The Development of a Strategic Prioritisation Method for Green Supply Chain Initiatives

PubMed Central

Masoumik, S. Maryam; Abdul-Rashid, Salwa Hanim; Olugu, Ezutah Udoncy

2015-01-01

To maintain a competitive position, companies are increasingly required to integrate their proactive environmental strategies into their business strategies. The shift from reactive and compliance-based to proactive and strategic environmental management has driven companies to consider the strategic factors while identifying the areas in which they should focus their green initiatives. In previous studies little attention was given to providing the managers with a basis from which they could strategically prioritise these green initiatives across their companies’ supply chains. Considering this lacuna in the literature, we present a decision-making method for prioritising green supply chain initiatives aligned with the preferred green strategies alternatives for the manufacturing companies. To develop this method, the study considered a position between determinism and the voluntarism orientation of environmental management involving both external pressures and internal competitive drivers and key resources as decision factors. This decision-making method was developed using the analytic network process (ANP) technique. The elements of the decision model were derived from the literature. The causal relationships among the multiple decision variables were validated based on the results of structural equation modelling (SEM) using a dataset collected from a survey of the ISO 14001-certified manufacturers in Malaysia. A portion of the relative weights required for computation in ANP was also calculated using the SEM results. A case study is presented to demonstrate the applicability of the method. PMID:26618353

[Adoption of new technologies by health services: the challenge of analyzing relevant factors].

PubMed

Trindade, Evelinda

2008-05-01

The exponential increase in the incorporation of health technologies has been considered a key factor in increased expenditures by the health sector. Such decisions involve multiple levels and stakeholders. Decentralization has multiplied the decision-making levels, with numerous difficult choices and limited resources. The interrelationship between stakeholders is complex, in creative systems with multiple determinants and confounders. The current review discusses the interaction between the factors influencing the decisions to incorporate technologies by health services, and proposes a structure for their analysis. The application and intensity of these factors in decision-making and the incorporation of products and programs by health services shapes the installed capacity of local and regional networks and modifies the health system. Empirical observation of decision-making and technology incorporation in Brazilian health services poses an important challenge. The structured recognition and measurement of these variables can assist proactive planning of health services.

A false sense of security: lesbian, gay, bisexual, and transgender (LGBT) surrogate health care decision-making rights.

PubMed

Wahlert, Lance; Fiester, Autumn

2013-01-01

This article addresses the timely and ethically problematic issue of surrogate decision-making rights for lesbian, gay, bisexual, and transgender (LGBT) patients and their families in the American health care system. Despite multiple pro-LGBT recommendations that have been released in recent years by the Obama administration, the Institute of Medicine, and the US Department of Health and Human Services, such initiatives, while laudable, also have unfortunately occasioned a "false sense of security" for many LGBT patients, their families, and their caregivers. In particular, new regulations on surrogate decision making merely invoke a sense of universal patient rights rather than actually generating them. Therefore, it is imperative that primary care physicians urge all LGBT patients to take proactive steps to protect themselves and their loved ones by naming proxy decision makers well before the crises that would necessitate such decisions.

Multi-criteria group decision making for evaluating the performance of e-waste recycling programs under uncertainty.

PubMed

Wibowo, Santoso; Deng, Hepu

2015-06-01

This paper presents a multi-criteria group decision making approach for effectively evaluating the performance of e-waste recycling programs under uncertainty in an organization. Intuitionistic fuzzy numbers are used for adequately representing the subjective and imprecise assessments of the decision makers in evaluating the relative importance of evaluation criteria and the performance of individual e-waste recycling programs with respect to individual criteria in a given situation. An interactive fuzzy multi-criteria decision making algorithm is developed for facilitating consensus building in a group decision making environment to ensure that all the interest of individual decision makers have been appropriately considered in evaluating alternative e-waste recycling programs with respect to their corporate sustainability performance. The developed algorithm is then incorporated into a multi-criteria decision support system for making the overall performance evaluation process effectively and simple to use. Such a multi-criteria decision making system adequately provides organizations with a proactive mechanism for incorporating the concept of corporate sustainability into their regular planning decisions and business practices. An example is presented for demonstrating the applicability of the proposed approach in evaluating the performance of e-waste recycling programs in organizations. Copyright © 2015 Elsevier Ltd. All rights reserved.

Towards modelling flood protection investment as a coupled human and natural system

NASA Astrophysics Data System (ADS)

O'Connell, P. E.; O'Donnell, G.

2013-06-01

Due to a number of recent high profile flood events and the apparent threat from global warming, governments and their agencies are under pressure to make proactive investments to protect people living in floodplains. However, adopting a proactive approach as a universal strategy is not affordable. It has been argued that delaying expensive and essentially irreversible capital decisions could be a prudent strategy in situations with high future uncertainty. This paper firstly uses Monte Carlo simulation to explore the performance of proactive and reactive investment strategies using a rational cost-benefit approach in a natural system with varying levels of persistence/interannual variability in Annual Maximum Floods. It is found that, as persistence increases, there is a change in investment strategy optimality from proactive to reactive. This could have implications for investment strategies under the increasingly variable climate that is expected with global warming. As part of the emerging holistic approaches to flood risk management, there is increasing emphasis on stakeholder participation in determining where and when flood protection investments are made, and so flood risk management is becoming more people-centred. As a consequence, multiple actors are involved in the decision-making process, and the social sciences are assuming an increasingly important role in flood risk management. There is a need for modelling approaches which can couple the natural and human system elements. It is proposed that Coupled Human and Natural System (CHANS) modelling could play an important role in understanding the motivations, actions and influence of citizens and institutions and how these impact on the effective delivery of flood protection investment. A framework for using Agent Based Modelling of human activities leading to flood investments is outlined, and some of the challenges associated with implementation are discussed.

Towards modelling flood protection investment as a coupled human and natural system

NASA Astrophysics Data System (ADS)

O'Connell, P. E.; O'Donnell, G.

2014-01-01

Due to a number of recent high-profile flood events and the apparent threat from global warming, governments and their agencies are under pressure to make proactive investments to protect people living in floodplains. However, adopting a proactive approach as a universal strategy is not affordable. It has been argued that delaying expensive and essentially irreversible capital decisions could be a prudent strategy in situations with high future uncertainty. This paper firstly uses Monte Carlo simulation to explore the performance of proactive and reactive investment strategies using a rational cost-benefit approach in a natural system with varying levels of persistence/interannual variability in annual maximum floods. It is found that, as persistence increases, there is a change in investment strategy optimality from proactive to reactive. This could have implications for investment strategies under the increasingly variable climate that is expected with global warming. As part of the emerging holistic approaches to flood risk management, there is increasing emphasis on stakeholder participation in determining where and when flood protection investments are made, and so flood risk management is becoming more people-centred. As a consequence, multiple actors are involved in the decision-making process, and the social sciences are assuming an increasingly important role in flood risk management. There is a need for modelling approaches which can couple the natural and human system elements. It is proposed that coupled human and natural system (CHANS) modelling could play an important role in understanding the motivations, actions and influence of citizens and institutions and how these impact on the effective delivery of flood protection investment. A framework for using agent-based modelling of human activities leading to flood investments is outlined, and some of the challenges associated with implementation are discussed.

Utilization of health technologies-Do not look where there is a light; shine your light where there is a need to look! Relating national health goals with resource allocation decision-making; illustration through examining the Israeli healthcare system.

PubMed

Shavit, Oren

2009-10-01

Innovative health technologies are often the focus of attention. However, in the allocation of public resources for improving health, the focus should be on the health needs of the population. It is the need that should be analyzed first, and decision makers should then evaluate the full range of interventions available, whether new or old, to meet this need. This is in contrast to analyzing the technology first and then characterizing the need it meets, which is the current practice in reimbursement decision-making in several countries. The identified health need should define national health goals, and these goals should be proactively assimilated into the reimbursement decision-making process. Differential reimbursement rates could reflect the relative contribution of the technology to the unmet health need.

Interventions Promoting Educators' Use of Data: Research Insights and Gaps

ERIC Educational Resources Information Center

Marsh, Julie A.

2012-01-01

Background/Context: In recent years, states, districts, schools, and external partners have recognized the need to proactively foster the use of data to guide educational decision-making and practice. Understanding that data alone will not guarantee use, individuals at all levels have invested in interventions to support better access to,…

Prediction Based Proactive Thermal Virtual Machine Scheduling in Green Clouds

PubMed Central

Kinger, Supriya; Kumar, Rajesh; Sharma, Anju

2014-01-01

Cloud computing has rapidly emerged as a widely accepted computing paradigm, but the research on Cloud computing is still at an early stage. Cloud computing provides many advanced features but it still has some shortcomings such as relatively high operating cost and environmental hazards like increasing carbon footprints. These hazards can be reduced up to some extent by efficient scheduling of Cloud resources. Working temperature on which a machine is currently running can be taken as a criterion for Virtual Machine (VM) scheduling. This paper proposes a new proactive technique that considers current and maximum threshold temperature of Server Machines (SMs) before making scheduling decisions with the help of a temperature predictor, so that maximum temperature is never reached. Different workload scenarios have been taken into consideration. The results obtained show that the proposed system is better than existing systems of VM scheduling, which does not consider current temperature of nodes before making scheduling decisions. Thus, a reduction in need of cooling systems for a Cloud environment has been obtained and validated. PMID:24737962

Using decision analysis to support proactive management of emerging infectious wildlife diseases

USGS Publications Warehouse

Grant, Evan H. Campbell; Muths, Erin L.; Katz, Rachel A.; Canessa, Stefano; Adams, Michael J.; Ballard, Jennifer R.; Berger, Lee; Briggs, Cheryl J.; Coleman, Jeremy; Gray, Matthew J.; Harris, M. Camille; Harris, Reid N.; Hossack, Blake R.; Huyvaert, Kathryn P.; Kolby, Jonathan E.; Lips, Karen R.; Lovich, Robert E.; McCallum, Hamish I.; Mendelson, Joseph R.; Nanjappa, Priya; Olson, Deanna H.; Powers, Jenny G.; Richgels, Katherine L. D.; Russell, Robin E.; Schmidt, Benedikt R.; Spitzen-van der Sluijs, Annemarieke; Watry, Mary Kay; Woodhams, Douglas C.; White, C. LeAnn

2017-01-01

Despite calls for improved responses to emerging infectious diseases in wildlife, management is seldom considered until a disease has been detected in affected populations. Reactive approaches may limit the potential for control and increase total response costs. An alternative, proactive management framework can identify immediate actions that reduce future impacts even before a disease is detected, and plan subsequent actions that are conditional on disease emergence. We identify four main obstacles to developing proactive management strategies for the newly discovered salamander pathogen Batrachochytrium salamandrivorans (Bsal). Given that uncertainty is a hallmark of wildlife disease management and that associated decisions are often complicated by multiple competing objectives, we advocate using decision analysis to create and evaluate trade-offs between proactive (pre-emergence) and reactive (post-emergence) management options. Policy makers and natural resource agency personnel can apply principles from decision analysis to improve strategies for countering emerging infectious diseases.

Making Decisions: Using Electronic Data Collection to Re-Envision Reference Services at the USF Tampa Libraries

ERIC Educational Resources Information Center

Todorinova, Lily; Huse, Andy; Lewis, Barbara; Torrence, Matt

2011-01-01

Declining reference statistics, diminishing human resources, and the desire to be more proactive and embedded in academic departments, prompted the University of South Florida Library to create a taskforce for re-envisioning reference services. The taskforce was charged with examining the staffing patterns at the desk and developing…

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…

Exploring leadership and team communication within the organizational environment of a dental practice.

PubMed

Chilcutt, Alexa Stough

2009-10-01

A lack of training in leadership and communication skills can place dentists at a disadvantage, leading to high degrees of staff-related stress and turnover. A dentist's leadership style directly affects an office's communication practices, and specific leadership behaviors affect the degree of team identity, interdependence and social distance (a measure of the influential power of team members). The author recruited 10 dental offices to take part in a study. Qualitative methods included in-depth interviews of one dentist, one senior staff member and one newer staff member from each office. The interview findings show that clear and definable relationships exist between leadership behaviors--hierarchical or team-oriented organizational perspectives, proactive or laissez-faire leadership styles, and autocratic or participative decision-making processes--and the team's communication practices. Decision-making processes directly affect the degree of team identification experienced by staff members, and conflict-management tactics affect team members' sense of interdependence and social distance. The findings of this study indicate that dentists should engage in participative decision-making processes that include staff members, thereby communicating their value to the practice and empowering employees. They also must become proactive in facilitating an environment that encourages collaboration and confrontation as healthy forms of conflict management. These leadership and communication behaviors are the most significant in creating a real rather than nominal team culture, which, in turn, leads to increased overall productivity, an enhanced level of services provided to patients and improved team member satisfaction.

Aircraft accident investigation: the decision-making in initial action scenario.

PubMed

Barreto, Marcia M; Ribeiro, Selma L O

2012-01-01

In the complex aeronautical environment, the efforts in terms of operational safety involve the adoption of proactive and reactive measures. The process of investigation begins right after the occurrence of the aeronautical accident, through the initial action. Thus, it is in the crisis scenario, that the person responsible for the initial action makes decisions and gathers the necessary information for the subsequent phases of the investigation process. Within this scenario, which is a natural environment, researches have shown the fragility of rational models of decision making. The theoretical perspective of naturalistic decision making constitutes a breakthrough in the understanding of decision problems demanded by real world. The proposal of this study was to verify if the initial action, after the occurrence of an accident, and the decision-making strategies, used by the investigators responsible for this activity, are characteristic of the naturalistic decision making theoretical approach. To attend the proposed objective a descriptive research was undertaken with a sample of professionals that work in this activity. The data collected through individual interviews were analyzed and the results demonstrated that the initial action environment, which includes restricted time, dynamic conditions, the presence of multiple actors, stress and insufficient information is characteristic of the naturalistic decision making. They also demonstrated that, when the investigators make their decisions, they use their experience and the mental simulation, intuition, improvisation, metaphors and analogues cases, as strategies, all of them related to the naturalistic approach of decision making, in order to satisfy the needs of the situation and reach the objectives of the initial action in the accident scenario.

Using strategic foresight to assess conservation opportunity.

PubMed

Cook, Carly N; Wintle, Bonnie C; Aldrich, Stephen C; Wintle, Brendan A

2014-12-01

The nature of conservation challenges can foster a reactive, rather than proactive approach to decision making. Failure to anticipate problems before they escalate results in the need for more costly and time-consuming solutions. Proactive conservation requires forward-looking approaches to decision making that consider possible futures without being overly constrained by the past. Strategic foresight provides a structured process for considering the most desirable future and for mapping the most efficient and effective approaches to promoting that future with tools that facilitate creative thinking. The process involves 6 steps: setting the scope, collecting inputs, analyzing signals, interpreting the information, determining how to act, and implementing the outcomes. Strategic foresight is ideal for seeking, recognizing, and realizing conservation opportunities because it explicitly encourages a broad-minded, forward-looking perspective on an issue. Despite its potential value, the foresight process is rarely used to address conservation issues, and previous attempts have generally failed to influence policy. We present the strategic foresight process as it can be used for proactive conservation planning, describing some of the key tools in the foresight tool kit and how they can be used to identify and exploit different types of conservation opportunities. Scanning is an important tool for collecting and organizing diverse streams of information and can be used to recognize new opportunities and those that could be created. Scenario planning explores how current trends, drivers of change, and key uncertainties might influence the future and can be used to identify barriers to opportunities. Backcasting is used to map out a path to a goal and can determine how to remove barriers to opportunities. We highlight how the foresight process was used to identify conservation opportunities during the development of a strategic plan to address climate change in New York State. The plan identified solutions that should be effective across a range of possible futures. Illustrating the application of strategic foresight to identify conservation opportunities should provide the impetus for decision makers to explore strategic foresight as a way to support more proactive conservation policy, planning, and management. © 2014 Society for Conservation Biology.

Technosocial Predictive Analytics in Support of Naturalistic Decision Making

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

Sanfilippo, Antonio P.; Cowell, Andrew J.; Malone, Elizabeth L.

2009-06-23

A main challenge we face in fostering sustainable growth is to anticipate outcomes through predictive and proactive across domains as diverse as energy, security, the environment, health and finance in order to maximize opportunities, influence outcomes and counter adversities. The goal of this paper is to present new methods for anticipatory analytical thinking which address this challenge through the development of a multi-perspective approach to predictive modeling as a core to a creative decision making process. This approach is uniquely multidisciplinary in that it strives to create decision advantage through the integration of human and physical models, and leverages knowledgemore » management and visual analytics to support creative thinking by facilitating the achievement of interoperable knowledge inputs and enhancing the user’s cognitive access. We describe a prototype system which implements this approach and exemplify its functionality with reference to a use case in which predictive modeling is paired with analytic gaming to support collaborative decision-making in the domain of agricultural land management.« less

Early Warning Signs: Identifying Opportunities to Disrupt Racial Inequities in School Discipline through Data-Based Decision Making

ERIC Educational Resources Information Center

Blake, Jamilia J.; Gregory, Anne; James, Marlon; Hasan, Gwen Webb

2016-01-01

The purpose of this study was to demonstrate how school psychologists can proactively address disparities in school suspension through the examination of office discipline referrals (ODR). Results of two studies examining high school ODRs suggest that there is value in school psychologists disaggregating and analyzing ODRs at the school level and…

Risk-Informed Decision Making: Application to Technology Development Alternative Selection

NASA Technical Reports Server (NTRS)

Dezfuli, Homayoon; Maggio, Gaspare; Everett, Christopher

2010-01-01

NASA NPR 8000.4A, Agency Risk Management Procedural Requirements, defines risk management in terms of two complementary processes: Risk-informed Decision Making (RIDM) and Continuous Risk Management (CRM). The RIDM process is used to inform decision making by emphasizing proper use of risk analysis to make decisions that impact all mission execution domains (e.g., safety, technical, cost, and schedule) for program/projects and mission support organizations. The RIDM process supports the selection of an alternative prior to program commitment. The CRM process is used to manage risk associated with the implementation of the selected alternative. The two processes work together to foster proactive risk management at NASA. The Office of Safety and Mission Assurance at NASA Headquarters has developed a technical handbook to provide guidance for implementing the RIDM process in the context of NASA risk management and systems engineering. This paper summarizes the key concepts and procedures of the RIDM process as presented in the handbook, and also illustrates how the RIDM process can be applied to the selection of technology investments as NASA's new technology development programs are initiated.

India: A Land of Contrasts. How to Develop Pro-Active Action Student Awareness and Understanding about the Third World in South Asia.

ERIC Educational Resources Information Center

Peters, Richard O.

This document presents a critical thinking/decision-making model to help students in grades K-12 understand East Indian culture. It is divided into three sections. Section 1 provides background information about India from the 15th century BC to the present. It briefly discusses religion, independence, political organization, social institutions,…

Economic decision-making in morning/evening-type people as a function of time of day.

PubMed

Correa, Angel; Ruiz-Herrera, Noelia; Ruz, Maria; Tonetti, Lorenzo; Martoni, Monica; Fabbri, Marco; Natale, Vincenzo

2017-01-01

Decision-making is affected by psychological factors like emotional state or cognitive control, which may also vary with circadian rhythmicity. Here, we tested the influence of chronotype (32 morning-type versus 32 evening-type) and time of day (9 a.m. versus 5 p.m.) on interpersonal decision-making as measured by the Ultimatum Game. Participants had to accept or reject different economic offers proposed by a virtual participant. Acceptance involved distribution of gains as proposed, whereas rejection resulted in no gain for either player. The results of the game showed a deviation from rational performance, as participants usually rejected the unfair offers. This behaviour was similar for both chronotype groups, and in both times of day. This result may reflect the robustness of decision-making strategies across standard circadian phases under ecological conditions. Furthermore, morning-types invested more time than evening-types to respond to high-uncertainty offers. This more cautious decision-making style of morning-types fits with our finding of higher proactive control as compared to evening-types when performing the AX-Continuous Performance Task. In line with the literature on personality traits, our results suggest that morning-types behave with more conscientiousness and less risk-taking than evening-type individuals.

The Experience of Decision Making in the Care of Children with Palliative Care Needs: The Experiences of Jordanian Mothers.

PubMed

Atout, Maha; Hemingway, Pippa; Seymour, Jane

2017-12-01

The purpose of this study was to explore the experience of decision making in the care of children with palliative care needs in Jordan, from the perspective of their mothers. This study employed a collective qualitative case study approach. Data were collected in 3 pediatric wards in a Jordanian hospital. The study used 2 data collection methods: participant observation (197 observational hours) and 56 semi-structured interviews with 24 mothers, 12 physicians and 20 nurses. The findings show how Jordanian mothers seek to transfer the role of decision making to physicians, as they perceive themselves to be unable to make decisions about critical issues related to the treatment of their children. Mothers had a widespread apprehension of "future guilt," especially when they feared that any decisions they might make could have an adverse impact on their children. Contrary to the predominant pattern, some mothers took a proactive approach towards decision making about their children's treatment. These mothers requested detailed information from primary physicians and sought different sources of knowledge such as second opinions, reading online resources, or talking to other parents who had a child with similar circumstances. The study concludes that mothers prefer to involve physicians in decisions about their children's healthcare and treatment to eliminate their fear of probable future guilt; this modifies any tendency to autonomously decide for their children. These findings are underpinned by the Jordanian culture in which doctors' opinions are highly regarded.

Perspectives of decision-making in requests for euthanasia: a qualitative research among patients, relatives and treating physicians in the Netherlands.

PubMed

Dees, Marianne K; Vernooij-Dassen, Myrra J; Dekkers, Wim J; Elwyn, Glyn; Vissers, Kris C; van Weel, Chris

2013-01-01

Euthanasia has been legally performed in the Netherlands since 2002. Respect for patient's autonomy is the underpinning ethical principal. However, patients have no right to euthanasia, and physicians have no obligation to provide it. Although over 3000 cases are conducted per year in the Netherlands, there is little known about how decision-making occurs and no guidance to support this difficult aspect of clinical practice. To explore the decision-making process in cases where patients request euthanasia and understand the different themes relevant to optimise this decision-making process. A qualitative thematic analysis of interviews with patients making explicit requests for euthanasia, most-involved relative(s) and treating physician. Thirty-two cases, 31 relatives and 28 treating physicians. Settings were patients' and relatives' homes and physicians' offices. Five main themes emerged: (1) initiation of sharing views and values about euthanasia, (2) building relationships as part of the negotiation, (3) fulfilling legal requirements, (4) detailed work of preparing and performing euthanasia and (5) aftercare and closing. A patient's request for euthanasia entails a complex process that demands emotional work by all participants. It is characterised by an intensive period of sharing information, relationship building and negotiation in order to reach agreement. We hypothesise that making decisions about euthanasia demands a proactive approach towards participants' preferences and values regarding end of life, towards the needs of relatives, towards the burden placed on physicians and a careful attention to shared decision-making. Future research should address the communicational skills professionals require for such complex decision-making.

Decision-making styles of business and industry: Five insights to improving your sales success

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

Bramson, R.M.

1996-04-01

Corporations, like people, have styles-even personalities-that in varied but vital ways affect every decision made at every level in the organization. This report describes five key organizational styles, methods for assessing which style a utility sales representative might encounter, and practical strategies that increase the odds of proposal acceptance. Each style is defined by its (1) goals and priorities, (2) administrative/communicative network, (3) key players, (4) events or circumstances prompting decisions, and (5) typical decision barriers, biases, and selling points. Written in highly readable style, this report provides tools that will help utility representatives proactively overcome organizational sales barriers, shortenmore » selling cycles, reduce sales expense, increase revenue and enhance customer loyalty.« less

Scenarios in Social-Ecological Systems: Co-Producing Futures in Arctic Alaska

NASA Astrophysics Data System (ADS)

Lovecraft, A. L.; Eicken, H.

2016-12-01

Companies use scenarios to gain the capacity to think ahead in rapidly changing complex competitive environments and make crucial decisions in absence of complete information about the future. Currently, at many regional scales of governance there is a growing need for tools that enable the actors at local-scales to address pressing concerns in the midst of uncertainty. This is particularly true of areas experiencing rapidly changing environments (e.g., drought, floods, diminishing sea ice, erosion) and complex social problems (e.g., remote communities, resource extraction, threatened cultures). Resilience theory and deliberative democracy both promote governance by informed actors in an effort to produce decisions that avoid social-environmental collapse. The former focusing on resilient ecosystems, the latter on informed social choices. Scenario exercises produce neither forecasts of what is to come nor are they visions of what participants would like to happen. Rather, they produce pertinent and accurate information related to questions of "what would happen if…" and thus provide the possibility of strategic decision-making to reduce risk and promote community resilience. Scenarios can be forms of social learning and among local-scale experts they create a deliberative process to make decisions about proactive adaptation. This talk represents the results from two projects from Alaska's Arctic Slope region. Resident expert participants from the Northwest Arctic and North Slope Boroughs addressed the focal question "What is needed for healthy sustainable communities by 2040?" Our findings reinforce the growing evidence from studies related to Arctic community sustainability and human development that indicate tight connections between fate-control, health, and environmental change. Our work differs, however, in using a future studies approach. The participants are addressing social-ecological resilience from a proactive standpoint thinking long-term about local and regional scale concerns rather than examining global-scale forecasts for near-term decision-making. The results contribute to a multi-disciplinary cross-cultural discussion of the importance of innovative thinking at the local scale and future directions for geophysical researchers in a rapidly changing Arctic.

Foundations for context-aware information retrieval for proactive decision support

NASA Astrophysics Data System (ADS)

Mittu, Ranjeev; Lin, Jessica; Li, Qingzhe; Gao, Yifeng; Rangwala, Huzefa; Shargo, Peter; Robinson, Joshua; Rose, Carolyn; Tunison, Paul; Turek, Matt; Thomas, Stephen; Hanselman, Phil

2016-05-01

Intelligence analysts and military decision makers are faced with an onslaught of information. From the now ubiquitous presence of intelligence, surveillance, and reconnaissance (ISR) platforms providing large volumes of sensor data, to vast amounts of open source data in the form of news reports, blog postings, or social media postings, the amount of information available to a modern decision maker is staggering. Whether tasked with leading a military campaign or providing support for a humanitarian mission, being able to make sense of all the information available is a challenge. Due to the volume and velocity of this data, automated tools are required to help support reasoned, human decisions. In this paper we describe several automated techniques that are targeted at supporting decision making. Our approaches include modeling the kinematics of moving targets as motifs; developing normalcy models and detecting anomalies in kinematic data; automatically classifying the roles of users in social media; and modeling geo-spatial regions based on the behavior that takes place in them. These techniques cover a wide-range of potential decision maker needs.

Breast cancer patients' use of health information in decision making and coping.

PubMed

Radina, M Elise; Ginter, Amanda C; Brandt, Julie; Swaney, Jan; Longo, Daniel R

2011-01-01

Breast cancer patients are some of today's most proactive healthcare consumers. Given how the media has highlighted the many issues involved in breast cancer, the unprecedented rise of consumerism in general, and the rise of healthcare consumerism specifically, a plethora of information on breast cancer has emerged in both scientific and popular media. It is timely and appropriate to consider breast cancer patients' perspectives regarding their search for health-related information and its use for treatment decision making and coping. The present study explores health information-seeking behaviors (passive and active), use of health information, sources of health information, and how such information is or is not used in patients' decision making about their treatment. This study used a secondary analysis of data regarding health information-seeking behaviors and treatment decisions from 2 separate but compatible qualitative data sets based on in-depth interviews with a total of 35 breast cancer survivors. Data were analyzed using thematic analysis. The majority of participating women were active information seekers (n = 26). Of the subsets of women who described their level of involvement in treatment decision making, the largest number (n = 13) reported a shared responsibility for decision making with their physician, and the next largest subset (n = 9) reported making the final decision themselves. These findings provide an enhanced understanding of the preferred source and method of delivery of information given health information-seeking behaviors and decision-making strategies. How health information is delivered in the future given these findings is discussed with specific attention to matching patient preferences with delivery methods to potentially enhance patients' sense of agency with regard to treatment, which has been shown to improve patients' psychosocial outcomes.

Participative management in health care services.

PubMed

Muller, M

1995-03-01

The need and demand for the highest-quality management of all health care delivery activities requires a participative management approach. The purpose with this article is to explore the process of participative management, to generate and describe a model for such management, focusing mainly on the process of participative management, and to formulate guidelines for operationalization of the procedure. An exploratory, descriptive and theory-generating research design is pursued. After a brief literature review, inductive reasoning is mainly employed to identify and define central concepts, followed by the formulation of a few applicable statements and guidelines. Participative management is viewed as a process of that constitutes the elements of dynamic interactive decision-making and problem-solving, shared governance, empowerment, organisational transformation, and dynamic communication within the health care organisation. The scientific method of assessment, planning, implementation and evaluation is utilised throughout the process of participative management. A continuum of interactive decision-making and problem-solving is described, the different role-players involved, as well as the levels of interactive decision-making and problem-solving. The most appropriate decision-making strategy should be employed in pro-active and reactive decision-making. Applicable principles and assumptions in each element of participative management is described. It is recommended that this proposed model for participative management be refined by means of a literature control, interactive dialogue with experts and a model case description or participative management, to ensure the trustworthiness of this research.

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.

The Voice of the Patient Methodology: A Novel Mixed-Methods Approach to Identifying Treatment Goals for Men with Prostate Cancer.

PubMed

Saigal, Christopher S; Lambrechts, Sylvia I; Seenu Srinivasan, V; Dahan, Ely

2017-06-01

Many guidelines advocate the use of shared decision making for men with newly diagnosed prostate cancer. Decision aids can facilitate the process of shared decision making. Implicit in this approach is the idea that physicians understand which elements of treatment matter to patients. Little formal work exists to guide physicians or developers of decision aids in identifying these attributes. We use a mixed-methods technique adapted from marketing science, the 'Voice of the Patient', to describe and identify treatment elements of value for men with localized prostate cancer. We conducted semi-structured interviews with 30 men treated for prostate cancer in the urology clinic of the West Los Angeles Veteran Affairs Medical Center. We used a qualitative analysis to generate themes in patient narratives, and a quantitative approach, agglomerative hierarchical clustering, to identify attributes of treatment that were most relevant to patients making decisions about prostate cancer. We identified five 'traditional' prostate cancer treatment attributes: sexual dysfunction, bowel problems, urinary problems, lifespan, and others' opinions. We further identified two novel treatment attributes: a treatment's ability to validate a sense of proactivity and the need for an incision (separate from risks of surgery). Application of a successful marketing technique, the 'Voice of the Customer', in a clinical setting elicits non-obvious attributes that highlight unique patient decision-making concerns. Use of this method in the development of decision aids may result in more effective decision support.

Automated Planning and Scheduling for Space Mission Operations

NASA Technical Reports Server (NTRS)

Chien, Steve; Jonsson, Ari; Knight, Russell

2005-01-01

Research Trends: a) Finite-capacity scheduling under more complex constraints and increased problem dimensionality (subcontracting, overtime, lot splitting, inventory, etc.) b) Integrated planning and scheduling. c) Mixed-initiative frameworks. d) Management of uncertainty (proactive and reactive). e) Autonomous agent architectures and distributed production management. e) Integration of machine learning capabilities. f) Wider scope of applications: 1) analysis of supplier/buyer protocols & tradeoffs; 2) integration of strategic & tactical decision-making; and 3) enterprise integration.

Using structured decision making to manage disease risk for Montana wildlife

USGS Publications Warehouse

Mitchell, Michael S.; Gude, Justin A.; Anderson, Neil J.; Ramsey, Jennifer M.; Thompson, Michael J.; Sullivan, Mark G.; Edwards, Victoria L.; Gower, Claire N.; Cochrane, Jean Fitts; Irwin, Elise R.; Walshe, Terry

2013-01-01

We used structured decision-making to develop a 2-part framework to assist managers in the proactive management of disease outbreaks in Montana, USA. The first part of the framework is a model to estimate the probability of disease outbreak given field observations available to managers. The second part of the framework is decision analysis that evaluates likely outcomes of management alternatives based on the estimated probability of disease outbreak, and applies managers' values for different objectives to indicate a preferred management strategy. We used pneumonia in bighorn sheep (Ovis canadensis) as a case study for our approach, applying it to 2 populations in Montana that differed in their likelihood of a pneumonia outbreak. The framework provided credible predictions of both probability of disease outbreaks, as well as biological and monetary consequences of management actions. The structured decision-making approach to this problem was valuable for defining the challenges of disease management in a decentralized agency where decisions are generally made at the local level in cooperation with stakeholders. Our approach provides local managers with the ability to tailor management planning for disease outbreaks to local conditions. Further work is needed to refine our disease risk models and decision analysis, including robust prediction of disease outbreaks and improved assessment of management alternatives.

Supportive Care: Communication Strategies to Improve Cultural Competence in Shared Decision Making.

PubMed

Brown, Edwina A; Bekker, Hilary L; Davison, Sara N; Koffman, Jonathan; Schell, Jane O

2016-10-07

Historic migration and the ever-increasing current migration into Western countries have greatly changed the ethnic and cultural patterns of patient populations. Because health care beliefs of minority groups may follow their religion and country of origin, inevitable conflict can arise with decision making at the end of life. The principles of truth telling and patient autonomy are embedded in the framework of Anglo-American medical ethics. In contrast, in many parts of the world, the cultural norm is protection of the patient from the truth, decision making by the family, and a tradition of familial piety, where it is dishonorable not to do as much as possible for parents. The challenge for health care professionals is to understand how culture has enormous potential to influence patients' responses to medical issues, such as healing and suffering, as well as the physician-patient relationship. Our paper provides a framework of communication strategies that enhance crosscultural competency within nephrology teams. Shared decision making also enables clinicians to be culturally competent communicators by providing a model where clinicians and patients jointly consider best clinical evidence in light of a patient's specific health characteristics and values when choosing health care. The development of decision aids to include cultural awareness could avoid conflict proactively, more productively address it when it occurs, and enable decision making within the framework of the patient and family cultural beliefs. Copyright © 2016 by the American Society of Nephrology.

Structured decision making for managing pneumonia epizootics in bighorn sheep

USGS Publications Warehouse

Sells, Sarah N.; Mitchell, Michael S.; Edwards, Victoria L.; Gude, Justin A.; Anderson, Neil J.

2016-01-01

Good decision-making is essential to conserving wildlife populations. Although there may be multiple ways to address a problem, perfect solutions rarely exist. Managers are therefore tasked with identifying decisions that will best achieve desired outcomes. Structured decision making (SDM) is a method of decision analysis used to identify the most effective, efficient, and realistic decisions while accounting for values and priorities of the decision maker. The stepwise process includes identifying the management problem, defining objectives for solving the problem, developing alternative approaches to achieve the objectives, and formally evaluating which alternative is most likely to accomplish the objectives. The SDM process can be more effective than informal decision-making because it provides a transparent way to quantitatively evaluate decisions for addressing multiple management objectives while incorporating science, uncertainty, and risk tolerance. To illustrate the application of this process to a management need, we present an SDM-based decision tool developed to identify optimal decisions for proactively managing risk of pneumonia epizootics in bighorn sheep (Ovis canadensis) in Montana. Pneumonia epizootics are a major challenge for managers due to long-term impacts to herds, epistemic uncertainty in timing and location of future epizootics, and consequent difficulty knowing how or when to manage risk. The decision tool facilitates analysis of alternative decisions for how to manage herds based on predictions from a risk model, herd-specific objectives, and predicted costs and benefits of each alternative. Decision analyses for 2 example herds revealed that meeting management objectives necessitates specific approaches unique to each herd. The analyses showed how and under what circumstances the alternatives are optimal compared to other approaches and current management. Managers can be confident that these decisions are effective, efficient, and realistic because they explicitly account for important considerations managers implicitly weigh when making decisions, including competing management objectives, uncertainty in potential outcomes, and risk tolerance.

Leadership of risk decision making in a complex, technology organization: The deliberative decision making model

NASA Astrophysics Data System (ADS)

Flaming, Susan C.

2007-12-01

The continuing saga of satellite technology development is as much a story of successful risk management as of innovative engineering. How do program leaders on complex, technology projects manage high stakes risks that threaten business success and satellite performance? This grounded theory study of risk decision making portrays decision leadership practices at one communication satellite company. Integrated product team (IPT) leaders of multi-million dollar programs were interviewed and observed to develop an extensive description of the leadership skills required to navigate organizational influences and drive challenging risk decisions to closure. Based on the study's findings the researcher proposes a new decision making model, Deliberative Decision Making, to describe the program leaders' cognitive and organizational leadership practices. This Deliberative Model extends the insights of prominent decision making models including the rational (or classical) and the naturalistic and qualifies claims made by bounded rationality theory. The Deliberative Model describes how leaders proactively engage resources to play a variety of decision leadership roles. The Model incorporates six distinct types of leadership decision activities, undertaken in varying sequence based on the challenges posed by specific risks. Novel features of the Deliberative Decision Model include: an inventory of leadership methods for managing task challenges, potential stakeholder bias and debates; four types of leadership meta-decisions that guide decision processes, and aligned organizational culture. Both supporting and constraining organizational influences were observed as leaders managed major risks, requiring active leadership on the most difficult decisions. Although the company's engineering culture emphasized the importance of data-based decisions, the uncertainties intrinsic to satellite risks required expert engineering judgment to be exercised throughout. An investigation into the co-variation of decision methods with uncertainty suggests that perceived risk severity may serve as a robust indicator for choices about decision practices. The Deliberative Decision processes incorporate multiple organizational and cultural controls as cross-checks to mitigate potential parochial bias of individuals, stakeholder groups, or leaders. Overall the Deliberative Decision framework describes how expert leadership practices, supportive organizational systems along with aligned cultural values and behavioral norms help leaders drive high stakes risk decisions to closure in this complex, advanced-technology setting.

Cognitive neuroscience in forensic science: understanding and utilizing the human element

PubMed Central

Dror, Itiel E.

2015-01-01

The human element plays a critical role in forensic science. It is not limited only to issues relating to forensic decision-making, such as bias, but also relates to most aspects of forensic work (some of which even take place before a crime is ever committed or long after the verification of the forensic conclusion). In this paper, I explicate many aspects of forensic work that involve the human element and therefore show the relevance (and potential contribution) of cognitive neuroscience to forensic science. The 10 aspects covered in this paper are proactive forensic science, selection during recruitment, training, crime scene investigation, forensic decision-making, verification and conflict resolution, reporting, the role of the forensic examiner, presentation in court and judicial decisions. As the forensic community is taking on the challenges introduced by the realization that the human element is critical for forensic work, new opportunities emerge that allow for considerable improvement and enhancement of the forensic science endeavour. PMID:26101281

Cognitive neuroscience in forensic science: understanding and utilizing the human element.

PubMed

Dror, Itiel E

2015-08-05

The human element plays a critical role in forensic science. It is not limited only to issues relating to forensic decision-making, such as bias, but also relates to most aspects of forensic work (some of which even take place before a crime is ever committed or long after the verification of the forensic conclusion). In this paper, I explicate many aspects of forensic work that involve the human element and therefore show the relevance (and potential contribution) of cognitive neuroscience to forensic science. The 10 aspects covered in this paper are proactive forensic science, selection during recruitment, training, crime scene investigation, forensic decision-making, verification and conflict resolution, reporting, the role of the forensic examiner, presentation in court and judicial decisions. As the forensic community is taking on the challenges introduced by the realization that the human element is critical for forensic work, new opportunities emerge that allow for considerable improvement and enhancement of the forensic science endeavour. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

The rise of politics and the decline of vulnerability as criteria in disaster decisions of the United States, 1953-2009.

PubMed

Daniels, R Steven

2013-10-01

This paper examines the shift from vulnerability to political responsiveness in presidential and gubernatorial disaster decisions in the United States from 1953-2009 (President Dwight D. Eisenhower to President Barack Obama) using annual request, declaration, and approval data from multiple sources. It makes three key conclusions: first, the 1988 Stafford Act expanded federal coverage to all categories of disasters, added a significant range of individual types of assistance, and provided extensive funding for recovery planning. Second, the election effects on disaster decisions increased over time whereas the impact of social and economic vulnerability (measured by scope of disaster) declined. Third, the changes affected governors more than presidents, and the choices of governors drove those of presidents. The analysis underscores the increasingly political nature of the disaster decision-making process, as well as the difficulty in emphasising mitigation and preparedness as intensively as response and recovery. Proactive intervention yields fewer political rewards than responsiveness. © 2013 The Author(s). Disasters © Overseas Development Institute, 2013.

Fertility preservation and cancer: Challenges for adolescent and young adult patients

PubMed Central

Benedict, Catherine; Thom, Bridgette; Kelvin, Joanne

2016-01-01

Purpose of review With increasing survival rates, fertility is an important quality of life concern for many young cancer patients. There is a critical need for improvements in clinical care to ensure patients are well informed about infertility risks and fertility preservation (FP) options and to support them in their reproductive decision-making prior to treatment. Recent findings A number of barriers prevent fertility from being adequately addressed in the clinical context. Providers’ and patients’ incomplete or inaccurate understanding of infertility risks exacerbate patients’ reproductive concerns. For female patients in particular, making decisions about FP before treatment often leads to decision conflict, reducing the likelihood of making informed, values-based decisions, and post-treatment regret and distress. Recent empirically-based interventions to improve provider training around fertility issues and to support patient decision-making about FP show promise. Summary Providers should be knowledgeable about the infertility risks associated with cancer therapies and proactively address fertility with all patients who might one day wish to have a child. Comprehensive counseling should also include related issues such as contraceptive use and health implications of early menopause, regardless of desire for future children. Although the negative psychosocial impact of cancer-related infertility is now well accepted, limited work has been done to explore how to improve clinical management of fertility issues in the context of cancer care. Evidence-based interventions should be developed to address barriers and provide psychosocial and decision-making support to patients who are concerned about their fertility and interested in FP options. PMID:26730794

Using Risk Assessment Methodologies to Meet Management Objectives

NASA Technical Reports Server (NTRS)

DeMott, D. L.

2015-01-01

Corporate and program objectives focus on desired performance and results. ?Management decisions that affect how to meet these objectives now involve a complex mix of: technology, safety issues, operations, process considerations, employee considerations, regulatory requirements, financial concerns and legal issues. ?Risk Assessments are a tool for decision makers to understand potential consequences and be in a position to reduce, mitigate or eliminate costly mistakes or catastrophic failures. Using a risk assessment methodology is only a starting point. ?A risk assessment program provides management with important input in the decision making process. ?A pro-active organization looks to the future to avoid problems, a reactive organization can be blindsided by risks that could have been avoided. ?You get out what you put in, how useful your program is will be up to the individual organization.

Beliefs, decision-making, and dialogue about complementary and alternative medicine (CAM) within families using CAM: a qualitative study.

PubMed

Nichol, James; Thompson, Elizabeth A; Shaw, Alison

2011-02-01

The rise in complementary and alternative medicine (CAM) use is well documented. Surveys provide varying estimates of the prevalence of CAM use. Qualitative research has explored individuals' decision-making regarding CAM. This study aimed to examine the family as a context for beliefs, decision-making, and dialogue about CAM. Families were recruited via the Avon Longitudinal Study of Parents and Children. A subsample of CAM users was targeted using purposeful sampling. Focus groups and interviews were conducted with 15 families and the data were analyzed thematically. Family understandings and beliefs about CAM: CAM was understood as treatments provided outside mainstream care, offering a more "natural" and "holistic" approach, tailored to individual needs and overlapping with wider healthy lifestyle practices. Hierarchies of acceptability of CAM: Physical and "mainstream" therapies were widely supported, with "fringe" therapies producing the most polarized views. There was a belief particularly among fathers and young people that certain therapies rely on "placebo" effects and their value was contested. Types of CAM users within families: Family members were predominantly "pragmatic" CAM users, with "committed" users (all mothers) characterized by deeper philosophical commitment to CAM and skepticism toward conventional medicine. Family dynamics of CAM decision-making: Mothers tended to "champion" CAM within families, while not determining family CAM use. Fathers largely positioned themselves as lacking expertise or skeptical of CAM. Young people were beginning to articulate independent and more critical views of CAM, some directly challenging their mother's perspective. However, all families shared openness to CAM as part of broader beliefs in proactive healthy lifestyles. Family focus groups and interviews allow a window on beliefs, decision-making, and dialogue about CAM within families, illuminating the CAM "champion" role held by mothers, and young people's developing autonomy regarding health beliefs and decision-making.

A Distributed, Collaborative Intelligent Agent System Approach for Proactive Postmarketing Drug Safety Surveillance

PubMed Central

Ji, Yanqing; Ying, Hao; Farber, Margo S.; Yen, John; Dews, Peter; Miller, Richard E.; Massanari, R. Michael

2014-01-01

Discovering unknown adverse drug reactions (ADRs) in postmarketing surveillance as early as possible is of great importance. The current approach to postmarketing surveillance primarily relies on spontaneous reporting. It is a passive surveillance system and limited by gross underreporting (<10% reporting rate), latency, and inconsistent reporting. We propose a novel team-based intelligent agent software system approach for proactively monitoring and detecting potential ADRs of interest using electronic patient records. We designed such a system and named it ADRMonitor. The intelligent agents, operating on computers located in different places, are capable of continuously and autonomously collaborating with each other and assisting the human users (e.g., the food and drug administration (FDA), drug safety professionals, and physicians). The agents should enhance current systems and accelerate early ADR identification. To evaluate the performance of the ADRMonitor with respect to the current spontaneous reporting approach, we conducted simulation experiments on identification of ADR signal pairs (i.e., potential links between drugs and apparent adverse reactions) under various conditions. The experiments involved over 275 000 simulated patients created on the basis of more than 1000 real patients treated by the drug cisapride that was on the market for seven years until its withdrawal by the FDA in 2000 due to serious ADRs. Healthcare professionals utilizing the spontaneous reporting approach and the ADRMonitor were separately simulated by decision-making models derived from a general cognitive decision model called fuzzy recognition-primed decision (RPD) model that we recently developed. The quantitative simulation results show that 1) the number of true ADR signal pairs detected by the ADRMonitor is 6.6 times higher than that by the spontaneous reporting strategy; 2) the ADR detection rate of the ADRMonitor agents with even moderate decision-making skills is five times higher than that of spontaneous reporting; and 3) as the number of patient cases increases, ADRs could be detected significantly earlier by the ADRMonitor. PMID:20007038

Integrating public commentary and participation into environmental decision-making: The implications of Ontario`s Environmental Bill of Rights, 1993

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

McRobert, D.

1995-12-31

In February 1994, the Environmental Bill of Rights, 1993 (EBR) was proclaimed into law by the Ontario government. The EBR is intended to promote a new era in environmental decision-making one characterized by enhanced public participation, citizen empowerment and greater accountability of decision makers. A key challenge in the implementation of the EBR is the change it will force in government decision-making. Historically, Ontario environmental regulation focused on the development of appropriate pollution control instruments, techniques and standards to control harmful environmental activity. Often the knowledge of outsiders, (i.e. the public), was considered inadequate or irrelevant to the regulatory process.more » In contrast, the EBR recognizes the relevance and validity of public knowledge, and is intended to encourage decision-makers to mesh public and scientific knowledge through a new regulatory approval system based on notice of new developments, approvals and laws on a province-wide electronic bulletin board service. The positive potential of the EBR is in its ability to promote social understanding of the issues and risks in environmental management. The EBR mandates open dialogue and proactive interaction between government, industry, environmental groups, citizen groups, and employees to explore new mechanisms in environmental decision making. In addition, the EBR seeks to enlist the cooperation of all sectors of society in addressing the complex issues posed by the environment so that not only problem solving but problem identification and prevention activities are conducted in the context of greater shared responsibility and accountability.« less

Clinical and regulatory considerations in pharmacogenetic testing.

PubMed

Schuck, Robert N; Marek, Elizabeth; Rogers, Hobart; Pacanowski, Michael

2016-12-01

Both regulatory science and clinical practice rely on best available scientific data to guide decision-making. However, changes in clinical practice may be driven by numerous other factors such as cost. In this review, we reexamine noteworthy examples where pharmacogenetic testing information was added to drug labeling to explore how the available evidence, potential public health impact, and predictive utility of each pharmacogenetic biomarker impacts clinical uptake. Advances in the field of pharmacogenetics have led to new discoveries about the genetic basis for variability in drug response. The Food and Drug Administration recognizes the value of pharmacogenetic testing strategies and has been proactive about incorporating pharmacogenetic information into the labeling of both new drugs and drugs already on the market. Although some examples have readily translated to routine clinical practice, clinical uptake of genetic testing for many drugs has been limited. Both regulatory science and clinical practice rely on data-driven approaches to guide decision making; however, additional factors are also important in clinical practice that do not impact regulatory decision making, and these considerations may result in heterogeneity in clinical uptake of pharmacogenetic testing. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Improving conservation of Florida manatees (Trichechus manatus latirostris): conceptualization and contributions toward a regional warm-water network management strategy for sustainable winter habitat.

PubMed

Flamm, Richard Owen; Reynolds, John Elliot; Harmak, Craig

2013-01-01

We used southwestern Florida as a case study to lay the groundwork for an intended and organized decision-making process for managing warm-water habitat needed by endangered manatees to survive winters in Florida. Scientists and managers have prioritized (a) projecting how the network of warm-water sites will change over the next 50 years as warmed industrial discharges may expire and as flows of natural springs are reduced through redirection of water for human uses, and (b) mitigating such changes to prevent undue consequences to manatees. Given the complexities introduced by manatee ecology; agency organizational structure; shifting public demands; fluctuating resource availability; and managing within interacting cultural, social, political, and environmental contexts, it was clear that a structured decision process was needed. To help promote such a process, we collected information relevant to future decisions including maps of known and suspected warm-water sites and prototyped a characterization of sites and networks. We propose steps that would lead to models that might serve as core tools in manatee/warm-water decision-making, and we summarized topics relevant for informed decision-making (e.g., manatee spatial cognition, risk of cold-stress morbidity and mortality, and human dimensions). A major impetus behind this effort is to ensure proactively that robust modeling tools are available well in advance of the anticipated need for a critical management decision.

Improving Conservation of Florida Manatees ( Trichechus manatus latirostris): Conceptualization and Contributions Toward a Regional Warm-Water Network Management Strategy for Sustainable Winter Habitat

NASA Astrophysics Data System (ADS)

Flamm, Richard Owen; Reynolds, John Elliot; Harmak, Craig

2013-01-01

We used southwestern Florida as a case study to lay the groundwork for an intended and organized decision-making process for managing warm-water habitat needed by endangered manatees to survive winters in Florida. Scientists and managers have prioritized (a) projecting how the network of warm-water sites will change over the next 50 years as warmed industrial discharges may expire and as flows of natural springs are reduced through redirection of water for human uses, and (b) mitigating such changes to prevent undue consequences to manatees. Given the complexities introduced by manatee ecology; agency organizational structure; shifting public demands; fluctuating resource availability; and managing within interacting cultural, social, political, and environmental contexts, it was clear that a structured decision process was needed. To help promote such a process, we collected information relevant to future decisions including maps of known and suspected warm-water sites and prototyped a characterization of sites and networks. We propose steps that would lead to models that might serve as core tools in manatee/warm-water decision-making, and we summarized topics relevant for informed decision-making (e.g., manatee spatial cognition, risk of cold-stress morbidity and mortality, and human dimensions). A major impetus behind this effort is to ensure proactively that robust modeling tools are available well in advance of the anticipated need for a critical management decision.

