sets of cultural values in their parenting. Although mothers discussed attempts to adopt a less authoritarian approach to parenting than they themselves experienced as children, some mothers' controlling attitudes were revealed through a close analysis of their language. The findings provide important insights into the parenting experiences of FSU immigrant mothers, and the way in which autonomy-related processes may vary cross-culturally. Implications for parenting and clinical practice are also discussed. PMID:29434558

"I Want Her to Make Correct Decisions on Her Own:" Former Soviet Union Mothers' Beliefs about Autonomy Development.

PubMed

Komolova, Masha; Lipnitsky, Jane Y

2017-01-01

This qualitative study examined Former Soviet Union (FSU) mothers' explicit and implicit attitudes and parenting practices around adolescents' autonomy development. Interviews were conducted with 10 mothers who had immigrated from the FSU to the US between 10 and 25 years ago, and who had daughters between the ages of 13 and 17 years. Mothers predominantly defined autonomy in terms of adolescents' ability to carry out instrumental tasks, make correct decisions, and financially provide for themselves, but rarely mentioned psychological or emotional independence. Mothers reflected on the various aspects of autonomy emphasized in their country of origin and America, and balancing the two sets of cultural values in their parenting. Although mothers discussed attempts to adopt a less authoritarian approach to parenting than they themselves experienced as children, some mothers' controlling attitudes were revealed through a close analysis of their language. The findings provide important insights into the parenting experiences of FSU immigrant mothers, and the way in which autonomy-related processes may vary cross-culturally. Implications for parenting and clinical practice are also discussed.

Virtual Surgery for the Nasal Airway: A Preliminary Report on Decision Support and Technology Acceptance.

PubMed

Vanhille, Derek L; Garcia, Guilherme J M; Asan, Onur; Borojeni, Azadeh A T; Frank-Ito, Dennis O; Kimbell, Julia S; Pawar, Sachin S; Rhee, John S

2018-01-01

Nasal airway obstruction (NAO) is a common problem that affects patient quality of life. Surgical success for NAO correction is variable. Virtual surgery planning via computational fluid dynamics (CFD) has the potential to improve the success rates of NAO surgery. To elicit surgeon feedback of a virtual surgery planning tool for NAO and to determine if this tool affects surgeon decision making. For this cross-sectional study, 60-minute face-to-face interviews with board-certified otolaryngologists were conducted at a single academic otolaryngology department from September 16, 2016, through October 7, 2016. Virtual surgery methods were introduced, and surgeons were able to interact with the virtual surgery planning tool interface. Surgeons were provided with a patient case of NAO, and open feedback of the platform was obtained, with emphasis on surgical decision making. Likert scale responses and qualitative feedback were collected for the virtual surgery planning tool and its influence on surgeon decision making. Our 9 study participants were all male, board-certified otolaryngologists with a mean (range) 15 (4-28) number of years in practice and a mean (range) number of nasal surgeries per month at 2.2 (0.0-6.0). When examined on a scale of 1 (not at all) to 5 (completely), surgeon mean (SD) score was 3.4 (0.5) for how realistic the virtual models were compared with actual surgery. On the same scale, when asked how much the virtual surgery planning tool changed surgeon decision making, mean (SD) score was 2.6 (1.6). On a scale of 1 (strongly disagree) to 7 (strongly agree), surgeon scores for perceived usefulness of the technology and attitude toward using it were 5.1 (1.1) and 5.7 (0.9), respectively. Our study shows positive surgeon experience with a virtual surgery planning tool for NAO based on CFD simulations. Surgeons felt that future applications and areas of study of the virtual surgery planning tool include its potential role for patient counseling, selecting appropriate surgical candidates, and identifying which anatomical structures should be targeted for surgical correction. NA.

Bioethics for clinicians: 18. Aboriginal cultures

PubMed Central

Ellerby, Jonathan H.; McKenzie, John; McKay, Stanley; Gariépy, Gilbert J.; Kaufert, Joseph M.

2000-01-01

Although philosophies and practices analogous to bioethics exist in Aboriginal cultures, the terms and categorical distinctions of "ethics" and "bioethics" do not generally exist. In this article we address ethical values appropriate to Aboriginal patients, rather than a preconceived "Aboriginal bioethic." Aboriginal beliefs are rooted in the context of oral history and culture. For Aboriginal people, decision-making is best understood as a process and not as the correct interpretation of a unified code. Aboriginal cultures differ from religious and cultural groups that draw on Scripture and textual foundations for their ethical beliefs and practices. Aboriginal ethical values generally emphasize holism, pluralism, autonomy, community- or family-based decision-making, and the maintenance of quality of life rather than the exclusive pursuit of a cure. Most Aboriginal belief systems also emphasize achieving balance and wellness within the domains of human life (mental, physical, emotional and spiritual). Although these bioethical tenets are important to understand and apply, examining specific applications in detail is not as useful as developing a more generalized understanding of how to approach ethical decision-making with Aboriginal people. Aboriginal ethical decisions are often situational and highly dependent on the values of the individual within the context of his or her family and community. PMID:11033715

Bioethics for clinicians: 18. Aboriginal cultures.

PubMed

Ellerby, J H; McKenzie, J; McKay, S; Gariépy, G J; Kaufert, J M

2000-10-03

Although philosophies and practices analogous to bioethics exist in Aboriginal cultures, the terms and categorical distinctions of "ethics" and "bioethics" do not generally exist. In this article we address ethical values appropriate to Aboriginal patients, rather than a preconceived "Aboriginal bioethic." Aboriginal beliefs are rooted in the context of oral history and culture. For Aboriginal people, decision-making is best understood as a process and not as the correct interpretation of a unified code. Aboriginal cultures differ from religious and cultural groups that draw on Scripture and textual foundations for their ethical beliefs and practices. Aboriginal ethical values generally emphasize holism, pluralism, autonomy, community- or family-based decision-making, and the maintenance of quality of life rather than the exclusive pursuit of a cure. Most Aboriginal belief systems also emphasize achieving balance and wellness within the domains of human life (mental, physical, emotional and spiritual). Although these bioethical tenets are important to understand and apply, examining specific applications in detail is not as useful as developing a more generalized understanding of how to approach ethical decision-making with Aboriginal people. Aboriginal ethical decisions are often situational and highly dependent on the values of the individual within the context of his or her family and community.

Evaluating a mobile application for improving clinical laboratory test ordering and diagnosis.

PubMed

Meyer, Ashley N D; Thompson, Pamela J; Khanna, Arushi; Desai, Samir; Mathews, Benji K; Yousef, Elham; Kusnoor, Anita V; Singh, Hardeep

2018-04-20

Mobile applications for improving diagnostic decision making often lack clinical evaluation. We evaluated if a mobile application improves generalist physicians' appropriate laboratory test ordering and diagnosis decisions and assessed if physicians perceive it as useful for learning. In an experimental, vignette study, physicians diagnosed 8 patient vignettes with normal prothrombin times (PT) and abnormal partial thromboplastin times (PTT). Physicians made test ordering and diagnosis decisions for 4 vignettes using each resource: a mobile app, PTT Advisor, developed by the Centers for Disease Control and Prevention (CDC)'s Clinical Laboratory Integration into Healthcare Collaborative (CLIHC); and usual clinical decision support. Then, physicians answered questions regarding their perceptions of the app's usefulness for diagnostic decision making and learning using a modified Kirkpatrick Training Evaluation Framework. Data from 368 vignettes solved by 46 physicians at 7 US health care institutions show advantages for using PTT Advisor over usual clinical decision support on test ordering and diagnostic decision accuracy (82.6 vs 70.2% correct; P < .001), confidence in decisions (7.5 vs 6.3 out of 10; P < .001), and vignette completion time (3:02 vs 3:53 min.; P = .06). Physicians reported positive perceptions of the app's potential for improved clinical decision making, and recommended it be used to address broader diagnostic challenges. A mobile app, PTT Advisor, may contribute to better test ordering and diagnosis, serve as a learning tool for diagnostic evaluation of certain clinical disorders, and improve patient outcomes. Similar methods could be useful for evaluating apps aimed at improving testing and diagnosis for other conditions.

Reward rate optimization in two-alternative decision making: empirical tests of theoretical predictions.

PubMed

Simen, Patrick; Contreras, David; Buck, Cara; Hu, Peter; Holmes, Philip; Cohen, Jonathan D

2009-12-01

The drift-diffusion model (DDM) implements an optimal decision procedure for stationary, 2-alternative forced-choice tasks. The height of a decision threshold applied to accumulating information on each trial determines a speed-accuracy tradeoff (SAT) for the DDM, thereby accounting for a ubiquitous feature of human performance in speeded response tasks. However, little is known about how participants settle on particular tradeoffs. One possibility is that they select SATs that maximize a subjective rate of reward earned for performance. For the DDM, there exist unique, reward-rate-maximizing values for its threshold and starting point parameters in free-response tasks that reward correct responses (R. Bogacz, E. Brown, J. Moehlis, P. Holmes, & J. D. Cohen, 2006). These optimal values vary as a function of response-stimulus interval, prior stimulus probability, and relative reward magnitude for correct responses. We tested the resulting quantitative predictions regarding response time, accuracy, and response bias under these task manipulations and found that grouped data conformed well to the predictions of an optimally parameterized DDM.

Errors in Aviation Decision Making: Bad Decisions or Bad Luck?

NASA Technical Reports Server (NTRS)

Orasanu, Judith; Martin, Lynne; Davison, Jeannie; Null, Cynthia H. (Technical Monitor)

1998-01-01

Despite efforts to design systems and procedures to support 'correct' and safe operations in aviation, errors in human judgment still occur and contribute to accidents. In this paper we examine how an NDM (naturalistic decision making) approach might help us to understand the role of decision processes in negative outcomes. Our strategy was to examine a collection of identified decision errors through the lens of an aviation decision process model and to search for common patterns. The second, and more difficult, task was to determine what might account for those patterns. The corpus we analyzed consisted of tactical decision errors identified by the NTSB (National Transportation Safety Board) from a set of accidents in which crew behavior contributed to the accident. A common pattern emerged: about three quarters of the errors represented plan-continuation errors, that is, a decision to continue with the original plan despite cues that suggested changing the course of action. Features in the context that might contribute to these errors were identified: (a) ambiguous dynamic conditions and (b) organizational and socially-induced goal conflicts. We hypothesize that 'errors' are mediated by underestimation of risk and failure to analyze the potential consequences of continuing with the initial plan. Stressors may further contribute to these effects. Suggestions for improving performance in these error-inducing contexts are discussed.

Collaborative Brain-Computer Interface for Aiding Decision-Making

PubMed Central

Poli, Riccardo; Valeriani, Davide; Cinel, Caterina

2014-01-01

We look at the possibility of integrating the percepts from multiple non-communicating observers as a means of achieving better joint perception and better group decisions. Our approach involves the combination of a brain-computer interface with human behavioural responses. To test ideas in controlled conditions, we asked observers to perform a simple matching task involving the rapid sequential presentation of pairs of visual patterns and the subsequent decision as whether the two patterns in a pair were the same or different. We recorded the response times of observers as well as a neural feature which predicts incorrect decisions and, thus, indirectly indicates the confidence of the decisions made by the observers. We then built a composite neuro-behavioural feature which optimally combines the two measures. For group decisions, we uses a majority rule and three rules which weigh the decisions of each observer based on response times and our neural and neuro-behavioural features. Results indicate that the integration of behavioural responses and neural features can significantly improve accuracy when compared with the majority rule. An analysis of event-related potentials indicates that substantial differences are present in the proximity of the response for correct and incorrect trials, further corroborating the idea of using hybrids of brain-computer interfaces and traditional strategies for improving decision making. PMID:25072739

Treatment decision-making and the form of risk communication: results of a factorial survey.

PubMed

Hembroff, Larry A; Holmes-Rovner, Margaret; Wills, Celia E

2004-11-16

Prospective users of preventive therapies often must evaluate complex information about therapeutic risks and benefits. The purpose of this study was to evaluate the effect of relative and absolute risk information on patient decision-making in scenarios typical of health information for patients. Factorial experiments within a telephone survey of the Michigan adult, non-institutionalized, English-speaking population. Average interview lasted 23 minutes. Subjects and sample design: 952 randomly selected adults within a random-digit dial sample of Michigan households. Completion rate was 54.3%. When presented hypothetical information regarding additional risks of breast cancer from a medication to prevent a bone disease, respondents reduced their willingness to recommend a female friend take the medication compared to the baseline rate (66.8% = yes). The decrease was significantly greater with relative risk information. Additional benefit information regarding preventing heart disease from the medication increased willingness to recommend the medication to a female friend relative to the baseline scenario, but did not differ between absolute and relative risk formats. When information about both increased risk of breast cancer and reduced risk of heart disease were provided, typical respondents appeared to make rational decisions consistent with Expected Utility Theory, but the information presentation format affected choices. Those 11% - 33% making decisions contrary to the medical indications were more likely to be Hispanic, older, more educated, smokers, and to have children in the home. In scenarios typical of health risk information, relative risk information led respondents to make non-normative decisions that were "corrected" when the frame used absolute risk information. This population sample made generally rational decisions when presented with absolute risk information, even in the context of a telephone interview requiring remembering rates given. The lack of effect of gender and race suggests that a standard strategy of presenting absolute risk information may improve patient decision-making.

Use of evidence-based management in healthcare administration decision-making.

PubMed

Guo, Ruiling; Berkshire, Steven D; Fulton, Lawrence V; Hermanson, Patrick M

2017-07-03

Purpose The purpose of this paper is to examine whether healthcare leaders use evidence-based management (EBMgt) when facing major decisions and what types of evidence healthcare administrators consult during their decision-making. This study also intends to identify any relationship that might exist among adoption of EBMgt in healthcare management, attitudes towards EBMgt, demographic characteristics and organizational characteristics. Design/methodology/approach A cross-sectional study was conducted among US healthcare leaders. Spearman's correlation and logistic regression were performed using the Statistical Package for the Social Sciences (SPSS) 23.0. Findings One hundred and fifty-four healthcare leaders completed the survey. The study results indicated that 90 per cent of the participants self-reported having used an EBMgt approach for decision-making. Professional experiences (87 per cent), organizational data (84 per cent) and stakeholders' values (63 per cent) were the top three types of evidence consulted daily and weekly for decision-making. Case study (75 per cent) and scientific research findings (75 per cent) were the top two types of evidence consulted monthly or less than once a month. An exploratory, stepwise logistic regression model correctly classified 75.3 per cent of all observations for a dichotomous "use of EBMgt" response variable using three independent variables: attitude towards EBMgt, number of employees in the organization and the job position. Spearman's correlation indicated statistically significant relationships between healthcare leaders' use of EBMgt and healthcare organization bed size ( r s = 0.217, n = 152, p < 0.01), attitude towards EBMgt ( r s = 0.517, n = 152, p < 0.01), and the number of organization employees ( r s = 0.195, n = 152, p = 0.016). Originality/value This study generated new research findings on the practice of EBMgt in US healthcare administration decision-making.

Physician decision-making in the management of work related upper extremity injuries.

PubMed

Szekeres, Mike; Macdermid, Joy C; Katchky, Adam; Grewal, Ruby

2018-05-22

Physicians working in a tertiary care injured worker clinic are faced with clinical decision-making that must balance the needs of patients and society in managing complex clinical problems that are complicated by the work-workplace context. The purpose of this study is to describe and characterize the decision-making process of upper extremity specialized surgeons when managing injured workers within a specialized worker's compensation clinic. Surgeons were interviewed in a semi-structured manner. Following each interview, the surgeon was also observed in a clinic visit during a new patient assessment, allowing observation of the interactional patterns between surgeon and patient, and comparison of the process described in the interview to what actually occurred during clinic visits. The primary central theme emerging from the surgeon interviews and the clinical observation was the focus on the importance of comprehensive assessment to make the first critical decision: an accurate diagnosis. Two subthemes were also found. The first of these involved the decision whether to proceed to management strategies or to continue with further investigation if the correct diagnosis is uncertain. Once the central theme of diagnosis was achieved, a second subtheme was highlighted; selecting appropriate management options, given the complexities of managing the injured worker, the workplace, and the compensation board. This study illustrates that upper extremity surgeons rely on their training and experience with upper extremity conditions to follow a sequential but iterative decision-making process to provide a more definitive diagnosis and treatment plan for workers with injuries that are often complex. The surgeons are challenged by the context which takes them out of their familiar zone of typical clinical practice to deal with the interactions between the injury, worker, work, workplace and insurer.

Use of Inverse Reinforcement Learning for Identity Prediction

NASA Technical Reports Server (NTRS)

Hayes, Roy; Bao, Jonathan; Beling, Peter; Horowitz, Barry

2011-01-01

We adopt Markov Decision Processes (MDP) to model sequential decision problems, which have the characteristic that the current decision made by a human decision maker has an uncertain impact on future opportunity. We hypothesize that the individuality of decision makers can be modeled as differences in the reward function under a common MDP model. A machine learning technique, Inverse Reinforcement Learning (IRL), was used to learn an individual's reward function based on limited observation of his or her decision choices. This work serves as an initial investigation for using IRL to analyze decision making, conducted through a human experiment in a cyber shopping environment. Specifically, the ability to determine the demographic identity of users is conducted through prediction analysis and supervised learning. The results show that IRL can be used to correctly identify participants, at a rate of 68% for gender and 66% for one of three college major categories.

Educational Effects of Practical Education Using a Debate Exercise on Engineering Ethics

NASA Astrophysics Data System (ADS)

Takanokura, Masato; Hayashi, Shigeo

The educational effects of practical education using a debate exercise are investigated using questionnaires. For the group-work composed of discussion and debate, students understand thoroughly various engineering ethical topics, such as factors preventing ethical decision-making. Students enhance their abilities to make a rational and logical decision by themselves such as a judgment based on correct information. Mutual evaluation by students through group interaction elevates positive educational effects. However, students answer fewer questions related to the understanding of professional duties and cooperate social responsibility because of the group-work using failure cases. Students also show less progress in their abilities to communicate with others and to express their opinions to audiences. A more suitable number of group members solves the latter problem.

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

PubMed

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

2014-12-12

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

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

PubMed

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

2016-06-01

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

Heuristic reasoning and cognitive biases: Are they hindrances to judgments and decision making in orthodontics?

PubMed

Hicks, E Preston; Kluemper, G Thomas

2011-03-01

Studies show that our brains use 2 modes of reasoning: heuristic (intuitive, automatic, implicit processing) and analytic (deliberate, rule-based, explicit processing). The use of intuition often dominates problem solving when innovative, creative thinking is required. Under conditions of uncertainty, we default to an even greater reliance on the heuristic processing. In health care settings and other such environments of increased importance, this mode becomes problematic. Since choice heuristics are quickly constructed from fragments of memory, they are often biased by prior evaluations of and preferences for the alternatives being considered. Therefore, a rigorous and systematic decision process notwithstanding, clinical judgments under uncertainty are often flawed by a number of unwitting biases. Clinical orthodontics is as vulnerable to this fundamental failing in the decision-making process as any other health care discipline. Several of the more common cognitive biases relevant to clinical orthodontics are discussed in this article. By raising awareness of these sources of cognitive errors in our clinical decision making, our intent was to equip the clinician to take corrective action to avoid them. Our secondary goal was to expose this important area of empirical research and encourage those with expertise in the cognitive sciences to explore, through further research, the possible relevance and impact of cognitive heuristics and biases on the accuracy of orthodontic judgments and decision making. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

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

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

PubMed

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

2018-04-25

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

Blood transfusion: patient identification and empowerment.

PubMed

Stout, Lynn; Joseph, Sundari

Positive patient identification is pivotal to several steps of the transfusion process; it is integral to ensuring that the correct blood is given to the correct patient. If patient misidentification occurs, this has potentially fatal consequences for patients. Historically patient involvement in healthcare has focused on clinical decision making, where the patient, having been provided with medical information, is encouraged to become involved in the decisions related to their individualised treatment. This article explores the aspects of patient contribution to patient safety relating to positive patient identification in transfusion. When involving patients in their care, however, clinicians must recognise the diversity of patients and the capacity of the patient to be involved. It must not be assumed that all patients will be willing or indeed able to participate. Additionally, clinicians' attitudes to patient involvement in patient safety can determine whether cultural change is successful.

The Quantitative Science of Evaluating Imaging Evidence.

PubMed

Genders, Tessa S S; Ferket, Bart S; Hunink, M G Myriam

2017-03-01

Cardiovascular diagnostic imaging tests are increasingly used in everyday clinical practice, but are often imperfect, just like any other diagnostic test. The performance of a cardiovascular diagnostic imaging test is usually expressed in terms of sensitivity and specificity compared with the reference standard (gold standard) for diagnosing the disease. However, evidence-based application of a diagnostic test also requires knowledge about the pre-test probability of disease, the benefit of making a correct diagnosis, the harm caused by false-positive imaging test results, and potential adverse effects of performing the test itself. To assist in clinical decision making regarding appropriate use of cardiovascular diagnostic imaging tests, we reviewed quantitative concepts related to diagnostic performance (e.g., sensitivity, specificity, predictive values, likelihood ratios), as well as possible biases and solutions in diagnostic performance studies, Bayesian principles, and the threshold approach to decision making. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Money, men and markets: economic and sexual empowerment of market women in southwestern Uganda.

PubMed

Nyanzi, Barbara; Nyanzi, Stella; Wolff, Brent; Whitworth, James

2005-01-01

Market trading requires access to cash, independent decision-making, mobility and social interaction. This study sought to explore whether market work empowers women with respect to spending decisions and negotiation over sex and condom-use. A semi-structured questionnaire was administered to 212 market women; and 12 focus group discussions and 52 in-depths interviews were conducted among market women in southwestern Uganda. Market women reported high levels of independence, mobility, assertiveness and social interaction. Access to cash was not synonymous with control over it, however. Spending decisions were limited by men's ability to selectively withdraw finances for expenditures central to women's concerns including household and children's needs. Trading in markets earns women masculine labels such as kiwagi, characterized variously as independent, rebellious and insubordinate. Earning money does not change expectations of correct behaviour for wives, making it difficult for women to initiate, deny sex or ask for condoms. Independence and income from market work may make it easier for women to enter and exit new sexual relationships. However, unable to protect themselves within partnerships, HIV risk may increase as a result.

Decision theory applied to image quality control in radiology.

PubMed

Lessa, Patrícia S; Caous, Cristofer A; Arantes, Paula R; Amaro, Edson; de Souza, Fernando M Campello

2008-11-13

The present work aims at the application of the decision theory to radiological image quality control (QC) in diagnostic routine. The main problem addressed in the framework of decision theory is to accept or reject a film lot of a radiology service. The probability of each decision of a determined set of variables was obtained from the selected films. Based on a radiology service routine a decision probability function was determined for each considered group of combination characteristics. These characteristics were related to the film quality control. These parameters were also framed in a set of 8 possibilities, resulting in 256 possible decision rules. In order to determine a general utility application function to access the decision risk, we have used a simple unique parameter called r. The payoffs chosen were: diagnostic's result (correct/incorrect), cost (high/low), and patient satisfaction (yes/no) resulting in eight possible combinations. Depending on the value of r, more or less risk will occur related to the decision-making. The utility function was evaluated in order to determine the probability of a decision. The decision was made with patients or administrators' opinions from a radiology service center. The model is a formal quantitative approach to make a decision related to the medical imaging quality, providing an instrument to discriminate what is really necessary to accept or reject a film or a film lot. The method presented herein can help to access the risk level of an incorrect radiological diagnosis decision.

Engaging Students in Survey Design and Data Collection

ERIC Educational Resources Information Center

Sole, Marla A.

2015-01-01

Every day, people use data to make decisions that affect their personal and professional lives, trusting that the data are correct. Many times, however, the data are inaccurate, as a result of a flaw in the design or methodology of the survey used to collect the data. Researchers agree that only questions that are clearly worded, unambiguous, free…

Return on Investment: A Placebo for the Chief Financial Officer... and Other Paradoxes

ERIC Educational Resources Information Center

Andru, Peter; Botchkarev, Alexei

2011-01-01

Background: Return on investment (ROI) is one of the most popular evaluation metrics. ROI analysis (when applied correctly) is a powerful tool of evaluating existing information systems and making informed decisions on the acquisitions. However, practical use of the ROI is complicated by a number of uncertainties and controversies. The article…

Computerized Vocational Information and Decision-Making in Secured Environments in New York State.

ERIC Educational Resources Information Center

Heller, Barbara R.; Gross, Linda Chitayat

A study was conducted on the use of the Guidance Information System (GIS), an on-line computer information retrieval system for occupational, two-year college, four-year college, and scholarship and financial aid information, in four detention/correctional facilities in New York. These were the Queens House of Detention for Men (QHDM), Brooklyn…

Examining Augmented Reality to Improve Navigation Skills in Postsecondary Students with Intellectual Disability

ERIC Educational Resources Information Center

Smith, Cate C.; Cihak, David F.; Kim, Byungkeon; McMahon, Don D.; Wright, Rachel

2017-01-01

The purpose of this study was to examine the effects of using mobile technology to improve navigation skills in three students with intellectual disability (ID) in a postsecondary education program. Navigation skills included using an augmented reality iPhone app to make correct "waypoint" decisions when traveling by foot on a university…

Best opening face system for sweepy, eccentric logs : a user’s guide

Treesearch

David W. Lewis

1985-01-01

Log breakdown simulation models have gained rapid acceptance within the sawmill industry in the last 15 years. Although they have many advantages over traditional decision making tools, the existing models do not calculate yield correctly when used to simulate the breakdown of eccentric, sweepy logs in North American sawmills producing softwood dimension lumber. In an...

Reporting Data with "Over-the-Counter" Data Analysis Supports Improves Educators' Data Analyses

ERIC Educational Resources Information Center

Rankin, Jenny Grant

2014-01-01

The benefits of making data-informed decisions to improve learning rely on educators correctly interpreting given data. Many educators routinely misinterpret data, even at districts with proactive support for data use. The tool most educators use for data analyses, which is an information technology data system or its reports, typically reports…

Unreliable gut feelings can lead to correct decisions: the somatic marker hypothesis in non-linear decision chains.

PubMed

Bedia, Manuel G; Di Paolo, Ezequiel

2012-01-01

Dual-process approaches of decision-making examine the interaction between affective/intuitive and deliberative processes underlying value judgment. From this perspective, decisions are supported by a combination of relatively explicit capabilities for abstract reasoning and relatively implicit evolved domain-general as well as learned domain-specific affective responses. One such approach, the somatic markers hypothesis (SMH), expresses these implicit processes as a system of evolved primary emotions supplemented by associations between affect and experience that accrue over lifetime, or somatic markers. In this view, somatic markers are useful only if their local capability to predict the value of an action is above a baseline equal to the predictive capability of the combined rational and primary emotional subsystems. We argue that decision-making has often been conceived of as a linear process: the effect of decision sequences is additive, local utility is cumulative, and there is no strong environmental feedback. This widespread assumption can have consequences for answering questions regarding the relative weight between the systems and their interaction within a cognitive architecture. We introduce a mathematical formalization of the SMH and study it in situations of dynamic, non-linear decision chains using a discrete-time stochastic model. We find, contrary to expectations, that decision-making events can interact non-additively with the environment in apparently paradoxical ways. We find that in non-lethal situations, primary emotions are represented globally over and above their local weight, showing a tendency for overcautiousness in situated decision chains. We also show that because they tend to counteract this trend, poorly attuned somatic markers that by themselves do not locally enhance decision-making, can still produce an overall positive effect. This result has developmental and evolutionary implications since, by promoting exploratory behavior, somatic markers would seem to be beneficial even at early stages when experiential attunement is poor. Although the model is formulated in terms of the SMH, the implications apply to dual systems theories in general since it makes minimal assumptions about the nature of the processes involved.

Unreliable Gut Feelings Can Lead to Correct Decisions: The Somatic Marker Hypothesis in Non-Linear Decision Chains

PubMed Central

Bedia, Manuel G.; Di Paolo, Ezequiel

2012-01-01

Dual-process approaches of decision-making examine the interaction between affective/intuitive and deliberative processes underlying value judgment. From this perspective, decisions are supported by a combination of relatively explicit capabilities for abstract reasoning and relatively implicit evolved domain-general as well as learned domain-specific affective responses. One such approach, the somatic markers hypothesis (SMH), expresses these implicit processes as a system of evolved primary emotions supplemented by associations between affect and experience that accrue over lifetime, or somatic markers. In this view, somatic markers are useful only if their local capability to predict the value of an action is above a baseline equal to the predictive capability of the combined rational and primary emotional subsystems. We argue that decision-making has often been conceived of as a linear process: the effect of decision sequences is additive, local utility is cumulative, and there is no strong environmental feedback. This widespread assumption can have consequences for answering questions regarding the relative weight between the systems and their interaction within a cognitive architecture. We introduce a mathematical formalization of the SMH and study it in situations of dynamic, non-linear decision chains using a discrete-time stochastic model. We find, contrary to expectations, that decision-making events can interact non-additively with the environment in apparently paradoxical ways. We find that in non-lethal situations, primary emotions are represented globally over and above their local weight, showing a tendency for overcautiousness in situated decision chains. We also show that because they tend to counteract this trend, poorly attuned somatic markers that by themselves do not locally enhance decision-making, can still produce an overall positive effect. This result has developmental and evolutionary implications since, by promoting exploratory behavior, somatic markers would seem to be beneficial even at early stages when experiential attunement is poor. Although the model is formulated in terms of the SMH, the implications apply to dual systems theories in general since it makes minimal assumptions about the nature of the processes involved. PMID:23087655

Planning Protective Action Decision-Making: Evacuate or Shelter-in-Place

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

Sorensen, J.H.

Appropriate protective action recommendations or decisions (PARs/PADs) are needed to achieve maximum protection of a population at risk. The factors that affect protective action decisions are complex but fairly well documented. Protective action decisions take into account population distributions, projected or actual exposure to a chemical substance, availability of adequate shelters, evacuation time estimates, and other relevant factors. To choose in-place sheltering, there should be a reasonable assurance that the movement of people beyond their residence, workplace, or school will endanger the health and safety of the public more so than allowing them to remain in place. The decision tomore » evacuate the public should be based on the reasonable assurance that the movement of people to an area outside of an affected area is in the best interest of their health and safety, and is of minimal risk to them. In reality, an evacuation decision is also a resource-dependent decision. The availability of transportation and other resources, including shelters, may factor heavily in the protective action decision-making process. All strategies to protect the health and safety of the public from a release of hazardous chemicals are explicitly considered during emergency decision making. Each institutional facility (such as hospitals, schools, day care centers, correctional facilities, assisted living facilities or nursing homes) in the community should be considered separately to determine what special protective actions may be necessary. Deciding whether to evacuate or to shelter-in-place is one of the most important questions facing local emergency planners responding to a toxic chemical release. That such a complex decision with such important potential consequences must be made with such urgency places tremendous responsibility on the planners and officials involved. Researchers have devoted considerable attention to the evacuation/shelter-in-place protection decision. While several decision aids have been developed, no single approach has achieved widespread acceptance based on validity, utility, and effectiveness (Ujihara 1989, Mannan and Kilpatrick 2000). In the absence of an agreed-upon methodology for making this decision, the best strategy for local emergency planners and officials is a thorough understanding of all the components affecting the decision. This paper summarizes what is currently known about the evacuation/shelter-in-place protection decision and points to available literature that more thoroughly explores the individual components of the decision. The next section summarizes the major issues in protective action decision process. This is followed by a discussion of all the factors that may bear on the protective action decision process. The final section address how to make a protective action decision.« less

A multicriteria decision making approach applied to improving maintenance policies in healthcare organizations.

PubMed

Carnero, María Carmen; Gómez, Andrés

2016-04-23

Healthcare organizations have far greater maintenance needs for their medical equipment than other organization, as many are used directly with patients. However, the literature on asset management in healthcare organizations is very limited. The aim of this research is to provide more rational application of maintenance policies, leading to an increase in quality of care. This article describes a multicriteria decision-making approach which integrates Markov chains with the multicriteria Measuring Attractiveness by a Categorical Based Evaluation Technique (MACBETH), to facilitate the best choice of combination of maintenance policies by using the judgements of a multi-disciplinary decision group. The proposed approach takes into account the level of acceptance that a given alternative would have among professionals. It also takes into account criteria related to cost, quality of care and impact of care cover. This multicriteria approach is applied to four dialysis subsystems: patients infected with hepatitis C, infected with hepatitis B, acute and chronic; in all cases, the maintenance strategy obtained consists of applying corrective and preventive maintenance plus two reserve machines. The added value in decision-making practices from this research comes from: (i) integrating the use of Markov chains to obtain the alternatives to be assessed by a multicriteria methodology; (ii) proposing the use of MACBETH to make rational decisions on asset management in healthcare organizations; (iii) applying the multicriteria approach to select a set or combination of maintenance policies in four dialysis subsystems of a health care organization. In the multicriteria decision making approach proposed, economic criteria have been used, related to the quality of care which is desired for patients (availability), and the acceptance that each alternative would have considering the maintenance and healthcare resources which exist in the organization, with the inclusion of a decision-making group. This approach is better suited to actual health care organization practice and depending on the subsystem analysed, improvements are introduced that are not included in normal maintenance policies; in this way, not only have different maintenance policies been suggested, but also alternatives that, in each case and according to viability, provide a more complete decision tool for the maintenance manager.

Economic evaluations of health technologies in Dutch healthcare decision-making: a qualitative study of the current and potential use, barriers, and facilitators.

PubMed

Roseboom, Kitty J; van Dongen, Johanna M; Tompa, Emile; van Tulder, Maurits W; Bosmans, Judith E

2017-01-26

The use of economic evaluations in healthcare decision-making can potentially help decision-makers in allocating scarce resources as efficiently as possible. Over a decade ago, the use of such studies was found to be limited in Dutch healthcare decision-making, but their current use is unknown. Therefore, this study aimed to provide insight into the current and potential use of economic evaluations in Dutch healthcare decision-making and to identify barriers and facilitators to the use of such studies. Interviews containing semi-structured and structured questions were conducted among Dutch healthcare decision-makers. Participants were purposefully selected and special efforts were made to include decision-makers working at the macro- (national), meso- (local/regional), and micro-level (patient setting). During the interviews, a topic list was used that was based on the research questions and a literature search, and was developed in consultation with the Dutch National Healthcare Institute. Responses to the semi-structured questions were analyzed using a constant comparative approach. As for the structured questions, participants' definitions of various economic evaluation concepts were scored as either being "correct" or "incorrect" by two researchers, and summary statistics were prepared. Sixteen healthcare decision-makers were interviewed and two health economists. Decision-makers' knowledge of economic evaluations was only modest, and their current use appeared to be limited. Nonetheless, decision-makers recognized the importance of economic evaluations and saw several opportunities for extending their use at the macro- and meso-level, but not at the micro-level. The disparity between the limited use and recognition of the importance of economic evaluations is likely due to the many barriers decision-makers experience preventing their use (e.g. lack of resources, lack of formal willingness-to-pay threshold). Possible facilitators for extending the use of economic evaluations include, amongst others, educating decision-makers and the general population about economic evaluations and presenting economic evaluation results in a clearer and more understandable way. This study demonstrated that the current use and impact of economic evaluations in Dutch healthcare decision-making is limited at best. Therefore, strategies are needed to overcome the barriers that currently prevent economic evaluations from being used extensively.

Can Classification Tree Analyses Help Improve Decision Making About Treatments for Depression and Anxiety Disorders? A Preliminary Investigation

PubMed Central

Rhodes, Louisa; Naumann, Ulrike M.

2011-01-01

Objective: To identify how decisions about treatment are being made in secondary services for anxiety disorders and depression and, specifically, whether it was possible to predict the decisions to refer for evidence-based treatments. Method: Post hoc classification tree analysis was performed using a sample from an audit on implementation of the National Institute for Health and Clinical Excellence Guidelines for Depression and Anxiety Disorders. The audit was of 5 teams offering secondary care services; they included psychiatrists, psychologists, community psychiatric nurses, social workers, dual-diagnosis workers, and vocational workers. The patient sample included all of those with a primary problem of depression (n = 56) or an anxiety disorder (n = 16) who were offered treatment from February 16 to April 3, 2009. The outcome variable was whether or not evidence-based treatments were offered, and the predictor variables were presenting problem, risk, comorbid problem, social problems, and previous psychiatric history. Results: Treatment decisions could be more accurately predicted for anxiety disorders (93% correct) than for depression (55%). For anxiety disorders, the presence or absence of social problems was a good predictor for whether evidence-based or non–evidence-based treatments were offered; 44% (4/9) of those with social problems vs 100% (6/6) of those without social problems were offered evidence-based treatments. For depression, patients’ risk rating had the largest impact on treatment decisions, although no one variable could be identified as individually predictive of all treatment decisions. Conclusions: Treatment decisions were generally consistent for anxiety disorders but more idiosyncratic for depression, making the development of a decision-making model very difficult for depression. The lack of clarity of some terms in the clinical guidelines and the more complex nature of depression could be factors contributing to this difficulty. Further research is needed to understand the complex nature of decision making with depressed patients. PMID:22295255

A calibration hierarchy for risk models was defined: from utopia to empirical data.

PubMed

Van Calster, Ben; Nieboer, Daan; Vergouwe, Yvonne; De Cock, Bavo; Pencina, Michael J; Steyerberg, Ewout W

2016-06-01

Calibrated risk models are vital for valid decision support. We define four levels of calibration and describe implications for model development and external validation of predictions. We present results based on simulated data sets. A common definition of calibration is "having an event rate of R% among patients with a predicted risk of R%," which we refer to as "moderate calibration." Weaker forms of calibration only require the average predicted risk (mean calibration) or the average prediction effects (weak calibration) to be correct. "Strong calibration" requires that the event rate equals the predicted risk for every covariate pattern. This implies that the model is fully correct for the validation setting. We argue that this is unrealistic: the model type may be incorrect, the linear predictor is only asymptotically unbiased, and all nonlinear and interaction effects should be correctly modeled. In addition, we prove that moderate calibration guarantees nonharmful decision making. Finally, results indicate that a flexible assessment of calibration in small validation data sets is problematic. Strong calibration is desirable for individualized decision support but unrealistic and counter productive by stimulating the development of overly complex models. Model development and external validation should focus on moderate calibration. Copyright © 2016 Elsevier Inc. All rights reserved.

A Bernoulli Formulation of the Land-Use Portfolio Model

USGS Publications Warehouse

Champion, Richard A.

2008-01-01

Decision making for natural-hazards mitigation can be sketched as knowledge available in advance (a priori), knowledge available later (a posteriori), and how consequences of the mitigation decision might be viewed once future outcomes are known. Two outcomes - mitigating for a hazard event that will occur, and not mitigating for a hazard event that will not occur - can be considered narrowly correct. Two alternative outcomes - mitigating for a hazard event that will not occur, and not mitigating for a hazard event that will occur - can be considered narrowly incorrect. The dilemma facing the decision maker is that mitigation choices must be made before the event, and often must be made with imperfect statistical techniques and imperfect data.

Feedback-related brain activity predicts learning from feedback in multiple-choice testing.

PubMed

Ernst, Benjamin; Steinhauser, Marco

2012-06-01

Different event-related potentials (ERPs) have been shown to correlate with learning from feedback in decision-making tasks and with learning in explicit memory tasks. In the present study, we investigated which ERPs predict learning from corrective feedback in a multiple-choice test, which combines elements from both paradigms. Participants worked through sets of multiple-choice items of a Swahili-German vocabulary task. Whereas the initial presentation of an item required the participants to guess the answer, corrective feedback could be used to learn the correct response. Initial analyses revealed that corrective feedback elicited components related to reinforcement learning (FRN), as well as to explicit memory processing (P300) and attention (early frontal positivity). However, only the P300 and early frontal positivity were positively correlated with successful learning from corrective feedback, whereas the FRN was even larger when learning failed. These results suggest that learning from corrective feedback crucially relies on explicit memory processing and attentional orienting to corrective feedback, rather than on reinforcement learning.

The accuracy and reproducibility of video assessment in the pitch-side management of concussion in elite rugby.

PubMed

Fuller, G W; Kemp, S P T; Raftery, M

2017-03-01

To investigate the accuracy and reliability of side-line video review of head impact events to aid identification of concussion in elite sport. Diagnostic accuracy and inter-rater agreement study. Immediate care, match day and team doctors involved in the 2015 Rugby Union World Cup viewed 20 video clips showing broadcaster's footage of head impact events occurring during elite Rugby matches. Subjects subsequently recorded whether any criteria warranting permanent removal from play or medical room head injury assessment were present. The accuracy of these ratings were compared to consensus expert opinion by calculating mean sensitivity and specificity across raters. The reproducibility of doctor's decisions was additionally assessed using raw agreement and Gwets AC1 chance corrected agreement coefficient. Forty rugby medicine doctors were included in the study. Compared to the expert reference standard overall sensitivity and specificity of doctors decisions were 77.5% (95% CI 73.1-81.5%) and 53.3% (95% CI 48.2-58.2%) respectively. Overall there was raw agreement of 67.8% (95% CI 57.9-77.7%) between doctors across all video clips. Chance corrected Gwets AC1 agreement coefficient was 0.39 (95% CI 0.17-0.62), indicating fair agreement. Rugby World Cup doctors' demonstrated moderate accuracy and fair reproducibility in head injury event decision making when assessing video clips of head impact events. The use of real-time video may improve the identification, decision making and management of concussion in elite sports. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

When Does Reward Maximization Lead to Matching Law?

PubMed Central

Sakai, Yutaka; Fukai, Tomoki

2008-01-01

What kind of strategies subjects follow in various behavioral circumstances has been a central issue in decision making. In particular, which behavioral strategy, maximizing or matching, is more fundamental to animal's decision behavior has been a matter of debate. Here, we prove that any algorithm to achieve the stationary condition for maximizing the average reward should lead to matching when it ignores the dependence of the expected outcome on subject's past choices. We may term this strategy of partial reward maximization “matching strategy”. Then, this strategy is applied to the case where the subject's decision system updates the information for making a decision. Such information includes subject's past actions or sensory stimuli, and the internal storage of this information is often called “state variables”. We demonstrate that the matching strategy provides an easy way to maximize reward when combined with the exploration of the state variables that correctly represent the crucial information for reward maximization. Our results reveal for the first time how a strategy to achieve matching behavior is beneficial to reward maximization, achieving a novel insight into the relationship between maximizing and matching. PMID:19030101

Robust Approach for Nonuniformity Correction in Infrared Focal Plane Array.

PubMed

Boutemedjet, Ayoub; Deng, Chenwei; Zhao, Baojun

2016-11-10

In this paper, we propose a new scene-based nonuniformity correction technique for infrared focal plane arrays. Our work is based on the use of two well-known scene-based methods, namely, adaptive and interframe registration-based exploiting pure translation motion model between frames. The two approaches have their benefits and drawbacks, which make them extremely effective in certain conditions and not adapted for others. Following on that, we developed a method robust to various conditions, which may slow or affect the correction process by elaborating a decision criterion that adapts the process to the most effective technique to ensure fast and reliable correction. In addition to that, problems such as bad pixels and ghosting artifacts are also dealt with to enhance the overall quality of the correction. The performance of the proposed technique is investigated and compared to the two state-of-the-art techniques cited above.

Robust Approach for Nonuniformity Correction in Infrared Focal Plane Array

PubMed Central

Boutemedjet, Ayoub; Deng, Chenwei; Zhao, Baojun

2016-01-01

In this paper, we propose a new scene-based nonuniformity correction technique for infrared focal plane arrays. Our work is based on the use of two well-known scene-based methods, namely, adaptive and interframe registration-based exploiting pure translation motion model between frames. The two approaches have their benefits and drawbacks, which make them extremely effective in certain conditions and not adapted for others. Following on that, we developed a method robust to various conditions, which may slow or affect the correction process by elaborating a decision criterion that adapts the process to the most effective technique to ensure fast and reliable correction. In addition to that, problems such as bad pixels and ghosting artifacts are also dealt with to enhance the overall quality of the correction. The performance of the proposed technique is investigated and compared to the two state-of-the-art techniques cited above. PMID:27834893

What difference do brain images make in US criminal trials?

PubMed

Hardcastle, Valerie Gray; Lamb, Edward

2018-05-09

One of the early concerns regarding the use of neuroscience data in criminal trials is that even if the brain images are ambiguous or inconclusive, they still might influence a jury in virtue of the fact that they appear easy to understand. By appearing visually simple, even though they are really statistically constructed maps with a host of assumptions built into them, a lay jury or a judge might take brain scans to be more reliable or relevant than they actually are. Should courts exclude brain scans for being more prejudicial than probative? Herein, we rehearse a brief history of brain scans admitted into criminal trials in the United States, then describe the results of a recent analysis of appellate court decisions that referenced 1 or more brain scans in the judicial decision. In particular, we aim to explain how courts use neuroscience imaging data: Do they interpret the data correctly? Does it seem that scans play an oversized role in judicial decision-making? And have they changed how criminal defendants are judged? It is our hope that in answering these questions, clinicians and defence attorneys will be able to make better informed decisions regarding about how to manage those incarcerated. © 2018 John Wiley & Sons, Ltd.

Evaluating effect of symptoms heterogeneity on decision-making ability in obsessive-compulsive disorder.