Meta-cognitive processes in executive control development: The case of reactive and proactive control

PubMed Central

Chevalier, Nicolas; Martis, Shaina Bailey; Curran, Tim; Munakata, Yuko

2015-01-01

Young children engage cognitive control reactively in response to events, rather than proactively preparing for events. Such limitations in executive control have been explained in terms of fundamental constraints on children’s cognitive capacities. Alternatively, young children might be capable of proactive control but differ from older children in their meta-cognitive decisions regarding when to engage proactive control. We examined these possibilities in three conditions of a task-switching paradigm, varying in whether task cues were available before or after target onset. Reaction times, ERPs, and pupil dilation showed that 5-year-olds did engage in advance preparation, a critical aspect of proactive control, but only when reactive control was made more difficult, whereas 10-year-olds engaged proactive control whenever possible. These findings highlight meta-cognitive processes in children’s cognitive control, an understudied aspect of executive control development. PMID:25603026

Subthalamic stimulation, oscillatory activity and connectivity reveal functional role of STN and network mechanisms during decision making under conflict.

PubMed

Hell, Franz; Taylor, Paul C J; Mehrkens, Jan H; Bötzel, Kai

2018-05-01

Inhibitory control is an important executive function that is necessary to suppress premature actions and to block interference from irrelevant stimuli. Current experimental studies and models highlight proactive and reactive mechanisms and claim several cortical and subcortical structures to be involved in response inhibition. However, the involved structures, network mechanisms and the behavioral relevance of the underlying neural activity remain debated. We report cortical EEG and invasive subthalamic local field potential recordings from a fully implanted sensing neurostimulator in Parkinson's patients during a stimulus- and response conflict task with and without deep brain stimulation (DBS). DBS made reaction times faster overall while leaving the effects of conflict intact: this lack of any effect on conflict may have been inherent to our task encouraging a high level of proactive inhibition. Drift diffusion modelling hints that DBS influences decision thresholds and drift rates are modulated by stimulus conflict. Both cortical EEG and subthalamic (STN) LFP oscillations reflected reaction times (RT). With these results, we provide a different interpretation of previously conflict-related oscillations in the STN and suggest that the STN implements a general task-specific decision threshold. The timecourse and topography of subthalamic-cortical oscillatory connectivity suggest the involvement of motor, frontal midline and posterior regions in a larger network with complementary functionality, oscillatory mechanisms and structures. While beta oscillations are functionally associated with motor cortical-subthalamic connectivity, low frequency oscillations reveal a subthalamic-frontal-posterior network. With our results, we suggest that proactive as well as reactive mechanisms and structures are involved in implementing a task-related dynamic inhibitory signal. We propose that motor and executive control networks with complementary oscillatory mechanisms are tonically active, react to stimuli and release inhibition at the response when uncertainty is resolved and return to their default state afterwards. Copyright © 2018 Elsevier Inc. All rights reserved.

Transforming home health nursing with telehealth technology.

PubMed

Farrar, Francisca Cisneros

2015-06-01

Telehealth technology is an evidence-based delivery model tool that can be integrated into the plan of care for mental health patients. Telehealth technology empowers access to health care, can help decrease or prevent hospital readmissions, assist home health nurses provide shared decision making, and focuses on collaborative care. Telehealth and the recovery model have transformed the role of the home health nurse. Nurses need to be proactive and respond to rapidly emerging technologies that are transforming their role in home care. Copyright © 2015 Elsevier Inc. All rights reserved.

Case based reasoning in criminal intelligence using forensic case data.

PubMed

Ribaux, O; Margot, P

2003-01-01

A model that is based on the knowledge of experienced investigators in the analysis of serial crime is suggested to bridge a gap between technology and methodology. Its purpose is to provide a solid methodology for the analysis of serial crimes that supports decision making in the deployment of resources, either by guiding proactive policing operations or helping the investigative process. Formalisation has helped to derive a computerised system that efficiently supports the reasoning processes in the analysis of serial crime. This novel approach fully integrates forensic science data.

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

PubMed Central

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

2013-01-01

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

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

PubMed

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

2013-01-01

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

Using decision analysis to support proactive management of emerging infectious wildlife diseases

Treesearch

Evan H Campbell Grant; Erin Muths; Rachel A Katz; Stefano Canessa; Michael J Adams; Jennifer R Ballard; Lee Berger; Cheryl J Briggs; Jeremy TH Coleman; Matthew J Gray; M Camille Harris; Reid N Harris; Blake Hossack; Kathryn P Huyvaert; Jonathan Kolby; Karen R Lips; Robert E Lovich; Hamish I McCallum; Joseph R Mendelson; Priya Nanjappa; Deanna H Olson; Jenny G Powers; Katherine LD Richgels; Robin E Russell; Benedikt R Schmidt; Annemarieke Spitzen-van der Sluijs; Mary Kay Watry; Douglas C Woodhams; C LeAnn White

2017-01-01

Despite calls for improved responses to emerging infectious diseases in wildlife, management is seldom considered until a disease has been detected in affected populations. Reactive approaches may limit the potential for control and increase total response costs. An alternative, proactive management framework can identify immediate actions that reduce future impacts...

Flood Protection Decision Making Within a Coupled Human and Natural System

NASA Astrophysics Data System (ADS)

O'Donnell, Greg; O'Connell, Enda

2013-04-01

Due to the perceived threat from climate change, prediction under changing climatic and hydrological conditions has become a dominant theme of hydrological research. Much of this research has been climate model-centric, in which GCM/RCM climate projections have been used to drive hydrological system models to explore potential impacts that should inform adaptation decision-making. However, adaptation fundamentally involves how humans may respond to increasing flood and drought hazards by changing their strategies, activities and behaviours which are coupled in complex ways to the natural systems within which they live and work. Humans are major agents of change in hydrological systems, and representing human activities and behaviours in coupled human and natural hydrological system models is needed to gain insight into the complex interactions that take place, and to inform adaptation decision-making. Governments and their agencies are under pressure to make proactive investments to protect people living in floodplains from the perceived increasing flood hazard. However, adopting this as a universal strategy everywhere is not affordable, particularly in times of economic stringency and given uncertainty about future climatic conditions. It has been suggested that the assumption of stationarity, which has traditionally been invoked in making hydrological risk assessments, is no longer tenable. However, before the assumption of hydrologic nonstationarity is accepted, the ability to cope with the uncertain impacts of global warming on water management via the operational assumption of hydrologic stationarity should be carefully examined. Much can be learned by focussing on natural climate variability and its inherent changes in assessing alternative adaptation strategies. A stationary stochastic multisite flood hazard model has been developed that can exhibit increasing variability/persistence in annual maximum floods, starting with the traditional assumption of independence. This has been coupled to an agent based model of how various stakeholders interact in determining where and when flood protection investments are made in a hypothetical region with multiple sites at risk from flood hazard. Monte Carlo simulation is used to explore how government agencies with finite resources might best invest in flood protection infrastructure in a highly variable climate with a high degree of future uncertainty. Insight is provided into whether proactive or reactive strategies are to be preferred in an increasingly variable climate.

The Structural Consequences of Big Data-Driven Education.

PubMed

Zeide, Elana

2017-06-01

Educators and commenters who evaluate big data-driven learning environments focus on specific questions: whether automated education platforms improve learning outcomes, invade student privacy, and promote equality. This article puts aside separate unresolved-and perhaps unresolvable-issues regarding the concrete effects of specific technologies. It instead examines how big data-driven tools alter the structure of schools' pedagogical decision-making, and, in doing so, change fundamental aspects of America's education enterprise. Technological mediation and data-driven decision-making have a particularly significant impact in learning environments because the education process primarily consists of dynamic information exchange. In this overview, I highlight three significant structural shifts that accompany school reliance on data-driven instructional platforms that perform core school functions: teaching, assessment, and credentialing. First, virtual learning environments create information technology infrastructures featuring constant data collection, continuous algorithmic assessment, and possibly infinite record retention. This undermines the traditional intellectual privacy and safety of classrooms. Second, these systems displace pedagogical decision-making from educators serving public interests to private, often for-profit, technology providers. They constrain teachers' academic autonomy, obscure student evaluation, and reduce parents' and students' ability to participate or challenge education decision-making. Third, big data-driven tools define what "counts" as education by mapping the concepts, creating the content, determining the metrics, and setting desired learning outcomes of instruction. These shifts cede important decision-making to private entities without public scrutiny or pedagogical examination. In contrast to the public and heated debates that accompany textbook choices, schools often adopt education technologies ad hoc. Given education's crucial impact on individual and collective success, educators and policymakers must consider the implications of data-driven education proactively and explicitly.

Proactive Motor Control Reduces Monetary Risk Taking in Gambling

PubMed Central

Adams, Rachel; Chambers, Christopher D.

2012-01-01

Less supervision by the executive system after disruption of the right prefrontal cortex leads to increased risk taking in gambling because superficially attractive—but risky—choices are not suppressed. Similarly, people might gamble more in multitask situations than in single-task situations because concurrent executive processes usually interfere with each other. In the study reported here, we used a novel monetary decision-making paradigm to investigate whether multitasking could reduce rather than increase risk taking in gambling. We found that performing a task that induced cautious motor responding reduced gambling in a multitask situation (Experiment 1). We then found that a short period of inhibitory training lessened risk taking in gambling at least 2 hr later (Experiments 2 and 3). Our findings indicate that proactive motor control strongly affects monetary risk taking in gambling. The link between control systems at different cognitive levels might be exploited to develop new methods for rehabilitation of addiction and impulse-control disorders. PMID:22692336

Proactive learning for artificial cognitive systems

NASA Astrophysics Data System (ADS)

Lee, Soo-Young

2010-04-01

The Artificial Cognitive Systems (ACS) will be developed for human-like functions such as vision, auditory, inference, and behavior. Especially, computational models and artificial HW/SW systems will be devised for Proactive Learning (PL) and Self-Identity (SI). The PL model provides bilateral interactions between robot and unknown environment (people, other robots, cyberspace). For the situation awareness in unknown environment it is required to receive audiovisual signals and to accumulate knowledge. If the knowledge is not enough, the PL should improve by itself though internet and others. For human-oriented decision making it is also required for the robot to have self-identify and emotion. Finally, the developed models and system will be mounted on a robot for the human-robot co-existing society. The developed ACS will be tested against the new Turing Test for the situation awareness. The Test problems will consist of several video clips, and the performance of the ACSs will be compared against those of human with several levels of cognitive ability.

Events and decision-making in the long-term care of Dutch nursing home patients in a vegetative state.

PubMed

Lavrijsen, Jan; van den Bosch, Hans; Koopmans, Raymond; van Weel, Chris; Froeling, Paul

2005-01-01

To clarify characteristics of long-term care and treatment of patients in a vegetative state. Qualitative, descriptive study in a Dutch nursing home. Review of clinical records of patients in a vegetative state after acute brain damage between 1978-2002. Five patients received intensive care of a multi-disciplinary team and showed considerable co-morbidity. There was no standard scenario for end-of-life decisions. Physicians play a more proactive role by evaluating the total medical treatment instead of withholding therapy in case of incidental complications. The families' attitude is a crucial factor in their ultimate decision. There is no standard solution to alleviate the fate of patients in a vegetative state and their families. Withdrawing all medical treatment, including artificial nutrition and hydration, can be an acceptable scenario for letting the patient die. More research is needed to identify the factors that contribute to acceptance of the physician's decision by the family.

New Directions in Measuring Reactive and Proactive Aggression: Validation of a Teacher Questionnaire

ERIC Educational Resources Information Center

Polman, Hanneke; de Castro, Bram Orobio; Thomaes, Sander; van Aken, Marcel

2009-01-01

The well-known distinction between reactive and proactive aggression is theoretically important but empirically controversial. Recently, aggression researchers have argued that we should separate the form and function of aggression to make a clearer distinction between reactive and proactive aggression. This article describes the validation of a…

Decision strategies to reduce teenage and young adult deaths in the United States.

PubMed

Keeney, Ralph L; Palley, Asa B

2013-09-01

This article uses decision analysis concepts and techniques to address an extremely important problem to any family with children, namely, how to avoid the tragic death of a child during the high-risk ages of 15-24. Descriptively, our analysis indicates that of the 35,000 annual deaths among this age group in the United States, approximately 20,000 could be avoided if individuals chose readily available alternatives for decisions relating to these deaths. Prescriptively, we develop a decision framework for parents and a child to both identify and proactively pursue decisions that can lower that child's exposure to life-threatening risks and positively alter decisions when facing such risks. Applying this framework for parents and the youth themselves, we illustrate the logic and process of generating proactive alternatives with numerous examples that each could pursue to lower these life-threatening risks and possibly avoid a tragic premature death, and discuss some public policy implications of our findings. © 2013 Society for Risk Analysis.

Transforming data into action: the Sonoma County Human Services Department.

PubMed

Harrison, Lindsay

2012-01-01

In order to centralize data-based initiatives, the Director of the Department worked with the Board of Supervisors and the executive team to develop a new Planning, Research, and Evaluation (PRE) division. PRE is establishing rules for data-based decision making and consolidating data collection to ensure quality and consistency. It aims to target resources toward visionary, pro-active program planning and implementation, and inform the public about the role of Human Services in creating a healthy, safe and productive environment. PRE staff spent several months studying the job functions of staff, to determine how they use information to inform practice, consulting other counties about their experiences. The PRE team developed Datascript, outlining two agency aims: (a) foster a decision-making environment that values and successfully uses empirical evidence for strategic change, and (b) manage the role and image of the Human Services Department in the external environment. The case study describes action steps developed to achieve each aim. Copyright © Taylor & Francis Group, LLC

Integrated Drought Monitoring and Forecasts for Decision Making in Water and Agricultural Sectors over the Southeastern US under Changing Climate

NASA Astrophysics Data System (ADS)

Arumugam, S.; Mazrooei, A.; Ward, R.

2017-12-01

Changing climate arising from structured oscillations such as ENSO and rising temperature poses challenging issues in meeting the increasing water demand (due to population growth) for public supply and agriculture over the Southeast US. This together with infrastructural (e.g., most reservoirs being within-year systems) and operational (e.g., static rule curves) constraints requires an integrated approach that seamlessly monitors and forecasts water and soil moisture conditions to support adaptive decision making in water and agricultural sectors. In this talk, we discuss the utility of an integrated drought management portal that both monitors and forecasts streamflow and soil moisture over the southeast US. The forecasts are continuously developed and updated by forcing monthly-to-seasonal climate forecasts with a land surface model for various target basins. The portal also houses a reservoir allocation model that allows water managers to explore different release policies in meeting the system constraints and target storages conditioned on the forecasts. The talk will also demonstrate how past events (e.g., 2007-2008 drought) could be proactively monitored and managed to improve decision making in water and agricultural sectors over the Southeast US. Challenges in utilizing the portal information from institutional and operational perspectives will also be presented.

The benefits of sexual orientation diversity in sport organizations.

PubMed

Cunningham, George B; Melton, E Nicole

2011-01-01

While sexual orientation diversity can potentially serve as a source of competitive advantage, researchers have largely failed to fully articulate the theoretical linkage between this diversity form and organizational effectiveness. As such, we propose a theoretical framework to understand these dynamics. Sexual orientation diversity is posited to positively contribute to organizational effectiveness through three mechanisms: enhanced decision making capabilities, improved marketplace understanding, and goodwill associated with engaging in socially responsible practices. We also propose two approaches to leveraging the benefits of sexual orientation diversity: targeting the categorization process and creating a proactive and inclusive diversity culture. Contributions and implications are discussed.

Student Worker Free Speech on the Public Campus: A New Twist to a Constant Issue

ERIC Educational Resources Information Center

Letzring, Timothy D.; Wolff, Lori A.

2009-01-01

Rather than anticipating an issue or proactively addressing it, college and university administrators often find themselves in the position of reacting to recent laws or court decisions. This paper examines an issue ripe for proactive thought; an issue not yet directly considered in court cases: free speech and the student employee. In the…

[Concordance and usefulness of a stratification system for clinical decision making].

PubMed

González González, Ana Isabel; Miquel Gómez, Ana María; Rodríguez Morales, David; Hernández Pascual, Montserrat; Sánchez Perruca, Luis; Mediavilla Herrera, Inmaculada

2017-04-01

1) To analyse concordance between the level of risk classification using the Adjusted Groups Morbidity (GMA) tool and the assigned level of intervention by general practitioners (GP). 2) To study the usefulness of the GMA tool as an aid in electronic medical records (EMR) for decision making. Cross-sectional observational study of concordance. Primary Care. Madrid Health Service. Twenty eight GPs. A sample of 840 patients assigned to participating GPs was selected by disproportionate stratified random sampling (0.65 kappa, 0.125 precision, 5% positive rate, 95% confidence level). Weighted Cohen Kappa index for the degree of concordance between the GMA tool and the GPs. The usefulness of the tool was assessed using an ad hoc developed questionnaire. Kappa weighted index obtained was 0.60 (95%CI: 0.55-0.65). In 3% of cases the disagreement was maximum. The GPs found that the grouping tool had been useful in 76% of cases. Moderate strength/good concordance; incorporating a grouping tool in the EMR helps as a reminder for taking more proactive/integrated decisions based on social and health needs of people with chronic diseases. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Collaborative human-machine analysis to disambiguate entities in unstructured text and structured datasets

NASA Astrophysics Data System (ADS)

Davenport, Jack H.

2016-05-01

Intelligence analysts demand rapid information fusion capabilities to develop and maintain accurate situational awareness and understanding of dynamic enemy threats in asymmetric military operations. The ability to extract relationships between people, groups, and locations from a variety of text datasets is critical to proactive decision making. The derived network of entities must be automatically created and presented to analysts to assist in decision making. DECISIVE ANALYTICS Corporation (DAC) provides capabilities to automatically extract entities, relationships between entities, semantic concepts about entities, and network models of entities from text and multi-source datasets. DAC's Natural Language Processing (NLP) Entity Analytics model entities as complex systems of attributes and interrelationships which are extracted from unstructured text via NLP algorithms. The extracted entities are automatically disambiguated via machine learning algorithms, and resolution recommendations are presented to the analyst for validation; the analyst's expertise is leveraged in this hybrid human/computer collaborative model. Military capability is enhanced by these NLP Entity Analytics because analysts can now create/update an entity profile with intelligence automatically extracted from unstructured text, thereby fusing entity knowledge from structured and unstructured data sources. Operational and sustainment costs are reduced since analysts do not have to manually tag and resolve entities.

Clinical decision making by nurses when faced with third-space fluid shift. How well do they fare?

PubMed

Redden, M; Wotton, K

2001-01-01

Nurses' use of knowledge, the connection of this knowledge to treatment decisions and information actually used to reach such decisions, delineates nurses' level of expertise. Previous research has shown that nurses in their clinical decision-making use the hypothetico-deductive method and intuitive judgment or pattern recognition. This interpretive study explored experienced critical care nurses' (n = 5) and gastrointestinal surgical nurses' (n = 5) clinical decision-making processes through ascertaining their knowledge and understanding of third-space fluid shift in elderly patients undergoing major gastrointestinal surgery. Both groups of nurses, because of their experience with elderly patients undergoing gastrointestinal surgery, were assumed to be experts. Data collection techniques included semi-structured interviews and the use of think aloud protocol for clinical scenario analysis. The findings demonstrated that the gastrointestinal surgical nurses used the hypothetico-deductive method to recognize critical cues and the existence of a problem but could not name the problem. The critical care nurses, on the other hand, used a combination of the hypothetico-deductive method and pattern recognition as a basis for identification of critical cues. The critical care nurses also possessed in depth knowledge of third-space fluid shift and were able to use pivotal cues to identify the actual phenomenon. Ultimately, it would appear that the structure of critical care nurses' work, their increased educational qualifications and the culture of the critical care unit promote a more proactive approach to reasoning in the physiological domain. The findings have implications for the development of practice guidelines and curriculum development in both tertiary and continuing nurse education.

Older patients with late-stage COPD: Their illness experiences and involvement in decision-making regarding mechanical ventilation and noninvasive ventilation.

PubMed

Jerpseth, Heidi; Dahl, Vegard; Nortvedt, Per; Halvorsen, Kristin

2018-02-01

To explore the illness experiences of older patients with late-stage chronic obstructive pulmonary disease and to develop knowledge about how patients perceive their preferences to be taken into account in decision-making processes concerning mechanical ventilation and/or noninvasive ventilation. Decisions about whether older patients with late-stage chronic obstructive pulmonary disease will benefit from noninvasive ventilation treatment or whether the time has come for palliative treatment are complicated, both medically and ethically. Knowledge regarding patients' values and preferences concerning ventilation support is crucial yet often lacking. Qualitative design with a hermeneutic-phenomenological approach. The data consist of qualitative in-depth interviews with 12 patients from Norway diagnosed with late-stage chronic obstructive pulmonary disease. The data were analysed within the three interpretative contexts described by Kvale and Brinkmann. The participants described their lives as fragile and burdensome, frequently interrupted by unpredictable and frightening exacerbations. They lacked information about their diagnosis and prognosis and were often not included in decisions about noninvasive ventilation or mechanical ventilation. Findings indicate that these patients are highly vulnerable and have complex needs in terms of nursing care and medical treatment. Moreover, they need access to proactive advanced care planning and an opportunity to discuss their wishes for treatment and care. To provide competent care for these patients, healthcare personnel must be aware of how patients experience being seriously ill. Advanced care planning and shared decision-making should be initiated alongside the curative treatment. © 2017 John Wiley & Sons Ltd.

The physician's role in selecting a factor replacement therapy.

PubMed

Pipe, S W

2006-03-01

Over the past 20 years, transmissions of human immunodeficiency virus (HIV), hepatitis B virus or hepatitis C virus have been virtually eliminated from plasma-derived or recombinant therapy in the USA, a record that can be largely attributed to the use of effective screening and inactivation technologies for known pathogens. The next significant threat will likely come from the emergence of a new, blood-borne infectious disease, perhaps one transmitted by a non-lipid-enveloped virus or prion, for which current inactivation methods are ineffective. Following the HIV crisis of the 1980s, government, patient advocacy groups, medical and scientific communities and the manufacturers of clotting therapies can learn from the past and approach potential threats from emerging pathogens in a proactive and productive manner. For clinicians, this includes actively engaging patients in a dialogue about all the factors that may influence their choice of clotting factor therapies, including emerging pathogens, patient convenience, consistency and reliability of supply, relative cost/benefit ratios, reimbursement issues (where applicable), patient preference and brand loyalty. It is our obligation as healthcare providers to understand potential risks and help make proactive decisions with our patients, decisions that often must be made in an environment of scientific uncertainty. Threats from infectious agents that were once deemed theoretical can, and often do, ultimately become real, with serious implications for morbidity and mortality.

Harnessing Information Technology to Inform Patients Facing Routine Decisions: Cancer Screening as a Test Case.

PubMed

Krist, Alex H; Woolf, Steven H; Hochheimer, Camille; Sabo, Roy T; Kashiri, Paulette; Jones, Resa M; Lafata, Jennifer Elston; Etz, Rebecca S; Tu, Shin-Ping

2017-05-01

Technology could transform routine decision making by anticipating patients' information needs, assessing where patients are with decisions and preferences, personalizing educational experiences, facilitating patient-clinician information exchange, and supporting follow-up. This study evaluated whether patients and clinicians will use such a decision module and its impact on care, using 3 cancer screening decisions as test cases. Twelve practices with 55,453 patients using a patient portal participated in this prospective observational cohort study. Participation was open to patients who might face a cancer screening decision: women aged 40 to 49 who had not had a mammogram in 2 years, men aged 55 to 69 who had not had a prostate-specific antigen test in 2 years, and adults aged 50 to 74 overdue for colorectal cancer screening. Data sources included module responses, electronic health record data, and a postencounter survey. In 1 year, one-fifth of the portal users (11,458 patients) faced a potential cancer screening decision. Among these patients, 20.6% started and 7.9% completed the decision module. Fully 47.2% of module completers shared responses with their clinician. After their next office visit, 57.8% of those surveyed thought their clinician had seen their responses, and many reported the module made their appointment more productive (40.7%), helped engage them in the decision (47.7%), broadened their knowledge (48.1%), and improved communication (37.5%). Many patients face decisions that can be anticipated and proactively facilitated through technology. Although use of technology has the potential to make visits more efficient and effective, cultural, workflow, and technical changes are needed before it could be widely disseminated. © 2017 Annals of Family Medicine, Inc.

Drug use in adolescents in relation to social support and reactive and proactive aggressive behavior.

PubMed

Gázquez, José J; Pérez-Fuentes, M C; Molero, M M; Barragán Martín, Ana B; Martos Martínez, África; Sánchez-Marchán, Cristina

2016-08-01

Aggressive behavior in adolescents, along with drug use, has become one of the great issues in education in recent years, among other things, due to its relationship with school failure and delinquency. The purpose of this paper was to find out whether social support fulfils a basic role in decision-making on drug use and the behavior of adolescents. 822 high school students participated in the study (M = 14.84, SD = 0.87). Data were collected with the Peer Conflict Scale and the Multidimensional Scale of Perceived Social Support, and an ad hoc questionnaire on drug use. The results show that drug use is significantly related to reactive and proactive aggressive behavior. It was also observed that higher use is significantly related to perceived social support by the peer group, and less support by family. It was shown that substance use is related to perceived social support by the adolescent’s peer group and to aggressive behavior. It is therefore necessary to intervene in both respects to avoid the presence of substance use in schools.

Commercial Flight Crew Decision-Making during Low-Visibility Approach Operations Using Fused Synthetic/Enhanced Vision Systems

NASA Technical Reports Server (NTRS)

Kramer, Lynda J.; Bailey, Randall E.; Prinzel, Lawrence J., III

2007-01-01

NASA is investigating revolutionary crew-vehicle interface technologies that strive to proactively overcome aircraft safety barriers that would otherwise constrain the full realization of the next-generation air transportation system. A fixed-based piloted simulation experiment was conducted to evaluate the complementary use of Synthetic and Enhanced Vision technologies. Specific focus was placed on new techniques for integration and/or fusion of Enhanced and Synthetic Vision and its impact within a two-crew flight deck on the crew's decision-making process during low-visibility approach and landing operations. Overall, the experimental data showed that significant improvements in situation awareness, without concomitant increases in workload and display clutter, could be provided by the integration and/or fusion of synthetic and enhanced vision technologies for the pilot-flying and the pilot-not-flying. During non-normal operations, the ability of the crew to handle substantial navigational errors and runway incursions were neither improved nor adversely impacted by the display concepts. The addition of Enhanced Vision may not, unto itself, provide an improvement in runway incursion detection without being specifically tailored for this application. Existing enhanced vision system procedures were effectively used in the crew decision-making process during approach and missed approach operations but having to forcibly transition from an excellent FLIR image to natural vision by 100 ft above field level was awkward for the pilot-flying.

What Ambulatory Care Managers Need to Know About Examination Room Utilization Measurement and Analysis.

PubMed

Klarich, Mark J; Rea, Ronald W; Lal, Tarun Mohan; Garcia, Angel L; Steffens, Fay L

2016-01-01

Demand for ambulatory care visits is projected to increase 22% between 2008 and 2025. Given this growth, ambulatory care managers need to proactively plan for efficient use of scarce resources (ie, space, equipment, and staff). One important component of ambulatory care space (the number of examination rooms) is dependent on multiple factors, including variation in demand, hours of operation, scheduling, and staff. The authors (1) outline common data collection methods, (2) highlight analysis and reporting considerations for examination room utilization, and (3) provide a strategic framework for short- and long-term decision making for facility design or renovation.

An Ensemble-Based Forecasting Framework to Optimize Reservoir Releases

NASA Astrophysics Data System (ADS)

Ramaswamy, V.; Saleh, F.

2017-12-01

Increasing frequency of extreme precipitation events are stressing the need to manage water resources on shorter timescales. Short-term management of water resources becomes proactive when inflow forecasts are available and this information can be effectively used in the control strategy. This work investigates the utility of short term hydrological ensemble forecasts for operational decision making during extreme weather events. An advanced automated hydrologic prediction framework integrating a regional scale hydrologic model, GIS datasets and the meteorological ensemble predictions from the European Center for Medium Range Weather Forecasting (ECMWF) was coupled to an implicit multi-objective dynamic programming model to optimize releases from a water supply reservoir. The proposed methodology was evaluated by retrospectively forecasting the inflows to the Oradell reservoir in the Hackensack River basin in New Jersey during the extreme hydrologic event, Hurricane Irene. Additionally, the flexibility of the forecasting framework was investigated by forecasting the inflows from a moderate rainfall event to provide important perspectives on using the framework to assist reservoir operations during moderate events. The proposed forecasting framework seeks to provide a flexible, assistive tool to alleviate the complexity of operational decision-making.

'Known unknowns - examining the burden of neurocognitive impairment in the end-stage renal failure population'.

PubMed

Wilson, Scott; Dhar, Arup; Tregaskis, Peter; Lambert, Gavin; Barton, David; Walker, Rowan

2018-01-18

The burden of neurocognitive impairment (NCI) in patients receiving maintenance dialysis represents a spectrum of deficits across multiple cognitive domains which are associated with hospitalisation, reduced quality-of-life, mortality and forced decision-making around dialysis withdrawal. Point prevalence data suggests that dialysis patients manifest NCI at rates 3-5 fold higher than the general population with executive function the most commonly affected cognitive domain. The unique physiology of the renal failure state and maintenance dialysis appears to drive an excess of vascular dementia subtype compared to the general population where classical Alzheimer's disease predominates. Despite the absence of evidence based cost-effective therapies for NCI, detecting it in this population creates opportunity to proactively personalise care through education, supported decision making and targeted communication strategies to cover specific areas of deficit and help define goals of care. This review discusses NCI in the dialysis setting, including developments in the definition of neurocognitive impairment, dialysis-specific epidemiology across modalities, screening strategies and opportunities for dialysis providers in this space. This article is protected by copyright. All rights reserved.

Decision-Making Involvement and Prediction of Adherence in Youth With Type 1 Diabetes: A Cohort Sequential Study.

PubMed

Miller, Victoria A; Jawad, Abbas F

2018-05-17

To assess developmental trajectories of decision-making involvement (DMI), defined as the ways in which parents and children engage each other in decision-making about illness management, in youth with type 1 diabetes (T1D) and examine the effects of DMI on levels of and changes in adherence with age. Participants included 117 youth with T1D, enrolled at ages 8-16 years and assessed five times over 2 years. The cohort sequential design allowed for the approximation of the longitudinal curve from age 8 to 19 from overlapping cohort segments. Children and parents completed the Decision-Making Involvement Scale, which yields subscales for different aspects of DMI, and a self-report adherence questionnaire. Mixed-effects growth curve modeling was used for analysis, with longitudinal measures nested within participant and participants nested within cohort. Most aspects of DMI (Parent Express, Parent Seek, Child Express, and Joint) increased with child age; scores on some child report subscales (Parent Express, Child Seek, and Joint) decreased after age 12-14 years. After accounting for age, Child Seek, Child Express, and Joint were associated with overall higher levels of adherence in both child (estimates = 0.08-0.13, p < .001) and parent (estimates = 0.07- 0.13, p < .01) report models, but they did not predict changes in adherence with age. These data suggest that helping children to be more proactive in T1D discussions, by encouraging them to express their opinions, share information, and solicit guidance from parents, is a potential target for interventions to enhance effective self-management.

Forecasting wildlife response to rapid warming in the Alaskan Arctic

USGS Publications Warehouse

Van Hemert, Caroline R.; Flint, Paul L.; Udevitz, Mark S.; Koch, Joshua C.; Atwood, Todd C.; Oakley, Karen L.; Pearce, John M.

2015-01-01

Arctic wildlife species face a dynamic and increasingly novel environment because of climate warming and the associated increase in human activity. Both marine and terrestrial environments are undergoing rapid environmental shifts, including loss of sea ice, permafrost degradation, and altered biogeochemical fluxes. Forecasting wildlife responses to climate change can facilitate proactive decisions that balance stewardship with resource development. In this article, we discuss the primary and secondary responses to physical climate-related drivers in the Arctic, associated wildlife responses, and additional sources of complexity in forecasting wildlife population outcomes. Although the effects of warming on wildlife populations are becoming increasingly well documented in the scientific literature, clear mechanistic links are often difficult to establish. An integrated science approach and robust modeling tools are necessary to make predictions and determine resiliency to change. We provide a conceptual framework and introduce examples relevant for developing wildlife forecasts useful to management decisions.

A framework to support human factors of automation in railway intelligent infrastructure.

PubMed

Dadashi, Nastaran; Wilson, John R; Golightly, David; Sharples, Sarah

2014-01-01

Technological and organisational advances have increased the potential for remote access and proactive monitoring of the infrastructure in various domains and sectors - water and sewage, oil and gas and transport. Intelligent Infrastructure (II) is an architecture that potentially enables the generation of timely and relevant information about the state of any type of infrastructure asset, providing a basis for reliable decision-making. This paper reports an exploratory study to understand the concepts and human factors associated with II in the railway, largely drawing from structured interviews with key industry decision-makers and attachment to pilot projects. Outputs from the study include a data-processing framework defining the key human factors at different levels of the data structure within a railway II system and a system-level representation. The framework and other study findings will form a basis for human factors contributions to systems design elements such as information interfaces and role specifications.

Business ethics: the materiel/manufacturing perspective.

PubMed

Marucheck, A S; Robbins, L B

1990-08-01

The discussion of purchasing practices and product integrity, which have ethical implications for materiel/manufacturing management, serves to illustrate how routine decisions can have larger implications for the firm as a whole. Management needs to take a proactive role in confronting ethical issues by (1) demonstrating a corporate commitment to sound ethics in business practices, (2) providing written policies where appropriate to provide a basis for sound ethical conducts, (3) educating various functional areas to understand their responsibility in seeming unrelated ethical problems, (4) delegating authority in ethical issues where such issues are considered in decision making, and (5) fostering interfunctional communication as a means in establishing corporatewide responsibility. The basic philosophical principles of JIT serve as a blueprint for recognizing and managing ethical responsibility. The unexpected by-products of a JIT implementation may be vendor/customer good will and an excellent reputation for the firm.

Structured decision making as a proactive approach to dealing with sea level rise in Florida

USGS Publications Warehouse

Martin, Julien; Fackler, Paul L.; Nichols, James D.; Lubow, Bruce C.; Eaton, Mitchell J.; Runge, Michael C.; Stith, Bradley M.; Langtimm, Catherine A.

2011-01-01

Sea level rise (SLR) projections along the coast of Florida present an enormous challenge for management and conservation over the long term. Decision makers need to recognize and adopt strategies to adapt to the potentially detrimental effects of SLR. Structured decision making (SDM) provides a rigorous framework for the management of natural resources. The aim of SDM is to identify decisions that are optimal with respect to management objectives and knowledge of the system. Most applications of SDM have assumed that the managed systems are governed by stationary processes. However, in the context of SLR it may be necessary to acknowledge that the processes underlying managed systems may be non-stationary, such that systems will be continuously changing. Therefore, SLR brings some unique considerations to the application of decision theory for natural resource management. In particular, SLR is expected to affect each of the components of SDM. For instance, management objectives may have to be reconsidered more frequently than under more stable conditions. The set of potential actions may also have to be adapted over time as conditions change. Models have to account for the non-stationarity of the modeled system processes. Each of the important sources of uncertainty in decision processes is expected to be exacerbated by SLR. We illustrate our ideas about adaptation of natural resource management to SLR by modeling a non-stationary system using a numerical example. We provide additional examples of an SDM approach for managing species that may be affected by SLR, with a focus on the endangered Florida manatee.

Enhancing clinical evidence by proactively building quality into clinical trials.

PubMed

Meeker-O'Connell, Ann; Glessner, Coleen; Behm, Mark; Mulinde, Jean; Roach, Nancy; Sweeney, Fergus; Tenaerts, Pamela; Landray, Martin J

2016-08-01

Stakeholders across the clinical trial enterprise have expressed concern that the current clinical trial enterprise is unsustainable. The cost and complexity of trials have continued to increase, threatening our ability to generate reliable evidence essential for making appropriate decisions concerning the benefits and harms associated with clinical interventions. Overcoming this inefficiency rests on improving protocol design, trial planning, and quality oversight. The Clinical Trials Transformation Initiative convened a project to evaluate methods to prospectively build quality into the scientific and operational design of clinical trials ("quality-by-design"), such that trials are feasible to conduct and important errors are prevented rather than remediated. A working group evaluated aspects of trial design and oversight and developed the Clinical Trials Transformation Initiative quality-by-design principles document, outlining a series of factors generally relevant to the reliability of trial conclusions and to patient safety. These principles were then applied and further refined during a series of hands-on workshops to evaluate their utility in facilitating proactive, cross-functional dialogue, and decision-making about trial design and planning. Following these workshops, independent qualitative interviews were conducted with 19 workshop attendees to explore the potential challenges for implementing a quality-by-design approach to clinical trials. The Clinical Trials Transformation Initiative project team subsequently developed recommendations and an online resource guide to support implementation of this approach. The Clinical Trials Transformation Initiative quality-by-design principles provide a framework for assuring that clinical trials adequately safeguard participants and provide reliable information on which to make decisions on the effects of treatments. The quality-by-design workshops highlighted the value of active discussions incorporating the different perspectives within and external to an organization (e.g. clinical investigators, research site staff, and trial participants) in improving trial design. Workshop participants also recognized the value of focusing oversight on those aspects of the trial where errors would have a major impact on participant safety and reliability of results. Applying the Clinical Trials Transformation Initiative quality-by-design recommendations and principles should enable organizations to prioritize the most critical determinants of a trial's quality, identify non-essential activities that can be eliminated to streamline trial conduct and oversight, and formulate appropriate plans to define, avoid, mitigate, monitor, and address important errors. © The Author(s) 2016.

Possibilities for Proactive Library Services.

ERIC Educational Resources Information Center

Morgan, Eric Lease

1999-01-01

Considers ways in which library services can be more proactive in today's networked-computer environment. Discusses how to find and use patterns of behavior, such as borrowing behavior and profiles of patrons' interests; making a CD-ROM with information describing the library's services and products; and reviving telephone reference. (LRW)

Nurses' autonomy in end-of-life situations in intensive care units.

PubMed

Paganini, Maria Cristina; Bousso, Regina Szylit

2015-11-01

The intensive care unit environment focuses on interventions and support therapies that prolong life. The exercise by nurses of their autonomy impacts on perception of the role they assume in the multidisciplinary team and on their function in the intensive care unit context. There is much international research relating to nurses' involvement in end-of-life situations; however, there is a paucity of research in this area in Brazil. In the Brazilian medical scenario, life support limitation generated a certain reluctance of a legal nature, which has now become unjustifiable with the publication of a resolution by the Federal Medical Council. In Brazil, the lack of medical commitments to end-of-life care is evident. To understand the process by which nurses exercise autonomy in making end-of-life decisions in intensive care units. Symbolic Interactionism and Corbin and Strauss theory methodology were used for this study. Data were collected through single audio-recorded qualitative interviews with 14 critical care nurses. The comparative analysis of the data has permitted the understanding of the meaning of nurse's experience in exercising autonomy relating to end-of-life decision-making. Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were anonymized. The results revealed that nurses experience the need to exercise autonomy in intensive care units on a daily basis. Their experience expressed by the process of increase opportunities to exercise autonomy is conditioned by the pressure of the intensive care unit environment, in which nurses can grow, feel empowered, and exercise their autonomy or else can continuously depend on the decisions made by other professionals. Nurses exercise their autonomy through care. They work to create new spaces at the same time that they acquire new knowledge and make decisions. Because of the complexity of the end-of-life situation, nurses must adopt a proactive attitude that inserts them into the decision-making process. © The Author(s) 2014.

Communication relating to family members' involvement and understandings about patients' medication management in hospital.

PubMed

Manias, Elizabeth

2015-10-01

Many patients with complex health-care needs are prescribed several medications on a daily basis. With admission to hospital, patients are often placed in a vulnerable position. Family members can therefore play an important role in supporting patients in decision making about managing medications and negotiating communication exchange with health professionals. From the perspective of family members, to explore family members' involvement with health professionals and patients about how patients' medications are managed in hospital. Using an ethnographic design, interviews were conducted with family members of patients admitted to hospital who had at least five medications prescribed in hospital. A purposive sampling approach was used for recruitment. A thematic framework process was used for analysis. Interviews took place in four surgical and four medical wards in each of two Australian hospitals. Forty interviews were conducted with family members in relation to their respective relative's medications. Family members tended to participate in passive, rather than active or shared decision-making activities. Those who demonstrated active or shared decision making were extensively involved in managing medications and in addressing problems relating to continuity of care. Communication with health professionals was generally insufficient, despite family members' keenness to speak with them. Improved communication is needed between family members, health professionals and patients in hospitals. Greater attention should be played by health professionals in initiating communication proactively. Family members possessed valuable, unique information about patients' medications that can be utilized to facilitate patient safety. © 2013 Blackwell Publishing Ltd.

Making things happen through challenging goals: leader proactivity, trust, and business-unit performance.

PubMed

Crossley, Craig D; Cooper, Cecily D; Wernsing, Tara S

2013-05-01

Building on decades of research on the proactivity of individual performers, this study integrates research on goal setting and trust in leadership to examine manager proactivity and business unit sales performance in one of the largest sales organizations in the United States. Results of a moderated-mediation model suggest that proactive senior managers establish more challenging goals for their business units (N = 50), which in turn are associated with higher sales performance. We further found that employees' trust in the manager is a critical contingency variable that facilitates the relationship between challenging sales goals and subsequent sales performance. This research contributes to growing literatures on trust in leadership and proactivity by studying their joint effects at a district-unit level of analysis while identifying district managers' tendency to set challenging goals as a process variable that helps translate their proactivity into the collective performance of their units. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Proactive Supply Chain Performance Management with Predictive Analytics

PubMed Central

Stefanovic, Nenad

2014-01-01

Today's business climate requires supply chains to be proactive rather than reactive, which demands a new approach that incorporates data mining predictive analytics. This paper introduces a predictive supply chain performance management model which combines process modelling, performance measurement, data mining models, and web portal technologies into a unique model. It presents the supply chain modelling approach based on the specialized metamodel which allows modelling of any supply chain configuration and at different level of details. The paper also presents the supply chain semantic business intelligence (BI) model which encapsulates data sources and business rules and includes the data warehouse model with specific supply chain dimensions, measures, and KPIs (key performance indicators). Next, the paper describes two generic approaches for designing the KPI predictive data mining models based on the BI semantic model. KPI predictive models were trained and tested with a real-world data set. Finally, a specialized analytical web portal which offers collaborative performance monitoring and decision making is presented. The results show that these models give very accurate KPI projections and provide valuable insights into newly emerging trends, opportunities, and problems. This should lead to more intelligent, predictive, and responsive supply chains capable of adapting to future business environment. PMID:25386605

Proactive supply chain performance management with predictive analytics.

PubMed

Stefanovic, Nenad

2014-01-01

Today's business climate requires supply chains to be proactive rather than reactive, which demands a new approach that incorporates data mining predictive analytics. This paper introduces a predictive supply chain performance management model which combines process modelling, performance measurement, data mining models, and web portal technologies into a unique model. It presents the supply chain modelling approach based on the specialized metamodel which allows modelling of any supply chain configuration and at different level of details. The paper also presents the supply chain semantic business intelligence (BI) model which encapsulates data sources and business rules and includes the data warehouse model with specific supply chain dimensions, measures, and KPIs (key performance indicators). Next, the paper describes two generic approaches for designing the KPI predictive data mining models based on the BI semantic model. KPI predictive models were trained and tested with a real-world data set. Finally, a specialized analytical web portal which offers collaborative performance monitoring and decision making is presented. The results show that these models give very accurate KPI projections and provide valuable insights into newly emerging trends, opportunities, and problems. This should lead to more intelligent, predictive, and responsive supply chains capable of adapting to future business environment.

Proactive action preparation: seeing action preparation as a continuous and proactive process.

PubMed

Pezzulo, Giovanni; Ognibene, Dimitri

2012-07-01

In this paper, we aim to elucidate the processes that occur during action preparation from both a conceptual and a computational point of view. We first introduce the traditional, serial model of goal-directed action and discuss from a computational viewpoint its subprocesses occurring during the two phases of covert action preparation and overt motor control. Then, we discuss recent evidence indicating that these subprocesses are highly intertwined at representational and neural levels, which undermines the validity of the serial model and points instead to a parallel model of action specification and selection. Within the parallel view, we analyze the case of delayed choice, arguing that action preparation can be proactive, and preparatory processes can take place even before decisions are made. Specifically, we discuss how prior knowledge and prospective abilities can be used to maximize utility even before deciding what to do. To support our view, we present a computational implementation of (an approximated version of) proactive action preparation, showing its advantages in a simulated tennis-like scenario.

Climate change adaptation in regulated water utilities

NASA Astrophysics Data System (ADS)

Vicuna, S.; Melo, O.; Harou, J. J.; Characklis, G. W.; Ricalde, I.

2017-12-01

Concern about climate change impacts on water supply systems has grown in recent years. However, there are still few examples of pro-active interventions (e.g. infrastructure investment or policy changes) meant to address plausible future changes. Deep uncertainty associated with climate impacts, future demands, and regulatory constraints might explain why utility planning in a range of contexts doesn't explicitly consider climate change scenarios and potential adaptive responses. Given the importance of water supplies for economic development and the cost and longevity of many water infrastructure investments, large urban water supply systems could suffer from lack of pro-active climate change adaptation. Water utilities need to balance the potential for high regret stranded assets on the one side, with insufficient supplies leading to potentially severe socio-economic, political and environmental failures on the other, and need to deal with a range of interests and constraints. This work presents initial findings from a project looking at how cities in Chile, the US and the UK are developing regulatory frameworks that incorporate utility planning under uncertainty. Considering for example the city of Santiago, Chile, recent studies have shown that although high scarcity cost scenarios are plausible, pre-emptive investment to guard from possible water supply failures is still remote and not accommodated by current planning practice. A first goal of the project is to compare and contrast regulatory approaches to utility risks considering climate change adaptation measures. Subsequently we plan to develop and propose a custom approach for the city of Santiago based on lessons learned from other contexts. The methodological approach combines institutional assessment of water supply regulatory frameworks with simulation-based decision-making under uncertainty approaches. Here we present initial work comparing the regulatory frameworks in Chile, UK and USA evaluating their ability to incorporate uncertain climate and other changes into long-term infrastructure investment planning. The potential for regulatory and financial adaptive measures is explored in addition to a discussion on evaluating their appropriateness via various modelling-based intervention decision-making approaches.

Interprofessional collaboration between junior doctors and nurses in the general ward setting: A qualitative exploratory study.

PubMed

Tang, Charmaine J; Zhou, Wen T; Chan, Sally W-C; Liaw, Sok Y

2018-01-01

To explore the collaboration experiences of junior physicians and nurses in the general ward setting. Junior physicians and nurses do not always work collaboratively and this could affect the quality of patient care. The understanding of the issues affecting junior physicians and nurses working together is needed to inform strategies to improve interprofessional collaboration. Nineteen junior physicians and nurses were interviewed in 2012 and 2013. Interviews were transcribed and analysed using thematic analysis. Junior physicians and nurses acknowledged the importance of working collaboratively to achieve better patient care, but they are struggling to cope due to heavy clinical workload, organisational constraints and differing power relationships. Nurses have to take on more responsibilities in the decision-making process of patients' care to foster effective interprofessional collaboration. The study calls for educational and organisational strategies to improve interprofessional collaboration between junior physicians and nurses. Nurse leaders should ensure that ward nurses are given a designated time to participate in ward rounds with physicians and have access to a communication tool that assists them in contributing proactively in the decision-making process of patient care. © 2017 John Wiley & Sons Ltd.

A Learning-Based Approach to Reactive Security

NASA Astrophysics Data System (ADS)

Barth, Adam; Rubinstein, Benjamin I. P.; Sundararajan, Mukund; Mitchell, John C.; Song, Dawn; Bartlett, Peter L.

Despite the conventional wisdom that proactive security is superior to reactive security, we show that reactive security can be competitive with proactive security as long as the reactive defender learns from past attacks instead of myopically overreacting to the last attack. Our game-theoretic model follows common practice in the security literature by making worst-case assumptions about the attacker: we grant the attacker complete knowledge of the defender's strategy and do not require the attacker to act rationally. In this model, we bound the competitive ratio between a reactive defense algorithm (which is inspired by online learning theory) and the best fixed proactive defense. Additionally, we show that, unlike proactive defenses, this reactive strategy is robust to a lack of information about the attacker's incentives and knowledge.

PRELIM: Predictive Relevance Estimation from Linked Models

DTIC Science & Technology

2014-10-14

code ) 14-10-2014 Final Report 11-07-2014 to 14-10-2014 PRELIM: Predictive Relevance Estimation from Linked Models N00014-14-P-1185 10257H. Van Dyke...Parunak, Ph.D. Soar Technology, Inc. 1 Executive  Summary   PRELIM (Predictive Relevance Estimation from Linked Models) draws on semantic models...The central challenge in proactive decision support is to anticipate the decision and information needs of decision-makers, in the light of likely

Making Schools Safe for Students: Creating a Proactive School Safety Plan.

ERIC Educational Resources Information Center

Blauvelt, Peter D.

This guide offers strategies for creating a proactive school safety plan that encourages parents, teachers, principals, and students to take the initiative and identify threats to school safety. It emphasizes that schools must have an active plan that addresses fights, name calling, bullying, changes in kid's behaviors, and staff who have run out…

Proactive Adjustments of Response Strategies in the Stop-Signal Paradigm

ERIC Educational Resources Information Center

Verbruggen, Frederick; Logan, Gordon D.

2009-01-01

In the stop-signal paradigm, fast responses are harder to inhibit than slow responses, so subjects must balance speed is the go task with successful stopping in the stop task. In theory, subjects achieve this balance by adjusting response thresholds for the go task, making proactive adjustments in response to instructions that indicate that…

Adapting to the Effects of Climate Change on Inuit Health

PubMed Central

Ford, James D.; Willox, Ashlee Cunsolo; Chatwood, Susan; Furgal, Christopher; Harper, Sherilee; Mauro, Ian; Pearce, Tristan

2014-01-01

Climate change will have far-reaching implications for Inuit health. Focusing on adaptation offers a proactive approach for managing climate-related health risks—one that views Inuit populations as active agents in planning and responding at household, community, and regional levels. Adaptation can direct attention to the root causes of climate vulnerability and emphasize the importance of traditional knowledge regarding environmental change and adaptive strategies. An evidence base on adaptation options and processes for Inuit regions is currently lacking, however, thus constraining climate policy development. In this article, we tackled this deficit, drawing upon our understanding of the determinants of health vulnerability to climate change in Canada to propose key considerations for adaptation decision-making in an Inuit context. PMID:24754615

An interplay model for authorities' actions and rumor spreading in emergency event

NASA Astrophysics Data System (ADS)

Huo, Liang-an; Huang, Peiqing; Fang, Xing

2011-10-01

Rumor spreading influences how rational individuals assess risks and evaluate needs, especially, it affects authorities to make decisions in an emergency-affected environments. Conversely, authorities' response to emergency will induct public opinions as well. In this paper, we present a simple model to describe the interplay between rumor spreading and authorities' actions in emergency situation based on utility theory. By drawing from differential equations we found that it is possible to minimize negative social utility of rumor spreading in the control of situation. At the same time, authorities' proactive actions can improve rumor management in emergency situation and yield positive social utility. Finally, we outline strategies for authorities that can contribute to rumor management in an emergency event.

Adapting to the effects of climate change on Inuit health.

PubMed

Ford, James D; Willox, Ashlee Cunsolo; Chatwood, Susan; Furgal, Christopher; Harper, Sherilee; Mauro, Ian; Pearce, Tristan

2014-06-01

Climate change will have far-reaching implications for Inuit health. Focusing on adaptation offers a proactive approach for managing climate-related health risks-one that views Inuit populations as active agents in planning and responding at household, community, and regional levels. Adaptation can direct attention to the root causes of climate vulnerability and emphasize the importance of traditional knowledge regarding environmental change and adaptive strategies. An evidence base on adaptation options and processes for Inuit regions is currently lacking, however, thus constraining climate policy development. In this article, we tackled this deficit, drawing upon our understanding of the determinants of health vulnerability to climate change in Canada to propose key considerations for adaptation decision-making in an Inuit context.

Road Network State Estimation Using Random Forest Ensemble Learning

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

Hou, Yi; Edara, Praveen; Chang, Yohan

Network-scale travel time prediction not only enables traffic management centers (TMC) to proactively implement traffic management strategies, but also allows travelers make informed decisions about route choices between various origins and destinations. In this paper, a random forest estimator was proposed to predict travel time in a network. The estimator was trained using two years of historical travel time data for a case study network in St. Louis, Missouri. Both temporal and spatial effects were considered in the modeling process. The random forest models predicted travel times accurately during both congested and uncongested traffic conditions. The computational times for themore » models were low, thus useful for real-time traffic management and traveler information applications.« less

Context Effects in Forensic Entomology and Use of Sequential Unmasking in Casework.

PubMed

Archer, Melanie S; Wallman, James F

2016-09-01

Context effects are pervasive in forensic science, and are being recognized by a growing number of disciplines as a threat to objectivity. Cognitive processes can be affected by extraneous context information, and many proactive scientists are therefore introducing context-minimizing systems into their laboratories. Forensic entomologists are also subject to context effects, both in the processes they undertake (e.g., evidence collection) and decisions they make (e.g., whether an invertebrate taxon is found in a certain geographic area). We stratify the risk of bias into low, medium, and high for the decisions and processes undertaken by forensic entomologists, and propose that knowledge of the time the deceased was last seen alive is the most potentially biasing piece of information for forensic entomologists. Sequential unmasking is identified as the best system for minimizing context information, illustrated with the results of a casework trial (n = 19) using this approach in Victoria, Australia. © 2016 American Academy of Forensic Sciences.

Is outcome responsibility at work emotionally exhausting? Investigating employee proactivity as a moderator.

PubMed

Schmitt, Antje; Den Hartog, Deanne N; Belschak, Frank D

2015-10-01

This study investigates the relationship between outcome responsibility and employees' well-being in terms of emotional exhaustion. Outcome responsibility is a job demand implying that employees' decisions at work have high material and/or nonmaterial consequences. Previous research indicates that outcome responsibility can have both positive and negative effects on employee well-being. Based on the person-job fit approach we hypothesize that whether or not outcome responsibility is positively or negatively related to emotional exhaustion depends on whether employees' behavioral style fits with this job demand. We investigate the role of proactive behavior as a personal resource that fits with high responsibility. We test our hypothesis in a multisource study among 138 employee-colleague dyads. Results of hierarchical moderated regression analysis reveal that peer-rated proactive behavior moderates the relationship between outcome responsibility and emotional exhaustion, such that the relationship is negative for employees showing high and nonsignificant for employees showing low proactivity. This finding holds also when controlling for trait positive and negative affect. The current study contributes to previous research on job design, proactivity, and occupational well-being and offers practical implications in terms of selection and training of employees for jobs high in outcome responsibility. (c) 2015 APA, all rights reserved).

Global Drought Services: Collaborations Toward an Information System for Early Warning

NASA Astrophysics Data System (ADS)

Hayes, M. J.; Pulwarty, R. S.; Svoboda, M.

2014-12-01

Drought is a hazard that lends itself well to diligent, sustained monitoring and early warning. However, unlike most hazards, the fact that droughts typically evolve slowly, can last for months or years and cover vast areas spanning multiple political boundaries/jurisdictions and economic sectors can make it a daunting task to monitor, develop plans for, and identify appropriate, proactive mitigation strategies. The National Drought Mitigation Center (NDMC) and National Integrated Drought Information System (NIDIS) have been working together to reduce societal vulnerability to drought by helping decision makers at all levels to: 1) implement drought early warning/forecasting and decision support systems; 2) support and advocate for better collection of, and understanding of drought impacts; and 3) increase long-term resilience to drought through proactive planning. The NDMC and NIDIS risk management approach has been the basis from which many partners around the world are developing a collaboration and coordination nexus with an ultimate goal of building comprehensive global drought early warning information systems (GDEWIS). The core emphasis of this model is on developing and applying useful and usable information that can be integrated and transferred freely to other regions around the globe. The High-Level Ministerial Declaration on Drought, the Integrated Drought Management Programme (IDMP) co-led by the WMO and the Global Water Partnership (GWP), and the Global Framework for Climate Services are drawing extensively from the integrated NDMC-NIDIS risk management framework. This presentation will describe, in detail, the various drought resources, tools, services, and collaborations already being provided and undertaken at the national and regional scales by the NDMC, NIDIS, and their partners. The presentation will be forward-looking, identifying improvements in existing and proposed mechanisms to help strengthen national and international drought early warning information systems to support preparedness and adaptation decisions in a changing climate.

Survey of UK radiology trainees in the aftermath of ‘Modernising Medical Careers’

PubMed Central

2012-01-01

Background Following implementation of Modernising Medical Careers (MMC) in the UK, potential radiology trainees must decide on their career and apply sooner than ever before. We aimed to determine whether current trainees were sufficiently informed to make an earlier career decision by comparing the early radiology experiences of Traditional and Foundation Trainees. Methods 344 radiology trainees were appointed through MMC in 2007/08. This cohort was surveyed online. Results Response rate was 174/344 (51%). Traditional Trainees made their career decision 2.6 years after graduation compared with 1.2 years for Foundation Trainees (57/167, 34%). Nearly half of responders (79/169, 47%) experienced no formal radiology teaching as undergraduates. Most trainees regularly attended radiology meetings, spent time in a radiology department and/or performed radiology research. Many trainees received no career advice specific to radiology (69/163, 42%) at any point prior to entering the specialty; this includes both formal and informal advice. Junior doctor experiences were more frequently cited as influencing career choice (98/164, 60%). An earlier career decision was associated with; undergraduate radiology projects (-0.72 years, p = 0.018), career advice (-0.63 years, p = 0.009) and regular attendance at radiology meetings (-0.65 years, p = 0.014). Conclusion Early experience of radiology enables trainees to make an earlier career decision, however current radiology trainees were not always afforded relevant experiences prior to entering training. Radiologists need to be more proactive in encouraging the next generation of trainees. PMID:23031228

Proactive Fault Tolerance for HPC with Xen Virtualization

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

Nagarajan, Arun Babu; Mueller, Frank; Engelmann, Christian

2007-01-01

with thousands of processors. At such large counts of compute nodes, faults are becoming common place. Current techniques to tolerate faults focus on reactive schemes to recover from faults and generally rely on a checkpoint/restart mechanism. Yet, in today's systems, node failures can often be anticipated by detecting a deteriorating health status. Instead of a reactive scheme for fault tolerance (FT), we are promoting a proactive one where processes automatically migrate from “unhealthy” nodes to healthy ones. Our approach relies on operating system virtualization techniques exemplied by but not limited to Xen. This paper contributes an automatic and transparent mechanismmore » for proactive FT for arbitrary MPI applications. It leverages virtualization techniques combined with health monitoring and load-based migration. We exploit Xen's live migration mechanism for a guest operating system (OS) to migrate an MPI task from a health-deteriorating node to a healthy one without stopping the MPI task during most of the migration. Our proactive FT daemon orchestrates the tasks of health monitoring, load determination and initiation of guest OS migration. Experimental results demonstrate that live migration hides migration costs and limits the overhead to only a few seconds making it an attractive approach to realize FT in HPC systems. Overall, our enhancements make proactive FT a valuable asset for long-running MPI application that is complementary to reactive FT using full checkpoint/ restart schemes since checkpoint frequencies can be reduced as fewer unanticipated failures are encountered. In the context of OS virtualization, we believe that this is the rst comprehensive study of proactive fault tolerance where live migration is actually triggered by health monitoring.« less

At Least I Tried: The Relationship between Regulatory Focus and Regret Following Action vs. Inaction

PubMed Central

Itzkin, Adi; Van Dijk, Dina; Azar, Ofer H.

2016-01-01

Regret is an unpleasant feeling that may arise following decisions that ended poorly, and may affect the decision-maker's well-being and future decision making. Some studies show that a decision to act leads to greater regret than a decision not to act when both resulted in failure, because the latter is usually the norm. In some cases, when the norm is to act, this pattern is reversed. We suggest that the decision maker's regulatory focus, affects regret after action or inaction. Specifically, promotion-focused individuals, who tend to be more proactive, view action as more normal than prevention-focused individuals, and therefore experience regulatory fit when an action decision is made. Hence, we hypothesized that promotion-focused individuals will feel less regret than prevention-focused individuals when a decision to act ended poorly. In addition, we hypothesized that a trigger for change implied in the situation, decreases the level of regret following action. We tested our hypotheses on a sample of 330 participants enrolled in an online survey. The participants received six decision scenarios, in which they were asked to evaluate the level of regret following action and inaction. Individual regulatory focus was measured by two different scales. Promotion-focused individuals attributed less regret than prevention-focused individuals to action decisions. Regret following inaction was not affected by regulatory focus. In addition, a trigger for change decreases regret following action. Orthodox people tend to attribute more regret than non-orthodox to a person who made an action decision. The results contribute to the literature by showing that not only the situation but also the decision maker's orientation affects the regret after action vs. inaction. PMID:27833581

A Qualitative Analysis of Patients' Perceptions of Shared Decision Making in the Emergency Department: "Let Me Know I Have a Choice".

PubMed

Schoenfeld, Elizabeth M; Goff, Sarah L; Downs, Gwendolyn; Wenger, Robert J; Lindenauer, Peter K; Mazor, Kathleen M

2018-03-25

Despite increasing attention to the use of shared decision making (SDM) in the emergency department (ED), little is known about ED patients' perspectives regarding this practice. We sought to explore the use of SDM from the perspectives of ED patients, focusing on what affects patients' desired level of involvement and what barriers and facilitators patients find most relevant to their experience. We conducted semistructured interviews with a purposive sample of ED patients or their proxies at two sites. An interview guide was developed from existing literature and expert consensus and based on a framework underscoring the importance of both knowledge and power. Interviews were recorded, transcribed, and analyzed in an iterative process by a three-person coding team. Emergent themes were identified, discussed, and organized. Twenty-nine patients and proxies participated. The mean age of participants was 56 years (range, 20 to 89 years), and 13 were female. Participants were diverse in regard to race/ethnicity, education, number of previous ED visits, and presence of chronic conditions. All participants wanted some degree of involvement in decision making. Participants who made statements suggesting high self-efficacy and those who expressed mistrust of the health care system or previous negative experiences wanted a greater degree of involvement. Facilitators to involvement included familiarity with the decision at hand, physicians' good communication skills, and clearly delineated options. Some participants felt that their own relative lack of knowledge, compared to that of the physicians, made their involvement inappropriate or unwanted. Many participants had no expectation for SDM and although they did want involvement when asked explicitly, they were otherwise likely to defer to physicians without discussion. Many did not recognize opportunities for SDM in their clinical care. This exploration of ED patients' perceptions of SDM suggests that most patients want some degree of involvement in medical decision making but more proactive engagement of patients by clinicians is often needed. Further research should examine these issues in a larger and more representative population. © 2018 by the Society for Academic Emergency Medicine.

Sustainability in Health care by Allocating Resources Effectively (SHARE) 7: supporting staff in evidence-based decision-making, implementation and evaluation in a local healthcare setting.

PubMed

Harris, Claire; Allen, Kelly; Waller, Cara; Dyer, Tim; Brooke, Vanessa; Garrubba, Marie; Melder, Angela; Voutier, Catherine; Gust, Anthony; Farjou, Dina

2017-06-21

This is the seventh in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was a systematic, integrated, evidence-based program for resource allocation within a large Australian health service. It aimed to facilitate proactive use of evidence from research and local data; evidence-based decision-making for resource allocation including disinvestment; and development, implementation and evaluation of disinvestment projects. From the literature and responses of local stakeholders it was clear that provision of expertise and education, training and support of health service staff would be required to achieve these aims. Four support services were proposed. This paper is a detailed case report of the development, implementation and evaluation of a Data Service, Capacity Building Service and Project Support Service. An Evidence Service is reported separately. Literature reviews, surveys, interviews, consultation and workshops were used to capture and process the relevant information. Existing theoretical frameworks were adapted for evaluation and explication of processes and outcomes. Surveys and interviews identified current practice in use of evidence in decision-making, implementation and evaluation; staff needs for evidence-based practice; nature, type and availability of local health service data; and preferred formats for education and training. The Capacity Building and Project Support Services were successful in achieving short term objectives; but long term outcomes were not evaluated due to reduced funding. The Data Service was not implemented at all. Factors influencing the processes and outcomes are discussed. Health service staff need access to education, training, expertise and support to enable evidence-based decision-making and to implement and evaluate the changes arising from those decisions. Three support services were proposed based on research evidence and local findings. Local factors, some unanticipated and some unavoidable, were the main barriers to successful implementation. All three proposed support services hold promise as facilitators of EBP in the local healthcare setting. The findings from this study will inform further exploration.

Sustainability in Health care by Allocating Resources Effectively (SHARE) 2: identifying opportunities for disinvestment in a local healthcare setting.

PubMed

Harris, Claire; Allen, Kelly; King, Richard; Ramsey, Wayne; Kelly, Cate; Thiagarajan, Malar

2017-05-05

This is the second in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Rising healthcare costs, continuing advances in health technologies and recognition of ineffective practices and systematic waste are driving disinvestment of health technologies and clinical practices that offer little or no benefit in order to maximise outcomes from existing resources. However there is little information to guide regional health services or individual facilities in how they might approach disinvestment locally. This paper outlines the investigation of potential settings and methods for decision-making about disinvestment in the context of an Australian health service. Methods include a literature review on the concepts and terminology relating to disinvestment, a survey of national and international researchers, and interviews and workshops with local informants. A conceptual framework was drafted and refined with stakeholder feedback. There is a lack of common terminology regarding definitions and concepts related to disinvestment and no guidance for an organisation-wide systematic approach to disinvestment in a local healthcare service. A summary of issues from the literature and respondents highlight the lack of theoretical knowledge and practical experience and provide a guide to the information required to develop future models or methods for disinvestment in the local context. A conceptual framework was developed. Three mechanisms that provide opportunities to introduce disinvestment decisions into health service systems and processes were identified. Presented in order of complexity, time to achieve outcomes and resources required they include 1) Explicit consideration of potential disinvestment in routine decision-making, 2) Proactive decision-making about disinvestment driven by available evidence from published research and local data, and 3) Specific exercises in priority setting and system redesign. This framework identifies potential opportunities to initiate disinvestment activities in a systematic integrated approach that can be applied across a whole organisation using transparent, evidence-based methods. Incorporating considerations for disinvestment into existing decision-making systems and processes might be achieved quickly with minimal cost; however establishment of new systems requires research into appropriate methods and provision of appropriate skills and resources to deliver them.

A Real-time Spectrum Handoff Algorithm for VoIP based Cognitive Radio Networks: Design and Performance Analysis

NASA Astrophysics Data System (ADS)

Chakraborty, Tamal; Saha Misra, Iti

2016-03-01

Secondary Users (SUs) in a Cognitive Radio Network (CRN) face unpredictable interruptions in transmission due to the random arrival of Primary Users (PUs), leading to spectrum handoff or dropping instances. An efficient spectrum handoff algorithm, thus, becomes one of the indispensable components in CRN, especially for real-time communication like Voice over IP (VoIP). In this regard, this paper investigates the effects of spectrum handoff on the Quality of Service (QoS) for VoIP traffic in CRN, and proposes a real-time spectrum handoff algorithm in two phases. The first phase (VAST-VoIP based Adaptive Sensing and Transmission) adaptively varies the channel sensing and transmission durations to perform intelligent dropping decisions. The second phase (ProReact-Proactive and Reactive Handoff) deploys efficient channel selection mechanisms during spectrum handoff for resuming communication. Extensive performance analysis in analytical and simulation models confirms a decrease in spectrum handoff delay for VoIP SUs by more than 40% and 60%, compared to existing proactive and reactive algorithms, respectively and ensures a minimum 10% reduction in call-dropping probability with respect to the previous works in this domain. The effective SU transmission duration is also maximized under the proposed algorithm, thereby making it suitable for successful VoIP communication.

A platform for proactive, risk-based slope asset management, phase II.

DOT National Transportation Integrated Search

2015-03-01

The lidar visualization technique developed by this project enables highway managers to understand changes in slope characteristics : along highways. This change detection and analysis can be the basis of informed decisions for slope inspection and r...

A platform for proactive, risk-based slope asset management, phase II.

DOT National Transportation Integrated Search

2015-08-01

The lidar visualization technique developed by this project enables highway managers to understand changes : in slope characteristics along highways. This change detection and analysis can be the basis of informed : decisions for slope inspection and...

Goals, dilemmas and assumptions in infant feeding education and support. Applying theory of constraints thinking tools to develop new priorities for action.

PubMed

Trickey, Heather; Newburn, Mary

2014-01-01

Three important infant feeding support problems are addressed: (1) mothers who use formula milk can feel undersupported and judged; (2) mothers can feel underprepared for problems with breastfeeding; and (3) many mothers who might benefit from breastfeeding support do not access help. Theory of constraints (TOC) is used to examine these problems in relation to ante-natal education and post-natal support. TOC suggests that long-standing unresolved problems or 'undesirable effects' in any system (in this case a system to provide education and support) are caused by conflicts, or dilemmas, within the system, which might not be explicitly acknowledged. Potential solutions are missed by failure to question assumptions which, when interrogated, often turn out to be invalid. Three core dilemmas relating to the three problems are identified, articulated and explored using TOC methodology. These are whether to: (1) promote feeding choice or to promote breastfeeding; (2) present breastfeeding positively, as straightforward and rewarding, or focus on preparing mothers for problems; and (3) offer support proactively or ensure that mothers themselves initiate requests for support. Assumptions are identified and interrogated, leading to clarified priorities for action relating to each problem. These are (1) shift the focus from initial decision-making towards support for mothers throughout their feeding journeys, enabling and protecting decisions to breastfeed as one aspect of ongoing support; (2) to promote the concept of an early-weeks investment and adjustment period during which breastfeeding is established; and (3) to develop more proactive mother-centred models of support for all forms of infant feeding. © 2012 John Wiley & Sons Ltd.

The Essential Elements of a Risk Governance Framework for Current and Future Nanotechnologies.

PubMed

Stone, Vicki; Führ, Martin; Feindt, Peter H; Bouwmeester, Hans; Linkov, Igor; Sabella, Stefania; Murphy, Finbarr; Bizer, Kilian; Tran, Lang; Ågerstrand, Marlene; Fito, Carlos; Andersen, Torben; Anderson, Diana; Bergamaschi, Enrico; Cherrie, John W; Cowan, Sue; Dalemcourt, Jean-Francois; Faure, Michael; Gabbert, Silke; Gajewicz, Agnieszka; Fernandes, Teresa F; Hristozov, Danail; Johnston, Helinor J; Lansdown, Terry C; Linder, Stefan; Marvin, Hans J P; Mullins, Martin; Purnhagen, Kai; Puzyn, Tomasz; Sanchez Jimenez, Araceli; Scott-Fordsmand, Janeck J; Streftaris, George; van Tongeren, Martie; Voelcker, Nicolas H; Voyiatzis, George; Yannopoulos, Spyros N; Poortvliet, P Marijn

2017-12-14

Societies worldwide are investing considerable resources into the safe development and use of nanomaterials. Although each of these protective efforts is crucial for governing the risks of nanomaterials, they are insufficient in isolation. What is missing is a more integrative governance approach that goes beyond legislation. Development of this approach must be evidence based and involve key stakeholders to ensure acceptance by end users. The challenge is to develop a framework that coordinates the variety of actors involved in nanotechnology and civil society to facilitate consideration of the complex issues that occur in this rapidly evolving research and development area. Here, we propose three sets of essential elements required to generate an effective risk governance framework for nanomaterials. (1) Advanced tools to facilitate risk-based decision making, including an assessment of the needs of users regarding risk assessment, mitigation, and transfer. (2) An integrated model of predicted human behavior and decision making concerning nanomaterial risks. (3) Legal and other (nano-specific and general) regulatory requirements to ensure compliance and to stimulate proactive approaches to safety. The implementation of such an approach should facilitate and motivate good practice for the various stakeholders to allow the safe and sustainable future development of nanotechnology. © 2017 Society for Risk Analysis.

Ten adaptive strategies for family and work balance: advice from successful families.

PubMed

Haddock, S A; Zimmerman, T S; Ziemba, S J; Current, L R

2001-10-01

Despite negative media images and social dynamics insensitive to the lives of many dual-career couples, research shows that these families are largely healthy and thriving. In this study, we investigated the adaptive strategies of middle-class, dual-earner couples (N = 47) with children that are successfully managing family and work. Guided by grounded-theory methodology, analysis of interview data revealed that these successful couples structured their lives around 10 major strategies: Valuing family, striving for partnership, deriving meaning from work, maintaining work boundaries, focusing and producing at work, taking pride in dual earning, prioritizing family fun, living simply, making decisions proactively, and valuing time. Each adaptive strategy is defined and illustrated through the participants' own words. Clinical applications for therapists working with dual-earner couples are offered.

Proactive and reactive sibling aggression and adjustment in adolescence.

PubMed

Tucker, Corinna Jenkins; Van Gundy, Karen T; Wiesen-Martin, Desireé; Hiley Sharp, Erin; Rebellon, Cesar J; Stracuzzi, Nena F

2015-03-01

Existing research on aggression tends to narrowly focus on peers; less is known about sibling aggression, most likely due to its historical acceptance. Aggression is characterized by its forms (i.e., physical vs. social or relational aggression) and its functions (i.e., the motivations behind the aggressive act and categorized as proactive vs. reactive aggression). We use data from a two-wave study of middle (n = 197; M age = 12.63 years at Wave 1) and older (n = 159; M age = 16.50 years at Wave 1) adolescents to assess the extent to which proactive and reactive functions of sibling aggression make unique or conditional contributions to adolescent adjustment (i.e., depression, delinquency, and substance use). We find that proactive sibling aggression increases risk for problem substance use and delinquent behavior, reactive sibling aggression increases risk for depressed mood and delinquent behavior, and such results are observed even with statistical adjustments for sociodemographic and family variables, stressful life events, and prior adjustment. Few conditional effects of proactive or reactive sibling aggression by sex or grade are observed; yet, for all three outcomes, the harmful effects of reactive sibling aggression are strongest among adolescents who report low levels of proactive sibling aggression. The results speak to the importance of understanding the proactive and reactive functions of sibling aggressive behaviors for adolescent adjustment. © The Author(s) 2014.

Understanding Crew Decision-Making in the Presence of Complexity: A Flight Simulation Experiment

NASA Technical Reports Server (NTRS)

Young, Steven D.; Daniels, Taumi S.; Evans, Emory; deHaag, Maarten Uijt; Duan, Pengfei

2013-01-01

Crew decision making and response have long been leading causal and contributing factors associated with aircraft accidents. Further, it is anticipated that future aircraft and operational environments will increase exposure to risks related to these factors if proactive steps are not taken to account for ever-increasing complexity. A flight simulation study was designed to collect data to help in understanding how complexity can, or may, be manifest. More specifically, an experimental apparatus was constructed that allowed for manipulation of information complexity and uncertainty, while also manipulating operational complexity and uncertainty. Through these manipulations, and the aid of experienced airline pilots, several issues have been discovered, related most prominently to the influence of information content, quality, and management. Flight crews were immersed in an environment that included new operational complexities suggested for the future air transportation system as well as new technological complexities (e.g. electronic flight bags, expanded data link services, synthetic and enhanced vision systems, and interval management automation). In addition, a set of off-nominal situations were emulated. These included, for example, adverse weather conditions, traffic deviations, equipment failures, poor data quality, communication errors, and unexpected clearances, or changes to flight plans. Each situation was based on one or more reference events from past accidents or incidents, or on a similar case that had been used in previous developmental tests or studies. Over the course of the study, 10 twopilot airline crews participated, completing over 230 flights. Each flight consisted of an approach beginning at 10,000 ft. Based on the recorded data and pilot and research observations, preliminary results are presented regarding decision-making issues in the presence of the operational and technological complexities encountered during the flights.

THE GLOBAL EARTH OBSERVATION SYSTEM OF SYTEMS (GEOSS): PROACTIVE ENVIRONMENTAL MONITORING

EPA Science Inventory

Golbal secruity can be improved through strong international coopeation and using existing national monitoring systems that will provide more complete accurate and accessible data and information to users and decision-makers. Environmenatal damage is typically collateral to even...

Sustaining Public Involvement in Long Range Planning Using a Stakeholder Based Process: A Case Study from Eugene-Springfield ,Oregon

DOT National Transportation Integrated Search

1998-09-16

The Intermodal Surface Transportation Efficiency Act requires a proactive : public involvement process that provides complete information, timely public : notice, full public access to key decisions, and supports early and continuing : involvement of...

Status of the US EPA’s National Atlas of Ecosystem Services

EPA Science Inventory

The US Environmental Protection Agency’s (USEPA) Ecosystem Services Research Program (ESRP) is focused on transdisciplinary research to develop tools to enable decision-makers at all levels of governance to proactively conserve ecosystems services. A major product from the ESRP ...

An Evaluation of Wellness Assessment Visualizations for Older Adults

PubMed Central

Reeder, Blaine; Yoo, Daisy; Aziz, Rafae; Thompson, Hilaire J.; Demiris, George

2015-01-01

Abstract Background Smart home technologies provide a valuable resource to unobtrusively monitor health and wellness within an older adult population. However, the breadth and density of data available along with aging associated decreases in working memory, prospective memory, spatial cognition, and processing speed can make it challenging to comprehend for older adults. We developed visualizations of smart home health data integrated into a framework of wellness. We evaluated the visualizations through focus groups with older adults and identified recommendations to guide the future development of visualizations. Materials and Methods We conducted four focus groups with older adult participants (n=31) at an independent retirement community. Participants were presented with three different visualizations from a wellness pilot study. A qualitative descriptive analysis was conducted to identify thematic content. Results We identified three themes related to processing and application of visualizations: (1) values of visualizations for wellness assessment, (2) cognitive processing approaches to visualizations, and (3) integration of health data for visualization. In addition, the focus groups highlighted key design considerations of visualizations important towards supporting decision-making and evaluation assessments within integrated health displays. Conclusions Participants found inherent value in having visualizations available to proactively engage with their healthcare provider. Integrating the visualizations into a wellness framework helped reduce the complexity of raw smart home data. There has been limited work on health visualizations from a consumer perspective, in particular for an older adult population. Creating appropriately designed visualizations is valuable towards promoting consumer involvement within the shared decision-making process of care. PMID:25401414

Variability in Proactive and Reactive Cognitive Control Processes Across the Adult Lifespan

PubMed Central

Karayanidis, Frini; Whitson, Lisa Rebecca; Heathcote, Andrew; Michie, Patricia T.

2011-01-01

Task-switching paradigms produce a highly consistent age-related increase in mixing cost [longer response time (RT) on repeat trials in mixed-task than single-task blocks] but a less consistent age effect on switch cost (longer RT on switch than repeat trials in mixed-task blocks). We use two approaches to examine the adult lifespan trajectory of control processes contributing to mixing cost and switch cost: latent variables derived from an evidence accumulation model of choice, and event-related potentials (ERP) that temporally differentiate proactive (cue-driven) and reactive (target-driven) control processes. Under highly practiced and prepared task conditions, aging was associated with increasing RT mixing cost but reducing RT switch cost. Both effects were largely due to the same cause: an age effect for mixed-repeat trials. In terms of latent variables, increasing age was associated with slower non-decision processes, slower rate of evidence accumulation about the target, and higher response criterion. Age effects on mixing costs were evident only on response criterion, the amount of evidence required to trigger a decision, whereas age effects on switch cost were present for all three latent variables. ERPs showed age-related increases in preparation for mixed-repeat trials, anticipatory attention, and post-target interference. Cue-locked ERPs that are linked to proactive control were associated with early emergence of age differences in response criterion. These results are consistent with age effects on strategic processes controlling decision caution. Consistent with an age-related decline in cognitive flexibility, younger adults flexibly adjusted response criterion from trial-to-trial on mixed-task blocks, whereas older adults maintained a high criterion for all trials. PMID:22073037

Assessment of safety culture among job positions in high-rise construction: a hybrid fuzzy multi criteria decision-making (FMCDM) approach.

PubMed

Ardeshir, A; Mohajeri, M

2018-06-01

The construction industry is known as one of the most dangerous industries, which not only requires sound operation of executive laws and regulations, but also necessitates the safety culture of all workers at workshops. Therefore, the aim of this research is to identify the factors of safety culture and ranking occupations in jobsites based on those factors in order to proactively improve the safety culture of construction projects and subsequently promote safety conditions and worksites. In this study, safety culture criteria are weighted by a combination of Fuzzy Decision Trail and Evaluation Laboratory and Fuzzy ANP methods. Next, different job positions in high-rise projects are ranked using the Fuzzy Technique for Order of Preference by Similarity to Ideal Solution method. Findings demonstrated that the project manager, site superintendent and supervisor occupations had the highest and labourers had the lowest level of safety culture in the high-rise construction industry. Furthermore, factors such as safety supervision and training must be considered more seriously in order to create a positive safety culture among workers.

A proactive approach to sustainable management of mine tailings

NASA Astrophysics Data System (ADS)

Edraki, Mansour; Baumgartl, Thomas

2015-04-01

The reactive strategies to manage mine tailings i.e. containment of slurries of tailings in tailings storage facilities (TSF's) and remediation of tailings solids or tailings seepage water after the decommissioning of those facilities, can be technically inefficient to eliminate environmental risks (e.g. prevent dispersion of contaminants and catastrophic dam wall failures), pose a long term economic burden for companies, governments and society after mine closure, and often fail to meet community expectations. Most preventive environmental management practices promote proactive integrated approaches to waste management whereby the source of environmental issues are identified to help make a more informed decisions. They often use life cycle assessment to find the "hot spots" of environmental burdens. This kind of approach is often based on generic data and has rarely been used for tailings. Besides, life cycle assessments are less useful for designing operations or simulating changes in the process and consequent environmental outcomes. It is evident that an integrated approach for tailings research linked to better processing options is needed. A literature review revealed that there are only few examples of integrated approaches. The aim of this project is to develop new tailings management models by streamlining orebody characterization, process optimization and rehabilitation. The approach is based on continuous fingerprinting of geochemical processes from orebody to tailings storage facility, and benchmark the success of such proactive initiatives by evidence of no impacts and no future projected impacts on receiving environments. We present an approach for developing such a framework and preliminary results from a case study where combined grinding and flotation models developed using geometallurgical data from the orebody were constructed to predict the properties of tailings produced under various processing scenarios. The modelling scenarios based on the case study data provide the capacity to predict the composition of tailings and the resulting environmental management implications. For example, the type and content of clay minerals in tailings will affect the geotechnical stability and water recovery. Clay content will also influence decisions made for paste or thickened tailings and underground backfilling. It is possible by using an integrated assessment framework to evaluate more alternatives, including the production of additional saleable and benign streams, alternative tailings treatment and disposal, as well as options for reuse, recycling and pre-processing of existing tailings.

[Bioethics in medical institutions--new custom or help? The example of clinical ethics consultation at a University Medical Center].

PubMed

Richter, G

2014-08-01

Although ethics committees are well established in the medical sciences for human clinical trials, animal research and scientific integrity, the development of clinical ethics in German hospitals started much later during the first decade of the twenty-first century. Clinical ethics consultation should be pragmatic and problem-centered and can be defined as an ethically qualified and informed conflict management within a given legal framework to deal with and resolve value-driven, normative problems in the care of patients. Clinical ethics consultations enable shared clinical decision-making of all parties (e.g. clinicians, patients, family and surrogates) involved in a particular patient's care. The clinical ethicist does not act as an ethics expert by making independent recommendations or decisions; therefore, the focus is different from other medical consultants. Ethics consultation was first established by healthcare ethics committees (HEC) or clinical ethics consultation (CEC) groups which were called in to respond to an ethically problematic situation. To avoid ethical dilemmas or crises and to act preventively with regard to ethical issues in individual patients, an ethics liaison service is an additional option to ethics case consultations which take place on a regular basis by scheduled ethics rounds during the normal ward rounds. The presence of the ethicist offers some unique advantages: it allows early recognition of even minor ethical problems and accommodates the dynamics of ethical and clinical goal-setting in the course of patient care. Most importantly, regular and non-authoritative participation of the ethicist in normal ward rounds allows continuous ethical education of the staff within the everyday clinical routine. By facilitating clinical ethical decision-making, the ethicist seeks to empower physicians and medical staff to deal appropriately with ethical problems by themselves. Because of this proactive approach, the ethics liaison service can make a significant contribution to preventative ethics in reducing the number of emerging ethical problems to the satisfaction of all parties involved.

Opinions and expectations of women in the treatment of cervical and uterine cancer in Spain.

PubMed

Rodríguez, María Angeles Prieto; Suess, Astrid; Cerdá, Joan Carles March; Carretero, María Escudero; Danet, Alina

2011-11-01

To know the experiences, needs and expectations of women in the treatment of cervical and uterine cancer in the Andalusian Health Service. Focus groups and in-depth interviews with women being treated for cervical-uterine cancer within the Andalusian Health Service. Analysis with Nudist Vivo 1.0 (QSR International Pty Ltd, Doncaster, Victoria, Australia). The needs and expectations detected were: coherence in the promotion strategies and the presence of a proactive approach by health professionals, availability of comprehensive information and understanding, possibility of expressing to health professionals one's doubts and fears, and of participation in decision-making, technical quality, humane treatment and continuity of care and attention to psychosocial aspects. The knowledge of women in the treatment of cancer of the cervix and uterus plays a crucial part in improving the delivery of these services.

Measures to reinforce the legal liability of the environmental interest subject —Based on the perspective of law and economics

NASA Astrophysics Data System (ADS)

Fa, L. N.

2017-11-01

Local government should be regarded as the main subject to be stipulated by environmental law, thus to avoid local government’s alignment with commercial interests. Such a shift would, furthermore, discourage collusion against environment law or speculative behaviors motivated by maximizing production at the expense of environment pollution. Moreover, whether companies make proactive decisions to prevent pollution or not depends on the severity of appropriate environment legal system’s sanctions for their action. It would encourage enterprises to undertake their own environmental responsibility if environmental law could further enhance their environmental liability. In addition, public environmental rights should be embedded into environmental law. In this way, the public may become more aware of their environmental rights as well as the positivity of total environmental interests.

Note on evaluating safety performance of road infrastructure to motivate safety competition.

PubMed

Han, Sangjin

2016-01-01

Road infrastructures are usually developed and maintained by governments or public sectors. There is no competitor in the market of their jurisdiction. This monopolic feature discourages road authorities from improving the level of safety with proactive motivation. This study suggests how to apply a principle of competition for roads, in particular by means of performance evaluation. It first discusses why road infrastructure has been slow in safety oriented development and management in respect of its business model. Then it suggests some practical ways of how to promote road safety between road authorities, particularly by evaluating safety performance of road infrastructure. These are summarized as decision of safety performance indicators, classification of spatial boundaries, data collection, evaluation, and reporting. Some consideration points are also discussed to make safety performance evaluation on road infrastructure lead to better road safety management.

e-Learning competency for practice nurses: an evaluation report.

PubMed

Heartfield, Marie; Morello, Andrea; Harris, Melanie; Lawn, Sharon; Pols, Vincenza; Stapleton, Carolyn; Battersby, Malcolm

2013-01-01

Practice nurses in Australia are now funded to facilitate chronic condition management, including self-management support. Chronic disease management requires an established rapport, support and proactivity between general practitioners, patients and the practice nurses. To achieve this, training in shared decision making is needed. e-Learning supports delivery and achievement of such policy outcomes, service improvements and skill development. However, e-learning effectiveness for health care professionals' is determined by several organisational, economic, pedagogical and individual factors, with positive e-learning experience linked closely to various supports. This paper reinforces previous studies showing nurses' expanding role across general practice teams and reports on some of the challenges of e-learning. Merely providing practice nurses with necessary information via web-based learning systems does not ensure successful learning or progress toward improving health outcomes for patients.

Sharing clinical trial data on patient level: Opportunities and challenges

PubMed Central

Koenig, Franz; Slattery, Jim; Groves, Trish; Lang, Thomas; Benjamini, Yoav; Day, Simon; Bauer, Peter; Posch, Martin

2015-01-01

In recent months one of the most controversially discussed topics among regulatory agencies, the pharmaceutical industry, journal editors, and academia has been the sharing of patient-level clinical trial data. Several projects have been started such as the European Medicines Agency´s (EMA) “proactive publication of clinical trial data”, the BMJ open data campaign, or the AllTrials initiative. The executive director of the EMA, Dr. Guido Rasi, has recently announced that clinical trial data on patient level will be published from 2014 onwards (although it has since been delayed). The EMA draft policy on proactive access to clinical trial data was published at the end of June 2013 and open for public consultation until the end of September 2013. These initiatives will change the landscape of drug development and publication of medical research. They provide unprecedented opportunities for research and research synthesis, but pose new challenges for regulatory authorities, sponsors, scientific journals, and the public. Besides these general aspects, data sharing also entails intricate biostatistical questions such as problems of multiplicity. An important issue in this respect is the interpretation of multiple statistical analyses, both prospective and retrospective. Expertise in biostatistics is needed to assess the interpretation of such multiple analyses, for example, in the context of regulatory decision-making by optimizing procedural guidance and sophisticated analysis methods. PMID:24942505

Relations of children's proactive and reactive assertiveness to peer acceptance: moderating effects of social interest.

PubMed

Lee, Han-Jong

2014-06-01

Previous studies on the social outcome of assertiveness reported mixed findings, failing to support the assumption that assertiveness promotes peer acceptance. In an attempt to provide explanations for the inconsistencies in prior findings, this study proposed making a distinction between proactive and reactive assertiveness and examined the moderating effects of social interest. A total of 441 fifth and sixth graders (232 boys, 209 girls; M age = 10.6 yr., SD = 0.6) participated in the study. Results indicated that proactive assertiveness was positively related to peer acceptance regardless of social interest. By contrast, reactive assertiveness was positively related to peer acceptance but only when social interest is high. When social interest is low, it was negatively associated with peer acceptance.

The National Atlas of Ecosystem Services: Spatially Explicit Characterization of Ecosystem Services

EPA Science Inventory

The US EPA’s Ecosystem Services Research Program (ESRP) is conducting transdisciplinary research to develop tools to enable decision-makers at all levels of governance to proactively conserve ecosystem services. One of these tools is a National Atlas of Ecosystem Services which ...

How to make the most of failure mode and effect analysis.

PubMed

Stalhandske, Erik; DeRosier, Joseph; Patail, Bryanne; Gosbee, John

2003-01-01

Current accreditation standards issued by the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) require hospitals to carry out a proactive risk assessment on at least 1 high-risk activity each year for each accredited program. Because hospital risk managers and patient safety managers generally do not have the knowledge or level of comfort for conducting a proactive risk assessment, they will appreciate the expertise offered by biomedical equipment technicians (BMETs), occupational safety and health professionals, and others. The skills that have been developed by BMETs and others while conducting job safety analyses or failure mode effect analysis can now be applied to a health care proactive analysis. This article touches on the Health Care Failure Mode and Effect Analysis (HFMEA) model that the Department of Veterans Affairs (VA) National Center for Patient Safety developed for proactive risk assessment within the health care community. The goal of this article is to enlighten BMETs and others on the growth of proactive risk assessment within health care and also on the support documents and materials produced by the VA. For additional information on HFMEA, visit the VA website at www.patientsafety.gov/HFMEA.html.

Sleep can reduce proactive interference.

PubMed

Abel, Magdalena; Bäuml, Karl-Heinz T

2014-01-01

Sleep has repeatedly been connected to processes of memory consolidation. While extensive research indeed documents beneficial effects of sleep on memory, little is yet known about the role of sleep for interference effects in episodic memory. Although two prior studies reported sleep to reduce retroactive interference, no sleep effect has previously been found for proactive interference. Here we applied a study format differing from that employed by the prior studies to induce a high degree of proactive interference, and asked participants to encode a single list or two interfering lists of paired associates via pure study cycles. Testing occurred after 12 hours of diurnal wakefulness or nocturnal sleep. Consistent with the prior work, we found sleep in comparison to wake did not affect memory for the single list, but reduced retroactive interference. In addition we found sleep reduced proactive interference, and reduced retroactive and proactive interference to the same extent. The finding is consistent with the view that arising benefits of sleep are caused by the reactivation of memory contents during sleep, which has been suggested to strengthen and stabilise memories. Such stabilisation may make memories less susceptible to competition from interfering memories at test and thus reduce interference effects.

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

NASA Astrophysics Data System (ADS)

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

2017-12-01

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

Quality of life and economic burdens of malocclusion in U.S. patients enrolled in Medicaid.

PubMed

Bresnahan, Brian W; Kiyak, H Asuman; Masters, Samuel H; McGorray, Susan P; Lincoln, Adam; King, Gregory

2010-10-01

Patients enrolled in Medicaid have limited access to orthodontic services in the United States. No studies are available, to the authors' knowledge, regarding the clinical and psychosocial burdens of malocclusion on these patients from an economic perspective. The authors conducted a systematic review of the relevant economic literature. They identified issues from the perspectives of the various stakeholders (dentists, patients and parents, Medicaid programs) and developed a conceptual model for studying decision making focused on the strategy of providing early interceptive and preventive treatment rather than, or in addition to, comprehensive care in the patient's permanent dentition. Medicaid coverage and reimbursement amounts vary nationwide, and decision making associated with obtaining care can be complex. The perspectives of all relevant stakeholders deserve assessment. A conceptual framework of the cost-effectiveness of interceptive orthodontic treatment compared with comprehensive treatment illustrates the issues to be considered when evaluating these strategies. Policymakers and the dental community should identify creative solutions to addressing low-income families' limited access to orthodontic services and compare them from various perspectives with regard to their relative cost-effectiveness. Dentists should be aware of the multiple problems faced by low-income families in obtaining orthodontic services and the impact of stakeholder issues on access to care; they also should be proactive in helping low-income patients obtain needed orthodontic services.

Listening and learning from women about mifepristone: implications for counseling and health education.

PubMed

Castle, M A; Harvey, S M; Beckman, L; Coeytaux, F; Garrity, J M

1995-01-01

The careful, reflective, and honest way in which the women in the study analyzed, questioned, and explored the benefits and disadvantages of a mifepristone abortion compared with vacuum aspiration yielded an extensive list of information needed by women to make informed choices as well as an understanding of the diverse social contexts in which choices are made. Needed information identified by this study included technical information about the drugs themselves and their mechanisms of action, roles and responsibilities of health personnel, and descriptions of other women's experiences with mifepristone. A multiplicity of factors entered the decision-making process, demonstrating at the same time a complexity and flexibility of thought. In their hypothetical evaluation of mifepristone, women weighed such factors as experience with childbirth, spontaneous abortion and vacuum aspiration, specific issues for teenagers, lack of a support system, experience with herbal emenagogues and nonprescription drugs intended as abortifacients, and the relative dependence on health care providers. Social, personal, and cultural factors entered into women's interpretation of the different options. These socio-cultural contexts can profoundly influence decisions and potentially affect clinical outcomes. If health care professionals are not proactive, do not fully provide answers to questions (even if unasked), and fail to probe for specific life circumstances, then poor choices and poor outcomes may follow with long term negative consequences for clients.(ABSTRACT TRUNCATED AT 250 WORDS)

AMCP Partnership Forum: FDAMA Section 114-Improving the Exchange of Health Care Economic Data.

PubMed

2016-07-01

The Food and Drug Administration Modernization Act (FDAMA) of 1997 included Section 114 as a regulatory safe harbor with the goal of increasing the dissemination of health care economic information (HCEI) to those responsible for formulary decision making. HCEI is typically not included within FDA-approved labeling. Although it has been nearly 20 years since passage and enactment of Section 114, proactive distribution of HCEI has been underutilized by biopharmaceutical companies partly because of (a) vague wording in the statute and (b) the absence of FDA-implementing regulations. Consequently, companies and health care decisions makers have had to speculate about the scope of the provisions. As a result, the biopharmaceutical industry has significant concerns about stepping over the line when using the safe harbor. Also, payers and other "payer-like" decision makers (e.g., self-funded corporate insurers) who are trying to make appropriate coverage and utilization decisions are demanding this information but are not receiving it because of the uncertainties in the statute. Considering this renewed interest by multiple stakeholders regarding the need for revisions and/or guidance pertaining to Section 114, the Academy of Managed Care Pharmacy held a partnership forum on March 1-2, 2016, with a diverse group of health care stakeholders to provide the FDA with considerations for disseminating a guidance document on current thinking for the sharing of HCEI with health care decision makers. Forum participants represented the managed care industry, biopharmaceutical industry, health care providers, pharmacoeconomic experts, policy experts, and patient advocacy groups with specific expertise in the development, use, and dissemination of HCEI. The multistakeholder group represented the key professionals and entities affected by the provisions of Section 114 and present the collective credibility necessary for Congress and the FDA to modernize and operationalize the safe harbor by using the consensus recommendations developed during the forum. Speakers, panelists, and attendees focused on 4 terms in Section 114 that remain open to interpretation by companies and enforcement bodies: (1) the scope of HCEI, (2) the scope of "formulary committee or similar entity," (3) the definition of "competent and reliable scientific evidence (CRSE)," and (4) the parameters of how information "directly relates to an approved indication." Based on the forum results, it was recommended that the safe harbor for companies' proactive dissemination of information under Section 114 should include health care decision makers beyond health plan formulary committees, including organizations, or individuals in their role in an organization, who make health care decisions for patient populations. Recommendations also suggested expansion to organizations that evaluate HCEI or develop value frameworks and compendia and individuals in such organizations. Forum participants also recommended that HCEI be truthful, and not misleading, and be based on the expertise of professionals in the relevant area. HCEI must also be developed and disclosed in a transparent, reproducible, and accurate manner. Forum participants also discussed and agreed on the types of information, format, and processes by which managed care pharmacy and other health care decision makers seek to receive HCEI from biopharmaceutical companies. Finally, participants encouraged the FDA, Congress, and other stakeholders to find ways to ensure that patients or their representative organizations have appropriate access to a full range of information about their medications and that information related to the medication pipeline is communicated to appropriate stakeholders in a timely manner. The AMCP Partnership Forum on FDAMA Section 114-Improving the Exchange of Pharmacoeconomic Data and the development of this proceedings document were supported by AbbVie, Amgen, Boehringer Ingelheim Pharmaceuticals, Merck & Co., National Pharmaceutical Council, Pharmaceutical Research and Manufacturers of America, Precision for Value, Pfizer, Takeda Pharmaceuticals, U.S.A., and Xcenda. All sponsors participated in the forum and participated in revising and approving the manuscript.

76 FR 1190 - Back Bay National Wildlife Refuge, City of Virginia Beach, VA; Final Comprehensive Conservation...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-07

... purpose of ``* * * the conservation of the wetlands of the Nation in order to maintain the public benefits... benefits our resource decisions, maintaining a proactive law enforcement program, protecting cultural...; developing new hiking trails; and developing and designing a new headquarters/visitor contact station...

Bioenergy Research and Strategic Planning: The Need for both Proactive and Reactive research

USDA-ARS?s Scientific Manuscript database

Public policy typically refers to governmental actions such as laws, regulatory measures, and funding decisions for a specified issue. As scientists, we should strive to provide unbiased, research information on which strategic planning and long-term goals can be based. However, research can contrib...

What To Measure? A New Look at the Concept of Creativity.

ERIC Educational Resources Information Center

Kaufmann, Geir

2003-01-01

Makes the case that the concept of creativity is too loosely defined and proposes a definition that clearly distinguishes creativity from intelligence. Makes a further distinction between proactive and reactive creativity and points out some shortcomings of existing tests of creativity. (SLD)

Is "Market-Driven" Good Enough?

ERIC Educational Resources Information Center

Kaufman, Roger

1995-01-01

Discusses marketing and management strategies and evaluates the path most traveled; going beyond market-driven; proactive and reactive organizational positioning; ways to manage human and physical resources to make both market-driven and market-making contributions; and values necessary for an organization to move from market-driven to…

An interactive activation and competition model of person knowledge, suggested by proactive interference by traits spontaneously inferred from behaviours.

PubMed

Wang, Yuanbo E; Higgins, Nancy C; Uleman, James S; Michaux, Aaron; Vipond, Douglas

2016-03-01

People unconsciously and unintentionally make inferences about others' personality traits based on their behaviours. In this study, a classic memory phenomenon--proactive interference (PI)--is for the first time used to detect spontaneous trait inferences. PI should occur when lists of behaviour descriptions, all implying the same trait, are to be remembered. Switching to a new trait should produce 'release' from proactive interference (or RPI). Results from two experiments supported these predictions. PI and RPI effects are consistent with an interactive activation and competition model of person perception (e.g., McNeill & Burton, 2002, J. Exp. Psychol., 55A, 1141), which predicts categorical organization of social behaviours based on personality traits. Advantages of this model are discussed. © 2015 The British Psychological Society.

Inside 'bed management': ethnographic insights from the vantage point of UK hospital nurses.