PubMed

Martoni, Riccardo Maria; Brombin, Chiara; Nonis, Alessandro; Salgari, Giulia Carlotta; Buongiorno, Angela; Cavallini, Maria Cristina; Galimberti, Elisa; Bellodi, Laura

2015-07-01

Despite having a univocal definition, obsessive-compulsive disorder (OCD) shows a remarkably phenotypic heterogeneity. The published reports show impaired decision-making in OCD patients, using tasks such as the Iowa Gambling Task (IGT). We wanted to verify the hypothesis of an IGT worse performance in a large sample of OCD patients and healthy control (HC) subjects and to examine the relation between neuropsychological performance in IGT and the OCD symptoms heterogeneity. Binary data from the Yale-Brown Obsessive Compulsive Scale collected on a large sample of OCD patients were analyzed using a multidimensional item response theory model to explore the underlying structure of data, thus revealing latent factors. Factor scores were categorized into quartiles. Then, for each factor, we identified patients respectively with the highest versus lowest score. We evaluated whether symptom dimensions affect the probability of a correct answer over time generalized, during IGT performance, fitting a generalized linear mixed model. We found a general deficit in ambiguous decision-making in OCD compared to HC. Moreover, our findings suggested that OCD symptoms heterogeneity affects decision-making learning abilities during IGT. In fact, while 'Symmetry' and 'Washing' patients showed a learning curve during the task, other subgroups did not. Our study confirmed previous findings suggesting that OCD is characterized by a deficit in decision-making under uncertainty. Moreover, our study gave evidence about biological specificity for each symptom dimension in OCD. Data were discussed in the context of the somatic marker hypothesis, which was hypothesized to be reduced in OCD patients. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

Sensorimotor Learning Biases Choice Behavior: A Learning Neural Field Model for Decision Making

PubMed Central

Schöner, Gregor; Gail, Alexander

2012-01-01

According to a prominent view of sensorimotor processing in primates, selection and specification of possible actions are not sequential operations. Rather, a decision for an action emerges from competition between different movement plans, which are specified and selected in parallel. For action choices which are based on ambiguous sensory input, the frontoparietal sensorimotor areas are considered part of the common underlying neural substrate for selection and specification of action. These areas have been shown capable of encoding alternative spatial motor goals in parallel during movement planning, and show signatures of competitive value-based selection among these goals. Since the same network is also involved in learning sensorimotor associations, competitive action selection (decision making) should not only be driven by the sensory evidence and expected reward in favor of either action, but also by the subject's learning history of different sensorimotor associations. Previous computational models of competitive neural decision making used predefined associations between sensory input and corresponding motor output. Such hard-wiring does not allow modeling of how decisions are influenced by sensorimotor learning or by changing reward contingencies. We present a dynamic neural field model which learns arbitrary sensorimotor associations with a reward-driven Hebbian learning algorithm. We show that the model accurately simulates the dynamics of action selection with different reward contingencies, as observed in monkey cortical recordings, and that it correctly predicted the pattern of choice errors in a control experiment. With our adaptive model we demonstrate how network plasticity, which is required for association learning and adaptation to new reward contingencies, can influence choice behavior. The field model provides an integrated and dynamic account for the operations of sensorimotor integration, working memory and action selection required for decision making in ambiguous choice situations. PMID:23166483

Evaluation of Natural Language Processors.

DTIC Science & Technology

1980-11-01

techniques described. Common practice in describing natural language processors is to describe the programs, then give about 20 examples of correctly...make a decision based on performance as to which approaches are most promising for further research and development. The lack of evaluation leaves...successively more difficult problems. This approach might be compared to children taking achievement tests in school. A 90% score on problems involving

Projectile Motion for Quarterbacks: How to Throw the Perfect Pass

ERIC Educational Resources Information Center

Tomin, Milan; Scipioni, Marco; DeAngelis, Fred

2018-01-01

In the sport of American football, the quarterback (QB) is the player almost always responsible for throwing the ball downfield to an open receiver. That important throw requires him to make a split second decision to launch the ball at the correct speed and angle to guarantee it lands directly into the hands of the receiver. In this paper we…

Take a Page from Your Coach's Play Book: Teaching Technical and Tactical Skills in Athletic Training

ERIC Educational Resources Information Center

Hawkins, Jeremy R.; Sharp, Elizabeth B.; Williams, Skip M.

2015-01-01

Context: The ability to demonstrate sound clinical reasoning is needed for a practicing athletic trainer. However, instruction on how to make a correct clinical decision may be deficient in many athletic training programs. Objective: To provide an overview of how to teach technical and tactical skills, using both a tradition and a nontraditional…

Executive Functioning of Sexually Compulsive and Non-Sexually Compulsive Men Before and After Watching an Erotic Video.

PubMed

Messina, Bruna; Fuentes, Daniel; Tavares, Hermano; Abdo, Carmita H N; Scanavino, Marco de T

2017-03-01

Despite the serious behavioral consequences faced by individuals with sexual compulsivity, related neuropsychological studies are sparse. To compare decision making and cognitive flexibility at baseline and after exposure to an erotic video in sexually compulsive participants and non-sexually compulsive controls. The sample consisted of 30 sexually compulsive men and 30 controls. Cognitive flexibility was investigated through the Wisconsin Card Sorting Test and decision making was examined through the Iowa Gambling Task. Wisconsin Card Sorting Test categories, correct responses, and perseverative errors and Iowa Gambling Task general trends and blocks. Sexually compulsive subjects and controls performed similarly at baseline. After watching an erotic video, controls performed better in block 1 of the Iowa Gambling Task (P = .01) and had more correct responses on the Wisconsin Card Sorting Test (P = .01). The controls presented fewer impulsive initial choices and better cognitive flexibility after exposure to erotic stimuli. Messina B, Fuentes D, Tavares H, et al. Executive Functioning of Sexually Compulsive and Non-Sexually Compulsive Men Before and After Watching an Erotic Video. J Sex Med 2017;14:347-354. Copyright © 2017. Published by Elsevier Inc.

[Etiology and antimicrobial resistance profile of urinary tract infection in children, Valdivia 2012].

PubMed

Herrera, Carolina; Navarro, Diego; Täger, Marlis

2014-12-01

Since initial antibiotic treatment in patients with urinary tract infection (UTI) is empiric, is very important to know the local epidemiology to make the correct therapeutical decisions. Determinate local features of antimicrobial resistance in pediatric patients with UTI. Retrospective review of urine culture tests of children under 15 years old, obtained in a pediatric emergency department in Valdivia, between february and december 2012. Escherichia coli showed high percentage of resistance to ampicillin (44,8%) and first generation cephalosporin (36%). A well understanding of local antimicrobial resistance profile is useful to a correct empiric treatment.

Medical equipment classification: method and decision-making support based on paraconsistent annotated logic.

PubMed

Oshiyama, Natália F; Bassani, Rosana A; D'Ottaviano, Itala M L; Bassani, José W M

2012-04-01

As technology evolves, the role of medical equipment in the healthcare system, as well as technology management, becomes more important. Although the existence of large databases containing management information is currently common, extracting useful information from them is still difficult. A useful tool for identification of frequently failing equipment, which increases maintenance cost and downtime, would be the classification according to the corrective maintenance data. Nevertheless, establishment of classes may create inconsistencies, since an item may be close to two classes by the same extent. Paraconsistent logic might help solve this problem, as it allows the existence of inconsistent (contradictory) information without trivialization. In this paper, a methodology for medical equipment classification based on the ABC analysis of corrective maintenance data is presented, and complemented with a paraconsistent annotated logic analysis, which may enable the decision maker to take into consideration alerts created by the identification of inconsistencies and indeterminacies in the classification.

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

PubMed Central

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

2016-01-01

Background Technology gains have improved tools for evaluating complex tasks by providing environmental supports (ES) that increase ease of use and improve performance outcomes through the use of information visualizations (info-vis). Complex info-vis emphasize the need to understand individual differences in abilities of target users, the key cognitive abilities needed to execute a decision task, and the graphical elements that can serve as the most effective ES. Older adults may be one such target user group that would benefit from increased ES to mitigate specific declines in cognitive abilities. For example, choosing a prescription drug plan is a necessary and complex task that can impact quality of life if the wrong choice is made. The decision to enroll in one plan over another can involve comparing over 15 plans across many categories. Within this context, the large amount of complex information and reduced working memory capacity puts older adults’ decision making at a disadvantage. An intentionally designed ES, such as an info-vis that reduces working memory demand, may assist older adults in making the most effective decision among many options. Objective The objective of this study is to examine whether the use of an info-vis can lower working memory demands and positively affect complex decision-making performance of older adults in the context of choosing a Medicare prescription drug plan. Methods Participants performed a computerized decision-making task in the context of finding the best health care plan. Data included quantitative decision-making performance indicators and surveys examining previous history with purchasing insurance. Participants used a colored info-vis ES or a table (no ES) to perform the decision task. Task difficulty was manipulated by increasing the number of selection criteria used to make an accurate decision. A repeated measures analysis was performed to examine differences between the two table designs. Results Twenty-three older adults between the ages of 66 and 80 completed the study. There was a main effect for accuracy such that older adults made more accurate decisions in the color info-vis condition than the table condition. In the low difficulty condition, participants were more successful at choosing the correct answer when the question was about the gap coverage attribute in the info-vis condition. Participants also made significantly faster decisions in the info-vis condition than in the table condition. Conclusions Reducing the working memory demand of the task through the use of an ES can improve decision accuracy, especially when selection criteria is only focused on a single attribute of the insurance plan. PMID:27251110

Corrective Action Decision Document for Corrective Action Unit 340: Pesticide Release sites, Nevada Test Site, Nevada

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

DOE /NV

This Corrective Action Decision Document has been prepared for Corrective Action Unit 340, the NTS Pesticide Release Sites, in accordance with the Federal Facility Agreement and Consent Order of 1996 (FFACO, 1996). Corrective Action Unit 340 is located at the Nevada Test Site, Nevada, and is comprised of the following Corrective Action Sites: 23-21-01, Area 23 Quonset Hut 800 Pesticide Release Ditch; 23-18-03, Area 23 Skid Huts Pesticide Storage; and 15-18-02, Area 15 Quonset Hut 15-11 Pesticide Storage. The purpose of this Corrective Action Decision Document is to identify and provide a rationale for the selection of a recommended correctivemore » action alternative for each Corrective Action Site. The scope of this Corrective Action Decision Document consists of the following tasks: Develop corrective action objectives; Identify corrective action alternative screening criteria; Develop corrective action alternatives; Perform detailed and comparative evaluations of the corrective action alternatives in relation to the corrective action objectives and screening criteria; and Recommend and justify a preferred corrective action alternative for each Corrective Action Site.« less

Quality metrics for sensor images

NASA Technical Reports Server (NTRS)

Ahumada, AL

1993-01-01

Methods are needed for evaluating the quality of augmented visual displays (AVID). Computational quality metrics will help summarize, interpolate, and extrapolate the results of human performance tests with displays. The FLM Vision group at NASA Ames has been developing computational models of visual processing and using them to develop computational metrics for similar problems. For example, display modeling systems use metrics for comparing proposed displays, halftoning optimizing methods use metrics to evaluate the difference between the halftone and the original, and image compression methods minimize the predicted visibility of compression artifacts. The visual discrimination models take as input two arbitrary images A and B and compute an estimate of the probability that a human observer will report that A is different from B. If A is an image that one desires to display and B is the actual displayed image, such an estimate can be regarded as an image quality metric reflecting how well B approximates A. There are additional complexities associated with the problem of evaluating the quality of radar and IR enhanced displays for AVID tasks. One important problem is the question of whether intruding obstacles are detectable in such displays. Although the discrimination model can handle detection situations by making B the original image A plus the intrusion, this detection model makes the inappropriate assumption that the observer knows where the intrusion will be. Effects of signal uncertainty need to be added to our models. A pilot needs to make decisions rapidly. The models need to predict not just the probability of a correct decision, but the probability of a correct decision by the time the decision needs to be made. That is, the models need to predict latency as well as accuracy. Luce and Green have generated models for auditory detection latencies. Similar models are needed for visual detection. Most image quality models are designed for static imagery. Watson has been developing a general spatial-temporal vision model to optimize video compression techniques. These models need to be adapted and calibrated for AVID applications.

The impact of human-technology cooperation and distributed cognition in forensic science: biasing effects of AFIS contextual information on human experts.

PubMed

Dror, Itiel E; Wertheim, Kasey; Fraser-Mackenzie, Peter; Walajtys, Jeff

2012-03-01

Experts play a critical role in forensic decision making, even when cognition is offloaded and distributed between human and machine. In this paper, we investigated the impact of using Automated Fingerprint Identification Systems (AFIS) on human decision makers. We provided 3680 AFIS lists (a total of 55,200 comparisons) to 23 latent fingerprint examiners as part of their normal casework. We manipulated the position of the matching print in the AFIS list. The data showed that latent fingerprint examiners were affected by the position of the matching print in terms of false exclusions and false inconclusives. Furthermore, the data showed that false identification errors were more likely at the top of the list and that such errors occurred even when the correct match was present further down the list. These effects need to be studied and considered carefully, so as to optimize human decision making when using technologies such as AFIS. © 2011 American Academy of Forensic Sciences.

Role of the medial prefrontal cortex in impaired decision making in juvenile attention-deficit/hyperactivity disorder.

PubMed

Hauser, Tobias U; Iannaccone, Reto; Ball, Juliane; Mathys, Christoph; Brandeis, Daniel; Walitza, Susanne; Brem, Silvia

2014-10-01

Attention-deficit/hyperactivity disorder (ADHD) has been associated with deficient decision making and learning. Models of ADHD have suggested that these deficits could be caused by impaired reward prediction errors (RPEs). Reward prediction errors are signals that indicate violations of expectations and are known to be encoded by the dopaminergic system. However, the precise learning and decision-making deficits and their neurobiological correlates in ADHD are not well known. To determine the impaired decision-making and learning mechanisms in juvenile ADHD using advanced computational models, as well as the related neural RPE processes using multimodal neuroimaging. Twenty adolescents with ADHD and 20 healthy adolescents serving as controls (aged 12-16 years) were examined using a probabilistic reversal learning task while simultaneous functional magnetic resonance imaging and electroencephalogram were recorded. Learning and decision making were investigated by contrasting a hierarchical Bayesian model with an advanced reinforcement learning model and by comparing the model parameters. The neural correlates of RPEs were studied in functional magnetic resonance imaging and electroencephalogram. Adolescents with ADHD showed more simplistic learning as reflected by the reinforcement learning model (exceedance probability, Px = .92) and had increased exploratory behavior compared with healthy controls (mean [SD] decision steepness parameter β: ADHD, 4.83 [2.97]; controls, 6.04 [2.53]; P = .02). The functional magnetic resonance imaging analysis revealed impaired RPE processing in the medial prefrontal cortex during cue as well as during outcome presentation (P < .05, family-wise error correction). The outcome-related impairment in the medial prefrontal cortex could be attributed to deficient processing at 200 to 400 milliseconds after feedback presentation as reflected by reduced feedback-related negativity (ADHD, 0.61 [3.90] μV; controls, -1.68 [2.52] μV; P = .04). The combination of computational modeling of behavior and multimodal neuroimaging revealed that impaired decision making and learning mechanisms in adolescents with ADHD are driven by impaired RPE processing in the medial prefrontal cortex. This novel, combined approach furthers the understanding of the pathomechanisms in ADHD and may advance treatment strategies.

Evaluating the decision accuracy and speed of clinical data visualizations.

PubMed

Pieczkiewicz, David S; Finkelstein, Stanley M

2010-01-01

Clinicians face an increasing volume of biomedical data. Assessing the efficacy of systems that enable accurate and timely clinical decision making merits corresponding attention. This paper discusses the multiple-reader multiple-case (MRMC) experimental design and linear mixed models as means of assessing and comparing decision accuracy and latency (time) for decision tasks in which clinician readers must interpret visual displays of data. These tools can assess and compare decision accuracy and latency (time). These experimental and statistical techniques, used extensively in radiology imaging studies, offer a number of practical and analytic advantages over more traditional quantitative methods such as percent-correct measurements and ANOVAs, and are recommended for their statistical efficiency and generalizability. An example analysis using readily available, free, and commercial statistical software is provided as an appendix. While these techniques are not appropriate for all evaluation questions, they can provide a valuable addition to the evaluative toolkit of medical informatics research.

[Diagnosis and treatment guidelines for difficult-to-control asthma in children].

PubMed

Navarro Merino, M; Andrés Martín, A; Asensio de la Cruz, O; García García, M L; Liñán Cortes, S; Villa Asensi, J R

2009-12-01

Children suffering from difficult-to-control asthma (DCA) require frequent appointments with their physician, complex treatment regimes and often admissions to hospital. Less than 5% of the asthmatic population suffer this condition. DCA must be correctly characterised to rule out false causes of DCA and requires making a differential diagnosis from pathologies that mimic asthma, comorbidity, environmental and psychological factors, and analysing the factors to determine poor treatment compliance. In true DCA cases, inflammation studies (exhaled nitric oxide, induced sputum, broncho-alveolar lavage and bronchial biopsy), pulmonary function and other clinical aspects can classify DCA into different phenotypes which could make therapeutic decision-making easier.

A role of decision-making competency in science learning utilizing a social valuation framework

NASA Astrophysics Data System (ADS)

Katsuo, Akihito

2005-11-01

The role of decision-making in learning performance has been an occasional topic in the research literature in science education, but rarely has it been a central issue in the field. Nonetheless, recent studies regarding the topic in several fields other than education, such as cognitive neuroscience and social choice theory, indicate the fundamental importance(s) of the topic. This study focuses on a possible role of decision-making in science learning. Initially the study was designed to probe the decision-making ability of elementary school children with a modified version of the Iowa Gambling Task (IGT). The experiment involved six Montessori 3rd and 4th grade students as the experimental group and eight public school 3rd and 4th grade students as the control group. The result of the modified IGT revealed a tendency in choice trajectories favoring children at the Montessori school. However, the probabilistic value went below the statistically significant level set by the U test. A further study focused on the impact of better decision-making ability revealed in the first experiment on performances with a science learning module that emphasized collective reasoning. The instruction was based on a set of worksheets with multiple choices on which students were asked to make predictions with and to provide supportive arguments regarding outcomes of experiments introduced in the worksheet. Then the whole class was involved with a real experiment to see which choice was correct. The findings in the study indicated that the Montessori students often obtained higher scores than non-Montessori students in making decision with a tendency of consistency in terms of their choices of the alternatives on the worksheets. The findings of the experiments were supported by a correlational analysis that was performed at the end of study. Although no statistically significant correlations were found, there was a tendency for positively associative shifts between the scores of the modified IGT and the scores for the performances on the science module for the Montessori students.

Target Uncertainty Mediates Sensorimotor Error Correction

PubMed Central

Vijayakumar, Sethu; Wolpert, Daniel M.

2017-01-01

Human movements are prone to errors that arise from inaccuracies in both our perceptual processing and execution of motor commands. We can reduce such errors by both improving our estimates of the state of the world and through online error correction of the ongoing action. Two prominent frameworks that explain how humans solve these problems are Bayesian estimation and stochastic optimal feedback control. Here we examine the interaction between estimation and control by asking if uncertainty in estimates affects how subjects correct for errors that may arise during the movement. Unbeknownst to participants, we randomly shifted the visual feedback of their finger position as they reached to indicate the center of mass of an object. Even though participants were given ample time to compensate for this perturbation, they only fully corrected for the induced error on trials with low uncertainty about center of mass, with correction only partial in trials involving more uncertainty. The analysis of subjects’ scores revealed that participants corrected for errors just enough to avoid significant decrease in their overall scores, in agreement with the minimal intervention principle of optimal feedback control. We explain this behavior with a term in the loss function that accounts for the additional effort of adjusting one’s response. By suggesting that subjects’ decision uncertainty, as reflected in their posterior distribution, is a major factor in determining how their sensorimotor system responds to error, our findings support theoretical models in which the decision making and control processes are fully integrated. PMID:28129323

Target Uncertainty Mediates Sensorimotor Error Correction.

PubMed

Acerbi, Luigi; Vijayakumar, Sethu; Wolpert, Daniel M

2017-01-01

Human movements are prone to errors that arise from inaccuracies in both our perceptual processing and execution of motor commands. We can reduce such errors by both improving our estimates of the state of the world and through online error correction of the ongoing action. Two prominent frameworks that explain how humans solve these problems are Bayesian estimation and stochastic optimal feedback control. Here we examine the interaction between estimation and control by asking if uncertainty in estimates affects how subjects correct for errors that may arise during the movement. Unbeknownst to participants, we randomly shifted the visual feedback of their finger position as they reached to indicate the center of mass of an object. Even though participants were given ample time to compensate for this perturbation, they only fully corrected for the induced error on trials with low uncertainty about center of mass, with correction only partial in trials involving more uncertainty. The analysis of subjects' scores revealed that participants corrected for errors just enough to avoid significant decrease in their overall scores, in agreement with the minimal intervention principle of optimal feedback control. We explain this behavior with a term in the loss function that accounts for the additional effort of adjusting one's response. By suggesting that subjects' decision uncertainty, as reflected in their posterior distribution, is a major factor in determining how their sensorimotor system responds to error, our findings support theoretical models in which the decision making and control processes are fully integrated.

High-resolution near real-time drought monitoring in South Asia

NASA Astrophysics Data System (ADS)

Aadhar, Saran; Mishra, Vimal

2017-10-01

Drought in South Asia affect food and water security and pose challenges for millions of people. For policy-making, planning, and management of water resources at sub-basin or administrative levels, high-resolution datasets of precipitation and air temperature are required in near-real time. We develop a high-resolution (0.05°) bias-corrected precipitation and temperature data that can be used to monitor near real-time drought conditions over South Asia. Moreover, the dataset can be used to monitor climatic extremes (heat and cold waves, dry and wet anomalies) in South Asia. A distribution mapping method was applied to correct bias in precipitation and air temperature, which performed well compared to the other bias correction method based on linear scaling. Bias-corrected precipitation and temperature data were used to estimate Standardized precipitation index (SPI) and Standardized Precipitation Evapotranspiration Index (SPEI) to assess the historical and current drought conditions in South Asia. We evaluated drought severity and extent against the satellite-based Normalized Difference Vegetation Index (NDVI) anomalies and satellite-driven Drought Severity Index (DSI) at 0.05°. The bias-corrected high-resolution data can effectively capture observed drought conditions as shown by the satellite-based drought estimates. High resolution near real-time dataset can provide valuable information for decision-making at district and sub-basin levels.

Saccadic eye movements as an index of perceptual decision-making.

PubMed

McSorley, Eugene; McCloy, Rachel

2009-10-01

One of the most common decisions we make is the one about where to move our eyes next. Here we examine the impact that processing the evidence supporting competing options has on saccade programming. Participants were asked to saccade to one of two possible visual targets indicated by a cloud of moving dots. We varied the evidence which supported saccade target choice by manipulating the proportion of dots moving towards one target or the other. The task was found to become easier as the evidence supporting target choice increased. This was reflected in an increase in percent correct and a decrease in saccade latency. The trajectory and landing position of saccades were found to deviate away from the non-selected target reflecting the choice of the target and the inhibition of the non-target. The extent of the deviation was found to increase with amount of sensory evidence supporting target choice. This shows that decision-making processes involved in saccade target choice have an impact on the spatial control of a saccade. This would seem to extend the notion of the processes involved in the control of saccade metrics beyond a competition between visual stimuli to one also reflecting a competition between options.

Building flexible real-time systems using the Flex language

NASA Technical Reports Server (NTRS)

Kenny, Kevin B.; Lin, Kwei-Jay

1991-01-01

The design and implementation of a real-time programming language called Flex, which is a derivative of C++, are presented. It is shown how different types of timing requirements might be expressed and enforced in Flex, how they might be fulfilled in a flexible way using different program models, and how the programming environment can help in making binding and scheduling decisions. The timing constraint primitives in Flex are easy to use yet powerful enough to define both independent and relative timing constraints. Program models like imprecise computation and performance polymorphism can carry out flexible real-time programs. In addition, programmers can use a performance measurement tool that produces statistically correct timing models to predict the expected execution time of a program and to help make binding decisions. A real-time programming environment is also presented.

Mill and the right to remain uninformed.

PubMed

Strasser, M

1986-08-01

In a recent article in the Journal of Medicine and Philosophy, David Ost (1984) claims that patients do not have a right to waive their right to information. He argues that patients cannot make informed rational decisions without full information and thus, a right to waive information would involve a right to avoid one's responsibility to act as an autonomous moral agent. In support of his position, Ost cites a passage from Mill. Yet, a correct interpretation of the passage in question would support one's right to remain uninformed in certain situations. If the information would hurt one's chances for survival or hurt one's ability to make calm, rational decisions, then one not only does not have a duty to find out the information, but one's exercising one's right to remain uninformed may be the only rational course of action to take.

Patients' misunderstanding of common orthopaedic terminology: the need for clarity

PubMed Central

Bagley, CHM; Hunter, AR; Bacarese-Hamilton, IA

2011-01-01

INTRODUCTION Patients' understanding of their medical problems is essential to allow them to make competent decisions, comply with treatment and enable recovery. We investigated Patients' understanding of orthopaedic terms to identify those words surgeons should make the most effort to explain. METHODS This questionnaire-based study recruited patients attending the orthopaedic clinics. Qualitative and quantitative data were collected using free text boxes for the Patients' written definitions and multiple choice questions (MCQs). RESULTS A total of 133 patients took part. Of these, 74% identified English as their first language. ‘Broken bone’ was correctly defined by 71% of respondents whereas ‘fractured bone’ was only correctly defined by 33%. ‘Sprain’ was correctly defined by 17% of respondents, with 29% being almost correct, 25% wrong and 29% unsure. In the MCQs, 51% of respondents answered correctly for ‘fracture’, 55% for ‘arthroscopy’, 46% for ‘meniscus’, 35% for ‘tendon’ and 23% for ‘ligament’. ‘Sprained’ caused confusion, with only 11% of patients answering correctly. Speaking English as a second language was a significant predictive factor for patients who had difficulty with definitions. There was no significant variation among different age groups. CONCLUSIONS Care should be taken by surgeons when using basic and common orthopaedic terminology in order to avoid misunderstanding. Educating patients in clinic is a routine part of practice. PMID:21943466

Decision-Making in the Ventral Premotor Cortex Harbinger of Action

PubMed Central

Pardo-Vazquez, Jose L.; Padron, Isabel; Fernandez-Rey, Jose; Acuña, Carlos

2011-01-01

Although the premotor (PM) cortex was once viewed as the substrate of pure motor functions, soon it was realized that it was involved in higher brain functions. By this it is meant that the PM cortex functions would better be explained as motor set, preparation for limb movement, or sensory guidance of movement rather than solely by a fixed link to motor performance. These findings, together with a better knowledge of the PM cortex histology and hodology in human and non-human primates prompted quantitative studies of this area combining behavioral tasks with electrophysiological recordings. In addition, the exploration of the PM cortex neurons with qualitative methods also suggested its participation in higher functions. Behavioral choices frequently depend on temporal cues, which together with knowledge of previous outcomes and expectancies are combined to decide and choose a behavioral action. In decision-making the knowledge about the consequences of decisions, either correct or incorrect, is fundamental because they can be used to adapt future behavior. The neuronal correlates of a decision process have been described in several cortical areas of primates. Among them, there is evidence that the monkey ventral premotor (PMv) cortex, an anatomical and physiological well-differentiated area of the PM cortex, supports both perceptual decisions and performance monitoring. Here we review the evidence that the steps in a decision-making process are encoded in the firing rate of the PMv neurons. This provides compelling evidence suggesting that the PMv is involved in the use of recent and long-term sensory memory to decide, execute, and evaluate the outcomes of the subjects’ choices. PMID:21991249

Human interaction with an intelligent computer in multi-task situations

NASA Technical Reports Server (NTRS)

Rouse, W. B.

1975-01-01

A general formulation of human decision making in multiple task situations is presented. It includes a description of the state, event, and action space in which the multiple task supervisor operates. A specific application to a failure detection and correction situation is discussed and results of a simulation experiment presented. Issues considered include static vs. dynamic allocation of responsibility and competitive vs. cooperative intelligence.

The `natural' body, God and contraceptive use in the southeastern United States

PubMed Central

WOODSONG, CYNTHIA; SHEDLIN, MICHELE; KOO, HELEN

2011-01-01

Data collected among African-American and Caucasian women and men in the southeastern USA indicate that participants' perceptions of nature, God's will and the human body influence reproductive health and decision-making. Attitudes about the health care system, pharmaceutical companies and government programmes for fertility regulation reinforce these views and may negatively affect willingness to use contraceptive methods consistently and correctly. PMID:21972833

The Impact of Data-Driven Decision Making on Educational Practice in Louisiana Schools

ERIC Educational Resources Information Center

James-Maxie, Dana

2012-01-01

Using data to improve educational practice in schools has become a popular reform strategy that has grown as a result of the No Child Left Behind Act of 2001. Districts and schools across the United States are under a great deal of pressure to collect and analyze data in hopes of identifying student weaknesses to implement corrective action plans…

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

Virtual Rain and Stream Gauge Information Service to Support Effective Decision Making in Lower Mekong Countries

NASA Astrophysics Data System (ADS)

Basnayake, S. B.; Jayasinghe, S.; Apirumanekul, C.; Pudashine, J.; Anderson, E.; Cutter, P. G.; Ganz, D.; Towashiraporn, P.

2016-12-01

During 1995-2015, about 47% of all weather related disasters affected 2.3 billion people, and the majority (95%) of them were from Asia. About 89% of the deaths due to storms were reported in lower and middle income courtiers even though they only experienced about 26% of all storms. In most of the developing countries, decision making processes are hampered by sparse hydro-meteorological observation networks. Thus, the virtual rain and stream gauge information service is designed and developed by SERVIR-Mekong of Asian Disaster Preparedness Center (ADPC) to support effective decision making in Cambodia, Lao PDR, Myanmar, Thailand and Vietnam. The information service contains four remotely sensed data streams with regional and country specific sub setting features for easy access in limited internet bandwidths conditions. It provides rainfall data from near real time GPM IMERG (6 hours latency) with 30 minutes and 0.1X0.1 degree resolutions; TRMM daily data of 0.25X0.25 degree resolution from 1998; and CHIRPS daily data of 0.05X0.05 degree resolution since 1981 with the latency of one month. Satellite altimetry-based Jason 2 Interim Geophysical Data Record virtual stream gauge data (water body height) is provided with 12 days latency for 15 identified locations in 5 countries since 2008. To regionalize and further promote uptake of these data, TRMM monthly data has been bias corrected for Myanmar as a pilot study with spatially interpolated 18-year average (1998-2015) observed monthly rainfall data using Standard Deviation (SD) Ratio method. The results encourage to use SD ratio method for monthly bias corrections. Gamma distribution method will be tested for correcting biases of daily rainfall data with the notion that it has some limitations of capturing extreme rainfalls. The virtual rain and stream gauge information service is publically accessible through a web-based user interface hosted at SERVIR-Mekong of ADPC. Usage of the information service by partner agencies is ensured through co-development and capacity building programs. This service helps lower Mekong countries and their relevant organizations effectively use of remotely sensed data for day-to-day operations, contingency and development planning.

Viewpoint: Availability of oestrogen receptor and HER2 status for the breast multidisciplinary meeting discussion; time to get it right.

PubMed

Francis, A; Bartlett, J; Rea, D; Pinder, S E; Stein, R C; Stobart, H; Purdie, C A; Rakha, E; Thompson, A; Shaaban, A M

2016-07-01

The efficacy and pivotal role of the multidisciplinary meeting (MDM) in informed decision making is well established. It aims to provide a forum in which clinical evidence combines with individual patient data to create a personalized treatment plan. It does not fulfil this role adequately when undertaken without the full results of the patient's investigations being available. Neither doctor nor patient can make an informed decision about treatment options without knowledge of the tumour receptor status. Both targeted therapies and the aim to treat a majority of patients within clinical trials must now drive MDM decision making to be based on accuracy and best available treatment choices. A fully informed decision on treatment delayed by 1-2 weeks is clearly preferable to rushed time target-driven decisions made without the patient being offered a fully informed choice as ratified by a multidisciplinary team. Whilst the early anxiety of waiting for all relevant information to be available may be stressful for patients, not being sure that they have been offered fully informed treatment choices is also stressful and could cause longer lasting anxiety both during and after treatment. MDMs need to develop (along with targeted therapies) to retain their role as a forum whereby patients receive a correct, but specifically a full diagnosis and allow a fully informed discussion of all treatment options, including pre-operative clinical trials. Copyright © 2016 Elsevier Ltd. All rights reserved.

Deepening the quality of clinical reasoning and decision-making in rural hospital nursing practice.

PubMed

Sedgwick, M G; Grigg, L; Dersch, S

2014-01-01

Rural acute care nursing requires an extensive breadth and depth of knowledge as well as the ability to quickly reason through problems in order to make sound clinical decisions. This reasoning often occurs within an environment that has minimal medical or ancillary support. Registered nurses (RN) new to rural nursing, and employers, have raised concerns about patient safety while new nurses make the transition into rural practice. In addition, feeling unprepared for the rigors of rural hospital nursing practice is a central issue influencing RN recruitment and retention. Understanding how rural RNs reason is a key element for identifying professional development needs and may support recruitment and retention of skilled rural nurses. The purpose of this study was to explore how rural RNs reason through clinical problems as well as to assess the quality of such reasoning. This study used a non-traditional approach for data collection. Fifteen rural acute care nurses with varying years of experience working in southern Alberta, Canada, were observed while they provided care to patients of varying acuity within a simulated rural setting. Following the simulation, semi-structured interviews were conducted using a substantive approach to critical thinking. Findings revealed that the ability to engage in deep clinical reasoning varied considerably among participants despite being given the same information under the same circumstances. Furthermore, the number of years of experience did not seem to be directly linked to the ability to engage in sound clinical reasoning. Novice nurses, however, did rely heavily on others in their decision making in order to ensure they were making the right decision. Hence, their relationships with other staff members influenced their ability to engage in clinical reasoning and decision making. In situations where the patient's condition was deteriorating quickly, regardless of years of experience, all of the participants depended on their colleagues when making decisions and reasoning throughout the simulation. Deep clinical reasoning and decision making is a function of reflection and self-correction that requires a critical self-awareness and is more about how nurses think than what they think. The degree of sophistication in reasoning of experts and novices is at times equivalent in that the reasoning of experts and novices can be somewhat limited and focused primarily on human physicality and less on conceptual knowledge. To become proficient in clinical reasoning, practice is necessary. The study supports the accumulating evidence that using clinical simulation and reflective interviewing that emphasize how clinical decisions are made enhances reasoning skills and confidence.

Methodological quality of economic evaluations of new pharmaceuticals in The Netherlands.

PubMed

Hoomans, Ties; Severens, Johan L; van der Roer, Nicole; Delwel, Gepke O

2012-03-01

In the Netherlands, decisions about the reimbursement of new pharmaceuticals are based on cost effectiveness, as well as therapeutic value and budget impact. Since 1 January 2005, drug manufacturers are formally required to substantiate the cost effectiveness of drugs that have therapeutic added value in comparison with existing ones through pharmacoeconomic evaluations. Dutch guidelines for pharmacoeconomic research provide methods guidance, ensuring consistency in both the evidence and the decision-making process about drug reimbursement. This study reviewed the methodological quality of all 21 formally required pharmacoeconomic evaluations of new pharmaceuticals between 1 January 2005 and 1 October 2008, and verified whether these evaluations complied with pharmacoeconomic guidelines. Data on the quality of the pharmacoeconomic evaluations were extracted from the pharmacoeconomic reports published by the Dutch Health Care Insurance Board (CVZ). The Board's newsletters provided information on the advice to, and reimbursement decisions made by, the Dutch Minister of Health. All data extraction was carried out by two independent reviewers, and descriptive analyses were conducted. The methodological quality was sound in only 8 of the 21 pharmacoeconomic evaluations. In most cases, the perspective of analysis, the comparator drugs, and the reporting of both total and incremental costs and effects were correct. However, drug indication, form (i.e. cost utility/cost effectiveness) and time horizon of the evaluations were frequently flawed. Moreover, the costs and effects of the pharmaceuticals were not always analysed correctly, and modelling studies were often non-transparent. Twelve drugs were reimbursed, and nine were not. The compliance with pharmacoeconomic guidelines in economic evaluations of new pharmaceuticals can be improved. This would improve the methodological quality of the pharmacoeconomic evaluations and ensure consistency in the evidence and the decision-making process for drug reimbursement in the Netherlands.

Compete, coordinate, and cooperate: How to exploit uncertain environments with social interaction.

PubMed

Schulze, Christin; Newell, Ben R

2015-10-01

Countless decisions, from the trivial to the crucial, are made in complex social contexts while facing uncertain consequences. Yet a large portion of decision making research focuses on either the effects of social interaction or the effects of environmental uncertainty by examining strategic games against others or individual games against nature. Drawing a connection between these approaches, the authors extend a standard individual choice paradigm to include social interaction with 1 other person. In this paradigm, 2 competing decision makers repeatedly select among 2 options, each offering a particular probability of a fixed payoff. When both players choose the same, correct option, the payoff is evenly split; when they choose different options, the player choosing the correct option receives the full payoff. The addition of this social dimension gives players an opportunity to fully exploit an uncertain environment via cooperation: By consistently choosing opposite options, two players can exploit the uncertain environment more effectively than a single player could. We present 2 experiments that manipulate environmental (Experiment 1) and social (Experiment 2) aspects of the paradigm. In Experiment 1, the outcome probabilities were either known or unknown to participants; in Experiment 2, participants' attention was drawn to individual or group gains by introducing either within- or between-group competition. Efficient cooperation did not emerge spontaneously in Experiment 1. Instead, most people probability maximized, mirroring the behavior observed in individual choice. By contrast, between--group competition in Experiment 2 facilitated efficient-but not always equitable--exploitation of uncertain environments. This work links the concepts of individual risky choice and strategic decision making under both environmental and social uncertainty. (c) 2015 APA, all rights reserved).

Aversion to ambiguity and willingness to take risks affect therapeutic decisions in managing atrial fibrillation for stroke prevention: results of a pilot study in family physicians.

PubMed

Raptis, Stavroula; Chen, Jia Ning; Saposnik, Florencia; Pelyavskyy, Roman; Liuni, Andrew; Saposnik, Gustavo

2017-01-01

Anticoagulation is the therapeutic paradigm for stroke prevention in patients with atrial fibrillation (AF). It is unknown how physicians make treatment decisions in primary stroke prevention for patients with AF. To evaluate the association between family physicians' risk preferences (aversion risk and ambiguity) and therapeutic recommendations (anticoagulation) in the management of AF for primary stroke prevention by applying concepts from behavioral economics. Overall, 73 family physicians participated and completed the study. Our study comprised seven simulated case vignettes, three behavioral experiments, and two validated surveys. Behavioral experiments and surveys incorporated an economic framework to determine risk preferences and biases (e.g., ambiguity aversion, willingness to take risks). The primary outcome was making the correct decision of anticoagulation therapy. Secondary outcomes included medical errors in the management of AF for stroke prevention. Overall, 23.3% (17/73) of the family physicians elected not to escalate the therapy from antiplatelets to anticoagulation when recommended by best practice guidelines. A total of 67.1% of physicians selected the correct therapeutic options in two or more of the three simulated case vignettes. Multivariate analysis showed that aversion to ambiguity was associated with appropriate change to anticoagulation therapy in the management of AF (OR 5.48, 95% CI 1.08-27.85). Physicians' willingness to take individual risk in multiple domains was associated with lower errors (OR 0.16, 95% CI 0.03-0.86). Physicians' aversion to ambiguity and willingness to take risks are associated with appropriate therapeutic decisions in the management of AF for primary stroke prevention. Further large scale studies are needed.

Aversion to ambiguity and willingness to take risks affect therapeutic decisions in managing atrial fibrillation for stroke prevention: results of a pilot study in family physicians

PubMed Central

Saposnik, Florencia; Pelyavskyy, Roman; Liuni, Andrew; Saposnik, Gustavo

2017-01-01

Background Anticoagulation is the therapeutic paradigm for stroke prevention in patients with atrial fibrillation (AF). It is unknown how physicians make treatment decisions in primary stroke prevention for patients with AF. Objectives To evaluate the association between family physicians’ risk preferences (aversion risk and ambiguity) and therapeutic recommendations (anticoagulation) in the management of AF for primary stroke prevention by applying concepts from behavioral economics. Methods Overall, 73 family physicians participated and completed the study. Our study comprised seven simulated case vignettes, three behavioral experiments, and two validated surveys. Behavioral experiments and surveys incorporated an economic framework to determine risk preferences and biases (e.g., ambiguity aversion, willingness to take risks). The primary outcome was making the correct decision of anticoagulation therapy. Secondary outcomes included medical errors in the management of AF for stroke prevention. Results Overall, 23.3% (17/73) of the family physicians elected not to escalate the therapy from antiplatelets to anticoagulation when recommended by best practice guidelines. A total of 67.1% of physicians selected the correct therapeutic options in two or more of the three simulated case vignettes. Multivariate analysis showed that aversion to ambiguity was associated with appropriate change to anticoagulation therapy in the management of AF (OR 5.48, 95% CI 1.08–27.85). Physicians’ willingness to take individual risk in multiple domains was associated with lower errors (OR 0.16, 95% CI 0.03–0.86). Conclusion Physicians’ aversion to ambiguity and willingness to take risks are associated with appropriate therapeutic decisions in the management of AF for primary stroke prevention. Further large scale studies are needed. PMID:28979101

Cognitive determinants of affective forecasting errors

PubMed Central

Hoerger, Michael; Quirk, Stuart W.; Lucas, Richard E.; Carr, Thomas H.

2011-01-01

Often to the detriment of human decision making, people are prone to an impact bias when making affective forecasts, overestimating the emotional consequences of future events. The cognitive processes underlying the impact bias, and methods for correcting it, have been debated and warrant further exploration. In the present investigation, we examined both individual differences and contextual variables associated with cognitive processing in affective forecasting for an election. Results showed that the perceived importance of the event and working memory capacity were both associated with an increased impact bias for some participants, whereas retrieval interference had no relationship with bias. Additionally, an experimental manipulation effectively reduced biased forecasts, particularly among participants who were most distracted thinking about peripheral life events. These findings have direct theoretical implications for understanding the impact bias, highlight the importance of individual differences in affective forecasting, and have ramifications for future decision making research. The possible functional role of the impact bias is discussed within the context of evolutionary psychology. PMID:21912580

Risky decisions and their consequences: neural processing by boys with Antisocial Substance Disorder.

PubMed

Crowley, Thomas J; Dalwani, Manish S; Mikulich-Gilbertson, Susan K; Du, Yiping P; Lejuez, Carl W; Raymond, Kristen M; Banich, Marie T

2010-09-22

Adolescents with conduct and substance problems ("Antisocial Substance Disorder" (ASD)) repeatedly engage in risky antisocial and drug-using behaviors. We hypothesized that, during processing of risky decisions and resulting rewards and punishments, brain activation would differ between abstinent ASD boys and comparison boys. We compared 20 abstinent adolescent male patients in treatment for ASD with 20 community controls, examining rapid event-related blood-oxygen-level-dependent (BOLD) responses during functional magnetic resonance imaging. In 90 decision trials participants chose to make either a cautious response that earned one cent, or a risky response that would either gain 5 cents or lose 10 cents; odds of losing increased as the game progressed. We also examined those times when subjects experienced wins, or separately losses, from their risky choices. We contrasted decision trials against very similar comparison trials requiring no decisions, using whole-brain BOLD-response analyses of group differences, corrected for multiple comparisons. During decision-making ASD boys showed hypoactivation in numerous brain regions robustly activated by controls, including orbitofrontal and dorsolateral prefrontal cortices, anterior cingulate, basal ganglia, insula, amygdala, hippocampus, and cerebellum. While experiencing wins, ASD boys had significantly less activity than controls in anterior cingulate, temporal regions, and cerebellum, with more activity nowhere. During losses ASD boys had significantly more activity than controls in orbitofrontal cortex, dorsolateral prefrontal cortex, brain stem, and cerebellum, with less activity nowhere. Adolescent boys with ASD had extensive neural hypoactivity during risky decision-making, coupled with decreased activity during reward and increased activity during loss. These neural patterns may underlie the dangerous, excessive, sustained risk-taking of such boys. The findings suggest that the dysphoria, reward insensitivity, and suppressed neural activity observed among older addicted persons also characterize youths early in the development of substance use disorders.

A recurrent network mechanism of time integration in perceptual decisions.