PubMed

Allen, Davina

2015-03-01

In the face of unprecedented financial and demographic challenges, optimising acute bed utilisation by the proactive management of patient flows is a pressing policy concern in high-income countries. Despite the growing literature on this topic, bed management has received scant sociological attention. Drawing on practice-based approaches, this article deploys ethnographic data to examine bed management from the perspective of UK hospital nurses. While the nursing contribution to bed management is recognised formally in their widespread employment in patient access and discharge liaison roles, nurses at all levels in the study site were enrolled in this organisational priority. Rather than the rational, centrally controlled processes promulgated by policymakers, bed management emerges as a predominantly distributed activity, described here as match-making. An example of micro-level rationing, for the most part, match-making was not informed by explicit criteria nor did it hinge on clearly identifiable decisions to grant or deny access. Rather it was embedded in the everyday practices and situated rationalities through which nurses accomplished the accommodations necessary to balance demand with resources. © 2014 Foundation for the Sociology of Health & Illness.

Word on the Street: Engaging Local Leaders in a Dialogue About Prostate Cancer Among African Americans

PubMed Central

Schoenfeld, Elinor R.; Francis, Linda E.

2016-01-01

African American men face the highest rates of prostate cancer, yet with no consensus for screening and treatment, making informed health care decisions is difficult. This study aimed to identify approaches to empowering African American men as proactive participants in prostate cancer decision making using an established community–campus partnership employing elements of community-based participatory research methods. Community stakeholders with an interest in, and knowledge about, health care in two local African American communities were recruited and completed key informant interviews (N = 39). Grounded theory coding identified common themes related to prostate cancer knowledge, beliefs, attitudes, and responses to them. Common barriers such as gender roles, fear, and fatalism were identified as barriers to work-up and treatment, and both communities’ inadequate and inaccurate prostate cancer information described as the key problem. To build on community strengths, participants said the change must come from inside these communities, not be imposed from the outside. To accomplish this, they suggested reaching men through women, connecting men to doctors they can trust, making men’s cancer education part of broader health education initiatives designed as fun and inexpensive family entertainment events, and having churches bring community members in to speak on their experiences with cancer. This study demonstrated the success of community engagement to identify not only barriers but also local strengths and facilitators to prostate cancer care in two suburban/rural African American communities. Building collaboratively on community strengths may improve prostate cancer care specifically and health care in general. PMID:25595017

Word on the Street: Engaging Local Leaders in a Dialogue About Prostate Cancer Among African Americans.

PubMed

Schoenfeld, Elinor R; Francis, Linda E

2016-09-01

African American men face the highest rates of prostate cancer, yet with no consensus for screening and treatment, making informed health care decisions is difficult. This study aimed to identify approaches to empowering African American men as proactive participants in prostate cancer decision making using an established community-campus partnership employing elements of community-based participatory research methods. Community stakeholders with an interest in, and knowledge about, health care in two local African American communities were recruited and completed key informant interviews (N = 39). Grounded theory coding identified common themes related to prostate cancer knowledge, beliefs, attitudes, and responses to them. Common barriers such as gender roles, fear, and fatalism were identified as barriers to work-up and treatment, and both communities' inadequate and inaccurate prostate cancer information described as the key problem. To build on community strengths, participants said the change must come from inside these communities, not be imposed from the outside. To accomplish this, they suggested reaching men through women, connecting men to doctors they can trust, making men's cancer education part of broader health education initiatives designed as fun and inexpensive family entertainment events, and having churches bring community members in to speak on their experiences with cancer. This study demonstrated the success of community engagement to identify not only barriers but also local strengths and facilitators to prostate cancer care in two suburban/rural African American communities. Building collaboratively on community strengths may improve prostate cancer care specifically and health care in general. © The Author(s) 2015.

"Make It Explicit!": Improving Collaboration through Increase of Script Coercion

ERIC Educational Resources Information Center

Papadopoulos, P. M.; Demetriadis, S. N.; Weinberger, A.

2013-01-01

This paper investigates the impact of the proposed "Make It Explicit!" technique on students' learning when participating in scripted collaborative activities. The method posits that when asking students to proactively articulate their own positions explicitly, then improved peer interaction is triggered in a subsequent…

Testing can counteract proactive interference by integrating competing information.

PubMed

Wahlheim, Christopher N

2015-01-01

Testing initially learned information before presenting new information has been shown to counteract the deleterious effects of proactive interference by segregating competing sources of information. The present experiments were conducted to demonstrate that testing can also have its effects in part by integrating competing information. Variations of classic A-B, A-D paired-associate learning paradigms were employed that included two lists of word pairs and a cued-recall test. Repeated pairs appeared in both lists (A-B, A-B), control pairs appeared in List 2 only (A-B, C-D), and changed pairs appeared with the same cue in both lists but with different responses (A-B, A-D). The critical manipulation was whether pairs were tested or restudied in an interpolated phase that occurred between Lists 1 and 2. On a final cued-recall test, participants recalled List 2 responses and then indicated when they recollected that responses had earlier changed between lists. The change recollection measure indexed the extent to which competing responses were integrated during List 2. Change was recollected more often for tested than for restudied pairs. Proactive facilitation was obtained in cued recall when change was recollected, whereas proactive interference was obtained when change was not recollected. These results provide evidence that testing counteracted proactive interference in part by making List 1 responses more accessible during List 2, thus promoting integration and increasing later recollection of change. These results have theoretical implications because they show that testing can counteract proactive interference by integrating or segregating competing information.

Benefits to blood banks of a sales and operations planning process.

PubMed

Keal, Donald A; Hebert, Phil

2010-12-01

A formal sales and operations planning (S&OP) process is a decision making and communication process that balances supply and demand while integrating all business operational components with customer-focused business plans that links high level strategic plans to day-to-day operations. Furthermore, S&OP can assist in managing change across the organization as it provides the opportunity to be proactive in the face of problems and opportunities while establishing a plan for everyone to follow. Some of the key outcomes from a robust S&OP process in blood banking would include: higher customer satisfaction (donors and health care providers), balanced inventory across product lines and customers, more stable production rates and higher productivity, more cooperation across the entire operation, and timely updates to the business plan resulting in better forecasting and fewer surprises that negatively impact the bottom line. © 2010 American Association of Blood Banks.

Facilitating collaboration among academic generalist disciplines: a call to action.

PubMed

Kutner, Jean S; Westfall, John M; Morrison, Elizabeth H; Beach, Mary Catherine; Jacobs, Elizabeth A; Rosenblatt, Roger A

2006-01-01

To meet its population's health needs, the United States must have a coherent system to train and support primary care physicians. This goal can be achieved only though genuine collaboration between academic generalist disciplines. Academic general pediatrics, general internal medicine, and family medicine may be hampering this effort and their own futures by lack of collaboration. This essay addresses the necessity of collaboration among generalist physicians in research, medical education, clinical care, and advocacy. Academic generalists should collaborate by (1) making a clear decision to collaborate, (2) proactively discussing the flow of money, (3) rewarding collaboration, (4) initiating regular generalist meetings, (5) refusing to tolerate denigration of other generalist disciplines, (6) facilitating strategic planning for collaboration among generalist disciplines, and (7) learning from previous collaborative successes and failures. Collaboration among academic generalists will enhance opportunities for trainees, primary care research, and advocacy; conserve resources; and improve patient care.

Proactive Approaches to Improving Outcomes for At-Risk Students.

ERIC Educational Resources Information Center

Freeman, G.; Gum, M.; Blackbourn, J. M.

This paper outlines two approaches for improving outcomes for students at risk for academic failure. Both take a systemic approach to the problem by focusing on how specific circumstances create a reality of failure for many students. One school analyzed factors related to retention/promotion decisions and determined that four factors directly…

Recruiting and Retaining Men in Nursing: A Review of the Literature.

ERIC Educational Resources Information Center

Villeneuve, Michael J.

1994-01-01

The language and history of nursing have labeled it women's work, influencing legal decisions and raising a significant recruitment/retention barrier for men: the job title and image. Proactive recruitment from target groups, role models, and use of appropriate media are strategies to redress the sex imbalance in nursing. (SK)

NursesforTomorrow: a proactive approach to nursing resource analysis.

PubMed

Bournes, Debra A; Plummer, Carolyn; Miller, Robert; Ferguson-Paré, Mary

2010-03-01

This paper describes the background, development, implementation and utilization of NursesforTomorrow (N4T), a practical and comprehensive nursing human resources analysis method to capture regional, institutional and patient care unit-specific actual and predicted nurse vacancies, nurse staff characteristics and nurse staffing changes. Reports generated from the process include forecasted shortfalls or surpluses of nurses, percentage of novice nurses, occupancy, sick time, overtime, agency use and other metrics. Readers will benefit from a description of the ways in which the data generated from the nursing resource analysis process are utilized at senior leadership, program and unit levels to support proactive hiring and resource allocation decisions and to predict unit-specific recruitment and retention patterns across multiple healthcare organizations and regions.

Medication communication through documentation in medical wards: knowledge and power relations.

PubMed

Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

2014-09-01

Health professionals communicate with each other about medication information using different forms of documentation. This article explores knowledge and power relations surrounding medication information exchanged through documentation among nurses, doctors and pharmacists. Ethnographic fieldwork was conducted in 2010 in two medical wards of a metropolitan hospital in Australia. Data collection methods included participant observations, field interviews, video-recordings, document retrieval and video reflexive focus groups. A critical discourse analytic framework was used to guide data analysis. The written medication chart was the main means of communicating medication decisions from doctors to nurses as compared to verbal communication. Nurses positioned themselves as auditors of the medication chart and scrutinised medical prescribing to maintain the discourse of patient safety. Pharmacists utilised the discourse of scientific judgement to guide their decision-making on the necessity of verbal communication with nurses and doctors. Targeted interdisciplinary meetings involving nurses, doctors and pharmacists should be organised in ward settings to discuss the importance of having documented medication information conveyed verbally across different disciplines. Health professionals should be encouraged to proactively seek out each other to relay changes in medication regimens and treatment goals. © 2013 John Wiley & Sons Ltd.

Sustaining a Mature Risk Management Process: Ensuring the International Space Station for a Vibrant Future

NASA Technical Reports Server (NTRS)

Raftery, Michael; Carter-Journet, Katrina

2013-01-01

The International Space Station (ISS) risk management methodology is an example of a mature and sustainable process. Risk management is a systematic approach used to proactively identify, analyze, plan, track, control, communicate, and document risks to help management make risk-informed decisions that increase the likelihood of achieving program objectives. The ISS has been operating in space for over 14 years and permanently crewed for over 12 years. It is the longest surviving habitable vehicle in low Earth orbit history. Without a mature and proven risk management plan, it would be increasingly difficult to achieve mission success throughout the life of the ISS Program. A successful risk management process must be able to adapt to a dynamic program. As ISS program-level decision processes have evolved, so too has the ISS risk management process continued to innovate, improve, and adapt. Constant adaptation of risk management tools and an ever-improving process is essential to the continued success of the ISS Program. Above all, sustained support from program management is vital to risk management continued effectiveness. Risk management is valued and stressed as an important process by the ISS Program.

Fishing for Space: Fine-Scale Multi-Sector Maritime Activities Influence Fisher Location Choice

PubMed Central

Tidd, Alex N.; Vermard, Youen; Marchal, Paul; Pinnegar, John; Blanchard, Julia L.; Milner-Gulland, E. J.

2015-01-01

The European Union and other states are moving towards Ecosystem Based Fisheries Management to balance food production and security with wider ecosystem concerns. Fishing is only one of several sectors operating within the ocean environment, competing for renewable and non-renewable resources that overlap in a limited space. Other sectors include marine mining, energy generation, recreation, transport and conservation. Trade-offs of these competing sectors are already part of the process but attempts to detail how the seas are being utilised have been primarily based on compilations of data on human activity at large spatial scales. Advances including satellite and shipping automatic tracking enable investigation of factors influencing fishers’ choice of fishing grounds at spatial scales relevant to decision-making, including the presence or avoidance of activities by other sectors. We analyse the determinants of English and Welsh scallop-dredging fleet behaviour, including competing sectors, operating in the eastern English Channel. Results indicate aggregate mining activity, maritime traffic, increased fishing costs, and the English inshore 6 and French 12 nautical mile limits negatively impact fishers’ likelihood of fishing in otherwise suitable areas. Past success, net-benefits and fishing within the 12 NM predispose fishers to use areas. Systematic conservation planning has yet to be widely applied in marine systems, and the dynamics of spatial overlap of fishing with other activities have not been studied at scales relevant to fisher decision-making. This study demonstrates fisher decision-making is indeed affected by the real-time presence of other sectors in an area, and therefore trade-offs which need to be accounted for in marine planning. As marine resource extraction demands intensify, governments will need to take a more proactive approach to resolving these trade-offs, and studies such as this will be required as the evidential foundation for future seascape planning. PMID:25625555

Fishing for space: fine-scale multi-sector maritime activities influence fisher location choice.

PubMed

Tidd, Alex N; Vermard, Youen; Marchal, Paul; Pinnegar, John; Blanchard, Julia L; Milner-Gulland, E J

2015-01-01

The European Union and other states are moving towards Ecosystem Based Fisheries Management to balance food production and security with wider ecosystem concerns. Fishing is only one of several sectors operating within the ocean environment, competing for renewable and non-renewable resources that overlap in a limited space. Other sectors include marine mining, energy generation, recreation, transport and conservation. Trade-offs of these competing sectors are already part of the process but attempts to detail how the seas are being utilised have been primarily based on compilations of data on human activity at large spatial scales. Advances including satellite and shipping automatic tracking enable investigation of factors influencing fishers' choice of fishing grounds at spatial scales relevant to decision-making, including the presence or avoidance of activities by other sectors. We analyse the determinants of English and Welsh scallop-dredging fleet behaviour, including competing sectors, operating in the eastern English Channel. Results indicate aggregate mining activity, maritime traffic, increased fishing costs, and the English inshore 6 and French 12 nautical mile limits negatively impact fishers' likelihood of fishing in otherwise suitable areas. Past success, net-benefits and fishing within the 12 NM predispose fishers to use areas. Systematic conservation planning has yet to be widely applied in marine systems, and the dynamics of spatial overlap of fishing with other activities have not been studied at scales relevant to fisher decision-making. This study demonstrates fisher decision-making is indeed affected by the real-time presence of other sectors in an area, and therefore trade-offs which need to be accounted for in marine planning. As marine resource extraction demands intensify, governments will need to take a more proactive approach to resolving these trade-offs, and studies such as this will be required as the evidential foundation for future seascape planning.

Towards sets of hazardous waste indicators. Essential tools for modern industrial management.

PubMed

Peterson, Peter J; Granados, Asa

2002-01-01

Decision-makers require useful tools, such as indicators, to help them make environmentally sound decisions leading to effective management of hazardous wastes. Four hazardous waste indicators are being tested for such a purpose by several countries within the Sustainable Development Indicator Programme of the United Nations Commission for Sustainable Development. However, these indicators only address the 'down-stream' end-of-pipe industrial situation. More creative thinking is clearly needed to develop a wider range of indicators that not only reflects all aspects of industrial production that generates hazardous waste but considers socio-economic implications of the waste as well. Sets of useful and innovative indicators are proposed that could be applied to the emerging paradigm shift away from conventional end-of-pipe management actions and towards preventive strategies that are being increasingly adopted by industry often in association with local and national governments. A methodological and conceptual framework for the development of a core-set of hazardous waste indicators has been developed. Some of the indicator sets outlined quantify preventive waste management strategies (including indicators for cleaner production, hazardous waste reduction/minimization and life cycle analysis), whilst other sets address proactive strategies (including changes in production and consumption patterns, eco-efficiency, eco-intensity and resource productivity). Indicators for quantifying transport of hazardous wastes are also described. It was concluded that a number of the indicators proposed could now be usefully implemented as management tools using existing industrial and economic data. As cleaner production technologies and waste minimization approaches are more widely deployed, and industry integrates environmental concerns at all levels of decision-making, it is expected that the necessary data for construction of the remaining indicators will soon become available.

Earth Girl 2: Learning and Perfecting Tsunami Preparedness with a Casual Strategy Game

NASA Astrophysics Data System (ADS)

Kerlow, I.; Taisne, B.; Switzer, A.; Meltzner, A. J.; Hubbard, J.; Sieh, K.

2014-12-01

"Earth Girl 2: Preparing for the Tsunami" is an interactive game about making strategic decisions that can directly increase the survival rate in coastal communities during earthquake and tsunami scenarios. Earth Girl is the host and guide in this casual strategy game with social impact, and the player is the protagonist. The game was developed by an interdisciplinary team of scientists and game artists at the Earth Observatory of Singapore. Earth Girl 2 is based on real-life situations, with an emphasis on learning preparedness and survival skills. It was inspired by the kids who live in coastal communities throughout Asia, and by the stories told by survivors of recent tsunamis. The action takes place in four main areas: the Market, the Map, the Toolbox, and two dozen game levels with a variety of evacuation scenarios. The gameplay encourages proactive exploration and discovery of these scenarios, with Earth Girl providing knowledge, tips and feedback throughout the game. The basic game play includes: learning about tsunami hazards by talking to people at the market, choosing tools based on a budget, exploring the site and making strategic decisions, and learning from watching the simulation. The level of success of players in this game depends on their strategic decisions which is somewhat tied to their level of interaction with the virtual community. The game is currently being tested with children in Southeast Asian communities and is scheduled for release in late 2014. The presentation will demonstrate aspects of the game (played on an iPad connected to the projector), and will describe some of the challenges and solutions encountered by the interdisciplinary team.

A Review of Legal Decisions Relevant to Technical Standards Used in Pharmacy School Admissions

PubMed Central

2017-01-01

The implementation of an effective and legally sound technical standards procedure for pharmacy schools requires a proactive approach by admissions officers. Applicants with disabilities are accorded significant rights that must not be infringed during the admissions process in order to ensure compliance with applicable law. This article provides a review of applicable state cases, federal cases, and OCR decisions and guidance to help pharmacy schools identify procedures and implement technical standards into their admissions processes as required by ACPE Standards 2016. PMID:28381897

Testing can counteract proactive interference by integrating competing information

PubMed Central

Wahlheim, Christopher N.

2015-01-01

Testing initially learned information before presenting new information has been shown to counteract the deleterious effects of proactive interference by segregating competing sources of information. The present experiments were conducted to demonstrate that testing can also have its effects in part by integrating competing information. Variations of classic A–B, A–D paired-associate learning paradigms were employed that included two lists of word pairs and a cued-recall test. Repeated pairs appeared in both lists (A–B, A–B), control pairs appeared in List 2 only (A–B, C–D), and changed pairs appeared with the same cue in both lists but with different responses (A–B, A–D). The critical manipulation was whether pairs were tested or restudied in an interpolated phase that occurred between Lists 1 and 2. On a final cued-recall test, participants recalled List 2 responses and then indicated when they recollected that responses had earlier changed between lists. The change recollection measure indexed the extent to which competing responses were integrated during List 2. Change was recollected more often for tested than for restudied pairs. Proactive facilitation was obtained in cued recall when change was recollected, whereas proactive interference was obtained when change was not recollected. These results provide evidence that testing counteracted proactive interference in part by making List 1 responses more accessible during List 2, thus promoting integration and increasing later recollection of change. These results have theoretical implications because they show that testing can counteract proactive interference by integrating or segregating competing information. PMID:25120241

Medium Range Ensembles Flood Forecasts for Community Level Applications

NASA Astrophysics Data System (ADS)

Fakhruddin, S.; Kawasaki, A.; Babel, M. S.; AIT

2013-05-01

Early warning is a key element for disaster risk reduction. In recent decades, there has been a major advancement in medium range and seasonal forecasting. These could provide a great opportunity to improve early warning systems and advisories for early action for strategic and long term planning. This could result in increasing emphasis on proactive rather than reactive management of adverse consequences of flood events. This can be also very helpful for the agricultural sector by providing a diversity of options to farmers (e.g. changing cropping pattern, planting timing, etc.). An experimental medium range (1-10 days) flood forecasting model has been developed for Bangladesh which provides 51 set of discharge ensembles forecasts of one to ten days with significant persistence and high certainty. This could help communities (i.e. farmer) for gain/lost estimation as well as crop savings. This paper describe the application of ensembles probabilistic flood forecast at the community level for differential decision making focused on agriculture. The framework allows users to interactively specify the objectives and criteria that are germane to a particular situation, and obtain the management options that are possible, and the exogenous influences that should be taken into account before planning and decision making. risk and vulnerability assessment was conducted through community consultation. The forecast lead time requirement, users' needs, impact and management options for crops, livestock and fisheries sectors were identified through focus group discussions, informal interviews and questionnaire survey.

Information technology in pharmacovigilance: Benefits, challenges, and future directions from industry perspectives.

PubMed

Lu, Zhengwu

2009-01-01

Risk assessment during clinical product development needs to be conducted in a thorough and rigorous manner. However, it is impossible to identify all safety concerns during controlled clinical trials. Once a product is marketed, there is generally a large increase in the number of patients exposed, including those with comorbid conditions and those being treated with concomitant medications. Therefore, postmarketing safety data collection and clinical risk assessment based on observational data are critical for evaluating and characterizing a product's risk profile and for making informed decisions on risk minimization. Information science promises to deliver effective e-clinical or e-health solutions to realize several core benefits: time savings, high quality, cost reductions, and increased efficiencies with safer and more efficacious medicines. The development and use of standard-based pharmacovigilance system with integration connection to electronic medical records, electronic health records, and clinical data management system holds promise as a tool for enabling early drug safety detections, data mining, results interpretation, assisting in safety decision making, and clinical collaborations among clinical partners or different functional groups. The availability of a publicly accessible global safety database updated on a frequent basis would further enhance detection and communication about safety issues. Due to recent high-profile drug safety problems, the pharmaceutical industry is faced with greater regulatory enforcement and increased accountability demands for the protection and welfare of patients. This changing climate requires biopharmaceutical companies to take a more proactive approach in dealing with drug safety and pharmacovigilance.

A cost-effectiveness analysis of a proactive management strategy for the Sprint Fidelis recall: a probabilistic decision analysis model.

PubMed

Bashir, Jamil; Cowan, Simone; Raymakers, Adam; Yamashita, Michael; Danter, Matthew; Krahn, Andrew; Lynd, Larry D

2013-12-01

The management of the recall is complicated by the competing risks of lead failure and complications that can occur with lead revision. Many of these patients are currently undergoing an elective generator change--an ideal time to consider lead revision. To determine the cost-effectiveness of a proactive management strategy for the Sprint Fidelis recall. We obtained detailed clinical outcomes and costing data from a retrospective analysis of 341 patients who received the Sprint Fidelis lead in British Columbia, where patients younger than 60 years were offered lead extraction when undergoing generator replacement. These population-based data were used to construct and populate a probabilistic Markov model in which a proactive management strategy was compared to a conservative strategy to determine the incremental cost per lead failure avoided. In our population, elective lead revisions were half the cost of emergent revisions and had a lower complication rate. In the model, the incremental cost-effectiveness ratio of proactive lead revision versus a recommended monitoring strategy was $12,779 per lead failure avoided. The proactive strategy resulted in 21 fewer failures per 100 patients treated and reduced the chance of an additional complication from an unexpected surgery. Cost-effectiveness analysis suggests that prospective lead revision should be considered when patients with a Sprint Fidelis lead present for pulse generator change. Elective revision of the lead is justified even when 25% of the population is operated on per year, and in some scenarios, it is both less costly and provides a better outcome. © 2013 Heart Rhythm Society Published by Heart Rhythm Society All rights reserved.

Decision Support Systems in the Public Sector; A Cybernetic Model for the Proactive Organization.

DTIC Science & Technology

1987-05-01

other markets; vandalism protection through indoor parking, and anything else that an ingenious personnel manager can concoct. The variable "age of...variable age - •of the labor force is restored to acceptability, there wi±l have teen a mutual adaptation between the company and the labor force. A

Doing All the Right Things: Teacher Retention Issues

ERIC Educational Resources Information Center

Brown, Kathleen M.; Schainker, Stanley A.

2008-01-01

Teacher retention has become a national crisis. This case study describes one principal's efforts to support new teachers and reduce the turnover rate at her school. Recognizing the problem a few years ago, the principal took what she thought were a number of proactive, decisive steps to resolve the issue--she is doing all the right things.…

Does fall history influence residential adjustments?

PubMed

Leland, Natalie; Porell, Frank; Murphy, Susan L

2011-04-01

To determine whether reported falls at baseline are associated with an older adult's decision to make a residential adjustment (RA) and the type of adjustment made in the subsequent 2 years. Observations (n = 25,036) were from the Health and Retirement Study, a nationally representative sample of community-living older adults, 65 years of age and older. At baseline, fall history (no fall, 1 fall no injury, 2 or more falls no injury, or 1 or more falls with an injury) and factors potentially associated with RA were used to predict the initiation of an RA (i.e., moving, home modifications, increased use of adaptive equipment, family support, or personal care assistance) during the subsequent 2 years. Compared with those with no history of falls, individuals with a history of falls had higher odds of making any RA. Among those making an RA, individuals with an injurious fall were more likely than those with no history of a fall to start using adaptive equipment or increase their use of personal care assistance. The higher initiation of RAs among fallers may indicate proactive steps to prevent future falls and may be influenced by interactions with the health care system. To optimize fall prevention efforts, older adults would benefit from education and interventions addressing optimal use of RAs before falls occur.

Reducing the Handover Delay in FMIPv6 Using Proactive Care-of Address Scheme

NASA Astrophysics Data System (ADS)

Li, Yong; Jin, Depeng; Su, Li; Zeng, Lieguang

To deal with the increasing number of mobile devices accessing the Internet and the increasing demands of mobility management, IETF has proposed Mobile IPv6 and its fast handover protocol FMIPv6. In FMIPv6, the possibility of Care-of Address (CoA) collision and the time for Return Routability (RR) procedure result in long handover delay, which makes it unsuitable for real-time applications. In this paper, we propose an improved handover scheme for FMIPv6, which reduces the handover delay by using proactive CoA acquisition, configuration and test method. In our proposal, collision-free CoA is proactively prepared, and the time for RR procedure does not contribute to the handover delay. Furthermore, we analyze our proposal's benefits and overhead tradeoff. The numerical results demonstrate that it outperforms the current schemes, such as FMIPv6 and enhanced FMIPv6, on the aspect of handover delay and packet transmission delay.

A Failing Grade for Our Efforts to Make Our Civilization More Environmentally Sustainable

ERIC Educational Resources Information Center

Nakajima, Nina; Vanderburg, Willem H.

2005-01-01

In the decades to come, the authors expect growing pressures to reform current production systems to make them more compatible with the biosphere. A proactive approach to this pressure involves consideration of an alternate value chain based on a comprehensive engineering and marketing approach to recover value from end-of-life products. To…

Students' Personal and Social Meaning Making in a Chinese Idiom Mobile Learning Environment

ERIC Educational Resources Information Center

Wong, Lung-Hsiang; Chin, Chee-Kuen; Tan, Chee-Lay; Liu, May

2010-01-01

In this paper, we present a design research study in Mobile Assisted Language Learning (MALL) that emphasizes learner created content and contextualized meaning making. In learning Chinese idioms, students proactively used smartphones on a 1:1 basis to capture photos of the real-life contexts pertaining to the idioms, and to construct sentences…

Turnaround High School Principals: Recruit, Prepare and Empower Leaders of Change.

ERIC Educational Resources Information Center

Schmidt-Davis, Jon; Bottoms, Gene

2012-01-01

Recent studies make one reality clear: While multiple factors can cause a low-performing high school to be in a turnaround situation, every high school that makes dramatic academic improvement has strong, effective school leadership. Turning a school around is no work for novices. It takes a skilled, visionary and proactive principal to pull apart…

Evansville: A Proactive Approach to Improvement. The Story behind the Indiana State Board of Education's Recent Decision

ERIC Educational Resources Information Center

Anderson, Charis

2014-01-01

The Indiana State Board of Education (ISBE) has not been shy about exercising its authority to intervene in chronically underperforming schools. Under the state's Public Law 221, the Indiana Board can mandate specific interventions for any school that has received six consecutive failing grades under the state's accountability system--up to a…

Ten Things New Teachers Need To Succeed. A SkyLight Guide.

ERIC Educational Resources Information Center

Fogarty, Robin

This guide for novice teachers includes ten sections: (1) "A Knowing Colleague as Counsel...About the Policies, Practices, and Politics!" (proactively seek a mentor); (2) "A Place Called 'My Room' for Students To Grow, To Groom, and To Zoom!" (create a climate that fosters growth and pride); (3) "A Method for Managing 1,500 Decisions: On Your…

Improving management of small natural features on private lands by negotiating the science-policy boundary for Maine vernal pools.

PubMed

Calhoun, Aram J K; Jansujwicz, Jessica S; Bell, Kathleen P; Hunter, Malcolm L

2014-07-29

Vernal pools are far more important for providing ecosystem services than one would predict based on their small size. However, prevailing resource-management strategies are not effectively conserving pools and other small natural features on private lands. Solutions are complicated by tensions between private property and societal rights, uncertainties over resource location and function, diverse stakeholders, and fragmented regulatory authority. The development and testing of new conservation approaches that link scientific knowledge, stakeholder decision-making, and conservation outcomes are important responses to this conservation dilemma. Drawing from a 15-y history of vernal pool conservation efforts in Maine, we describe the coevolution of pool conservation and research approaches, focusing on how research-based knowledge was produced and used in support of management decisions. As management shifted from reactive, top-down approaches to proactive and flexible approaches, research shifted from an ecology-focused program to an interdisciplinary program based on social-ecological systems. The most effective strategies for linking scientific knowledge with action changed as the decision-makers, knowledge needs, and context for vernal pool management advanced. Interactions among stakeholders increased the extent to which knowledge was coproduced and shifted the objective of stakeholder engagement from outreach to research collaboration and development of innovative conservation approaches. New conservation strategies were possible because of the flexible, solutions-oriented collaborations and trust between scientists and decision-makers (fostered over 15 y) and interdisciplinary, engaged research. Solutions to the dilemma of conserving small natural features on private lands, and analogous sustainability science challenges, will benefit from repeated negotiations of the science-policy boundary.

The Carrot or the Stick? Evaluation of Education and Enforcement as Management Tools for Human-Wildlife Conflicts

PubMed Central

Baruch-Mordo, Sharon; Breck, Stewart W.; Wilson, Kenneth R.; Broderick, John

2011-01-01

Evidence-based decision-making is critical for implementing conservation actions, especially for human-wildlife conflicts, which have been increasing worldwide. Conservation practitioners recognize that long-term solutions should include altering human behaviors, and public education and enforcement of wildlife-related laws are two management actions frequently implemented, but with little empirical evidence evaluating their success. We used a system where human-black bear conflicts were common, to experimentally test the efficacy of education and enforcement in altering human behavior to better secure attractants (garbage) from bears. We conducted 3 experiments in Aspen CO, USA to evaluate: 1) on-site education in communal dwellings and construction sites, 2) Bear Aware educational campaign in residential neighborhoods, and 3) elevated law enforcement at two levels in the core business area of Aspen. We measured human behaviors as the response including: violation of local wildlife ordinances, garbage availability to bears, and change in use of bear-resistance refuse containers. As implemented, we found little support for education, or enforcement in the form of daily patrolling in changing human behavior, but found more support for proactive enforcement, i.e., dispensing warning notices. More broadly we demonstrated the value of gathering evidence before and after implementing conservation actions, and the dangers of measuring responses in the absence of ecological knowledge. We recommend development of more effective educational methods, application of proactive enforcement, and continued evaluation of tools by directly measuring change in human behavior. We provide empirical evidence adding to the conservation managers' toolbox, informing policy makers, and promoting solutions to human-wildlife conflicts. PMID:21264267

Risk evaluation and monitoring in multiple sclerosis therapeutics.

PubMed

Clanet, Michel C; Wolinsky, Jerry S; Ashton, Raymond J; Hartung, Hans-Peter; Reingold, Stephen C

2014-09-01

Risk for multiple sclerosis (MS) disease-modifying therapies (DMT) must be assessed on an ongoing basis. Early concerns regarding the first-approved DMTs for MS have been mitigated, but recently licensed therapies have been linked to possibly greater risks. The objective of this review is to discuss risk assessment in MS therapeutics based on an international workshop and comprehensive literature search and recommend strategies for risk assessment/monitoring. Assessment and perception of therapeutic risks vary between patients, doctors and regulators. Acceptability of risk depends on the magnitude of risk and the demonstrated clinical benefits of any agent. Safety signals must be distinguishable from chance occurrences in a clinical trial and in long-term use of medications. Post-marketing research is crucial for assessing longer-term safety in large patient cohorts. Reporting of adverse events is becoming more proactive, allowing more rapid identification of risks. Communication about therapeutic risks and their relationship to clinical benefit must involve patients in shared decision making. It is difficult to produce a general risk-assessment algorithm for all MS therapies. Specific algorithms are required for each DMT in every treated-patient population. New and evolving risks must be evaluated and communicated rapidly to allow patients and physicians to be well informed and able to share treatment decisions. © The Author(s) 2013.

Requirements Flowdown for Prognostics and Health Management

NASA Technical Reports Server (NTRS)

Goebel, Kai; Saxena, Abhinav; Roychoudhury, Indranil; Celaya, Jose R.; Saha, Bhaskar; Saha, Sankalita

2012-01-01

Prognostics and Health Management (PHM) principles have considerable promise to change the game of lifecycle cost of engineering systems at high safety levels by providing a reliable estimate of future system states. This estimate is a key for planning and decision making in an operational setting. While technology solutions have made considerable advances, the tie-in into the systems engineering process is lagging behind, which delays fielding of PHM-enabled systems. The derivation of specifications from high level requirements for algorithm performance to ensure quality predictions is not well developed. From an engineering perspective some key parameters driving the requirements for prognostics performance include: (1) maximum allowable Probability of Failure (PoF) of the prognostic system to bound the risk of losing an asset, (2) tolerable limits on proactive maintenance to minimize missed opportunity of asset usage, (3) lead time to specify the amount of advanced warning needed for actionable decisions, and (4) required confidence to specify when prognosis is sufficiently good to be used. This paper takes a systems engineering view towards the requirements specification process and presents a method for the flowdown process. A case study based on an electric Unmanned Aerial Vehicle (e-UAV) scenario demonstrates how top level requirements for performance, cost, and safety flow down to the health management level and specify quantitative requirements for prognostic algorithm performance.

Offshore safety case approach and formal safety assessment of ships.

PubMed

Wang, J

2002-01-01

Tragic marine and offshore accidents have caused serious consequences including loss of lives, loss of property, and damage of the environment. A proactive, risk-based "goal setting" regime is introduced to the marine and offshore industries to increase the level of safety. To maximize marine and offshore safety, risks need to be modeled and safety-based decisions need to be made in a logical and confident way. Risk modeling and decision-making tools need to be developed and applied in a practical environment. This paper describes both the offshore safety case approach and formal safety assessment of ships in detail with particular reference to the design aspects. The current practices and the latest development in safety assessment in both the marine and offshore industries are described. The relationship between the offshore safety case approach and formal ship safety assessment is described and discussed. Three examples are used to demonstrate both the offshore safety case approach and formal ship safety assessment. The study of risk criteria in marine and offshore safety assessment is carried out. The recommendations on further work required are given. This paper gives safety engineers in the marine and offshore industries an overview of the offshore safety case approach and formal ship safety assessment. The significance of moving toward a risk-based "goal setting" regime is given.

Use of volunteers' information to support proactive inspection of hydraulic structures

NASA Astrophysics Data System (ADS)

Cortes Arevalo, Juliette; Sterlacchini, Simone; Bogaard, Thom; Frigerio, Simone; Junier, Sandra; Schenato, Luca; van den Giesen, Nick

2016-04-01

Proactive management is particularly important to deal with the increasing occurrence of hydro-meteorological hazards in mountain areas were threats are often caused by multiple and sudden onset hazards such as debris flows. Citizen volunteers can be involved in supporting technicians on inspecting the structures' functional status. Such collaborative effort between managing organizations and local volunteers becomes more important under limited resources. To consider volunteers' information in support of proactive inspection of hydraulic structures, we developed a methodology applicable in day-to-day risk management. At first, in collaboration with technicians-in-charge, a data collection approach was developed for first level or pre-screening visual inspections that can be performed by volunteers. Methods comprise of a data collection exercise, an inspection forms and a learning session based on existent procedures in the FVG region and neighbouring regions. To systematically evaluate the individual inspection reports, we designed a support method by means of a multi-criteria method with fuzzy terms. The method allows the technicians-in-charge to categorize the reports in one of three levels, each corresponding with a course of action. To facilitate the evaluation of inspection reports, we transformed the decision support method into a prototype Web-GIS application. The design process of the Web-GIS framework followed a user-centred approach. The conceptual design incorporates four modules for managing the inspection reports: 1) Registered users, 2) Inspection planning; 3) Available reports and 4) Evaluation of reports. The development of the prototype focused on the evaluation module and was implemented based on standard and interoperable open source tools. Finally, we organized a workshop with technicians in the study area to test the decision support method and get insights about the usefulness of the Web-GIS framework. Participants that took part of the workshop included technicians that were not involved in previous research activities. The involvement of new technicians was important due to their fresh perspectives. We looked at the effect of the quality of the input reports on the output of the decision support method. In addition, we compared the differences in the participants' advice during the inspection and the output from the decision support method. Participants' feedback led to a set of suggested improvements in the decision support method and the web-GIS application. We hope that the knowledge, theory and concept behind this decision support method can be developed into a full-scale web-GIS application. The advantage of using this decision support method is that it allows inspections to be carried out by either skilled volunteers or technicians while ensuring technicians-in-charge that they can systematically evaluate the collected reports. Volunteers can become skilled inspectors by teaming up with technicians for the inspection of hydraulic structures. Technicians can become more aware about local impacts and changes in the structures' status by teaming up with volunteers.

Advanced text and video analytics for proactive decision making

NASA Astrophysics Data System (ADS)

Bowman, Elizabeth K.; Turek, Matt; Tunison, Paul; Porter, Reed; Thomas, Steve; Gintautas, Vadas; Shargo, Peter; Lin, Jessica; Li, Qingzhe; Gao, Yifeng; Li, Xiaosheng; Mittu, Ranjeev; Rosé, Carolyn Penstein; Maki, Keith; Bogart, Chris; Choudhari, Samrihdi Shree

2017-05-01

Today's warfighters operate in a highly dynamic and uncertain world, and face many competing demands. Asymmetric warfare and the new focus on small, agile forces has altered the framework by which time critical information is digested and acted upon by decision makers. Finding and integrating decision-relevant information is increasingly difficult in data-dense environments. In this new information environment, agile data algorithms, machine learning software, and threat alert mechanisms must be developed to automatically create alerts and drive quick response. Yet these advanced technologies must be balanced with awareness of the underlying context to accurately interpret machine-processed indicators and warnings and recommendations. One promising approach to this challenge brings together information retrieval strategies from text, video, and imagery. In this paper, we describe a technology demonstration that represents two years of tri-service research seeking to meld text and video for enhanced content awareness. The demonstration used multisource data to find an intelligence solution to a problem using a common dataset. Three technology highlights from this effort include 1) Incorporation of external sources of context into imagery normalcy modeling and anomaly detection capabilities, 2) Automated discovery and monitoring of targeted users from social media text, regardless of language, and 3) The concurrent use of text and imagery to characterize behaviour using the concept of kinematic and text motifs to detect novel and anomalous patterns. Our demonstration provided a technology baseline for exploiting heterogeneous data sources to deliver timely and accurate synopses of data that contribute to a dynamic and comprehensive worldview.

Unlocking the Full Potential of Earth Observation During the 2015 Texas Flood Disaster

NASA Technical Reports Server (NTRS)

Schumann, G. J-P.; Frye, S.; Wells, G.; Adler, R.; Brakenridge, R.; Bolten, J.; Murray, J.; Slayback, D.; Policelli, F.; Kirschbaum, D.;

Rethinking Resident Supervision to Improve Safety: From Hierarchical to Interprofessional Models

PubMed Central

Tamuz, Michal; Giardina, Traber Davis; Thomas, Eric J.; Menon, Shailaja; Singh, Hardeep

2011-01-01

Background Inadequate supervision is a significant contributing factor to medical errors involving trainees but supervision in high-risk settings such as the Intensive Care Unit (ICU) is not well studied. Objective We explored how residents in the ICU experienced supervision related to medication safety not only from supervising physicians but also from other professionals. Design, Setting, Measurements Using qualitative methods, we examined in-depth interviews with 17 residents working in ICUs of three tertiary-care hospitals. We analyzed residents' perspectives on receiving and initiating supervision from physicians within the traditional medical hierarchy and from other professionals, including nurses, staff pharmacists and clinical pharmacists (“interprofessional supervision”). Results While initiating their own supervision within the traditional hierarchy, residents believed in seeking assistance from fellows and attendings and articulated rules of thumb for doing so; however, they also experienced difficulties. Some residents were concerned that their questions would reflect poorly on them; others were embarrassed by their mistaken decisions. Conversely, residents described receiving interprofessional supervision from nurses and pharmacists, who proactively monitored, intervened in, and guided residents' decisions. Residents relied on nurses and pharmacists for non-judgmental answers to their queries, especially after-hours. To enhance both types of supervision, residents emphasized the importance of improving interpersonal communication skills. Conclusions Residents depended on interprofessional supervision when making decisions regarding medications in the ICU. Improving interprofessional supervision, which thus far has been under-recognized and underemphasized in graduate medical education, can potentially improve medication safety in high-risk settings. PMID:21990173

Unlocking the full potential of Earth observation during the 2015 Texas flood disaster

NASA Astrophysics Data System (ADS)

Schumann, G. J.-P.; Frye, S.; Wells, G.; Adler, R.; Brakenridge, R.; Bolten, J.; Murray, J.; Slayback, D.; Policelli, F.; Kirschbaum, D.; Wu, H.; Cappelaere, P.; Howard, T.; Flamig, Z.; Clark, R.; Stough, T.; Chini, M.; Matgen, P.; Green, D.; Jones, B.

2016-05-01

Intense rainfall during late April and early May 2015 in Texas and Oklahoma led to widespread and sustained flooding in several river basins. Texas state agencies relevant to emergency response were activated when severe weather then ensued for 6 weeks from 8 May until 19 June following Tropical Storm Bill. An international team of scientists and flood response experts assembled and collaborated with decision-making authorities for user-driven high-resolution satellite acquisitions over the most critical areas; while experimental automated flood mapping techniques provided daily ongoing monitoring. This allowed mapping of flood inundation from an unprecedented number of spaceborne and airborne images. In fact, a total of 27,174 images have been ingested to the USGS Hazards Data Distribution System (HDDS) Explorer, except for the SAR images used. Based on the Texas flood use case, we describe the success of this effort as well as the limitations in fulfilling the needs of the decision-makers, and reflect upon these. In order to unlock the full potential for Earth observation data in flood disaster response, we suggest in a call for action (i) stronger collaboration from the onset between agencies, product developers, and decision-makers; (ii) quantification of uncertainties when combining data from different sources in order to augment information content; (iii) include a default role for the end-user in satellite acquisition planning; and (iv) proactive assimilation of methodologies and tools into the mandated agencies.

Does decentralization influence efficiency of health units? A study of opinion and perception of health workers in Odisha.

PubMed

Panda, Bhuputra; Thakur, Harshad P; Zodpey, Sanjay P

2016-10-31

Health systems in low and middle income countries are struggling to improve efficiency in the functioning of health units of which workforce is one of the most critical building blocks. In India, Rogi Kalyan Samiti (RKS) was established at every health unit as institutions of local decision making in order to improve productive efficiency and quality. Measuring efficiency of health units is a complex task. This study aimed at assessing the perception (opinion and satisfaction) of health workers about influence of RKS on improving efficiency of peripheral decision making health units (DMHU); examining differences between priority and non-priority set-ups; identifying predictors of satisfaction at work; and discussing suggestions to improve performance. Following a cross-sectional, comparative study design, 130 health workers from 30 institutions were selected through a multi-stage stratified random sampling. A semi-structured questionnaire was administered to assess perception and opinion of health workers about influence of RKS on efficiency of decision making at local level, motivation and performance of staff, and availability of funds; improvement of quality of services, and coordination among co-workers; and participation of community in local decision making. Three districts with highest infant mortality rate (IMR), one each, from 3 zones of Odisha and 3 with lowest IMR were selected on the basis of IMR estimates of 2011. The former constituted priority districts (PD) and the latter, non-priority districts (NPD). Composite scores were developed and compared between PD and NPD. Adjusted linear regression was conducted to identify predictors of satisfaction at work. A majority of respondents felt that RKS was efficient in decision making that resulted in improvement of all critical parameters of health service delivery, including quality; this was significantly higher in PD. Further, higher proportion of respondents from PD was highly satisfied with the current set of provisions and manners of functioning of the sample health units. Active community engagement, participation of elected representatives, selection of a pro-active Chairman, and training to RKS members were suggested as the immediate priority action points for the state government. Mean scores differed significantly between PD and NPD with regard to: influence of RKS on individual-centric, organizational-centric and patient-centric performance, and the responsibilities to be entrusted with RKS. Absenteeism was strongly associated with satisfaction and local self-governance. Work-related factors, systemic factors, local accountability and patients' involvement were found to be the key predictors of satisfaction of health workforce. The understanding on quality improvement strategies was found to be very poor among the health workers. Tailor-made capacity building measures at district and sub-district levels could be critical to equip the peripheral health units to achieve the universal health coverage goals. Work environment, systemic factors and accountability need to be addressed on priority for retention of health workforce. The hypothesized link between efficient local decision making, perception of health workers about efficiency of health units and the health status of population needs further investigation.

Statistical analysis in MSW collection performance assessment.

PubMed

Teixeira, Carlos Afonso; Avelino, Catarina; Ferreira, Fátima; Bentes, Isabel

2014-09-01

The increase of Municipal Solid Waste (MSW) generated over the last years forces waste managers pursuing more effective collection schemes, technically viable, environmentally effective and economically sustainable. The assessment of MSW services using performance indicators plays a crucial role for improving service quality. In this work, we focus on the relevance of regular system monitoring as a service assessment tool. In particular, we select and test a core-set of MSW collection performance indicators (effective collection distance, effective collection time and effective fuel consumption) that highlights collection system strengths and weaknesses and supports pro-active management decision-making and strategic planning. A statistical analysis was conducted with data collected in mixed collection system of Oporto Municipality, Portugal, during one year, a week per month. This analysis provides collection circuits' operational assessment and supports effective short-term municipality collection strategies at the level of, e.g., collection frequency and timetables, and type of containers. Copyright © 2014 Elsevier Ltd. All rights reserved.

Semantic-Based Knowledge Management in E-Government: Modeling Attention for Proactive Information Delivery

NASA Astrophysics Data System (ADS)

Samiotis, Konstantinos; Stojanovic, Nenad

E-government has become almost synonymous with a consumer-led revolution of government services inspired and made possible by the Internet. With technology being the least of the worries for government organizations nowadays, attention is shifting towards managing complexity as one of the basic antecedents of operational and decision-making inefficiency. Complexity has been traditionally preoccupying public administrations and owes its origins to several sources. Among them we encounter primarily the cross-functional nature and the degree of legal structuring of administrative work. Both of them have strong reliance to the underlying process and information infrastructure of public organizations. Managing public administration work thus implies managing its processes and information. Knowledge management (KM) and business process reengineering (BPR) have been deployed already by private organizations with success for the same purposes and certainly comprise improvement practices that are worthwhile investigating. Our contribution through this paper is on the utilization of KM for the e-government.

Psychosocial oncofertility issues faced by adolescents and young adults over their lifetime: a review of the research.

PubMed

Crawshaw, Marilyn

2013-03-01

This review considers psychosocial oncofertility research relevant to adolescents and young adults over their lifetime. There is growing awareness of the fertility preservation needs of younger males including lowering practical barriers and attending to emotional impact. Despite decisional challenges facing females--the experimental nature of procedures, time involved and potential involvement of partners/donors (for embryo cryopreservation)--findings suggest they too benefit from fertility information at diagnosis and access to fertility specialists. Studies consistently report that fertility concerns affect well-being, relationships and life planning. Both genders thus want fertility issues to be raised proactively by professionals in the years following diagnosis: to help them make informed decisions at a time relevant to them, develop coping strategies for current and future related areas and to be referred to specialist and/or therapeutic help if needed. Little is known about why cancer survivors are less likely to marry or have children, or about their parenthood experiences.

The Clean Air Act Amendments of 1990: Hazardous Air Pollutant Requirements and the DOE Clean Coal Technology Program

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

Moskowitz, P.D.; DePhillips, M.; Fthenakis, V.M.

1991-12-31

The purpose of the US Department of Energy -- Office of Fossil Energy (DOE FE) Clean Coal Technology Program (CCTP) is to provide the US energy marketplace with advanced, efficient, and environmentally sound coal-based technologies. The design, construction, and operation of Clean Coal Technology Demonstration Projects (CCTDP) will generate data needed to make informed, confident decisions on the commercial readiness of these technologies. These data also will provide information needed to ensure a proactive response by DOE and its industrial partners to the establishment of new regulations or a reactive response to existing regulations promulgated by the US Environmental Protectionmore » Agency (EPA). The objectives of this paper are to: (1) Present a preliminary examination of the potential implications of the Clean Air Act Amendments (CAAA) -- Title 3 Hazardous Air Pollutant requirements to the commercialization of CCTDP; and (2) help define options available to DOE and its industrial partners to respond to this newly enacted Legislation.« less

The Clean Air Act Amendments of 1990: Hazardous Air Pollutant Requirements and the DOE Clean Coal Technology Program

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

Moskowitz, P.D.; DePhillips, M.; Fthenakis, V.M.

1991-01-01

The purpose of the US Department of Energy -- Office of Fossil Energy (DOE FE) Clean Coal Technology Program (CCTP) is to provide the US energy marketplace with advanced, efficient, and environmentally sound coal-based technologies. The design, construction, and operation of Clean Coal Technology Demonstration Projects (CCTDP) will generate data needed to make informed, confident decisions on the commercial readiness of these technologies. These data also will provide information needed to ensure a proactive response by DOE and its industrial partners to the establishment of new regulations or a reactive response to existing regulations promulgated by the US Environmental Protectionmore » Agency (EPA). The objectives of this paper are to: (1) Present a preliminary examination of the potential implications of the Clean Air Act Amendments (CAAA) -- Title 3 Hazardous Air Pollutant requirements to the commercialization of CCTDP; and (2) help define options available to DOE and its industrial partners to respond to this newly enacted Legislation.« less

Editorial Note

NASA Astrophysics Data System (ADS)

2016-02-01

As from January 2016, Dr. Andrew Barry and Dr. Andrea Rinaldo have retired as Editors of Advances in Water Resources. Dr Barry has been a long serving Editor for 14 years, beginning this role on January 1, 2002. During this time he has served the science community with dedication, commitment, and diligence while bringing to the journal a strong vision and a wealth of knowledge that has tremendously improved the visibility and impact of Advances in Water Resources. Throughout this period he has also broadened the scope of the journal by adapting to the new emerging needs of the field through proactively seeking and promoting numerous special issues, which have now become a hallmark of the journal. The importance of obtaining high quality reviews and timeliness in decision-making, have always been a priority under Dr Barry's Editorship. It is clear that Advances in Water Resources and the community which it serves, has benefited enormously under Andrew's tenure and we will miss his energy, enthusiasm and passion for hydrologic science.

Today's challenges in pharmacovigilance: what can we learn from epoetins?

PubMed

Ebbers, Hans C; Mantel-Teeuwisse, Aukje K; Moors, Ellen H M; Schellekens, Huub; Leufkens, Hubert G

2011-04-01

Highly publicized safety issues of medicinal products in recent years and the accompanying political pressure have forced both the US FDA and the European Medicines Agency (EMA) to implement stronger regulations concerning pharmacovigilance. These legislative changes demand more proactive risk management strategies of both pharmaceutical companies and regulators to characterize and minimize known and potential safety concerns. Concurrently, comprehensive surveillance systems are implemented, intended to identify and confirm adverse drug reactions, including the creation of large pharmacovigilance databases and the cooperation with epidemiological centres. Although the ambitions are high, not much is known about how effective all these measures are, or will be. In this review we analyse how the pharmacovigilance community has acted upon two adverse events associated with the use of erythropoiesis-stimulating agents: the sudden increase in pure red cell aplasia and the possible risk of tumour progression associated with these products. These incidents provide important insight for improving pharmacovigilance, but also pose new challenges for regulatory decision making.

Perceived Relevance of Educative Information on Public (Skin) Health: Results of a Representative, Population-Based Telephone Survey.

PubMed

Haluza, Daniela; Schwab, Markus; Simic, Stana; Cervinka, Renate; Moshammer, Hanns

2015-11-09

Individual skin health attitudes are influenced by various factors, including public education campaigns, mass media, family, and friends. Evidence-based, educative information materials assist communication and decision-making in doctor-patient interactions. The present study aims at assessing the prevailing use of skin health information material and sources and their impact on skin health knowledge, motives to tan, and sun protection. We conducted a questionnaire survey among a representative sample of Austrian residents. Print media and television were perceived as the two most relevant sources for skin health information, whereas the source physician was ranked third. Picking the information source physician increased participants' skin health knowledge (p = 0.025) and sun-protective behavior (p < 0.001). The study results highlight the demand for targeted health messages to attain lifestyle changes towards photo-protective habits. Providing resources that encourage pro-active counseling in every-day doctor-patient communication could increase skin health knowledge and sun-protective behavior, and thus, curb the rise in skin cancer incidence rates.

The role of data fusion in predictive maintenance using digital twin

NASA Astrophysics Data System (ADS)

Liu, Zheng; Meyendorf, Norbert; Mrad, Nezih

2018-04-01

Modern aerospace industry is migrating from reactive to proactive and predictive maintenance to increase platform operational availability and efficiency, extend its useful life cycle and reduce its life cycle cost. Multiphysics modeling together with data-driven analytics generate a new paradigm called "Digital Twin." The digital twin is actually a living model of the physical asset or system, which continually adapts to operational changes based on the collected online data and information, and can forecast the future of the corresponding physical counterpart. This paper reviews the overall framework to develop a digital twin coupled with the industrial Internet of Things technology to advance aerospace platforms autonomy. Data fusion techniques particularly play a significant role in the digital twin framework. The flow of information from raw data to high-level decision making is propelled by sensor-to-sensor, sensor-to-model, and model-to-model fusion. This paper further discusses and identifies the role of data fusion in the digital twin framework for aircraft predictive maintenance.

The use of personal flotation devices in the Northeast lobster fishing industry: An examination of the decision-making process.

PubMed

Weil, R; Pinto, K; Lincoln, J; Hall-Arber, M; Sorensen, J

2016-01-01

This study explored perspectives of Northeast commercial lobstermen regarding the use of personal flotation devices (PFDs). Researchers sought to identify factors contributing to low PFD use, and motivators that could lead to increased use of PFDs. This qualitative research (n = 72) included 25 commercial fishermen who participated in in-depth, semi-structured interviews, and 47 attendees of Lobstermen's meetings who engaged in focus groups. The results showed substantial barriers to PFD use. Fishermen described themselves as being proactive about safety whenever possible, but described a longstanding tradition of not wearing PFDs. Key factors integrally linked with the lack of PFD use were workability, identity/social stigma, and risk diffusion. Future safety interventions will need to address significant barriers to PFD use that include issues of comfort and ease of use, as well as social acceptability of PFDs and reorientation of risk perceptions related to falls overboard. © 2015 Wiley Periodicals, Inc.

Proactive and Adaptive Decision Support Study (PDS)

DTIC Science & Technology

2014-12-09

situations diverge from known models. Note that identifying the mission is not an open -ended problem, and is consequently not intractable. The set of...Simulation ( BRIMS ) Conference, Amelia Island, FL, 2012. [9] L. P. Kaelbling, M. L. Littman, and A. R. Cassandra, “Planning and acting in partially...Simulation Conference ( BRIMS ), Sundance, Utah, 2011. PDS Study Final Report 15 Distribution Statement A. Approved for public release; distribution

A proactive transfer policy for critical patient flow management.

PubMed

González, Jaime; Ferrer, Juan-Carlos; Cataldo, Alejandro; Rojas, Luis

2018-02-17

Hospital emergency departments are often overcrowded, resulting in long wait times and a public perception of poor attention. Delays in transferring patients needing further treatment increases emergency department congestion, has negative impacts on their health and may increase their mortality rates. A model built around a Markov decision process is proposed to improve the efficiency of patient flows between the emergency department and other hospital units. With each day divided into time periods, the formulation estimates bed demand for the next period as the basis for determining a proactive rather than reactive transfer decision policy. Due to the high dimensionality of the optimization problem involved, an approximate dynamic programming approach is used to derive an approximation of the optimal decision policy, which indicates that a certain number of beds should be kept free in the different units as a function of the next period demand estimate. Testing the model on two instances of different sizes demonstrates that the optimal number of patient transfers between units changes when the emergency patient arrival rate for transfer to other units changes at a single unit, but remains stable if the change is proportionally the same for all units. In a simulation using real data for a hospital in Chile, significant improvements are achieved by the model in key emergency department performance indicators such as patient wait times (reduction higher than 50%), patient capacity (21% increase) and queue abandonment (from 7% down to less than 1%).

Community oncology in an era of payment reform.

PubMed

Cox, John V; Ward, Jeffery C; Hornberger, John C; Temel, Jennifer S; McAneny, Barbara L

2014-01-01

Patients and payers (government and private) are frustrated with the fee-for-service system (FFS) of payment for outpatient health services. FFS rewards volume and highly valued services, including expensive diagnostics and therapeutics, over lesser valued cognitive services. Proposed payment schemes would incent collaboration and coordination of care among providers and reward quality. In oncology, new payment schemes must address the high costs of all services, particularly drugs, while preserving the robust distribution of sites of service available to patients in the United States. Information technology and personalized cancer care are changing the practice of oncology. Twenty-first century oncology will require increasing cognitive work and shared decision making, both of which are not well regarded in the FFS model. A high proportion of health care dollars are consumed in the final months of life. Effective delivery of palliative and end-of-life care must be addressed by practice and by new models of payment. Value-based reimbursement schemes will require oncology practices to change how they are structured. Lessons drawn from the principles of primary care's Patient Centered Medical Home (PCMH) will help oncology practice to prepare for new schemes. PCMH principles place a premium on proactively addressing toxicities of therapies, coordinating care with other providers, and engaging patients in shared decision making, supporting the ideal of value defined in the triple aim-to measurably improve patient experience and quality of care at less cost. Payment reform will be disruptive to all. Oncology must be engaged in policy discussions and guide rational shifts in priorities defined by new payment models.

Preeradication vaccine policy options for poliovirus infection and disease control.

PubMed

Thompson, Kimberly M; Pallansch, Mark A; Duintjer Tebbens, Radboud J; Wassilak, Steve G; Kim, Jong-Hoon; Cochi, Stephen L

2013-04-01

With the circulation of wild poliovirus (WPV) types 1 and 3 continuing more than a decade after the original goal of eradicating all three types of WPVs by 2000, policymakers consider many immunization options as they strive to stop transmission in the remaining endemic and outbreak areas and prevent reintroductions of live polioviruses into nonendemic areas. While polio vaccination choices may appear simple, our analysis of current options shows remarkable complexity. We offer important context for current and future polio vaccine decisions and policy analyses by developing decision trees that clearly identify potential options currently used by countries as they evaluate national polio vaccine choices. Based on a comprehensive review of the literature we (1) identify the current vaccination options that national health leaders consider for polio vaccination, (2) characterize current practices and factors that appear to influence national and international choices, and (3) assess the evidence of vaccine effectiveness considering sources of variability between countries and uncertainties associated with limitations of the data. With low numbers of cases occurring globally, the management of polio risks might seem like a relatively low priority, but stopping live poliovirus circulation requires making proactive and intentional choices to manage population immunity in the remaining endemic areas and to prevent reestablishment in nonendemic areas. Our analysis shows remarkable variability in the current national polio vaccine product choices and schedules, with combination vaccine options containing inactivated poliovirus vaccine and different formulations of oral poliovirus vaccine making choices increasingly difficult for national health leaders. © 2013 Society for Risk Analysis.

Communal proactive coping strategies among Tamil refugees in Norway: A case study in a naturalistic setting

PubMed Central

2011-01-01

Background An exclusive focus on individual or family coping strategies may be inadequate for people whose major point of concern may be collective healing on a more communal level. Methods To our knowledge, the current study is the first to make use of ethnographic fieldwork methods to investigate this type of coping as a process in a natural setting over time. Participant observation was employed within a Tamil NGO in Norway between August 2006 and December 2008. Results Tamil refugees in Norway co-operated to appraise their shared life situation and accumulate resources communally to improve it in culturally meaningful ways. Long term aspirations were related to both the situation in the homeland and in exile. However, unforeseen social events created considerable challenges and forced them to modify and adapt their coping strategies. Conclusions We describe a form of coping previously not described in the scientific literature: Communal proactive coping strategies, defined as the process by which group members feel collectively responsible for their future well-being and co-operate to promote desired outcomes and prevent undesired changes. The study shows that proactive coping efforts occur in a dynamic social setting which may force people to use their accumulated proactive coping resources in reactive coping efforts. Theoretical and clinical implications are explored. PMID:21521494

Integrating Statistical Machine Learning in a Semantic Sensor Web for Proactive Monitoring and Control.

PubMed

Adeleke, Jude Adekunle; Moodley, Deshendran; Rens, Gavin; Adewumi, Aderemi Oluyinka

2017-04-09

Proactive monitoring and control of our natural and built environments is important in various application scenarios. Semantic Sensor Web technologies have been well researched and used for environmental monitoring applications to expose sensor data for analysis in order to provide responsive actions in situations of interest. While these applications provide quick response to situations, to minimize their unwanted effects, research efforts are still necessary to provide techniques that can anticipate the future to support proactive control, such that unwanted situations can be averted altogether. This study integrates a statistical machine learning based predictive model in a Semantic Sensor Web using stream reasoning. The approach is evaluated in an indoor air quality monitoring case study. A sliding window approach that employs the Multilayer Perceptron model to predict short term PM 2 . 5 pollution situations is integrated into the proactive monitoring and control framework. Results show that the proposed approach can effectively predict short term PM 2 . 5 pollution situations: precision of up to 0.86 and sensitivity of up to 0.85 is achieved over half hour prediction horizons, making it possible for the system to warn occupants or even to autonomously avert the predicted pollution situations within the context of Semantic Sensor Web.

Integrating Statistical Machine Learning in a Semantic Sensor Web for Proactive Monitoring and Control

PubMed Central

Adeleke, Jude Adekunle; Moodley, Deshendran; Rens, Gavin; Adewumi, Aderemi Oluyinka

2017-01-01

Proactive monitoring and control of our natural and built environments is important in various application scenarios. Semantic Sensor Web technologies have been well researched and used for environmental monitoring applications to expose sensor data for analysis in order to provide responsive actions in situations of interest. While these applications provide quick response to situations, to minimize their unwanted effects, research efforts are still necessary to provide techniques that can anticipate the future to support proactive control, such that unwanted situations can be averted altogether. This study integrates a statistical machine learning based predictive model in a Semantic Sensor Web using stream reasoning. The approach is evaluated in an indoor air quality monitoring case study. A sliding window approach that employs the Multilayer Perceptron model to predict short term PM2.5 pollution situations is integrated into the proactive monitoring and control framework. Results show that the proposed approach can effectively predict short term PM2.5 pollution situations: precision of up to 0.86 and sensitivity of up to 0.85 is achieved over half hour prediction horizons, making it possible for the system to warn occupants or even to autonomously avert the predicted pollution situations within the context of Semantic Sensor Web. PMID:28397776

Cost-Effectiveness of a Model Infection Control Program for Preventing Multi-Drug-Resistant Organism Infections in Critically Ill Surgical Patients.

PubMed

Jayaraman, Sudha P; Jiang, Yushan; Resch, Stephen; Askari, Reza; Klompas, Michael

2016-10-01

Interventions to contain two multi-drug-resistant Acinetobacter (MDRA) outbreaks reduced the incidence of multi-drug-resistant (MDR) organisms, specifically methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Clostridium difficile in the general surgery intensive care unit (ICU) of our hospital. We therefore conducted a cost-effective analysis of a proactive model infection-control program to reduce transmission of MDR organisms based on the practices used to control the MDRA outbreak. We created a model of a proactive infection control program based on the 2011 MDRA outbreak response. We built a decision analysis model and performed univariable and probabilistic sensitivity analyses to evaluate the cost-effectiveness of the proposed program compared with standard infection control practices to reduce transmission of these MDR organisms. The cost of a proactive infection control program would be $68,509 per year. The incremental cost-effectiveness ratio (ICER) was calculated to be $3,804 per aversion of transmission of MDR organisms in a one-year period compared with standard infection control. On the basis of probabilistic sensitivity analysis, a willingness-to-pay (WTP) threshold of $14,000 per transmission averted would have a 42% probability of being cost-effective, rising to 100% at $22,000 per transmission averted. This analysis gives an estimated ICER for implementing a proactive program to prevent transmission of MDR organisms in the general surgery ICU. To better understand the causal relations between the critical steps in the program and the rate reductions, a randomized study of a package of interventions to prevent healthcare-associated infections should be considered.

Better governance, better access: practising responsible data sharing in the METADAC governance infrastructure.

PubMed

Murtagh, Madeleine J; Blell, Mwenza T; Butters, Olly W; Cowley, Lorraine; Dove, Edward S; Goodman, Alissa; Griggs, Rebecca L; Hall, Alison; Hallowell, Nina; Kumari, Meena; Mangino, Massimo; Maughan, Barbara; Mills, Melinda C; Minion, Joel T; Murphy, Tom; Prior, Gillian; Suderman, Matthew; Ring, Susan M; Rogers, Nina T; Roberts, Stephanie J; Van der Straeten, Catherine; Viney, Will; Wiltshire, Deborah; Wong, Andrew; Walker, Neil; Burton, Paul R

2018-04-26

Genomic and biosocial research data about individuals is rapidly proliferating, bringing the potential for novel opportunities for data integration and use. The scale, pace and novelty of these applications raise a number of urgent sociotechnical, ethical and legal questions, including optimal methods of data storage, management and access. Although the open science movement advocates unfettered access to research data, many of the UK's longitudinal cohort studies operate systems of managed data access, in which access is governed by legal and ethical agreements between stewards of research datasets and researchers wishing to make use of them. Amongst other things, these agreements aim to respect the reasonable expectations of the research participants who provided data and samples, as expressed in the consent process. Arguably, responsible data management and governance of data and sample use are foundational to the consent process in longitudinal studies and are an important source of trustworthiness in the eyes of those who contribute data to genomic and biosocial research. This paper presents an ethnographic case study exploring the foundational principles of a governance infrastructure for Managing Ethico-social, Technical and Administrative issues in Data ACcess (METADAC), which are operationalised through a committee known as the METADAC Access Committee. METADAC governs access to phenotype, genotype and 'omic' data and samples from five UK longitudinal studies. Using the example of METADAC, we argue that three key structural features are foundational for practising responsible data sharing: independence and transparency; interdisciplinarity; and participant-centric decision-making. We observe that the international research community is proactively working towards optimising the use of research data, integrating/linking these data with routine data generated by health and social care services and other administrative data services to improve the analysis, interpretation and utility of these data. The governance of these new complex data assemblages will require a range of expertise from across a number of domains and disciplines, including that of study participants. Human-mediated decision-making bodies will be central to ensuring achievable, reasoned and responsible decisions about the use of these data; the METADAC model described in this paper provides an example of how this could be realised.

A proactive system for maritime environment monitoring.

PubMed

Moroni, Davide; Pieri, Gabriele; Tampucci, Marco; Salvetti, Ovidio

2016-01-30

The ability to remotely detect and monitor oil spills is becoming increasingly important due to the high demand of oil-based products. Indeed, shipping routes are becoming very crowded and the likelihood of oil slick occurrence is increasing. In this frame, a fully integrated remote sensing system can be a valuable monitoring tool. We propose an integrated and interoperable system able to monitor ship traffic and marine operators, using sensing capabilities from a variety of electronic sensors, along with geo-positioning tools, and through a communication infrastructure. Our system is capable of transferring heterogeneous data, freely and seamlessly, between different elements of the information system (and their users) in a consistent and usable form. The system also integrates a collection of decision support services providing proactive functionalities. Such services demonstrate the potentiality of the system in facilitating dynamic links among different data, models and actors, as indicated by the performed field tests. Copyright © 2015 Elsevier Ltd. All rights reserved.

Sinecatechins and imiquimod as proactive sequential therapy of external genital and perianal warts in adults.

PubMed

Schöfer, Helmut; Tatti, Silvio; Lynde, Charles W; Skerlev, Mihael; Hercogová, Jana; Rotaru, Maria; Ballesteros, Juan; Calzavara-Pinton, Piergiacomo

2017-12-01

This review about the proactive sequential therapy (PST) of external genital and perianal warts (EGW) is based on the most current available clinical literature and on the broad clinical experience of a group of international experts, physicians who are well versed in the treatment of human papillomavirus-associated diseases. It provides a practical guide for the treatment of EGW, including epidemiology, etiology, clinical appearance, and diagnostic procedures for these viral infections. Furthermore, the treatment goals and current treatment options, elucidating provider- and patient-applied therapies, and the parameters driving treatment decisions are summarized. Specifically, the mode of action of the topical treatments sinecatechins and imiquimod, as well as the PST for EGW to achieve rapid and sustained clearance is discussed. The group of experts has developed a treatment algorithm giving healthcare providers a practical tool for the treatment of EGW which is very valuable in the presence of many different treatment options.

Improving management of small natural features on private lands by negotiating the science–policy boundary for Maine vernal pools

PubMed Central

Calhoun, Aram J. K.; Jansujwicz, Jessica S.; Bell, Kathleen P.; Hunter, Malcolm L.

2014-01-01

Vernal pools are far more important for providing ecosystem services than one would predict based on their small size. However, prevailing resource-management strategies are not effectively conserving pools and other small natural features on private lands. Solutions are complicated by tensions between private property and societal rights, uncertainties over resource location and function, diverse stakeholders, and fragmented regulatory authority. The development and testing of new conservation approaches that link scientific knowledge, stakeholder decision-making, and conservation outcomes are important responses to this conservation dilemma. Drawing from a 15-y history of vernal pool conservation efforts in Maine, we describe the coevolution of pool conservation and research approaches, focusing on how research-based knowledge was produced and used in support of management decisions. As management shifted from reactive, top-down approaches to proactive and flexible approaches, research shifted from an ecology-focused program to an interdisciplinary program based on social–ecological systems. The most effective strategies for linking scientific knowledge with action changed as the decision-makers, knowledge needs, and context for vernal pool management advanced. Interactions among stakeholders increased the extent to which knowledge was coproduced and shifted the objective of stakeholder engagement from outreach to research collaboration and development of innovative conservation approaches. New conservation strategies were possible because of the flexible, solutions-oriented collaborations and trust between scientists and decision-makers (fostered over 15 y) and interdisciplinary, engaged research. Solutions to the dilemma of conserving small natural features on private lands, and analogous sustainability science challenges, will benefit from repeated negotiations of the science–policy boundary. PMID:25002496

Responsible Internet Use.

ERIC Educational Resources Information Center

Truett, Carol; And Others

1997-01-01

Provides advice for making school Internet-use guidelines. Outlines responsible proactive use of the Internet for educators and librarians, discusses strengths and weaknesses of Internet blocking software and rating systems, and describes acceptable-use policies (AUP). Lists resources for creating your own AUP, Internet filtering software, and…

Employee benefits annual checkup.

PubMed

Brossman, M E; Taran, J

2001-06-01

An annual checkup is a prudent preventive measure for employee benefit plans. It allows plan fiduciaries to assess the overall "health" of the plans they administer and to make proactive corrections. This article lists some of the most important items to consider in evaluating a plan.

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

PubMed Central

Dowie, J.

2001-01-01

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

Predictions instead of panics: the framework and utility of systematic forecasting of novel psychoactive drug trends.

PubMed

Stogner, John M

2015-01-01

Countless novel psychoactive substances have been sensationally described in the last 15 years by the media and academia. Though some become significant issues, most fail to become a substantial threat. The diversity and breadth of these potential problem substances has led policymakers, law enforcement officers, and healthcare providers alike to feel overwhelmed and underprepared for dealing with novel drugs. Inadequacies in training and preparation may be remedied by a response that is more selective and more proactive. The current manuscript seeks to clarify how to most efficiently forecast the "success" of each newly introduced novel psychoactive substance in order to allow for more efficient decision making and proactive resource allocation. A review of literature, published case reports, and legal studies was used to determine which factors were most closely linked to use of a novel drug spreading. Following the development of a forecasting framework, examples of its use are provided. The resulting five-step forecast method relies on assessments of the availability of a potential user base, the costs--legal and otherwise--of the drug relative to existent analogues, the subjective experience, the substance's dependence potential and that of any existent analogue, and ease of acquisition. These five factors should serve to forecast the prevalence of novel drug use, but reaction should be conditioned by the potential for harm. The five-step forecast method predicts that use of acetyl fentanyl, kratom, Leonotis leonurus, and e-cigarettes will grow, but that use of dragonfly and similar substances will not. While this forecasting approach should not be used as a replacement for monitoring, the use of the five-step method will allow policymakers, law enforcement and practitioners to quickly begin targeted evaluative, intervention, and treatment initiatives only for those drugs with predicted harm.

Preparing nurse leaders for 2020.

PubMed

Huston, Carol

2008-11-01

This article highlights eight leadership competencies likely to be an essential part of the nurse leader's repertoire in 2020. Planning for the future is difficult, even when environments are relatively static. When environments are dynamic, the challenges multiply exponentially. Unfortunately, few environments have been more unpredictable in the 21st century than health care. The healthcare system is in chaos, as is much of the business world. It is critical then that contemporary nursing and healthcare leaders identify skill sets that will be needed by nurse leaders in 2020 and begin now to create the educational models and management development programs necessary to assure these skills are present. Essential nurse leader competencies for 2020 include: (i) A global perspective or mindset regarding healthcare and professional nursing issues. (ii) Technology skills which facilitate mobility and portability of relationships, interactions, and operational processes. (iii) Expert decision-making skills rooted in empirical science. (iv) The ability to create organization cultures that permeate quality healthcare and patient/worker safety. (v) Understanding and appropriately intervening in political processes. (vi) Highly developed collaborative and team building skills. (vii) The ability to balance authenticity and performance expectations. (viii) Being able to envision and proactively adapt to a healthcare system characterized by rapid change and chaos. Nursing education programmes and healthcare organizations must be begin now to prepare nurses to be effective leaders in 2020. This will require the formal education and training that are a part of most management development programmes as well as a development of appropriate attitudes through social learning. Proactive succession planning will also be key to having nurse leaders who can respond effectively to the new challenges and opportunities that will be presented to them in 2020.

Early outreach to survivors of the shootings in Norway on the 22nd of July 2011

PubMed Central

Dyb, Grete; Jensen, Tine; Glad, Kristin Alve; Nygaard, Egil; Thoresen, Siri

2014-01-01

Background Under-treatment and unmet needs among survivors have been documented years after terror attacks. Improved early and proactive outreach strategies, including targeted interventions for individuals in need, are required. After the terrorist attacks in Norway on 22 July 2011, a national, proactive outreach strategy was developed and implemented to help those who were directly affected. Objectives The aims of this study were threefold: (1) to investigate whether the survivors at the island of Utøya had received proactive outreach from the municipalities, (2) to examine the relationships between received health services and the survivors’ level of exposure and post-trauma health problems, and (3) to explore the level of unmet needs among survivors 5 months post-terror. Methods Three hundred and twenty five survivors (M age=19.4, SD=4.6, 47.1% females, response rate 66%) of the 2011 massacre on Utøya Island, Norway, were interviewed face-to-face 4–5 months post-terror. The survivors were asked if they had received proactive outreach from their municipality, and what type of health services they had received. Survivors’ level of peri-trauma exposure, loss and injury, posttraumatic stress reactions, symptoms of anxiety and depression, somatic health problems, and sick leave, were assessed. Results Most participants (87%) reported that they had received early and proactive outreach, and most (84%) had a contact person. In addition a majority of the survivors has received support from their general practitioner (63%), or other municipal help services (66%). Specialized mental health services by psychiatrists or psychologists had been provided to 73.1% of the survivors. Survivors who had been referred to specialized mental health services reported higher levels of exposure to trauma, posttraumatic stress reactions, depression and anxiety, and somatic health problems, compared to non-receivers of such services. Forty-three survivors (14%) reported unmet needs for services. Conclusion In accordance with the national strategy, the vast majority of the participants in this study had received an early and proactive outreach and targeted responses from specialized mental health services had been provided to survivors in need of more extensive help. However, an important minority of the participants had not been reached as planned. The knowledge from this study may guide professionals and decision makers in planning for future disasters and improve the levels of care. PMID:25018858

Network Security Is Manageable

ERIC Educational Resources Information Center

Roberts, Gary

2006-01-01

An effective systems librarian must understand security vulnerabilities and be proactive in preventing problems. Specifics of future attacks or security challenges cannot possibly be anticipated, but this paper suggests some simple measures that can be taken to make attacks less likely to occur: program the operating system to get automatic…

Corporate governance and proactive environmental management in Novo Hamburgo and neighbouring cities, Brazil.

PubMed

Naime, R; Spilki, F R; Nascimento, C A

2015-05-01

This study compiled data on environmental auditing and voluntary certification of environment-friendly businesses of the Commercial and Industrial Association of Novo Hamburgo, Campo Bom and Estância Velha and analysed them according to classical environmental management principles: sustainable development and corporate governance. It assessed the level of application of the concepts of corporate governance to everyday business in companies and organisations and estimated how the interconnection and vertical permeability of these concepts might help to make bureaucratic environmental management systemic, proactive and evaluative, changes that may add great value to the operations evaluated. Results showed that, when analysing only audited items not directly defined in legislation, no significant changes were identified. The inclusion of more advanced indices may promote the transition from bureaucratic management, which meets regulated environmental standards only satisfactorily, into proactive and systemic environmental management, which adds value to companies and helps to perpetuate them. Audited and analysed data did not reveal actions that depend on the internal redistribution of power and the interconnection or verticality of attitudes that may materialize concepts of corporate governance.

The disruptive effects of methamphetamine on delayed-matching-to-sample performance reflect proactive interference and are reduced by SCH23390.

PubMed

Macaskill, Anne C; Harrow, Catherine C; Harper, David N

2015-01-01

Different drugs produce different patterns of impairment on delayed matching-to-sample tasks. For example, (+/-)3,4-methylenedioxymethamphetamine (MDMA) produces an increase in proactive interference. That is, subjects are less accurate when they are required to make a response different to the one they made on the immediately previous trial. The current study assessed whether methamphetamine also produces this particular pattern of disruption in delayed matching-to-sample performance in rats. Methamphetamine primarily reduced accuracy on trials where the correct response differed from the one made on the previous trial. Thus methamphetamine, like MDMA and other stimulant-based drugs of abuse, increased proactive interference. This impairment was reduced by prior administration of the dopamine D1 antagonist SCH23390. These results further extend a general conclusion that a range of stimulant-based drugs may disrupt working memory function indirectly via a tendency to repeat previously made responses and that this disruption is related to D1 receptor activity. Copyright © 2014 Elsevier Inc. All rights reserved.

Institutional Solutions to the ``Two-Body Problem"

NASA Astrophysics Data System (ADS)

Knezek, P.

2005-05-01

The Committee on the Status of Women (CSWA), in conjunction with the Employment Committee (EC), will hold a special session that will focus on institutional approaches to solving the ``two-body problem". In step with the national employment trend, for the majority of astronomers with partners, those partners work outside the home. This is particularly true for female astronomers, who generally are married to professionals (and often to other astronomers). Academic and professional institutions that employ the majority of astronomers are now beginning to recognize the importance of addressing what has come to be known as the ``two-body" problem in order to attract and retain the best scientists. A few of those institutions are making pioneering efforts to create pro-active approaches to the issue of dual-career couples. The special session will feature two or three speakers involved with the administration at institutions with pro-active policies. This special session will be coupled with the normal afternoon CSWA session, which will focus on the other side of the issue - how dual-career couples have successfully approached the issue at institutions that do NOT have proactive policies.

A Novel Framework for Adaptation in Agriculture: Lessons Learned from California's Wine Industry (Invited)

NASA Astrophysics Data System (ADS)

Nicholas, K. A.

2010-12-01

While crop yields are threatened by climate change, the management decisions of growers, including their practices to modify the microclimate experienced by the crop, can partially or even completely offset these damages. However, there have been few evaluations of adaptation on the farm scale, where managers are on the front lines of responding to global change. I will present a framework for classifying potential adaptations based on their temporal and spatial scale, their ease of implementation, and their effectiveness in altering or maintaining crop production. Applying this framework to the winegrowing industry in California, it appears that many strategies suggested in the literature for adaptation will either be of limited effectiveness, likely to be cost-prohibitive, or are not compatible with the current values of growers. However, interviews with and observations of winegrowers reveal that novel adaptations, not widely discussed in the literature, are already being employed, often by individuals in an experimental capacity and without community coordination. For example, in addition to irrigation, water is used to modify the vine microclimate for both heating (frost protection) and evaporative cooling. An analysis of responses to past environmental stresses in the wine industry revealed that growers tended to respond to stresses individually rather than collectively, except for severe, novel pests and diseases. Responses may be reactive or proactive; most proactive strategies have been short-term, in response to imminent stress. Growers tend to rely on their own experience to guide their management decisions, which may offer poor guidance under novel climate regimes. These findings highlight some of the difficulties expected in adapting to global change, as well as areas for strategic investments to enhance agricultural resilience to climate change. In particular, strategies to enhance the potential for effective proactive, collective responses could improve adaptive capacity in the context of climate change.

Flexibility in flood management design: proactive planning under uncertainty

NASA Astrophysics Data System (ADS)

Smet, K.; de Neufville, R.; van der Vlist, M.

2016-12-01

This paper presents a value-enhancing approach for proactive planning and design of long-lived flood management infrastructure given uncertain future flooding threats. Designing infrastructure that can be adapted over time is a method to safeguard the efficacy of current design decisions given future uncertainties. We explore the value of embedding "options" in a physical structure, where an option is the right but not the obligation to do something at a later date (e.g. over-dimensioning a floodwall foundation now facilitates a future height addition in response to observed increases in sea level; building extra pump bays in a drainage pumping station enables the easy addition of pumping capacity whenever increased precipitation warrants an expansion.) The proposed approach couples a simulation model that captures future climate induced changes to the hydrologic operating environment of a structure, with an economic model that estimates the lifetime economic performance of alternative investment strategies. The economic model uses Real "In" Options analysis, a type of cash flow analysis that quantifies the implicit value of options and the flexibility they provide. We demonstrate the approach using replacement planning for the multi-functional pumping station IJmuiden on the North Sea Canal in the Netherlands. The analysis models flexibility in design decisions, varying the size and specific options included in the new structure. Results indicate that the incorporation of options within the structural design has the potential to improve its economic performance, as compared to more traditional, "build it once and build it big" designs where flexibility is not an explicit design criterion. The added value resulting from the incorporation of flexibility varies with the range of future conditions considered, and the specific options examined. This approach could be applied to explore investment strategies for the design of other flood management structures, as well as be expanded to look more at flexibility within an infrastructure network rather than a single structure. Flexibility in flood management design:proactive planning under uncertainty

Human papillomavirus vaccine awareness, acceptability, and decision-making factors among Chinese college students.

PubMed

Wang, Shao-Ming; Zhang, Shao-Kai; Pan, Xiong-Fei; Ren, Ze-Fang; Yang, Chun-Xia; Wang, Zeng-Zhen; Gao, Xiao-Hong; Li, Man; Zheng, Quan-Qing; Ma, Wei; Zhao, Fang-Hui; Qiao, You-Lin; Sivasubramaniam, Priya

2014-01-01

College students are recommended as the target groups for catch-up human papillomavirus (HPV) vaccination. Systematical exploration of awareness, acceptability, and decision-making factors of HPV vaccination among Chinese college students has been limited. A multi-center survey was conducted in mainland China between November 2011 and May 2012. College students aged 18-22 years were stratified by their grade, gender, and major for sampling. Socio-demographic and HPV-related information such as knowledge, perceptions, acceptability, and attitudes were collected through a questionnaire. A total of 3,497 undergraduates completed the questionnaire, among which 1,686 were males. The acceptability of the HPV vaccine was high (70.8%). Undergraduates from high-level universities, at lower grade, or with greater prior knowledge of HPV vaccines showed higher acceptability of HPV vaccination (ptrend <0.001). Additionally, undergraduates with vaccination experience outside the National Expanded Program on Immunization (OR=1.29; 95%CI: 1.10-1.51) or fear of HPV-related diseases (OR=2.79; 95%CI: 2.28-3.41) were more willing to accept HPV vaccination. General knowledge of HPV vaccine was low among undergraduates, and safety was a major concern (71.05%). The majority of students wished to pay less than 300RMB for HPV vaccine and chose the Chinese Center for Disease Control and Prevention as the most appropriate venue for vaccination. Although most undergraduates demonstrate positive attitudes towards HPV vaccination, challenges pertaining to introduction exist in China. Corresponding proactive education and governmental subsidy to do so are urgently needed by this age-group population. Suggestions and potential strategies indicated may help shape the future HPV vaccination program in China.

Exploring the interactions between forecast accuracy, risk perception and perceived forecast reliability in reservoir operator's decision to use forecast

NASA Astrophysics Data System (ADS)

Shafiee-Jood, M.; Cai, X.

2017-12-01

Advances in streamflow forecasts at different time scales offer a promise for proactive flood management and improved risk management. Despite the huge potential, previous studies have found that water resources managers are often not willing to incorporate streamflow forecasts information in decisions making, particularly in risky situations. While low accuracy of forecasts information is often cited as the main reason, some studies have found that implementation of streamflow forecasts sometimes is impeded by institutional obstacles and behavioral factors (e.g., risk perception). In fact, a seminal study by O'Connor et al. (2005) found that risk perception is the strongest determinant of forecast use while managers' perception about forecast reliability is not significant. In this study, we aim to address this issue again. However, instead of using survey data and regression analysis, we develop a theoretical framework to assess the user-perceived value of streamflow forecasts. The framework includes a novel behavioral component which incorporates both risk perception and perceived forecast reliability. The framework is then used in a hypothetical problem where reservoir operator should react to probabilistic flood forecasts with different reliabilities. The framework will allow us to explore the interactions among risk perception and perceived forecast reliability, and among the behavioral components and information accuracy. The findings will provide insights to improve the usability of flood forecasts information through better communication and education.

The relationship between self-reported oral health, self-regulation, proactive coping, procrastination and proactive attitude.

PubMed

Dumitrescu, A L; Dogaru, B C; Dogaru, C D; Manolescu, B

2011-06-01

This cross-sectional study investigated the relationship between self-regulation, proactive coping, procrastination and proactive attitude, perceived oral health and self-reported oral-health behaviours. The study sample consisted of 198 first year medical students. The questionnaire included information about socio-demographic factors, behavioural variables, self-reported oral health status, proactive coping (proactive coping subscale of the Proactive Coping Inventory), procrastination (Procrastination Scale) and proactive attitude (Proactive Attitude Scale). Significant differences were found on self-regulation, proactive coping, procrastination and proactive attitude scales between participants who rated their gingival condition as very good/excellent and those who evaluated it as being poor, very poor or normal (p < 0.05). Results revealed significant differences in procrastination level among individuals who never visit their dentist and those who visit their dentist for check-up or for tooth cleaning and scaling (p = 0.001) or when treatment is needed or when in pain (p < 0.05). In multiple linear regression analyses, proactive coping was associated with toothbrushing frequency and reason for dental visiting. The result suggested that procrastination and proactive coping are important determinants of perceived oral health and self-reported oral-health behaviours.

Where Personalized Medicine, Patient Engagement, and Primary Care Collide.

PubMed

Bell, Megan

2017-01-01

Personalized medicine and patient engagement have become common buzzwords in the context of health care reform. Independently both concepts have showed some promise in impacting health outcomes, but when synergistically applied, they have more power, as both are critical pieces of personalized health care (PHC). PHC is a health care model that embraces the need for patient engagement along with personalized medicine technologies to make the health care process more personalized, patient-driven, and proactive. Primary care presents an ideal setting for the application of PHC through the use of patient engagement techniques such as patient portals, patient-generated health data, and self-management programs, with the goal of supporting a preventative proactive health care approach. Copyright© South Dakota State Medical Association.

Supporting Distance Learners: Making Practice More Effective

ERIC Educational Resources Information Center

Pratt, Keryn

2015-01-01

This paper reports on a qualitative evaluation of the postgraduate courses offered by distance in one university department. The types and amount of support provided to students was evaluated and compared with Simpson's (2008a) Proactive Motivational Support model (PaMS). While students were largely satisfied with the support they received during…

Developing Meaningfulness at Work through Emotional Intelligence Training

ERIC Educational Resources Information Center

Thory, Kathryn

2016-01-01

To date, there remains a significant gap in the human resource development (HRD) literature in understanding how training and development contributes to meaningful work. In addition, little is known about how individuals proactively make their work more meaningful. This article shows how emotional intelligence (EI) training promotes learning about…

78 FR 45441 - Sugar Program; Feedstock Flexibility Program for Bioenergy Producers

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-29

... sugarcane processors may borrow from CCC, pledging their sugar production as collateral for any such loan... sugar for bioenergy production under FFP as a proactive means for CCC to avoid forfeitures. FFP is... production. In addition, CCC will make quarterly announcements of revised estimates of such quantity. CCC's...

Evolving the Role of Campus Security

ERIC Educational Resources Information Center

May, Vern

2008-01-01

One of the problems security professionals see in security is that there are few benchmarks to quantify the effectiveness of proactive security initiatives. This hurts them with funding support and also with ensuring community buy-in outside of crisis situations. The reactive nature of many institutions makes it difficult to move forward with…

What to give the patient who has everything? A qualitative study of prescribing for multimorbidity in primary care.

PubMed

Sinnott, Carol; Hugh, Sheena Mc; Boyce, Maria B; Bradley, Colin P

2015-03-01

Using clinical guidelines in the management of patients with multimorbidity can lead to the prescription of multiple and sometimes conflicting medications. To explore how GPs make decisions when prescribing for multimorbid patients, with a view to informing intervention design. In-depth qualitative interviews incorporating chart-stimulated recall with purposively sampled GPs in the Republic of Ireland. Grounded theory analysis with iterative theory development. Twenty GPs were interviewed about 51 multimorbid cases. In these cases, GPs integrated information from multiple sources including the patient, specialists, and evidence-based medicine. Difficulties arose when recommendations or preferences conflicted, to which GPs responded by 'satisficing': accepting care that they deemed satisfactory and sufficient for a particular patient. Satisficing was manifest as relaxing targets for disease control, negotiating compromise with the patient, or making 'best guesses' about the most appropriate course of action to take. In multimorbid patients perceived as stable, GPs preferred to 'maintain the status quo' rather than rationalise medications, even in cases with significant polypharmacy. Proactive changes in medications were facilitated by continuity of care, sufficient consultation time, and open lines of communication with the patient, other healthcare professionals, and other GPs. GPs respond to conflicts in the management of multimorbid patients by making compromises between patient-centred and evidence-based care. These findings will be used to inform interventions that aim to care in multimorbidity. © British Journal of General Practice 2015.

Future land use threats to range-restricted fish species in the United States

DOE PAGES

Januchowski-Hartley, Stephanie R.; Holtz, Lauren A.; Martinuzzi, Sebastian; ...

2016-03-04

Land use change is one major threat to freshwater biodiversity, and land use change scenarios can help to assess threats from future land use change, thereby guiding proactive conservation decisions. Furthermore, our goal was to identify which range-restricted freshwater fish species are most likely to be affected by land use change and to determine where threats to these species from future land use change in the conterminous United States are most pronounced.

A Proactive and Top-Down Approach to Managing Risk at NASA

NASA Technical Reports Server (NTRS)

Dezfuli, Homayoon

2010-01-01

Our ultimate goal is to manage risk in a holistic and coherent fashion across the Agency: a) The RIDM process is intended to risk-inform direction-setting decisions. c) The CRM process is intended to manage risk associated with the implementation of baseline performance requirements. Currently we are working on: a) Enhancements to the CRM process. b) Better integration of the RIDM and CRM processes. c) Better integration of institutional risk considerations into RM framework.

Future land use threats to range-restricted fish species in the United States

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

Januchowski-Hartley, Stephanie R.; Holtz, Lauren A.; Martinuzzi, Sebastian

Land use change is one major threat to freshwater biodiversity, and land use change scenarios can help to assess threats from future land use change, thereby guiding proactive conservation decisions. Furthermore, our goal was to identify which range-restricted freshwater fish species are most likely to be affected by land use change and to determine where threats to these species from future land use change in the conterminous United States are most pronounced.

Reasoning and Knowledge Acquisition Framework for 5G Network Analytics

PubMed Central

2017-01-01

Autonomic self-management is a key challenge for next-generation networks. This paper proposes an automated analysis framework to infer knowledge in 5G networks with the aim to understand the network status and to predict potential situations that might disrupt the network operability. The framework is based on the Endsley situational awareness model, and integrates automated capabilities for metrics discovery, pattern recognition, prediction techniques and rule-based reasoning to infer anomalous situations in the current operational context. Those situations should then be mitigated, either proactive or reactively, by a more complex decision-making process. The framework is driven by a use case methodology, where the network administrator is able to customize the knowledge inference rules and operational parameters. The proposal has also been instantiated to prove its adaptability to a real use case. To this end, a reference network traffic dataset was used to identify suspicious patterns and to predict the behavior of the monitored data volume. The preliminary results suggest a good level of accuracy on the inference of anomalous traffic volumes based on a simple configuration. PMID:29065473

Marketing and strategic management: integrating skills for a better hospital.

PubMed

Hunter, S S

1987-05-01

Participants in a 1985 one-day seminar sponsored by the American Hospital Association's Society for Hospital Planning and Marketing were asked two questions: How many of the hospitals represented here have conducted marketing surveys in the recent past? How many of you were satisfied with the results of the survey or could integrate it into the strategic management of your institution? While all but two of the 125 participants answered yes to the first question, only two responded affirmatively to the second. A gap between having a survey done and implementing the results had been identified. The administrators had probably rushed into "marketing" with little forethought and even less effort to comprehend how this management skill fits into existing institutional skills, capabilities, roles, and goals. To close the gap between marketing theory and practice an institution must adopt a more far-reaching, proactive stance toward integrating marketing into the management routine at an early stage. This article presents a case study that may help health care administrators rethink the role of marketing in management and its place in the sequence of strategic decision making for their institution.

Android and ODK based data collection framework to aid in epidemiological analysis

PubMed Central

Raja, A.; Tridane, A.; Gaffar, A.; Lindquist, T.; Pribadi, K.

2014-01-01

Periodic collection of field data, analysis and interpretation of data are key to a good healthcare service. This data is used by the subsequent decision makers to recognize preventive measures, provide timely support to the affected and to help measure the effects of their interventions. While the resources required for good disease surveillance and proactive healthcare are available more readily in developed countries, the lack of these in developing countries may compromise the quality of service provided. This combined with the critical nature of some diseases makes this an essential issue to be addressed. Taking advantage of the rapid growth of cell phone usage and related infrastructure in developed as well as developing countries, several systems have been established to address the gaps in data collection. Android, being an open sourced platform, has gained considerable popularity in this aspect. Open data kit is one such tool developed to aid in data collection. The aim of this paper is to present a prototype framework built using few such existing tools and technologies to address data collection for seasonal influenza, commonly referred to as the flu. PMID:24678381

Modeling and simulating human teamwork behaviors using intelligent agents

NASA Astrophysics Data System (ADS)

Fan, Xiaocong; Yen, John

2004-12-01

Among researchers in multi-agent systems there has been growing interest in using intelligent agents to model and simulate human teamwork behaviors. Teamwork modeling is important for training humans in gaining collaborative skills, for supporting humans in making critical decisions by proactively gathering, fusing, and sharing information, and for building coherent teams with both humans and agents working effectively on intelligence-intensive problems. Teamwork modeling is also challenging because the research has spanned diverse disciplines from business management to cognitive science, human discourse, and distributed artificial intelligence. This article presents an extensive, but not exhaustive, list of work in the field, where the taxonomy is organized along two main dimensions: team social structure and social behaviors. Along the dimension of social structure, we consider agent-only teams and mixed human-agent teams. Along the dimension of social behaviors, we consider collaborative behaviors, communicative behaviors, helping behaviors, and the underpinning of effective teamwork-shared mental models. The contribution of this article is that it presents an organizational framework for analyzing a variety of teamwork simulation systems and for further studying simulated teamwork behaviors.

Reasoning and Knowledge Acquisition Framework for 5G Network Analytics.

PubMed

Sotelo Monge, Marco Antonio; Maestre Vidal, Jorge; García Villalba, Luis Javier

2017-10-21

Autonomic self-management is a key challenge for next-generation networks. This paper proposes an automated analysis framework to infer knowledge in 5G networks with the aim to understand the network status and to predict potential situations that might disrupt the network operability. The framework is based on the Endsley situational awareness model, and integrates automated capabilities for metrics discovery, pattern recognition, prediction techniques and rule-based reasoning to infer anomalous situations in the current operational context. Those situations should then be mitigated, either proactive or reactively, by a more complex decision-making process. The framework is driven by a use case methodology, where the network administrator is able to customize the knowledge inference rules and operational parameters. The proposal has also been instantiated to prove its adaptability to a real use case. To this end, a reference network traffic dataset was used to identify suspicious patterns and to predict the behavior of the monitored data volume. The preliminary results suggest a good level of accuracy on the inference of anomalous traffic volumes based on a simple configuration.

Perceived Relevance of Educative Information on Public (Skin) Health: Results of a Representative, Population-Based Telephone Survey

PubMed Central

Haluza, Daniela; Schwab, Markus; Simic, Stana; Cervinka, Renate; Moshammer, Hanns

2015-01-01

Individual skin health attitudes are influenced by various factors, including public education campaigns, mass media, family, and friends. Evidence-based, educative information materials assist communication and decision-making in doctor-patient interactions. The present study aims at assessing the prevailing use of skin health information material and sources and their impact on skin health knowledge, motives to tan, and sun protection. We conducted a questionnaire survey among a representative sample of Austrian residents. Print media and television were perceived as the two most relevant sources for skin health information, whereas the source physician was ranked third. Picking the information source physician increased participants’ skin health knowledge (p = 0.025) and sun-protective behavior (p < 0.001). The study results highlight the demand for targeted health messages to attain lifestyle changes towards photo-protective habits. Providing resources that encourage pro-active counseling in every-day doctor-patient communication could increase skin health knowledge and sun-protective behavior, and thus, curb the rise in skin cancer incidence rates. PMID:26569274

Portfolio Optimization of Nanomaterial Use in Clean Energy Technologies.

PubMed

Moore, Elizabeth A; Babbitt, Callie W; Gaustad, Gabrielle; Moore, Sean T

2018-04-03

While engineered nanomaterials (ENMs) are increasingly incorporated in diverse applications, risks of ENM adoption remain difficult to predict and mitigate proactively. Current decision-making tools do not adequately account for ENM uncertainties including varying functional forms, unique environmental behavior, economic costs, unknown supply and demand, and upstream emissions. The complexity of the ENM system necessitates a novel approach: in this study, the adaptation of an investment portfolio optimization model is demonstrated for optimization of ENM use in renewable energy technologies. Where a traditional investment portfolio optimization model maximizes return on investment through optimal selection of stock, ENM portfolio optimization maximizes the performance of energy technology systems by optimizing selective use of ENMs. Cumulative impacts of multiple ENM material portfolios are evaluated in two case studies: organic photovoltaic cells (OPVs) for renewable energy and lithium-ion batteries (LIBs) for electric vehicles. Results indicate ENM adoption is dependent on overall performance and variance of the material, resource use, environmental impact, and economic trade-offs. From a sustainability perspective, improved clean energy applications can help extend product lifespans, reduce fossil energy consumption, and substitute ENMs for scarce incumbent materials.

Climate Change, Public Health, and Decision Support: The New Threat of Vector-borne Disease

NASA Astrophysics Data System (ADS)

Grant, F.; Kumar, S.

2011-12-01

Climate change and vector-borne diseases constitute a massive threat to human development. It will not be enough to cut emissions of greenhouse gases-the tide of the future has already been established. Climate change and vector-borne diseases are already undermining the world's efforts to reduce extreme poverty. It is in the best interests of the world leaders to think in terms of concerted global actions, but adaptation and mitigation must be accomplished within the context of local community conditions, resources, and needs. Failure to act will continue to consign developed countries to completely avoidable health risks and significant expense. Failure to act will also reduce poorest of the world's population-some 2.6 billion people-to a future of diminished opportunity. Northrop Grumman has taken significant steps forward to develop the tools needed to assess climate change impacts on public health, collect relevant data for decision making, model projections at regional and local levels; and, deliver information and knowledge to local and regional stakeholders. Supporting these tools is an advanced enterprise architecture consisting of high performance computing, GIS visualization, and standards-based architecture. To address current deficiencies in local planning and decision making with respect to regional climate change and its effect on human health, our research is focused on performing a dynamical downscaling with the Weather Research and Forecasting (WRF) model to develop decision aids that translate the regional climate data into actionable information for users. For the present climate WRF was forced with the Max Planck Institute European Center/Hamburg Model version 5 (ECHAM5) General Circulation Model 20th century simulation. For the 21th century climate, we used an ECHAM5 simulation with the Special Report on Emissions (SRES) A1B emissions scenario. WRF was run in nested mode at spatial resolution of 108 km, 36 km and 12 km and 28 vertical levels. This model was examined relative to two mosquito vectors, both competent carriers of dengue fever, a viral, vector-borne disease. Models which incorporate public health considerations can enable decision makers to take proactive steps to mitigate the impacts and adapt to the changing environmental conditions. In this paper we provide a snapshot of our climate initiative and some examples relative to our public health practice work in vector-borne diseases to illustrate how integrated decision support could be of assistance to regional and local communities worldwide.