PubMed

Wong, Kong-Fatt; Wang, Xiao-Jing

2006-01-25

Recent physiological studies using behaving monkeys revealed that, in a two-alternative forced-choice visual motion discrimination task, reaction time was correlated with ramping of spike activity of lateral intraparietal cortical neurons. The ramping activity appears to reflect temporal accumulation, on a timescale of hundreds of milliseconds, of sensory evidence before a decision is reached. To elucidate the cellular and circuit basis of such integration times, we developed and investigated a simplified two-variable version of a biophysically realistic cortical network model of decision making. In this model, slow time integration can be achieved robustly if excitatory reverberation is primarily mediated by NMDA receptors; our model with only fast AMPA receptors at recurrent synapses produces decision times that are not comparable with experimental observations. Moreover, we found two distinct modes of network behavior, in which decision computation by winner-take-all competition is instantiated with or without attractor states for working memory. Decision process is closely linked to the local dynamics, in the "decision space" of the system, in the vicinity of an unstable saddle steady state that separates the basins of attraction for the two alternative choices. This picture provides a rigorous and quantitative explanation for the dependence of performance and response time on the degree of task difficulty, and the reason for which reaction times are longer in error trials than in correct trials as observed in the monkey experiment. Our reduced two-variable neural model offers a simple yet biophysically plausible framework for studying perceptual decision making in general.

Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study

PubMed Central

Meyer, Brett C.; Raman, Rema; Hemmen, Thomas; Obler, Richard; Zivin, Justin A.; Rao, Ramesh; Thomas, Ronald G.; Lyden, Patrick D.

2009-01-01

Background To increase effective use of rt-PA for acute stroke, vascular neurology expertise must be disseminated more widely. We prospectively assessed whether telemedicine (real-time, 2 way audio/video and DICOM interpretation) or telephone was superior for decision-making in acute telemedicine consultations. Methods Acute stroke patients were randomized to telemedicine or telephone consultation. Primary outcome measure was whether the thrombolytic treatment decision was correct, as determined by central adjudication. Secondary outcomes included rt-PA use-rate, 90 day functional outcomes, hemorrhages, and technical observations. Findings Two hundred thirty-four patients were prospectively evaluated. Mean NIHSS score was 9.5 (11.4±8.7 telemedicine, 7.7±7.0 telephone; p=0.0020). One telemedicine consult (0.9%) was aborted for technical reasons, though was included in intention-to-treat analyses. Correct treatment decision was made more often in telemedicine (98.2% telemedicine, 82% telephone; OR 10.9; 95%CI 2.7-44.6; p=0.0009). IV rt-PA use-rate was 25% (28% telemedicine, 23% telephone; OR 1.3; 95%CI 0.7-2.5; p=0.4248). Ninety day functional outcomes were not different for BI(95–100) (OR 0.6; 95%CI 0.4-1.1; p=0.1268) or for mRS (OR 0.6; 95%CI 0.3-1.1; p=0.0898). There was no mortality difference (OR 1.6; 95%CI 0.8-3.4; p=0.2690). Post-rt-PA ICH rates were not different (7% telemedicine, 8% telephone; OR 0.8; 95%CI 0.1-6.3; p=1.0). There was a difference noted for amount of non-completed data (3.1% telemedicine, 12.0% telephone; OR 0.2; 95%CI 0.1-0.3; p<0.001). Interpretation This trial reports that stroke telemedicine consultations result in more accurate decision making, compared to telephone, and can serve as a model for the effective use of telemedicine in other medical fields. The more appropriate decisions, high rt-PA userates, improved data collection, low ICH rates, low technical complications, and favorable time requirements all support telemedicine’s efficacy, most specifically for decision-making, and may enable more practitioners to use telemedicine in daily stroke care. PMID:18676180

Prestimulus alpha power predicts fidelity of sensory encoding in perceptual decision making.

PubMed

Lou, Bin; Li, Yun; Philiastides, Marios G; Sajda, Paul

2014-02-15

Pre-stimulus α power has been shown to correlate with the behavioral accuracy of perceptual decisions. In most cases, these correlations have been observed by comparing α power for different behavioral outcomes (e.g. correct vs incorrect trials). In this paper we investigate such covariation within the context of behaviorally-latent fluctuations in task-relevant post-stimulus neural activity. Specially we consider variations of pre-stimulus α power with post-stimulus EEG components in a two alternative forced choice visual discrimination task. EEG components, discriminative of stimulus class, are identified using a linear multivariate classifier and only the variability of the components for correct trials (regardless of stimulus class, and for nominally identical stimuli) are correlated with the corresponding pre-stimulus α power. We find a significant relationship between the mean and variance of the pre-stimulus α power and the variation of the trial-to-trial magnitude of an early post-stimulus EEG component. This relationship is not seen for a later EEG component that is also discriminative of stimulus class and which has been previously linked to the quality of evidence driving the decision process. Our results suggest that early perceptual representations, rather than temporally later neural correlates of the perceptual decision, are modulated by pre-stimulus state. © 2013 Elsevier Inc. All rights reserved.

Prestimulus alpha power predicts fidelity of sensory encoding in perceptual decision making

PubMed Central

Lou, Bin; Li, Yun; Philiastides, Marios G.; Sajda, Paul

2013-01-01

Pre-stimulus α power has been shown to correlate with the behavioral accuracy of perceptual decisions. In most cases, these correlations have been observed by comparing α power for different behavioral outcomes (e.g. correct vs incorrect trials). In this paper we investigate such covariation within the context of behaviorally-latent fluctuations in task-relevant post-stimulus neural activity. Specially we consider variations of pre-stimulus α power with post-stimulus EEG components in a two alternative forced choice visual discrimination task. EEG components, discriminative of stimulus class, are identified using a linear multivariate classifier and only the variability of the components for correct trials (regardless of stimulus class, and for nominally identical stimuli) are correlated with the corresponding pre-stimulus α power. We find a significant relationship between the mean and variance of the pre-stimulus α power and the variation of the trial-to-trial magnitude of an early post-stimulus EEG component. This relationship is not seen for a later EEG component that is also discriminative of stimulus class and which has been previously linked to the quality of evidence driving the decision process. Our results suggest that early perceptual representations, rather than temporally later neural correlates of the perceptual decision, are modulated by pre-stimulus state. PMID:24185020

Development and pilot testing of an online case-based approach to shared decision making skills training for clinicians.

PubMed

Volk, Robert J; Shokar, Navkiran K; Leal, Viola B; Bulik, Robert J; Linder, Suzanne K; Mullen, Patricia Dolan; Wexler, Richard M; Shokar, Gurjeet S

2014-11-01

Although research suggests that patients prefer a shared decision making (SDM) experience when making healthcare decisions, clinicians do not routinely implement SDM into their practice and training programs are needed. Using a novel case-based strategy, we developed and pilot tested an online educational program to promote shared decision making (SDM) by primary care clinicians. A three-phased approach was used: 1) development of a conceptual model of the SDM process; 2) development of an online teaching case utilizing the Design A Case (DAC) authoring template, a well-tested process used to create peer-reviewed web-based clinical cases across all levels of healthcare training; and 3) pilot testing of the case. Participants were clinician members affiliated with several primary care research networks across the United States who answered an invitation email. The case used prostate cancer screening as the clinical context and was delivered online. Post-intervention ratings of clinicians' general knowledge of SDM, knowledge of specific SDM steps, confidence in and intention to perform SDM steps were also collected online. Seventy-nine clinicians initially volunteered to participate in the study, of which 49 completed the case and provided evaluations. Forty-three clinicians (87.8%) reported the case met all the learning objectives, and 47 (95.9%) indicated the case was relevant for other equipoise decisions. Thirty-one clinicians (63.3%) accessed supplementary information via links provided in the case. After viewing the case, knowledge of SDM was high (over 90% correctly identified the steps in a SDM process). Determining a patient's preferred role in making the decision (62.5% very confident) and exploring a patient's values (65.3% very confident) about the decisions were areas where clinician confidence was lowest. More than 70% of the clinicians intended to perform SDM in the future. A comprehensive model of the SDM process was used to design a case-based approach to teaching SDM skills to primary care clinicians. The case was favorably rated in this pilot study. Clinician skills training for helping patients clarify their values and for assessing patients' desire for involvement in decision making remain significant challenges and should be a focus of future comparative studies.

Involvement of Rabbinic and communal authorities in decision-making by haredi Jews in the UK with breast cancer: an interpretative phenomenological analysis.

PubMed

Coleman-Brueckheimer, Kate; Spitzer, Joseph; Koffman, Jonathan

2009-01-01

This paper examines how Rabbinic and communal authorities participated in treatment decisions made by a group of strictly orthodox haredi Jews with breast cancer living in London. Semi-structured interviews were conducted with five haredi breast cancer patients. The transcripts were analysed using interpretative phenomenological analysis. Demographic and personal data were collected using structured questionnaires. All participants sought Rabbinic involvement, with four seeking rulings concerning religious rituals and treatment options. Participants' motivations were to ensure their actions accorded with Jewish law and hence God's will. By delegating treatment decisions, decision-making became easier and participants could avoid guilt and blame. They could actively participate in the process by choosing which Rabbi to approach, by providing personal information and by stating their preferences. Attitudes towards Rabbinic involvement were occasionally conflicted. This was related to the understanding that Rabbinic rulings were binding, and occasional doubts that their situation would be correctly interpreted. Three participants consulted the community's 'culture broker' for medical referrals and non-binding advice concerning treatment. Those who consulted the culture broker had to transcend social norms restricting unnecessary contact between men and women. Hence, some participants described talking to him as uncomfortable. Other concerns related to confidentiality. By consulting Rabbinic authorities, haredi cancer patients participated in a socially sanctioned method of decision-making continuous with their religious values. Imposing meaning on their illness in this way may be associated with positive psychological adjustment. Rabbinic and communal figures may endorse therapeutic recommendations and make religious and cultural issues comprehensible to clinicians, and as such healthcare practitioners may benefit from this involvement.

Three-dimensional-printed cardiac prototypes aid surgical decision-making and preoperative planning in selected cases of complex congenital heart diseases: Early experience and proof of concept in a resource-limited environment.

PubMed

Kappanayil, Mahesh; Koneti, Nageshwara Rao; Kannan, Rajesh R; Kottayil, Brijesh P; Kumar, Krishna

2017-01-01

Three-dimensional. (3D) printing is an innovative manufacturing process that allows computer-assisted conversion of 3D imaging data into physical "printouts" Healthcare applications are currently in evolution. The objective of this study was to explore the feasibility and impact of using patient-specific 3D-printed cardiac prototypes derived from high-resolution medical imaging data (cardiac magnetic resonance imaging/computed tomography [MRI/CT]) on surgical decision-making and preoperative planning in selected cases of complex congenital heart diseases (CHDs). Five patients with complex CHD with previously unresolved management decisions were chosen. These included two patients with complex double-outlet right ventricle, two patients with criss-cross atrioventricular connections, and one patient with congenitally corrected transposition of great arteries with pulmonary atresia. Cardiac MRI was done for all patients, cardiac CT for one; specific surgical challenges were identified. Volumetric data were used to generate patient-specific 3D models. All cases were reviewed along with their 3D models, and the impact on surgical decision-making and preoperative planning was assessed. Accurate life-sized 3D cardiac prototypes were successfully created for all patients. The models enabled radically improved 3D understanding of anatomy, identification of specific technical challenges, and precise surgical planning. Augmentation of existing clinical and imaging data by 3D prototypes allowed successful execution of complex surgeries for all five patients, in accordance with the preoperative planning. 3D-printed cardiac prototypes can radically assist decision-making, planning, and safe execution of complex congenital heart surgery by improving understanding of 3D anatomy and allowing anticipation of technical challenges.

Evaluating Fidelity to a Modified NIATx Process Improvement Strategy for Improving HIV Services in Correctional Facilities.

PubMed

Pankow, Jennifer; Willett, Jennifer; Yang, Yang; Swan, Holly; Dembo, Richard; Burdon, William M; Patterson, Yvonne; Pearson, Frank S; Belenko, Steven; Frisman, Linda K

2018-04-01

In a study aimed at improving the quality of HIV services for inmates, an organizational process improvement strategy using change teams was tested in 14 correctional facilities in 8 US states and Puerto Rico. Data to examine fidelity to the process improvement strategy consisted of quantitative ratings of the structural and process components of the strategy and qualitative notes that explicate challenges in maintaining fidelity to the strategy. Fidelity challenges included (1) lack of communication and leadership within change teams, (2) instability in team membership, and (3) issues with data utilization in decision-making to implement improvements to services delivery.

Achieving realistic performance and decison-making capabilities in computer-generated air forces

NASA Astrophysics Data System (ADS)

Banks, Sheila B.; Stytz, Martin R.; Santos, Eugene, Jr.; Zurita, Vincent B.; Benslay, James L., Jr.

1997-07-01

For a computer-generated force (CGF) system to be useful in training environments, it must be able to operate at multiple skill levels, exhibit competency at assigned missions, and comply with current doctrine. Because of the rapid rate of change in distributed interactive simulation (DIS) and the expanding set of performance objectives for any computer- generated force, the system must also be modifiable at reasonable cost and incorporate mechanisms for learning. Therefore, CGF applications must have adaptable decision mechanisms and behaviors and perform automated incorporation of past reasoning and experience into its decision process. The CGF must also possess multiple skill levels for classes of entities, gracefully degrade its reasoning capability in response to system stress, possess an expandable modular knowledge structure, and perform adaptive mission planning. Furthermore, correctly performing individual entity behaviors is not sufficient. Issues related to complex inter-entity behavioral interactions, such as the need to maintain formation and share information, must also be considered. The CGF must also be able to acceptably respond to unforeseen circumstances and be able to make decisions in spite of uncertain information. Because of the need for increased complexity in the virtual battlespace, the CGF should exhibit complex, realistic behavior patterns within the battlespace. To achieve these necessary capabilities, an extensible software architecture, an expandable knowledge base, and an adaptable decision making mechanism are required. Our lab has addressed these issues in detail. The resulting DIS-compliant system is called the automated wingman (AW). The AW is based on fuzzy logic, the common object database (CODB) software architecture, and a hierarchical knowledge structure. We describe the techniques we used to enable us to make progress toward a CGF entity that satisfies the requirements presented above. We present our design and implementation of an adaptable decision making mechanism that uses multi-layered, fuzzy logic controlled situational analysis. Because our research indicates that fuzzy logic can perform poorly under certain circumstances, we combine fuzzy logic inferencing with adversarial game tree techniques for decision making in strategic and tactical engagements. We describe the approach we employed to achieve this fusion. We also describe the automated wingman's system architecture and knowledge base architecture.

Improving nurses' knowledge of continuous ST-segment monitoring.

PubMed

Chronister, Connie

2014-01-01

Continuous ST-segment monitoring can result in detection of myocardial ischemia, but in clinical practice, continuous ST-segment monitoring is conducted incorrectly and underused by many registered nurses (RNs). Many RNs are unable to correctly institute ST-segment monitoring guidelines because of a lack of education. To evaluate whether an educational intervention, provided to 32 RNs, increases knowledge and correct clinical decision making (CDM) for the use of continuous ST-segment monitoring. At a single institution, an ST-segment monitoring class was provided to RNs in 2 cardiovascular units. Knowledge and correct CDM instruments were used for a baseline pretest and subsequent posttest after ST-segment monitoring education. Statistical significance between pretest and posttest scores for knowledge and correct CDM practice was noted with dependent t tests (P = .0001). Many RNs responsible for electrocardiographic monitoring are not aware of evidence-based ST-segment monitoring practice guidelines and cannot properly place precordial leads needed for ST-segment monitoring. Knowledge and correct CDM with ST-segment monitoring can be improved with focused education.

Army General Fund Adjustments Not Adequately Documented or Supported

DTIC Science & Technology

2016-07-26

compilation process. Finding The Office of the Assistant Secretary of the Army (Financial Management & Comptroller) (OASA[FM&C]) and the Defense Finance and...statements were unreliable and lacked an adequate audit trail. Furthermore, DoD and Army managers could not rely on the data in their accounting...systems when making management and resource decisions. Until the Army and DFAS Indianapolis correct these control deficiencies, there is considerable

Comments on localized and integral localized approximations in spherical coordinates

NASA Astrophysics Data System (ADS)

Gouesbet, Gérard; Lock, James A.

2016-08-01

Localized approximation procedures are efficient ways to evaluate beam shape coefficients of laser beams, and are particularly useful when other methods are ineffective or inefficient. Comments on these procedures are, however, required in order to help researchers make correct decisions concerning their use. This paper has the flavor of a short review and takes the opportunity to attract the attention of the readers to a required refinement of terminology.

China Report Economic Affairs No. 348.

DTIC Science & Technology

1983-06-08

four modernizations in the country , which urge us, on the premise of steadily upgrading economic returns and on the basis of the 1980 figure, to...with foreign countries . In line with the history of economic development, the current situation and future trends, we have made estimations on the...to correctly handle the relation between the achievements in labour and the benefits of staff and workers; to expand the decision-making power of

Older driver failures of attention at intersections: using change blindness methods to assess turn decision accuracy.

PubMed

Caird, Jeff K; Edwards, Christopher J; Creaser, Janet I; Horrey, William J

2005-01-01

A modified version of the flicker technique to induce change blindness was used to examine the effects of time constraints on decision-making accuracy at intersections on a total of 62 young (18-25 years), middle-aged (26-64 years), young-old (65-73 years), and old-old (74+ years) drivers. Thirty-six intersection photographs were manipulated so that one object (i.e., pedestrian, vehicle, sign, or traffic control device) in the scene would change when the images were alternated for either 5 or 8 s using the modified flicker method. Young and middle-aged drivers made significantly more correct decisions than did young-old and old-old drivers. Logistic regression analysis of the data indicated that age and/or time were significant predictors of decision performance in 14 of the 36 intersections. Actual or potential applications of this research include driving assessment and crash investigation.

Some comments on clinical studies in orthodontics and their applications to orthodontic treatment.

PubMed

Baumrind, S

1999-06-01

This article indicates the origins and background of the current series of National Institute of Dental and Craniofacial Research-funded, university-based clinical studies of orthodontic treatment. It suggests that future studies should be less focused on refining our estimates of mean changes during treatment and concentrate research on the systematic analysis of individual differences among patients' responses to treatment, and study how skilled clinicians make in-course corrections in response to unexpected changes in treatment conditions. Finally, some suggestions are made concerning optimization of decision making in the presence of uncertainty.

Effective information management and assurance for a modern organisation during a crisis.

PubMed

MacLeod, Andrew

2015-01-01

During a crisis, organisations face a major unpredictable event with potentially negative consequences. Effective information management and assurance can assist the organisation in making sure that they have the correct information in a secure format to make decisions to recover their operations. The main elements of effective information management and assurance are confidentiality, integrity and availability, combined with non-repudiation. Should an element of effective information management or assurance be removed it can have a detrimental effect on the other elements and render the information management and assurance practices of the organisation ineffectual.

Learning the wrong lessons? Science and fisheries management in the Chesapeake Bay blue crab fishery.

PubMed

Beem, Betsi

2012-05-01

This paper argues that information produced and then taken up for policy decision making is a function of a complex interplay within the scientific community and between scientists and the broader policy network who are all grappling with issues in a complex environment with a high degree of scientific uncertainty. The dynamics of forming and re-forming the scientific community are shaped by political processes, as are the directions and questions scientists attend to in their roles as policy advisors. Three factors: 1) social construction of scientific communities, 2) the indeterminacy of science, and 3) demands by policy makers to have concrete information for decision making; are intertwined in the production and dissemination of information that may serve as the basis for policy learning. Through this process, however, what gets learned may not be what is needed to mitigate the problem, be complete in terms of addressing multiple causations, or be correct.

Evolving neural networks for strategic decision-making problems.

PubMed

Kohl, Nate; Miikkulainen, Risto

2009-04-01

Evolution of neural networks, or neuroevolution, has been a successful approach to many low-level control problems such as pole balancing, vehicle control, and collision warning. However, certain types of problems-such as those involving strategic decision-making-have remained difficult for neuroevolution to solve. This paper evaluates the hypothesis that such problems are difficult because they are fractured: The correct action varies discontinuously as the agent moves from state to state. A method for measuring fracture using the concept of function variation is proposed and, based on this concept, two methods for dealing with fracture are examined: neurons with local receptive fields, and refinement based on a cascaded network architecture. Experiments in several benchmark domains are performed to evaluate how different levels of fracture affect the performance of neuroevolution methods, demonstrating that these two modifications improve performance significantly. These results form a promising starting point for expanding neuroevolution to strategic tasks.

Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset.

PubMed

Roehle, Robert; Wieske, Viktoria; Schuetz, Georg M; Gueret, Pascal; Andreini, Daniele; Meijboom, Willem Bob; Pontone, Gianluca; Garcia, Mario; Alkadhi, Hatem; Honoris, Lily; Hausleiter, Jörg; Bettencourt, Nuno; Zimmermann, Elke; Leschka, Sebastian; Gerber, Bernhard; Rochitte, Carlos; Schoepf, U Joseph; Shabestari, Abbas Arjmand; Nørgaard, Bjarne; Sato, Akira; Knuuti, Juhani; Meijs, Matthijs F L; Brodoefel, Harald; Jenkins, Shona M M; Øvrehus, Kristian Altern; Diederichsen, Axel Cosmus Pyndt; Hamdan, Ashraf; Halvorsen, Bjørn Arild; Mendoza Rodriguez, Vladimir; Wan, Yung Liang; Rixe, Johannes; Sheikh, Mehraj; Langer, Christoph; Ghostine, Said; Martuscelli, Eugenio; Niinuma, Hiroyuki; Scholte, Arthur; Nikolaou, Konstantin; Ulimoen, Geir; Zhang, Zhaoqi; Mickley, Hans; Nieman, Koen; Kaufmann, Philipp A; Buechel, Ronny Ralf; Herzog, Bernhard A; Clouse, Melvin; Halon, David A; Leipsic, Jonathan; Bush, David; Jakamy, Reda; Sun, Kai; Yang, Lin; Johnson, Thorsten; Laissy, Jean-Pierre; Marcus, Roy; Muraglia, Simone; Tardif, Jean-Claude; Chow, Benjamin; Paul, Narinder; Maintz, David; Hoe, John; de Roos, Albert; Haase, Robert; Laule, Michael; Schlattmann, Peter; Dewey, Marc

2018-03-19

To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset. The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT). 4,673 individual patient data from the CoMe-CCT Consortium were analysed. Major differences in definitions in the Duke clinical score and NICE guideline were found for the predictors age and number of risk factors. Pretest probability calculation using guideline criteria was only possible for 30.8 % (1,439/4,673) of patients despite availability of all required data due to ambiguity in guideline definitions for risk factors and age groups. Agreement regarding patient management groups was found in only 70 % (366/523) of patients in whom pretest probability calculation was possible according to both models. Our results suggest that pretest probability calculation for clinical decision making about cardiac imaging as implemented in the NICE clinical guideline for patients has relevant limitations. • Duke clinical score is not implemented correctly in NICE guideline 95. • Pretest probability assessment in NICE guideline 95 is impossible for most patients. • Improved clinical decision making requires accurate pretest probability calculation. • These refinements are essential for appropriate use of cardiac CT.

Decision making under uncertainty: a quasimetric approach.

PubMed

N'Guyen, Steve; Moulin-Frier, Clément; Droulez, Jacques

2013-01-01

We propose a new approach for solving a class of discrete decision making problems under uncertainty with positive cost. This issue concerns multiple and diverse fields such as engineering, economics, artificial intelligence, cognitive science and many others. Basically, an agent has to choose a single or series of actions from a set of options, without knowing for sure their consequences. Schematically, two main approaches have been followed: either the agent learns which option is the correct one to choose in a given situation by trial and error, or the agent already has some knowledge on the possible consequences of his decisions; this knowledge being generally expressed as a conditional probability distribution. In the latter case, several optimal or suboptimal methods have been proposed to exploit this uncertain knowledge in various contexts. In this work, we propose following a different approach, based on the geometric intuition of distance. More precisely, we define a goal independent quasimetric structure on the state space, taking into account both cost function and transition probability. We then compare precision and computation time with classical approaches.

Empowerment: A fundamental tenet of risk communication and the Nimby syndrome

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

Stevens, A.D.

1995-12-01

Why do people want to be involved in decisions that have the potential to affect their community? Why not-wouldn`t you? The answer seems to obvious that it makes the question appear naive and trite. Yet, for years, government agencies and corporations have behaved in a manner that assumed the correctness of decisions and forced local residents to prove a right to be heard and to fight for the courtesy of respect. To the surprise and growing irritation of organization officials, the degree of trust and acceptance residents have for organizational pronouncements and activities has eroded into a seemingly intractable impediment.more » Given this environment, it is significant that two veins of social science research, risk communication and rhetorical theroy analyzing the Not-In-My-Back Yard (NIMBY) Phenomenon, are converging to the same point. Both approaches are finding that citizen empowerment--the legitimate intellectual sovereignty and meaningful involvement of individuals in decision making processes--is essential to the success of either type of communicative interaction. An appropriate context must precede the content in risk dialogue.« less

Performance and process in collective and individual memory: the role of social decision schemes and memory bias in collective memory.

PubMed

Van Swol, Lyn M

2008-04-01

To assess performance and processes in collective and individual memory, participants watched two job candidates on video. Beforehand, half the participants were told they would be tested on their memory of the interviews, and the other half were asked to make a decision to hire one of the candidates. Afterwards, participants completed a recognition memory task in either a group or individual condition. Groups had better recognition memory than individuals. Individuals made more false positives than false negatives and groups exaggerated this. Post-hoc analysis found that groups only exaggerated the tendency towards false positives on items that reflected negatively on the job candidate. There was no significant difference between instruction conditions. When reaching consensus on the recognition task, groups tended to choose the correct answer if at least two members had the correct answer. This method of consensus is discussed as a factor in groups' superior memory performance.

Integrated Bayesian models of learning and decision making for saccadic eye movements.

PubMed

Brodersen, Kay H; Penny, Will D; Harrison, Lee M; Daunizeau, Jean; Ruff, Christian C; Duzel, Emrah; Friston, Karl J; Stephan, Klaas E

2008-11-01

The neurophysiology of eye movements has been studied extensively, and several computational models have been proposed for decision-making processes that underlie the generation of eye movements towards a visual stimulus in a situation of uncertainty. One class of models, known as linear rise-to-threshold models, provides an economical, yet broadly applicable, explanation for the observed variability in the latency between the onset of a peripheral visual target and the saccade towards it. So far, however, these models do not account for the dynamics of learning across a sequence of stimuli, and they do not apply to situations in which subjects are exposed to events with conditional probabilities. In this methodological paper, we extend the class of linear rise-to-threshold models to address these limitations. Specifically, we reformulate previous models in terms of a generative, hierarchical model, by combining two separate sub-models that account for the interplay between learning of target locations across trials and the decision-making process within trials. We derive a maximum-likelihood scheme for parameter estimation as well as model comparison on the basis of log likelihood ratios. The utility of the integrated model is demonstrated by applying it to empirical saccade data acquired from three healthy subjects. Model comparison is used (i) to show that eye movements do not only reflect marginal but also conditional probabilities of target locations, and (ii) to reveal subject-specific learning profiles over trials. These individual learning profiles are sufficiently distinct that test samples can be successfully mapped onto the correct subject by a naïve Bayes classifier. Altogether, our approach extends the class of linear rise-to-threshold models of saccadic decision making, overcomes some of their previous limitations, and enables statistical inference both about learning of target locations across trials and the decision-making process within trials.

Peripheral Serotonin 1B Receptor Transcription Predicts the Effect of Acute Tryptophan Depletion on Risky Decision-Making.

PubMed

Faulkner, Paul; Mancinelli, Federico; Lockwood, Patricia L; Matarin, Mar; Dolan, Raymond J; Wood, Nick W; Dayan, Peter; Roiser, Jonathan P

2017-01-01

The effects of acute tryptophan depletion on human decision-making suggest that serotonin modulates the processing of rewards and punishments. However, few studies have assessed which of the many types of serotonin receptors are responsible. Using a within-subject, double-blind, sham-controlled design in 26 subjects, we examined whether individual differences in serotonin system gene transcription, measured in peripheral blood, predicted the effect of acute tryptophan depletion on decision-making. Participants performed a task in which they chose between successive pairs of fixed, lower-stakes (control) and variable, higher-stakes (experimental) gambles, each involving wins or losses. In 21 participants, mRNA from 9 serotonin system genes was measured in whole blood prior to acute tryptophan depletion: 5-HT1B, 5-HT1F, 5-HT2A, 5-HT2B, 5-HT3A, 5-HT3E, 5-HT7 (serotonin receptors), 5-HTT (the serotonin transporter), and tryptophan hydroxylase 1. Acute tryptophan depletion did not significantly influence participants' sensitivity to probability, wins, or losses, although there was a trend for a lower tendency to choose experimental gambles overall following depletion. Significant positive correlations, which survived correction for multiple comparisons, were detected between baseline 5-HT1B mRNA levels and acute tryptophan depletion-induced increases in both the overall tendency to choose the experimental gamble and sensitivity to wins. No significant relationship was observed with any other peripheral serotonin system markers. Computational analyses of decision-making data provided results consistent with these findings. These results suggest that the 5-HT1B receptor may modulate the effects of acute tryptophan depletion on risky decision-making. Peripheral levels of serotonin markers may predict response to treatments that act upon the serotonin system, such as selective serotonin reuptake inhibitors. © The Author 2016. Published by Oxford University Press on behalf of CINP.

A pathway linking reward circuitry, impulsive sensation-seeking and risky decision-making in young adults: identifying neural markers for new interventions

PubMed Central

Chase, H W; Fournier, J C; Bertocci, M A; Greenberg, T; Aslam, H; Stiffler, R; Lockovich, J; Graur, S; Bebko, G; Forbes, E E; Phillips, M L

2017-01-01

High trait impulsive sensation seeking (ISS) is common in 18–25-year olds, and is associated with risky decision-making and deleterious outcomes. We examined relationships among: activity in reward regions previously associated with ISS during an ISS-relevant context, uncertain reward expectancy (RE), using fMRI; ISS impulsivity and sensation-seeking subcomponents; and risky decision-making in 100, transdiagnostically recruited 18–25-year olds. ISS, anhedonia, anxiety, depression and mania were measured using self-report scales; clinician-administered scales also assessed the latter four. A post-scan risky decision-making task measured ‘risky' (possible win/loss/mixed/neutral) fMRI-task versus ‘sure thing' stimuli. ‘Bias' reflected risky over safe choices. Uncertain RE-related activity in left ventrolateral prefrontal cortex and bilateral ventral striatum was positively associated with an ISS composite score, comprising impulsivity and sensation-seeking–fun-seeking subcomponents (ISSc; P⩽0.001). Bias positively associated with sensation seeking–experience seeking (ES; P=0.003). This relationship was moderated by ISSc (P=0.009): it was evident only in high ISSc individuals. Whole-brain analyses showed a positive relationship between: uncertain RE-related left ventrolateral prefrontal cortical activity and ISSc; uncertain RE-related visual attention and motor preparation neural network activity and ES; and uncertain RE-related dorsal anterior cingulate cortical activity and bias, specifically in high ISSc participants (all ps<0.05, peak-level, family-wise error corrected). We identify an indirect pathway linking greater levels of uncertain RE-related activity in reward, visual attention and motor networks with greater risky decision-making, via positive relationships with impulsivity, fun seeking and ES. These objective neural markers of high ISS can guide new treatment developments for young adults with high levels of this debilitating personality trait. PMID:28418404

High-Resolution Near Real-Time Drought Monitoring in South Asia

NASA Astrophysics Data System (ADS)

Aadhar, S.; Mishra, V.

2017-12-01

Drought in South Asia affect food and water security and pose challenges for millions of people. For policy-making, planning and management of water resources at the sub-basin or administrative levels, high-resolution datasets of precipitation and air temperature are required in near-real time. Here we develop a high resolution (0.05 degree) bias-corrected precipitation and temperature data that can be used to monitor near real-time drought conditions over South Asia. Moreover, the dataset can be used to monitor climatic extremes (heat waves, cold waves, dry and wet anomalies) in South Asia. A distribution mapping method was applied to correct bias in precipitation and air temperature (maximum and minimum), which performed well compared to the other bias correction method based on linear scaling. Bias-corrected precipitation and temperature data were used to estimate Standardized precipitation index (SPI) and Standardized Precipitation Evapotranspiration Index (SPEI) to assess the historical and current drought conditions in South Asia. We evaluated drought severity and extent against the satellite-based Normalized Difference Vegetation Index (NDVI) anomalies and satellite-driven Drought Severity Index (DSI) at 0.05˚. We find that the bias-corrected high-resolution data can effectively capture observed drought conditions as shown by the satellite-based drought estimates. High resolution near real-time dataset can provide valuable information for decision-making at district and sub- basin levels.

Simple heuristics in over-the-counter drug choices: a new hint for medical education and practice.

PubMed

Riva, Silvia; Monti, Marco; Antonietti, Alessandro

2011-01-01

Over-the-counter (OTC) drugs are widely available and often purchased by consumers without advice from a health care provider. Many people rely on self-management of medications to treat common medical conditions. Although OTC medications are regulated by the National and the International Health and Drug Administration, many people are unaware of proper dosing, side effects, adverse drug reactions, and possible medication interactions. This study examined how subjects make their decisions to select an OTC drug, evaluating the role of cognitive heuristics which are simple and adaptive rules that help the decision-making process of people in everyday contexts. By analyzing 70 subjects' information-search and decision-making behavior when selecting OTC drugs, we examined the heuristics they applied in order to assess whether simple decision-making processes were also accurate and relevant. Subjects were tested with a sequence of two experimental tests based on a computerized Java system devised to analyze participants' choices in a virtual environment. We found that subjects' information-search behavior reflected the use of fast and frugal heuristics. In addition, although the heuristics which correctly predicted subjects' decisions implied significantly fewer cues on average than the subjects did in the information-search task, they were accurate in describing order of information search. A simple combination of a fast and frugal tree and a tallying rule predicted more than 78% of subjects' decisions. The current emphasis in health care is to shift some responsibility onto the consumer through expansion of self medication. To know which cognitive mechanisms are behind the choice of OTC drugs is becoming a relevant purpose of current medical education. These findings have implications both for the validity of simple heuristics describing information searches in the field of OTC drug choices and for current medical education, which has to prepare competent health specialists to orientate and support the choices of their patients.

Simple heuristics in over-the-counter drug choices: a new hint for medical education and practice

PubMed Central

Riva, Silvia; Monti, Marco; Antonietti, Alessandro

2011-01-01

Introduction Over-the-counter (OTC) drugs are widely available and often purchased by consumers without advice from a health care provider. Many people rely on self-management of medications to treat common medical conditions. Although OTC medications are regulated by the National and the International Health and Drug Administration, many people are unaware of proper dosing, side effects, adverse drug reactions, and possible medication interactions. Purpose This study examined how subjects make their decisions to select an OTC drug, evaluating the role of cognitive heuristics which are simple and adaptive rules that help the decision-making process of people in everyday contexts. Subjects and methods By analyzing 70 subjects’ information-search and decision-making behavior when selecting OTC drugs, we examined the heuristics they applied in order to assess whether simple decision-making processes were also accurate and relevant. Subjects were tested with a sequence of two experimental tests based on a computerized Java system devised to analyze participants’ choices in a virtual environment. Results We found that subjects’ information-search behavior reflected the use of fast and frugal heuristics. In addition, although the heuristics which correctly predicted subjects’ decisions implied significantly fewer cues on average than the subjects did in the information-search task, they were accurate in describing order of information search. A simple combination of a fast and frugal tree and a tallying rule predicted more than 78% of subjects’ decisions. Conclusion The current emphasis in health care is to shift some responsibility onto the consumer through expansion of self medication. To know which cognitive mechanisms are behind the choice of OTC drugs is becoming a relevant purpose of current medical education. These findings have implications both for the validity of simple heuristics describing information searches in the field of OTC drug choices and for current medical education, which has to prepare competent health specialists to orientate and support the choices of their patients. PMID:23745077

A serious game can be a valid method to train clinical decision-making in surgery.

PubMed

Graafland, Maurits; Vollebergh, Maarten F; Lagarde, Sjoerd M; van Haperen, M; Bemelman, Willem A; Schijven, Marlies P

2014-12-01

A serious game was developed to train surgical residents in clinical decision-making regarding biliary tract disease. Serious or applied gaming is a novel educational approach to postgraduate training, combining training and assessment of clinical decision-making in a fun and challenging way. Although interest for serious games in medicine is rising, evidence on its validity is lacking. This study investigates face, content, and construct validity of this serious game. Experts structurally validated the game's medical content. Subsequently, 41 participants played the game. Decision scores and decision speed were compared among surgeons, surgical residents, interns, and medical students, determining the game's discriminatory ability between different levels of expertise. After playing, participants completed a questionnaire on the game's perceived realism and teaching ability. Surgeons solved more cases correctly (mean 77 %) than surgical residents (67 %), interns (60 %), master-degree students (50 %), and bachelor-degree students (39 % (p < 0.01). Trainees performed significantly better in their second play session than in the first (median 72 vs. 48 %, p = 0.00). Questionnaire results showed that educators and surgical trainees found the game both realistic and useful for surgical training. The majority perceived the game as fun (91.2 %), challenging (85.3 %), and would recommend the game to educate their colleagues (81.8 %). This serious game showed clear discriminatory ability between different levels of expertise in biliary tract disease management and clear teaching capability. It was perceived as appealing and realistic. Serious gaming has the potential to increase adherence to training programs in surgical residency training and medical school.

Individual differences in attention influence perceptual decision making.

PubMed

Nunez, Michael D; Srinivasan, Ramesh; Vandekerckhove, Joachim

2015-01-01

Sequential sampling decision-making models have been successful in accounting for reaction time (RT) and accuracy data in two-alternative forced choice tasks. These models have been used to describe the behavior of populations of participants, and explanatory structures have been proposed to account for between individual variability in model parameters. In this study we show that individual differences in behavior from a novel perceptual decision making task can be attributed to (1) differences in evidence accumulation rates, (2) differences in variability of evidence accumulation within trials, and (3) differences in non-decision times across individuals. Using electroencephalography (EEG), we demonstrate that these differences in cognitive variables, in turn, can be explained by attentional differences as measured by phase-locking of steady-state visual evoked potential (SSVEP) responses to the signal and noise components of the visual stimulus. Parameters of a cognitive model (a diffusion model) were obtained from accuracy and RT distributions and related to phase-locking indices (PLIs) of SSVEPs with a single step in a hierarchical Bayesian framework. Participants who were able to suppress the SSVEP response to visual noise in high frequency bands were able to accumulate correct evidence faster and had shorter non-decision times (preprocessing or motor response times), leading to more accurate responses and faster response times. We show that the combination of cognitive modeling and neural data in a hierarchical Bayesian framework relates physiological processes to the cognitive processes of participants, and that a model with a new (out-of-sample) participant's neural data can predict that participant's behavior more accurately than models without physiological data.

Decision Making In A High-Tech World: Automation Bias and Countermeasures

NASA Technical Reports Server (NTRS)

Mosier, Kathleen L.; Skitka, Linda J.; Burdick, Mark R.; Heers, Susan T.; Rosekind, Mark R. (Technical Monitor)

1996-01-01

Automated decision aids and decision support systems have become essential tools in many high-tech environments. In aviation, for example, flight management systems computers not only fly the aircraft, but also calculate fuel efficient paths, detect and diagnose system malfunctions and abnormalities, and recommend or carry out decisions. Air Traffic Controllers will soon be utilizing decision support tools to help them predict and detect potential conflicts and to generate clearances. Other fields as disparate as nuclear power plants and medical diagnostics are similarly becoming more and more automated. Ideally, the combination of human decision maker and automated decision aid should result in a high-performing team, maximizing the advantages of additional cognitive and observational power in the decision-making process. In reality, however, the presence of these aids often short-circuits the way that even very experienced decision makers have traditionally handled tasks and made decisions, and introduces opportunities for new decision heuristics and biases. Results of recent research investigating the use of automated aids have indicated the presence of automation bias, that is, errors made when decision makers rely on automated cues as a heuristic replacement for vigilant information seeking and processing. Automation commission errors, i.e., errors made when decision makers inappropriately follow an automated directive, or automation omission errors, i.e., errors made when humans fail to take action or notice a problem because an automated aid fails to inform them, can result from this tendency. Evidence of the tendency to make automation-related omission and commission errors has been found in pilot self reports, in studies using pilots in flight simulations, and in non-flight decision making contexts with student samples. Considerable research has found that increasing social accountability can successfully ameliorate a broad array of cognitive biases and resultant errors. To what extent these effects generalize to performance situations is not yet empirically established. The two studies to be presented represent concurrent efforts, with student and professional pilot samples, to determine the effects of accountability pressures on automation bias and on the verification of the accurate functioning of automated aids. Students (Experiment 1) and commercial pilots (Experiment 2) performed simulated flight tasks using automated aids. In both studies, participants who perceived themselves as accountable for their strategies of interaction with the automation were significantly more likely to verify its correctness, and committed significantly fewer automation-related errors than those who did not report this perception.

Using Video Images to Improve the Accuracy of Surrogate Decision-Making: A Randomized Controlled Trial

PubMed Central

Volandes, Angelo E.; Mitchell, Susan L.; Gillick, Muriel R.; Chang, Yuchiao; Paasche-Orlow, Michael K.

2009-01-01

Introduction When patients are unable to make important end-of-life decisions, doctors ask surrogate decision makers to provide insight into patients’ preferences. Unfortunately, multiple studies have shown that surrogates’ knowledge of patient preferences is poor. We hypothesized that a video decision tool would improve concordance between patients and their surrogates for end-of-life preferences. Objective To compare the concordance of preferences among elderly patients and their surrogates listening to only a verbal description of advanced dementia or viewing a video decision support tool of the disease after hearing the verbal description. Methods This was a randomized controlled trial of a convenience sample of community-dwelling elderly subjects (≥65 years) and their surrogates, and was conducted at 2 geriatric clinics affiliated with 2 academic medical centers in Boston. The study was conducted between September 1, 2007, and May 30, 2008. Random assignment of patient and surrogate dyads was to either a verbal narrative or a video decision support tool after the verbal narrative. End points were goals of care chosen by the patient and predicted goals of care by the surrogate. Goals of care included life-prolonging care (CPR, mechanical ventilation), limited care (hospitalization, antibiotics, but not CPR), and comfort care (only treatment to relieve symptoms). The primary outcome measure was the concordance rate of preferences between patients and their surrogates. Results A total of 14 pairs of patients and their surrogates were randomized to verbal narrative (n = 6) or video after verbal narrative (n = 8). Among the 6 patients receiving only the verbal narrative, 3 (50%) preferred comfort care, 1 (17%) chose limited care, and 2 (33%) desired life-prolonging care. Among the surrogates for these patients, only 2 correctly chose what their loved one would want if in a state of advanced dementia, yielding a concordance rate of 33%. Among the 8 patients receiving the video decision support tool, all 8 chose comfort care. Among the surrogates for these patients, all 8 correctly chose what their loved one would want if in a state of advanced dementia, yielding a concordance rate of 100%. Conclusion Patients and surrogates viewing a video decision support tool for advanced dementia are more likely to concur about the patient’s end-of-life preferences than when solely listening to a verbal description of the disease. PMID:19808156

Speed accuracy trade-off under response deadlines

PubMed Central

Karşılar, Hakan; Simen, Patrick; Papadakis, Samantha; Balcı, Fuat

2014-01-01

Perceptual decision making has been successfully modeled as a process of evidence accumulation up to a threshold. In order to maximize the rewards earned for correct responses in tasks with response deadlines, participants should collapse decision thresholds dynamically during each trial so that a decision is reached before the deadline. This strategy ensures on-time responding, though at the cost of reduced accuracy, since slower decisions are based on lower thresholds and less net evidence later in a trial (compared to a constant threshold). Frazier and Yu (2008) showed that the normative rate of threshold reduction depends on deadline delays and on participants' uncertainty about these delays. Participants should start collapsing decision thresholds earlier when making decisions under shorter deadlines (for a given level of timing uncertainty) or when timing uncertainty is higher (for a given deadline). We tested these predictions using human participants in a random dot motion discrimination task. Each participant was tested in free-response, short deadline (800 ms), and long deadline conditions (1000 ms). Contrary to optimal-performance predictions, the resulting empirical function relating accuracy to response time (RT) in deadline conditions did not decline to chance level near the deadline; nor did the slight decline we typically observed relate to measures of endogenous timing uncertainty. Further, although this function did decline slightly with increasing RT, the decline was explainable by the best-fitting parameterization of Ratcliff's diffusion model (Ratcliff, 1978), whose parameters are constant within trials. Our findings suggest that at the very least, typical decision durations are too short for participants to adapt decision parameters within trials. PMID:25177265

Use of an automated decision support tool optimizes clinicians' ability to interpret and appropriately respond to structured self-monitoring of blood glucose data.