Defining and Enabling Resiliency of Electric Distribution Systems With Multiple Microgrids

DOE PAGES

Chanda, Sayonsom; Srivastava, Anurag K.

2016-05-02

This paper presents a method for quantifying and enabling the resiliency of a power distribution system (PDS) using analytical hierarchical process and percolation theory. Using this metric, quantitative analysis can be done to analyze the impact of possible control decisions to pro-actively enable the resilient operation of distribution system with multiple microgrids and other resources. Developed resiliency metric can also be used in short term distribution system planning. The benefits of being able to quantify resiliency can help distribution system planning engineers and operators to justify control actions, compare different reconfiguration algorithms, develop proactive control actions to avert power systemmore » outage due to impending catastrophic weather situations or other adverse events. Validation of the proposed method is done using modified CERTS microgrids and a modified industrial distribution system. Furthermore, simulation results show topological and composite metric considering power system characteristics to quantify the resiliency of a distribution system with the proposed methodology, and improvements in resiliency using two-stage reconfiguration algorithm and multiple microgrids.« less

Proactive control of proactive interference using the method of loci.

PubMed

Bass, Willa S; Oswald, Karl M

2014-01-01

Proactive interferencebuilds up with exposure to multiple lists of similar items with a resulting reduction in recall. This study examined the effectiveness of using a proactive strategy of the method of loci to reduce proactive interference in a list recall paradigm of categorically similar words. While all participants reported using some form of strategy to recall list words, this study demonstrated that young adults were able to proactively use the method of loci after 25 min of instruction to reduce proactive interference as compared with other personal spontaneous strategies. The implications of this study are that top-down proactive strategies such as the method of loci can significantly reduce proactive interference, and that the use of image and sequence or location are especially useful in this regard.

Proactive control of proactive interference using the method of loci

PubMed Central

Bass, Willa S.; Oswald, Karl M.

2014-01-01

Proactive interferencebuilds up with exposure to multiple lists of similar items with a resulting reduction in recall. This study examined the effectiveness of using a proactive strategy of the method of loci to reduce proactive interference in a list recall paradigm of categorically similar words. While all participants reported using some form of strategy to recall list words, this study demonstrated that young adults were able to proactively use the method of loci after 25 min of instruction to reduce proactive interference as compared with other personal spontaneous strategies. The implications of this study are that top-down proactive strategies such as the method of loci can significantly reduce proactive interference, and that the use of image and sequence or location are especially useful in this regard. PMID:25157300

When in doubt, seize the day? Security values, prosocial values, and proactivity under ambiguity.

PubMed

Grant, Adam M; Rothbard, Nancy P

2013-09-01

Researchers have suggested that both ambiguity and values play important roles in shaping employees' proactive behaviors, but have not theoretically or empirically integrated these factors. Drawing on theories of situational strength and values, we propose that ambiguity constitutes a weak situation that strengthens the relationship between the content of employees' values and their proactivity. A field study of 204 employees and their direct supervisors in a water treatment plant provided support for this contingency perspective. Ambiguity moderated the relationship between employees' security and prosocial values and supervisor ratings of proactivity. Under high ambiguity, security values predicted lower proactivity, whereas prosocial values predicted higher proactivity. Under low ambiguity, values were not associated with proactivity. We replicated these findings in a laboratory experiment with 232 participants in which we measured proactivity objectively as initiative taken to correct errors: Participants with strong security values were less proactive, and participants with strong prosocial values were more proactive, but only when performance expectations were ambiguous. We discuss theoretical implications for research on proactivity, values, and ambiguity and uncertainty. PsycINFO Database Record (c) 2013 APA, all rights reserved

Information for a New Age: Redefining the Librarian.

ERIC Educational Resources Information Center

American Library Association, Chicago, IL. Library Instruction Round Table.

Bibliographic Instruction (BI), which focuses on the need to make library patrons become more proficient in locating and using information, is a major contributor to information literacy. The 14 papers and essays in this volume describe approaches to proactive interaction with library users with the single goal of achieving an information literate…

Structured Recess: Finding a Way to Make It Work

ERIC Educational Resources Information Center

Scudieri, Dena; Schwager, Susan

2017-01-01

Time is a highly contested resource in today's schools. Proactive physical educators and savvy school administrators are acknowledging the benefits of devoting time during the school day, beyond regular physical education classes, for students to engage in physical activity with an eye toward enhancing student's health and well-being, as well as…

School-Wide Proactive Approaches to Working with Students with Challenging Behaviors.

ERIC Educational Resources Information Center

Bullock, Lyndal M., Ed.; Gable, Robert A., Ed.

This monograph presents highlights from a 2002 forum on school-wide approaches to working with students with challenging behaviors. The forum's focus was on ways to make systemic changes to create school environments that support the use of positive academic and behavioral interventions at the building and classroom levels. The following…

An Overview of the State of Environmental Assessment Education at Canadian Universities

ERIC Educational Resources Information Center

Stelmack, Colleen M.; Sinclair, John A.; Fitzpatrick, Patricia

2005-01-01

Purpose--Environmental assessment (EA) is a proactive planning tool designed to consider the ecological, cultural, socio-political and economic impacts of potential projects, making it a major tool for achieving sustainable development. Meaningful EA requires a bridging of the natural sciences with the social sciences to broaden understanding of…

Sexual Harassment and Experiential Education Programs: A Closer Look.

ERIC Educational Resources Information Center

Loeffler, T. A.

Sexual harassment can be devastating and have tremendous impact on the emotional well-being, physical health, and vocational success of those who experience it. It is especially important for outdoor education program staff to proactively address sexual harassment because these programs often take place in remote locations that may make escape…

Correlates of Pure and Co-Occurring Proactive and Reactive Aggressors In Hong Kong

ERIC Educational Resources Information Center

Chan, Jacob Yuichung; Fung, Annis L.; Gerstein, Lawrence H.

2013-01-01

Research on aggression in the West has focused mainly on the dichotomy between proactive and reactive aggression, but not the co-occurring proactive-reactive aggression subtype, despite its prevalence. The authors investigated the differences in psychological and behavioral correlates among proactive, reactive, and proactive-reactive student…

Beyond NextGen: AutoMax Overview and Update

NASA Technical Reports Server (NTRS)

Kopardekar, Parimal; Alexandrov, Natalia

2013-01-01

Main Message: National and Global Needs - Develop scalable airspace operations management system to accommodate increased mobility needs, emerging airspace uses, mix, future demand. Be affordable and economically viable. Sense of Urgency. Saturation (delays), emerging airspace uses, proactive development. Autonomy is Needed for Airspace Operations to Meet Future Needs. Costs, time critical decisions, mobility, scalability, limits of cognitive workload. AutoMax to Accommodate National and Global Needs. Auto: Automation, autonomy, autonomicity for airspace operations. Max: Maximizing performance of the National Airspace System. Interesting Challenges and Path Forward.

K-12 students with concussions: a legal perspective.

PubMed

Zirkel, Perry A; Brown, Brenda Eagan

2015-04-01

This article provides a multipart analysis of the public schools' responsibility for students with concussions. The first part provides the prevailing diagnostic definitions of concussions and postconcussive syndrome. The second and central part provides (a) the legal framework of the two overlapping federal laws--the Individuals with Disabilities Education Act and Section 504 of the Rehabilitation Act and the varying state laws or local policies for individual health plans and (b) a summary of the developing body of hearing officer decisions, court decisions, and Office for Civil Rights rulings that have applied this framework to K-12 students with concussions. The final part offers recommendations for proactive return to school policies, with the school nurse playing a central supporting role. © The Author(s) 2014.

Proactive Strategies to Address Health Equity and Disparities: Recommendations from a Bi-National Symposium.

PubMed

Haggerty, Jeannie; Chin, Marshall H; Katz, Alan; Young, Kue; Foley, Jonathan; Groulx, Antoine; Pérez-Stable, Eliseo J; Turnbull, Jeff; DeVoe, Jennifer E; Uchendo, Uche

2018-01-01

Health inequities persist in Canada and the United States. Both countries show differential health status and health care quality by social characteristics, making zip or postal code a greater predictor of health than genetics. Many social determinants of health overlap in the same individuals or communities, exacerbating their vulnerability. Many of the contributing factors and problems are structural and evade simple solutions. In March 2017 a binational Canada-US symposium was held in Washington DC involving 150 primary care thought leaders, including clinicians, researchers, patients, and policy makers to address transformation in integrated primary care. This commentary summarizes the session's principal insights and solutions of the session tackling health inequities at policy and delivery levels. The solution lies in intervening proactively to reduce disparities-developing risk-adjustment measures that integrate social factors; increasing the socioeconomic, racial, and ethnic diversity of health providers; teaching cultural humility; supporting community-oriented primary care; and integrating equity considerations into health system funding. We propose moving from retrospective analysis to proactive measures; from equality to equity; from needs-based to strength-based approaches; and from an individual to a population focus. © Copyright 2018 by the American Board of Family Medicine.

Reciprocal relationship between proactive personality and work characteristics: a latent change score approach.

PubMed

Li, Wen-Dong; Fay, Doris; Frese, Michael; Harms, Peter D; Gao, Xiang Yu

2014-09-01

Previous proactivity research has predominantly assumed that proactive personality generates positive environmental changes in the workplace. Grounded in recent research on personality development from a broad interactionist theoretical approach, the present article investigates whether work characteristics, including job demands, job control, social support from supervisors and coworkers, and organizational constraints, change proactive personality over time and, more important, reciprocal relationships between proactive personality and work characteristics. Latent change score analyses based on longitudinal data collected in 3 waves across 3 years show that job demands and job control have positive lagged effects on increases in proactive personality. In addition, proactive personality exerts beneficial lagged effects on increases in job demands, job control, and supervisory support, and on decreases in organizational constraints. Dynamic reciprocal relationships are observed between proactive personality with job demands and job control. The revealed corresponsive change relationships between proactive personality and work characteristics contribute to the proactive personality literature by illuminating more nuanced interplays between the agentic person and work characteristics, and also have important practical implications for organizations and employees. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Social oocyte cryopreservation: a portrayal of Brazilian women.

PubMed

Santo, Elisangela V Espirito; Dieamant, Felipe; Petersen, Claudia G; Mauri, Ana L; Vagnini, Laura D; Renzi, Adriana; Zamara, Camila; Oliveira, João Batista A; Baruffi, Ricardo L R; Franco, José G

2017-06-01

This study aimed to determine what Brazilian childless women of reproductive age think about oocyte cryopreservation to postpone pregnancy and their reasons for performing or not performing this procedure. Women of reproductive age were randomly selected from the general population using different e-mail lists and were invited to participate in the study by completing an online web survey regarding social oocyte cryopreservation. The survey was also distributed through social media to women of reproductive age. Although most of the responders had a partner (86.9%) and had already planned the pregnancy of their first child (69.6%), 85.4% (379) considered the potential of social oocyte freezing to improve their chances of giving birth later in life. Those that had already planned pregnancy were two times more likely to intend to freeze their oocytes (p=0.03). The most important barrier for not undergoing oocyte cryopreservation was cost. The women who indicated that they could not currently undergo the procedure now because of cost were two times (p=0.03) more likely to intend to cryopreserve their oocytes than women who thought that they would not need to delay pregnancy. Brazilian women who think that they are not ready to have a family are discovering the option of oocyte cryopreservation. Most participants considered safeguarding their reproductive potential. Making the procedure more accessible could give women the opportunity to make proactive decisions about the future of their fertility.

A concept analysis of proactive behaviour in midwifery.

PubMed

Mestdagh, Eveline; Van Rompaey, Bart; Beeckman, Katrien; Bogaerts, Annick; Timmermans, Olaf

2016-06-01

To report an analysis of the concept of proactive behaviour and apply the findings to midwifery. Proactive behaviour is a universal phenomenon generalizable to multiple professions. The purpose of this work was to establish a link with midwifery. Concept analysis by Walker and Avant's method. Literature was searched in PubMed, ERIC, NARCIS, Emerald and reference lists of related journal articles with a timeline of 1990 - April 2015 in the period of November 2014 - June 2015. Next key words were combined by the use of Boolean operators: 'proactive behaviour', 'midwifery', 'midwife', 'proactivity' and 'proactive'. Fifteen studies were included. A focused review of scientific publications in midwifery, health care, healthcare education and social sciences, which highlighted the concept of proactive behaviour. In the studied literature, several attributes of proactive behaviour were cited. These attributes were narrowed by applying it on a midwifery model case, borderline case and contrary case. Related concepts were elaborated and distinguished of the concept of proactive behaviour in midwifery. Proactive behaviour is triggered by different individual and contextual antecedents and has consequences at multiple levels. A midwife who behaves proactive would not look at changes as a boundary, persistently improves things she experienced as wrong, anticipates future barriers and looks for viable alternatives to carry out her work as efficiently and effectively as possible. Various individual and/or contextual antecedents trigger proactive behaviour in midwifery, and this behaviour could cause multiple future benefits for the constant evolving reproductive health care. © 2016 John Wiley & Sons Ltd.

Untrained users derail your caboose? Learn to get on track

NASA Technical Reports Server (NTRS)

Bentley-Smith, M.

2000-01-01

You've implemented Oracle, and low-and-behold, your users can't bear it. They're making costly errors, finding creative work-arounds, and being mavericks with your system, because user training wasn't on track. This paper discusses how to build a proactive, comprehensive training program to get your users back on track.

Aligning smoke management with ecological and public health goals

Treesearch

Jonathan W. Long; Leland W. Tarnay; Malcolm P. North

2017-01-01

Past and current forest management affects wildland fire smoke impacts on downwind human populations. However, mismatches between the scale of benefits and risks make it difficult to proactively manage wildland fires to promote both ecological and public health. Building on recent literature and advances in modeling smoke and health effects, we outline a framework to...

Making Choices: A Proactive Way to Improve Behaviors for Young Children with Challenging Behaviors

ERIC Educational Resources Information Center

Green, Katherine B.; Mays, Nicole M.; Jolivette, Kristine

2011-01-01

Preschool teachers and caregivers today are faced with an increasing number of children as young as 2 years old who exhibit challenging behavior. Unfortunately, these challenging behaviors may continue into adolescence and adulthood if not remediated early. Recently, there has been an increase in research showing promising evidence that when…

Intrapreneurship--A New Way of Doing Business: Maintaining Academic Integrity in the Face of the Political Imperative To Make Money.

ERIC Educational Resources Information Center

Elford, Elsie; Hemstreet, Brad

In the context of educational institutions, intrapreneurs are proactive and innovative educational leaders who work as entrepreneurs inside the institution. In order to successfully carry out intrapreneurial activities, community colleges must have a structural and administrative framework that supports a market orientation and a reduced…

Individual decisions to vaccinate one's child or oneself: A discrete choice experiment rejecting free-riding motives.

PubMed

Verelst, Frederik; Willem, Lander; Kessels, Roselinde; Beutels, Philippe

2018-06-01

It is essential for public health to understand what drives people's hesitance towards vaccination. Theoretical models of vaccination decisions are ubiquitous, often incorporating herd immunity, perceptions of vaccine-related side-effects (VRSE) and of vaccine-preventable burden of disease, but with little to no empirical exploration. Herd immunity is a (usually) positive externality where vaccinated individuals influence others' risks by their reduced capability to transmit an infectious disease to them. It is often assumed that (rational) individuals incorporate this externality in their strategic vaccination decision, from which free-riding behavior arises. We performed a Bayesian D-efficient discrete choice experiment in February-March 2017 to study vaccination behavior in 1919 Belgian respondents. Choice sets with vaccine profiles were constructed using six attributes: vaccine effectiveness, VRSE, accessibility (in terms of convenience and reimbursement), vaccine-preventable burden of disease, local (respondents' network of contacts) vaccination coverage, and population (the population at large) vaccination coverage. VRSE and accessibility are the most influential attributes, followed by vaccine effectiveness and burden of disease. Both population and local coverage are less important than the other attributes, but show a significant direct linear relationship with vaccine utility. This supports the existence of peer influence (more incentivized as more and more vaccinate), rather than free-riding on herd immunity. These findings were independent of whether respondents made vaccine choices for themselves or for their child. Around 40% of the respondents indicated accepting vaccination with little or no questioning. These 'acceptors' were less sensitive to changes in the vaccine-preventable burden of disease for their child's vaccination choices (but not for themselves). Public health institutions are critical in stimulating vaccine uptake by making vaccines conveniently available at an affordable price and by communicating pro-actively on perceived VRSEs. The free-riding assumption as a driver of individual vaccine decisions, seems inappropriate, but this observation needs confirming in other populations. Copyright © 2018 Elsevier Ltd. All rights reserved.

Promoting seismic retrofit implementation through "nudge": using warranty as a driver.

PubMed

Fujimi, Toshio; Tatano, Hirokazu

2013-10-01

This article proposes a new type of warranty policy that applies the "nudge" concept developed by Thaler and Sunstein to encourage homeowners in Japan to implement seismic retrofitting. Homeowner adaptation to natural disasters through loss reduction measures is known to be inadequate. To encourage proactive risk management, the "nudge" approach capitalizes on how choice architecture can influence human decision-making tendencies. For example, people tend to place more value on a warranty for consumer goods than on actuarial value. This article proposes a "warranty for seismic retrofitting" as a "nudge" policy that gives homeowners the incentive to adopt loss reduction measures. Under such a contract, the government guarantees all repair costs in the event of earthquake damage to the house if the homeowner implements seismic retrofitting. To estimate the degree to which a warranty will increase the perceived value of seismic retrofitting, we use field survey data from 1,200 homeowners. Our results show that a warranty increases the perceived value of seismic retrofitting by an average of 33%, and an approximate cost-benefit analysis indicates that such a warranty can be more economically efficient than an ex ante subsidy. Furthermore, we address the failure of the standard expected utility model to explain homeowners' decisions based on warranty evaluation, and explore the significant influence of ambiguity aversion on the efficacy of seismic retrofitting and nonanalytical factors such as feelings or trust. © 2013 Society for Risk Analysis.

IMPROVING THE EFFECTIVENESS AND EFFICIENCY OF EVIDENCE PRODUCTION FOR HEALTH TECHNOLOGY ASSESSMENT.

PubMed

Facey, Karen; Henshall, Chris; Sampietro-Colom, Laura; Thomas, Sarah

2015-01-01

Health Technology Assessment (HTA) needs to address the challenges posed by high cost, effective technologies, expedited regulatory approaches, and the opportunities provided by collaborative real-world evaluation of technologies. The Health Technology Assessment International (HTAi) Policy Forum met to consider these issues and the implications for evidence production to inform HTA. This paper shares their discussion to stimulate further debate. A background paper, presentations, group discussions, and stakeholder role play at the 2015 HTAi Policy Forum meeting informed this paper. HTA has an important role to play in helping improve evidence production and ensuring that the health service is ready to adopt effective technologies. It needs to move from simply informing health system decisions to also working actively to align stakeholder expectations about realistic evidence requirements. Processes to support dialogue over the health technology life cycle need to be developed that are mindful of limited resources, operate across jurisdictions and learn from past processes. Collaborations between health technology developers and health systems in different countries should be encouraged to develop evidence that will inform decision making. New analytical techniques emerging for real-world data should be harnessed to support modeling for HTA. A paradigm shift (to "Health Innovation System 2.0") is suggested where HTA adopts a more central, proactive role to support alignment within and amongst stakeholders over the whole life cycle of the technology. This could help ensure that evidence production is better aligned with patient and health system needs and so is more effective and efficient.

Psychosocial issues of women with type 1 diabetes transitioning to motherhood: a structured literature review.

PubMed

Rasmussen, Bodil; Hendrieckx, Christel; Clarke, Brydie; Botti, Mari; Dunning, Trisha; Jenkins, Alicia; Speight, Jane

2013-11-23

Life transitions often involve complex decisions, challenges and changes that affect diabetes management. Transition to motherhood is a major life event accompanied by increased risk that the pregnancy will lead to or accelerate existing diabetes-related complications, as well as risk of adverse pregnancy outcomes, all of which inevitably increase anxiety. The frequency of hyperglycaemia and hypoglycaemia often increases during pregnancy, which causes concern for the health and physical well-being of the mother and unborn child. This review aimed to examine the experiences of women with T1DM focusing on the pregnancy and postnatal phases of their transition to motherhood. The structured literature review comprised a comprehensive search strategy identifying primary studies published in English between 1990-2012. Standard literature databases were searched along with the contents of diabetes-specific journals. Reference lists of included studies were checked. Search terms included: 'diabetes', 'type 1', 'pregnancy', 'motherhood', 'transition', 'social support', 'quality of life' and 'psychological well-being'. Of 112 abstracts returned, 62 articles were reviewed in full-text, and 16 met the inclusion criteria. There was a high level of diversity among these studies but three common key themes were identified. They related to physical (maternal and fetal) well-being, psychological well-being and social environment. The results were synthesized narratively. Women with type 1 diabetes experience a variety of psychosocial issues in their transition to motherhood: increased levels of anxiety, diabetes-related distress, guilt, a sense of disconnectedness from health professionals, and a focus on medicalisation of pregnancy rather than the positive transition to motherhood. A trusting relationship with health professionals, sharing experiences with other women with diabetes, active social support, shared decision and responsibilities for diabetes management assisted the women to make a positive transition. Health professionals can promote a positive transition to motherhood by proactively supporting women with T1DM in informed decision-making, by facilitating communication within the healthcare team and co-ordinating care for women with type 1 diabetes transitioning to motherhood.

Psychosocial issues of women with type 1 diabetes transitioning to motherhood: a structured literature review

PubMed Central

2013-01-01

Background Life transitions often involve complex decisions, challenges and changes that affect diabetes management. Transition to motherhood is a major life event accompanied by increased risk that the pregnancy will lead to or accelerate existing diabetes-related complications, as well as risk of adverse pregnancy outcomes, all of which inevitably increase anxiety. The frequency of hyperglycaemia and hypoglycaemia often increases during pregnancy, which causes concern for the health and physical well-being of the mother and unborn child. This review aimed to examine the experiences of women with T1DM focusing on the pregnancy and postnatal phases of their transition to motherhood. Methods The structured literature review comprised a comprehensive search strategy identifying primary studies published in English between 1990–2012. Standard literature databases were searched along with the contents of diabetes-specific journals. Reference lists of included studies were checked. Search terms included: ‘diabetes’, ‘type 1’, ‘pregnancy’, ‘motherhood’, ‘transition’, ‘social support’, ‘quality of life’ and ‘psychological well-being’. Result Of 112 abstracts returned, 62 articles were reviewed in full-text, and 16 met the inclusion criteria. There was a high level of diversity among these studies but three common key themes were identified. They related to physical (maternal and fetal) well-being, psychological well-being and social environment. The results were synthesized narratively. Conclusion Women with type 1 diabetes experience a variety of psychosocial issues in their transition to motherhood: increased levels of anxiety, diabetes-related distress, guilt, a sense of disconnectedness from health professionals, and a focus on medicalisation of pregnancy rather than the positive transition to motherhood. A trusting relationship with health professionals, sharing experiences with other women with diabetes, active social support, shared decision and responsibilities for diabetes management assisted the women to make a positive transition. Health professionals can promote a positive transition to motherhood by proactively supporting women with T1DM in informed decision-making, by facilitating communication within the healthcare team and co-ordinating care for women with type 1 diabetes transitioning to motherhood. PMID:24267919

When staff is underpaid: dealing with the individual coping strategies of health personnel.

PubMed Central

Van Lerberghe, Wim; Conceicao, Claudia; Van Damme, Wim; Ferrinho, Paulo

2002-01-01

Health sector workers respond to inadequate salaries and working conditions by developing various individual "coping strategies"--some, but not all, of which are of a predatory nature. The paper reviews what is known about these practices and their potential consequences (competition for time, brain drain and conflicts of interest). By and large, governments have rarely been proactive in dealing with such problems, mainly because of their reluctance to address the issue openly. The effectiveness of many of these piecemeal reactions, particularly attempts to prohibit personnel from developing individual coping strategies, has been disappointing. The paper argues that a more proactive approach is required. Governments will need to recognize the dimension of the phenomenon and systematically assess the consequences of policy initiatives on the situation and behaviour of the individuals that make up their workforce. PMID:12163923

The new immigration contestation: social movements and local immigration policy making in the United States, 2000-2011.

PubMed

Steil, Justin Peter; Vasi, Ion Bogdan

2014-01-01

Analyzing oppositional social movements in the context of municipal immigration ordinances, the authors examine whether the explanatory power of resource mobilization, political process, and strain theories of social movements' impact on policy outcomes differs when considering proactive as opposed to reactive movements. The adoption of pro-immigrant (proactive) ordinances was facilitated by the presence of immigrant community organizations and of sympathetic local political allies. The adoption of anti-immigrant (reactive) ordinances was influenced by structural social changes, such as rapid increases in the local Latino population, that were framed as threats. The study also finds that pro-immigrant protest events can influence policy in two ways, contributing both to the passage of pro-immigrant ordinances in the locality where protests occur and also inhibiting the passage of anti-immigrant ordinances in neighboring cities.

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.

From proactive personality to organizational citizenship behavior: mediating role of harmony.

PubMed

Gan, Yiqun; Cheung, Fanny M

2010-06-01

The objective of the present study was to examine the moderating role of interpersonal harmony in the relation of proactive personality with organizational citizenship behavior. 158 employees in Chinese state-owned companies completed the Proactive Personality Scale (Bateman & Crant, 1993), Harmony scale, and Organizational Citizenship Behavior Questionnaire. Proactive personality had insignificant correlation with job dedication. The correlation between interpersonal facilitation and proactive personality was significant but quite low. Results of the hierarchical regression analyses indicated that when demographic variables were controlled, Harmony had significant moderating effects on the relations of proactive behavior and job dedication/interpersonal facilitation. In the high Harmony group, the correlation between proactive personality and organizational citizenship behavior was significant; whereas in the low Harmony group, this correlation was not significant.

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.

Drawbacks of proactivity: Effects of daily proactivity on daily salivary cortisol and subjective well-being.

PubMed

Fay, Doris; Hüttges, Annett

2017-10-01

The benefit of proactive work behaviors for performance-related outcomes has been well established. However, this approach to studying proactivity has not yet acknowledged its potential implications for the actor's well-being. Drawing on the fact that resources at work are limited and that the workplace is a social system characterized by interdependencies, we proposed that daily proactivity could have a negative effect on daily well-being. We furthermore proposed that this effect should be mediated by work overload and negative affect. We conducted a daily diary study (N = 72) to test the potential negative effects of proactivity on daily well-being. Data was collected across 3 consecutive work days. During several daily measurement occasions, participants reported proactivity, work overload, negative affect, and fatigue. They also provided 4 saliva samples per day, from which cortisol was assayed. Based on the 4 samples, a measure of daily cortisol output was produced. Multilevel analyses showed that daily proactivity was positively associated with higher daily cortisol output. The positive association of daily proactivity with bedtime fatigue was marginally significant. There was no support for a mediating effect of work overload and negative affect. Implications for theory-building on the proactivity-well-being link are discussed. (PsycINFO Database Record (c) 2017 APA, 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.

Fishing for ecosystem services.

PubMed

Pope, Kevin L; Pegg, Mark A; Cole, Nicholas W; Siddons, Stephen F; Fedele, Alexis D; Harmon, Brian S; Ruskamp, Ryan L; Turner, Dylan R; Uerling, Caleb C

2016-12-01

Ecosystems are commonly exploited and manipulated to maximize certain human benefits. Such changes can degrade systems, leading to cascading negative effects that may be initially undetected, yet ultimately result in a reduction, or complete loss, of certain valuable ecosystem services. Ecosystem-based management is intended to maintain ecosystem quality and minimize the risk of irreversible change to natural assemblages of species and to ecosystem processes while obtaining and maintaining long-term socioeconomic benefits. We discuss policy decisions in fishery management related to commonly manipulated environments with a focus on influences to ecosystem services. By focusing on broader scales, managing for ecosystem services, and taking a more proactive approach, we expect sustainable, quality fisheries that are resilient to future disturbances. To that end, we contend that: (1) management always involves tradeoffs; (2) explicit management of fisheries for ecosystem services could facilitate a transition from reactive to proactive management; and (3) adaptive co-management is a process that could enhance management for ecosystem services. We propose adaptive co-management with an ecosystem service framework where actions are implemented within ecosystem boundaries, rather than political boundaries, through strong interjurisdictional relationships. Published by Elsevier Ltd.

Fishing for ecosystem services

USGS Publications Warehouse

Pope, Kevin L.; Pegg, Mark A.; Cole, Nicholas W.; Siddons, Stephen F.; Fedele, Alexis D.; Harmon, Brian S.; Ruskamp, Ryan L.; Turner, Dylan R.; Uerling, Caleb C.

2016-01-01

Ecosystems are commonly exploited and manipulated to maximize certain human benefits. Such changes can degrade systems, leading to cascading negative effects that may be initially undetected, yet ultimately result in a reduction, or complete loss, of certain valuable ecosystem services. Ecosystem-based management is intended to maintain ecosystem quality and minimize the risk of irreversible change to natural assemblages of species and to ecosystem processes while obtaining and maintaining long-term socioeconomic benefits. We discuss policy decisions in fishery management related to commonly manipulated environments with a focus on influences to ecosystem services. By focusing on broader scales, managing for ecosystem services, and taking a more proactive approach, we expect sustainable, quality fisheries that are resilient to future disturbances. To that end, we contend that: (1) management always involves tradeoffs; (2) explicit management of fisheries for ecosystem services could facilitate a transition from reactive to proactive management; and (3) adaptive co-management is a process that could enhance management for ecosystem services. We propose adaptive co-management with an ecosystem service framework where actions are implemented within ecosystem boundaries, rather than political boundaries, through strong interjurisdictional relationships.

Analyzing discharge strategies during acute care: a discrete-event simulation study.

PubMed

Crawford, Elizabeth A; Parikh, Pratik J; Kong, Nan; Thakar, Charuhas V

2014-02-01

We developed a discrete-event simulation model of patient pathway through an acute care hospital that comprises an ED and several inpatient units. The effects of discharge timing on ED waiting and boarding times, ambulance diversions, leave without treatment, and readmissions were explicitly modeled. We then analyzed the impact of 1 static and 2 proactive discharge strategies on these system outcomes. Our analysis indicated that although the 2 proactive discharge strategies significantly reduced ED waiting and boarding times, and several other measures, compared with the static strategy (P < 0.01), the number of readmissions increased substantially. Further analysis indicated that these findings are sensitive to changes in patient arrival rate and conditions for ambulance diversion. Determining the appropriate time to discharge patients not only can affect individual patients' health outcomes, but also can affect various aspects of the hospital. The study improves our understanding of how individual inpatient discharge decisions can be objectively viewed in terms of their impact on other operations, such as ED crowding and readmission, in an acute care hospital.

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

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

PubMed Central

Nakao, Takashi; Ohira, Hideki; Northoff, Georg

2012-01-01

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

The gendered health workforce: mixed methods analysis from four fragile and post-conflict contexts.

PubMed

Witter, Sophie; Namakula, Justine; Wurie, Haja; Chirwa, Yotamu; So, Sovanarith; Vong, Sreytouch; Ros, Bandeth; Buzuzi, Stephen; Theobald, Sally

2017-12-01

It is well known that the health workforce composition is influenced by gender relations. However, little research has been done which examines the experiences of health workers through a gender lens, especially in fragile and post-conflict states. In these contexts, there may not only be opportunities to (re)shape occupational norms and responsibilities in the light of challenges in the health workforce, but also threats that put pressure on resources and undermine gender balance, diversity and gender responsive human resources for health (HRH). We present mixed method research on HRH in four fragile and post-conflict contexts (Sierra Leone, Zimbabwe, northern Uganda and Cambodia) with different histories to understand how gender influences the health workforce. We apply a gender analysis framework to explore access to resources, occupations, values, decision-making and power. We draw largely on life histories with male and female health workers to explore their lived experiences, but complement the analysis with evidence from surveys, document reviews, key informant interviews, human resource data and stakeholder mapping. Our findings shed light on patterns of employment: in all contexts women predominate in nursing and midwifery cadres, are under-represented in management positions and are clustered in lower paying positions. Gendered power relations shaped by caring responsibilities at the household level, affect attitudes to rural deployment and women in all contexts face challenges in accessing both pre- and in-service training. Coping strategies within conflict emerged as a key theme, with experiences here shaped by gender, poverty and household structure. Most HRH regulatory frameworks did not sufficiently address gender concerns. Unless these are proactively addressed post-crisis, health workforces will remain too few, poorly distributed and unable to meet the health needs of vulnerable populations. Practical steps need to be taken to identify gender barriers proactively and engage staff and communities on best approaches for change. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

The gendered health workforce: mixed methods analysis from four fragile and post-conflict contexts

PubMed Central

Witter, Sophie; Namakula, Justine; Wurie, Haja; Chirwa, Yotamu; So, Sovanarith; Vong, Sreytouch; Ros, Bandeth; Buzuzi, Stephen; Theobald, Sally

2017-01-01

Abstract It is well known that the health workforce composition is influenced by gender relations. However, little research has been done which examines the experiences of health workers through a gender lens, especially in fragile and post-conflict states. In these contexts, there may not only be opportunities to (re)shape occupational norms and responsibilities in the light of challenges in the health workforce, but also threats that put pressure on resources and undermine gender balance, diversity and gender responsive human resources for health (HRH). We present mixed method research on HRH in four fragile and post-conflict contexts (Sierra Leone, Zimbabwe, northern Uganda and Cambodia) with different histories to understand how gender influences the health workforce. We apply a gender analysis framework to explore access to resources, occupations, values, decision-making and power. We draw largely on life histories with male and female health workers to explore their lived experiences, but complement the analysis with evidence from surveys, document reviews, key informant interviews, human resource data and stakeholder mapping. Our findings shed light on patterns of employment: in all contexts women predominate in nursing and midwifery cadres, are under-represented in management positions and are clustered in lower paying positions. Gendered power relations shaped by caring responsibilities at the household level, affect attitudes to rural deployment and women in all contexts face challenges in accessing both pre- and in-service training. Coping strategies within conflict emerged as a key theme, with experiences here shaped by gender, poverty and household structure. Most HRH regulatory frameworks did not sufficiently address gender concerns. Unless these are proactively addressed post-crisis, health workforces will remain too few, poorly distributed and unable to meet the health needs of vulnerable populations. Practical steps need to be taken to identify gender barriers proactively and engage staff and communities on best approaches for change. PMID:29244105

Flight doesn't solve everything: Mitigation of road impacts on Birds

Treesearch

Angela Kociolek; Clara Grilo; Sandra Jacobson

2015-01-01

Roads and traffic are typically more of a threat to the conservation of birds rather than a safety issue for motorists. Some bird species have biological features and life history traits that make them particularly vulnerable to habitat loss from roads and mortality due to wildlife-vehicle collisions (WVC). Road planning that proactively considers the biological needs...

Heterogeneity in the development of proactive and reactive aggression in childhood: Common and specific genetic - environmental factors

PubMed Central

Lacourse, Eric; Brendgen, Mara; Vitaro, Frank; Dionne, Ginette; Tremblay, Richard Ernest; Boivin, Michel

2017-01-01

Background Few studies are grounded in a developmental framework to study proactive and reactive aggression. Furthermore, although distinctive correlates, predictors and outcomes have been highlighted, proactive and reactive aggression are substantially correlated. To our knowledge, no empirical study has examined the communality of genetic and environmental underpinning of the development of both subtypes of aggression. The current study investigated the communality and specificity of genetic-environmental factors related to heterogeneity in proactive and reactive aggression’s development throughout childhood. Methods Participants were 223 monozygotic and 332 dizygotic pairs. Teacher reports of aggression were obtained at 6, 7, 9, 10 and 12 years of age. Joint development of both phenotypes were analyzed through a multivariate latent growth curve model. Set point, differentiation, and genetic maturation/environmental modulation hypotheses were tested using a biometric decomposition of intercepts and slopes. Results Common genetic factors accounted for 64% of the total variation of proactive and reactive aggression’s intercepts. Two other sets of uncorrelated genetic factors accounted for reactive aggression’s intercept (17%) on the one hand, and for proactive (43%) and reactive (13%) aggression’s slopes on the other. Common shared environmental factors were associated with proactive aggression’s intercept (21%) and slope (26%) and uncorrelated shared environmental factors were also associated with reactive aggression’s slope (14%). Common nonshared environmental factors explained most of the remaining variability of proactive and reactive aggression slopes. Conclusions A genetic differentiation hypothesis common to both phenotypes was supported by common genetic factors associated with the developmental heterogeneity of proactive and reactive aggression in childhood. A genetic maturation hypothesis common to both phenotypes, albeit stronger for proactive aggression, was supported by common genetic factors associated with proactive and reactive aggression slopes. A shared environment set point hypothesis for proactive aggression was supported by shared environmental factors associated with proactive aggression baseline and slope. Although there are many common features to proactive and reactive aggression, the current research underscores the advantages of differentiating them when studying aggression. PMID:29211810

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,…

Proactive behavior, but not inhibitory control, predicts repeated innovation by spotted hyenas tested with a multi-access box.

PubMed

Johnson-Ulrich, Lily; Johnson-Ulrich, Zoe; Holekamp, Kay

2018-05-01

Innovation is widely linked to cognitive ability, brain size, and adaptation to novel conditions. However, successful innovation appears to be influenced by both cognitive factors, such as inhibitory control, and non-cognitive behavioral traits. We used a multi-access box (MAB) paradigm to measure repeated innovation, the number of unique innovations learned across trials, by 10 captive spotted hyenas (Crocuta crocuta). Spotted hyenas are highly innovative in captivity and also display striking variation in behavioral traits, making them good model organisms for examining the relationship between innovation and other behavioral traits. We measured persistence, motor diversity, motivation, activity, efficiency, inhibitory control, and neophobia demonstrated by hyenas while interacting with the MAB. We also independently assessed inhibitory control with a detour cylinder task. Most hyenas were able to solve the MAB at least once, but only four hyenas satisfied learning criteria for all four possible solutions. Interestingly, neither measure of inhibitory control predicted repeated innovation. Instead, repeated innovation was predicted by a proactive syndrome of behavioral traits that included high persistence, high motor diversity, high activity and low neophobia. Our results suggest that this proactive behavioral syndrome may be more important than inhibitory control for successful innovation with the MAB by members of this species.

An Integrated Framework for Human-Robot Collaborative Manipulation.

PubMed

Sheng, Weihua; Thobbi, Anand; Gu, Ye

2015-10-01

This paper presents an integrated learning framework that enables humanoid robots to perform human-robot collaborative manipulation tasks. Specifically, a table-lifting task performed jointly by a human and a humanoid robot is chosen for validation purpose. The proposed framework is split into two phases: 1) phase I-learning to grasp the table and 2) phase II-learning to perform the manipulation task. An imitation learning approach is proposed for phase I. In phase II, the behavior of the robot is controlled by a combination of two types of controllers: 1) reactive and 2) proactive. The reactive controller lets the robot take a reactive control action to make the table horizontal. The proactive controller lets the robot take proactive actions based on human motion prediction. A measure of confidence of the prediction is also generated by the motion predictor. This confidence measure determines the leader/follower behavior of the robot. Hence, the robot can autonomously switch between the behaviors during the task. Finally, the performance of the human-robot team carrying out the collaborative manipulation task is experimentally evaluated on a platform consisting of a Nao humanoid robot and a Vicon motion capture system. Results show that the proposed framework can enable the robot to carry out the collaborative manipulation task successfully.

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.

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.

Application of Raman Spectroscopy and Univariate Modelling As a Process Analytical Technology for Cell Therapy Bioprocessing

PubMed Central

Baradez, Marc-Olivier; Biziato, Daniela; Hassan, Enas; Marshall, Damian

2018-01-01

Cell therapies offer unquestionable promises for the treatment, and in some cases even the cure, of complex diseases. As we start to see more of these therapies gaining market authorization, attention is turning to the bioprocesses used for their manufacture, in particular the challenge of gaining higher levels of process control to help regulate cell behavior, manage process variability, and deliver product of a consistent quality. Many processes already incorporate the measurement of key markers such as nutrient consumption, metabolite production, and cell concentration, but these are often performed off-line and only at set time points in the process. Having the ability to monitor these markers in real-time using in-line sensors would offer significant advantages, allowing faster decision-making and a finer level of process control. In this study, we use Raman spectroscopy as an in-line optical sensor for bioprocess monitoring of an autologous T-cell immunotherapy model produced in a stirred tank bioreactor system. Using reference datasets generated on a standard bioanalyzer, we develop chemometric models from the Raman spectra for glucose, glutamine, lactate, and ammonia. These chemometric models can accurately monitor donor-specific increases in nutrient consumption and metabolite production as the primary T-cell transition from a recovery phase and begin proliferating. Using a univariate modeling approach, we then show how changes in peak intensity within the Raman spectra can be correlated with cell concentration and viability. These models, which act as surrogate markers, can be used to monitor cell behavior including cell proliferation rates, proliferative capacity, and transition of the cells to a quiescent phenotype. Finally, using the univariate models, we also demonstrate how Raman spectroscopy can be applied for real-time monitoring. The ability to measure these key parameters using an in-line Raman optical sensor makes it possible to have immediate feedback on process performance. This could help significantly improve cell therapy bioprocessing by allowing proactive decision-making based on real-time process data. Going forward, these types of in-line sensors also open up opportunities to improve bioprocesses further through concepts such as adaptive manufacturing. PMID:29556497

Application of Raman Spectroscopy and Univariate Modelling As a Process Analytical Technology for Cell Therapy Bioprocessing.

PubMed

Baradez, Marc-Olivier; Biziato, Daniela; Hassan, Enas; Marshall, Damian

2018-01-01

Cell therapies offer unquestionable promises for the treatment, and in some cases even the cure, of complex diseases. As we start to see more of these therapies gaining market authorization, attention is turning to the bioprocesses used for their manufacture, in particular the challenge of gaining higher levels of process control to help regulate cell behavior, manage process variability, and deliver product of a consistent quality. Many processes already incorporate the measurement of key markers such as nutrient consumption, metabolite production, and cell concentration, but these are often performed off-line and only at set time points in the process. Having the ability to monitor these markers in real-time using in-line sensors would offer significant advantages, allowing faster decision-making and a finer level of process control. In this study, we use Raman spectroscopy as an in-line optical sensor for bioprocess monitoring of an autologous T-cell immunotherapy model produced in a stirred tank bioreactor system. Using reference datasets generated on a standard bioanalyzer, we develop chemometric models from the Raman spectra for glucose, glutamine, lactate, and ammonia. These chemometric models can accurately monitor donor-specific increases in nutrient consumption and metabolite production as the primary T-cell transition from a recovery phase and begin proliferating. Using a univariate modeling approach, we then show how changes in peak intensity within the Raman spectra can be correlated with cell concentration and viability. These models, which act as surrogate markers, can be used to monitor cell behavior including cell proliferation rates, proliferative capacity, and transition of the cells to a quiescent phenotype. Finally, using the univariate models, we also demonstrate how Raman spectroscopy can be applied for real-time monitoring. The ability to measure these key parameters using an in-line Raman optical sensor makes it possible to have immediate feedback on process performance. This could help significantly improve cell therapy bioprocessing by allowing proactive decision-making based on real-time process data. Going forward, these types of in-line sensors also open up opportunities to improve bioprocesses further through concepts such as adaptive manufacturing.

Resolving the problem of compliance with the ever increasing and changing regulations

NASA Astrophysics Data System (ADS)

Leigh, Harley

1992-01-01

The most common problem identified at several U.S. Department of Energy (DOE) sites is regulatory compliance. Simply, the project viability depends on identifying regulatory requirements at the beginning of a specific project to avoid possible delays and cost overruns. The Radioisotope Power Systems Facility (RPSF) is using the Regulatory Compliance System (RCS) to deal with the problem that well over 1000 regulatory documents had to be reviewed for possible compliance requirements applicable to the facility. This overwhelming number of possible documents is not atypical of all DOE facilities thus far reviewed using the RCS system. The RCS was developed to provide control and tracking of all the regulatory and institutional requirements on a given project. WASTREN, Inc., developed the RCS through various DOE contracts and continues to enhance and update the system for existing and new contracts. The RCS provides the information to allow the technical expert to assimilate and manage accurate resource information, compile the necessary checklists, and document that the project or facility fulfills all of the appropriate regulatory requirements. The RCS provides on-line information, including status throughout the project life, thereby allowing more intelligent and proactive decision making. Also, consistency and traceability are provided for regulatory compliance documentation.

Economic Burden of Hearing Loss for the U.S. Military: A Proposed Framework for Estimation.

PubMed

Alamgir, Hasanat; Tucker, David L; Kim, Sun-Young; Betancourt, Jose A; Turner, Caryn A; Gorrell, Natasha S; Wong, Nicole J; Sagiraju, Hari K R; Cooper, Sharon P; Douphrate, David I; Whitworth, Kristina W; Marko, Dritana; Gimeno, David; Cornell, John; Hammill, Tanisha L; Senchak, Andrew J; Packer, Mark D

2016-04-01

The goal of this multiphased research is to develop methods to comprehensively determine the economic impact of hearing impairment and noise-induced hearing injury among active duty U.S. Service Members. Several steps were undertaken to develop a framework and model for economic burden analysis: (1) a literature review identifying studies reporting the cost of health conditions and injuries in the Department of Defense, (2) consultation with a panel of subject matter experts who reviewed these cost items, and (3) discussions with DoD data stewards and review of relevant data dictionaries and databases. A Markov model was developed to represent the cumulative economic effect of events along the career span, such as retraining after hearing impairment and injury, by synthesizing inputs from various sources. The model, as developed and proposed in this study, will be a valuable decision-making tool for the DoD to identify high-risk groups, take proactive measures, and develop focused education, customized equipping, and return-to-duty and reintegration programs, thereby maximizing the retention of skilled, experienced, and mission-ready Service Members. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Comparative Review of Antimicrobial Resistance in Humans and Nonhuman Primates.

PubMed

Kim, Jeffrey; Coble, Dondrae J; Salyards, Gregory W; Habing, Gregory G

2018-04-02

Antimicrobial resistance (AMR) presents serious threats to human and animal health. Although AMR of pathogens is often evaluated independently between humans and animals, comparative analysis of AMR between humans and animals is necessary for zoonotic pathogens. Major surveillance systems monitor AMR of zoonotic pathogens in humans and food animals, but comprehensive AMR data in veterinary medicine is not diligently monitored for most animal species with which humans commonly contact, including NHP. The objective of this review is to provide a complete report of the prevalences of AMR among zoonotic bacteria that present the greatest threats to NHP, occupational, and public health. High prevalences of AMR exist among Shigella, Campylobacter, and Yersinia, including resistance to antimicrobials important to public health, such as macrolides. Despite improvements in regulations, standards, policies, practices, and zoonotic awareness, occupational exposures to and illnesses due to zoonotic pathogens continue to be reported and, given the documented prevalences of AMR, constitute an occupational and public health risk. However, published literature is sparse, thus indicating the need for veterinarians to proactively monitor AMR in dangerous zoonotic bacteria, to enable veterinarians to make more informed decisions to maximize antimicrobial therapy and minimize occupational risk.

Comparative Review of Antimicrobial Resistance in Humans and Nonhuman Primates.

PubMed

Kim, Jeffrey; Coble, Dondrae J; Salyards, Gregory W; Habing, Gregory G

2019-03-01

Antimicrobial resistance (AMR) presents serious threats to human and animal health. Although AMR of pathogens is often evaluated independently between humans and animals, comparative analysis of AMR between humans and animals is necessary for zoonotic pathogens. Major surveillance systems monitor AMR of zoonotic pathogens in humans and food animals, but comprehensive AMR data in veterinary medicine is not diligently monitored for most animal species with which humans commonly contact, including NHP. The objective of this review is to provide a complete report of the prevalences of AMR among zoonotic bacteria that present the greatest threats to NHP, occupational, and public health. High prevalences of AMR exist among Shigella, Campylobacter, and Yersinia, including resistance to antimicrobials important to public health, such as macrolides. Despite improvements in regulations, standards, policies, practices, and zoonotic awareness, occupational exposures to and illnesses due to zoonotic pathogens continue to be reported and, given the documented prevalences of AMR, constitute an occupational and public health risk. However, published literature is sparse, thus indicating the need for veterinarians to proactively monitor AMR in dangerous zoonotic bacteria, to enable veterinarians to make more informed decisions to maximize antimicrobial therapy and minimize occupational risk.

Perceived agricultural runoff impact on drinking water.

PubMed

Crampton, Andrea; Ragusa, Angela T

2014-09-01

Agricultural runoff into surface water is a problem in Australia, as it is in arguably all agriculturally active countries. While farm practices and resource management measures are employed to reduce downstream effects, they are often either technically insufficient or practically unsustainable. Therefore, consumers may still be exposed to agrichemicals whenever they turn on the tap. For rural residents surrounded by agriculture, the link between agriculture and water quality is easy to make and thus informed decisions about water consumption are possible. Urban residents, however, are removed from agricultural activity and indeed drinking water sources. Urban and rural residents were interviewed to identify perceptions of agriculture's impact on drinking water. Rural residents thought agriculture could impact their water quality and, in many cases, actively avoided it, often preferring tank to surface water sources. Urban residents generally did not perceive agriculture to pose health risks to their drinking water. Although there are more agricultural contaminants recognised in the latest Australian Drinking Water Guidelines than previously, we argue this is insufficient to enhance consumer protection. Health authorities may better serve the public by improving their proactivity and providing communities and water utilities with the capacity to effectively monitor and address agricultural runoff.

Using the Internet in the management of asthma.

PubMed

Patel, A M

2001-01-01

The ultimate goals of managing asthma are to eliminate death, prevent or promptly treat exacerbations, and maximize the quality of life and health status of patients. Current strategies include appropriate education, trigger control, and timely access to effective pharmacotherapy and follow-up. Internet-based technologies have emerged as potentially powerful tools to enable meaningful communication and proactive partnership in care for various medical conditions. The main types of Internet-based applications for asthma management include remote monitoring and feedback between health professionals and their patients; online education and marketing for either patients or professionals; networking and collaborative research; and administrative oversight through policy making, planning, and decision support. With increased understanding of integrated disease management and the technostructural as well as psychodynamic issues related to Internet use, further refinement and evolution of the Internet and related technologies may drastically improve the way we monitor, educate, treat, and establish policies for this global problem while attending to individual or local community needs. This review presents a conceptual overview of the current challenges and use of the Internet for improving asthma management through timely and tailored education and appropriate access to health care expertise.

Moving upstream or muddying the waters? Incentives for managing for health.

PubMed

Marks, Linda; Hunter, David J

2005-11-01

The objective of this study was to identify factors influencing the capacity of NHS managers to 'manage for health'. Semi-structured interviews (32) were carried out over the telephone or face to face with national stakeholders (15) and NHS senior managers (17) from four Strategic Health Authorities (SHAs) and five Primary Care Trusts (PCTs) in England. Interviews were transcribed and a qualitative analysis carried out. The current system of targets and incentives prioritised access to acute services, public health skills were too thinly spread, baseline data were inadequate, decision-making for public health investment was fragmented and evidence for effective interventions was scanty. Health improvement targets should be plausible, longer term and locally owned, but key factors in creating a proactive public health organisation were a strong public health ethos, and effective management and leadership skills. Strengthening the NHS's role in managing for health was welcomed, but enthusiasm was tempered by concurrent NHS policy initiatives and incentives pulling in opposing directions. Key NHS policy initiatives have been developed in isolation from each other. While their combined effect remains unpredictable, they may serve to threaten the welcome shift towards managing for health improvement.