PubMed

Rodbard, Helena W; Schnell, Oliver; Unger, Jeffrey; Rees, Christen; Amstutz, Linda; Parkin, Christopher G; Jelsovsky, Zhihong; Wegmann, Nathan; Axel-Schweitzer, Matthias; Wagner, Robin S

2012-04-01

We evaluated the impact of an automated decision support tool (DST) on clinicians' ability to identify glycemic abnormalities in structured self-monitoring of blood glucose (SMBG) data and then make appropriate therapeutic changes based on the glycemic patterns observed. In this prospective, randomized, controlled, multicenter study, 288 clinicians (39.6% family practice physicians, 37.9% general internal medicine physicians, and 22.6% nurse practitioners) were randomized to structured SMBG alone (STG; n = 72); structured SMBG with DST (DST; n = 72); structured SMBG with an educational DVD (DVD; n = 72); and structured SMBG with DST and the educational DVD (DST+DVD; n = 72). Clinicians analyzed 30 patient cases (type 2 diabetes), identified the primary abnormality, and selected the most appropriate therapy. A total of 222 clinicians completed all 30 patient cases with no major protocol deviations. Significantly more DST, DVD, and DST+DVD clinicians correctly identified the glycemic abnormality and selected the most appropriate therapeutic option compared with STG clinicians: 49, 51, and 55%, respectively, vs. 33% (all P < 0.0001) with no significant differences among DST, DVD, and DST+DVD clinicians. Use of structured SMBG, combined with the DST, the educational DVD, or both, enhances clinicians' ability to correctly identify significant glycemic patterns and make appropriate therapeutic decisions to address those patterns. Structured testing interventions using either the educational DVD or the DST are equally effective in improving data interpretation and utilization. The DST provides a viable alternative when comprehensive education is not feasible, and it may be integrated into medical practices with minimal training.

Seniors' perceptions of prescription drug advertisements: a pilot study of the potential impact on informed decision making.

PubMed

Grenard, Jerry L; Uy, Visith; Pagán, José A; Frosch, Dominick L

2011-10-01

To conduct a pilot study exploring seniors' perceptions of direct-to-consumer advertising (DTCA) of prescription drugs and how the advertisements might prepare them for making informed decisions with their physicians. We interviewed 15 seniors (ages 63-82) individually after they each watched nine prescription drug advertisements recorded from broadcast television. Grounded Theory methods were used to identify core themes related to the research questions. Four themes emerged from the interviews about DTCA: (1) awareness of medications was increased, (2) information was missing or misleading and drugs were often perceived as more effective than clinical evidence would suggest, (3) most seniors were more strongly influenced by personal or vicarious experience with a drug - and by their physician - than by DTCA, and (4) most seniors were circumspect about the information in commercial DTCA. DTCA may have some limited benefit for informed decision making by seniors, but the advertisements do not provide enough detailed information and some information is misinterpreted. Physicians should be aware that many patients may misunderstand DTCA, and that a certain amount of time may be required during consultations to correct these misconceptions until better advertising methods are employed by the pharmaceutical industry. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Seniors' perceptions of prescription drug advertisements: A pilot study of the potential impact on informed decision making

PubMed Central

Grenard, Jerry L.; Uy, Vsith; Pagán, José A.; Frosch, Dominick L.

2014-01-01

Objective To conduct a pilot study exploring seniors' perceptions of direct-to-consumer advertising (DTCA) of prescription drugs and how the advertisements might prepare them for making informed decisions with their physicians. Methods We interviewed 15 seniors (ages 63-82) individually after they each watched nine prescription drug advertisements recorded from broadcast television. Grounded Theory methods were used to identify core themes related to the research questions. Results Four themes emerged from the interviews about DTCA: (1) awareness of medications was increased, (2) information was missing or misleading and drugs were often perceived as more effective than clinical evidence would suggest, (3) most seniors were more strongly influenced by personal or vicarious experience with a drug – and by their physician – than by DTCA, and (4) most seniors were circumspect about the information in commercial DTCA. Conclusions DTCA may have some limited benefit for informed decision making by seniors, but the advertisements do not provide enough detailed information and some information is misinterpreted. Practical Implications Physicians should be aware that many patients may misunderstand DTCA, and that a certain amount of time may be required during consultations to correct these misconceptions until better advertising methods are employed by the pharmaceutical industry. PMID:21044826

Contrast-Enhanced Ultrasound Guided Biopsy of Undetermined Abdominal Lesions: A Multidisciplinary Decision-Making Approach.

PubMed

Mao, Feng; Dong, Yi; Ji, Zhengbiao; Cao, Jiaying; Wang, Wen-Ping

2017-01-01

Aim. To investigate the value of contrast-enhanced ultrasound (CEUS) guided biopsy of undetermined abdominal lesions in multidisciplinary treatment (MDT) decision-making approach. Methods. Between Jan 2012 and Dec 2015, 60 consecutive patients (male, 37; female, 23; mean age, 51.3 years ± 14.6) who presented with undetermined abdominal lesions were included. CEUS and core needle percutaneous biopsy was performed under real-time CEUS guidance in all lesions. Data were recorded and compared with conventional ultrasound (US) guidance group ( n = 75). All CEUS findings and clinical data were evaluated in MDT. Results. CEUS enabled the delimitation of more (88.3% versus 41.3%) and larger (14.1 ± 10.7 mm versus 32.3 ± 18.5 mm) nonenhanced necrotic areas. More inner (20.0% versus 6.7%) and surrounding (18.3% versus 2.7%) major vessels were visualized and avoided during biopsies. CEUS-guided biopsy increased the diagnostic accuracy from 93.3% to 98.3%, with correct diagnosis in 57 of 60 lesions (95.0%). The therapeutic plan was influenced by CEUS guided biopsies findings in the majority of patients (98.3%). Conclusion. The combination of CEUS guided biopsy and MDT decision-making approach is useful in the diagnostic work-up and therapeutic management.

To t-Test or Not to t-Test? A p-Values-Based Point of View in the Receiver Operating Characteristic Curve Framework.

PubMed

Vexler, Albert; Yu, Jihnhee

2018-04-13

A common statistical doctrine supported by many introductory courses and textbooks is that t-test type procedures based on normally distributed data points are anticipated to provide a standard in decision-making. In order to motivate scholars to examine this convention, we introduce a simple approach based on graphical tools of receiver operating characteristic (ROC) curve analysis, a well-established biostatistical methodology. In this context, we propose employing a p-values-based method, taking into account the stochastic nature of p-values. We focus on the modern statistical literature to address the expected p-value (EPV) as a measure of the performance of decision-making rules. During the course of our study, we extend the EPV concept to be considered in terms of the ROC curve technique. This provides expressive evaluations and visualizations of a wide spectrum of testing mechanisms' properties. We show that the conventional power characterization of tests is a partial aspect of the presented EPV/ROC technique. We desire that this explanation of the EPV/ROC approach convinces researchers of the usefulness of the EPV/ROC approach for depicting different characteristics of decision-making procedures, in light of the growing interest regarding correct p-values-based applications.

Adversity magnifies the importance of social information in decision-making.

PubMed

Pérez-Escudero, Alfonso; de Polavieja, Gonzalo G

2017-11-01

Decision-making theories explain animal behaviour, including human behaviour, as a response to estimations about the environment. In the case of collective behaviour, they have given quantitative predictions of how animals follow the majority option. However, they have so far failed to explain that in some species and contexts social cohesion increases when conditions become more adverse (i.e. individuals choose the majority option with higher probability when the estimated quality of all available options decreases). We have found that this failure is due to modelling simplifications that aided analysis, like low levels of stochasticity or the assumption that only one choice is the correct one. We provide a more general but simple geometric framework to describe optimal or suboptimal decisions in collectives that gives insight into three different mechanisms behind this effect. The three mechanisms have in common that the private information acts as a gain factor to social information: a decrease in the privately estimated quality of all available options increases the impact of social information, even when social information itself remains unchanged. This increase in the importance of social information makes it more likely that agents will follow the majority option. We show that these results quantitatively explain collective behaviour in fish and experiments of social influence in humans. © 2017 The Authors.

Bias Correction of Satellite Precipitation Products (SPPs) using a User-friendly Tool: A Step in Enhancing Technical Capacity

NASA Astrophysics Data System (ADS)

Rushi, B. R.; Ellenburg, W. L.; Adams, E. C.; Flores, A.; Limaye, A. S.; Valdés-Pineda, R.; Roy, T.; Valdés, J. B.; Mithieu, F.; Omondi, S.

2017-12-01

SERVIR, a joint NASA-USAID initiative, works to build capacity in Earth observation technologies in developing countries for improved environmental decision making in the arena of: weather and climate, water and disasters, food security and land use/land cover. SERVIR partners with leading regional organizations in Eastern and Southern Africa, Hindu Kush-Himalaya, Mekong region, and West Africa to achieve its objectives. SERVIR develops hydrological applications to address specific needs articulated by key stakeholders and daily rainfall estimates are a vital input for these applications. Satellite-derived rainfall is subjected to systemic biases which need to be corrected before it can be used for any hydrologic application such as real-time or seasonal forecasting. SERVIR and the SWAAT team at the University of Arizona, have co-developed an open-source and user friendly tool of rainfall bias correction approaches for SPPs. Bias correction tools were developed based on Linear Scaling and Quantile Mapping techniques. A set of SPPs, such as PERSIANN-CCS, TMPA-RT, and CMORPH, are bias corrected using Climate Hazards Group InfraRed Precipitation with Station (CHIRPS) data which incorporates ground based precipitation observations. This bias correction tools also contains a component, which is included to improve monthly mean of CHIRPS using precipitation products of the Global Surface Summary of the Day (GSOD) database developed by the National Climatic Data Center (NCDC). This tool takes input from command-line which makes it user-friendly and applicable in any operating platform without prior programming skills. This presentation will focus on this bias-correction tool for SPPs, including application scenarios.

The water intensity of the plugged-in automotive economy.

PubMed

King, Carey W; Webber, Michael E

2008-06-15

Converting light-duty vehicles from full gasoline power to electric power, by using either hybrid electric vehicles or fully electric power vehicles, is likely to increase demand for water resources. In the United States in 2005, drivers of 234 million cars, lighttrucks, and SUVs drove approximately 2.7 trillion miles and consumed over 380 million gallons of gasoline per day. We compare figures from literature and government surveys to calculate the water usage, consumption, and withdrawal, in the United States during petroleum refining and electricity generation. In displacing gasoline miles with electric miles, approximately 2-3 [corrected] times more water is consumed (0.24 [corrected] versus 0.07--0.14 gallons/mile) and over 12 [corrected] times more water is withdrawn (7.8 [corrected] versus 0.6 gallons/mile) primarily due to increased water cooling of thermoelectric power plants to accommodate increased electricity generation. Overall, we conclude that the impact on water resources from a widespread shift to grid-based transportation would be substantial enough to warrant consideration for relevant public policy decision-making. That is not to say that the negative impacts on water resources make such a shift undesirable, but rather this increase in water usage presents a significant potential impact on regional water resources and should be considered when planning for a plugged-in automotive economy.

Extending Hypothesis Testing of Edge Organizations Using Functional Magnetic Resonance Imaging (fMRI) During ELICIT

DTIC Science & Technology

2010-06-01

task difficulty and response correctness on neural systems supporting fluid reasoning. Cognitive Neurodynamics 1 (1): 71-84. Kaplan, J.T., Iacoboni...dynamic influences on decision-making and trust during social interaction. ELICITing Behavior ELICIT is designed to explore social and cognitive ...a person’s own self-awareness in the game experience, (2) their cognitive processes of reasoning, and (3) the modulation of uncertainty that primes

Probabilistic Risk Assessment for Decision Making During Spacecraft Operations

NASA Technical Reports Server (NTRS)

Meshkat, Leila

2009-01-01

Decisions made during the operational phase of a space mission often have significant and immediate consequences. Without the explicit consideration of the risks involved and their representation in a solid model, it is very likely that these risks are not considered systematically in trade studies. Wrong decisions during the operational phase of a space mission can lead to immediate system failure whereas correct decisions can help recover the system even from faulty conditions. A problem of special interest is the determination of the system fault protection strategies upon the occurrence of faults within the system. Decisions regarding the fault protection strategy also heavily rely on a correct understanding of the state of the system and an integrated risk model that represents the various possible scenarios and their respective likelihoods. Probabilistic Risk Assessment (PRA) modeling is applicable to the full lifecycle of a space mission project, from concept development to preliminary design, detailed design, development and operations. The benefits and utilities of the model, however, depend on the phase of the mission for which it is used. This is because of the difference in the key strategic decisions that support each mission phase. The focus of this paper is on describing the particular methods used for PRA modeling during the operational phase of a spacecraft by gleaning insight from recently conducted case studies on two operational Mars orbiters. During operations, the key decisions relate to the commands sent to the spacecraft for any kind of diagnostics, anomaly resolution, trajectory changes, or planning. Often, faults and failures occur in the parts of the spacecraft but are contained or mitigated before they can cause serious damage. The failure behavior of the system during operations provides valuable data for updating and adjusting the related PRA models that are built primarily based on historical failure data. The PRA models, in turn, provide insight into the effect of various faults or failures on the risk and failure drivers of the system and the likelihood of possible end case scenarios, thereby facilitating the decision making process during operations. This paper describes the process of adjusting PRA models based on observed spacecraft data, on one hand, and utilizing the models for insight into the future system behavior on the other hand. While PRA models are typically used as a decision aid during the design phase of a space mission, we advocate adjusting them based on the observed behavior of the spacecraft and utilizing them for decision support during the operations phase.

Surgical Updates in the Treatment of Pelvic Organ Prolapse.

PubMed

Geynisman-Tan, Julia; Kenton, Kimberly

2017-04-28

Pelvic organ prolapse affects approximately 8% of women, and the demand for pelvic organ prolapse surgery is expected to increase by nearly 50% over the next 40 years. The surgical techniques used to correct pelvic organ prolapse have evolved over the last 10 years, with multiple well-designed studies addressing the risks, outcomes, reoperation rates, and optimal surgical approaches. Here we review the most recent evidence on the route of access, concomitant procedures, and synthetic materials for augmenting the repair. Ultimately, this review highlights that there is no optimal method for correcting pelvic organ prolapse and that the risks, benefits, and approaches should be discussed in a patient-centered, goal-oriented approach to decision-making.

Prestimulus Alpha Power Influences Tactile Temporal Perceptual Discrimination and Confidence in Decisions.

PubMed

Baumgarten, Thomas J; Schnitzler, Alfons; Lange, Joachim

2016-03-01

Recent studies have demonstrated that prestimulus alpha-band activity substantially influences perception of near-threshold stimuli. Here, we studied the influence of prestimulus alpha power fluctuations on temporal perceptual discrimination of suprathreshold tactile stimuli and subjects' confidence regarding their perceptual decisions. We investigated how prestimulus alpha-band power influences poststimulus decision-making variables. We presented electrical stimuli with different stimulus onset asynchronies (SOAs) to human subjects, and determined the SOA for which temporal perceptual discrimination varied on a trial-by-trial basis between perceiving 1 or 2 stimuli, prior to recording brain activity with magnetoencephalography. We found that low prestimulus alpha power in contralateral somatosensory and occipital areas predicts the veridical temporal perceptual discrimination of 2 stimuli. Additionally, prestimulus alpha power was negatively correlated with confidence ratings in correctly perceived trials, but positively correlated for incorrectly perceived trials. Finally, poststimulus event-related fields (ERFs) were modulated by prestimulus alpha power and reflect the result of a decisional process rather than physical stimulus parameters around ∼150 ms. These findings provide new insights into the link between spontaneous prestimulus alpha power fluctuations, temporal perceptual discrimination, decision making, and decisional confidence. The results suggest that prestimulus alpha power modulates perception and decisions on a continuous scale, as reflected in confidence ratings. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

IQ Scores Should Be Corrected for the Flynn Effect in High-Stakes Decisions

ERIC Educational Resources Information Center

Fletcher, Jack M.; Stuebing, Karla K.; Hughes, Lisa C.

2010-01-01

IQ test scores should be corrected for high stakes decisions that employ these assessments, including capital offense cases. If scores are not corrected, then diagnostic standards must change with each generation. Arguments against corrections, based on standards of practice, information present and absent in test manuals, and related issues,…

Apply creative thinking of decision support in electrical nursing record.

PubMed

Hao, Angelica Te-Hui; Hsu, Chien-Yeh; Li-Fang, Huang; Jian, Wen-Shan; Wu, Li-Bin; Kao, Ching-Chiu; Lu, Mei-Show; Chang, Her-Kung

2006-01-01

The nursing process consists of five interrelated steps: assessment, diagnosis, planning, intervention, and evaluation. In the nursing process, the nurse collects a great deal of data and information. The amount of data and information may exceed the amount the nurse can process efficiently and correctly. Thus, the nurse needs assistance to become proficient in the planning of nursing care, due to the difficulty of simultaneously processing a large set of information. Computer systems are viewed as tools to expand the capabilities of the nurse's mind. Using computer technology to support clinicians' decision making may provide high-quality, patient-centered, and efficient healthcare. Although some existing nursing information systems aid in the nursing process, they only provide the most fundamental decision support--i.e., standard care plans associated with common nursing diagnoses. Such a computerized decision support system helps the nurse develop a care plan step-by-step. But it does not assist the nurse in the decision-making process. The decision process about how to generate nursing diagnoses from data and how to individualize the care plans still reminds of the nurse. The purpose of this study is to develop a pilot structure in electronic nursing record system integrated with international nursing standard for improving the proficiency and accuracy of plan of care in clinical pathway process. The proposed pilot systems not only assist both student nurses and nurses who are novice in nursing practice, but also experts who need to work in a practice area which they are not familiar with.

The Cost of Accumulating Evidence in Perceptual Decision Making

PubMed Central

Drugowitsch, Jan; Moreno-Bote, Rubén; Churchland, Anne K.; Shadlen, Michael N.; Pouget, Alexandre

2012-01-01

Decision making often involves the accumulation of information over time, but acquiring information typically comes at a cost. Little is known about the cost incurred by animals and humans for acquiring additional information from sensory variables, due, for instance, to attentional efforts. Through a novel integration of diffusion models and dynamic programming, we were able to estimate the cost of making additional observations per unit of time from two monkeys and six humans in a reaction time random dot motion discrimination task. Surprisingly, we find that, the cost is neither zero nor constant over time, but for the animals and humans features a brief period in which it is constant but increases thereafter. In addition, we show that our theory accurately matches the observed reaction time distributions for each stimulus condition, the time-dependent choice accuracy both conditional on stimulus strength and independent of it, and choice accuracy and mean reaction times as a function of stimulus strength. The theory also correctly predicts that urgency signals in the brain should be independent of the difficulty, or stimulus strength, at each trial. PMID:22423085

Incidental Fetal Ultrasound Findings: Interpretation and Management.

PubMed

Kaplan, Rebekah; Adams, Sharon

2018-05-01

Ultrasonography is a common component of prenatal care worldwide and is often used in early pregnancy to determine gestational age, number of fetuses, fetal cardiac activity, and placental location. Patients and their families may also consider ultrasonography a social event, as it provides confirmation and reassurance of a normal pregnancy. Ultrasound screening is typically scheduled in the second trimester to visualize fetal anatomy and confirm gestational age. Most ultrasound examinations are reassuring, but some incidentally identify structural anomalies and soft markers for aneuploidy, making it necessary for health care providers to correctly interpret these findings. The health care provider's ability to prepare patients prior to the ultrasound and deliver the necessary information needed to make informed decisions regarding any follow-up screening or diagnostic testing is critical to reducing parental anxiety. Preparation for the anatomic survey should include counseling for normal and abnormal findings. The ethical concepts of patient autonomy and shared decision making are used as a guide in providing this critical information and enabling informed choices during follow-up for incidental ultrasound findings. © 2018 by the American College of Nurse-Midwives.

The intersection of race, poverty and risk: understanding the decision to provide services to clients and to remove children.

PubMed

Rivaux, Stephanie L; James, Joyce; Wittenstrom, Kim; Baumann, Donald; Sheets, Janess; Henry, Judith; Jeffries, Victoria

2008-01-01

Studies have found that certain racial groups, particularly the children of African American families, are placed in foster care at a higher rate than children of other races. These families are also sometimes found to be afforded fewer services that might prevent these removals, relative to families of other races. It is unclear why this is so. Poverty has been suspected, and sometimes found, to be the primary cause of the disparity. Lacking in some of these analyses, however, was how risk of future abuse/neglect to the child entered into the decisions and particularly, how assumptions about race, poverty, and risk are factored into the decision-making process. It is important to understand this process if we are to find a way to correct it. The current study addresses this process.

Evaluation of risk communication in a mammography patient decision aid.

PubMed

Klein, Krystal A; Watson, Lindsey; Ash, Joan S; Eden, Karen B

2016-07-01

We characterized patients' comprehension, memory, and impressions of risk communication messages in a patient decision aid (PtDA), Mammopad, and clarified perceived importance of numeric risk information in medical decision making. Participants were 75 women in their forties with average risk factors for breast cancer. We used mixed methods, comprising a risk estimation problem administered within a pretest-posttest design, and semi-structured qualitative interviews with a subsample of 21 women. Participants' positive predictive value estimates of screening mammography improved after using Mammopad. Although risk information was only briefly memorable, through content analysis, we identified themes describing why participants value quantitative risk information, and obstacles to understanding. We describe ways the most complicated graphic was incompletely comprehended. Comprehension of risk information following Mammopad use could be improved. Patients valued receiving numeric statistical information, particularly in pictograph format. Obstacles to understanding risk information, including potential for confusion between statistics, should be identified and mitigated in PtDA design. Using simple pictographs accompanied by text, PtDAs may enhance a shared decision-making discussion. PtDA designers and providers should be aware of benefits and limitations of graphical risk presentations. Incorporating comprehension checks could help identify and correct misapprehensions of graphically presented statistics. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Evaluation of risk communication in a mammography patient decision aid

PubMed Central

Klein, Krystal A.; Watson, Lindsey; Ash, Joan S.; Eden, Karen B.

2016-01-01

Objectives We characterized patients’ comprehension, memory, and impressions of risk communication messages in a patient decision aid (PtDA), Mammopad, and clarified perceived importance of numeric risk information in medical decision making. Methods Participants were 75 women in their forties with average risk factors for breast cancer. We used mixed methods, comprising a risk estimation problem administered within a pretest–posttest design, and semi-structured qualitative interviews with a subsample of 21 women. Results Participants’ positive predictive value estimates of screening mammography improved after using Mammopad. Although risk information was only briefly memorable, through content analysis, we identified themes describing why participants value quantitative risk information, and obstacles to understanding. We describe ways the most complicated graphic was incompletely comprehended. Conclusions Comprehension of risk information following Mammopad use could be improved. Patients valued receiving numeric statistical information, particularly in pictograph format. Obstacles to understanding risk information, including potential for confusion between statistics, should be identified and mitigated in PtDA design. Practice implications Using simple pictographs accompanied by text, PtDAs may enhance a shared decision-making discussion. PtDA designers and providers should be aware of benefits and limitations of graphical risk presentations. Incorporating comprehension checks could help identify and correct misapprehensions of graphically presented statistics PMID:26965020

The role of computerized diagnostic proposals in the interpretation of the 12-lead electrocardiogram by cardiology and non-cardiology fellows.

PubMed

Novotny, Tomas; Bond, Raymond; Andrsova, Irena; Koc, Lumir; Sisakova, Martina; Finlay, Dewar; Guldenring, Daniel; Spinar, Jindrich; Malik, Marek

2017-05-01

Most contemporary 12-lead electrocardiogram (ECG) devices offer computerized diagnostic proposals. The reliability of these automated diagnoses is limited. It has been suggested that incorrect computer advice can influence physician decision-making. This study analyzed the role of diagnostic proposals in the decision process by a group of fellows of cardiology and other internal medicine subspecialties. A set of 100 clinical 12-lead ECG tracings was selected covering both normal cases and common abnormalities. A team of 15 junior Cardiology Fellows and 15 Non-Cardiology Fellows interpreted the ECGs in 3 phases: without any diagnostic proposal, with a single diagnostic proposal (half of them intentionally incorrect), and with four diagnostic proposals (only one of them being correct) for each ECG. Self-rated confidence of each interpretation was collected. Availability of diagnostic proposals significantly increased the diagnostic accuracy (p<0.001). Nevertheless, in case of a single proposal (either correct or incorrect) the increase of accuracy was present in interpretations with correct diagnostic proposals, while the accuracy was substantially reduced with incorrect proposals. Confidence levels poorly correlated with interpretation scores (rho≈2, p<0.001). Logistic regression showed that an interpreter is most likely to be correct when the ECG offers a correct diagnostic proposal (OR=10.87) or multiple proposals (OR=4.43). Diagnostic proposals affect the diagnostic accuracy of ECG interpretations. The accuracy is significantly influenced especially when a single diagnostic proposal (either correct or incorrect) is provided. The study suggests that the presentation of multiple computerized diagnoses is likely to improve the diagnostic accuracy of interpreters. Copyright © 2017 Elsevier B.V. All rights reserved.

22 CFR 1101.14 - Appeal of agency decision not to correct or amend a record.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Appeal of agency decision not to correct or amend a record. 1101.14 Section 1101.14 Foreign Relations INTERNATIONAL BOUNDARY AND WATER COMMISSION, UNITED STATES AND MEXICO, UNITED STATES SECTION PRIVACY ACT OF 1974 § 1101.14 Appeal of agency decision not to correct or amend a record. (a) An appea...

Caudate Microstimulation Increases Value of Specific Choices.

PubMed

Santacruz, Samantha R; Rich, Erin L; Wallis, Joni D; Carmena, Jose M

2017-11-06

Value-based decision-making involves an assessment of the value of items available and the actions required to obtain them. The basal ganglia are highly implicated in action selection and goal-directed behavior [1-4], and the striatum in particular plays a critical role in arbitrating between competing choices [5-9]. Previous work has demonstrated that neural activity in the caudate nucleus is modulated by task-relevant action values [6, 8]. Nonetheless, how value is represented and maintained in the striatum remains unclear since decision-making in these tasks relied on spatially lateralized responses, confounding the ability to generalize to a more abstract choice task [6, 8, 9]. Here, we investigate striatal value representations by applying caudate electrical stimulation in macaque monkeys (n = 3) to bias decision-making in a task that divorces the value of a stimulus from motor action. Electrical microstimulation is known to induce neural plasticity [10, 11], and caudate microstimulation in primates has been shown to accelerate associative learning [12, 13]. Our results indicate that stimulation paired with a particular stimulus increases selection of that stimulus, and this effect was stimulus dependent and action independent. The modulation of choice behavior using microstimulation was best modeled as resulting from changes in stimulus value. Caudate neural recordings (n = 1) show that changes in value-coding neuron activity are stimulus value dependent. We argue that caudate microstimulation can differentially increase stimulus values independent of action, and unilateral manipulations of value are sufficient to mediate choice behavior. These results support potential future applications of microstimulation to correct maladaptive plasticity underlying dysfunctional decision-making related to neuropsychiatric conditions. Copyright © 2017 Elsevier Ltd. All rights reserved.

An evaluation of learning clinical decision-making for early rehabilitation in the ICU via interactive education with audience response system.

PubMed

Toonstra, Amy L; Nelliot, Archana; Aronson Friedman, Lisa; Zanni, Jennifer M; Hodgson, Carol; Needham, Dale M

2017-06-01

Knowledge-related barriers to safely implement early rehabilitation programs in intensive care units (ICUs) may be overcome via targeted education. The purpose of this study was to evaluate the effectiveness of an interactive educational session on short-term knowledge of clinical decision-making for safe rehabilitation of patients in ICUs. A case-based teaching approach, drawing from published safety recommendations for initiation of rehabilitation in ICUs, was used with a multidisciplinary audience. An audience response system was incorporated to promote interaction and evaluate knowledge before vs. after the educational session. Up to 175 audience members, of 271 in attendance (129 (48%) physical therapists, 51 (19%) occupational therapists, 31 (11%) nursing, 14 (5%) physician, 46 (17%) other), completed both the pre- and post-test questions for each of the six unique patient cases. In four of six patient cases, there was a significant (p< 0.001) increase in identifying the correct answer regarding initiation of rehabilitation activities. This learning effect was similar irrespective of participants' years of experience and clinical discipline. An interactive, case-based, educational session may be effective for increasing short-term knowledge, and identifying knowledge gaps, regarding clinical decision-making for safe rehabilitation of patients in ICUs. Implications for Rehabilitation Lack of knowledge regarding the safety considerations for early rehabilitation of ICU patients is a barrier to implementing early rehabilitation. Interactive educational formats, such as the use of audience response systems, offer a new method of teaching and instantly assessing learning of clinically important information. In a small study, we have shown that an interactive, case-based educational format may be used to effectively teach clinical decision-making for the safe rehabilitation of ICU patients to a diverse audience of clinicians.

Current recommendations on the estimation of transition probabilities in Markov cohort models for use in health care decision-making: a targeted literature review.

PubMed

Olariu, Elena; Cadwell, Kevin K; Hancock, Elizabeth; Trueman, David; Chevrou-Severac, Helene

2017-01-01

Although Markov cohort models represent one of the most common forms of decision-analytic models used in health care decision-making, correct implementation of such models requires reliable estimation of transition probabilities. This study sought to identify consensus statements or guidelines that detail how such transition probability matrices should be estimated. A literature review was performed to identify relevant publications in the following databases: Medline, Embase, the Cochrane Library, and PubMed. Electronic searches were supplemented by manual-searches of health technology assessment (HTA) websites in Australia, Belgium, Canada, France, Germany, Ireland, Norway, Portugal, Sweden, and the UK. One reviewer assessed studies for eligibility. Of the 1,931 citations identified in the electronic searches, no studies met the inclusion criteria for full-text review, and no guidelines on transition probabilities in Markov models were identified. Manual-searching of the websites of HTA agencies identified ten guidelines on economic evaluations (Australia, Belgium, Canada, France, Germany, Ireland, Norway, Portugal, Sweden, and UK). All identified guidelines provided general guidance on how to develop economic models, but none provided guidance on the calculation of transition probabilities. One relevant publication was identified following review of the reference lists of HTA agency guidelines: the International Society for Pharmacoeconomics and Outcomes Research taskforce guidance. This provided limited guidance on the use of rates and probabilities. There is limited formal guidance available on the estimation of transition probabilities for use in decision-analytic models. Given the increasing importance of cost-effectiveness analysis in the decision-making processes of HTA bodies and other medical decision-makers, there is a need for additional guidance to inform a more consistent approach to decision-analytic modeling. Further research should be done to develop more detailed guidelines on the estimation of transition probabilities.

Iterative near-term ecological forecasting: Needs, opportunities, and challenges

USGS Publications Warehouse

Dietze, Michael C.; Fox, Andrew; Beck-Johnson, Lindsay; Betancourt, Julio L.; Hooten, Mevin B.; Jarnevich, Catherine S.; Keitt, Timothy H.; Kenney, Melissa A.; Laney, Christine M.; Larsen, Laurel G.; Loescher, Henry W.; Lunch, Claire K.; Pijanowski, Bryan; Randerson, James T.; Read, Emily; Tredennick, Andrew T.; Vargas, Rodrigo; Weathers, Kathleen C.; White, Ethan P.

2018-01-01

Two foundational questions about sustainability are “How are ecosystems and the services they provide going to change in the future?” and “How do human decisions affect these trajectories?” Answering these questions requires an ability to forecast ecological processes. Unfortunately, most ecological forecasts focus on centennial-scale climate responses, therefore neither meeting the needs of near-term (daily to decadal) environmental decision-making nor allowing comparison of specific, quantitative predictions to new observational data, one of the strongest tests of scientific theory. Near-term forecasts provide the opportunity to iteratively cycle between performing analyses and updating predictions in light of new evidence. This iterative process of gaining feedback, building experience, and correcting models and methods is critical for improving forecasts. Iterative, near-term forecasting will accelerate ecological research, make it more relevant to society, and inform sustainable decision-making under high uncertainty and adaptive management. Here, we identify the immediate scientific and societal needs, opportunities, and challenges for iterative near-term ecological forecasting. Over the past decade, data volume, variety, and accessibility have greatly increased, but challenges remain in interoperability, latency, and uncertainty quantification. Similarly, ecologists have made considerable advances in applying computational, informatic, and statistical methods, but opportunities exist for improving forecast-specific theory, methods, and cyberinfrastructure. Effective forecasting will also require changes in scientific training, culture, and institutions. The need to start forecasting is now; the time for making ecology more predictive is here, and learning by doing is the fastest route to drive the science forward.

Iterative near-term ecological forecasting: Needs, opportunities, and challenges.

PubMed

Dietze, Michael C; Fox, Andrew; Beck-Johnson, Lindsay M; Betancourt, Julio L; Hooten, Mevin B; Jarnevich, Catherine S; Keitt, Timothy H; Kenney, Melissa A; Laney, Christine M; Larsen, Laurel G; Loescher, Henry W; Lunch, Claire K; Pijanowski, Bryan C; Randerson, James T; Read, Emily K; Tredennick, Andrew T; Vargas, Rodrigo; Weathers, Kathleen C; White, Ethan P

2018-02-13

Two foundational questions about sustainability are "How are ecosystems and the services they provide going to change in the future?" and "How do human decisions affect these trajectories?" Answering these questions requires an ability to forecast ecological processes. Unfortunately, most ecological forecasts focus on centennial-scale climate responses, therefore neither meeting the needs of near-term (daily to decadal) environmental decision-making nor allowing comparison of specific, quantitative predictions to new observational data, one of the strongest tests of scientific theory. Near-term forecasts provide the opportunity to iteratively cycle between performing analyses and updating predictions in light of new evidence. This iterative process of gaining feedback, building experience, and correcting models and methods is critical for improving forecasts. Iterative, near-term forecasting will accelerate ecological research, make it more relevant to society, and inform sustainable decision-making under high uncertainty and adaptive management. Here, we identify the immediate scientific and societal needs, opportunities, and challenges for iterative near-term ecological forecasting. Over the past decade, data volume, variety, and accessibility have greatly increased, but challenges remain in interoperability, latency, and uncertainty quantification. Similarly, ecologists have made considerable advances in applying computational, informatic, and statistical methods, but opportunities exist for improving forecast-specific theory, methods, and cyberinfrastructure. Effective forecasting will also require changes in scientific training, culture, and institutions. The need to start forecasting is now; the time for making ecology more predictive is here, and learning by doing is the fastest route to drive the science forward.

Anxiety Evokes Hypofrontality and Disrupts Rule-Relevant Encoding by Dorsomedial Prefrontal Cortex Neurons.

PubMed

Park, Junchol; Wood, Jesse; Bondi, Corina; Del Arco, Alberto; Moghaddam, Bita

2016-03-16

Anxiety is a debilitating symptom of most psychiatric disorders, including major depression, post-traumatic stress disorder, schizophrenia, and addiction. A detrimental aspect of anxiety is disruption of prefrontal cortex (PFC)-mediated executive functions, such as flexible decision making. Here we sought to understand how anxiety modulates PFC neuronal encoding of flexible shifting between behavioral strategies. We used a clinically substantiated anxiogenic treatment to induce sustained anxiety in rats and recorded from dorsomedial PFC (dmPFC) and orbitofrontal cortex (OFC) neurons while they were freely moving in a home cage and while they performed a PFC-dependent task that required flexible switches between rules in two distinct perceptual dimensions. Anxiety elicited a sustained background "hypofrontality" in dmPFC and OFC by reducing the firing rate of spontaneously active neuronal subpopulations. During task performance, the impact of anxiety was subtle, but, consistent with human data, behavior was selectively impaired when previously correct conditions were presented as conflicting choices. This impairment was associated with reduced recruitment of dmPFC neurons that selectively represented task rules at the time of action. OFC rule representation was not affected by anxiety. These data indicate that a neural substrate of the decision-making deficits in anxiety is diminished dmPFC neuronal encoding of task rules during conflict-related actions. Given the translational relevance of the model used here, the data provide a neuronal encoding mechanism for how anxiety biases decision making when the choice involves overcoming a conflict. They also demonstrate that PFC encoding of actions, as opposed to cues or outcome, is especially vulnerable to anxiety. A debilitating aspect of anxiety is its impact on decision making and flexible control of behavior. These cognitive constructs depend on proper functioning of the prefrontal cortex (PFC). Understanding how anxiety affects PFC encoding of cognitive events is of great clinical and evolutionary significance. Using a clinically valid experimental model, we find that, under anxiety, decision making may be skewed by salient and conflicting environmental stimuli at the expense of flexible top-down guided choices. We also find that anxiety suppresses spontaneous activity of PFC neurons, and weakens encoding of task rules by dorsomedial PFC neurons. These data provide a neuronal encoding scheme for how anxiety disengages PFC during decision making. Copyright © 2016 the authors 0270-6474/16/363322-14$15.00/0.

Corrective Action Investigation Plan for Corrective Action Unit 204: Storage Bunkers, Nevada Test Site, Nevada (December 2002, Revision No.: 0), Including Record of Technical Change No. 1

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

NNSA /NSO

The Corrective Action Investigation Plan contains the U.S. Department of Energy, National Nuclear Security Administration Nevada Operations Office's approach to collect the data necessary to evaluate corrective action alternatives appropriate for the closure of Corrective Action Unit (CAU) 204 under the Federal Facility Agreement and Consent Order. Corrective Action Unit 204 is located on the Nevada Test Site approximately 65 miles northwest of Las Vegas, Nevada. This CAU is comprised of six Corrective Action Sites (CASs) which include: 01-34-01, Underground Instrument House Bunker; 02-34-01, Instrument Bunker; 03-34-01, Underground Bunker; 05-18-02, Chemical Explosives Storage; 05-33-01, Kay Blockhouse; 05-99-02, Explosive Storage Bunker.more » Based on site history, process knowledge, and previous field efforts, contaminants of potential concern for Corrective Action Unit 204 collectively include radionuclides, beryllium, high explosives, lead, polychlorinated biphenyls, total petroleum hydrocarbons, silver, warfarin, and zinc phosphide. The primary question for the investigation is: ''Are existing data sufficient to evaluate appropriate corrective actions?'' To address this question, resolution of two decision statements is required. Decision I is to ''Define the nature of contamination'' by identifying any contamination above preliminary action levels (PALs); Decision II is to ''Determine the extent of contamination identified above PALs. If PALs are not exceeded, the investigation is completed. If PALs are exceeded, then Decision II must be resolved. In addition, data will be obtained to support waste management decisions. Field activities will include radiological land area surveys, geophysical surveys to identify any subsurface metallic and nonmetallic debris, field screening for applicable contaminants of potential concern, collection and analysis of surface and subsurface soil samples from biased locations, and step-out sampling to define the extent of contamination, as necessary. The results of this field investigation will support a defensible evaluation of corrective action alternatives in the corrective action decision document.« less

Adaptive History Biases Result from Confidence-Weighted Accumulation of past Choices

PubMed Central

2018-01-01

Perceptual decision-making is biased by previous events, including the history of preceding choices: observers tend to repeat (or alternate) their judgments of the sensory environment more often than expected by chance. Computational models postulate that these so-called choice history biases result from the accumulation of internal decision signals across trials. Here, we provide psychophysical evidence for such a mechanism and its adaptive utility. Male and female human observers performed different variants of a challenging visual motion discrimination task near psychophysical threshold. In a first experiment, we decoupled categorical perceptual choices and motor responses on a trial-by-trial basis. Choice history bias was explained by previous perceptual choices, not motor responses, highlighting the importance of internal decision signals in action-independent formats. In a second experiment, observers performed the task in stimulus environments containing different levels of autocorrelation and providing no external feedback about choice correctness. Despite performing under overall high levels of uncertainty, observers adjusted both the strength and the sign of their choice history biases to these environments. When stimulus sequences were dominated by either repetitions or alternations, the individual degree of this adjustment of history bias was about as good a predictor of individual performance as individual perceptual sensitivity. The history bias adjustment scaled with two proxies for observers' confidence about their previous choices (accuracy and reaction time). Together, our results are consistent with the idea that action-independent, confidence-modulated decision variables are accumulated across choices in a flexible manner that depends on decision-makers' model of their environment. SIGNIFICANCE STATEMENT Decisions based on sensory input are often influenced by the history of one's preceding choices, manifesting as a bias to systematically repeat (or alternate) choices. We here provide support for the idea that such choice history biases arise from the context-dependent accumulation of a quantity referred to as the decision variable: the variable's sign dictates the choice and its magnitude the confidence about choice correctness. We show that choices are accumulated in an action-independent format and a context-dependent manner, weighted by the confidence about their correctness. This confidence-weighted accumulation of choices enables decision-makers to flexibly adjust their behavior to different sensory environments. The bias adjustment can be as important for optimizing performance as one's sensitivity to the momentary sensory input. PMID:29371318

Adaptive History Biases Result from Confidence-weighted Accumulation of Past Choices.

PubMed

Braun, Anke; Urai, Anne E; Donner, Tobias H

2018-01-25

Perceptual decision-making is biased by previous events, including the history of preceding choices: Observers tend to repeat (or alternate) their judgments of the sensory environment more often than expected by chance. Computational models postulate that these so-called choice history biases result from the accumulation of internal decision signals across trials. Here, we provide psychophysical evidence for such a mechanism and its adaptive utility. Male and female human observers performed different variants of a challenging visual motion discrimination task near psychophysical threshold. In a first experiment, we decoupled categorical perceptual choices and motor responses on a trial-by-trial basis. Choice history bias was explained by previous perceptual choices, not motor responses, highlighting the importance of internal decision signals in action-independent formats. In a second experiment, observers performed the task in stimulus environments containing different levels of auto-correlation and providing no external feedback about choice correctness. Despite performing under overall high levels of uncertainty, observers adjusted both the strength and the sign of their choice history biases to these environments. When stimulus sequences were dominated by either repetitions or alternations, the individual degree of this adjustment of history bias was about as good a predictor of individual performance as individual perceptual sensitivity. The history bias adjustment scaled with two proxies for observers' confidence about their previous choices (accuracy and reaction time). Taken together, our results are consistent with the idea that action-independent, confidence-modulated decision variables are accumulated across choices in a flexible manner that depends on decision-makers' model of their environment. Significance statement: Decisions based on sensory input are often influenced by the history of one's preceding choices, manifesting as a bias to systematically repeat (or alternate) choices. We here provide support for the idea that such choice history biases arise from the context-dependent accumulation of a quantity referred to as the decision variable: the variable's sign dictates the choice and its magnitude the confidence about choice correctness. We show that choices are accumulated in an action-independent format and a context-dependent manner, weighted by the confidence about their correctness. This confidence-weighted accumulation of choices enables decision-makers to flexibly adjust their behavior to different sensory environments. The bias adjustment can be as important for optimizing performance as one's sensitivity to the momentary sensory input. Copyright © 2018 Braun et al.

Implication of the first decision on visual information-sampling in the spatial frequency domain in pulmonary nodule recognition

NASA Astrophysics Data System (ADS)

Pietrzyk, Mariusz W.; Manning, David; Donovan, Tim; Dix, Alan

2010-02-01

Aim: To investigate the impact on visual sampling strategy and pulmonary nodule recognition of image-based properties of background locations in dwelled regions where the first overt decision was made. . Background: Recent studies in mammography show that the first overt decision (TP or FP) has an influence on further image reading including the correctness of the following decisions. Furthermore, the correlation between the spatial frequency properties of the local background following decision sites and the first decision correctness has been reported. Methods: Subjects with different radiological experience were eye tracked during detection of pulmonary nodules from PA chest radiographs. Number of outcomes and the overall quality of performance are analysed in terms of the cases where correct or incorrect decisions were made. JAFROC methodology is applied. The spatial frequency properties of selected local backgrounds related to a certain decisions were studied. ANOVA was used to compare the logarithmic values of energy carried by non redundant stationary wavelet packet coefficients. Results: A strong correlation has been found between the number of TP as a first decision and the JAFROC score (r = 0.74). The number of FP as a first decision was found negatively correlated with JAFROC (r = -0.75). Moreover, the differential spatial frequency profiles outcomes depend on the first choice correctness.

Does electronic clinical microbiology results reporting influence medical decision making: a pre- and post-interview study of medical specialists.

PubMed

Bruins, Marjan J; Ruijs, Gijs J H M; Wolfhagen, Maurice J H M; Bloembergen, Peter; Aarts, Jos E C M

2011-03-30

Clinicians view the accuracy of test results and the turnaround time as the two most important service aspects of the clinical microbiology laboratory. Because of the time needed for the culturing of infectious agents, final hardcopy culture results will often be available too late to have a significant impact on early antimicrobial therapy decisions, vital in infectious disease management. The clinical microbiologist therefore reports to the clinician clinically relevant preliminary results at any moment during the diagnostic process, mostly by telephone. Telephone reporting is error prone, however. Electronic reporting of culture results instead of reporting on paper may shorten the turnaround time and may ensure correct communication of results. The purpose of this study was to assess the impact of the implementation of electronic reporting of final microbiology results on medical decision making. In a pre- and post-interview study using a semi-structured design we asked medical specialists in our hospital about their use and appreciation of clinical microbiology results reporting before and after the implementation of an electronic reporting system. Electronic reporting was highly appreciated by all interviewed clinicians. Major advantages were reduction of hardcopy handling and the possibility to review results in relation to other patient data. Use and meaning of microbiology reports differ significantly between medical specialties. Most clinicians need preliminary results for therapy decisions quickly. Therefore, after the implementation of electronic reporting, telephone consultation between clinician and microbiologist remained the key means of communication. Overall, electronic reporting increased the workflow efficiency of the medical specialists, but did not have an impact on their decision-making. © 2011 Bruins et al; licensee BioMed Central Ltd.