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.

Proactive Policing by Post and Community Officers

ERIC Educational Resources Information Center

Famega, Christine N.

2009-01-01

Using data collected through social observations of 188 police officer shifts, the current research examines the time allocated to proactive and reactive activities by traditional and community police officers to assess (a) the extent to which post officers engage in proactive activities, (b) whether these activities differ from the (proactive)…

Proactive life extension of pressure vessels

NASA Astrophysics Data System (ADS)

Mager, Lloyd

1998-03-01

For a company to maintain its competitive edge in today's global market every opportunity to gain an advantage must be exploited. Many companies are strategically focusing on improved utilization of existing equipment as well as regulatory compliance. Abbott Laboratories is no exception. Pharmaceutical companies such as Abbott Laboratories realize that reliability and availability of their production equipment is critical to be successful and competitive. Abbott Laboratories, like many of our competitors, is working to improve safety, minimize downtime and maximize the productivity and efficiency of key production equipment such as the pressure vessels utilized in our processes. The correct strategy in obtaining these objectives is to perform meaningful inspection with prioritization based on hazard analysis and risk. The inspection data gathered in Abbott Laboratories pressure vessel program allows informed decisions leading to improved process control. The results of the program are reduced risks to the corporation and employees when operating pressure retaining equipment. Accurate and meaningful inspection methods become the cornerstone of a program allowing proper preventative maintenance actions to occur. Successful preventative/predictive maintenance programs must utilize meaningful nondestructive evaluation techniques and inspection methods. Nondestructive examination methods require accurate useful tools that allow rapid inspection for the entire pressure vessel. Results from the examination must allow the owner to prove compliance of all applicable regulatory laws and codes. At Abbott Laboratories the use of advanced NDE techniques, primarily B-scan ultrasonics, has provided us with the proper tools allowing us to obtain our objectives. Abbott Laboratories uses B-scan ultrasonics utilizing a pulse echo pitch catch technique to provide essential data on our pressure vessels. Equipment downtime is reduced because the nondestructive examination usually takes place while our vessels are in service. As the inspection takes place we are able to view a real time image of detected discontinuities on a video monitor. The B-scan ultrasonic technique is allowing us to perform fast accurate examinations covering up to 95% of the surface area of each pressure vessel. Receiving data on 95% of a pressure vessel provides us with a lot of useful information. We use this data to determine the condition of each pressure vessel. Once the condition is known the vessels are classed by risk. The risk level is then managed by making decisions related to repair, operating parameters, accepting and monitoring or replacement of the equipment. Inspection schedules are set at maximum intervals and reinspection is minimized for the vessels that are not at risk. The remaining life of each pressure vessel is determined, mechanical integrity is proven and regulatory requirements are met. Abbott Laboratories is taking this proactive approach because we understand that our process equipment is a critical element for successful operation. A run to failure practice would never allow Abbott Laboratories to achieve the corporation's objective of being the world's leading health care company. Nondestructive state of the art technology and the understanding of its capabilities and limitations are key components of a proactive program for life extension of pressure vessels. 26

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

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.

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.

Ensemble Streamflow Forecast Improvements in NYC's Operations Support Tool

NASA Astrophysics Data System (ADS)

Wang, L.; Weiss, W. J.; Porter, J.; Schaake, J. C.; Day, G. N.; Sheer, D. P.

2013-12-01

Like most other water supply utilities, New York City's Department of Environmental Protection (DEP) has operational challenges associated with drought and wet weather events. During drought conditions, DEP must maintain water supply reliability to 9 million customers as well as meet environmental release requirements downstream of its reservoirs. During and after wet weather events, DEP must maintain turbidity compliance in its unfiltered Catskill and Delaware reservoir systems and minimize spills to mitigate downstream flooding. Proactive reservoir management - such as release restrictions to prepare for a drought or preventative drawdown in advance of a large storm - can alleviate negative impacts associated with extreme events. It is important for water managers to understand the risks associated with proactive operations so unintended consequences such as endangering water supply reliability with excessive drawdown prior to a storm event are minimized. Probabilistic hydrologic forecasts are a critical tool in quantifying these risks and allow water managers to make more informed operational decisions. DEP has recently completed development of an Operations Support Tool (OST) that integrates ensemble streamflow forecasts, real-time observations, and a reservoir system operations model into a user-friendly graphical interface that allows its water managers to take robust and defensible proactive measures in the face of challenging system conditions. Since initial development of OST was first presented at the 2011 AGU Fall Meeting, significant improvements have been made to the forecast system. First, the monthly AR1 forecasts ('Hirsch method') were upgraded with a generalized linear model (GLM) utilizing historical daily correlations ('Extended Hirsch method' or 'eHirsch'). The development of eHirsch forecasts improved predictive skill over the Hirsch method in the first week to a month from the forecast date and produced more realistic hydrographs on the tail end of high flow periods. These improvements allowed DEP to more effectively manage water quality control and spill mitigation operations immediately after storm events. Later on, post-processed hydrologic forecasts from the National Weather Service (NWS) including the Advanced Hydrologic Prediction Service (AHPS) and the Hydrologic Ensemble Forecast Service (HEFS) were implemented into OST. These forecasts further increased the predictive skill over the initial statistical models as current basin conditions (e.g. soil moisture, snowpack) and meteorological forecasts (with HEFS) are now explicitly represented. With the post-processed HEFS forecasts, DEP may now truly quantify impacts associated with wet weather events on the horizon, rather than relying on statistical representations of current hydrologic trends. This presentation will highlight the benefits of the improved forecasts using examples from actual system operations.

Risk assessment and management approaches on mental health units.

PubMed

Woods, P

2013-11-01

This exploratory and descriptive study took place in one Canadian province. The study aimed to: (1) to identify and describe the nature and extent of current risk assessment and management approaches used in the adult inpatient mental health and forensic units; and (2) to identify good practice and shortfalls in the nature and extent of the approaches currently utilized. Data were collected from 48 participants through nine focus groups. Participants reported that they used a clinical approach to risk assessment. They had also not considered risk assessment and management as a proactive structured process. Education and training was also limited and skills were developed over time through practice. Five keys issues are discussed as important: reliance on clinical judgement alone is not the best choice to make; the need to consider risk as a whole concept; risk management being more reactive than proactive; education and training; and client involvement in risk assessment. © 2012 John Wiley & Sons Ltd.

Developing a proactive research agenda to advance nail salon worker health, safety, and rights.

PubMed

Quach, Thu; Liou, Julia; Fu, Lisa; Mendiratta, Anuja; Tong, My; Reynolds, Peggy

2012-01-01

Nail salons represent a burgeoning industry with Vietnamese immigrant workers making up the majority. Workers routinely handle cosmetic products containing hazardous compounds, with implications for their health. This paper describes how a collaborative of multiple organizations and community members collectively developed a proactive research agenda for salon worker health, safety, and rights during a pivotal multistakeholder convening, and advanced on such recommendations, including creating groundbreaking policy changes. Key recommendations included (1) creating a multidisciplinary research advisory committee, (2) conducting research on workplace exposures and long-term health impacts, (3) advocating for better governmental oversight of product manufacturers, and (4) identifying safer product alternatives via green chemistry, albeit with cost considerations to salon businesses. The participation of diverse stakeholders in the discussions allowed for cross-dialogue on a complex issue, helped to align different stakeholders as allies, and identified critical resources to addressing research gaps.

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.

Spatial Knowledge Infrastructures - Creating Value for Policy Makers and Benefits the Community

NASA Astrophysics Data System (ADS)

Arnold, L. M.

2016-12-01

The spatial data infrastructure is arguably one of the most significant advancements in the spatial sector. It's been a game changer for governments, providing for the coordination and sharing of spatial data across organisations and the provision of accessible information to the broader community of users. Today however, end-users such as policy-makers require far more from these spatial data infrastructures. They want more than just data; they want the knowledge that can be extracted from data and they don't want to have to download, manipulate and process data in order to get the knowledge they seek. It's time for the spatial sector to reduce its focus on data in spatial data infrastructures and take a more proactive step in emphasising and delivering the knowledge value. Nowadays, decision-makers want to be able to query at will the data to meet their immediate need for knowledge. This is a new value proposal for the decision-making consumer and will require a shift in thinking. This paper presents a model for a Spatial Knowledge Infrastructure and underpinning methods that will realise a new real-time approach to delivering knowledge. The methods embrace the new capabilities afforded through the sematic web, domain and process ontologies and natural query language processing. Semantic Web technologies today have the potential to transform the spatial industry into more than just a distribution channel for data. The Semantic Web RDF (Resource Description Framework) enables meaning to be drawn from data automatically. While pushing data out to end-users will remain a central role for data producers, the power of the semantic web is that end-users have the ability to marshal a broad range of spatial resources via a query to extract knowledge from available data. This can be done without actually having to configure systems specifically for the end-user. All data producers need do is make data accessible in RDF and the spatial analytics does the rest.

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

When does transformational leadership enhance employee proactive behavior? The role of autonomy and role breadth self-efficacy.

PubMed

Den Hartog, Deanne N; Belschak, Frank D

2012-01-01

Two multisource studies address the interactive effects of personal and contextual variables on employees' proactive behavior. In line with previous work, we find positive main effects of transformational leadership, role breadth self-efficacy, and job autonomy on employee proactive behavior (personal initiative in Study 1 and prosocial proactive behavior in Study 2). As expected, a 3-way interaction qualifies these main effects: In situations of high autonomy, transformational leadership relates positively to proactive behavior for individuals high (but not low) on self-efficacy. Vice versa, in situations low on job autonomy, transformational leadership relates positively to proactive behavior for individuals low (but not high) on self-efficacy. This pattern is found both for self-ratings and peer-ratings of employees' proactive behavior in Study 1 and for supervisor ratings of such behavior in Study 2.

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,…

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.

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.

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.

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

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.

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.

Motor command inhibition and the representation of response mode during motor imagery.

PubMed

Scheil, Juliane; Liefooghe, Baptist

2018-05-01

Research on motor imagery proposes that overt actions during motor imagery can be avoided by proactively signaling subthreshold motor commands to the effectors and by invoking motor-command inhibition. A recent study by Rieger, Dahm, and Koch (2017) found evidence in support of motor command inhibition, which indicates that MI cannot be completed on the sole basis of subthreshold motor commands. However, during motor imagery, participants know in advance when a covert response is to be made and it is thus surprising such additional motor-command inhibition is needed. Accordingly, the present study tested whether the demand to perform an action covertly can be proactively integrated by investigating the formation of task-specific action rules during motor imagery. These task-specific action rules relate the decision rules of a task to the mode in which these rules need to be applied (e.g., if smaller than 5, press the left key covertly). To this end, an experiment was designed in which participants had to switch between two numerical judgement tasks and two response modes: covert responding and overt responding. First, we observed markers of motor command inhibition and replicated the findings of Rieger and colleagues. Second, we observed evidence suggesting that task-specific action rules are created for the overt response mode (e.g., if smaller than 5, press the left key). In contrast, for the covert response mode, no task-specific action rules are formed and decision rules do not include mode-specific information (e.g., if smaller than 5, left). Copyright © 2018 Elsevier B.V. All rights reserved.

Providing an information prescription in veterinary medical clinics: a pilot study.

PubMed

Kogan, Lori R; Schoenfeld-Tacher, Regina; Gould, Lauren; Viera, Ann R; Hellyer, Peter W

2014-01-01

The study assesses the impact on client behavior and attitudes toward receiving an information prescription as part of a veterinary office visit. A random sample of veterinary clinics from a Western US metropolitan area was asked to distribute an information prescription in addition to their customary veterinary services. All clients, regardless of the reason for their visit, were presented with an information prescription: a handout that included the uniform resource locator (URL) to a general veterinary medicine website and several tips to help their clients make more informed choices about where to seek pet health information online. Nearly 40% of clients who reported that they remembered receiving the information prescription accessed the website at least once. Of the clients who reported accessing the suggested website, 86.3% reported finding it "very helpful" or "somewhat helpful." Nearly all the clients (87.9%) reported feeling the information on the site helped them make better decisions for their pets. Most clients reported that it helped them talk to their veterinarians (89.9%) and added to the information they received during their veterinary visits (83.5%). Clients appreciate and utilize veterinary prescriptions, suggesting that this is a tool that both veterinarians and librarians can use to improve animal health and client relations. The value placed on reliable Internet information by veterinary clients suggests several opportunities for librarians to become more proactive in partnering with veterinarians to facilitate the education of pet owners.

Providing an information prescription in veterinary medical clinics: a pilot study

PubMed Central

Kogan, Lori R.; Schoenfeld-Tacher, Regina; Gould, Lauren; Viera, Ann R.; Hellyer, Peter W.

2014-01-01

Objective: The study assesses the impact on client behavior and attitudes toward receiving an information prescription as part of a veterinary office visit. Methods: A random sample of veterinary clinics from a Western US metropolitan area was asked to distribute an information prescription in addition to their customary veterinary services. All clients, regardless of the reason for their visit, were presented with an information prescription: a handout that included the uniform resource locator (URL) to a general veterinary medicine website and several tips to help their clients make more informed choices about where to seek pet health information online. Results: Nearly 40% of clients who reported that they remembered receiving the information prescription accessed the website at least once. Of the clients who reported accessing the suggested website, 86.3% reported finding it “very helpful” or “somewhat helpful.” Nearly all the clients (87.9%) reported feeling the information on the site helped them make better decisions for their pets. Most clients reported that it helped them talk to their veterinarians (89.9%) and added to the information they received during their veterinary visits (83.5%). Conclusions: Clients appreciate and utilize veterinary prescriptions, suggesting that this is a tool that both veterinarians and librarians can use to improve animal health and client relations. Implications: The value placed on reliable Internet information by veterinary clients suggests several opportunities for librarians to become more proactive in partnering with veterinarians to facilitate the education of pet owners. PMID:24415918

Knowledge deficit of patients with stage 1-4 CKD: a focus group study.

PubMed

Lopez-Vargas, Pamela A; Tong, Allison; Phoon, Richard K S; Chadban, Steven J; Shen, Yvonne; Craig, Jonathan C

2014-04-01

Patients with early-stage chronic kidney disease (CKD) must make lifestyle modifications and adhere to treatment regimens to prevent their progression to end-stage kidney disease. The aim of this study was to elicit the perspectives of patients with stage 1-4 CKD about their disease, with a specific focus on their information needs in managing and living with CKD and its sequelae. Patients with CKD stages 1-4 were purposively sampled from three major hospitals in Sydney, Australia to participate in focus groups. Transcripts were thematically analysed. From nine focus groups including 38 participants, six major themes were identified: medical attentiveness (shared decision-making, rapport, indifference and insensitivity); learning self-management (diet and nutrition, barriers to physical activity, medication safety); contextualizing comorbidities (prominence of CKD, contradictory treatment); prognostic uncertainty (hopelessness, fear of disease progression, disbelief regarding diagnosis); motivation and coping mechanisms (engage in research, pro-active management, optimism, feeling normal); and knowledge gaps (practical advice, access to information, comprehension of pathology results and CKD diagnosis, education for general practitioners). Patients capacity to slow the progression of CKD may be limited by their lack of knowledge about the disease, its comorbidities, psychosocial influences and their ability to interact and communicate effectively with their health-care provider. Support from a multidisciplinary care team, combined with provision of comprehensive, accessible and practical educational resources may enhance patients' ability and motivation to access and adhere to therapeutic and lifestyle interventions to retard progression of CKD. © 2014 Asian Pacific Society of Nephrology.

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.

Can Regional Colleges Make a Difference in Rural America? The Main Street Economist: Commentary on the Rural Economy.

ERIC Educational Resources Information Center

Rosenfeld, Stuart A.; Sheaff, Katharine

Some regional two-year and four-year colleges are moving beyond their traditional mission of education to take proactive roles in promoting the economic development of their regions and communities. A study of regional colleges that help rural businesses and labor forces adapt to the challenges of rural economies found five outstanding goals of…

The Use of Spatial Cognition in Graph Interpretation

DTIC Science & Technology

2007-08-01

Mathematics has emphasized the importance of proactively teaching students of all ages to interpret graphs and use them to make inferences ( NCTM ... Mathematics . Reston, VA: National Council of Teachers of Mathematics . Oh, S., & Kim, M. (2004). The role of spatial working memory in visual...in learning science (Schunn et al, in press). Not coincidentally, in developing its recent national standards, the National Council of Teachers of

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.

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

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.

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

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.

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

What Is Engagement? Proactivity as the Missing Link in the HEXACO Model of Personality.

PubMed

de Vries, Reinout E; Wawoe, Kilian W; Holtrop, Djurre

2016-04-01

We tested the hypothesis that proactivity represents the engagement vector in the HEXACO model of personality. Questionnaire data were obtained in five studies, three of which consisted (mostly) of students: Study 1 (N = 188, Mage  = 20.0, 89.4% women), Study 3 (N = 315, Mage  = 20.4, 80.6% women), and Study 4 (N = 309 self-ratings, Mage  = 20.0, 78.3% women; N = 307 other-ratings, Mage  = 24.5, 62.2% women). Participants in the other two studies came from an ISO-certified representative community panel: Study 2 (N = 525, Mage  = 51.2, 52.0% women) and Study 5 (N = 736, Mage  = 42.2, 48.0% women). Proactive Personality and Proactivity were positively related to Extraversion, Conscientiousness, and Openness to Experience, but only weakly related or unrelated to Honesty-Humility, Emotionality, and Agreeableness, supporting the alignment of Proactive Personality/Proactivity with the hypothesized HEXACO engagement vector. Additionally, Proactivity explained incremental variance in self-rated job performance on top of the HEXACO facets that were most closely associated with Proactive Personality/Proactivity, that is, Social Boldness (an Extraversion facet), Diligence (a Conscientiousness facet), and Creativity (an Openness to Experience facet), but not in entrepreneurship and intrapreneurship. Proactivity is the missing engagement link in the HEXACO model of personality. The results are discussed in light of higher-order factors (e.g., general factor of personality and Alpha and Beta) of personality and bandwidth-fidelity controversies. © 2014 Wiley Periodicals, Inc.

Understanding the relationship between proactive and reactive aggression, and cyberbullying across United States and Singapore adolescent samples.

PubMed

Ang, Rebecca P; Huan, Vivien S; Florell, Dan

2014-01-01

This study examined cyberbullying among adolescents across United States and Singapore samples. Specifically, the purpose of the investigation was to study the differential associations between proactive and reactive aggression, and cyberbullying across two cultures. A total of 425 adolescents from the United States (M age = 13 years) and a total of 332 adolescents from Singapore (M age = 14.2 years) participated in the study. Results of the moderator analyses suggested that nationality was not a moderator of the relationship between proactive aggression and cyberbullying, and between reactive aggression and cyberbullying. As expected, findings showed proactive aggression to be positively associated with cyberbullying, after controlling for reactive aggression, across both samples. Likewise, as hypothesized, reactive aggression and cyberbullying was not found to be significant after controlling for proactive aggression across both samples. Implications of these findings were discussed: (a) Proactive aggression is a possible risk factor for both bullying and cyberbullying; (b) proactive and reactive aggression could be argued to be distinct as they have different correlates-only proactive aggression contributed to cyberbullying after controlling for reactive aggression; (c) this research extends previous work and contributes toward cross-cultural work using similar and comparable measures across different samples; and (d) prevention and intervention programs targeted at proactive aggressive adolescents could adopt a two-pronged approach by changing mind sets, and by understanding and adopting a set of rules for Internet etiquette.

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

Acute care clinical pharmacy practice: unit- versus service-based models.

PubMed

Haas, Curtis E; Eckel, Stephen; Arif, Sally; Beringer, Paul M; Blake, Elizabeth W; Lardieri, Allison B; Lobo, Bob L; Mercer, Jessica M; Moye, Pamela; Orlando, Patricia L; Wargo, Kurt

2012-02-01

This commentary from the 2010 Task Force on Acute Care Practice Model of the American College of Clinical Pharmacy was developed to compare and contrast the "unit-based" and "service-based" orientation of the clinical pharmacist within an acute care pharmacy practice model and to offer an informed opinion concerning which should be preferred. The clinical pharmacy practice model must facilitate patient-centered care and therefore must position the pharmacist to be an active member of the interprofessional team focused on providing high-quality pharmaceutical care to the patient. Although both models may have advantages and disadvantages, the most important distinction pertains to the patient care role of the clinical pharmacist. The unit-based pharmacist is often in a position of reacting to an established order or decision and frequently is focused on task-oriented clinical services. By definition, the service-based clinical pharmacist functions as a member of the interprofessional team. As a team member, the pharmacist proactively contributes to the decision-making process and the development of patient-centered care plans. The service-based orientation of the pharmacist is consistent with both the practice vision embraced by ACCP and its definition of clinical pharmacy. The task force strongly recommends that institutions pursue a service-based pharmacy practice model to optimally deploy their clinical pharmacists. Those who elect to adopt this recommendation will face challenges in overcoming several resource, technologic, regulatory, and accreditation barriers. However, such challenges must be confronted if clinical pharmacists are to contribute fully to achieving optimal patient outcomes. © 2012 Pharmacotherapy Publications, Inc.

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

Differences in cortisol response affect the distinction of observed reactive and proactive aggression in children with aggressive behaviour disorders.

PubMed

Kempes, M; de Vries, H; Matthys, W; van Engeland, H; van Hooff, J

2008-01-01

Various researchers distinguished two categories of aggressive behaviour, namely reactive and proactive aggression. Reactive aggression is an aggressive response to a perceived threat or provocation, whereas proactive aggression is behaviour that anticipates a reward. In the present study, including both a sample of disruptive behaviour disordered (DBD) and normal control (NC) children, we observed reactive and proactive aggressive behaviour during an experimental dyadic play session. DBD children showed more observed reactive and proactive aggression. Subsequently, we investigated whether the observed measures correlated with parent-rated measures of reactive and proactive aggression in. We distinguished in both NC and DBD children a subgroup showing a rise in cortisol level, i.e. responders, and a subgroup who did not show a rise in cortisol, i.e. non-responders. Results suggest that differences in the cortisol response affects the correspondence between observed and parent-rated reactive and proactive aggression since only DBD non-responders showed the expected correlations.

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.

Role Breadth Self-Efficacy and Foci of Proactive Behavior: Moderating Role of Collective, Relational, and Individual Self-Concept.

PubMed

Hwang, Pin-Chyuan; Han, Ming-Chuan; Chiu, Su-Fen

2015-01-01

This study aims to identify the interactive effect of role breadth self-efficacy (RBSE) and the three levels of self-concept (collective, relational, and individual) in predicting of different foci of proactive behaviors. Results from 259 matched responses from an airline company in Taiwan showed that RBSE had a positive effect on (1) pro-organizational proactive behavior among those with higher collective self-concept, (2) pro-supervisor proactive behavior among those with higher relational self-concept, and (3) pro-self proactive behavior among those with higher individual self-concept. Our findings provide insights into the moderating role of different levels of self-concept on RBSE-proactive behavior process in terms of specific targets or beneficiaries. Further implications for organizational research and practice are discussed.

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.

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.

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

Ten Years, Forty Decision Aids, And Thousands Of Patient Uses: Shared Decision Making At Massachusetts General Hospital.

PubMed

Sepucha, Karen R; Simmons, Leigh H; Barry, Michael J; Edgman-Levitan, Susan; Licurse, Adam M; Chaguturu, Sreekanth K

2016-04-01

Shared decision making is a core component of population health strategies aimed at improving patient engagement. Massachusetts General Hospital's integration of shared decision making into practice has focused on the following three elements: developing a culture receptive to, and health care providers skilled in, shared decision making conversations; using patient decision aids to help inform and engage patients; and providing infrastructure and resources to support the implementation of shared decision making in practice. In the period 2005-15, more than 900 clinicians and other staff members were trained in shared decision making, and more than 28,000 orders for one of about forty patient decision aids were placed to support informed patient-centered decisions. We profile two different implementation initiatives that increased the use of patient decision aids at the hospital's eighteen adult primary care practices, and we summarize key elements of the shared decision making program. Project HOPE—The People-to-People Health Foundation, Inc.

Role of affect in decision making.

PubMed

Bandyopadhyay, Debarati; Pammi, V S Chandrasekhar; Srinivasan, Narayanan

2013-01-01

Emotion plays a major role in influencing our everyday cognitive and behavioral functions, including decision making. We introduce different ways in which emotions are characterized in terms of the way they influence or elicited by decision making. This chapter discusses different theories that have been proposed to explain the role of emotions in judgment and decision making. We also discuss incidental emotional influences, both long-duration influences like mood and short-duration influences by emotional context present prior to or during decision making. We present and discuss results from a study with emotional pictures presented prior to decision making and how that influences both decision processes and postdecision experience as a function of uncertainty. We conclude with a summary of the work on emotions and decision making in the context of decision-making theories and our work on incidental emotions. Copyright © 2013 Elsevier B.V. All rights reserved.

A decision-making model based on a spiking neural circuit and synaptic plasticity.

PubMed

Wei, Hui; Bu, Yijie; Dai, Dawei

2017-10-01

To adapt to the environment and survive, most animals can control their behaviors by making decisions. The process of decision-making and responding according to cues in the environment is stable, sustainable, and learnable. Understanding how behaviors are regulated by neural circuits and the encoding and decoding mechanisms from stimuli to responses are important goals in neuroscience. From results observed in Drosophila experiments, the underlying decision-making process is discussed, and a neural circuit that implements a two-choice decision-making model is proposed to explain and reproduce the observations. Compared with previous two-choice decision making models, our model uses synaptic plasticity to explain changes in decision output given the same environment. Moreover, biological meanings of parameters of our decision-making model are discussed. In this paper, we explain at the micro-level (i.e., neurons and synapses) how observable decision-making behavior at the macro-level is acquired and achieved.

Neuroanatomical basis for recognition primed decision making.

PubMed

Hudson, Darren

2013-01-01

Effective decision making under time constraints is often overlooked in medical decision making. The recognition primed decision making (RPDM) model was developed by Gary Klein based on previous recognized situations to develop a satisfactory solution to the current problem. Bayes Theorem is the most popular decision making model in medicine but is limited by the need for adequate time to consider all probabilities. Unlike other decision making models, there is a potential neurobiological basis for RPDM. This model has significant implication for health informatics and medical education.

Supporting End of Life Decision Making: Case Studies of Relational Closeness in Supported Decision Making for People with Severe or Profound Intellectual Disability

ERIC Educational Resources Information Center

Watson, Joanne; Wilson, Erin; Hagiliassis, Nick

2017-01-01

Background: The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) promotes the use of supported decision making in lieu of substitute decision making. To date, there has been a lack of focus on supported decision making for people with severe or profound intellectual disability, including for end of life decisions.…

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

PubMed

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

2013-01-01

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

Informed shared decision-making supported by decision coaches for women with ductal carcinoma in situ: study protocol for a cluster randomized controlled trial.

PubMed

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

2015-10-12

Women with breast cancer want to participate in treatment decision-making. Guidelines have confirmed the right of informed shared decision-making. However, previous research has shown that the implementation of informed shared decision-making is suboptimal for reasons of limited resources of physicians, power imbalances between patients and physicians and missing evidence-based patient information. We developed an informed shared decision-making program for women with primary ductal carcinoma in situ (DCIS). The program provides decision coaching for women by specialized nurses and aims at supporting involvement in decision-making and informed choices. In this trial, the informed shared decision-making program will be evaluated in breast care centers. A cluster randomized controlled trial will be conducted to compare the informed shared decision-making program with standard care. The program comprises an evidence-based patient decision aid and training of physicians (2 hours) and specialized breast care and oncology nurses (4 days) in informed shared decision-making. Sixteen certified breast care centers will be included, with 192 women with primary DCIS being recruited. Primary outcome is the extent of patients' involvement in shared decision-making as assessed by the MAPPIN-Odyad (Multifocal approach to the 'sharing' in shared decision-making: observer instrument dyad). Secondary endpoints include the sub-measures of the MAPPIN-inventory (MAPPIN-Onurse, MAPPIN-Ophysician, MAPPIN-Opatient, MAPPIN-Qnurse, MAPPIN-Qpatient and MAPPIN-Qphysician), informed choice, decisional conflict and the duration of encounters. It is expected that decision coaching and the provision of evidence-based patient decision aids will increase patients' involvement in decision-making with informed choices and reduce decisional conflicts and duration of physician encounters. Furthermore, an accompanying process evaluation will be conducted. To our knowledge, this is the first study investigating the implementation of decision coaches in German breast care centers. Current Controlled Trials ISRCTN46305518 , date of registration: 5 June 2015.

Complexity science and participation in decision making among Taiwanese nurses.

PubMed

Liu, Yi

2008-04-01

The perspective of interconnection in complexity science is used to examine the concept of participation in decision making among Taiwanese nurses in the context of Chinese communication culture. Participation in decision making among nurses has been widely discussed and tested in the Western healthcare systems. Many studies have shown that participation in decision making relates to nurses' autonomy, job satisfaction and quality of care. However, participation in decision making has not been fully discussed in Taiwan's nursing community. In a different cultural environment, participation in decision making may have different effects. The concept of participation in decision making is analysed in three facets of Chinese communication culture: (1) hierarchical social relationship; (2) harmony maintenance; and (3) insider effects. Key issues Taiwanese nurses might establish different levels of participation and need to use different strategies to enhance participation in decision making for desired outcomes. While applying participation in decision making in a different context, it is very important to consider the social and cultural differences. Two implications are made. First, nursing leaders/managers who are working with a multicultural team should be aware of the cultural difference in the pattern of interaction in the process of participation in decision making. Second, leaders/managers should be creative and try to apply different strategies to encourage staff's participation in decision making.

A review of clinical decision making: models and current research.

PubMed

Banning, Maggi

2008-01-01

The aim of this paper was to review the current literature clinical decision-making models and the educational application of models to clinical practice. This was achieved by exploring the function and related research of the three available models of clinical decision making: information-processing model, the intuitive-humanist model and the clinical decision-making model. Clinical decision making is a unique process that involves the interplay between knowledge of pre-existing pathological conditions, explicit patient information, nursing care and experiential learning. Historically, two models of clinical decision making are recognized from the literature; the information-processing model and the intuitive-humanist model. The usefulness and application of both models has been examined in relation the provision of nursing care and care related outcomes. More recently a third model of clinical decision making has been proposed. This new multidimensional model contains elements of the information-processing model but also examines patient specific elements that are necessary for cue and pattern recognition. Literature review. Evaluation of the literature generated from MEDLINE, CINAHL, OVID, PUBMED and EBESCO systems and the Internet from 1980 to November 2005. The characteristics of the three models of decision making were identified and the related research discussed. Three approaches to clinical decision making were identified, each having its own attributes and uses. The most recent addition to the clinical decision making is a theoretical, multidimensional model which was developed through an evaluation of current literature and the assessment of a limited number of research studies that focused on the clinical decision-making skills of inexperienced nurses in pseudoclinical settings. The components of this model and the relative merits to clinical practice are discussed. It is proposed that clinical decision making improves as the nurse gains experience of nursing patients within a specific speciality and with experience, nurses gain a sense of saliency in relation to decision making. Experienced nurses may use all three forms of clinical decision making both independently and concurrently to solve nursing-related problems. It is suggested that O'Neill's clinical decision-making model could be tested by educators and experienced nurses to assess the efficacy of this hybrid approach to decision making.

An Evaluation of Deficits in Semantic Cuing, Proactive and Retroactive Interference as Early Features of Alzheimer’s disease

PubMed Central

Crocco, Elizabeth; Curiel, Rosie E.; Acevedo, Amarilis; Czaja, Sara J.; Loewenstein, David A.

2015-01-01

OBJECTIVE To determine the degree to which susceptibility to different types of semantic interference may reflect the earliest manifestations of early Alzheimer disease (AD) beyond the effects of global memory impairment. METHODS Normal elderly (NE) subjects (n= 47), subjects with amnestic mild cognitive impairment (aMCI: n=34) and 40 subjects with probable AD were evaluated using a unique cued recall paradigm that allowed for an evaluation of both proactive and retroactive interference effects while controlling for global memory impairment (LASSI-L procedure). RESULTS Controlling for overall memory impairment, aMCI subjects had much greater proactive and retroactive interference effects than NE subjects. LASSI-L indices of learning using cued recall evidenced high levels of sensitivity and specificity with an overall correct classification rate of 90%. These provided better discrimination than traditional neuropsychological measures of memory function. CONCLUSION The LASSI-L paradigm is unique and unlike other assessments of memory in that items presented for cued recall are explicitly presented, and semantic interference and cuing effects can be assessed while controlling for initial level of memory impairment. This represents a powerful procedure allowing the participant to serve as his or her own control. The high levels of discrimination between subjects with aMCI and normal cognition that exceeded traditional neuropsychological measures makes the LASSI-L worthy of further research in the detection of early AD. PMID:23768680

A proactive approach for managing indoor air quality

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

Greene, R.E.; Casey, J.M.; Williams, P.L.

1997-11-01

Ventilation and maintenance, followed by psychosocial issues, are the factors most often implicated in indoor air quality (IAQ) investigations. The absence of accepted exposure standards and the presence of a wide variety of building designs, ages, ventilation systems, and usages often make IAQ complaint investigations ineffective. Thus, the best approach to achieving IAQ is to prevent problems from occurring. This paper presents the framework for a proactive approach to managing the causes most often implicated in IAQ investigations. It is the aim of this proactive protocol to provide a cost-effective guide for preventing IAQ problems in nonindustrial settings and inmore » buildings for which there are no current IAQ complaints. The proposed protocol focuses on heating, ventilation, and air-conditioning (HVAC) system maintenance and operation; psychosocial factors; and the handling and investigation of complaints. An IAQ manager is designated to implement and manage the protocol. The HVAC system portion of the protocol focuses on proper maintenance of the components often identified as sources of problems in IAQ studies, documentation of the maintenance procedures, and training of individuals responsible for building maintenance. The protocol addresses the psychosocial factors with an environmental survey that rates the occupants` perceptions of the indoor air to identify potential IAQ problems. The psychosocial portion of the protocol also incorporates occupant education and awareness. Finally, a three-step initial investigation procedure for addressing IAQ problems is presented.« less

Data-Based Decision Making in Education: Challenges and Opportunities

ERIC Educational Resources Information Center

Schildkamp, Kim, Ed.; Lai, Mei Kuin, Ed.; Earl, Lorna, Ed.

2013-01-01

In a context where schools are held more and more accountable for the education they provide, data-based decision making has become increasingly important. This book brings together scholars from several countries to examine data-based decision making. Data-based decision making in this book refers to making decisions based on a broad range of…

Decision Support Systems and the Conflict Model of Decision Making: A Stimulus for New Computer-Assisted Careers Guidance Systems.

ERIC Educational Resources Information Center

Ballantine, R. Malcolm

Decision Support Systems (DSSs) are computer-based decision aids to use when making decisions which are partially amenable to rational decision-making procedures but contain elements where intuitive judgment is an essential component. In such situations, DSSs are used to improve the quality of decision-making. The DSS approach is based on Simon's…

Callous-Unemotional Traits, Proactive Aggression, and Treatment Outcomes of Aggressive Children with Attention-Deficit/Hyperactivity Disorder

PubMed Central

Blader, Joseph C.; Pliszka, Steven R.; Kafantaris, Vivian; Foley, Carmel A.; Crowell, Judith A.; Carlson, Gabrielle A.; Sauder, Colin; Margulies, David M.; Sinha, Christa; Sverd, Jeffrey; Matthews, Thomas L.; Bailey, Brigitte Y.; Daviss, W. Burleson

2013-01-01

Objective Stimulant treatment improves impulse control among children with attention-deficit/hyperactivity disorder (ADHD). Decreased aggression often accompanies stimulant pharmacotherapy, suggesting that impulsiveness is integral to their aggressive behavior. However, children with high callous-unemotional (CU) traits and proactive aggression may benefit less from ADHD pharmacotherapy because their aggressive behavior seems more purposeful and deliberate. This study’s objective was to determine if pretreatment CU traits and proactive aggression affect treatment outcomes among aggressive children with ADHD receiving stimulant monotherapy. Method We implemented a stimulant optimization protocol with 160 6- to 13-year-olds (mean [SD] age of 9.31 [2.02] years; 78.75% males) with ADHD, oppositional defiant or conduct disorder, and significant aggressive behavior. Family-focused behavioral intervention was provided concurrently. Primary outcome was the Retrospective Modified Overt Aggression Scale. The Antisocial Process Screening Device and the Aggression Scale, also completed by parents, measured CU traits and proactive aggression, respectively. Analyses examined moderating effects of CU traits and proactive aggression on outcomes. Results 82 children (51%) experienced remission of aggressive behavior. Neither CU traits nor proactive aggression predicted remission (CU traits: odds ratio=0.94, 95% CI=0.80–1.11; proactive aggression, odds ratio=1.05, 95% CI=0.86–1.29). Children whose overall aggression remitted showed decreases in CU traits (effect size=−0.379, 95% CI=−0.60 to −0.16) and proactive aggression (effect size=−0.463, 95% CI=−0.69 to −0.23). Conclusions Findings suggest that pretreatment CU traits and proactive aggression do not forecast worse outcomes for aggressive children with ADHD receiving optimized stimulant pharmacotherapy. With such treatment, CU traits and proactive aggression may decline alongside other behavioral improvements. PMID:24290461

Multiple perspectives on shared decision-making and interprofessional collaboration in mental healthcare.

PubMed

Chong, Wei Wen; Aslani, Parisa; Chen, Timothy F

2013-05-01

Shared decision-making is an essential element of patient-centered care in mental health. Since mental health services involve healthcare providers from different professions, a multiple perspective to shared decision-making may be valuable. The objective of this study was to explore the perceptions of different healthcare professionals on shared decision-making and current interprofessional collaboration in mental healthcare. Semi-structured interviews were conducted with 31 healthcare providers from a range of professions, which included medical practitioners (psychiatrists, general practitioners), pharmacists, nurses, occupational therapists, psychologists and social workers. Findings indicated that healthcare providers supported the notion of shared decision-making in mental health, but felt that it should be condition dependent. Medical practitioners advocated a more active participation from consumers in treatment decision-making; whereas other providers (e.g. pharmacists, occupational therapists) focused more toward acknowledging consumers' needs in decisions, perceiving themselves to be in an advisory role in supporting consumers' decision-making. Although healthcare providers acknowledged the importance of interprofessional collaboration, only a minority discussed it within the context of shared decision-making. In conclusion, healthcare providers appeared to have differing perceptions on the level of consumer involvement in shared decision-making. Interprofessional roles to facilitate shared decision-making in mental health need to be acknowledged, understood and strengthened, before an interprofessional approach to shared decision-making in mental health can be effectively implemented.

Graphic Representations as Tools for Decision Making.

ERIC Educational Resources Information Center

Howard, Judith

2001-01-01

Focuses on the use of graphic representations to enable students to improve their decision making skills in the social studies. Explores three visual aids used in assisting students with decision making: (1) the force field; (2) the decision tree; and (3) the decision making grid. (CMK)

Fertility Preservation in Pediatric and Adolescent Oncology Patients: The Decision-Making Process of Parents.

PubMed

Li, Nancy; Jayasinghe, Yasmin; Kemertzis, Matthew A; Moore, Paddy; Peate, Michelle

2017-06-01

Decisions surrounding fertility preservation (FP) in children, adolescents, and adults can be difficult due to the distress of a cancer diagnosis, time constraints for decision-making, and lack of efficacy data. This review examines the decision-making process of oncology patients and their parents (if patients are in the pediatric or adolescent population) to better understand experiences of decisional conflict and regret. Two electronic databases, Embase and Pubmed, were searched using the terms (Decision-making OR Conflict (Psychology) OR Decision regret) AND (Freezing OR Oocyte OR Ovarian tissue OR Semen preservation OR Fertility preservation OR Cryopreservation) AND (Neoplasms OR Cancer OR Chemotherapy OR Drug therapy OR Radiotherapy). Medical Subject Heading terms were utilized where possible. Included articles discussed FP decision-making from the patient's perspective. Thirty-five articles discussing FP decision-making were included (24 in the adult population, 11 in the pediatric and adolescent population). Key themes from these articles included the following: factors considered in FP decision-making, decision-making in established procedures and experimental procedures, decisional conflict and regret, the perceived importance of information, adolescent involvement in decision-making, and ethical considerations in the pediatric population. Unique ethical issues arise in the pediatric and adolescent population. Considering that the decision to pursue FP is known to be difficult in the adult population, decisional conflict and regret may be greater for parents who are making the decision for their child.

Development of an instrument to understand the child protective services decision-making process, with a focus on placement decisions.

PubMed

Dettlaff, Alan J; Christopher Graham, J; Holzman, Jesse; Baumann, Donald J; Fluke, John D

2015-11-01

When children come to the attention of the child welfare system, they become involved in a decision-making process in which decisions are made that have a significant effect on their future and well-being. The decision to remove children from their families is particularly complex; yet surprisingly little is understood about this decision-making process. This paper presents the results of a study to develop an instrument to explore, at the caseworker level, the context of the removal decision, with the objective of understanding the influence of the individual and organizational factors on this decision, drawing from the Decision Making Ecology as the underlying rationale for obtaining the measures. The instrument was based on the development of decision-making scales used in prior decision-making studies and administered to child protection caseworkers in several states. Analyses included reliability analyses, principal components analyses, and inter-correlations among the resulting scales. For one scale regarding removal decisions, a principal components analysis resulted in the extraction of two components, jointly identified as caseworkers' decision-making orientation, described as (1) an internal reference to decision-making and (2) an external reference to decision-making. Reliability analyses demonstrated acceptable to high internal consistency for 9 of the 11 scales. Full details of the reliability analyses, principal components analyses, and inter-correlations among the seven scales are discussed, along with implications for practice and the utility of this instrument to support the understanding of decision-making in child welfare. Copyright © 2015 Elsevier Ltd. All rights reserved.

National Evidence on the Use of Shared Decision Making in Prostate-Specific Antigen Screening

PubMed Central

Han, Paul K. J.; Kobrin, Sarah; Breen, Nancy; Joseph, Djenaba A.; Li, Jun; Frosch, Dominick L.; Klabunde, Carrie N.

2013-01-01

PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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. PMID:23835816

Shared decision making in chronic care in the context of evidence based practice in nursing.

PubMed

Friesen-Storms, Jolanda H H M; Bours, Gerrie J J W; van der Weijden, Trudy; Beurskens, Anna J H M

2015-01-01

In the decision-making environment of evidence-based practice, the following three sources of information must be integrated: research evidence of the intervention, clinical expertise, and the patient's values. In reality, evidence-based practice usually focuses on research evidence (which may be translated into clinical practice guidelines) and clinical expertise without considering the individual patient's values. The shared decision-making model seems to be helpful in the integration of the individual patient's values in evidence-based practice. We aim to discuss the relevance of shared decision making in chronic care and to suggest how it can be integrated with evidence-based practice in nursing. We start by describing the following three possible approaches to guide the decision-making process: the paternalistic approach, the informed approach, and the shared decision-making approach. Implementation of shared decision making has gained considerable interest in cases lacking a strong best-treatment recommendation, and when the available treatment options are equivalent to some extent. We discuss that in chronic care it is important to always invite the patient to participate in the decision-making process. We delineate the following six attributes of health care interventions in chronic care that influence the degree of shared decision making: the level of research evidence, the number of available intervention options, the burden of side effects, the impact on lifestyle, the patient group values, and the impact on resources. Furthermore, the patient's willingness to participate in shared decision making, the clinical expertise of the nurse, and the context in which the decision making takes place affect the shared decision-making process. A knowledgeable and skilled nurse with a positive attitude towards shared decision making—integrated with evidence-based practice—can facilitate the shared decision-making process. We conclude that nurses as well as other health care professionals in chronic care should integrate shared decision making with evidence-based practice to deliver patient-centred care. Copyright © 2014 Elsevier Ltd. All rights reserved.

Proactivity in VTE prevention: a concept analysis.

PubMed

Adams, Averil

Venous thromboembolism (VTE) prevention is an international patient safety issue. The author has observed gaps in prescription and provision of VTE prophylaxis, and that the attitude to VTE is often reactive rather than proactive. This concept analysis aims to explore proactivity and apply it to VTE prevention to address this. Ten databases were searched (1992-2012) using the keywords proactive, proactivity, nurse, nursing, VTE/venous thromboembolism, prevent/prevention/preventing, behaviour, DVT/PE (deep vein thrombosis, pulmonary embolism). The Walker and Avant (2010) method of concept analysis identified the defining attributes as personal initiative, taking charge and feedback-seeking behaviour. Antecedents and consequences have been identified, and empirical referents are demonstrated. Defining proactivity in VTE prevention has the potential to increase prescription and, crucially, provision of prophylaxis, thereby improving patient care, reducing avoidable harm and improving the patient experience.

Proactive aggression in early school-aged children with externalizing behavior problems: A longitudinal study on the influence of empathy in response to distress.

PubMed

Deschamps, Peter K; Verhulp, Esmee E; de Castro, Bram Orobio; Matthys, Walter

2018-01-01

The course of proactive aggressive behavior may be affected by empathy in response to sadness and distress of others. The aim of the current study is to examine empathy in response to sadness and distress and its relation to proactive and reactive aggression in a clinical sample of children with externalizing behavior problems. At baseline (T1) and 12 months later (T2), parents and teachers of 104 six- and seven-year-old children completed the Instrument for Reactive and Proactive Aggression. At T1, parents and teachers also reported empathy in response to sadness and distress on the Griffith Empathy Measure. Findings show that low levels of parent-reported empathy at baseline were specifically associated with high parent-reported proactive aggression but not with reactive aggression. Similarly, low teacher-reported empathy was specifically related to high teacher-reported proactive aggression. Furthermore, high parent-reported but not teacher-reported empathy at baseline was associated with low proactive aggression at 12 months after controlling for proactive aggression at baseline. The conclusions support the notion that in the study of the course of aggression in clinical groups, the distinction between proactive and reactive aggression as well as the study of empathy in response to distress is relevant for a better understanding and might be taken into account in the development of future interventions. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Risk-taking and decision-making in youth: relationships to addiction vulnerability.

PubMed

Balogh, Kornelia N; Mayes, Linda C; Potenza, Marc N

2013-03-01

Decision-making and risk-taking behavior undergo developmental changes during adolescence. Disadvantageous decision-making and increased risk-taking may lead to problematic behaviors such as substance use and abuse, pathological gambling and excessive internet use. Based on MEDLINE searches, this article reviews the literature on decision-making and risk-taking and their relationship to addiction vulnerability in youth. Decision-making and risk-taking behaviors involve brain areas that undergoing developmental changes during puberty and young adulthood. Individual differences and peer pressure also relate importantly to decision-making and risk-taking. Brain-based changes in emotional, motivational and cognitive processing may underlie risk-taking and decision-making propensities in adolescence, making this period a time of heightened vulnerability for engagement in additive behaviors.

Satisfaction with treatment decision-making and treatment regret among Latinas and non-Latina whites with DCIS

PubMed Central

López, Mónica E.; Kaplan, Celia P.; Nápoles, Anna M.; Hwang, E. Shelly; Livaudais, Jennifer C.; Karliner, Leah S.

2013-01-01

Objective To examine differences in treatment decision-making participation, satisfaction, and regret among Latinas and non-Latina whites with DCIS. Methods Survey of Latina and non-Latina white women diagnosed with DCIS. We assessed women’s preferences for involvement in decision-making, primary treatment decision maker, and participatory decision-making. We examined primary outcomes of satisfaction with treatment decision-making and treatment regret by ethnic-language group. Results Among 745 participants (349 Latinas, 396 white) Spanish-speaking Latinas (SSL) had the highest mean preference for involvement in decision-making score and the lowest mean participatory decision-making score and were more likely to defer their final treatment decision to their physicians than English-speaking Latinas or whites (26%, 13%, 18%, p<.05). SSLs reported lower satisfaction with treatment decision-making (OR 0.4; CI 95%, 0.2-0.8) and expressed more regret than whites (OR 6.2; CI 95%, 3.0-12.4). More participatory decision-making increased the odds of satisfaction (OR 1.5; CI 95%, 1.3-1.8) and decreased the odds of treatment regret (OR 0.8; CI 95%, 0.7-1.0), independent of ethnicity-language. Conclusion Language barriers impede the establishment of decision-making partnerships between Latinas and their physicians, and result in less satisfaction with the decision-making process and more treatment regret. Practice Implications Use of professional interpreters may address communication-related disparities for these women. PMID:24207116

Satisfaction with treatment decision-making and treatment regret among Latinas and non-Latina whites with DCIS.

PubMed

López, Mónica E; Kaplan, Celia P; Nápoles, Anna M; Hwang, E Shelley; Livaudais, Jennifer C; Karliner, Leah S

2014-01-01

To examine differences in treatment decision-making participation, satisfaction, and regret among Latinas and non-Latina whites with DCIS. Survey of Latina and non-Latina white women diagnosed with DCIS. We assessed women's preferences for involvement in decision-making, primary treatment decision maker, and participatory decision-making. We examined primary outcomes of satisfaction with treatment decision-making and treatment regret by ethnic-language group. Among 745 participants (349 Latinas, 396 white) Spanish-speaking Latinas (SSL) had the highest mean preference for involvement in decision-making score and the lowest mean participatory decision-making score and were more likely to defer their final treatment decision to their physicians than English-speaking Latinas or whites (26%, 13%, 18%, p<0.05). SSLs reported lower satisfaction with treatment decision-making (OR 0.4; CI 95%, 0.2-0.8) and expressed more regret than whites (OR 6.2; CI 95%, 3.0-12.4). More participatory decision-making increased the odds of satisfaction (OR 1.5; CI 95%, 1.3-1.8) and decreased the odds of treatment regret (OR 0.8; CI 95%, 0.7-1.0), independent of ethnicity-language. Language barriers impede the establishment of decision-making partnerships between Latinas and their physicians, and result in less satisfaction with the decision-making process and more treatment regret. Use of professional interpreters may address communication-related disparities for these women. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Narrative Interest Standard: A Novel Approach to Surrogate Decision-Making for People With Dementia.

PubMed

Wilkins, James M

2017-06-17

Dementia is a common neurodegenerative process that can significantly impair decision-making capacity as the disease progresses. When a person is found to lack capacity to make a decision, a surrogate decision-maker is generally sought to aid in decision-making. Typical bases for surrogate decision-making include the substituted judgment standard and the best interest standard. Given the heterogeneous and progressive course of dementia, however, these standards for surrogate decision-making are often insufficient in providing guidance for the decision-making for a person with dementia, escalating the likelihood of conflict in these decisions. In this article, the narrative interest standard is presented as a novel and more appropriate approach to surrogate decision-making for people with dementia. Through case presentation and ethical analysis, the standard mechanisms for surrogate decision-making for people with dementia are reviewed and critiqued. The narrative interest standard is then introduced and discussed as a dementia-specific model for surrogate decision-making. Through incorporation of elements of a best interest standard in focusing on the current benefit-burden ratio and elements of narrative to provide context, history, and flexibility for values and preferences that may change over time, the narrative interest standard allows for elaboration of an enriched context for surrogate decision-making for people with dementia. More importantly, however, a narrative approach encourages the direct contribution from people with dementia in authoring the story of what matters to them in their lives.