Development of an English-language version of a Japanese iPad application to facilitate collaborative goal setting in rehabilitation: a Delphi study and field test

PubMed Central

Tomori, Kounosuke; Takahashi, Kayoko; Sherrington, Aidan J

2018-01-01

Objective This study aimed to investigate the content of an English-language version of a Japanese iPad application designed to facilitate shared decision-making around goal setting in rehabilitation: Aid for Decision-making in Occupational Choice—English (ADOC-E). Design Phase 1: Delphi methods to reach consensus with an international group of expert occupational therapists on the text and images in ADOC-E. Phase 2: Testing correct recognition (unprompted and prompted) of images in ADOC-E by health service users in inpatient rehabilitation and residential care. Setting Phase 1: International, online. Phase 2: Three healthcare services in New Zealand—(1) a residential rehabilitation service for traumatic brain injury, (2) a nursing home for frail older adults and (3) an inpatient rehabilitation ward in a public hospital. Participants Phase 1: Fourteen experienced occupational therapists from New Zealand (4), Australia (4), UK (2) and USA (4). Phase 2: Twenty-four rehabilitation and residential care service users (10 men, 14 women; 20–95 years; Mini-Mental State Exam scores 13–30). Results Four Delphi rounds were required to reach consensus with the experienced occupational therapists on the content of ADOC-E, ending with 100 items covering daily activities that people do and social roles they participate in. Ninety-five per cent (95/100) of ADOC-E items could each be correctly identified by over 80% of service user participants with either unprompted or prompted recognition. Conclusion While a few of the more abstract concepts in ADOC-E (related to complex social roles) were less likely to be correctly recognised by all participants, the text and images ADOC-E were deemed to be fit for purpose overall and ready for future clinical testing. PMID:29500204

An evidence-based approach to the creation of normative data: base rates of impaired scores within a brief neuropsychological battery argue for age corrections, but against corrections for medical conditions.

PubMed

O'Connell, Megan E; Tuokko, Holly; Voll, Stacey; Simard, Martine; Griffith, Lauren E; Taler, Vanessa; Wolfson, Christina; Kirkland, Susan; Raina, Parminder

We detail a new approach to the creation of normative data for neuropsychological tests. The traditional approach to normative data creation is to make demographic adjustments based on observations of correlations between single neuropsychological tests and selected demographic variables. We argue, however, that this does not describe the implications for clinical practice, such as increased likelihood of misclassification of cognitive impairment, nor does it elucidate the impact on decision-making with a neuropsychological battery. We propose base rate analyses; specifically, differential base rates of impaired scores between theoretical and actual base rates as the basis for decisions to create demographic adjustments within normative data. Differential base rates empirically describe the potential clinical implications of failing to create an appropriate normative group. We demonstrate this approach with data from a short telephone-administered neuropsychological battery given to a large, neurologically healthy sample aged 45-85 years old. We explored whether adjustments for age and medical conditions were warranted based on differential base rates of spuriously impaired scores. Theoretical base rates underestimated the frequency of impaired scores in older adults and overestimated the frequency of impaired scores in younger adults, providing an evidence base for the creation of age-corrected normative data. In contrast, the number of medical conditions (numerous cardiovascular, hormonal, and metabolic conditions) was not related to differential base rates of impaired scores. Despite a small correlation between number of medical conditions and each neuropsychological variable, normative adjustments for number of medical conditions does not appear warranted. Implications for creation of normative data are discussed.

Vitamin-Fortified Snack Food May Lead Consumers to Make Poor Dietary Decisions.

PubMed

Verrill, Linda; Wood, Dallas; Cates, Sheryl; Lando, Amy; Zhang, Yuanting

2017-03-01

The US Food and Drug Administration's (FDA's) fortification policy discourages the fortification of certain foods, including sugars and snack foods such as cookies, candies, cakes, chips, and carbonated beverages, yet manufacturers sometimes add vitamins and minerals to snack foods. To assess whether vitamin-fortified snack foods affect consumers' information-seeking, purchase decisions, and product-related health perceptions. For this experimental study, participants were randomly assigned to study conditions to compare products that varied in product type, nutrition profile, and fortification and nutrient claim status. Data were collected via an online consumer panel. US adults aged 18 years and older were randomly selected from Research Now's e-panel online household panel. Data were collected during fall 2014 (N=5,076). Participants were randomly assigned to one of 24 conditions: two products (vegetable chip/potato chip), two nutrition profiles (healthier/less healthy), two fortification scenarios (not fortified/fortified), and three nutrient claim conditions (two no claim/one with claim). The design was not balanced; claims were not shown on products that were not vitamin fortified. Outcome measures were information-seeking (viewed the Nutrition Facts label), purchase decisions, perception of product healthfulness, and correct selection of product with the healthier nutrient profile. Logistic regression was used to test all models. Analyses was adjusted for general label use, consumes product, health status, age, sex, level of education, presence of children in the household, and race/ethnicity. When the snack food carried a nutrient claim for vitamin fortification, participants were 1) less likely to look for nutrition information on the Nutrition Facts label, 2) more likely to select the product for purchase, 3) more likely to perceive the product as healthier, and 4) less likely to correctly choose the healthier product. Snack foods that have been vitamin-fortified may cause consumers to make poor dietary decisions. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Impact of web searching and social feedback on consumer decision making: a prospective online experiment.

PubMed

Lau, Annie Y S; Coiera, Enrico W

2008-01-22

The World Wide Web has increasingly become an important source of information in health care consumer decision making. However, little is known about whether searching online resources actually improves consumers' understanding of health issues. The aim was to study whether searching on the World Wide Web improves consumers' accuracy in answering health questions and whether consumers' understanding of health issues is subject to further change under social feedback. This was a pre/post prospective online study. A convenience sample of 227 undergraduate students was recruited from the population of the University of New South Wales. Subjects used a search engine that retrieved online documents from PubMed, MedlinePlus, and HealthInsite and answered a set of six questions (before and after use of the search engine) designed for health care consumers. They were then presented with feedback consisting of a summary of the post-search answers provided by previous subjects for the same questions and were asked to answer the questions again. There was an improvement in the percentage of correct answers after searching (pre-search 61.2% vs post-search 82.0%, P <.001) and after feedback with other subjects' answers (pre-feedback 82.0% vs post-feedback 85.3%, P =.051). The proportion of subjects with highly confident correct answers (ie, confident or very confident) and the proportion with highly confident incorrect answers significantly increased after searching (correct pre-search 61.6% vs correct post-search 95.5%, P <.001; incorrect pre-search 55.3% vs incorrect post-search 82.0%, P <.001). Subjects who were not as confident in their post-search answers were 28.5% more likely than those who were confident or very confident to change their answer after feedback with other subjects' post-search answers (chi(2) (1)= 66.65, P <.001). Searching across quality health information sources on the Web can improve consumers' accuracy in answering health questions. However, a consumer's confidence in an answer is not a good indicator of the answer being correct. Consumers who are not confident in their answers after searching are more likely to be influenced to change their views when provided with feedback from other consumers.

New auto-segment method of cerebral hemorrhage

NASA Astrophysics Data System (ADS)

Wang, Weijiang; Shen, Tingzhi; Dang, Hua

2007-12-01

A novel method for Computerized tomography (CT) cerebral hemorrhage (CH) image automatic segmentation is presented in the paper, which uses expert system that models human knowledge about the CH automatic segmentation problem. The algorithm adopts a series of special steps and extracts some easy ignored CH features which can be found by statistic results of mass real CH images, such as region area, region CT number, region smoothness and some statistic CH region relationship. And a seven steps' extracting mechanism will ensure these CH features can be got correctly and efficiently. By using these CH features, a decision tree which models the human knowledge about the CH automatic segmentation problem has been built and it will ensure the rationality and accuracy of the algorithm. Finally some experiments has been taken to verify the correctness and reasonable of the automatic segmentation, and the good correct ratio and fast speed make it possible to be widely applied into practice.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 541: Small Boy Nevada National Security Site and Nevada Test and Training Range, Nevada, Revision 0 with ROTC-1

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

Kidman, Raymond; Matthews, Patrick

The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 541 based on the no further action alternative listed in Table ES-1.

[Cost-effectiveness of new drugs impacts reimbursement decision making but room for improvement].

PubMed

Hoomans, Ties; van der Roer, Nicole; Severens, Johan L; Delwel, Gepke O

2010-01-01

For new drugs to be included in appendix 1B of the drug reimbursement system, they must have proven added therapeutic value, an acceptable budget impact, and be cost-effective. To validate the latter, pharmacoeconomic evaluations have become mandatory. These evaluations should adhere to guidelines for pharmacoeconomic research. Our study evaluates: 1) the extent to which the pharmacoeconomic evaluations adherence pharmacoeconomic guidelines; 2) which guidelines are decisive in evaluating the validation of cost-effectiveness of new drugs; and 3) the impact of pharmacoeconomics in the recommendations and final decision making on drug reimbursement. Retrospective, descriptive study. We examined all 1B requests for reimbursement submitted to the Dutch Health Care Insurance Board and the Medicinal Products Reimbursement Committee between 1 January 2005 and 30 September 2008, and on which recommendations on drug reimbursement have been published (n = 21). Data on adherence to guidelines, validation of cost-effectiveness, and recommendations and decision making on drug reimbursement were extracted from publicly available sources by two independent evaluators. Quantitatively and qualitatively descriptive analyses were carried out. Since pharmacoeconomic evaluations have become mandatory, these evaluations increasingly adhere to guidelines for pharmacoeconomic research. This was particularly true of the perspective chosen, the relevant treatment comparator and the incremental and total analyses of costs and effects of the drugs under comparison. However, cost-effectiveness of new drugs was often inadequately validated by incorrect indications for drug use, and incorrect forms of evaluation or periods of analysis. In addition, costs and effects were not always correctly analysed, nor and not enough insight was provided into the analysis model used. Partially on the basis of pharmacoeconomics, 12 new drugs are reimbursed and 9 not. Cost-effectiveness of new drugs and more valid pharmacoeconomic evaluations appear to play an ever more important role in reimbursement decision making and the pursuit of better and affordable health care.

Towards policy relevant environmental modeling: contextual validity and pragmatic models

USGS Publications Warehouse

Miles, Scott B.

2000-01-01

"What makes for a good model?" In various forms, this question is a question that, undoubtedly, many people, businesses, and institutions ponder with regards to their particular domain of modeling. One particular domain that is wrestling with this question is the multidisciplinary field of environmental modeling. Examples of environmental models range from models of contaminated ground water flow to the economic impact of natural disasters, such as earthquakes. One of the distinguishing claims of the field is the relevancy of environmental modeling to policy and environment-related decision-making in general. A pervasive view by both scientists and decision-makers is that a "good" model is one that is an accurate predictor. Thus, determining whether a model is "accurate" or "correct" is done by comparing model output to empirical observations. The expected outcome of this process, usually referred to as "validation" or "ground truthing," is a stamp on the model in question of "valid" or "not valid" that serves to indicate whether or not the model will be reliable before it is put into service in a decision-making context. In this paper, I begin by elaborating on the prevailing view of model validation and why this view must change. Drawing from concepts coming out of the studies of science and technology, I go on to propose a contextual view of validity that can overcome the problems associated with "ground truthing" models as an indicator of model goodness. The problem of how we talk about and determine model validity has much to do about how we perceive the utility of environmental models. In the remainder of the paper, I argue that we should adopt ideas of pragmatism in judging what makes for a good model and, in turn, developing good models. From such a perspective of model goodness, good environmental models should facilitate communication, convey—not bury or "eliminate"—uncertainties, and, thus, afford the active building of consensus decisions, instead of promoting passive or self-righteous decisions.

First- and second-language phonological representations in the mental lexicon.

PubMed

Sebastian-Gallés, Núria; Rodríguez-Fornells, Antoni; de Diego-Balaguer, Ruth; Díaz, Begoña

2006-08-01

Performance-based studies on the psychological nature of linguistic competence can conceal significant differences in the brain processes that underlie native versus nonnative knowledge of language. Here we report results from the brain activity of very proficient early bilinguals making a lexical decision task that illustrates this point. Two groups of Spanish-Catalan early bilinguals (Spanish-dominant and Catalan-dominant) were asked to decide whether a given form was a Catalan word or not. The nonwords were based on real words, with one vowel changed. In the experimental stimuli, the vowel change involved a Catalan-specific contrast that previous research had shown to be difficult for Spanish natives to perceive. In the control stimuli, the vowel switch involved contrasts common to Spanish and Catalan. The results indicated that the groups of bilinguals did not differ in their behavioral and event-related brain potential measurements for the control stimuli; both groups made very few errors and showed a larger N400 component for control nonwords than for control words. However, significant differences were observed for the experimental stimuli across groups: Specifically, Spanish-dominant bilinguals showed great difficulty in rejecting experimental nonwords. Indeed, these participants not only showed very high error rates for these stimuli, but also did not show an error-related negativity effect in their erroneous nonword decisions. However, both groups of bilinguals showed a larger correct-related negativity when making correct decisions about the experimental nonwords. The results suggest that although some aspects of a second language system may show a remarkable lack of plasticity (like the acquisition of some foreign contrasts), first-language representations seem to be more dynamic in their capacity of adapting and incorporating new information.

Robust sampling of decision information during perceptual choice

PubMed Central

Vandormael, Hildward; Herce Castañón, Santiago; Balaguer, Jan; Li, Vickie; Summerfield, Christopher

2017-01-01

Humans move their eyes to gather information about the visual world. However, saccadic sampling has largely been explored in paradigms that involve searching for a lone target in a cluttered array or natural scene. Here, we investigated the policy that humans use to overtly sample information in a perceptual decision task that required information from across multiple spatial locations to be combined. Participants viewed a spatial array of numbers and judged whether the average was greater or smaller than a reference value. Participants preferentially sampled items that were less diagnostic of the correct answer (“inlying” elements; that is, elements closer to the reference value). This preference to sample inlying items was linked to decisions, enhancing the tendency to give more weight to inlying elements in the final choice (“robust averaging”). These findings contrast with a large body of evidence indicating that gaze is directed preferentially to deviant information during natural scene viewing and visual search, and suggest that humans may sample information “robustly” with their eyes during perceptual decision-making. PMID:28223519

Stimulation of dopamine D₁ receptor improves learning capacity in cooperating cleaner fish.

PubMed

Messias, João P M; Santos, Teresa P; Pinto, Maria; Soares, Marta C

2016-01-27

Accurate contextual decision-making strategies are important in social environments. Specific areas in the brain are tasked to process these complex interactions and generate correct follow-up responses. The dorsolateral and dorsomedial parts of the telencephalon in the teleost fish brain are neural substrates modulated by the neurotransmitter dopamine (DA), and are part of an important neural circuitry that drives animal behaviour from the most basic actions such as learning to search for food, to properly choosing partners and managing decisions based on context. The Indo-Pacific cleaner wrasse Labroides dimidiatus is a highly social teleost fish species with a complex network of interactions with its 'client' reef fish. We asked if changes in DA signalling would affect individual learning ability by presenting cleaner fish two ecologically different tasks that simulated a natural situation requiring accurate decision-making. We demonstrate that there is an involvement of the DA system and D1 receptor pathways on cleaners' natural abilities to learn both tasks. Our results add significantly to the growing literature on the physiological mechanisms that underlie and facilitate the expression of cooperative abilities. © 2016 The Author(s).

Visual attention in a complex search task differs between honeybees and bumblebees.

PubMed

Morawetz, Linde; Spaethe, Johannes

2012-07-15

Mechanisms of spatial attention are used when the amount of gathered information exceeds processing capacity. Such mechanisms have been proposed in bees, but have not yet been experimentally demonstrated. We provide evidence that selective attention influences the foraging performance of two social bee species, the honeybee Apis mellifera and the bumblebee Bombus terrestris. Visual search tasks, originally developed for application in human psychology, were adapted for behavioural experiments on bees. We examined the impact of distracting visual information on search performance, which we measured as error rate and decision time. We found that bumblebees were significantly less affected by distracting objects than honeybees. Based on the results, we conclude that the search mechanism in honeybees is serial like, whereas in bumblebees it shows the characteristics of a restricted parallel-like search. Furthermore, the bees differed in their strategy to solve the speed-accuracy trade-off. Whereas bumblebees displayed slow but correct decision-making, honeybees exhibited fast and inaccurate decision-making. We propose two neuronal mechanisms of visual information processing that account for the different responses between honeybees and bumblebees, and we correlate species-specific features of the search behaviour to differences in habitat and life history.

Mechano-logical model of C. elegans germ line suggests feedback on the cell cycle

PubMed Central

Atwell, Kathryn; Qin, Zhao; Gavaghan, David; Kugler, Hillel; Hubbard, E. Jane Albert; Osborne, James M.

2015-01-01

The Caenorhabditis elegans germ line is an outstanding model system in which to study the control of cell division and differentiation. Although many of the molecules that regulate germ cell proliferation and fate decisions have been identified, how these signals interact with cellular dynamics and physical forces within the gonad remains poorly understood. We therefore developed a dynamic, 3D in silico model of the C. elegans germ line, incorporating both the mechanical interactions between cells and the decision-making processes within cells. Our model successfully reproduces key features of the germ line during development and adulthood, including a reasonable ovulation rate, correct sperm count, and appropriate organization of the germ line into stably maintained zones. The model highlights a previously overlooked way in which germ cell pressure may influence gonadogenesis, and also predicts that adult germ cells might be subject to mechanical feedback on the cell cycle akin to contact inhibition. We provide experimental data consistent with the latter hypothesis. Finally, we present cell trajectories and ancestry recorded over the course of a simulation. The novel approaches and software described here link mechanics and cellular decision-making, and are applicable to modeling other developmental and stem cell systems. PMID:26428008

Subconscious Visual Cues during Movement Execution Allow Correct Online Choice Reactions

PubMed Central

Leukel, Christian; Lundbye-Jensen, Jesper; Christensen, Mark Schram; Gollhofer, Albert; Nielsen, Jens Bo; Taube, Wolfgang

2012-01-01

Part of the sensory information is processed by our central nervous system without conscious perception. Subconscious processing has been shown to be capable of triggering motor reactions. In the present study, we asked the question whether visual information, which is not consciously perceived, could influence decision-making in a choice reaction task. Ten healthy subjects (28±5 years) executed two different experimental protocols. In the Motor reaction protocol, a visual target cue was shown on a computer screen. Depending on the displayed cue, subjects had to either complete a reaching movement (go-condition) or had to abort the movement (stop-condition). The cue was presented with different display durations (20–160 ms). In the second Verbalization protocol, subjects verbalized what they experienced on the screen. Again, the cue was presented with different display durations. This second protocol tested for conscious perception of the visual cue. The results of this study show that subjects achieved significantly more correct responses in the Motor reaction protocol than in the Verbalization protocol. This difference was only observed at the very short display durations of the visual cue. Since correct responses in the Verbalization protocol required conscious perception of the visual information, our findings imply that the subjects performed correct motor responses to visual cues, which they were not conscious about. It is therefore concluded that humans may reach decisions based on subconscious visual information in a choice reaction task. PMID:23049749

Reducing risk and increasing confidence of decision making at a lower cost: In-situ pXRF assessment of metal-contaminated sites.

PubMed

Rouillon, Marek; Taylor, Mark P; Dong, Chenyin

2017-10-01

This study evaluates the in-situ use of field portable X-ray Fluorescence (pXRF) for metal-contaminated site assessments, and assesses the advantages of increased sampling to reduce risk, and increase confidence of decision making at a lower cost. Five metal-contaminated sites were assessed using both in-situ pXRF and ex-situ inductively coupled plasma mass spectrometry (ICP-MS) analyses at various sampling resolutions. Twenty second in-situ pXRF measurements of Mn, Zn and Pb were corrected using a subset of parallel ICP-MS measurements taken at each site. Field and analytical duplicates revealed sampling as the major contributor (>95% variation) to measurement uncertainties. This study shows that increased sampling led to several benefits including more representative site characterisation, higher soil-metal mapping resolution, reduced uncertainty around the site mean, and reduced sampling uncertainty. Real time pXRF data enabled efficient, on-site decision making for further judgemental sampling, without the need to return to the site. Additionally, in-situ pXRF was more cost effective than the current approach of ex-situ sampling and ICP-MS analysis, even with higher sampling at each site. Lastly, a probabilistic site assessment approach was applied to demonstrate the advantages of integrating estimated measurement uncertainties into site reporting. Copyright © 2017 Elsevier Ltd. All rights reserved.

Using statistical process control to make data-based clinical decisions.

PubMed

Pfadt, A; Wheeler, D J

1995-01-01

Applied behavior analysis is based on an investigation of variability due to interrelationships among antecedents, behavior, and consequences. This permits testable hypotheses about the causes of behavior as well as for the course of treatment to be evaluated empirically. Such information provides corrective feedback for making data-based clinical decisions. This paper considers how a different approach to the analysis of variability based on the writings of Walter Shewart and W. Edwards Deming in the area of industrial quality control helps to achieve similar objectives. Statistical process control (SPC) was developed to implement a process of continual product improvement while achieving compliance with production standards and other requirements for promoting customer satisfaction. SPC involves the use of simple statistical tools, such as histograms and control charts, as well as problem-solving techniques, such as flow charts, cause-and-effect diagrams, and Pareto charts, to implement Deming's management philosophy. These data-analytic procedures can be incorporated into a human service organization to help to achieve its stated objectives in a manner that leads to continuous improvement in the functioning of the clients who are its customers. Examples are provided to illustrate how SPC procedures can be used to analyze behavioral data. Issues related to the application of these tools for making data-based clinical decisions and for creating an organizational climate that promotes their routine use in applied settings are also considered.

Electrophysiological distinctions between recognition memory with and without awareness

PubMed Central

Ko, Philip C.; Duda, Bryant; Hussey, Erin P.; Ally, Brandon A.

2013-01-01

The influence of implicit memory representations on explicit recognition may help to explain cases of accurate recognition decisions made with high uncertainty. During a recognition task, implicit memory may enhance the fluency of a test item, biasing decision processes to endorse it as “old”. This model may help explain recognition-without-identification, a remarkable phenomenon in which participants make highly accurate recognition decisions despite the inability to identify the test item. The current study investigated whether recognition-without-identification for pictures elicits a similar pattern of neural activity as other types of accurate recognition decisions made with uncertainty. Further, this study also examined whether recognition-without-identification for pictures could be attained by the use of perceptual and conceptual information from memory. To accomplish this, participants studied pictures and then performed a recognition task under difficult viewing conditions while event-related potentials (ERPs) were recorded. Behavioral results showed that recognition was highly accurate even when test items could not be identified, demonstrating recognition-without identification. The behavioral performance also indicated that recognition-without-identification was mediated by both perceptual and conceptual information, independently of one another. The ERP results showed dramatically different memory related activity during the early 300 to 500 ms epoch for identified items that were studied compared to unidentified items that were studied. Similar to previous work highlighting accurate recognition without retrieval awareness, test items that were not identified, but correctly endorsed as “old,” elicited a negative posterior old/new effect (i.e., N300). In contrast, test items that were identified and correctly endorsed as “old,” elicited the classic positive frontal old/new effect (i.e., FN400). Importantly, both of these effects were elicited under conditions when participants used perceptual information to make recognition decisions. Conceptual information elicited very different ERPs than perceptual information, showing that the informational wealth of pictures can evoke multiple routes to recognition even without awareness of memory retrieval. These results are discussed within the context of current theories regarding the N300 and the FN400. PMID:23287567

Clinical decision-making about inpatient violence risk at admission to a public-sector acute psychiatric hospital.

PubMed

Newton, Virginia M; Elbogen, Eric B; Brown, Carrie L; Snyder, Jennifer; Barrick, Ann Louise

2012-01-01

This is an examination of the extent to which patients who are violent in the hospital can be distinguished from nonviolent patients, based on information that is readily available at the time of admission to a state acute psychiatric hospital. The charts of 235 inpatients were examined retrospectively, by selecting 103 patients who had engaged in inpatient violence and comparing them with 132 randomly selected patients who had not during the same period. Data were gathered from initial psychiatric assessment and admissions face sheets in patients' charts, reflecting information available to a mental health professional within the first 24 hours of a patient's admission. Multivariate analysis showed that violent and nonviolent patients were distinguished by diagnosis, age, gender, estimated intelligence, psychiatric history, employment history, living situation, and agitated behavior. These factors led to an 80 percent correct classification of violent patients and thus may assist clinicians to structure decision-making about the risk of inpatient violence.

New paradoxes of risky decision making.

PubMed

Birnbaum, Michael H

2008-04-01

During the last 25 years, prospect theory and its successor, cumulative prospect theory, replaced expected utility as the dominant descriptive theories of risky decision making. Although these models account for the original Allais paradoxes, 11 new paradoxes show where prospect theories lead to self-contradiction or systematic false predictions. The new findings are consistent with and, in several cases, were predicted in advance by simple "configural weight" models in which probability-consequence branches are weighted by a function that depends on branch probability and ranks of consequences on discrete branches. Although they have some similarities to later models called "rank-dependent utility," configural weight models do not satisfy coalescing, the assumption that branches leading to the same consequence can be combined by adding their probabilities. Nor do they satisfy cancellation, the "independence" assumption that branches common to both alternatives can be removed. The transfer of attention exchange model, with parameters estimated from previous data, correctly predicts results with all 11 new paradoxes. Apparently, people do not frame choices as prospects but, instead, as trees with branches.

Diagnostic Reasoning using Prognostic Information for Unmanned Aerial Systems

NASA Technical Reports Server (NTRS)

Schumann, Johann; Roychoudhury, Indranil; Kulkarni, Chetan

2015-01-01

With increasing popularity of unmanned aircraft, continuous monitoring of their systems, software, and health status is becoming more and more important to ensure safe, correct, and efficient operation and fulfillment of missions. The paper presents integration of prognosis models and prognostic information with the R2U2 (REALIZABLE, RESPONSIVE, and UNOBTRUSIVE Unit) monitoring and diagnosis framework. This integration makes available statistically reliable health information predictions of the future at a much earlier time to enable autonomous decision making. The prognostic information can be used in the R2U2 model to improve diagnostic accuracy and enable decisions to be made at the present time to deal with events in the future. This will be an advancement over the current state of the art, where temporal logic observers can only do such valuation at the end of the time interval. Usefulness and effectiveness of this integrated diagnostics and prognostics framework was demonstrated using simulation experiments with the NASA Dragon Eye electric unmanned aircraft.

Advanced driver assistance system: Road sign identification using VIAPIX system and a correlation technique

NASA Astrophysics Data System (ADS)

Ouerhani, Y.; Alfalou, A.; Desthieux, M.; Brosseau, C.

2017-02-01

We present a three-step approach based on the commercial VIAPIX® module for road traffic sign recognition and identification. Firstly, detection in a scene of all objects having characteristics of traffic signs is performed. This is followed by a first-level recognition based on correlation which consists in making a comparison between each detected object with a set of reference images of a database. Finally, a second level of identification allows us to confirm or correct the previous identification. In this study, we perform a correlation-based analysis by combining and adapting the Vander Lugt correlator with the nonlinear joint transformation correlator (JTC). Of particular significance, this approach permits to make a reliable decision on road traffic sign identification. We further discuss a robust scheme allowing us to track a detected road traffic sign in a video sequence for the purpose of increasing the decision performance of our system. This approach can have broad practical applications in the maintenance and rehabilitation of transportation infrastructure, or for drive assistance.

A hybrid fuzzy-ontology based intelligent system to determine level of severity and treatment recommendation for Benign Prostatic Hyperplasia.

PubMed

Torshizi, Abolfazl Doostparast; Zarandi, Mohammad Hossein Fazel; Torshizi, Ghazaleh Doostparast; Eghbali, Kamyar

2014-01-01

This paper deals with application of fuzzy intelligent systems in diagnosing severity level and recommending appropriate therapies for patients having Benign Prostatic Hyperplasia. Such an intelligent system can have remarkable impacts on correct diagnosis of the disease and reducing risk of mortality. This system captures various factors from the patients using two modules. The first module determines severity level of the Benign Prostatic Hyperplasia and the second module, which is a decision making unit, obtains output of the first module accompanied by some external knowledge and makes an appropriate treatment decision based on its ontology model and a fuzzy type-1 system. In order to validate efficiency and accuracy of the developed system, a case study is conducted by 44 participants. Then the results are compared with the recommendations of a panel of experts on the experimental data. Then precision and accuracy of the results were investigated based on a statistical analysis. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Students academic performance based on behavior

NASA Astrophysics Data System (ADS)

Maulida, Juwita Dien; Kariyam

2017-12-01

Utilization of data in an information system that can be used for decision making that utilizes existing data warehouse to help dig useful information to make decisions correctly and accurately. Experience API (xAPI) is one of the enabling technologies for collecting data, so xAPI can be used as a data warehouse that can be used for various needs. One software application whose data is collected in xAPI is LMS. LMS is a software used in an electronic learning process that can handle all aspects of learning, by using LMS can also be known how the learning process and the aspects that can affect learning achievement. One of the aspects that can affect the learning achievement is the background of each student, which is not necessarily the student with a good background is an outstanding student or vice versa. Therefore, an action is needed to anticipate this problem. Prediction of student academic performance using Naive Bayes algorithm obtained accuracy of 67.7983% and error 32.2917%.

Implementation of shared decision-making in oncology: development and pilot study of a nurse-led decision-coaching programme for women with ductal carcinoma in situ.

PubMed

Berger-Höger, Birte; Liethmann, Katrin; Mühlhauser, Ingrid; Steckelberg, Anke

2017-12-06

To implement informed shared decision-making (ISDM) in breast care centres, we developed and piloted an inter-professional complex intervention. We developed an intervention consisting of three components: an evidence-based patient decision aid (DA) for women with ductal carcinoma in situ, a decision-coaching led by specialised nurses (breast care nurses and oncology nurses) and structured physician encounters. In order to enable professionals to gain ISDM competencies, we developed and tested a curriculum-based training programme for specialised nurses and a workshop for physicians. After successful testing of the components, we conducted a pilot study to test the feasibility of the entire revised intervention in two breast care centres. Here the acceptance of the intervention by women and professionals, the applicability to the breast care centres' procedures, women's knowledge, patient involvement in treatment decision-making assessed with the MAPPIN'SDM-observer instrument MAPPIN'O dyad, and barriers to and facilitators of the implementation were taken into consideration. We used questionnaires, structured verbal and written feedback and video recordings. Qualitative data were analysed descriptively, and mean values and ranges of quantitative data were calculated. To test the DA, focus groups and individual interviews were conducted with 27 women. Six expert reviews were obtained. The components of the nurse training were tested with 18 specialised nurses and 19 health science students. The development and piloting of the components were successful. The pilot test of the entire intervention included seven patients. In general, the intervention is applicable. Patients attained adequate knowledge (range of correct answers: 9-11 of 11). On average, a basic level of patient involvement in treatment decision-making was observed for nurses and patient-nurse dyads (M(MAPPIN-O dyad ): 2.15 and M(MAPPIN-O nurse ): 1.90). Relevant barriers were identified; physicians barely tolerated women's preferences that were not in line with the medical recommendation. Classifying women as inappropriate for ISDM due to age or education led physicians to neglect eligible women during the recruitment phase. Decision-coaching is feasible. Nevertheless, there are some indications that structural changes are needed for long-term implementation. We are currently evaluating the intervention in a cluster randomised controlled trial in 16 breast care centres.

Many facets of reluctance: African Americans and the decision (not) to donate organs.

PubMed Central

Morgan, Susan E.

2006-01-01

Although the body of research on African Americans and organ donation continues to grow, the literature still suffers from a lack of reliance on theory to guide research as well as a surfeit of advanced statistical analytical strategies. A more sophisticated approach to understanding the barriers and facilitating factors that African Americans experience in the process of making the decision to become potential organ donors would yield more sound campaign strategies to increase donation. In this study, a sample of 310 African-American adult members of the NAACP was surveyed about their attitudes, knowledge and beliefs about organ donation. Logistic regression demonstrated that the level of knowledge, attitudes, social norms and altruism resulted in correct classification of organ donor card status in 69.3% of cases. When variables such as medical mistrust, bodily integrity and religiosity were added, an even more powerful model resulted, with 73.2% of the cases correctly classified according to organ donor card status. Recommendations for campaigns targeting African Americans' willingness to donate organs are offered. PMID:16749644

Diagnosing pulmonary embolisms: the clinician's point of view.

PubMed

Carrillo Alcaraz, A; Martínez, A López; Solano, F J Sotos

Pulmonary thromboembolism is common and potentially severe. To ensure the correct approach to the diagnostic workup of pulmonary thromboembolism, it is essential to know the basic concepts governing the use of the different tests available. The diagnostic approach to pulmonary thromboembolism is an example of the application of the conditional probabilities of Bayes' theorem in daily practice. To interpret the available diagnostic tests correctly, it is necessary to analyze different concepts that are fundamental for decision making. Thus, it is necessary to know what the likelihood ratios, 95% confidence intervals, and decision thresholds mean. Whether to determine the D-dimer concentration or to do CT angiography or other imaging tests depends on their capacity to modify the pretest probability of having the disease to a posttest probability that is higher or lower than the thresholds for action. This review aims to clarify the diagnostic sequence of thromboembolic pulmonary disease, analyzing the main diagnostic tools (clinical examination, laboratory tests, and imaging tests), placing special emphasis on the principles that govern evidence-based medicine. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

The effects of aging on the speed-accuracy compromise: Boundary optimality in the diffusion model.

PubMed

Starns, Jeffrey J; Ratcliff, Roger

2010-06-01

We evaluated age-related differences in the optimality of decision boundary settings in a diffusion model analysis. In the model, the width of the decision boundary represents the amount of evidence that must accumulate in favor of a response alternative before a decision is made. Wide boundaries lead to slow but accurate responding, and narrow boundaries lead to fast but inaccurate responding. There is a single value of boundary separation that produces the most correct answers in a given period of time, and we refer to this value as the reward rate optimal boundary (RROB). We consistently found across a variety of decision tasks that older adults used boundaries that were much wider than the RROB value. Young adults used boundaries that were closer to the RROB value, although age differences in optimality were smaller with instructions emphasizing speed than with instructions emphasizing accuracy. Young adults adjusted their boundary settings to more closely approach the RROB value when they were provided with accuracy feedback and extensive practice. Older participants showed no evidence of making boundary adjustments in response to feedback or task practice, and they consistently used boundary separation values that produced accuracy levels that were near asymptote. Our results suggest that young adults attempt to balance speed and accuracy to achieve the most correct answers per unit time, whereas older adultts attempt to minimize errors even if they must respond quite slowly to do so. (c) 2010 APA, all rights reserved

Informed consent and moral integrity.

PubMed Central

Gillett, G R

1989-01-01

Informed consent is required for any medical procedure although the situations in which it is given are beset by uncertainties and indeterminacies. These make medicolegal scrutiny of such situations very difficult. Although some people find the decision in the Sidaway case incomprehensible because of its continuing regard for a 'professional practice standard' in informed consent, I will argue that an important fact in many cases is the moral integrity of the doctor concerned and the pattern of his practice. This may provide the only morally principled and legally accessible evidence enabling a correct decision to be made in a difficult case. Although the epistemological significance of a professional practice standard is thereby defended the 'prudent patient standard' for what counts as consent is left intact. PMID:2795625

Simple Additive Weighting to Diagnose Rabbit Disease

NASA Astrophysics Data System (ADS)

Ramadiani; Marissa, Dyna; Jundillah, Muhammad Labib; Azainil; Hatta, Heliza Rahmania

2018-02-01

Rabbit is one of the many pets maintained by the general public in Indonesia. Like other pet, rabbits are also susceptible to various diseases. Society in general does not understand correctly the type of rabbit disease and the way of treatment. To help care for sick rabbits it is necessary a decision support system recommendation diagnosis of rabbit disease. The purpose of this research is to make the application of rabbit disease diagnosis system so that can help user in taking care of rabbit. This application diagnoses the disease by tracing the symptoms and calculating the recommendation of the disease using Simple Additive Weighting method. This research produces a web-based decision support system that is used to help rabbit breeders and the general public.

[Advantages and disadvantages of femtosecond laser assisted LASIK and SMILE].

PubMed

Zhang, F J; Sun, M S

2018-01-11

With the development of excimer laser and femtosecond laser equipment, application of diversified and customized surgical decision in modern corneal refractive surgery has been an inevitable trend. However, how to make a personalized decision with an accurate surgical design to achieve better visual quality becomes the main focus in clinical applications. Small-incision lenticule extraction (SMILE) and femtosecond assisted laser in situ keratomileusis (FS-LASIK) have been commonly acknowledged as the mainstream of corneal refractive surgery for ametropia correction nowadays. Both methods have been verified by clinical practice for many years. This article compares and elaborates the different characteristics with advantages and disadvantages of the two methods so as to provide some reasonable treatment options for refractive surgery. (Chin J Ophthalmol, 2018, 54: 7-10) .

Hierarchical decision processes that operate over distinct timescales underlie choice and changes in strategy

PubMed Central

Purcell, Braden A.; Kiani, Roozbeh

2016-01-01

Decision-making in a natural environment depends on a hierarchy of interacting decision processes. A high-level strategy guides ongoing choices, and the outcomes of those choices determine whether or not the strategy should change. When the right decision strategy is uncertain, as in most natural settings, feedback becomes ambiguous because negative outcomes may be due to limited information or bad strategy. Disambiguating the cause of feedback requires active inference and is key to updating the strategy. We hypothesize that the expected accuracy of a choice plays a crucial rule in this inference, and setting the strategy depends on integration of outcome and expectations across choices. We test this hypothesis with a task in which subjects report the net direction of random dot kinematograms with varying difficulty while the correct stimulus−response association undergoes invisible and unpredictable switches every few trials. We show that subjects treat negative feedback as evidence for a switch but weigh it with their expected accuracy. Subjects accumulate switch evidence (in units of log-likelihood ratio) across trials and update their response strategy when accumulated evidence reaches a bound. A computational framework based on these principles quantitatively explains all aspects of the behavior, providing a plausible neural mechanism for the implementation of hierarchical multiscale decision processes. We suggest that a similar neural computation—bounded accumulation of evidence—underlies both the choice and switches in the strategy that govern the choice, and that expected accuracy of a choice represents a key link between the levels of the decision-making hierarchy. PMID:27432960

Hierarchical decision processes that operate over distinct timescales underlie choice and changes in strategy.

PubMed

Purcell, Braden A; Kiani, Roozbeh

2016-08-02

Decision-making in a natural environment depends on a hierarchy of interacting decision processes. A high-level strategy guides ongoing choices, and the outcomes of those choices determine whether or not the strategy should change. When the right decision strategy is uncertain, as in most natural settings, feedback becomes ambiguous because negative outcomes may be due to limited information or bad strategy. Disambiguating the cause of feedback requires active inference and is key to updating the strategy. We hypothesize that the expected accuracy of a choice plays a crucial rule in this inference, and setting the strategy depends on integration of outcome and expectations across choices. We test this hypothesis with a task in which subjects report the net direction of random dot kinematograms with varying difficulty while the correct stimulus-response association undergoes invisible and unpredictable switches every few trials. We show that subjects treat negative feedback as evidence for a switch but weigh it with their expected accuracy. Subjects accumulate switch evidence (in units of log-likelihood ratio) across trials and update their response strategy when accumulated evidence reaches a bound. A computational framework based on these principles quantitatively explains all aspects of the behavior, providing a plausible neural mechanism for the implementation of hierarchical multiscale decision processes. We suggest that a similar neural computation-bounded accumulation of evidence-underlies both the choice and switches in the strategy that govern the choice, and that expected accuracy of a choice represents a key link between the levels of the decision-making hierarchy.

Decision making under uncertainty and mood induction: further evidence for liberal acceptance in schizophrenia.

PubMed

Moritz, S; Veckenstedt, R; Randjbar, S; Hottenrott, B; Woodward, T S; von Eckstaedt, F V; Schmidt, C; Jelinek, L; Lincoln, T M

2009-11-01

Cognitive biases, especially jumping to conclusions (JTC), are ascribed a vital role in the pathogenesis of schizophrenia. This study set out to explore motivational factors for JTC using a newly developed paradigm. Twenty-seven schizophrenia patients and 32 healthy controls were shown 15 classical paintings, divided into three blocks. Four alternative titles (one correct and three lure titles) had to be appraised according to plausibility (0-10). Optionally, participants could decide for one option and reject one or more alternatives. In random order across blocks, anxiety-evoking music, happy music or no music was played in the background. Patients with schizophrenia, particularly those with delusions, made more decisions than healthy subjects. In line with the liberal acceptance (LA) account of schizophrenia, the decision threshold was significantly lowered in patients relative to controls. Patients were also more prone than healthy controls to making a decision when the distance between the first and second best alternative was close. Furthermore, implausible alternatives were judged as significantly more plausible by patients. Anxiety-evoking music resulted in more decisions in currently deluded patients relative to non-deluded patients and healthy controls. The results confirm predictions derived from the LA account and assert that schizophrenia patients decide hastily under conditions of continued uncertainty. The fact that mood induction did not exert an overall effect could be due to the explicit nature of the manipulation, which might have evoked strategies to counteract their influence.

Nurses' Responses and Reactions to an Emergent Pediatric Simulation Exercise.

PubMed

Hoffman, Kenneth; von Sadovszky, Victoria

Pediatric nurses' responses and reactions in emergent simulations are understudied. Using authority gradient theory as a guide, the purpose of this study was to examine nurses' reactions during an emergency simulation exercise when directed to give an incorrect medication dose. Ten groups of noncritical care nurses were videotaped from the beginning of the simulation through debriefing. Although errors were made during the simulation event, all groups responded correctly during debriefing, indicating that authority gradient may play a role in clinical decision-making.

Comments on: blood product transfusion in emergency department patients: a case control study of practice patterns and impact on outcome.

PubMed

Karami, Manoochehr; Khazaei, Salman

2017-12-06

Clinical decision makings according studies result require the valid and correct data collection, andanalysis. However, there are some common methodological and statistical issues which may ignore by authors. In individual matched case- control design bias arising from the unconditional analysis instead of conditional analysis. Using an unconditional logistic for matched data causes the imposition of a large number of nuisance parameters which may result in seriously biased estimates.

Learning the preferences of physicians for the organization of result lists of medical evidence articles.

PubMed

O'Sullivan, D; Wilk, S; Michalowski, W; Slowinski, R; Thomas, R; Kadzinski, M; Farion, K

2014-01-01

Online medical knowledge repositories such as MEDLINE and The Cochrane Library are increasingly used by physicians to retrieve articles to aid with clinical decision making. The prevailing approach for organizing retrieved articles is in the form of a rank-ordered list, with the assumption that the higher an article is presented on a list, the more relevant it is. Despite this common list-based organization, it is seldom studied how physicians perceive the association between the relevance of articles and the order in which articles are presented. In this paper we describe a case study that captured physician preferences for 3-element lists of medical articles in order to learn how to organize medical knowledge for decision-making. Comprehensive relevance evaluations were developed to represent 3-element lists of hypothetical articles that may be retrieved from an online medical knowledge source such as MEDLINE or The Cochrane Library. Comprehensive relevance evaluations asses not only an article's relevance for a query, but also whether it has been placed on the correct list position. In other words an article may be relevant and correctly placed on a result list (e.g. the most relevant article appears first in the result list), an article may be relevant for a query but placed on an incorrect list position (e.g. the most relevant article appears second in a result list), or an article may be irrelevant for a query yet still appear in the result list. The relevance evaluations were presented to six senior physicians who were asked to express their preferences for an article's relevance and its position on a list by pairwise comparisons representing different combinations of 3-element lists. The elicited preferences were assessed using a novel GRIP (Generalized Regression with Intensities of Preference) method and represented as an additive value function. Value functions were derived for individual physicians as well as the group of physicians. The results show that physicians assign significant value to the 1st position on a list and they expect that the most relevant article is presented first. Whilst physicians still prefer obtaining a correctly placed article on position 2, they are also quite satisfied with misplaced relevant article. Low consideration of the 3rd position was uniformly confirmed. Our findings confirm the importance of placing the most relevant article on the 1st position on a list and the importance paid to position on a list significantly diminishes after the 2nd position. The derived value functions may be used by developers of clinical decision support applications to decide how best to organize medical knowledge for decision making and to create personalized evaluation measures that can augment typical measures used to evaluate information retrieval systems.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada, Revision 1

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

Matthews, Patrick

2014-01-01

The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 105 based on the implementation of the corrective actions. Corrective action investigation (CAI) activities were performed from October 22, 2012, through May 23, 2013, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites; and in accordance with the Soils Activity Quality Assurance Plan, which establishes requirements, technical planning, and general quality practices.

Probabilistic Radiological Performance Assessment Modeling and Uncertainty

NASA Astrophysics Data System (ADS)

Tauxe, J.

2004-12-01

A generic probabilistic radiological Performance Assessment (PA) model is presented. The model, built using the GoldSim systems simulation software platform, concerns contaminant transport and dose estimation in support of decision making with uncertainty. Both the U.S. Nuclear Regulatory Commission (NRC) and the U.S. Department of Energy (DOE) require assessments of potential future risk to human receptors of disposal of LLW. Commercially operated LLW disposal facilities are licensed by the NRC (or agreement states), and the DOE operates such facilities for disposal of DOE-generated LLW. The type of PA model presented is probabilistic in nature, and hence reflects the current state of knowledge about the site by using probability distributions to capture what is expected (central tendency or average) and the uncertainty (e.g., standard deviation) associated with input parameters, and propagating through the model to arrive at output distributions that reflect expected performance and the overall uncertainty in the system. Estimates of contaminant release rates, concentrations in environmental media, and resulting doses to human receptors well into the future are made by running the model in Monte Carlo fashion, with each realization representing a possible combination of input parameter values. Statistical summaries of the results can be compared to regulatory performance objectives, and decision makers are better informed of the inherently uncertain aspects of the model which supports their decision-making. While this information may make some regulators uncomfortable, they must realize that uncertainties which were hidden in a deterministic analysis are revealed in a probabilistic analysis, and the chance of making a correct decision is now known rather than hoped for. The model includes many typical features and processes that would be part of a PA, but is entirely fictitious. This does not represent any particular site and is meant to be a generic example. A practitioner could, however, start with this model as a GoldSim template and, by adding site specific features and parameter values (distributions), use this model as a starting point for a real model to be used in real decision making.

Injury severity and disability in the selection of next level of care following acute medical treatment for traumatic brain injury.

PubMed

Malec, James F; Mandrekar, Jayawant N; Brown, Allen W; Moessner, Anne M

2009-01-01

To evaluate the association of demographic factors, post-traumatic amnesia (PTA) and a standardized measure of ability limitations with clinical decisions for Next Level of Care following acute hospital treatment for moderate-severe traumatic brain injury (TBI). A TBI Clinical Nurse specialist recorded PTA for 212 individuals and rated 159 on the Ability and Adjustment Indices of the Mayo-Portland Adaptability Inventory (MPAI-4) for comparison with clinical decisions. Multivariate logistic regression analyses revealed that independent ratings on the MPAI-4 Ability Index and PTA were associated with the clinical decision to admit to Inpatient Rehabilitation vs discharge to Home in 92.7% of the sample; ratings on the Ability Index alone were associated with this decision in 92.2% of cases. Age over 65 was the only variable associated with discharge to a Skilled Nursing Facility, correctly predicting this decision in 64% of cases. Use of a standardized measure of ability limitations appears feasible to provide supportive documentation and potentially improve the consistency of decision-making in recommending Inpatient Rehabilitation vs discharge to Home. Although age is a significant factor in the decision to discharge to a Skilled Nursing Facility, this decision appears complex and merits further study.

Improving decision making in crisis.

PubMed

Higgins, Guy; Freedman, Jennifer

2013-01-01

The most critical activity during emergencies or crises is making decisions about what to do next. This paper provides insights into the challenges that people face in making decisions at any time, but particularly during emergencies and crises. It also introduces the reader to the concept of different sense-making/decision-making domains, the human behaviours that can adversely affect decision making - decision derailers - and ways in which emergency responders can leverage this knowledge to make better decisions. While the literature on decision making is extensive, this paper is focused on those aspects that apply particularly to decision making in emergencies or times of crisis.

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

PubMed

Nibbelink, Christine W; Brewer, Barbara B

2018-03-01

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

Shared Decision-Making in the Management of Congenital Vascular Malformations.

PubMed

Horbach, Sophie E R; Ubbink, Dirk T; Stubenrouch, Fabienne E; Koelemay, Mark J W; van der Vleuten, Carine J M; Verhoeven, Bas H; Reekers, Jim A; Schultze Kool, Leo J; van der Horst, Chantal M A M

2017-03-01

In shared decision-making, clinicians and patients arrive at a joint treatment decision, by incorporating best available evidence and the patients' personal values and preferences. Little is known about the role of shared decision-making in managing patients with congenital vascular malformations, for which preference-sensitive decision-making seems obvious. The authors investigated preferences regarding decision-making and current shared decision-making behavior during physician-patient encounters. In two Dutch university hospitals, adults and children with congenital vascular malformations facing a treatment-related decision were enrolled. Before the consultation, patients (or parents of children) expressed their preference regarding decision-making (Control Preferences Scale). Afterward, participants completed shared decision-making-specific questionnaires (nine-item Shared Decision-Making Questionnaire, CollaboRATE, and satisfaction), and physicians completed the Shared Decision-Making Questionnaire-Physician questionnaire. Consultations were audiotaped and patient involvement was scored by two independent researchers using the five-item Observing Patient Involvement instrument. All questionnaire results were expressed on a scale of 0 to 100 (optimum shared decision-making). Fifty-five participants (24 parents and 31 adult patients) were included. Two-thirds preferred the shared decision-making approach (Control Preferences Scale). Objective five-item Observing Patient Involvement scores were low (mean ± SD, 31 ± 15), whereas patient and physician Shared Decision-Making Questionnaire scores were high, with means of 68 ± 18 and 68 ± 19, respectively. The median CollaboRATE score was 93. There was no clear relationship between shared decision-making and satisfaction scores. Although adults and parents of children with vascular malformations express a strong desire for shared decision-making, objective shared decision-making behavior is still lacking, most likely because of poor awareness of the shared decision-making concept among patients, parents, and physicians. To improve shared decision-making practice, targeted interventions (e.g., decision aids, staff training) are essential.

Decision Making on the Labor and Delivery Unit: An Investigation of Influencing Factors.

PubMed

Gregory, Megan E; Sonesh, Shirley C; Feitosa, Jennifer; Benishek, Lauren E; Hughes, Ashley M; Salas, Eduardo

2017-09-01

Objective The aim of this study was to describe the relationship between negative affect (NA), decision-making style, time stress, and decision quality in health care. Background Health care providers must often make swift, high-stakes decisions. Influencing factors of the decision-making process in this context have been understudied. Method Within a sample of labor and delivery nurses, physicians, and allied personnel, we used self-report measures to examine the impact of trait factors, including NA, decision-making style, and perceived time stress, on decision quality in a situational judgment test (Study 1). In Study 2, we observed the influence of state NA, state decision-making style, state time stress, and their relationship with decision quality on real clinical decisions. Results In Study 1, we found that trait NA significantly predicted avoidant decision-making style. Furthermore, those who were higher on trait time stress and trait avoidant decision-making style exhibited poorer decisions. In Study 2, we observed associations between state NA with state avoidant and analytical decision-making styles. We also observed that these decision-making styles, when considered in tandem with time stress, were influential in predicting clinical decision quality. Conclusion NA predicts some decision-making styles, and decision-making style can affect decision quality under time stress. This is particularly true for state factors. Application Individual differences, such as affect and decision-making style, should be considered during selection. Training to reduce time stress perceptions should be provided.

Barriers to and facilitators of implementing shared decision making and decision support in a paediatric hospital: A descriptive study.

PubMed

Boland, Laura; McIsaac, Daniel I; Lawson, Margaret L

2016-04-01

To explore multiple stakeholders' perceived barriers to and facilitators of implementing shared decision making and decision support in a tertiary paediatric hospital. An interpretive descriptive qualitative study was conducted using focus groups and interviews to examine senior hospital administrators', clinicians', parents' and youths' perceived barriers to and facilitators of shared decision making and decision support implementation. Data were analyzed using inductive thematic analysis. Fifty-seven stakeholders participated. Six barrier and facilitator themes emerged. The main barrier was gaps in stakeholders' knowledge of shared decision making and decision support. Facilitators included compatibility between shared decision making and the hospital's culture and ideal practices, perceptions of positive patient and family outcomes associated with shared decision making, and positive attitudes regarding shared decision making and decision support. However, youth attitudes regarding the necessity and usefulness of a decision support program were a barrier. Two themes were both a barrier and a facilitator. First, stakeholder groups were uncertain which clinical situations are suitable for shared decision making (eg, new diagnoses, chronic illnesses, complex decisions or urgent decisions). Second, the clinical process may be hindered if shared decision making and decision support decrease efficiency and workflow; however, shared decision making may reduce repeat visits and save time over the long term. Specific knowledge translation strategies that improve shared decision making knowledge and match specific barriers identified by each stakeholder group may be required to promote successful shared decision making and decision support implementation in the authors' paediatric hospital.

Development and testing of a decision aid on goals of care for advanced dementia.

PubMed

Einterz, Seth F; Gilliam, Robin; Lin, Feng Chang; McBride, J Marvin; Hanson, Laura C

2014-04-01

Decision aids are effective to improve decision-making, yet they are rarely tested in nursing homes (NHs). Study objectives were to (1) examine the feasibility of a goals of care (GOC) decision aid for surrogate decision-makers (SDMs) of persons with dementia; and (2) to test its effect on quality of communication and decision-making. Pre-post intervention to test a GOC decision aid intervention for SDMs for persons with dementia in NHs. Investigators collected data from reviews of resident health records and interviews with SDMs at baseline and 3-month follow-up. Two NHs in North Carolina. Eighteen residents who were over 65 years of age, had moderate to severe dementia on the global deterioration scale (5, 6, or 7), and an English-speaking surrogate decision-maker. (1) GOC decision aid video viewed by the SDM and (2) a structured care plan meeting between the SDM and interdisciplinary NH team. Surrogate knowledge, quality of communication with health care providers, surrogate-provider concordance on goals of care, and palliative care domains addressed in the care plan. Eighty-nine percent of the SDMs thought the decision aid was relevant to their needs. After viewing the video decision aid, SDMs increased the number of correct responses on knowledge-based questions (12.5 vs 14.2; P < .001). At 3 months, they reported improved quality of communication scores (6.1 vs 6.8; P = .01) and improved concordance on primary goal of care with NH team (50% vs 78%; P = .003). The number of palliative care domains addressed in the care plan increased (1.8 vs 4.3; P < .001). The decision-support intervention piloted in this study was feasible and relevant for surrogate decision-makers of persons with advanced dementia in NHs, and it improved quality of communication between SDM and NH providers. A larger randomized clinical trial is underway to provide further evidence of the effects of this decision aid intervention. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Decision-making on shared sanitation in the informal settlements of Kisumu, Kenya.

PubMed

Simiyu, Sheillah; Swilling, Mark; Cairncross, Sandy

2017-10-01

Unlike most quantitative studies that investigate decision-making on investing in sanitation, this study adopted a qualitative approach to investigate decision-making on shared sanitation in the informal settlements of Kisumu city, in Kenya. Using a grounded theory approach, landlords and tenants were interviewed to identify sanitation decisions, individuals involved in decision-making and factors influencing decision-making. The results indicate that the main sanitation decisions are on investment, emptying, repair and cleaning. Landlords make investment, emptying and repair decisions, while tenants make cleaning decisions. Absentee landlords are less involved in most decision-making compared to live-in landlords, who rarely consult tenants in decision-making. Tenants make decisions after consultations with a third party and often collectively with other tenants. Sanitation interventions in informal settlements should thus, target landlords and tenants, with investment efforts being directed at landlords and maintenance efforts at tenants.

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

PubMed

Gillespie, Mary

2010-11-01

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

[Decision Making and Electrodermal Activity].

PubMed

Kobayakawa, Mutsutaka

2016-08-01

Decision making is aided by emotions. Bodily responses, such as sweating, heartbeat, and visceral sensation, are used to monitor the emotional state during decision making. Because decision making in dairy life is complicated and cognitively demanding, these bodily signals are thought to facilitate the decision making process by assigning positive or negative values for each of the behavioral options. The sweat response in a decision making task is measured by skin conductance response (SCR). SCR in decision making is divided into two categories: anticipatory SCR is observed before making decisions, and reward/punishment SCR is observed after the outcome of the decision is perceived. Brain lesion studies in human revealed that the amygdala and ventromedial prefrontal cortex are important in decision making. Patients with lesinon in the amygdala exhibit neither the anticipatory nor reward/punishment SCRs, while patients with the ventromedial prefrontal lesions have deficits only in the anticipatory SCRs. Decision making tasks and SCR analysis have contributed to reveal the implicit aspects of decision making. Further research is necessary for clarifying the role of explicit process of decision making and its relationship with the implicit process.

Responsiveness of a Brief Measure of Lung Cancer Screening Knowledge.

PubMed

Housten, Ashley J; Lowenstein, Lisa M; Leal, Viola B; Volk, Robert J

2016-12-14

Our aim was to examine the responsiveness of a lung cancer screening brief knowledge measure (LCS-12). Eligible participants were aged 55-80 years, current smokers or had quit within 15 years, and English speaking. They completed a baseline pretest survey, viewed a lung cancer screening video-based patient decision aid, and then filled out a follow-up posttest survey. We performed a paired samples t-test, calculated effect size, and calculated absolute and relative percent improvement for each item. Participants (n = 30) were primarily White (63%) with less than a college degree (63%), and half were female (50%). Mean age was 61.5 years (standard deviation [SD] = 4.67) and average smoking history was 30.4 pack-years (range = 4.6-90.0). Mean score on the 12-item measure increased from 47.3% correct on the pretest to 80.3% correct on the posttest (mean pretest score = 5.67 vs. mean posttest score = 9.63; mean score difference = 3.97, SD = 2.87, 95% CI = 2.90, 5.04). Total knowledge scores improved significantly and were responsive to the decision aid intervention (paired samples t-test = 7.57, p < .001; Cohen's effect size = 1.59; standard response mean [SRM] = 1.38). All individual items were responsive, yet two items had lower absolute responsiveness than the others (item 8: "Without screening, is lung cancer often found at a later stage when cure is less likely?" pretest correct = 83.3% vs. posttest = 96.7%, responsiveness = 13.4%; and item 10: "Can a CT scan find lung disease that is not cancer?" pretest correct = 80.0% vs. posttest = 93.3%, responsiveness = 13.3%). The LCS-12 knowledge measure may be a useful outcome measure of shared decision making for lung cancer screening.

What is a “good” treatment decision?: Decisional control, knowledge, treatment decision-making, and quality of life in men with clinically localized prostate cancer

PubMed Central

Orom, Heather; Biddle, Caitlin; Underwood, Willie; Nelson, Christian J.; Homish, D. Lynn

2016-01-01

Objective We explored whether active patient involvement in decision making and greater patient knowledge are associated with better treatment decision making experiences and better quality of life (QOL) among men with clinically localized prostate cancer. Localized prostate cancer treatment decision-making is an advantageous model for studying patient treatment decision-making dynamics as there are multiple treatment options and a lack of empirical evidence to recommend one over the other; consequently, it is recommended that patients be fully involved in making the decision. Methods Men with newly diagnosed clinically localized prostate cancer (N=1529) completed measures of decisional control, prostate cancer knowledge, and their decision-making experience (decisional conflict, and decision-making satisfaction and difficulty) shortly after they made their treatment decision. Prostate cancer-specific QOL was assessed 6-months after treatment. Results More active involvement in decision making and greater knowledge were associated with lower decisional conflict and higher decision-making satisfaction, but greater decision-making difficulty. An interaction between decisional control and knowledge revealed that greater knowledge was only associated with greater difficulty for men actively involved in making the decision (67% of sample). Greater knowledge, but not decisional control predicted better QOL 6-months post-treatment. Conclusion Although men who are actively involved in decision making and more knowledgeable may make more informed decisions, they could benefit from decisional support (e.g., decision-making aids, emotional support from providers, strategies for reducing emotional distress) to make the process easier. Men who were more knowledgeable about prostate cancer and treatment side effects at the time they made their treatment decision may have appraised their QOL as higher because they had realistic expectations about side effects. PMID:26957566

What Is a "Good" Treatment Decision? Decisional Control, Knowledge, Treatment Decision Making, and Quality of Life in Men with Clinically Localized Prostate Cancer.

PubMed

Orom, Heather; Biddle, Caitlin; Underwood, Willie; Nelson, Christian J; Homish, D Lynn

2016-08-01

We explored whether active patient involvement in decision making and greater patient knowledge are associated with better treatment decision-making experiences and better quality of life (QOL) among men with clinically localized prostate cancer. Localized prostate cancer treatment decision making is an advantageous model for studying patient treatment decision-making dynamics because there are multiple treatment options and a lack of empirical evidence to recommend one over the other; consequently, it is recommended that patients be fully involved in making the decision. Men with newly diagnosed clinically localized prostate cancer (N = 1529) completed measures of decisional control, prostate cancer knowledge, and decision-making experiences (decisional conflict and decision-making satisfaction and difficulty) shortly after they made their treatment decision. Prostate cancer-specific QOL was assessed at 6 months after treatment. More active involvement in decision making and greater knowledge were associated with lower decisional conflict and higher decision-making satisfaction but greater decision-making difficulty. An interaction between decisional control and knowledge revealed that greater knowledge was only associated with greater difficulty for men actively involved in making the decision (67% of sample). Greater knowledge, but not decisional control, predicted better QOL 6 months after treatment. Although men who are actively involved in decision making and more knowledgeable may make more informed decisions, they could benefit from decisional support (e.g., decision-making aids, emotional support from providers, strategies for reducing emotional distress) to make the process easier. Men who were more knowledgeable about prostate cancer and treatment side effects at the time that they made their treatment decision may have appraised their QOL as higher because they had realistic expectations about side effects. © The Author(s) 2016.

Barriers to and facilitators of implementing shared decision making and decision support in a paediatric hospital: A descriptive study

PubMed Central

Boland, Laura; McIsaac, Daniel I; Lawson, Margaret L

2016-01-01

OBJECTIVE: To explore multiple stakeholders’ perceived barriers to and facilitators of implementing shared decision making and decision support in a tertiary paediatric hospital. METHODS: An interpretive descriptive qualitative study was conducted using focus groups and interviews to examine senior hospital administrators’, clinicians’, parents’ and youths’ perceived barriers to and facilitators of shared decision making and decision support implementation. Data were analyzed using inductive thematic analysis. RESULTS: Fifty-seven stakeholders participated. Six barrier and facilitator themes emerged. The main barrier was gaps in stakeholders’ knowledge of shared decision making and decision support. Facilitators included compatibility between shared decision making and the hospital’s culture and ideal practices, perceptions of positive patient and family outcomes associated with shared decision making, and positive attitudes regarding shared decision making and decision support. However, youth attitudes regarding the necessity and usefulness of a decision support program were a barrier. Two themes were both a barrier and a facilitator. First, stakeholder groups were uncertain which clinical situations are suitable for shared decision making (eg, new diagnoses, chronic illnesses, complex decisions or urgent decisions). Second, the clinical process may be hindered if shared decision making and decision support decrease efficiency and workflow; however, shared decision making may reduce repeat visits and save time over the long term. CONCLUSIONS: Specific knowledge translation strategies that improve shared decision making knowledge and match specific barriers identified by each stakeholder group may be required to promote successful shared decision making and decision support implementation in the authors’ paediatric hospital. PMID:27398058

22 CFR 1101.14 - Appeal of agency decision not to correct or amend a record.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Appeal of agency decision not to correct or amend a record. 1101.14 Section 1101.14 Foreign Relations INTERNATIONAL BOUNDARY AND WATER COMMISSION, UNITED STATES AND MEXICO, UNITED STATES SECTION PRIVACY ACT OF 1974 § 1101.14 Appeal of agency decision...

22 CFR 1101.14 - Appeal of agency decision not to correct or amend a record.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 2 2012-04-01 2009-04-01 true Appeal of agency decision not to correct or amend a record. 1101.14 Section 1101.14 Foreign Relations INTERNATIONAL BOUNDARY AND WATER COMMISSION, UNITED STATES AND MEXICO, UNITED STATES SECTION PRIVACY ACT OF 1974 § 1101.14 Appeal of agency decision...

Corrective Action Decision Document for Corrective Action Unit 224: Decon Pad and Septic Systems Nevada Test Site, Nevada, Rev. No.: 0

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

David A. Strand

2005-05-01

This Corrective Action Decision Document has been prepared for Corrective Action Unit (CAU) 224, Decon Pad and Septic Systems, in Areas 2, 3, 5, 6, 11, and 23 of the Nevada Test Site, Nevada, in accordance with the ''Federal Facility Agreement and Consent Order'' (1996). Corrective Action Unit 224 is comprised of the following corrective action sites (CASs): (1) 02-04-01, Septic Tank (Buried); (2) 03-05-01, Leachfield; (3) 05-04-01, Septic Tanks (4)/Discharge Area; (4) 06-03-01, Sewage Lagoons (3); (5) 06-05-01, Leachfield; (6) 06-17-04, Decon Pad and Wastewater Catch; (7) 06-23-01, Decon Pad Discharge Piping; (8) 11-04-01, Sewage Lagoon; and (9) 23-05-02,more » Leachfield. The purpose of this Corrective Action Decision Document is to identify and provide the rationale for the recommendation of a corrective action alternative for the nine CASs within CAU 224. Corrective action investigation activities were performed from August 10, 2004, through January 18, 2005, as set forth in the CAU 224 Corrective Action Investigation Plan.« less

One Way of Thinking About Decision Making.

ERIC Educational Resources Information Center

Dalis, Gus T.; Strasser, Ben B.

The authors present the DALSTRA model of decision making, a descriptive statement of ways individuals or groups respond to different kinds of decision-making problems they encounter. Decision making is viewed in two phases: the decision-making antecedents (whether to decide, how to decide) and the modes of decision making (Chance/Impulse,…

Cost comparison: limb salvage versus amputation in diabetic patients with charcot foot.

PubMed

Gil, Joseph; Schiff, Adam P; Pinzur, Michael S

2013-08-01

The negative impact on health-related quality of life in patients with Charcot foot has prompted operative correction of the acquired deformity. Comparative effectiveness financial models are being introduced to provide valuable information to assist clinical decision making. Seventy-six patients with Charcot foot underwent operative correction with the use of circular external fixation. Thirty-eight (50%) had osteomyelitis. A control group was created from 17 diabetic patients who successfully underwent transtibial amputation and prosthetic fitting during the same period. Cost of care during the 12 months following surgery was derived from inpatient hospitalization, placement in a rehabilitation unit or skilled nursing facility, home health care including parenteral antibiotic therapy, physical therapy, and purchase of prosthetic devices or footwear. Fifty-three of the patients with limb salvage (69.7%) did not require inpatient rehabilitation. Their average cost of care was $56,712. Fourteen of the patients with amputation (82.4%) required inpatient rehabilitation, with an average cost of $49,251. Many surgeons now favor operative correction of Charcot foot deformity. This investigation provides preliminary data on the relative cost of transtibial amputation and prosthetic limb fitting compared with limb salvage. The use of comparative effectiveness models such as this simple attempt may provide valuable information in planning resource allocation for similar complex groups of patients. Level III, economic and decision analysis.

Strategic Decision Making Paradigms: A Primer for Senior Leaders

DTIC Science & Technology

2009-07-01

decision making . STRATEGIC DECISION MAKING Strategic Change: There are several strategic...influenced by stakeholders outside of the organization. The Ontology of Strategic Decision Making . Strategic decisions are non-routine and involve...Coates USAWC, July 2009 5 The Complexity of Strategic Decision Making Strategic decisions entail “ill-structured,”6 “messy” or

Training in Decision-making Strategies: An approach to enhance students' competence to deal with socio-scientific issues

NASA Astrophysics Data System (ADS)

Gresch, Helge; Hasselhorn, Marcus; Bögeholz, Susanne

2013-10-01

Dealing with socio-scientific issues in science classes enables students to participate productively in controversial discussions concerning ethical topics, such as sustainable development. In this respect, well-structured decision-making processes are essential for elaborate reasoning. To foster decision-making competence, a computer-based programme was developed that trains secondary school students (grades 11-13) in decision-making strategies. The main research question is: does training students to use these strategies foster decision-making competence? In addition, the influence of meta-decision aids was examined. Students conducted a task analysis to select an appropriate strategy prior to the decision-making process. Hence, the second research question is: does combining decision-making training with a task analysis enhance decision-making competence at a higher rate? To answer these questions, 386 students were tested in a pre-post-follow-up control-group design that included two training groups (decision-making strategies/decision-making strategies combined with a task analysis) and a control group (decision-making with additional ecological information instead of strategic training). An open-ended questionnaire was used to assess decision-making competence in situations related to sustainable development. The decision-making training led to a significant improvement in the post-test and the follow-up, which was administered three months after the training. Long-term effects on the quality of the students' decisions were evident for both training groups. Gains in competence when reflecting upon the decision-making processes of others were found, to a lesser extent, in the training group that received the additional meta-decision training. In conclusion, training in decision-making strategies is a promising approach to deal with socio-scientific issues related to sustainable development.

Shared Decision Making in ICUs: An American College of Critical Care Medicine and American Thoracic Society Policy Statement.

PubMed

Kon, Alexander A; Davidson, Judy E; Morrison, Wynne; Danis, Marion; White, Douglas B

2016-01-01

Shared decision making is endorsed by critical care organizations; however, there remains confusion about what shared decision making is, when it should be used, and approaches to promote partnerships in treatment decisions. The purpose of this statement is to define shared decision making, recommend when shared decision making should be used, identify the range of ethically acceptable decision-making models, and present important communication skills. The American College of Critical Care Medicine and American Thoracic Society Ethics Committees reviewed empirical research and normative analyses published in peer-reviewed journals to generate recommendations. Recommendations approved by consensus of the full Ethics Committees of American College of Critical Care Medicine and American Thoracic Society were included in the statement. Six recommendations were endorsed: 1) DEFINITION: Shared decision making is a collaborative process that allows patients, or their surrogates, and clinicians to make healthcare decisions together, taking into account the best scientific evidence available, as well as the patient's values, goals, and preferences. 2) Clinicians should engage in a shared decision making process to define overall goals of care (including decisions regarding limiting or withdrawing life-prolonging interventions) and when making major treatment decisions that may be affected by personal values, goals, and preferences. 3) Clinicians should use as their "default" approach a shared decision making process that includes three main elements: information exchange, deliberation, and making a treatment decision. 4) A wide range of decision-making approaches are ethically supportable, including patient- or surrogate-directed and clinician-directed models. Clinicians should tailor the decision-making process based on the preferences of the patient or surrogate. 5) Clinicians should be trained in communication skills. 6) Research is needed to evaluate decision-making strategies. Patient and surrogate preferences for decision-making roles regarding value-laden choices range from preferring to exercise significant authority to ceding such authority to providers. Clinicians should adapt the decision-making model to the needs and preferences of the patient or surrogate.

Automated inspection and precision grinding of spiral bevel gears

NASA Technical Reports Server (NTRS)

Frint, Harold

1987-01-01

The results are presented of a four phase MM&T program to define, develop, and evaluate an improved inspection system for spiral bevel gears. The improved method utilizes a multi-axis coordinate measuring machine which maps the working flank of the tooth and compares it to nominal reference values stored in the machine's computer. A unique feature of the system is that corrective grinding machine settings can be automatically calculated and printed out when necessary to correct an errant tooth profile. This new method eliminates most of the subjective decision making involved in the present method, which compares contact patterns obtained when the gear set is run under light load in a rolling test machine. It produces a higher quality gear with significant inspection time and cost savings.

A re-examination of the effects of biased lineup instructions in eyewitness identification.

PubMed

Clark, Steven E

2005-10-01

A meta-analytic review of research comparing biased and unbiased instructions in eyewitness identification experiments showed an asymmetry; specifically, that biased instructions led to a large and consistent decrease in accuracy in target-absent lineups, but produced inconsistent results for target-present lineups, with an average effect size near zero (Steblay, 1997). The results for target-present lineups are surprising, and are inconsistent with statistical decision theories (i.e., Green & Swets, 1966). A re-examination of the relevant studies and the meta-analysis of those studies shows clear evidence that correct identification rates do increase with biased lineup instructions, and that biased witnesses make correct identifications at a rate considerably above chance. Implications for theory, as well as police procedure and policy, are discussed.

A re-examination of the effects of biased lineup instructions in eyewitness identification.

PubMed

Clark, Steven E

2005-08-01

A meta-analytic review of research comparing biased and unbiased instructions in eyewitness identification experiments showed an asymmetry, specifically that biased instructions led to a large and consistent decrease in accuracy in target-absent lineups, but produced inconsistent results for target-present lineups, with an average effect size near zero (N. M. Steblay, 1997). The results for target-present lineups are surprising, and are inconsistent with statistical decision theories (i.e., D. M. Green & J. A. Swets, 1966). A re-examination of the relevant studies and the meta-analysis of those studies shows clear evidence that correct identification rates do increase with biased lineup instructions, and that biased witnesses make correct identifications at a rate considerably above chance. Implications for theory, as well as police procedure and policy, are discussed.

Modelling elderly cardiac patients decision making using Cognitive Work Analysis: identifying requirements for patient decision aids.

PubMed

Dhukaram, Anandhi Vivekanandan; Baber, Chris

2015-06-01

Patients make various healthcare decisions on a daily basis. Such day-to-day decision making can have significant consequences on their own health, treatment, care, and costs. While decision aids (DAs) provide effective support in enhancing patient's decision making, to date there have been few studies examining patient's decision making process or exploring how the understanding of such decision processes can aid in extracting requirements for the design of DAs. This paper applies Cognitive Work Analysis (CWA) to analyse patient's decision making in order to inform requirements for supporting self-care decision making. This study uses focus groups to elicit information from elderly cardiovascular disease (CVD) patients concerning a range of decision situations they face on a daily basis. Specifically, the focus groups addressed issues related to the decision making of CVD in terms of medication compliance, pain, diet and exercise. The results of these focus groups are used to develop high level views using CWA. CWA framework decomposes the complex decision making problem to inform three approaches to DA design: one design based on high level requirements; one based on a normative model of decision-making for patients; and the third based on a range of heuristics that patients seem to use. CWA helps in extracting and synthesising decision making from different perspectives: decision processes, work organisation, patient competencies and strategies used in decision making. As decision making can be influenced by human behaviour like skills, rules and knowledge, it is argued that patients require support to different types of decision making. This paper also provides insights for designers in using CWA framework for the design of effective DAs to support patients in self-management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 569: Area 3 Yucca Flat Atmospheric Test Sites Nevada National Security Site, Nevada with ROTC 1, Revision 0

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

Sloop, Christy

2013-04-01

This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 569: Area 3 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada. CAU 569 comprises the following nine corrective action sites (CASs): • 03-23-09, T-3 Contamination Area • 03-23-10, T-3A Contamination Area • 03-23-11, T-3B Contamination Area • 03-23-12, T-3S Contamination Area • 03-23-13, T-3T Contamination Area • 03-23-14, T-3V Contamination Area • 03-23-15, S-3G Contamination Area • 03-23-16, S-3H Contamination Area • 03-23-21, Pike Contamination Area The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supportingmore » the recommendation that no further corrective action is needed for CAU 569 based on the implementation of the corrective actions listed in Table ES-2.« less

A decision support system and rule-based algorithm to augment the human interpretation of the 12-lead electrocardiogram.

PubMed

Cairns, Andrew W; Bond, Raymond R; Finlay, Dewar D; Guldenring, Daniel; Badilini, Fabio; Libretti, Guido; Peace, Aaron J; Leslie, Stephen J

The 12-lead Electrocardiogram (ECG) has been used to detect cardiac abnormalities in the same format for more than 70years. However, due to the complex nature of 12-lead ECG interpretation, there is a significant cognitive workload required from the interpreter. This complexity in ECG interpretation often leads to errors in diagnosis and subsequent treatment. We have previously reported on the development of an ECG interpretation support system designed to augment the human interpretation process. This computerised decision support system has been named 'Interactive Progressive based Interpretation' (IPI). In this study, a decision support algorithm was built into the IPI system to suggest potential diagnoses based on the interpreter's annotations of the 12-lead ECG. We hypothesise semi-automatic interpretation using a digital assistant can be an optimal man-machine model for ECG interpretation. To improve interpretation accuracy and reduce missed co-abnormalities. The Differential Diagnoses Algorithm (DDA) was developed using web technologies where diagnostic ECG criteria are defined in an open storage format, Javascript Object Notation (JSON), which is queried using a rule-based reasoning algorithm to suggest diagnoses. To test our hypothesis, a counterbalanced trial was designed where subjects interpreted ECGs using the conventional approach and using the IPI+DDA approach. A total of 375 interpretations were collected. The IPI+DDA approach was shown to improve diagnostic accuracy by 8.7% (although not statistically significant, p-value=0.1852), the IPI+DDA suggested the correct interpretation more often than the human interpreter in 7/10 cases (varying statistical significance). Human interpretation accuracy increased to 70% when seven suggestions were generated. Although results were not found to be statistically significant, we found; 1) our decision support tool increased the number of correct interpretations, 2) the DDA algorithm suggested the correct interpretation more often than humans, and 3) as many as 7 computerised diagnostic suggestions augmented human decision making in ECG interpretation. Statistical significance may be achieved by expanding sample size. Copyright © 2017 Elsevier Inc. All rights reserved.

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

PubMed

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

2017-12-01

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

Shared decision-making - Rhetoric and reality: Women's experiences and perceptions of adjuvant treatment decision-making for breast cancer.

PubMed

Mahmoodi, Neda; Sargeant, Sally

2017-01-01

This interview-based study uses phenomenology as a theoretical framework and thematic analysis to challenge existing explanatory frameworks of shared decision-making, in an exploration of women's experiences and perceptions of shared decision-making for adjuvant treatment in breast cancer. Three themes emerged are as follows: (1) women's desire to participate in shared decision-making, (2) the degree to which shared decision-making is perceived to be shared and (3) to what extent are women empowered within shared decision-making. Studying breast cancer patients' subjective experiences of adjuvant treatment decision-making provides a broader perspective on patient participatory role preferences and doctor-patient power dynamics within shared decision-making for breast cancer.

Measuring Shared Decision Making in Psychiatric Care

PubMed Central

Salyers, Michelle P.; Matthias, Marianne S.; Fukui, Sadaaki; Holter, Mark C.; Collins, Linda; Rose, Nichole; Thompson, John; Coffman, Melinda; Torrey, William C.

2014-01-01

Objective Shared decision making is widely recognized to facilitate effective health care; tools are needed to measure the level of shared decision making in psychiatric practice. Methods A coding scheme assessing shared decision making in medical settings (1) was adapted, including creation of a manual. Trained raters analyzed 170 audio recordings of psychiatric medication check-up visits. Results Inter-rater reliability among three raters for a subset of 20 recordings ranged from 67% to 100% agreement for the presence of each of nine elements of shared decision making and 100% for the overall agreement between provider and consumer. Just over half of the decisions met minimum criteria for shared decision making. Shared decision making was not related to length of visit after controlling for complexity of decision. Conclusions The shared decision making rating scale appears to reliably assess shared decision making in psychiatric practice and could be helpful for future research, training, and implementation efforts. PMID:22854725

Corrective Action Decision Document/Closure Report for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada, Revision 0

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

Matthews, Patrick

2013-09-01

This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 105: Area 2 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada. CAU 105 comprises the following five corrective action sites (CASs): -02-23-04 Atmospheric Test Site - Whitney Closure In Place -02-23-05 Atmospheric Test Site T-2A Closure In Place -02-23-06 Atmospheric Test Site T-2B Clean Closure -02-23-08 Atmospheric Test Site T-2 Closure In Place -02-23-09 Atmospheric Test Site - Turk Closure In Place The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that nomore » further corrective action is needed for CAU 105 based on the implementation of the corrective actions. Corrective action investigation (CAI) activities were performed from October 22, 2012, through May 23, 2013, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites; and in accordance with the Soils Activity Quality Assurance Plan, which establishes requirements, technical planning, and general quality practices.« less

[The relevance of internal and external participation for patient satisfaction].

PubMed

Zimmermann, L; Michaelis, M; Quaschning, K; Müller, C; Körner, M

2014-08-01

Patient satisfaction is an essential quality and outcome criteria for patient-centered treatment of chronic diseases. For successful implementation of integrated patient-centered care it is important to take the needs and expectations of the patients into consideration in the treatment process and to involve them in decision-making (external participation), as well as establishing patient-centered collaboration within the team and organization (internal participation). This study examines in what respect patient satisfaction can be predicted through parameters that focus on the personal needs of the individual or internal and external participation. To this end we used a multicenter cross-sectional study to collect evaluations from N=329 patients with different chronic diseases in 11 rehabilitation clinics. Patient satisfaction (ZUF-8) served as the criterion, and the predictors were external participation (PEF-FB-9), satisfaction with decision-making (Man-Son-Hing Scale) and internal participation (Internal Participation Scale), socio-demographic factors and rehabilitation status (IRES-24). The data were analyzed statistically using multiple linear regression. A high degree of variance of patient satisfaction could be explained by the parameters applied (Goodness-of-fit: R²corrected=47.3%). The strongest predictors of satisfaction were internal participation (Beta=0.44, p<0.001) and satisfaction with the decision-making (Beta=0.36, p<0.001). The study provides initial indications of the positive effects of internal and external participation. Further studies are necessary to substantiate the connection between internal and external participation and patient satisfaction. © Georg Thieme Verlag KG Stuttgart · New York.

Research on Application of FMECA in Missile Equipment Maintenance Decision

NASA Astrophysics Data System (ADS)

Kun, Wang

2018-03-01

Fault mode effects and criticality analysis (FMECA) is a method widely used in engineering. Studying the application of FMEA technology in military equipment maintenance decision-making, can help us build a better equipment maintenance support system, and increase the using efficiency of weapons and equipment. Through Failure Modes, Effects and Criticality Analysis (FMECA) of equipment, known and potential failure modes and their causes are found out, and the influence on the equipment performance, operation success, personnel security are determined. Furthermore, according to the synthetical effects of the severity of effects and the failure probability, possible measures for prevention and correction are put forward. Through replacing or adjusting the corresponding parts, corresponding maintenance strategy is decided for preventive maintenance of equipment, which helps improve the equipment reliability.

Sequential lineup presentation promotes less-biased criterion setting but does not improve discriminability.

PubMed

Palmer, Matthew A; Brewer, Neil

2012-06-01

When compared with simultaneous lineup presentation, sequential presentation has been shown to reduce false identifications to a greater extent than it reduces correct identifications. However, there has been much debate about whether this difference in identification performance represents improved discriminability or more conservative responding. In this research, data from 22 experiments that compared sequential and simultaneous lineups were analyzed using a compound signal-detection model, which is specifically designed to describe decision-making performance on tasks such as eyewitness identification tests. Sequential (cf. simultaneous) presentation did not influence discriminability, but produced a conservative shift in response bias that resulted in less-biased choosing for sequential than simultaneous lineups. These results inform understanding of the effects of lineup presentation mode on eyewitness identification decisions.

Least reliable bits coding (LRBC) for high data rate satellite communications

NASA Technical Reports Server (NTRS)

Vanderaar, Mark; Budinger, James; Wagner, Paul

1992-01-01

LRBC, a bandwidth efficient multilevel/multistage block-coded modulation technique, is analyzed. LRBC uses simple multilevel component codes that provide increased error protection on increasingly unreliable modulated bits in order to maintain an overall high code rate that increases spectral efficiency. Soft-decision multistage decoding is used to make decisions on unprotected bits through corrections made on more protected bits. Analytical expressions and tight performance bounds are used to show that LRBC can achieve increased spectral efficiency and maintain equivalent or better power efficiency compared to that of BPSK. The relative simplicity of Galois field algebra vs the Viterbi algorithm and the availability of high-speed commercial VLSI for block codes indicates that LRBC using block codes is a desirable method for high data rate implementations.

Linking decision-making research and cancer prevention and control: important themes.

PubMed

McCaul, Kevin D; Peters, Ellen; Nelson, Wendy; Stefanek, Michael

2005-07-01

This article describes 6 themes underlying the multiple presentations from the Basic and Applied Decision Making in Cancer Control meeting, held February 19-20, 2004. The following themes have important implications for research and practice linking basic decision-making research to cancer prevention and control: (a) Traditional decision-making theories fail to capture real-world decision making, (b) decision makers are often unable to predict future preferences, (c) preferences are often constructed on the spot and thus are influenced by situational cues, (d) decision makers often rely on feelings rather than beliefs when making a decision, (e) the perspective of the decision maker is critical in determining preferences, and (f) informed decision making may--or may not--yield the best decisions.

Colorectal Cancer Screening in Vulnerable Patients: Promoting Informed and Shared Decisions.

PubMed

Brenner, Alison T; Hoffman, Richard; McWilliams, Andrew; Pignone, Michael P; Rhyne, Robert L; Tapp, Hazel; Weaver, Mark A; Callan, Danelle; de Hernandez, Brisa Urquieta; Harbi, Khalil; Reuland, Daniel S

2016-10-01

Low-income, low-literacy, limited English-proficient populations have low colorectal cancer (CRC) screening rates and experience poor patient-provider communication and decision-making processes around screening. The purpose of this study was to test the effect of a CRC screening decision aid on screening-related communication and decision making in primary care visits. RCT with data collected from patients at baseline and immediately after the provider encounter. Patients aged 50-75 years, due for CRC screening, were recruited from two safety net clinics in North Carolina and New Mexico (data collection, January 2014-September 2015; analysis, 2015). Participants viewed a CRC screening decision aid or a food safety (control) video immediately before their provider encounter. CRC screening-related knowledge, discussion, intent, test preferences, and test ordering. The study population (N=262) had a mean age of 58.3 years and was 66% female, 61% Latino, 17% non-Latino black, and 16% non-Latino white. Among Latino participants, 71% preferred Spanish. Compared with controls, intervention participants had greater screening-related knowledge (on average 4.6 vs 2.8 of six knowledge items correct, adjusted difference [AD]=1.8, 95% CI=1.5, 2.1) and were more likely to report screening discussion (71.0% vs 45.0%, AD=26.1%, 95% CI=14.3%, 38.0%) and high screening intent (93.1% vs 84.7%, AD=9.0%, 95% CI=2.0%, 16.0%). Intervention participants were more likely to indicate a specific screening test preference (93.1% vs 68.0%, AD=26.5%, 95% CI=17.2%, 35.8%) and to report having a test ordered (56.5% vs 32.1%, AD=25.8%, 95% CI=14.4%, 37.2%). Viewing a CRC screening decision aid before a primary care encounter improves knowledge and shared decision making around screening in a racially, ethnically, and linguistically diverse safety net clinic population. This study is registered at www.clinicaltrials.gov NCT02054598. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Couples’ reports of household decision-making and the utilization of maternal health services in Bangladesh

PubMed Central

Story, William T.; Burgard, Sarah A.

2012-01-01

This study examines the association between maternal health service utilization and household decision-making in Bangladesh. Most studies of the predictors of reproductive health service use focus on women’s reports; however, men are often involved in these decisions as well. Recently, studies have started to explore the association between health outcomes and reports of household decision-making from both husbands and wives as matched pairs. Many studies of household decision-making emphasize the importance of the wife alone making decisions; however, some have argued that joint decision-making between husbands and wives may yield better reproductive health outcomes than women making decisions without input or agreement from their partners. Husbands’ involvement in decision-making is particularly important in Bangladesh because men often dominate household decisions related to large, health-related purchases. We use matched husband and wife reports about who makes common household decisions to predict use of antenatal and skilled delivery care, using data from the 2007 Bangladesh Demographic and Health Survey. Results from regression analyses suggest that it is important to consider whether husbands and wives give concordant responses about who makes household decisions since discordant reports about who makes these decisions are negatively associated with reproductive health care use. In addition, compared to joint decision-making, husband-only decision-making is negatively associated with antenatal care use and skilled delivery care. Finally, associations between household decision-making arrangements and health service utilization vary depending on whose report is used and the type of health service utilized. PMID:23068556

Couples' reports of household decision-making and the utilization of maternal health services in Bangladesh.

PubMed

Story, William T; Burgard, Sarah A

2012-12-01

This study examines the association between maternal health service utilization and household decision-making in Bangladesh. Most studies of the predictors of reproductive health service utilization focus on women's reports; however, men are often involved in these decisions as well. Recently, studies have started to explore the association between health outcomes and reports of household decision-making from both husbands and wives as matched pairs. Many studies of household decision-making emphasize the importance of the wife alone making decisions; however, some have argued that joint decision-making between husbands and wives may yield better reproductive health outcomes than women making decisions without input or agreement from their partners. Husbands' involvement in decision-making is particularly important in Bangladesh because men often dominate household decisions related to large, health-related purchases. We use matched husband and wife reports about who makes common household decisions to predict use of antenatal and skilled delivery care, using data from the 2007 Bangladesh Demographic and Health Survey. Results from regression analyses suggest that it is important to consider whether husbands and wives give concordant responses about who makes household decisions since discordant reports about who makes these decisions are negatively associated with reproductive health care use. In addition, compared to joint decision-making, husband-only decision-making is negatively associated with antenatal care use and skilled delivery care. Finally, associations between household decision-making arrangements and health service utilization vary depending on whose report is used and the type of health service utilized. Copyright © 2012 Elsevier Ltd. All rights reserved.

Using Discrete Choice Experiments to Inform the Benefit-Risk Assessment of Medicines: Are We Ready Yet?

PubMed

Vass, Caroline M; Payne, Katherine

2017-09-01

There is emerging interest in the use of discrete choice experiments as a means of quantifying the perceived balance between benefits and risks (quantitative benefit-risk assessment) of new healthcare interventions, such as medicines, under assessment by regulatory agencies. For stated preference data on benefit-risk assessment to be used in regulatory decision making, the methods to generate these data must be valid, reliable and capable of producing meaningful estimates understood by decision makers. Some reporting guidelines exist for discrete choice experiments, and for related methods such as conjoint analysis. However, existing guidelines focus on reporting standards, are general in focus and do not consider the requirements for using discrete choice experiments specifically for quantifying benefit-risk assessments in the context of regulatory decision making. This opinion piece outlines the current state of play in using discrete choice experiments for benefit-risk assessment and proposes key areas needing to be addressed to demonstrate that discrete choice experiments are an appropriate and valid stated preference elicitation method in this context. Methodological research is required to establish: how robust the results of discrete choice experiments are to formats and methods of risk communication; how information in the discrete choice experiment can be presented effectually to respondents; whose preferences should be elicited; the correct underlying utility function and analytical model; the impact of heterogeneity in preferences; and the generalisability of the results. We believe these methodological issues should be addressed, alongside developing a 'reference case', before agencies can safely and confidently use discrete choice experiments for quantitative benefit-risk assessment in the context of regulatory decision making for new medicines and healthcare products.

The passive-aggressive organization.

PubMed

Kaplan, Robert S; Norton, David P

2005-10-01

Passive-aggressive organizations are friendly places to work: People are congenial, conflict is rare, and consensus is easy to reach. But, at the end of the day, even the best proposals fail to gain traction, and a company can go nowhere so imperturbably that it's easy to pretend everything is fine. Such companies are not necessarily saddled with mulishly passive-aggressive employees. Rather, they are filled with mostly well-intentioned people who are the victirms of flawed processes and policies. Commonly, a growing company's halfhearted or poorly thought-out attempts to decentralize give rise to multiple layers of managers, whose authority for making decisions becomes increasingly unclear. Some managers, as a result, hang back, while others won't own up to the calls they've made, inviting colleagues to second-guess or overturn the decisions. In such organizations, information does not circulate freely, and that makes it difficult for workers to understand the impact of their actions on company performance and for managers to correctly appraise employees' value to the organization. A failure to accurately match incentives to performance stifles initiative, and people do just enough to get by. Breaking free from this pattern is hard; a long history of seeing corporate initiatives ignored and then fade away tends to make people cynical. Often it's best to bring in an outsider to signal that this time things will be different. He or she will need to address every obstacle all at once: clarify decision rights; see to it that decisions stick; and reward people for sharing information and adding value, not for successfully negotiating corporate politics. If those steps are not taken, it's only a matter of time before the diseased elements of a passive-aggressive organization overwhelm the remaining healthy ones and drive the company into financial distress.

Do peer review models affect clinicians' trust in journals? A survey of junior doctors.

PubMed

Patel, Jigisha; Pierce, Mary; Boughton, Stephanie L; Baldeweg, Stephanie E

2017-01-01

The aim of this survey was to determine the level of awareness and understanding of peer review and peer review models amongst junior hospital doctors and whether this influences clinical decision-making. A 30-question online anonymous survey was developed aimed at determining awareness of peer review models and the purpose of peer review, perceived trustworthiness of different peer review models and the role of peer review in clinical decision-making. It was sent to 800 trainee doctors in medical specialties on the University College London Partners trainee database. The response rate was (178/800) 22%. Most respondents were specialist registrars. Checking that research is conducted correctly (152/178, 85%) and the data interpreted correctly (148/178, 83%) were viewed as the most important purposes of peer review. Most respondents were aware of open (133/178, 75%), double-blind (125/178, 70%) and single-blind peer review (121/178, 68%). 101/178 (57%) had heard of collaborative, 87/178 (49%) of post publication and 29/178 (16%) of decoupled peer review. Of those who were aware of double-blind, single-blind open and collaborative peer review, 85 (68%), 82 (68%), 74 (56%) and 24 (24%), respectively, understood how they worked. The NEJM , Lancet and The BMJ were deemed to have most trustworthy peer review, 137/178 (77%), 129/178 (72%) and 115/178 (65%), respectively. That peer review had taken place was important for a journal content to be used for clinical decision-making 152/178 (85%), but the ability to see peer review reports was not as important 22/178 (12%). Most felt there was a need for peer review training and that this should be at the specialist registrar stage of training. Junior hospital doctors view peer review to be important as a means of quality control, but do not value the ability to scrutinize peer review themselves. The unquestioning acceptance of peer review as final validation in the field of medicine emphasises not only the responsibility held by medical journals to ensure peer review is done well but also the need to raise awareness amongst the medical community of the limitations of the current peer review process.

The decision to extract: part II. Analysis of clinicians' stated reasons for extraction.

PubMed

Baumrind, S; Korn, E L; Boyd, R L; Maxwell, R

1996-04-01

In a recently reported study, the pretreatment records of each subject in a randomized clinical trial of 148 patients with Class I and Class II malocclusions presenting for orthodontic treatment were evaluated independently by five experienced clinicians (drawn from a panel of 14). The clinicians displayed a higher incidence of agreement with each other than had been expected with respect to the decision as to whether extraction was indicated in each specific case. To improve our understanding of how clinicians made their decisions on whether to extract or not, the records of a subset of 72 subjects randomly selected from the full sample of 148, have now been examined in greater detail. In 21 of these cases, all five clinicians decided to treat without extraction. Among the remaining 51 cases, there were 202 decisions to extract (31 unanimous decision cases and 20 split decision cases). The clinicians cited a total of 469 reasons to support these decisions. Crowding was cited as the first reason in 49% of decisions to extract, followed by incisor protrusion (14%), need for profile correction (8%), Class II severity (5%), and achievement of a stable result (5%). When all the reasons for extraction in each clinician's decision were considered as a group, crowding was cited in 73% of decisions, incisor protrusion in 35%, need for profile correction in 27%, Class II severity in 15% and posttreatment stability in 9%. Tooth size anomalies, midline deviations, reduced growth potential, severity of overjet, maintenance of existing profile, desire to close the bite, periodontal problems, and anticipation of poor cooperation accounted collectively for 12% of the first reasons and were mentioned in 54% of the decisions, implying that these considerations play a consequential, if secondary, role in the decision-making process. All other reasons taken together were mentioned in fewer than 20% of cases. In this sample at least, clinicians focused heavily on appearance-related factors that are qualitatively determinable by physical examination of the surface structures of the face and teeth. They appear to have made primary use of indicators available on study casts and facial photographs and relatively little use of information that is available only on cephalograms or that involves the application of specialized orthodontic theories.

Social Priorities as Data

NASA Astrophysics Data System (ADS)

Grubert, E.

2015-12-01

Decision makers' responses to local risks and expected changes to a community from circumstances like natural hazards, human developments, and demographic changes can greatly affect social and environmental outcomes in a community. Translating physical data based in disciplines like engineering and geosciences into positive outcomes for communities can be challenging and often results in conflict that appears to pit "science" against "the public." Scientists can be reluctant to offer recommendations for action based on their work, often (and often correctly) noting that their role is not to make value judgments for a community - particularly for a community that is not their own. Conversely, decision makers can be frustrated by the lack of guidance they receive to help translate data into effective and acceptable action. The solution posed by this submission, given the goal of co-production of knowledge by scientists and decision makers to foster better community outcomes, is to involve the community directly by integrating social scientific methods that address decision making and community engagement to the scientist-decision maker interaction. Specifically, the missing dataset in many scientist-decision maker interactions is the nature of community priorities. Using scientifically valid methods to rigorously collect and characterize community priorities to help recommend tradeoffs between different outcomes indicated by the work of physical and natural scientists can bridge the gap between science and action by involving the community in the process. This submission presents early work on US preferences for different types of social and environmental outcomes designed to integrate directly with engineering and physical science frameworks like Life Cycle Assessment and Environmental Impact Statements. Cardinal preference data are based on surveys of US adults using tools like the Analytical Hierarchy Process, budget allocation, and ranking.

Dynamic Interplay of Value and Sensory Information in High-Speed Decision Making.

PubMed

Afacan-Seref, Kivilcim; Steinemann, Natalie A; Blangero, Annabelle; Kelly, Simon P

2018-03-05

In dynamic environments, split-second sensorimotor decisions must be prioritized according to potential payoffs to maximize overall rewards. The impact of relative value on deliberative perceptual judgments has been examined extensively [1-6], but relatively little is known about value-biasing mechanisms in the common situation where physical evidence is strong but the time to act is severely limited. In prominent decision models, a noisy but statistically stationary representation of sensory evidence is integrated over time to an action-triggering bound, and value-biases are affected by starting the integrator closer to the more valuable bound. Here, we show significant departures from this account for humans making rapid sensory-instructed action choices. Behavior was best explained by a simple model in which the evidence representation-and hence, rate of accumulation-is itself biased by value and is non-stationary, increasing over the short decision time frame. Because the value bias initially dominates, the model uniquely predicts a dynamic "turn-around" effect on low-value cues, where the accumulator first launches toward the incorrect action but is then re-routed to the correct one. This was clearly exhibited in electrophysiological signals reflecting motor preparation and evidence accumulation. Finally, we construct an extended model that implements this dynamic effect through plausible sensory neural response modulations and demonstrate the correspondence between decision signal dynamics simulated from a behavioral fit of that model and the empirical decision signals. Our findings suggest that value and sensory information can exert simultaneous and dynamically countervailing influences on the trajectory of the accumulation-to-bound process, driving rapid, sensory-guided actions. Copyright © 2018 Elsevier Ltd. All rights reserved.

Shared decision-making in epilepsy management.

PubMed

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

2015-06-01

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

[Shared decision-making in medical practice--patient-centred communication skills].

PubMed

van Staveren, Remke

2011-01-01

Most patients (70%) want to participate actively in important healthcare decisions, the rest (30%) prefer the doctor to make the decision for them. Shared decision-making provides more patient satisfaction, a better quality of life and contributes to a better doctor-patient relationship. Patients making their own decision generally make a well considered and medically sensible choice. In shared decision-making the doctor asks many open questions, gives and requests much information, asks if the patient wishes to participate in the decision-making and explicitly takes into account patient circumstances and preferences. Shared decision-making should remain an individual choice and should not become a new dogma.

Advancing in the Career Decision-Making Process: The Role of Coping Strategies and Career Decision-Making Profiles

ERIC Educational Resources Information Center

Perez, Maya; Gati, Itamar

2017-01-01

We tested the associations among the career decision-making difficulties, the career decision status, and either (a) the career decision-making profiles of 575 young adults, or (b) the coping strategies of 379 young adults. As hypothesized, a more advanced decision status was negatively associated with both career decision-making difficulties…

Inside the black box of shared decision making: distinguishing between the process of involvement and who makes the decision

PubMed Central

Edwards, Adrian; Elwyn, Glyn

2006-01-01

Abstract Background  Shared decision making has practical implications for everyday health care. However, it stems from largely theoretical frameworks and is not widely implemented in routine practice. Aims  We undertook an empirical study to inform understanding of shared decision making and how it can be operationalized more widely. Method  The study involved patients visiting UK general practitioners already well experienced in shared decision making. After these consultations, semi‐structured telephone interviews were conducted and analysed using the constant comparative method of content analysis. Results  All patients described at least some components of shared decision making but half appeared to perceive the decision as shared and half as ‘patient‐led’. However, patients exhibited some uncertainty about who had made the decision, reflecting different meanings of decision making from those described in the literature. A distinction is indicated between the process of involvement (option portrayal, exchange of information and exploring preferences for who makes the decision) and the actual decisional responsibility (who makes the decision). The process of involvement appeared to deliver benefits for patients, not the action of making the decision. Preferences for decisional responsibility varied during some consultations, generating unsatisfactory interactions when actual decisional responsibility did not align with patient preferences at that stage of a consultation. However, when conducted well, shared decision making enhanced reported satisfaction, understanding and confidence in the decisions. Conclusions  Practitioners can focus more on the process of involving patients in decision making rather than attaching importance to who actually makes the decision. They also need to be aware of the potential for changing patient preferences for decisional responsibility during a consultation and address non‐alignment of patient preferences with the actual model of decision making if this occurs. PMID:17083558

Implementation of standardization in clinical practice: not always an easy task.

PubMed

Panteghini, Mauro

2012-02-29

As soon as a new reference measurement system is adopted, clinical validation of correctly calibrated commercial methods should take place. Tracing back the calibration of routine assays to a reference system can actually modify the relation of analyte results to existing reference intervals and decision limits and this may invalidate some of the clinical decision-making criteria currently used. To maintain the accumulated clinical experience, the quantitative relationship to the previous calibration system should be established and, if necessary, the clinical decision-making criteria should be adjusted accordingly. The implementation of standardization should take place in a concerted action of laboratorians, manufacturers, external quality assessment scheme organizers and clinicians. Dedicated meetings with manufacturers should be organized to discuss the process of assay recalibration and studies should be performed to obtain convincing evidence that the standardization works, improving result comparability. Another important issue relates to the surveillance of the performance of standardized assays through the organization of appropriate analytical internal and external quality controls. Last but not least, uncertainty of measurement that fits for this purpose must be defined across the entire traceability chain, starting with the available reference materials, extending through the manufacturers and their processes for assignment of calibrator values and ultimately to the final result reported to clinicians by laboratories.

Interpreting “statistical hypothesis testing” results in clinical research

PubMed Central

Sarmukaddam, Sanjeev B.

2012-01-01

Difference between “Clinical Significance and Statistical Significance” should be kept in mind while interpreting “statistical hypothesis testing” results in clinical research. This fact is already known to many but again pointed out here as philosophy of “statistical hypothesis testing” is sometimes unnecessarily criticized mainly due to failure in considering such distinction. Randomized controlled trials are also wrongly criticized similarly. Some scientific method may not be applicable in some peculiar/particular situation does not mean that the method is useless. Also remember that “statistical hypothesis testing” is not for decision making and the field of “decision analysis” is very much an integral part of science of statistics. It is not correct to say that “confidence intervals have nothing to do with confidence” unless one understands meaning of the word “confidence” as used in context of confidence interval. Interpretation of the results of every study should always consider all possible alternative explanations like chance, bias, and confounding. Statistical tests in inferential statistics are, in general, designed to answer the question “How likely is the difference found in random sample(s) is due to chance” and therefore limitation of relying only on statistical significance in making clinical decisions should be avoided. PMID:22707861

Toward an Expanded Definition of Adaptive Decision Making.

ERIC Educational Resources Information Center

Phillips, Susan D.

1997-01-01

Uses the lifespan, life-space model to examine the definition of adaptive decision making. Reviews the existing definition of adaptive decision making as "rational" decision making and offers alternate perspectives on decision making with an emphasis on the implications of using the model. Makes suggestions for future theory, research,…

Some ethical problems of hazardous substances in the working environment1

PubMed Central

Lee, W. R.

1977-01-01

ABSTRACT Exposure of persons to conditions at work may involve some risk to health. It is not possible always to ensure that exposure can be kept below a level from which it may be categorically stated that there is no risk. The decision that has to be made, what ought to be done, poses an ethical problem. What principles are available for examining such ethical problems? Two theories from the study of ethics seem relevant. On the one hand Intuitionism asserts that we possess a moral sense which, correctly applied, enables us to determine what is a right action. The familiar use of 'conscience' and the teachings of some of the influential Western religions follow this theory. On the other hand Utilitarianism (in particular Objective Utilitarianism) asserts that we may judge the rightness of an action by looking at its consequences. This theory, translated into legislative reform, has provided a substantial basis for much of the social reforming legislation of the last century. In economic terms it appears as cost benefit analysis. Despite its attraction and almost plausible objectivity, Utilitarianism requires the quantification and even costing of consequences which cannot always be measured (for example, emotions) but which from an important part of the totality of life. Decisions about the right course of action are required politically but cannot always be made objectively. They may require an element of judgement—a correct application of the moral sense—to use the Intuitionists' phrase. Doctors, used to making ethical decisions in the clinical setting, must examine carefully their role when contributing to ethical decisions in the industrial setting. PMID:588483

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.

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

PubMed

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

2012-10-01

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

Utility of hand-held echocardiography in outpatient pediatric cardiology management.

PubMed

Riley, Alan; Sable, Craig; Prasad, Aparna; Spurney, Christopher; Harahsheh, Ashraf; Clauss, Sarah; Colyer, Jessica; Gierdalski, Marcin; Johnson, Ashley; Pearson, Gail D; Rosenthal, Joanna

2014-12-01

Adult patient series have shown hand-held echocardiography (echo) units (HHE) to be accurate for rapid diagnosis and triage. This is the first study to evaluate the ability of HHE to inform decision making in outpatient pediatric cardiology. New pediatric cardiology patients in outpatient clinics staffed by six pediatric cardiologists (experience 1-17 years) were prospectively enrolled if an echocardiogram (echo) was ordered during their initial visit. After history and physical examination and before a standard echo, the cardiologists performed a bedside HHE examination (GE Vscan 1.7-3.8 MHz), documented findings, and made a clinical decision. Diagnoses and decisions based on HHE were compared with final management after the standard echo. The study enrolled 101 subjects (ages 9 days to 19 years). The cardiologists considered HHE imaging adequate for decision making for 80 of the 101 subjects. For 77 of the 80 subjects with acceptable HHE imaging (68/68 normal and 9/12 abnormal standard echoes), the HHE-based primary diagnoses and decisions agreed with the final management. The sensitivity of HHE was 75 % (95 % confidence interval [CI] 43-94 %) and the positive predictive value 100 % (95 % CI 66-100 %) for pediatric heart disease. The agreement between standard echocardiography and HHE imaging was substantial (κ = 0.82). Excluding one of the least experienced cardiologists, HHE provided the basis for correct cardiac diagnoses and management for all the subjects with acceptable HHE imaging (58/58 normal and 9/9 abnormal echoes). In outpatient pediatric cardiology, HHE has potential as a tool to complement physical examination. Further investigation is needed to evaluate how value improves with clinical experience.

Managing flowback and produced water from hydraulic fracturing under stochastic environment

NASA Astrophysics Data System (ADS)

Zhang, X.; Sun, A. Y.; Duncan, I. J.; Vesselinov, V. V.

2017-12-01

A large volume of wastewater is being generated from hydraulic fracturing in shale gas plays, including flowback and produced water. The produced wastewater in terms of its quantity and quality has become one of the main environmental problems facing shale gas industries worldwide. Cost-effective planning and management of flowback and produced water is highly desirable. Careful choice of treatment, disposal, and reuse options can lower costs and reduce potential environmental impacts. To handle the recourse issue in decision-making, a two-stage stochastic management model is developed to provide optimal alternatives for fracturing wastewater management. The proposed model is capable of prompting corrective actions to allow decision makers to adjust the pre-defined management strategies. By using this two-stage model, potential penalties arising from decision infeasibility can be minimized. The applicability of the proposed model is demonstrated using a representative synthetic example, in which tradeoffs between economic and environmental goals are quantified. This approach can generate informed defensible decisions for shale gas wastewater management. In addition, probabilistic and non-probabilistic uncertainties are effectively addressed.

The impact of failing to identify suspect effort in patients undergoing adult attention-deficit/hyperactivity disorder (ADHD) assessment.

PubMed

Marshall, Paul S; Hoelzle, James B; Heyerdahl, Danielle; Nelson, Nathaniel W

2016-10-01

[Correction Notice: An Erratum for this article was reported in Vol 28(10) of Psychological Assessment (see record 2016-22725-001). In the article, the penultimate sentence of the abstract should read “These results suggest that a significant percentage of those making a suspect effort will be diagnosed with ADHD using the most commonly employed assessment methods: an interview alone (71%); an interview and ADHD behavior rating scales combined (65%); and an interview, behavior rating scales, and most continuous performance tests combined (62%).” All versions of this article have been corrected.] This retrospective study examines how many adult patients would plausibly receive a diagnosis of attention-deficit/hyperactivity disorder (ADHD) if performance and symptom validity measures were not administered during neuropsychological evaluations. Five hundred fifty-four patients were extracted from an archival clinical dataset. A total of 102 were diagnosed with ADHD based on cognitive testing, behavior rating scales, effort testing, and clinical interview; 115 were identified as putting forth suspect effort in accordance with the Slick, Sherman, and Iverson (1999) criteria. From a clinical decision-making perspective, suspect effort and ADHD groups were nearly indistinguishable on ADHD behavior, executive function, and functional impairment rating scales, as well as on cognitive testing and key clinical interview questions. These results suggest that a significant percentage of those making a suspect effort will be diagnosed with ADHD using the most commonly employed assessment methods: an interview alone (71%); an interview and ADHD behavior rating scales combined (65%); and an interview, behavior rating scales, and most continuous performance tests combined (62%) [corrected]. This research makes clear that it is essential to evaluate task engagement and possible symptom amplification during clinical evaluations. PsycINFO Database Record (c) 2016 APA, all rights reserved

Effects of Cerebellar Disease on Sequences of Rapid Eye Movements

PubMed Central

King, Susan; Chen, Athena L.; Joshi, Anand; Serra, Alessandro; Leigh, R. John

2011-01-01

Summary Studying saccades can illuminate the more complex decision-making processes required for everyday movements. The double-step task, in which a target jumps to two successive locations before the subject has time to react, has proven a powerful research tool to investigate the brain’s ability to program sequential responses. We asked how patients with a range of cerebellar disorders responded to the double-step task, specifically, whether the initial saccadic response made to a target is affected by the appearance of a second target jump. We also sought to determine whether cerebellar patients were able to make corrective saccades towards the remembered second target location, if it were turned off soon after presentation. We tested saccades to randomly interleaved single- and double-step target jumps to eight locations on a circle. Patient’s initial responses to double-step stimuli showed 50% more error than saccades to single target jumps, and often, they failed to make a saccade to the first target jump. The presence of a second target jump had similar, but smaller effects in control subjects (error increased by 18%). During memory-guided double-step trials, both patients and controls made corrective saccades in darkness to the remembered location of the second jump. We conclude that in cerebellar patients, the second target jump interferes with programming of the saccade to the first target jump of a double-step stimulus; this defect highlights patients’ impaired ability to respond appropriately to sudden, conflicting changes in their environment. Conversely, since cerebellar patients can make corrective memory-guided saccades in darkness, they retain the ability to remember spatial locations, possibly due to non-retinal neural signals (corollary discharge) from cerebral hemispheric areas concerned with spatial localization. PMID:21385592

A timely account of the role of duration in decision making.

PubMed

Ariely, D; Zakay, D

2001-09-01

The current work takes a general perspective on the role of time in decision making. There are many different relationships and interactions between time and decision making, and no single summary can do justice to this topic. In this paper we will describe a few of the aspects in which time and decision making are interleaved: (a) temporal perspectives of decisions--the various temporal orientations that decision-makers may adopt while making decisions, and the impact of such temporal orientations on the decision process and its outcomes; (b) time as a medium within which decisions take place--the nature of decision processes that occur along time; (c) time as a resource and as a contextual factor--the implications of shortage in time resources and the impact of time limits on decision making processes and performance; (d) time as a commodity--time as the subject matter of decision making. The paper ends with a few general questions on the role of duration in decision making.

Task-related modulation of effective connectivity during perceptual decision making: dissociation between dorsal and ventral prefrontal cortex.

PubMed

Akaishi, Rei; Ueda, Naoko; Sakai, Katsuyuki

2013-01-01

The dorsal and ventral parts of the lateral prefrontal cortex have been thought to play distinct roles in decision making. Although its dorsal part such as the frontal eye field (FEF) is shown to play roles in accumulation of sensory information during perceptual decision making, the role of the ventral prefrontal cortex (PFv) is not well-documented. Previous studies have suggested that the PFv is involved in selective attention to the task-relevant information and is associated with accuracy of the behavioral performance. It is unknown, however, whether the accumulation and selection processes are anatomically dissociated between the FEF and PFv. Here we show that, by using concurrent TMS and EEG recording, the short-latency (20-40 ms) TMS-evoked potentials after stimulation of the FEF change as a function of the time to behavioral response, whereas those after stimulation of the PFv change depending on whether the response is correct or not. The potentials after stimulation of either region did not show significant interaction between time to response and performance accuracy, suggesting dissociation between the processes subserved by the FEF and PFv networks. The results are consistent with the idea that the network involving the FEF plays a role in information accumulation, whereas the network involving the PFv plays a role in selecting task relevant information. In addition, stimulation of the FEF and PFv induced activation in common regions in the dorsolateral and medial frontal cortices, suggesting convergence of information processed in the two regions. Taken together, the results suggest dissociation between the FEF and PFv networks for their computational roles in perceptual decision making. The study also highlights the advantage of TMS-EEG technique in investigating the computational processes subserved by the neural network in the human brain with a high temporal resolution.

Could 68-Ga PSMA PET/CT become a new tool in the decision-making strategy of prostate cancer patients with biochemical recurrence of PSA after radical prostatectomy? A preliminary, monocentric series.

PubMed

De Bari, Berardino; Mazzola, Rosario; Aiello, Dario; Fersino, Sergio; Gregucci, Fabiana; Alongi, Pierpaolo; Nicodemo, Maurizio; Cavalleri, Stefano; Salgarello, Matteo; Alongi, Filippo

2018-04-23

To evaluate the impact of gallium68 PSMA-11 (HBED-CC)-PET/CT on decision-making strategy of patients with relapsing prostate cancer (PC) presenting a second biochemical relapse after radical prostatectomy (RP) and salvage RT or salvage androgen deprivation therapy (ADT). 40 patients were retrospectively analyzed. All of them had received prostatectomy. Thirteen out of 40 were addressed to gallium68 PSMA-11 (HBED-CC)-PET/CT for a biochemical relapse after RP, 14/40 after a salvage RT and 13/40 after salvage or adjuvant ADT. The PSA level ranged between 0.1 and 1.62 ng/ml (median value: 0.51 ng/ml). We studied the impact on the decision-making process of a multidisciplinary tumor board of additional data obtained from gallium68 PSMA-11 (HBED-CC)-PET/CT. Thirty-one out of 40 evaluated patients showed positive findings at gallium68 PSMA-11 (HBED-CC)-PET/CT (77.5%). Of them, five were positive in the prostatic bed, nine in the pelvic nodes, twelve in nodes outside the pelvis and eight at bone level. Nine patients presented two different sites of relapse (22.5%). Gallium68 PSMA-11 (HBED-CC)-PET/CT data changed the therapeutic approach in 28 patients (70%). Gallium68 PSMA-11 (HBED-CC)-PET/CT can be a useful tool in the restaging of post-RP, RT or ADT patients presenting biochemical relapse of PC and it could change the decision-making process in up of 70% of these patients. Prospective, larger series are needed to establish the correct role of this very promising tool in the staging and therapeutic approach of PC patients.

Implications of Modeling Uncertainty for Water Quality Decision Making

NASA Astrophysics Data System (ADS)

Shabman, L.

2002-05-01

The report, National Academy of Sciences report, "Assessing the TMDL Approach to Water Quality Management" endorsed the "watershed" and "ambient water quality focused" approach" to water quality management called for in the TMDL program. The committee felt that available data and models were adequate to move such a program forward, if the EPA and all stakeholders better understood the nature of the scientific enterprise and its application to the TMDL program. Specifically, the report called for a greater acknowledgement of model prediction uncertinaity in making and implementing TMDL plans. To assure that such uncertinaity was addressed in water quality decision making the committee called for a commitment to "adaptive implementation" of water quality management plans. The committee found that the number and complexity of the interactions of multiple stressors, combined with model prediction uncertinaity means that we need to avoid the temptation to make assurances that specific actions will result in attainment of particular water quality standards. Until the work on solving a water quality problem begins, analysts and decision makers cannot be sure what the correct solutions are, or even what water quality goals a community should be seeking. In complex systems we need to act in order to learn; adaptive implementation is a concurrent process of action and learning. Learning requires (1) continued monitoring of the waterbody to determine how it responds to the actions taken and (2) carefully designed experiments in the watershed. If we do not design learning into what we attempt we are not doing adaptive implementation. Therefore, there needs to be an increased commitment to monitoring and experiments in watersheds that will lead to learning. This presentation will 1) explain the logic for adaptive implementation; 2) discuss the ways that water quality modelers could characterize and explain model uncertinaity to decision makers; 3) speculate on the implications of the adaptive implementation for setting of water quality standards, for design of watershed monitoring programs and for the regulatory rules governing the TMDL program implementation.

What is known about parents' treatment decisions? A narrative review of pediatric decision making.

PubMed

Lipstein, Ellen A; Brinkman, William B; Britto, Maria T

2012-01-01

With the increasing complexity of decisions in pediatric medicine, there is a growing need to understand the pediatric decision-making process. To conduct a narrative review of the current research on parent decision making about pediatric treatments and identify areas in need of further investigation. Articles presenting original research on parent decision making were identified from MEDLINE (1966-6/2011), using the terms "decision making," "parent," and "child." We included papers focused on treatment decisions but excluded those focused on information disclosure to children, vaccination, and research participation decisions. We found 55 papers describing 52 distinct studies, the majority being descriptive, qualitative studies of the decision-making process, with very limited assessment of decision outcomes. Although parents' preferences for degree of participation in pediatric decision making vary, most are interested in sharing the decision with the provider. In addition to the provider, parents are influenced in their decision making by changes in their child's health status, other community members, prior knowledge, and personal factors, such as emotions and faith. Parents struggle to balance these influences as well as to know when to include their child in decision making. Current research demonstrates a diversity of influences on parent decision making and parent decision preferences; however, little is known about decision outcomes or interventions to improve outcomes. Further investigation, using prospective methods, is needed in order to understand how to support parents through the difficult treatment decisions.

Developing effective warning systems: Ongoing research at Ruapehu volcano, New Zealand

NASA Astrophysics Data System (ADS)

Leonard, Graham S.; Johnston, David M.; Paton, Douglas; Christianson, Amy; Becker, Julia; Keys, Harry

2008-05-01

PurposeThis paper examines the unique challenges to volcanic risk management associated with having a ski area on an active volcano. Using a series of simulated eruption/lahar events at Ruapehu volcano, New Zealand, as a context, a model of risk management that integrates warning system design and technology, risk perceptions and the human response is explored. Principal resultsDespite increases in the observed audibility and comprehension of the warning message, recall of public education content, and people's awareness of volcanic risk, a persistent minority of the public continued to demonstrate only moderate awareness of the correct actions to take during a warning and failed to respond effectively. A relationship between level of staff competence and correct public response allowed the level of public response to be used to identify residual risk and additional staff training needs. The quality of staff awareness, action and decision-making has emerged as a critical factor, from detailed staff and public interviews and from exercise observations. Staff actions are especially important for mobilising correct public response at Ruapehu ski areas due to the transient nature of the visitor population. Introduction of education material and staff training strategies that included the development of emergency decision-making competencies improved knowledge of correct actions, and increased the proportion of people moving out of harm's way during blind tests. Major conclusionsWarning effectiveness is a function of more than good hazard knowledge and the generation and notification of an early warning message. For warning systems to be effective, these factors must be complemented by accurate knowledge of risk and risk management actions. By combining the Ruapehu findings with those of other warning system studies in New Zealand, and internationally, a practical five-step model for effective early warning systems is discussed. These steps must be based upon sound and regularly updated underpinning science and be tied to formal effectiveness evaluation, which is fed back into system improvements. The model presented emphasises human considerations, the development of which arguably require even more effort than the hardware components of early warning systems.

Genetic background of supernumerary teeth.

PubMed

Subasioglu, Asli; Savas, Selcuk; Kucukyilmaz, Ebru; Kesim, Servet; Yagci, Ahmet; Dundar, Munis

2015-01-01

Supernumerary teeth (ST) are odontostomatologic anomaly characterized by as the existence excessive number of teeth in relation to the normal dental formula. This condition is commonly seen with several congenital genetic disorders such as Gardner's syndrome, cleidocranial dysostosis and cleft lip and palate. Less common syndromes that are associated with ST are; Fabry Disease, Ellis-van Creveld syndrome, Nance-Horan syndrome, Rubinstein-Taybi Syndrome and Trico-Rhino-Phalangeal syndrome. ST can be an important component of a distinctive disorder and an important clue for early diagnosis. Certainly early detecting the abnormalities gives us to make correct management of the patient and also it is important for making well-informed decisions about long-term medical care and treatment. In this review, the genetic syndromes that are related with ST were discussed.

Ambulatory Blood Pressure Monitoring in the Diagnosis and Treatment of Hypertension.

PubMed

Islam, Md Shahidul

2017-01-01

Clinicians should take initiatives to establish ambulatory blood pressure monitoring (ABPM) services in their own practice, or to ensure that they have access to such services elsewhere. Whenever possible, ABPM should be performed in suitable cases, where it is likely to deliver clinically useful information for making a correct diagnosis, or for tailoring the anti-hypertensive treatment regimen for each individual patient. ABPM is clinically useful, among others, for identifying people with "masked normotension", "masked hypertension", "sleep-time hypertension", and "reduced decline of sleep-time blood pressure". This review briefly outlines the rationales for the use of ABPM, interpretations of the ABPM-derived parameters, and the advantages of ABPM in decision making in the management of hypertension.

Composite collective decision-making

PubMed Central

Czaczkes, Tomer J.; Czaczkes, Benjamin; Iglhaut, Carolin; Heinze, Jürgen

2015-01-01

Individual animals are adept at making decisions and have cognitive abilities, such as memory, which allow them to hone their decisions. Social animals can also share information. This allows social animals to make adaptive group-level decisions. Both individual and collective decision-making systems also have drawbacks and limitations, and while both are well studied, the interaction between them is still poorly understood. Here, we study how individual and collective decision-making interact during ant foraging. We first gathered empirical data on memory-based foraging persistence in the ant Lasius niger. We used these data to create an agent-based model where ants may use social information (trail pheromones), private information (memories) or both to make foraging decisions. The combined use of social and private information by individuals results in greater efficiency at the group level than when either information source was used alone. The modelled ants couple consensus decision-making, allowing them to quickly exploit high-quality food sources, and combined decision-making, allowing different individuals to specialize in exploiting different resource patches. Such a composite collective decision-making system reaps the benefits of both its constituent parts. Exploiting such insights into composite collective decision-making may lead to improved decision-making algorithms. PMID:26019155

SSVEP-BCI implementation for 37-40 Hz frequency range.

PubMed

Müller, Sandra Mara Torres; Diez, Pablo F; Bastos-Filho, Teodiano Freire; Sarcinelli-Filho, Mário; Mut, Vicente; Laciar, Eric

2011-01-01

This work presents a Brain-Computer Interface (BCI) based on Steady State Visual Evoked Potentials (SSVEP), using higher stimulus frequencies (>30 Hz). Using a statistical test and a decision tree, the real-time EEG registers of six volunteers are analyzed, with the classification result updated each second. The BCI developed does not need any kind of settings or adjustments, which makes it more general. Offline results are presented, which corresponds to a correct classification rate of up to 99% and a Information Transfer Rate (ITR) of up to 114.2 bits/min.

Two-Stage Fracturing Wastewater Management in Shale Gas Development

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

Zhang, Xiaodong; Sun, Alexander Y.; Duncan, Ian J.

Here, management of shale gas wastewater treatment, disposal, and reuse has become a significant environmental challenge, driven by an ongoing boom in development of U.S. shale gas reservoirs. Systems-analysis based decision support is helpful for effective management of wastewater, and provision of cost-effective decision alternatives from a whole-system perspective. Uncertainties are inherent in many modeling parameters, affecting the generated decisions. In order to effectively deal with the recourse issue in decision making, in this work a two-stage stochastic fracturing wastewater management model, named TSWM, is developed to provide decision support for wastewater management planning in shale plays. Using the TSWMmore » model, probabilistic and nonprobabilistic uncertainties are effectively handled. The TSWM model provides flexibility in generating shale gas wastewater management strategies, in which the first-stage decision predefined by decision makers before uncertainties are unfolded is corrected in the second stage to achieve the whole-system’s optimality. Application of the TSWM model to a comprehensive synthetic example demonstrates its practical applicability and feasibility. Optimal results are generated for allowable wastewater quantities, excess wastewater, and capacity expansions of hazardous wastewater treatment plants to achieve the minimized total system cost. The obtained interval solutions encompass both optimistic and conservative decisions. Trade-offs between economic and environmental objectives are made depending on decision makers’ knowledge and judgment, as well as site-specific information. In conclusion, the proposed model is helpful in forming informed decisions for wastewater management associated with shale gas development.« less

Two-Stage Fracturing Wastewater Management in Shale Gas Development

DOE PAGES

Zhang, Xiaodong; Sun, Alexander Y.; Duncan, Ian J.; ...

2017-01-19

Here, management of shale gas wastewater treatment, disposal, and reuse has become a significant environmental challenge, driven by an ongoing boom in development of U.S. shale gas reservoirs. Systems-analysis based decision support is helpful for effective management of wastewater, and provision of cost-effective decision alternatives from a whole-system perspective. Uncertainties are inherent in many modeling parameters, affecting the generated decisions. In order to effectively deal with the recourse issue in decision making, in this work a two-stage stochastic fracturing wastewater management model, named TSWM, is developed to provide decision support for wastewater management planning in shale plays. Using the TSWMmore » model, probabilistic and nonprobabilistic uncertainties are effectively handled. The TSWM model provides flexibility in generating shale gas wastewater management strategies, in which the first-stage decision predefined by decision makers before uncertainties are unfolded is corrected in the second stage to achieve the whole-system’s optimality. Application of the TSWM model to a comprehensive synthetic example demonstrates its practical applicability and feasibility. Optimal results are generated for allowable wastewater quantities, excess wastewater, and capacity expansions of hazardous wastewater treatment plants to achieve the minimized total system cost. The obtained interval solutions encompass both optimistic and conservative decisions. Trade-offs between economic and environmental objectives are made depending on decision makers’ knowledge and judgment, as well as site-specific information. In conclusion, the proposed model is helpful in forming informed decisions for wastewater management associated with shale gas development.« less

Analysis of the decision-making process of nurse managers: a collective reflection.

PubMed

Eduardo, Elizabete Araujo; Peres, Aida Maris; de Almeida, Maria de Lourdes; Roglio, Karina de Dea; Bernardino, Elizabeth

2015-01-01

to analyze the decision-making model adopted by nurses from the perspective of some decision-making process theories. qualitative approach, based on action research. Semi-structured questionnaires and seminars were conducted from April to June 2012 in order to understand the nature of decisions and the decision-making process of nine nurses in position of managers at a public hospital in Southern Brazil. Data were subjected to content analysis. data were classified in two categories: the current situation of decision-making, which showed a lack of systematization; the construction and collective decision-making, which emphasizes the need to develop a decision-making model. the decision-making model used by nurses is limited because it does not consider two important factors: the limits of human rationality, and the external and internal organizational environments that influence and determine right decisions.

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

PubMed

Truglio-Londrigan, Marie; Slyer, Jason T

2018-01-01

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

Corrective Action Decision Document/Closure Report for Corrective Action Unit 252: Area 25 Engine Test Stand 1 Decontamination Pad, Nevada Test Site, Nevada

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

DOE /NV

This Corrective Action Decision Document/Closure Report (CADD/CR) has been prepared for Corrective Action Unit (CAU) 252: Area 25 Engine Test Stand-1 Decontamination Pad, in accordance with the Federal Facility Agreement and Consent Order (FFACO). Located at the Nevada Test Site in Nevada, CAU 252 consists of only one Corrective Action Site (25-07-04, Decontamination Pad). This CADD/CR identifies and rationalizes the U.S. Department of Energy, Nevada Operations Office's (DOE/NV's) recommendation that no corrective action is deemed necessary at CAU 252. The Corrective Action Decision Document and Closure Report have been combined into one report because the potential contaminants of concern weremore » either not detected during the corrective action investigation or were only present at naturally occurring concentrations. Based on the field results, neither corrective action or a corrective action plan is required at this site. A Notice of Completion to DOE/NV is being requested from the Nevada Division of Environmental Protection for closure of CAU 252, as well as a request that this site be moved from Appendix III to Appendix IV of the FFACO. Further, no use restrictions are required to be placed on this CAU.« less

Does future-oriented thinking predict adolescent decision making?

PubMed

Eskritt, Michelle; Doucette, Jesslyn; Robitaille, Lori

2014-01-01

A number of theorists, as well as plain common sense, suggest that future-oriented thinking (FOT) should be involved in decision making; therefore, the development of FOT should be related to better quality decision making. FOT and quality of the decision making were measured in adolescents as well as adults in 2 different experiments. Though the results of the first experiment revealed an increase in quality of decision making across adolescence into adulthood, there was no relationship between FOT and decision making. In the second experiment, FOT predicted performance on a more deliberative decision-making task independent of age, but not performance on the Iowa Gambling Task (IGT). Performance on the IGT was instead related to emotion regulation. The study's findings suggest that FOT can be related to reflective decision making but not necessarily decision making that is more intuitive.

Mothers' process of decision making for gastrostomy placement.

PubMed

Brotherton, Ailsa; Abbott, Janice

2012-05-01

In this article we present the findings of an exploration of mothers' discourses on decision making for gastrostomy placement for their child. Exploring in-depth interviews of a purposive sample, we analyzed the mothers' discourses of the decision-making process to understand how their experiences of the process influenced their subsequent constructions of decision making. Mothers negotiated decision making by reflecting on their personal experiences of feeding their child, either orally or via a tube, and interwove their background experiences with the communications from members of the health care team until a decision was reached. Decision making was often fraught with difficulty, resulting in anxiety and guilt. Experiences of decision making ranged from perceived coercion to true choice, which encompasses a truly child-centered decision. The resulting impact of the decision-making process on the mothers was profound. We conclude with an exploration of the implications for clinical practice and describe how health care professionals can support mothers to ensure that decision-making processes for gastrostomy placement in children are significantly improved.

Path Analysis Examining Self-Efficacy and Decision-Making Performance on a Simulated Baseball Task

ERIC Educational Resources Information Center

Hepler, Teri J.; Feltz, Deborah L.

2012-01-01

The purpose of this study was to examine the relationship between decision-making self-efficacy and decision-making performance in sport. Undergraduate students (N = 78) performed 10 trials of a decision-making task in baseball. Self-efficacy was measured before performing each trial. Decision-making performance was assessed by decision speed and…

Decision Styles and Rationality: An Analysis of the Predictive Validity of the General Decision-Making Style Inventory

ERIC Educational Resources Information Center

Curseu, Petru Lucian; Schruijer, Sandra G. L.

2012-01-01

This study investigates the relationship between the five decision-making styles evaluated by the General Decision-Making Style Inventory, indecisiveness, and rationality in decision making. Using a sample of 102 middle-level managers, the results show that the rational style positively predicts rationality in decision making and negatively…

Patients' understanding of shared decision making in a mental health setting.

PubMed

Eliacin, Johanne; Salyers, Michelle P; Kukla, Marina; Matthias, Marianne S

2015-05-01

Shared decision making is a fundamental component of patient-centered care and has been linked to positive health outcomes. Increasingly, researchers are turning their attention to shared decision making in mental health; however, few studies have explored decision making in these settings from patients' perspectives. We examined patients' accounts and understanding of shared decision making. We analyzed interviews from 54 veterans receiving outpatient mental health care at a Department of Veterans Affairs Medical Center in the United States. Although patients' understanding of shared decision making was consistent with accounts published in the literature, participants reported that shared decision making goes well beyond these components. They identified the patient-provider relationship as the bedrock of shared decision making and highlighted several factors that interfere with shared decision making. Our findings highlight the importance of the patient-provider relationship as a fundamental element of shared decision making and point to areas for potential improvement. © The Author(s) 2014.

National evidence on the use of shared decision making in prostate-specific antigen screening.

PubMed

Han, Paul K J; Kobrin, Sarah; Breen, Nancy; Joseph, Djenaba A; Li, Jun; Frosch, Dominick L; Klabunde, Carrie N

2013-01-01

Recent clinical practice guidelines on prostate cancer screening using the prostate-specific antigen (PSA) test (PSA screening) have recommended that clinicians practice shared decision making-a process involving clinician-patient discussion of the pros, cons, and uncertainties of screening. We undertook a study to determine the prevalence of shared decision making in both PSA screening and nonscreening, as well as patient characteristics associated with shared decision making. A nationally representative sample of 3,427 men aged 50 to 74 years participating in the 2010 National Health Interview Survey responded to questions on the extent of shared decision making (past physician-patient discussion of advantages, disadvantages, and scientific uncertainty associated with PSA screening), PSA screening intensity (tests in past 5 years), and sociodemographic and health-related characteristics. Nearly two-thirds (64.3%) of men reported no past physician-patient discussion of advantages, disadvantages, or scientific uncertainty (no shared decision making); 27.8% reported discussion of 1 to 2 elements only (partial shared decision making); 8.0% reported discussion of all 3 elements (full shared decision making). Nearly one-half (44.2%) reported no PSA screening, 27.8% reported low-intensity (less-than-annual) screening, and 25.1% reported high-intensity (nearly annual) screening. Absence of shared decision making was more prevalent in men who were not screened; 88% (95% CI, 86.2%-90.1%) of nonscreened men reported no shared decision making compared with 39% (95% CI, 35.0%-43.3%) of men undergoing high-intensity screening. Extent of shared decision making was associated with black race, Hispanic ethnicity, higher education, health insurance, and physician recommendation. Screening intensity was associated with older age, higher education, usual source of medical care, and physician recommendation, as well as with partial vs no or full shared decision making. Most US men report little shared decision making in PSA screening, and the lack of shared decision making is more prevalent in nonscreened than in screened men. Screening intensity is greatest with partial shared decision making, and different elements of shared decision making are associated with distinct patient characteristics. Shared decision making needs to be improved in decisions for and against PSA screening.

Evaluation of Pharmacy and Therapeutic (P&T) Committee member knowledge, attitudes and ability regarding the use of comparative effectiveness research (CER) in health care decision-making.

PubMed

Tang, D H; Warholak, T L; Hines, L E; Hurwitz, J; Brown, M; Taylor, A M; Brixner, D; Malone, D C

2014-01-01

Comparative effectiveness research (CER) is a constellation of research methods designed to improve health care decision making. Educational programs that improve health care decision makers' CER knowledge and awareness may ultimately lead to more cost-effective use of health care resources. This study was conducted to evaluate changes in CER knowledge, attitudes, and ability among Pharmacy and Therapeutics (P&T) Committee members and support staff after attending a tailored educational program. Physicians and pharmacists from two professional societies and the Indian Health Service who participated in the P&T process were invited via email to participate in this study. Participants completed a questionnaire, designed specifically for this study, prior to and following the 4-hour live, educational program on CER to determine the impact on their related knowledge, attitudes, and ability to use CER in decision-making. Rasch analysis was used to assess validity and reliability of subsections of the questionnaire and regression analysis was used to assess programmatic impact on CER knowledge, attitude, and ability. One hundred and forty of the 199 participants completed both the pre- and post-CER session questionnaires (response rate = 70.4%). Most participants (>75%) correctly answered eight of the ten knowledge items after attending the educational session. More than 60% of the respondents had a positive attitude toward CER both before and after the program. Compared to baseline (pretest), participants reported significant improvements in their perceived ability to use CER after attending the session in these areas: using CER reviews, knowledge of CER methods, identifying problems with randomized controlled trials, identifying threats to validity, understanding of evidence synthesis approaches, and evaluating the quality of CER (all P values < 0.001). The questionnaire demonstrated acceptable reliability and validity evidence (limited evidence of construct under-representation and construct irrelevant variance). The CER educational program was effective in increasing participants' CER knowledge and self-perceived ability to evaluate relevant evidence. Improving knowledge and awareness of CER and its applicability is a critical first step in improving its use in health care decision making. Copyright © 2014 Elsevier Inc. All rights reserved.

Defining decision making: a qualitative study of international experts' views on surgical trainee decision making.

PubMed

Rennie, Sarah C; van Rij, Andre M; Jaye, Chrystal; Hall, Katherine H

2011-06-01

Decision making is a key competency of surgeons; however, how best to assess decisions and decision makers is not clearly established. The aim of the present study was to identify criteria that inform judgments about surgical trainees' decision-making skills. A qualitative free text web-based survey was distributed to recognized international experts in Surgery, Medical Education, and Cognitive Research. Half the participants were asked to identify features of good decisions, characteristics of good decision makers, and essential factors for developing good decision-making skills. The other half were asked to consider these areas in relation to poor decision making. Template analysis of free text responses was performed. Twenty-nine (52%) experts responded to the survey, identifying 13 categories for judging a decision and 14 for judging a decision maker. Twelve features/characteristics overlapped (considered, informed, well timed, aware of limitations, communicated, knowledgeable, collaborative, patient-focused, flexible, able to act on the decision, evidence-based, and coherent). Fifteen categories were generated for essential factors leading to development of decision-making skills that fall into three major themes (personal qualities, training, and culture). The categories compiled from the perspectives of good/poor were predominantly the inverse of each other; however, the weighting given to some categories varied. This study provides criteria described by experts when considering surgical decisions, decision makers, and development of decision-making skills. It proposes a working definition of a good decision maker. Understanding these criteria will enable clinical teachers to better recognize and encourage good decision-making skills and identify poor decision-making skills for remediation.

Autonomy and couples' joint decision-making in healthcare.

PubMed

Osamor, Pauline E; Grady, Christine

2018-01-11

Respect for autonomy is a key principle in bioethics. However, respecting autonomy in practice is complex because most people define themselves and make decisions influenced by a complex network of social relationships. The extent to which individual autonomy operates for each partner within the context of decision-making within marital or similar relationships is largely unexplored. This paper explores issues related to decision-making by couples (couples' joint decision-making) for health care and the circumstances under which such a practice should be respected as compatible with autonomous decision-making. We discuss the concept of autonomy as it applies to persons and to actions, human interdependency and gender roles in decision-making, the dynamics and outcomes of couples' joint decision-making, and the ethics of couples' joint decision-making. We believe that the extent to which couples' joint decision-making might be deemed ethically acceptable will vary depending on the context. Given that in many traditional marriages the woman is the less dominant partner, we consider a spectrum of scenarios of couples' joint decision-making about a woman's own health care that move from those that are acceptably autonomous to those that are not consistent with respecting the woman's autonomous decision-making. To the extent that there is evidence that both members of a couple understand a decision, intend it, and that neither completely controls the other, couples' joint decision-making should be viewed as consistent with the principle of respect for the woman's autonomy. At the other end of the spectrum are decisions made by the man without the woman's input, representing domination of one partner by the other. We recommend viewing the dynamics of couples' joint decision-making as existing on a continuum of degrees of autonomy. This continuum-based perspective implies that couples' joint decision-making should not be taken at face value but should be assessed against the specific cultural, ethnic, and religious backgrounds and personal circumstances of the individuals in question.

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

Decision ambiguity is mediated by a late positive potential originating from cingulate cortex.

PubMed

Sun, Sai; Zhen, Shanshan; Fu, Zhongzheng; Wu, Daw-An; Shimojo, Shinsuke; Adolphs, Ralph; Yu, Rongjun; Wang, Shuo

2017-08-15

People often make decisions in the face of ambiguous information, but it remains unclear how ambiguity is represented in the brain. We used three types of ambiguous stimuli and combined EEG and fMRI to examine the neural representation of perceptual decisions under ambiguity. We identified a late positive potential, the LPP, which differentiated levels of ambiguity, and which was specifically associated with behavioral judgments about choices that were ambiguous, rather than passive perception of ambiguous stimuli. Mediation analyses together with two further control experiments confirmed that the LPP was generated only when decisions are made (not during mere perception of ambiguous stimuli), and only when those decisions involved choices on a dimension that is ambiguous. A further control experiment showed that a stronger LPP arose in the presence of ambiguous stimuli compared to when only unambiguous stimuli were present. Source modeling suggested that the LPP originated from multiple loci in cingulate cortex, a finding we further confirmed using fMRI and fMRI-guided ERP source prediction. Taken together, our findings argue for a role of an LPP originating from cingulate cortex in encoding decisions based on task-relevant perceptual ambiguity, a process that may in turn influence confidence judgment, response conflict, and error correction. Copyright © 2017 Elsevier Inc. All rights reserved.

An introduction to behavioural decision-making theories for paediatricians.

PubMed

Haward, Marlyse F; Janvier, Annie

2015-04-01

Behavioural decision-making theories provide insights into how people make choices under conditions of uncertainty. However, few have been studied in paediatrics. This study introduces these theories, reviews current research and makes recommendations for their application within the context of shared decision-making. As parents are expected to share decision-making in paediatrics, it is critical that the fields of behavioural economics, communication and decision sciences merge with paediatric clinical ethics to optimise decision-making. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Corrective response times in a coordinated eye-head-arm countermanding task.

PubMed

Tao, Gordon; Khan, Aarlenne Z; Blohm, Gunnar

2018-06-01

Inhibition of motor responses has been described as a race between two competing decision processes of motor initiation and inhibition, which manifest as the reaction time (RT) and the stop signal reaction time (SSRT); in the case where motor initiation wins out over inhibition, an erroneous movement occurs that usually needs to be corrected, leading to corrective response times (CRTs). Here we used a combined eye-head-arm movement countermanding task to investigate the mechanisms governing multiple effector coordination and the timing of corrective responses. We found a high degree of correlation between effector response times for RT, SSRT, and CRT, suggesting that decision processes are strongly dependent across effectors. To gain further insight into the mechanisms underlying CRTs, we tested multiple models to describe the distribution of RTs, SSRTs, and CRTs. The best-ranked model (according to 3 information criteria) extends the LATER race model governing RTs and SSRTs, whereby a second motor initiation process triggers the corrective response (CRT) only after the inhibition process completes in an expedited fashion. Our model suggests that the neural processing underpinning a failed decision has a residual effect on subsequent actions. NEW & NOTEWORTHY Failure to inhibit erroneous movements typically results in corrective movements. For coordinated eye-head-hand movements we show that corrective movements are only initiated after the erroneous movement cancellation signal has reached a decision threshold in an accelerated fashion.

Shared decision-making, gender and new technologies.

PubMed

Zeiler, Kristin

2007-09-01

Much discussion of decision-making processes in medicine has been patient-centred. It has been assumed that there is, most often, one patient. Less attention has been given to shared decision-making processes where two or more patients are involved. This article aims to contribute to this special area. What conditions need to be met if decision-making can be said to be shared? What is a shared decision-making process and what is a shared autonomous decision-making process? Why make the distinction? Examples are drawn from the area of new reproductive medicine and clinical genetics. Possible gender-differences in shared decision-making are discussed.

What Is Known about Parents’ Treatment Decisions? A Narrative Review of Pediatric Decision Making

PubMed Central

Lipstein, Ellen A.; Brinkman, William B.; Britto, Maria T.

2013-01-01

Background With the increasing complexity of decisions in pediatric medicine, there is a growing need to understand the pediatric decision-making process. Objective To conduct a narrative review of the current research on parent decision making about pediatric treatments and identify areas in need of further investigation. Methods Articles presenting original research on parent decision making were identified from MEDLINE (1966–6/2011), using the terms “decision making,” “parent,” and “child.” We included papers focused on treatment decisions but excluded those focused on information disclosure to children, vaccination, and research participation decisions. Results We found 55 papers describing 52 distinct studies, the majority being descriptive, qualitative studies of the decision-making process, with very limited assessment of decision outcomes. Although parents’ preferences for degree of participation in pediatric decision making vary, most are interested in sharing the decision with the provider. In addition to the provider, parents are influenced in their decision making by changes in their child’s health status, other community members, prior knowledge, and personal factors, such as emotions and faith. Parents struggle to balance these influences as well as to know when to include their child in decision making. Conclusions Current research demonstrates a diversity of influences on parent decision making and parent decision preferences; however, little is known about decision outcomes or interventions to improve outcomes. Further investigation, using prospective methods, is needed in order to understand how to support parents through the difficult treatment decisions. PMID:21969136

Establishing Final Cleanup Decisions for the Hanford Site River Corridor

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

Lerch, J.A.; Sands, J.P.

2007-07-01

A major challenge in the River Corridor Closure Contract is establishing final cleanup decisions for the source operable units in the Hanford Site river corridor. Cleanup actions in the river corridor began in 1994 and have been performed in accordance with a 'bias for action' approach adopted by the Tri-Parties - the U.S. Department of Energy, U.S. Environmental Protection Agency, and Washington State Department of Ecology. This approach enabled early application of cleanup dollars on actual remediation of contaminated waste sites. Consequently, the regulatory framework authorizing cleanup actions at source operable units in the river corridor consists largely of interimmore » action records of decision, which were supported by qualitative risk assessments. Obtaining final cleanup decisions for the source operable units is necessary to determine whether past cleanup actions in the river corridor are protective of human health and the environment and to identify any course corrections that may be needed to ensure that ongoing and future cleanup actions are protective. Because the cleanup actions are ongoing, it is desirable to establish the final cleanup decisions as early as possible to minimize the impacts of any identified course corrections to the present cleanup approach. Development of a strategy to obtain final cleanup decisions for the source operable units in a manner that is responsive to desires for an integrated approach with the groundwater and Columbia River components while maintaining the ability to evaluate each component on its own merit represents a significant challenge. There are many different options for grouping final cleanup decisions, and each involved party or stakeholder brings slightly different interests that shape the approach. Regardless of the selected approach, there are several specific challenges and issues to be addressed before making final cleanup decisions. A multi-agency and contractor working group has been established to address these issues and develop an endorsed strategy. Ultimately, it is anticipated that the Tri-Parties will establish a set of milestones to document pathway selection and define schedule requirements. (authors)« less

Administrative decision making: a stepwise method.

PubMed

Oetjen, Reid M; Oetjen, Dawn M; Rotarius, Timothy

2008-01-01

Today's health care organizations face tremendous challenges and fierce competition. These pressures impact the decisions that managers must execute on any given day, not to mention the ever-present constraints of time, personnel, competencies, and finances. The importance of making quality and informed decisions cannot be underestimated. Traditional decision making methods are inadequate for today's larger, more complex health care organizations and the rapidly changing health care environment. As a result, today's health care managers and their teams need new approaches to making decisions for their organizations. This article examines the managerial decision making process and offers a model that can be used as a decision making template to help managers successfully navigate the choppy health care seas. The administrative decision making model will enable health care managers and other key decision makers to avoid the common pitfalls of poor decision making and guide their organizations to success.

This "Ethical Trap" Is for Roboticists, Not Robots: On the Issue of Artificial Agent Ethical Decision-Making.

PubMed

Miller, Keith W; Wolf, Marty J; Grodzinsky, Frances

2017-04-01

In this paper we address the question of when a researcher is justified in describing his or her artificial agent as demonstrating ethical decision-making. The paper is motivated by the amount of research being done that attempts to imbue artificial agents with expertise in ethical decision-making. It seems clear that computing systems make decisions, in that they make choices between different options; and there is scholarship in philosophy that addresses the distinction between ethical decision-making and general decision-making. Essentially, the qualitative difference between ethical decisions and general decisions is that ethical decisions must be part of the process of developing ethical expertise within an agent. We use this distinction in examining publicity surrounding a particular experiment in which a simulated robot attempted to safeguard simulated humans from falling into a hole. We conclude that any suggestions that this simulated robot was making ethical decisions were misleading.

Toward a Psychology of Surrogate Decision Making.

PubMed

Tunney, Richard J; Ziegler, Fenja V

2015-11-01

In everyday life, many of the decisions that we make are made on behalf of other people. A growing body of research suggests that we often, but not always, make different decisions on behalf of other people than the other person would choose. This is problematic in the practical case of legally designated surrogate decision makers, who may not meet the substituted judgment standard. Here, we review evidence from studies of surrogate decision making and examine the extent to which surrogate decision making accurately predicts the recipient's wishes, or if it is an incomplete or distorted application of the surrogate's own decision-making processes. We find no existing domain-general model of surrogate decision making. We propose a framework by which surrogate decision making can be assessed and a novel domain-general theory as a unifying explanatory concept for surrogate decisions. © The Author(s) 2015.

Alpha phase determines successful lexical decision in noise.

PubMed

Strauß, Antje; Henry, Molly J; Scharinger, Mathias; Obleser, Jonas

2015-02-18

Psychophysical target detection has been shown to be modulated by slow oscillatory brain phase. However, thus far, only low-level sensory stimuli have been used as targets. The current human electroencephalography (EEG) study examined the influence of neural oscillatory phase on a lexical-decision task performed for stimuli embedded in noise. Neural phase angles were compared for correct versus incorrect lexical decisions using a phase bifurcation index (BI), which quantifies differences in mean phase angles and phase concentrations between correct and incorrect trials. Neural phase angles in the alpha frequency range (8-12 Hz) over right anterior sensors were approximately antiphase in a prestimulus time window, and thus successfully distinguished between correct and incorrect lexical decisions. Moreover, alpha-band oscillations were again approximately antiphase across participants for correct versus incorrect trials during a later peristimulus time window (∼500 ms) at left-central electrodes. Strikingly, lexical decision accuracy was not predicted by either event-related potentials (ERPs) or oscillatory power measures. We suggest that correct lexical decisions depend both on successful sensory processing, which is made possible by the alignment of stimulus onset with an optimal alpha phase, as well as integration and weighting of decisional information, which is coupled to alpha phase immediately following the critical manipulation that differentiated words from pseudowords. The current study constitutes a first step toward characterizing the role of dynamic oscillatory brain states for higher cognitive functions, such as spoken word recognition. Copyright © 2015 the authors 0270-6474/15/353256-07$15.00/0.

Group Dynamics and Decision Making: Backcountry Recreationists in Avalanche Terrain

ERIC Educational Resources Information Center

Bright, Leslie Shay

2010-01-01

The purpose of this study was to describe and determine the prevalence of decision-making characteristics of recreational backcountry groups when making a decision of where to travel and ride in avalanche terrain from the perspective of individuals. Decision-making characteristics encompassed communication, decision-making processes, leadership,…

24 CFR 55.20 - Decision making process.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Decision making process. 55.20... Decision making process. The decision making process for compliance with this part contains eight steps... decision making process are: (a) Step 1. Determine whether the proposed action is located in a 100-year...

Field and Experience Influences on Ethical Decision-Making in the Sciences

PubMed Central

Mumford, Michael D.; Connelly, Shane; Murphy, Stephen T.; Devenport, Lynn D.; Antes, Alison L.; Brown, Ryan P.; Hill, Jason H.; Waples, Ethan P.

2009-01-01

Differences across fields and experience levels are frequently considered in discussions of ethical decision-making and ethical behavior. In the present study, doctoral students in the health, biological, and social sciences completed measures of ethical decision-making. The effects of field and level of experience with respect to ethical decision-making, metacognitive reasoning strategies, social-behavioral responses, and exposure to unethical events were examined. Social and biological scientists performed better than health scientists with respect to ethical decision-making. Furthermore, the ethical decision-making of health science students decreased as experience increased. Moreover, these effects appeared to be linked to the specific strategies underlying participants' ethical decision-making. The implications of these findings for ethical decision-making are discussed. PMID:19750129

Research on Bidding Decision-making of International Public-Private Partnership Projects

NASA Astrophysics Data System (ADS)

Hu, Zhen Yu; Zhang, Shui Bo; Liu, Xin Yan

2018-06-01

In order to select the optimal quasi-bidding project for an investment enterprise, a bidding decision-making model for international PPP projects was established in this paper. Firstly, the literature frequency statistics method was adopted to screen out the bidding decision-making indexes, and accordingly the bidding decision-making index system for international PPP projects was constructed. Then, the group decision-making characteristic root method, the entropy weight method, and the optimization model based on least square method were used to set the decision-making index weights. The optimal quasi-bidding project was thus determined by calculating the consistent effect measure of each decision-making index value and the comprehensive effect measure of each quasi-bidding project. Finally, the bidding decision-making model for international PPP projects was further illustrated by a hypothetical case. This model can effectively serve as a theoretical foundation and technical support for the bidding decision-making of international PPP projects.

Categorization = Decision Making + Generalization

PubMed Central

Seger, Carol A; Peterson, Erik J.

2013-01-01

We rarely, if ever, repeatedly encounter exactly the same situation. This makes generalization crucial for real world decision making. We argue that categorization, the study of generalizable representations, is a type of decision making, and that categorization learning research would benefit from approaches developed to study the neuroscience of decision making. Similarly, methods developed to examine generalization and learning within the field of categorization may enhance decision making research. We first discuss perceptual information processing and integration, with an emphasis on accumulator models. We then examine learning the value of different decision making choices via experience, emphasizing reinforcement learning modeling approaches. Next we discuss how value is combined with other factors in decision making, emphasizing the effects of uncertainty. Finally, we describe how a final decision is selected via thresholding processes implemented by the basal ganglia and related regions. We also consider how memory related functions in the hippocampus may be integrated with decision making mechanisms and contribute to categorization. PMID:23548891

Analyzing the effectiveness of teaching and factors in clinical decision-making.

PubMed

Hsieh, Ming-Chen; Lee, Ming-Shinn; Chen, Tsung-Ying; Tsai, Tsuen-Chiuan; Pai, Yi-Fong; Sheu, Min-Muh

2017-01-01

The aim of this study is to prepare junior physicians, clinical education should focus on the teaching of clinical decision-making. This research is designed to explore teaching of clinical decision-making and to analyze the benefits of an "Analogy guide clinical decision-making" as a learning intervention for junior doctors. This study had a "quasi-experimental design" and was conducted in a medical center in eastern Taiwan. Participants and Program Description: Thirty junior doctors and three clinical teachers were involved in the study. The experimental group (15) received 1 h of instruction from the "Analogy guide for teaching clinical decision-making" every day for 3 months. Program Evaluation: A "Clinical decision-making self-evaluation form" was used as the assessment tool to evaluate participant learning efficiency before and after the teaching program. Semi-structured qualitative research interviews were also conducted. We found using the analogy guide for teaching clinical decision-making could help enhance junior doctors' self-confidence. Important factors influencing clinical decision-making included workload, decision-making, and past experience. Clinical teaching using the analogy guide for clinical decision-making may be a helpful tool for training and can contribute to a more comprehensive understanding of decision-making.

Father- and Mother-Adolescent Decision-Making in Mexican-Origin Families

PubMed Central

Perez-Brena, Norma; Updegraff, Kimberly A.; Umaña-Taylor, Adriana J.

2013-01-01

Understanding the prevalence and correlates of decisional autonomy within specific cultural contexts is necessary to fully understand how family processes are embedded within culture. The goals of this study were to describe mothers’ and fathers’ decision-making with adolescents (M = 12.51 years, SD = 0.58; 51% female), including parent-unilateral, joint, and youth-unilateral decision-making, and to examine the socio-cultural and family characteristics associated with these different types of decision-making in 246 Mexican-origin families. Mothers reported more joint and youth-unilateral decision-making and less parent-unilateral decision-making than did fathers. Fathers reported more youth-unilateral decision-making with sons than with daughters. Further, for mothers, more traditional gender role attitudes and higher levels of mother-adolescent conflict were associated with more parent-unilateral and less joint decision-making. In contrast, for fathers, lower levels of respect values were associated with more youth-unilateral decision-making with sons, and higher levels of parent-adolescent warmth was associated with more youth-unilateral decision-making with daughters. The importance of understanding the different correlates of mothers’ and fathers’ decision-making with sons versus daughters is discussed. PMID:21484288

An automated approach to the design of decision tree classifiers

NASA Technical Reports Server (NTRS)

Argentiero, P.; Chin, P.; Beaudet, P.

1980-01-01

The classification of large dimensional data sets arising from the merging of remote sensing data with more traditional forms of ancillary data is considered. Decision tree classification, a popular approach to the problem, is characterized by the property that samples are subjected to a sequence of decision rules before they are assigned to a unique class. An automated technique for effective decision tree design which relies only on apriori statistics is presented. This procedure utilizes a set of two dimensional canonical transforms and Bayes table look-up decision rules. An optimal design at each node is derived based on the associated decision table. A procedure for computing the global probability of correct classfication is also provided. An example is given in which class statistics obtained from an actual LANDSAT scene are used as input to the program. The resulting decision tree design has an associated probability of correct classification of .76 compared to the theoretically optimum .79 probability of correct classification associated with a full dimensional Bayes classifier. Recommendations for future research are included.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 567: Miscellaneous Soil Sites - Nevada National Security Site, Nevada

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

Matthews, Patrick

2014-12-01

This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 567: Miscellaneous Soil Sites, Nevada National Security Site, Nevada. The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 567 based on the implementation of the corrective actions. The corrective actions implemented at CAU 567 were developed based on an evaluation of analytical data from the CAI, the assumed presence of COCs at specific locations, and the detailed and comparative analysis of the CAAs. The CAAs weremore » selected on technical merit focusing on performance, reliability, feasibility, safety, and cost. The implemented corrective actions meet all requirements for the technical components evaluated. The CAAs meet all applicable federal and state regulations for closure of the site. Based on the implementation of these corrective actions, the DOE, National Nuclear Security Administration Nevada Field Office provides the following recommendations: • No further corrective actions are necessary for CAU 567. • The Nevada Division of Environmental Protection issue a Notice of Completion to the DOE, National Nuclear Security Administration Nevada Field Office for closure of CAU 567. • CAU 567 be moved from Appendix III to Appendix IV of the FFACO.« less

Shared Decision-Making for Nursing Practice: An Integrative Review

PubMed Central

Truglio-Londrigan, Marie; Slyer, Jason T.

2018-01-01

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

Composite collective decision-making.

PubMed

Czaczkes, Tomer J; Czaczkes, Benjamin; Iglhaut, Carolin; Heinze, Jürgen

2015-06-22

Individual animals are adept at making decisions and have cognitive abilities, such as memory, which allow them to hone their decisions. Social animals can also share information. This allows social animals to make adaptive group-level decisions. Both individual and collective decision-making systems also have drawbacks and limitations, and while both are well studied, the interaction between them is still poorly understood. Here, we study how individual and collective decision-making interact during ant foraging. We first gathered empirical data on memory-based foraging persistence in the ant Lasius niger. We used these data to create an agent-based model where ants may use social information (trail pheromones), private information (memories) or both to make foraging decisions. The combined use of social and private information by individuals results in greater efficiency at the group level than when either information source was used alone. The modelled ants couple consensus decision-making, allowing them to quickly exploit high-quality food sources, and combined decision-making, allowing different individuals to specialize in exploiting different resource patches. Such a composite collective decision-making system reaps the benefits of both its constituent parts. Exploiting such insights into composite collective decision-making may lead to improved decision-making algorithms. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

The Relations between Decision Making in Social Relationships and Decision Making Styles

ERIC Educational Resources Information Center

Sari, Enver

2008-01-01

The research reported in this paper aimed to examine the relationships between decisiveness in social relationships, and the decision-making styles of a group of university students and to investigate the contributions of decision-making styles in predicting decisiveness in social relationship (conflict resolution, social relationship selection…

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

Ernst, Kathleen M; Van Riemsdijk, Dr. Micheline

This article studies the participation of stakeholders in climate change decision-making in Alaska s National Parks. We place stakeholder participation within literatures on environmental and climate change decision-making. We conducted participant observation and interviews in two planning workshops to investigate the decision-making process, and our findings are three-fold. First, the inclusion of diverse stakeholders expanded climate change decision-making beyond National Park Service (NPS) institutional constraints. Second, workshops of the Climate Change Scenario Planning Project (CCSPP) enhanced institutional understandings of participants attitudes towards climate change and climate change decision-making. Third, the geographical context of climate change influences the decision-making process. Asmore » the first regional approach to climate change decision-making within the NPS, the CCSPP serves as a model for future climate change planning in public land agencies. This study shows how the participation of stakeholders can contribute to robust decisions, may move climate change decision-making beyond institutional barriers, and can provide information about attitudes towards climate change decision-making.« less

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.

Multi-disciplinary decision making in general practice.

PubMed

Kirby, Ann; Murphy, Aileen; Bradley, Colin

2018-04-09

Purpose Internationally, healthcare systems are moving towards delivering care in an integrated manner which advocates a multi-disciplinary approach to decision making. Such an approach is formally encouraged in the management of Atrial Fibrillation patients through the European Society of Cardiology guidelines. Since the emergence of new oral anticoagulants switching between oral anticoagulants (OACs) has become prevalent. This case study considers the role of multi-disciplinary decision making, given the complex nature of the agents. The purpose of this paper is to explore Irish General Practitioners' (GPs) experience of switching between all OACs for Arial Fibrillation (AF) patients; prevalence of multi-disciplinary decision making in OAC switching decisions and seeks to determine the GP characteristics that appear to influence the likelihood of multi-disciplinary decision making. Design/methodology/approach A probit model is used to determine the factors influencing multi-disciplinary decision making and a multinomial logit is used to examine the factors influencing who is involved in the multi-disciplinary decisions. Findings Results reveal that while some multi-disciplinary decision-making is occurring (64 per cent), it is not standard practice despite international guidelines on integrated care. Moreover, there is a lack of patient participation in the decision-making process. Female GPs and GPs who have initiated prescriptions for OACs are more likely to engage in multi-disciplinary decision-making surrounding switching OACs amongst AF patients. GPs with training practices were less likely to engage with cardiac consultants and those in urban areas were more likely to engage with other (non-cardiac) consultants. Originality/value For optimal decision making under uncertainty multi-disciplinary decision-making is needed to make a more informed judgement and to improve treatment decisions and reduce the opportunity cost of making the wrong decision.

Decision sidestepping: How the motivation for closure prompts individuals to bypass decision making.

PubMed

Otto, Ashley S; Clarkson, Joshua J; Kardes, Frank R

2016-07-01

We all too often have to make decisions-from the mundane (e.g., what to eat for breakfast) to the complex (e.g., what to buy a loved one)-and yet there exists a multitude of strategies that allows us to make a decision. This work focuses on a subset of decision strategies that allows individuals to make decisions by bypassing the decision-making process-a phenomenon we term decision sidestepping. Critical to the present manuscript, however, we contend that decision sidestepping stems from the motivation to achieve closure. We link this proposition back to the fundamental nature of closure and how those seeking closure are highly bothered by decision making. As such, we argue that the motivation to achieve closure prompts a reliance on sidestepping strategies (e.g., default bias, choice delegation, status quo bias, inaction inertia, option fixation) to reduce the bothersome nature of decision making. In support of this framework, five experiments demonstrate that (a) those seeking closure are more likely to engage in decision sidestepping, (b) the effect of closure on sidestepping stems from the bothersome nature of decision making, and (c) the reliance on sidestepping results in downstream consequences for subsequent choice. Taken together, these findings offer unique insight into the cognitive motivations stimulating a reliance on decision sidestepping and thus a novel framework by which to understand how individuals make decisions while bypassing the decision-making process. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

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

PubMed

Samsi, Kritika; Manthorpe, Jill

2013-06-01

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

Japanese cancer patient participation in and satisfaction with treatment-related decision-making: A qualitative study.

PubMed

Watanabe, Yoshiko; Takahashi, Miyako; Kai, Ichiro

2008-02-27

Over the last decade, patient involvement in treatment-related decision-making has been widely advocated in Japan, where patient-physician encounters are still under the influence of the long-standing tradition of paternalism. Despite this profound change in clinical practice, studies investigating the actual preferences of Japanese people regarding involvement in treatment-related decision-making are limited. The main objectives of this study were to (1) reveal the actual level of involvement of Japanese cancer patients in the treatment-related decision-making and their overall satisfaction with the decision-making process, and (2) consider the practical implications of increased satisfaction in cancer patients with regard to the decision-making process. We conducted semi-structured interviews with 24 Japanese cancer patients who were recruited from a cancer self-help group in Tokyo. The interviews were qualitatively analysed using the approach described by Lofland and Lofland. The analyses of the patients' interviews focused on 2 aspects: (1) who made treatment-related decisions (the physician or the patient), and (2) the informants' overall satisfaction with the decision-making process. The analyses revealed the following 5 categories of decision-making: 'patient as the active decision maker', 'doctor selection', 'wilfully entrusting the physician', 'compelled decision-making', and 'surrendering decision-making'. While the informants under the first 3 categories were fairly satisfied with the decision-making process, those under the latter 2 were extremely dissatisfied. Informants' views regarding their preferred role in the decision-making process varied substantially from complete physician control to complete patient control; the key factor for their satisfaction was the relation between their preferred involvement in decision-making and their actual level of involvement, irrespective of who the decision maker was. In order to increase patient satisfaction with regard to the treatment-related decision-making process, healthcare professionals in Japan must assess individual patient preferences and provide healthcare accordingly. Moreover, a better environment should be created in hospitals and in society to facilitate patients in expressing their preferences and appropriate resources need to be made available to facilitate their decision-making process.

Conceptual model of a logical system processor of selection to electrical filters for correction of harmonics in low voltage lines

NASA Astrophysics Data System (ADS)

Lastre, Arlys; Torriente, Ives; Méndez, Erik F.; Cordovés, Alexis

2017-06-01

In the present investigation, the authors propose a conceptual model for the analysis and the decision making of the corrective models to use in the mitigation of the harmonic distortion. The authors considered the setting of conventional models, and such adaptive models like the filters incorporation to networks neuronal artificial (RNA's) for the mitigating effect. In addition to the present work is a showing of the experimental model that learns by means of a flowchart denoting the need to use artificial intelligence skills for the exposition of the proposed model. The other aspect considered and analyzed are the adaptability and usage of the same, considering a local reference of the laws and lineaments of energy quality that demands the Department of Electricity and Energy Renewable (MEER) of Equator.

Choice numeracy and physicians-in-training performance: the case of Medicare Part D

PubMed Central

Hanoch, Yaniv; Miron-Shatz, Talya; Cole, Helen; Himmelstein, Mary; Federman, Alex D.

2017-01-01

In choosing a prescription plan, Medicare beneficiaries in the US usually face over 50 options. Many have turned to their physicians for help with this complex task. However, exactly how well do physicians navigate information on Part D plans is still an open question. In this study, we explored this unanswered question by examining the effect of choice-set size and numeracy levels on a physician-in-training’s ability to choose appropriate Medicare drug plans. Consistent with our hypotheses, increases in choice sets correlated significantly with fewer correct answers, and higher numeracy levels were associated with more correct answers. Hence, our data further highlight the role of numeracy in financial- and health-related decision making, and also raise concerns about physicians’ ability to help patients choose the optimal Part D plan. PMID:20658834

Modeling Common-Sense Decisions in Artificial Intelligence

NASA Technical Reports Server (NTRS)

Zak, Michail

2010-01-01

A methodology has been conceived for efficient synthesis of dynamical models that simulate common-sense decision- making processes. This methodology is intended to contribute to the design of artificial-intelligence systems that could imitate human common-sense decision making or assist humans in making correct decisions in unanticipated circumstances. This methodology is a product of continuing research on mathematical models of the behaviors of single- and multi-agent systems known in biology, economics, and sociology, ranging from a single-cell organism at one extreme to the whole of human society at the other extreme. Earlier results of this research were reported in several prior NASA Tech Briefs articles, the three most recent and relevant being Characteristics of Dynamics of Intelligent Systems (NPO -21037), NASA Tech Briefs, Vol. 26, No. 12 (December 2002), page 48; Self-Supervised Dynamical Systems (NPO-30634), NASA Tech Briefs, Vol. 27, No. 3 (March 2003), page 72; and Complexity for Survival of Living Systems (NPO- 43302), NASA Tech Briefs, Vol. 33, No. 7 (July 2009), page 62. The methodology involves the concepts reported previously, albeit viewed from a different perspective. One of the main underlying ideas is to extend the application of physical first principles to the behaviors of living systems. Models of motor dynamics are used to simulate the observable behaviors of systems or objects of interest, and models of mental dynamics are used to represent the evolution of the corresponding knowledge bases. For a given system, the knowledge base is modeled in the form of probability distributions and the mental dynamics is represented by models of the evolution of the probability densities or, equivalently, models of flows of information. Autonomy is imparted to the decisionmaking process by feedback from mental to motor dynamics. This feedback replaces unavailable external information by information stored in the internal knowledge base. Representation of the dynamical models in a parameterized form reduces the task of common-sense-based decision making to a solution of the following hetero-associated-memory problem: store a set of m predetermined stochastic processes given by their probability distributions in such a way that when presented with an unexpected change in the form of an input out of the set of M inputs, the coupled motormental dynamics converges to the corresponding one of the m pre-assigned stochastic process, and a sample of this process represents the decision.

The potential for shared decision-making and decision aids in rehabilitation medicine.

PubMed

van Til, Janine A; Drossaert, Constance H C; Punter, R Annemiek; Ijzerman, Maarten J

2010-06-01

Shared decision-making and the use of decision aids are increasingly promoted in various healthcare settings. The extent of their current use and potential in rehabilitation medicine is unknown. The aim of the present study was to explore the barriers to and facilitators of shared decision-making and use of decision aids in daily practice, and to explore the perceptions of physical and rehabilitation medicine (PRM) physicians toward them. A cross-sectional survey of 408 PRM physicians was performed (response rate 31%). PRM physicians expressed the highest levels of comfort with shared decision-making as opposed to paternalistic and informed decision-making. The majority reported that shared decision-making constituted their usual approach. The most important barriers to shared decision-making were cases in which the patient received conflicting recommendations and when the patient had difficulty accepting the disease. Key facilitators were the patient's trust in the PRM physician and the patient being knowledgeable about the disease and about treatment options. PRM physicians' attitudes towards the use of decision aids to inform patients were moderately positive. Shared decision-making appears to have great potential in the rehabilitation setting. Increasing the use of decision aids may contribute to the further implementation of shared decision-making.

Conflict and Group Decision-Making: A New Approach.

ERIC Educational Resources Information Center

Dace, Karen L.

In the opinion of decision-making scholars, conflict is a natural component of group decision-making. A new direction for conflict and group decision-making theory and research will help dispel the confusion as to the promotive or disruptive nature of disagreement in group decision-making. Conflict literature is replete with descriptions of the…

Dementia, Decision Making, and Capacity.

PubMed

Darby, R Ryan; Dickerson, Bradford C

After participating in this activity, learners should be better able to:• Assess the neuropsychological literature on decision making and the medical and legal assessment of capacity in patients with dementia• Identify the limitations of integrating findings from decision-making research into capacity assessments for patients with dementia ABSTRACT: Medical and legal professionals face the challenge of assessing capacity and competency to make medical, legal, and financial decisions in dementia patients with impaired decision making. While such assessments have classically focused on the capacity for complex reasoning and executive functions, research in decision making has revealed that motivational and metacognitive processes are also important. We first briefly review the neuropsychological literature on decision making and on the medical and legal assessment of capacity. Next, we discuss the limitations of integrating findings from decision-making research into capacity assessments, including the group-to-individual inference problem, the unclear role of neuroimaging in capacity assessments, and the lack of capacity measures that integrate important facets of decision making. Finally, we present several case examples where we attempt to demonstrate the potential benefits and important limitations of using decision-making research to aid in capacity determinations.

A meta-ethnography and theory of parental ethical decision making in the neonatal intensive care unit.

PubMed

Rosenthal, Sara A; Nolan, Marie T

2013-07-01

To synthesize the existing qualitative literature about parent ethical decision making in the neonatal intensive care unit (NICU) and to investigate the potential impact of culture on parents' decision making experiences. PubMed, CINAHL plus, and PsychInfo using the search terms parental decision making, culture, race, decision making, and parental decisions. Qualitative research studies investigating decision making for infants in the NICU from the parents' perspective were included. Studies involving older pediatric populations were excluded. Ten primary qualitative research articles were included. The primary author read all manuscripts and tabulated themes related to parents' ethical decision making. Study findings were synthesized using meta-ethnography involving translating concepts of separate studies into one another, exploring contradictions, and organizing these concepts into new theories. Key themes included parent involvement in decision making, parental role, necessity of good information, need for communication, desire for hope and compassion conveyed by providers, decision making satisfaction, and trust in caregiving team. A preliminary theoretical framework of ethical parent decision making was modeled based on the proposed relationships between the themes. Parent preferences for their involvement in decision making, their perceptions of communication with providers, and their relationships with providers are all important factors in the experience of making decisions for their infants. Needs of parents were the same regardless the ethnic or racial diversity of study participants. © 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Decision making about Pap test use among Korean immigrant women: A qualitative study.

PubMed

Kim, Kyounghae; Kim, Soohyun; Gallo, Joseph J; Nolan, Marie T; Han, Hae-Ra

2017-08-01

Understanding how individuals make decisions about Pap tests concerning their personal values helps health-care providers offer tailored approaches to guide patients' decision making. Yet research has largely ignored decision making about Pap tests among immigrant women who experience increased risk of cervical cancer. To explore decision making about Pap tests among Korean immigrant women. We conducted a qualitative descriptive study using 32 semi-structured, in-depth interviews with Korean immigrant women residing in a north-eastern metropolitan area. Data were audio-recorded, transcribed verbatim and analysed using inductive coding. Although most women with positive decisions made their own decisions, some women deferred to their providers, and others made decisions in collaboration with their providers and significant others. While women making positive decisions tended to consider both barriers to and facilitators of having Pap tests, women making negative decisions predominantly discussed the barriers to having Pap tests, such as modesty and differences between the South Korean and US health-care systems. The women's reflections on their decisions differed regarding their Pap test decisions. Women's desired roles in the decision-making process and reflection on their decision outcome appeared to vary, although most participants with positive decisions made their own decisions and were satisfied with their decisions. Future research should conduct longitudinal, quantitative studies to test our findings regarding decision-making processes and outcomes about Pap tests. The findings should be incorporated into cervical cancer screening practices to fulfil the unmet needs of immigrant women in patient-provider communication and to facilitate women's decision making about Pap tests. © 2016 The Authors. Health Expectations published by John Wiley & Sons Ltd.

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.

Microfinance participation and contraceptive decision-making: results from a national sample of women in Bangladesh.

PubMed

Murshid, N S; Ely, G E

2016-10-01

Our objective was to assess whether microfinance participation affords greater contraceptive decision-making power to women. Population based secondary data analysis. In this cross-sectional study using nationally representative data from the Bangladesh Demographic and Health Survey 2011 we conducted multinomial logistic regression to estimate the odds of contraceptive decision-making by respondents and their husbands based on microfinance participation. Microfinance participation was measured as a dichotomous variable and contraceptive decision-making was conceptualized based on who made decisions about contraceptive use: respondents only; their partners or husbands only; or both. The odds of decision-making by the respondent, with the reference case being joint decision-making, were higher for microfinance participants, but they were not significant. The odds of decision-making by the husband, with the reference case again being joint decision-making, were significantly lower among men who were partnered with women who participated in microfinance (RRR = 0.70, P < 0.01). Microfinance participation by women allowed men to share decision-making power with their wives that resulted in higher odds of joint decision-making. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Skin-deep diagnosis: affective bias and zebra retreat complicating the diagnosis of systemic sclerosis.

PubMed

Miller, Chad S

2013-01-01

Nearly half of medical errors can be attributed to an error of clinical reasoning or decision making. It is estimated that the correct diagnosis is missed or delayed in between 5% and 14% of acute hospital admissions. Through understanding why and how physicians make these errors, it is hoped that strategies can be developed to decrease the number of these errors. In the present case, a patient presented with dyspnea, gastrointestinal symptoms and weight loss; the diagnosis was initially missed when the treating physicians took mental short cuts and used heuristics as in this case. Heuristics have an inherent bias that can lead to faulty reasoning or conclusions, especially in complex or difficult cases. Affective bias, which is the overinvolvement of emotion in clinical decision making, limited the available information for diagnosis because of the hesitancy to acquire a full history and perform a complete physical examination in this patient. Zebra retreat, another type of bias, is when a rare diagnosis figures prominently on the differential diagnosis but the physician retreats for various reasons. Zebra retreat also factored in the delayed diagnosis. Through the description of these clinical reasoning errors in an actual case, it is hoped that future errors can be prevented or inspiration for additional research in this area will develop.

Evaluating ambivalence: social-cognitive and affective brain regions associated with ambivalent decision-making

PubMed Central

van Harreveld, Frenk; Rotteveel, Mark; Lelieveld, Gert-Jan; Crone, Eveline A.

2014-01-01

Ambivalence is a state of inconsistency that is often experienced as affectively aversive. In this functional magnetic resonance imaging study, we investigated the role of cognitive and social-affective processes in the experience of ambivalence and coping with its negative consequences. We examined participants’ brain activity during the dichotomous evaluation (pro vs contra) of pretested ambivalent (e.g. alcohol), positive (e.g. happiness) and negative (e.g. genocide) word stimuli. We manipulated evaluation relevance by varying the probability of evaluation consequences, under the hypothesis that ambivalence is experienced as more negative when outcomes are relevant. When making ambivalent evaluations, more activity was found in the anterior cingulate cortex, the insula, the temporal parietal junction (TPJ) and the posterior cingulate cortex (PCC)/precuneus, for both high and low evaluation relevance. After statistically conservative corrections, activity in the TPJ and PCC/precuneus was negatively correlated with experienced ambivalence after scanning, as measured by Priester and Petty’s felt ambivalence scale (1996). The findings show that cognitive and social-affective brain areas are involved in the experience of ambivalence. However, these networks are differently associated with subsequent reduction of ambivalence, thus highlighting the importance of understanding both cognitive and affective processes involved in ambivalent decision-making. PMID:23685774

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

PubMed

Kelly, B D

2015-03-01

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

Considering Risk and Resilience in Decision-Making

NASA Technical Reports Server (NTRS)

Torres-Pomales, Wilfredo

2015-01-01

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

Parent-Child Engagement in Decision Making and the Development of Adolescent Affective Decision Capacity and Binge Drinking

PubMed Central

Xiao, Lin; Bechara, Antoine; Palmer, Paula H.; Trinidad, Dennis R.; Wei, Yonglan; Jia, Yong; Johnson, C. Anderson

2010-01-01

The goal of this study was to investigate how parents’ engagement of their child in everyday decision-making influenced their adolescent’s development on two neuropsychological functions, namely, affective decision-making and working memory, and its effect on adolescent binge-drinking behavior. We conducted a longitudinal study of 192 Chinese adolescents. In 10th grade, the adolescents were tested for their affective decision-making ability using the Iowa Gambling Task (IGT) and working memory capacity using the Self-ordered Pointing Test (SOPT). Questionnaires were used to assess perceived parent-child engagement in decision-making, academic performance and drinking behavior. At one-year follow-up, the same neuropsychological tasks and questionnaires were repeated. Results indicate that working memory and academic performance were uninfluenced by parent-child engagement in decision-making. However, compared to adolescents whose parents made solitary decisions for them, adolescents engaged in everyday decision-making showed significant improvement on affective decision capacity and significantly less binge-drinking one year later. These findings suggest that parental engagement of children in everyday decision-making might foster the development of neurocognitive functioning relative to affective decision-making and reduce adolescent substance use behaviors. PMID:21804682

Corrective Action Decision Document/Closure Report for Corrective Action Unit 570: Area 9 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada, Revision 0

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

Matthews, Patrick

2013-11-01

This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 570: Area 9 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada. This complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. The purpose of the CADD/CR is to provide justification and documentation supporting the recommendation that no further corrective action is needed.