Development of shared decision-making resources to help inform difficult healthcare decisions: An example focused on dysvascular partial foot and transtibial amputations.

PubMed

Quigley, Matthew; Dillon, Michael P; Fatone, Stefania

2018-02-01

Shared decision making is a consultative process designed to encourage patient participation in decision making by providing accurate information about the treatment options and supporting deliberation with the clinicians about treatment options. The process can be supported by resources such as decision aids and discussion guides designed to inform and facilitate often difficult conversations. As this process increases in use, there is opportunity to raise awareness of shared decision making and the international standards used to guide the development of quality resources for use in areas of prosthetic/orthotic care. To describe the process used to develop shared decision-making resources, using an illustrative example focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Development process: The International Patient Decision Aid Standards were used to guide the development of the decision aid and discussion guide focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Examples from these shared decision-making resources help illuminate the stages of development including scoping and design, research synthesis, iterative development of a prototype, and preliminary testing with patients and clinicians not involved in the development process. Lessons learnt through the process, such as using the International Patient Decision Aid Standards checklist and development guidelines, may help inform others wanting to develop similar shared decision-making resources given the applicability of shared decision making to many areas of prosthetic-/orthotic-related practice. Clinical relevance Shared decision making is a process designed to guide conversations that help patients make an informed decision about their healthcare. Raising awareness of shared decision making and the international standards for development of high-quality decision aids and discussion guides is important as the approach is introduced in prosthetic-/orthotic-related practice.

The involvement of the striatum in decision making

PubMed Central

Goulet-Kennedy, Julie; Labbe, Sara; Fecteau, Shirley

2016-01-01

Decision making has been extensively studied in the context of economics and from a group perspective, but still little is known on individual decision making. Here we discuss the different cognitive processes involved in decision making and its associated neural substrates. The putative conductors in decision making appear to be the prefrontal cortex and the striatum. Impaired decision-making skills in various clinical populations have been associated with activity in the prefrontal cortex and in the striatum. We highlight the importance of strengthening the degree of integration of both cognitive and neural substrates in order to further our understanding of decision-making skills. In terms of cognitive paradigms, there is a need to improve the ecological value of experimental tasks that assess decision making in various contexts and with rewards; this would help translate laboratory learnings into real-life benefits. In terms of neural substrates, the use of neuroimaging techniques helps characterize the neural networks associated with decision making; more recently, ways to modulate brain activity, such as in the prefrontal cortex and connected regions (eg, striatum), with noninvasive brain stimulation have also shed light on the neural and cognitive substrates of decision making. Together, these cognitive and neural approaches might be useful for patients with impaired decision-making skills. The drive behind this line of work is that decision-making abilities underlie important aspects of wellness, health, security, and financial and social choices in our daily lives. PMID:27069380

Mild cognitive impairment is associated with poorer decision-making in community-based older persons.

PubMed

Han, S Duke; Boyle, Patricia A; James, Bryan D; Yu, Lei; Bennett, David A

2015-04-01

To test the hypothesis that mild cognitive impairment (MCI) is associated with poorer financial and healthcare decision-making. Community-based epidemiological cohort study. Communities throughout northeastern Illinois. Older persons without dementia from the Rush Memory and Aging Project (N = 730). All participants underwent a detailed clinical evaluation and decision-making assessment using a measure that closely approximates materials used in real-world financial and healthcare settings. This allowed for measurement of total decision-making and financial and healthcare decision-making. Regression models were used to examine whether MCI was associated with a lower level of decision-making. In subsequent analyses, the relationship between specific cognitive systems (episodic memory, semantic memory, working memory, perceptual speed, visuospatial ability) and decision-making was explored in participants with MCI. MCI was associated with lower total, financial, and healthcare decision-making scores after accounting for the effects of age, education, and sex. The effect of MCI on total decision-making was equivalent to the effect of more than 10 additional years of age. Additional models showed that, when considering multiple cognitive systems, perceptual speed accounted for the most variance in decision-making in participants with MCI. Persons with MCI may have poorer financial and healthcare decision-making in real-world situations, and perceptual speed may be an important contributor to poorer decision-making in persons with MCI. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Understanding shared decision making in pediatric otolaryngology.

PubMed

Chorney, Jill; Haworth, Rebecca; Graham, M Elise; Ritchie, Krista; Curran, Janet A; Hong, Paul

2015-05-01

The aim of this study was to describe the level of decisional conflict experienced by parents considering surgery for their children and to determine if decisional conflict and perceptions of shared decision making are related. Prospective cohort study. Academic pediatric otolaryngology clinic. Sixty-five consecutive parents of children who underwent surgical consultation for elective otolaryngological procedures were prospectively enrolled. Participants completed the Shared Decision Making Questionnaire and the Decisional Conflict Scale. Surgeons completed the Shared Decision Making Questionnaire-Physician version. Eleven participants (16.9%) scored over 25 on the Decisional Conflict Scale, a previously defined clinical cutoff indicating significant decisional conflict. Parent years of education and parent ratings of shared decision making were significantly correlated with decisional conflict (positively and negatively correlated, respectively). A logistic regression indicated that shared decision making but not education predicted the presence of significant decisional conflict. Parent and physician ratings of shared decision making were not related, and there was no correlation between physician ratings of shared decision making and parental decisional conflict. Many parents experienced considerable decisional conflict when making decisions about their child's surgical treatment. Parents who perceived themselves as being more involved in the decision-making process reported less decisional conflict. Parents and physicians had different perceptions of shared decision making. Future research should develop and assess interventions to increase parents' involvement in decision making and explore the impact of significant decisional conflict on health outcomes. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.

Navigating the Decision Space: Shared Medical Decision Making as Distributed Cognition.

PubMed

Lippa, Katherine D; Feufel, Markus A; Robinson, F Eric; Shalin, Valerie L

2017-06-01

Despite increasing prominence, little is known about the cognitive processes underlying shared decision making. To investigate these processes, we conceptualize shared decision making as a form of distributed cognition. We introduce a Decision Space Model to identify physical and social influences on decision making. Using field observations and interviews, we demonstrate that patients and physicians in both acute and chronic care consider these influences when identifying the need for a decision, searching for decision parameters, making actionable decisions Based on the distribution of access to information and actions, we then identify four related patterns: physician dominated; physician-defined, patient-made; patient-defined, physician-made; and patient-dominated decisions. Results suggests that (a) decision making is necessarily distributed between physicians and patients, (b) differential access to information and action over time requires participants to transform a distributed task into a shared decision, and (c) adverse outcomes may result from failures to integrate physician and patient reasoning. Our analysis unifies disparate findings in the medical decision-making literature and has implications for improving care and medical training.

Theories of Health Care Decision Making at the End of Life: A Meta-Ethnography.

PubMed

Kim, Kyounghae; Heinze, Katherine; Xu, Jiayun; Kurtz, Melissa; Park, Hyunjeong; Foradori, Megan; Nolan, Marie T

2017-08-01

The aim of this meta-ethnography is to appraise the types and uses of theories relative to end-of-life decision making and to develop a conceptual framework to describe end-of-life decision making among patients with advanced cancers, heart failure, and amyotrophic lateral sclerosis (ALS) and their caregivers or providers. We used PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to extract English-language articles published between January 2002 and April 2015. Forty-three articles were included. The most common theories included decision-making models ( n = 14) followed by family-centered ( n = 11) and behavioral change models ( n = 7). A conceptual framework was developed using themes including context of decision making, communication and negotiation of decision making, characteristics of decision makers, goals of decision making, options and alternatives, and outcomes. Future research should enhance and apply these theories to guide research to develop patient-centered decision-making programs that facilitate informed and shared decision making at the end of life among patients with advanced illness and their caregivers.

Supporting end of life decision making: Case studies of relational closeness in supported decision making for people with severe or profound intellectual disability.

PubMed

Watson, Joanne; Wilson, Erin; Hagiliassis, Nick

2017-11-01

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) promotes the use of supported decision making in lieu of substitute decision making. To date, there has been a lack of focus on supported decision making for people with severe or profound intellectual disability, including for end of life decisions. Five people with severe or profound intellectual disability's experiences of supported decision making were examined. This article is particularly focused on one participant's experiences at the end of his life. All five case studies identified that supporters were most effective in providing decision-making support for participants when they were relationally close to the person and had knowledge of the person's life story, particularly in relation to events that demonstrated preference. Findings from this study provide new understandings of supported decision making for people with severe or profound intellectual disability and have particular relevance for supporting decision making at the end of life. © 2017 John Wiley & Sons Ltd.

Adapting Scott and Bruce's General Decision-Making Style Inventory to Patient Decision Making in Provider Choice.

PubMed

Fischer, Sophia; Soyez, Katja; Gurtner, Sebastian

2015-05-01

Research testing the concept of decision-making styles in specific contexts such as health care-related choices is missing. Therefore, we examine the contextuality of Scott and Bruce's (1995) General Decision-Making Style Inventory with respect to patient choice situations. Scott and Bruce's scale was adapted for use as a patient decision-making style inventory. In total, 388 German patients who underwent elective joint surgery responded to a questionnaire about their provider choice. Confirmatory factor analyses within 2 independent samples assessed factorial structure, reliability, and validity of the scale. The final 4-dimensional, 13-item patient decision-making style inventory showed satisfactory psychometric properties. Data analyses supported reliability and construct validity. Besides the intuitive, dependent, and avoidant style, a new subdimension, called "comparative" decision-making style, emerged that originated from the rational dimension of the general model. This research provides evidence for the contextuality of decision-making style to specific choice situations. Using a limited set of indicators, this report proposes the patient decision-making style inventory as valid and feasible tool to assess patients' decision propensities. © The Author(s) 2015.

A Review of Shared Decision-Making and Patient Decision Aids in Radiation Oncology.

PubMed

Woodhouse, Kristina Demas; Tremont, Katie; Vachani, Anil; Schapira, Marilyn M; Vapiwala, Neha; Simone, Charles B; Berman, Abigail T

2017-06-01

Cancer treatment decisions are complex and may be challenging for patients, as multiple treatment options can often be reasonably considered. As a result, decisional support tools have been developed to assist patients in the decision-making process. A commonly used intervention to facilitate shared decision-making is a decision aid, which provides evidence-based outcomes information and guides patients towards choosing the treatment option that best aligns with their preferences and values. To ensure high quality, systematic frameworks and standards have been proposed for the development of an optimal aid for decision making. Studies have examined the impact of these tools on facilitating treatment decisions and improving decision-related outcomes. In radiation oncology, randomized controlled trials have demonstrated that decision aids have the potential to improve patient outcomes, including increased knowledge about treatment options and decreased decisional conflict with decision-making. This article provides an overview of the shared-decision making process and summarizes the development, validation, and implementation of decision aids as patient educational tools in radiation oncology. Finally, this article reviews the findings from decision aid studies in radiation oncology and offers various strategies to effectively implement shared decision-making into clinical practice.

Frequencies of decision making and monitoring in adaptive resource management

PubMed Central

Johnson, Fred A.

2017-01-01

Adaptive management involves learning-oriented decision making in the presence of uncertainty about the responses of a resource system to management. It is implemented through an iterative sequence of decision making, monitoring and assessment of system responses, and incorporating what is learned into future decision making. Decision making at each point is informed by a value or objective function, for example total harvest anticipated over some time frame. The value function expresses the value associated with decisions, and it is influenced by system status as updated through monitoring. Often, decision making follows shortly after a monitoring event. However, it is certainly possible for the cadence of decision making to differ from that of monitoring. In this paper we consider different combinations of annual and biennial decision making, along with annual and biennial monitoring. With biennial decision making decisions are changed only every other year; with biennial monitoring field data are collected only every other year. Different cadences of decision making combine with annual and biennial monitoring to define 4 scenarios. Under each scenario we describe optimal valuations for active and passive adaptive decision making. We highlight patterns in valuation among scenarios, depending on the occurrence of monitoring and decision making events. Differences between years are tied to the fact that every other year a new decision can be made no matter what the scenario, and state information is available to inform that decision. In the subsequent year, however, in 3 of the 4 scenarios either a decision is repeated or monitoring does not occur (or both). There are substantive differences in optimal values among the scenarios, as well as the optimal policies producing those values. Especially noteworthy is the influence of monitoring cadence on valuation in some years. We highlight patterns in policy and valuation among the scenarios, and discuss management implications and extensions. PMID:28800591

Frequencies of decision making and monitoring in adaptive resource management

USGS Publications Warehouse

Williams, Byron K.; Johnson, Fred A.

2017-01-01

Adaptive management involves learning-oriented decision making in the presence of uncertainty about the responses of a resource system to management. It is implemented through an iterative sequence of decision making, monitoring and assessment of system responses, and incorporating what is learned into future decision making. Decision making at each point is informed by a value or objective function, for example total harvest anticipated over some time frame. The value function expresses the value associated with decisions, and it is influenced by system status as updated through monitoring. Often, decision making follows shortly after a monitoring event. However, it is certainly possible for the cadence of decision making to differ from that of monitoring. In this paper we consider different combinations of annual and biennial decision making, along with annual and biennial monitoring. With biennial decision making decisions are changed only every other year; with biennial monitoring field data are collected only every other year. Different cadences of decision making combine with annual and biennial monitoring to define 4 scenarios. Under each scenario we describe optimal valuations for active and passive adaptive decision making. We highlight patterns in valuation among scenarios, depending on the occurrence of monitoring and decision making events. Differences between years are tied to the fact that every other year a new decision can be made no matter what the scenario, and state information is available to inform that decision. In the subsequent year, however, in 3 of the 4 scenarios either a decision is repeated or monitoring does not occur (or both). There are substantive differences in optimal values among the scenarios, as well as the optimal policies producing those values. Especially noteworthy is the influence of monitoring cadence on valuation in some years. We highlight patterns in policy and valuation among the scenarios, and discuss management implications and extensions.

36 CFR 907.14 - Corporation decision making procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

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

Decision making from economic and signal detection perspectives: development of an integrated framework

PubMed Central

Lynn, Spencer K.; Wormwood, Jolie B.; Barrett, Lisa F.; Quigley, Karen S.

2015-01-01

Behavior is comprised of decisions made from moment to moment (i.e., to respond one way or another). Often, the decision maker cannot be certain of the value to be accrued from the decision (i.e., the outcome value). Decisions made under outcome value uncertainty form the basis of the economic framework of decision making. Behavior is also based on perception—perception of the external physical world and of the internal bodily milieu, which both provide cues that guide decision making. These perceptual signals are also often uncertain: another person's scowling facial expression may indicate threat or intense concentration, alternatives that require different responses from the perceiver. Decisions made under perceptual uncertainty form the basis of the signals framework of decision making. Traditional behavioral economic approaches to decision making focus on the uncertainty that comes from variability in possible outcome values, and typically ignore the influence of perceptual uncertainty. Conversely, traditional signal detection approaches to decision making focus on the uncertainty that arises from variability in perceptual signals and typically ignore the influence of outcome value uncertainty. Here, we compare and contrast the economic and signals frameworks that guide research in decision making, with the aim of promoting their integration. We show that an integrated framework can expand our ability to understand a wider variety of decision-making behaviors, in particular the complexly determined real-world decisions we all make every day. PMID:26217275

Factor Structure of the Reactive-Proactive Aggression Questionnaire in Turkish Children and Gender, Grade-Level, and Socioeconomic Status Differences in Reactive and Proactive Aggression

ERIC Educational Resources Information Center

Uz Bas, Asli; Yurdabakan, Irfan

2012-01-01

The present study aimed to evaluate the factor structure of the Reactive-Proactive Aggression Questionnaire (RPQ) with Turkish children, and to investigate gender, grade-level, and socioeconomic status (SES) differences in reactive and proactive aggression. Participants consisted of 1,081 Turkish children (544 boys and 537 girls) aged 9 to 14…

Genital surgery for disorders of sex development: implementing a shared decision-making approach.

PubMed

Karkazis, Katrina; Tamar-Mattis, Anne; Kon, Alexander A

2010-08-01

Ongoing controversy surrounds early genital surgery for children with disorders of sex development, making decisions about these procedures extraordinarily complex. Professional organizations have encouraged healthcare providers to adopt shared decision-making due to its broad potential to improve the decision-making process, perhaps most so when data are lacking, when there is no clear "best-choice" treatment, when decisions involve more than one choice, where each choice has both advantages and disadvantages, and where the ranking of options depends heavily on the decision-maker's values. We present a 6-step model for shared decision-making in decisions about genital surgery for disorders of sex development: (1) Set the stage and develop an appropriate team; (2) Establish preferences for information and roles in decision-making; (3) Perceive and address emotions; (4) Define concerns and values; (5) Identify options and present evidence; and (6) Share responsibility for making a decision. As long as controversy persists regarding surgery for DSD, an SDM process can facilitate the increased sharing of relevant information essential for making important health care decisions.

Real-life decision making in college students. II: Do individual differences show reliable effects?

PubMed

Galotti, Kathleen M; Tandler, Jane M; Wiener, Hillary J D

2014-01-01

First-year undergraduates participated in a short-term longitudinal study of real-life decision making over their first 14 months of college. They were surveyed about 7 different decisions: choosing courses for upcoming terms (on 3 different occasions), choosing an academic major (twice), planning for the upcoming summer, and planning for sophomore-year housing. They also completed a survey of self-reported decision-making styles and the Need for Cognition survey (Cacioppo & Petty, 1982) to assess their focus on rationality and enjoyment of analytic thinking. Results showed few statistically significant correlations between stylistic measures and behavioral measures of decision making, in either the amount of information considered or the way in which the information integration tracked predictions of linear models of decision making applied to each participant's data. However, there were consistent correlations, across the 7 decisions, between stylistic measures and affective reactions to, or retrospective descriptions of, episodes of decision making. We suggest that decision-making styles instruments may better reflect the construction of narratives of self as a decision maker more than they do actual behavior during decision making.

Are Empowered Employees More Proactive? The Contingency of How They Evaluate Their Leader

PubMed Central

Yin, Kui; Xing, Lu; Li, Can; Guo, Yungui

2017-01-01

Finding ways to enhance employee proactive behavior is a focal concern for academics and practitioners. Previous studies have found a positive association between empowering leadership and proactive behavior (Martin et al., 2013; Li et al., 2017). However, these studies lack elaboration on mechanisms and do not rule out the effect of employees’ proactive personality during empirical testing. We investigate empowering leadership from individual perspective due to the variation of empowerment levels even in the same team. Our research proposes a more elaborated theoretical model that explains why, and when, empowering leadership might promote employee proactive behavior. Specifically, we examine mediating mechanisms based on social cognitive theory and propose trust in leader competency as boundary condition. Using a sample of 280 leader–follower dyads from a large state-owned Chinese company, our results revealed that (1) empowering leadership was positively related to proactive behavior, with role breadth self-efficacy acting as a mediator for this relationship; (2) employees’ trust in leader competency moderated both the empowering leadership–subordinate proactive behavior relationship and the mediating effect of role breadth self-efficacy, such that the empowering leadership–subordinate proactive behavior relationship was weaker, and the mediating effect of role breadth self-efficacy was stronger, for employees with high levels of trust in leader competency. PMID:29163249

Are Empowered Employees More Proactive? The Contingency of How They Evaluate Their Leader.

PubMed

Yin, Kui; Xing, Lu; Li, Can; Guo, Yungui

2017-01-01

Finding ways to enhance employee proactive behavior is a focal concern for academics and practitioners. Previous studies have found a positive association between empowering leadership and proactive behavior (Martin et al., 2013; Li et al., 2017). However, these studies lack elaboration on mechanisms and do not rule out the effect of employees' proactive personality during empirical testing. We investigate empowering leadership from individual perspective due to the variation of empowerment levels even in the same team. Our research proposes a more elaborated theoretical model that explains why, and when, empowering leadership might promote employee proactive behavior. Specifically, we examine mediating mechanisms based on social cognitive theory and propose trust in leader competency as boundary condition. Using a sample of 280 leader-follower dyads from a large state-owned Chinese company, our results revealed that (1) empowering leadership was positively related to proactive behavior, with role breadth self-efficacy acting as a mediator for this relationship; (2) employees' trust in leader competency moderated both the empowering leadership-subordinate proactive behavior relationship and the mediating effect of role breadth self-efficacy, such that the empowering leadership-subordinate proactive behavior relationship was weaker, and the mediating effect of role breadth self-efficacy was stronger, for employees with high levels of trust in leader competency.

Proactivity despite discouraging supervisors: The powerful role of prosocial motivation.

PubMed

Lebel, R David; Patil, Shefali V

2018-03-26

Although considerable research demonstrates that employees are unlikely to be proactive when they view their supervisors as discouraging this type of behavior, we challenge the assumption that this is true for all employees. Drawing on motivated information processing theory, we argue that prosocial motivation can spark employees to be proactive even when supervisors are perceived as discouraging. Specifically, prosocial motivation may weaken the negative relationship between perceived discouraging supervisor behaviors and proactivity by driving employees to bring about change to impact coworkers or the organization. Because they are less focused on self-interest and more focused on benefitting others, prosocially motivated employees are able to maintain their reason-to (felt responsibility for change) and can-do (efficacy to be proactive) motivation even when supervisors do not welcome proactivity. We test our hypotheses across three studies, using multisource data from employees and supervisors in two organizations (Studies 1a and 1b), and lagged data from employees working in a range of industries (Study 2). By identifying the mechanisms driving prosocially motivated employees to be proactive despite having supervisors who are perceived to be discouraging, we offer novel theoretical and practical insights regarding the effects of context on proactivity at work. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Development of a model to guide decision making in amyotrophic lateral sclerosis multidisciplinary care.

PubMed

Hogden, Anne; Greenfield, David; Nugus, Peter; Kiernan, Matthew C

2015-10-01

Patients with amyotrophic lateral sclerosis (ALS) face numerous decisions for symptom management and quality of life. Models of decision making in chronic disease and cancer care are insufficient for the complex and changing needs of patients with ALS . The aim was to examine the question: how can decision making that is both effective and patient-centred be enacted in ALS multidisciplinary care? Fifty-four respondents (32 health professionals, 14 patients and eight carers) from two specialized ALS multidisciplinary clinics participated in semi-structured interviews. Interviews were transcribed, coded and analysed thematically. Comparison of stakeholder perspectives revealed six key themes of ALS decision making. These were the decision-making process; patient-centred focus; timing and planning; information sources; engagement with specialized ALS services; and access to non-specialized services. A model, embedded in the specialized ALS multidisciplinary clinic, was derived to guide patient decision making. The model is cyclic, with four stages: 'Participant Engagement'; 'Option Information'; 'Option Deliberation'; and 'Decision Implementation'. Effective and patient-centred decision making is enhanced by the structure of the specialized ALS clinic, which promotes patients' symptom management and quality of life goals. However, patient and carer engagement in ALS decision making is tested by the dynamic nature of ALS, and patient and family distress. Our model optimizes patient-centred decision making, by incorporating patients' cyclic decision-making patterns and facilitating carer inclusion in decision processes. The model captures the complexities of patient-centred decision making in ALS. The framework can assist patients and carers, health professionals, researchers and policymakers in this challenging disease environment. © 2013 John Wiley & Sons Ltd.

What is a good medical decision? A research agenda guided by perspectives from multiple stakeholders

PubMed Central

Hamilton, Jada G.; Lillie, Sarah E.; Alden, Dana L.; Scherer, Laura; Oser, Megan; Rini, Christine; Tanaka, Miho; Baleix, John; Brewster, Mikki; Lee, Simon Craddock; Goldstein, Mary K.; Jacobson, Robert M.; Myers, Ronald E.; Zikmund-Fisher, Brian J.; Waters, Erika A.

2016-01-01

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. PMID:27566316

Proactive pavement asset management with climate change aspects

NASA Astrophysics Data System (ADS)

Zofka, Adam

2018-05-01

Pavement Asset Management System is a systematic and objective tool to manage pavement network based on the rational, engineering and economic principles. Once implemented and mature Pavement Asset Management System serves the entire range of users starting with the maintenance engineers and ending with the decision-makers. Such a system is necessary to coordinate agency management strategy including proactive maintenance. Basic inputs in the majority of existing Pavement Asset Management System approaches comprise the actual pavement inventory with associated construction history and condition, traffic information as well as various economical parameters. Some Pavement Management System approaches include also weather aspects which is of particular importance considering ongoing climate changes. This paper presents challenges in implementing the Pavement Asset Management System for those National Road Administrations that manage their pavement assets using more traditional strategies, e.g. worse-first approach. Special considerations are given to weather-related inputs and associated analysis to demonstrate the effects of climate change in a short- and long-term range. Based on the presented examples this paper concludes that National Road Administrations should account for the weather-related factors in their Pavement Management Systems as this has a significant impact on the system outcomes from the safety and economical perspective.

Adolescents' aggressive and prosocial behavior: associations with jealousy and social anxiety.

PubMed

Culotta, Carmen M; Goldstein, Sara E

2008-03-01

The authors examined how relational aggression, physical aggression, and proactive prosocial behavior were associated with jealousy and social anxiety in a diverse sample of 60 middle school students. After the authors controlled for gender and race, jealousy predicted relational aggression and proactive prosocial behavior, but it did not predict physical aggression. Additionally, social anxiety predicted proactive prosocial behavior. Adolescents who were more jealous in their peer relationships also tended to engage in relational aggression and proactive prosocial behavior, and adolescents who were more socially anxious also tended to be proactively prosocial. The authors discuss the implications of these findings and suggest directions for future research.

Proactive personality and career success.

PubMed

Seibert, S E; Crant, J M; Kraimer, M L

1999-06-01

This study examined the relationship between proactive personality and career success by surveying a sample of 496 employees (320 men and 176 women) from a diverse set of occupations and organizations. Proactive personality was positively associated with both self-reported objective (salary and promotions) and subjective (career satisfaction) indicators of career success. Hierarchical regression analyses showed that proactive personality explained additional variance in both objective and subjective career success even after controlling for several relevant variables (demographic, human capital, motivational, organizational, and industry) that have previously been found to be predictive of career outcomes. These findings were consistent using both self-report and significant--other ratings of proactive personality.

The Effect of Decision-Making Skill Training Programs on Self-Esteem and Decision-Making Styles

ERIC Educational Resources Information Center

Colakkadioglu, Oguzhan; Celik, D. Billur

2016-01-01

Problem Statement: Decision making is a critical cognitive process in every area of human life. In this process, the individuals play an active role and obtain outputs with their functional use of decision-making skills. Therefore, the decision-making process can affect the course of life, life satisfaction, and the social relations of an…

Adolescent Sexual Decision-Making: An Integrative Review.

PubMed

Hulton, Linda J.

2001-10-03

PURPOSE: The purpose of this integrative review was to summarize the present literature to identify factors associated with adolescent sexual decision-making. Thirty-eight salient research studies were selected as a basis of this review from the databases of Medline, CINAHL, and Psychinfo using the Cooper methodology. CONCLUSIONS: Two categories of decision-making were identified: 1) The research on factors related to the decisions that adolescents make to become sexually active or to abstain from sexual activity; 2) The research on factors related to contraceptive decision-making. The most consistent findings were that the factors of gender differences, cognitive development, perception of benefits, parental influences, social influences, and sexual knowledge were important variables in the decision-making processes of adolescents. IMPLICATIONS: Practice implications for nursing suggest that clinicians should assess adolescent sexual decision-making in greater detail and address the social and psychological context in which sexual experiences occur. Nurses must be aware of the differences between adolescent and adult decision-making processes and incorporate knowledge of growth and development into intervention strategies. Moreover, to the degree that adolescent sexual decision-making proves to be less than rational, interventions designed to improve competent sexual decision-making are needed.

The relationships among three factors affecting the financial decision-making abilities of adults with mild intellectual disabilities.

PubMed

Suto, W M I; Clare, I C H; Holland, A J; Watson, P C

2005-03-01

Among adults with intellectual disabilities (IDs), there is a need not only to assess financial decision-making capacity, but also to understand how it can be maximized. Although increased financial independence is a goal for many people, it is essential that individuals' decision-making abilities are sufficient, and many factors may affect the development of such abilities. As part of a wider project on financial decision-making, we analysed previous data from a group of 30 adults with mild IDs, identifying correlations among four variables: (i) financial decision-making abilities; (ii) intellectual ability; (iii) understanding of some basic concepts relevant to finance; and (iv) decision-making opportunities in everyday life. The analysis indicated a direct relationship between ID and basic financial understanding. Strong relationships of a potentially reciprocal nature were identified between basic financial understanding and everyday decision-making opportunities, and between such opportunities and financial decision-making abilities. The findings suggest that the role of intellectual ability in determining financial decision-making abilities is only indirect, and that access to both basic skills education and everyday decision-making opportunities is crucial for maximizing capacity. The implications of this are discussed.

Decision-making impairment in anorexia nervosa: New insights into the role of age and decision-making style.

PubMed

Giannunzio, Valeria; Degortes, Daniela; Tenconi, Elena; Collantoni, Enrico; Solmi, Marco; Santonastaso, Paolo; Favaro, Angela

2018-07-01

Patients with anorexia nervosa (AN) often report difficulties in decision making, which may interfere with treatment. The aim of this study was to investigate decision making in a large sample of adolescent and adult patients with AN, by using the Iowa gambling task. Participants were 611 female individuals (310 patients and 301 controls) who underwent neuropsychological and clinical assessment. Significantly poorer decision-making performance was observed in adult patients, whereas no difference emerged between affected and nonaffected adolescents. Both adolescent and adult patients were characterized by trends for higher levels of attention to losses in comparison with healthy controls. Although healthy adult women exhibited better decision-making performance than healthy adolescents, in AN, there was no improvement of decision making with age. A cluster analysis identified 2 different styles of decision making in both patients and controls: a conservative style and an impulsive style. Our study provides evidence of dysfunctional decision making in adult patients with AN and reveals an association between poor decision making and excessive punishment sensitivity in AN. The clinical and scientific implications of these findings merit further exploration. Copyright © 2018 John Wiley & Sons, Ltd and Eating Disorders Association.

Twelve myths about shared decision making.

PubMed

Légaré, France; Thompson-Leduc, Philippe

2014-09-01

As shared decision makes increasing headway in healthcare policy, it is under more scrutiny. We sought to identify and dispel the most prevalent myths about shared decision making. In 20 years in the shared decision making field one of the author has repeatedly heard mention of the same barriers to scaling up shared decision making across the healthcare spectrum. We conducted a selective literature review relating to shared decision making to further investigate these commonly perceived barriers and to seek evidence supporting their existence or not. Beliefs about barriers to scaling up shared decision making represent a wide range of historical, cultural, financial and scientific concerns. We found little evidence to support twelve of the most common beliefs about barriers to scaling up shared decision making, and indeed found evidence to the contrary. Our selective review of the literature suggests that twelve of the most commonly perceived barriers to scaling up shared decision making across the healthcare spectrum should be termed myths as they can be dispelled by evidence. Our review confirms that the current debate about shared decision making must not deter policy makers and clinicians from pursuing its scaling up across the healthcare continuum. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Medical decision-making in children and adolescents: developmental and neuroscientific aspects.

PubMed

Grootens-Wiegers, Petronella; Hein, Irma M; van den Broek, Jos M; de Vries, Martine C

2017-05-08

Various international laws and guidelines stress the importance of respecting the developing autonomy of children and involving minors in decision-making regarding treatment and research participation. However, no universal agreement exists as to at what age minors should be deemed decision-making competent. Minors of the same age may show different levels of maturity. In addition, patients deemed rational conversation-partners as a child can suddenly become noncompliant as an adolescent. Age, context and development all play a role in decision-making competence. In this article we adopt a perspective on competence that specifically focuses on the impact of brain development on the child's decision-making process. We believe that the discussion on decision-making competence of minors can greatly benefit from a multidisciplinary approach. We adopted such an approach in order to contribute to the understanding on how to deal with children in decision-making situations. Evidence emerging from neuroscience research concerning the developing brain structures in minors is combined with insights from various other fields, such as psychology, decision-making science and ethics. Four capacities have been described that are required for (medical) decision-making: (1) communicating a choice; (2) understanding; (3) reasoning; and (4) appreciation. Each capacity is related to a number of specific skills and abilities that need to be sufficiently developed to support the capacity. Based on this approach it can be concluded that at the age of 12 children can have the capacity to be decision-making competent. However, this age coincides with the onset of adolescence. Early development of the brain's reward system combined with late development of the control system diminishes decision-making competence in adolescents in specific contexts. We conclude that even adolescents possessing capacities required for decision-making, may need support of facilitating environmental factors. This paper intends to offer insight in neuroscientific mechanisms underlying the medical decision-making capacities in minors and to stimulate practices for optimal involvement of minors. Developing minors become increasingly capable of decision-making, but the neurobiological development in adolescence affects competence in specific contexts. Adequate support should be offered in order to create a context in which minors can make competently make decisions.

Mild Cognitive Impairment is Associated with PoorerDecision Making in Community-Based Older Persons

PubMed Central

Duke Han, S.; Boyle, Patricia A.; James, Bryan D.; Yu, Lei; Bennett, David A.

2015-01-01

Background/Objectives Financial and healthcare decision making are important for maintaining wellbeing and independence in old age. We tested the hypothesis that Mild Cognitive Impairment (MCI) is associated with poorer decision making in financial and healthcare matters. Design Community-based epidemiologic cohort study. Setting Communities throughout Northeastern Illinois. Participants Participants were 730 older nondemented persons from the Rush Memory and Aging Project. Measurements All participants underwent a detailed clinical evaluation and decision making assessment using a measure that closely approximates materials utilized in real world financial and healthcare settings. This allowed for measurement of total decision making, as well as financial and healthcare decision making. Regression models were used to examine whether the presence of MCI was associated with a lower level of decision making. In subsequent analyses, we explored the relation of specific cognitive systems (i.e., episodic memory, semantic memory, working memory, perceptual speed, and visuospatial ability) with decision making in those with MCI. Results Results showed that MCI was associated with lower decision making total scores as well as financial and healthcare scores, respectively, after accounting for the effects of age, education, and sex. The effect of MCI on total decision making was equivalent to the effect of more than 10 additional years of age. Additional models showed that when considering multiple cognitive systems, perceptual speed accounted for the most variance in decision making among participants with MCI. Conclusion Results suggest that persons with MCI may exhibit poorer financial and healthcare decision making in real world situations, and that perceptual speed may be an important contributor to poorer decision making among persons with MCI. PMID:25850350

Family health care decision making and self-efficacy with patients with ALS at the end of life

PubMed Central

NOLAN, MARIE T.; KUB, JOAN; HUGHES, MARK T.; TERRY, PETER B.; ASTROW, ALAN B.; CARBO, CYNTHIA A.; THOMPSON, RICHARD E.; CLAWSON, LORA; TEXEIRA, KENNETH; SULMASY, DANIEL P.

2008-01-01

Objective: Persons with ALS differ from those with other terminal illnesses in that they commonly retain capacity for decision making close to death. The role patients would opt to have their families play in decision making at the end of life may therefore be unique. This study compared the preferences of patients with ALS for involving family in health care decisions at the end of life with the actual involvement reported by the family after death. Methods: A descriptive correlational design with 16 patient–family member dyads was used. Quantitative findings were enriched with in-depth interviews of a subset of five family members following the patient's death. Results: Eighty-seven percent of patients had issued an advance directive. Patients who would opt to make health care decisions independently (i.e., according to the patient's preferences alone) were most likely to have their families report that decisions were made in the style that the patient preferred. Those who preferred shared decision making with family or decision making that relied upon the family were more likely to have their families report that decisions were made in a style that was more independent than preferred. When interviewed in depth, some family members described shared decision making although they had reported on the survey that the patient made independent decisions. Significance of results: The structure of advance directives may suggest to families that independent decision making is the ideal, causing them to avoid or underreport shared decision making. Fear of family recriminations may also cause family members to avoid or underreport shared decision making. Findings from this study might be used to guide clinicians in their discussions of treatments and health care decision making with persons with ALS and their families. PMID:18662421

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

PubMed

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

2016-09-01

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

Family involvement in cancer treatment decision-making: A qualitative study of patient, family, and clinician attitudes and experiences.

PubMed

Laidsaar-Powell, Rebekah; Butow, Phyllis; Bu, Stella; Charles, Cathy; Gafni, Amiram; Fisher, Alana; Juraskova, Ilona

2016-07-01

Little is known about how family are involved in cancer treatment decision-making. This study aimed to qualitatively explore Australian oncology clinicians', patients', and family members' attitudes towards, and experiences of, family involvement in decision-making. Semi-structured interviews were conducted with 30 cancer patients, 33 family members, 10 oncology nurses and 11 oncologists. Framework analysis methods were used. Three main themes were uncovered: (i) how family are involved in the decision-making process: specific behaviours of family across 5 (extended) decision-making stages; (ii) attitudes towards family involvement in the decision-making process: balancing patient authority with the rights of the family; and (iii) factors influencing family involvement: patient, family, cultural, relationship, and decision. This study highlighted many specific behaviours of family throughout the decision-making process, the complex participant attitudes toward retaining patient authority whilst including the family, and insight into influencing factors. These findings will inform a conceptual framework describing family involvement in decision-making. Clinicians could ascertain participant preferences and remain open to the varying forms of family involvement in decision-making. Given the important role of family in the decision-making process, family inclusive consultation strategies are needed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Individual differences in decision making competence revealed by multivariate fMRI.

PubMed

Talukdar, Tanveer; Román, Francisco J; Operskalski, Joachim T; Zwilling, Christopher E; Barbey, Aron K

2018-06-01

While an extensive literature in decision neuroscience has elucidated the neurobiological foundations of decision making, prior research has focused primarily on group-level effects in a sample population. Due to the presence of inherent differences between individuals' cognitive abilities, it is also important to examine the neural correlates of decision making that explain interindividual variability in cognitive performance. This study therefore investigated how individual differences in decision making competence, as measured by the Adult Decision Making Competence (A-DMC) battery, are related to functional brain connectivity patterns derived from resting-state fMRI data in a sample of 304 healthy participants. We examined connectome-wide associations, identifying regions within frontal, parietal, temporal, and occipital cortex that demonstrated significant associations with decision making competence. We then assessed whether the functional interactions between brain regions sensitive to decision making competence and seven intrinsic connectivity networks (ICNs) were predictive of specific facets of decision making assessed by subtests of the A-DMC battery. Our findings suggest that individual differences in specific facets of decision making competence are mediated by ICNs that support executive, social, and perceptual processes, and motivate an integrative framework for understanding the neural basis of individual differences in decision making competence. © 2018 Wiley Periodicals, Inc.

Career Decision-Making Characteristics of Primary Education Students in Greece

ERIC Educational Resources Information Center

Sidiropoulou-Dimakakou, Despina; Mylonas, Kostas; Argyropoulou, Katerina; Drosos, Nikos

2013-01-01

The present study aims at investigating career decision-making process of 6th grade students with the use of the Childhood Career Decision-Making Questionnaire (CCDMQ). CCDMQ offers scores for the following three decision-making dimensions: (a) "Concerns/fears regarding career future", (b) "Investment ?n decision-making…

Decision Making in Adults with ADHD

ERIC Educational Resources Information Center

Montyla, Timo; Still, Johanna; Gullberg, Stina; Del Missier, Fabio

2012-01-01

Objectives: This study examined decision-making competence in ADHD by using multiple decision tasks with varying demands on analytic versus affective processes. Methods: Adults with ADHD and healthy controls completed two tasks of analytic decision making, as measured by the Adult Decision-Making Competence (A-DMC) battery, and two affective…

Genetic and Environmental Stability Differs in Reactive and Proactive Aggression

PubMed Central

Tuvblad, Catherine; Raine, Adrian; Zheng, Mo; Baker, Laura A.

2009-01-01

The aim of this study was to examine stability and change in genetic and environmental influences on reactive (impulsive and affective) and proactive (planned and instrumental) aggression from childhood to early adolescence. The sample was drawn from an ongoing longitudinal twin study of risk factors for antisocial behavior at the University of Southern California (USC). The twins were measured on two occasions: ages 9–10 years (N = 1,241) and 11–14 years (N = 874). Reactive and proactive aggressive behaviors were rated by parents. The stability in reactive aggression was due to genetic and nonshared environmental influences, whereas the continuity in proactive aggression was primarily genetically mediated. Change in both reactive and proactive aggression between the two occasions was mainly explained by nonshared environmental influences, although some evidence for new genetic variance at the second occasion was found for both forms of aggression. These results suggest that proactive and reactive aggression differ in their genetic and environmental stability, and provide further evidence for some distinction between reactive and proactive forms of aggression. PMID:19688841

A qualitative exploration of patient and family views and experiences of treatment decision-making in bipolar II disorder.

PubMed

Fisher, Alana; Manicavasagar, Vijaya; Sharpe, Louise; Laidsaar-Powell, Rebekah; Juraskova, Ilona

2018-02-01

Treatment decision-making in bipolar II disorder (BPII) is challenging, yet the decision support needs of patients and family remain unknown. To explore patient and family perspectives of treatment decision-making in BPII. Semistructured, qualitative interviews were conducted with 28 patients with BPII-diagnosis and 13 family members with experience in treatment decision-making in the outpatient setting. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Participant demographics, clinical characteristics and preferences for patient decision-making involvement were assessed. Four inter-related themes emerged: (1) Attitudes and response to diagnosis and treatment; (2) Influences on decision-making; (3) The nature and flow of decision-making; (4) Decision support and challenges. Views differed according to patient involvement preferences, time since diagnosis and patients' current mood symptoms. This is the first known study to provide in-depth patient and family insights into the key factors influencing BPII treatment decision-making, and potential improvements and challenges to this process. Findings will inform the development of BPII treatment decision-making resources that better meet the informational and decision-support priorities of end users. This research was partly funded by a Postgraduate Research Grant awarded to the first author by the University of Sydney. No conflicts of interest declared.

Take the First Heuristic, Self-Efficacy, and Decision-Making in Sport

ERIC Educational Resources Information Center

Hepler, Teri J.; Feltz, Deborah L.

2012-01-01

Can taking the first (TTF) option in decision-making lead to the best decisions in sports contexts? And, is one's decision-making self-efficacy in that context linked to TTF decisions? The purpose of this study was to examine the role of the TTF heuristic and self-efficacy in decision-making on a simulated sports task. Undergraduate and graduate…

Decision Making Under Uncertainty

DTIC Science & Technology

2010-11-01

A sound approach to rational decision making requires a decision maker to establish decision objectives, identify alternatives, and evaluate those...often violate the axioms of rationality when making decisions under uncertainty. The systematic description of such observations may lead to the...which leads to “anchoring” on the initial value. The fact that individuals have been shown to deviate from rationality when making decisions

The enactment stage of end-of-life decision-making for children.

PubMed

Sullivan, Jane Elizabeth; Gillam, Lynn Heather; Monagle, Paul Terence

2018-01-11

Typically pediatric end-of-life decision-making studies have examined the decision-making process, factors, and doctors' and parents' roles. Less attention has focussed on what happens after an end-of-life decision is made; that is, decision enactment and its outcome. This study explored the views and experiences of bereaved parents in end-of-life decision-making for their child. Findings reported relate to parents' experiences of acting on their decision. It is argued that this is one significant stage of the decision-making process. A qualitative methodology was used. Semi-structured interviews were conducted with bereaved parents, who had discussed end-of-life decisions for their child who had a life-limiting condition and who had died. Data were thematically analysed. Twenty-five bereaved parents participated. Findings indicate that, despite differences in context, including the child's condition and age, end-of-life decision-making did not end when an end-of-life decision was made. Enacting the decision was the next stage in a process. Time intervals between stages and enactment pathways varied, but the enactment was always distinguishable as a separate stage. Decision enactment involved making further decisions - parents needed to discern the appropriate time to implement their decision to withdraw or withhold life-sustaining medical treatment. Unexpected events, including other people's actions, impacted on parents enacting their decision in the way they had planned. Several parents had to re-implement decisions when their child recovered from serious health issues without medical intervention. Significance of results A novel, critical finding was that parents experienced end-of-life decision-making as a sequence of interconnected stages, the final stage being enactment. The enactment stage involved further decision-making. End-of-life decision-making is better understood as a process rather than a discrete once-off event. The enactment stage has particular emotional and practical implications for parents. Greater understanding of this stage can improve clinician's support for parents as they care for their child.

Decision-making about complementary and alternative medicine by cancer patients: integrative literature review.

PubMed

Weeks, Laura; Balneaves, Lynda G; Paterson, Charlotte; Verhoef, Marja

2014-01-01

Patients with cancer consistently report conflict and anxiety when making decisions about complementary and alternative medicine (CAM) treatment. To design evidence-informed decision-support strategies, a better understanding is needed of how the decision-making process unfolds for these patients during their experience with cancer. We undertook this study to review the research literature regarding CAM-related decision-making by patients with cancer within the context of treatment, survivorship, and palliation. We also aimed to summarize emergent concepts within a preliminary conceptual framework. We conducted an integrative literature review, searching 12 electronic databases for articles published in English that described studies of the process, context, or outcomes of CAM-related decision-making. We summarized descriptive data using frequencies and used a descriptive constant comparative method to analyze statements about original qualitative results, with the goal of identifying distinct concepts pertaining to CAM-related decision-making by patients with cancer and the relationships among these concepts. Of 425 articles initially identified, 35 met our inclusion criteria. Seven unique concepts related to CAM and cancer decision-making emerged: decision-making phases, information-seeking and evaluation, decision-making roles, beliefs, contextual factors, decision-making outcomes, and the relationship between CAM and conventional medical decision-making. CAM decision-making begins with the diagnosis of cancer and encompasses 3 distinct phases (early, mid, and late), each marked by unique aims for CAM treatment and distinct patterns of information-seeking and evaluation. Phase transitions correspond to changes in health status or other milestones within the cancer trajectory. An emergent conceptual framework illustrating relationships among the 7 central concepts is presented. CAM-related decision-making by patients with cancer occurs as a nonlinear, complex, dynamic process. The conceptual framework presented here identifies influential factors within that process, as well as patients' unique needs during different phases. The framework can guide the development and evaluation of theory-based decision-support programs that are responsive to patients' beliefs and preferences.

[Cancer screening in clinical practice: the value of shared decision-making].

PubMed

Cornuz, Jacques; Junod, Noëlle; Pasche, Olivier; Guessous, Idris

2010-07-14

Shared decision-making approach to uncertain clinical situations such as cancer screening seems more appropriate than ever. Shared decision making can be defined as an interactive process where physician and patient share all the stages of the decision making process. For patients who wish to be implicated in the management of their health conditions, physicians might express difficulty to do so. Use of patient decision aids appears to improve such process of shared decision making.

"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

Proactive risk assessment of blood transfusion process, in pediatric emergency, using the Health Care Failure Mode and Effects Analysis (HFMEA).

PubMed

Dehnavieh, Reza; Ebrahimipour, Hossein; Molavi-Taleghani, Yasamin; Vafaee-Najar, Ali; Noori Hekmat, Somayeh; Esmailzdeh, Hamid

2014-12-25

Pediatric emergency has been considered as a high risk area, and blood transfusion is known as a unique clinical measure, therefore this study was conducted with the purpose of assessing the proactive risk assessment of blood transfusion process in Pediatric Emergency of Qaem education- treatment center in Mashhad, by the Healthcare Failure Mode and Effects Analysis (HFMEA) methodology. This cross-sectional study analyzed the failure mode and effects of blood transfusion process by a mixture of quantitative-qualitative method. The proactive HFMEA was used to identify and analyze the potential failures of the process. The information of the items in HFMEA forms was collected after obtaining a consensus of experts' panel views via the interview and focus group discussion sessions. The Number of 77 failure modes were identified for 24 sub-processes enlisted in 8 processes of blood transfusion. Totally 13 failure modes were identified as non-acceptable risk (a hazard score above 8) in the blood transfusion process and were transferred to the decision tree. Root causes of high risk modes were discussed in cause-effect meetings and were classified based on the UK national health system (NHS) approved classifications model. Action types were classified in the form of acceptance (11.6%), control (74.2%) and elimination (14.2%). Recommendations were placed in 7 categories using TRIZ ("Theory of Inventive Problem Solving.") The re-engineering process for the required changes, standardizing and updating the blood transfusion procedure, root cause analysis of blood transfusion catastrophic events, patient identification bracelet, training classes and educational pamphlets for raising awareness of personnel, and monthly gathering of transfusion medicine committee have all been considered as executive strategies in work agenda in pediatric emergency.

Proactive Risk Assessment of Blood Transfusion Process, in Pediatric Emergency, Using the Health Care Failure Mode and Effects Analysis (HFMEA)

PubMed Central

Dehnavieh, Reza; Ebrahimipour, Hossein; Molavi-Taleghani, Yasamin; Vafaee-Najar, Ali; Hekmat, Somayeh Noori; Esmailzdeh, Hamid

2015-01-01

Introduction: Pediatric emergency has been considered as a high risk area, and blood transfusion is known as a unique clinical measure, therefore this study was conducted with the purpose of assessing the proactive risk assessment of blood transfusion process in Pediatric Emergency of Qaem education- treatment center in Mashhad, by the Healthcare Failure Mode and Effects Analysis (HFMEA) methodology. Methodology: This cross-sectional study analyzed the failure mode and effects of blood transfusion process by a mixture of quantitative-qualitative method. The proactive HFMEA was used to identify and analyze the potential failures of the process. The information of the items in HFMEA forms was collected after obtaining a consensus of experts’ panel views via the interview and focus group discussion sessions. Results: The Number of 77 failure modes were identified for 24 sub-processes enlisted in 8 processes of blood transfusion. Totally 13 failure modes were identified as non-acceptable risk (a hazard score above 8) in the blood transfusion process and were transferred to the decision tree. Root causes of high risk modes were discussed in cause-effect meetings and were classified based on the UK national health system (NHS) approved classifications model. Action types were classified in the form of acceptance (11.6%), control (74.2%) and elimination (14.2%). Recommendations were placed in 7 categories using TRIZ (“Theory of Inventive Problem Solving.”) Conclusion: The re-engineering process for the required changes, standardizing and updating the blood transfusion procedure, root cause analysis of blood transfusion catastrophic events, patient identification bracelet, training classes and educational pamphlets for raising awareness of personnel, and monthly gathering of transfusion medicine committee have all been considered as executive strategies in work agenda in pediatric emergency. PMID:25560332

Decision-Making under Criteria Uncertainty

NASA Astrophysics Data System (ADS)

Kureychik, V. M.; Safronenkova, I. B.

2018-05-01

Uncertainty is an essential part of a decision-making procedure. The paper deals with the problem of decision-making under criteria uncertainty. In this context, decision-making under uncertainty, types and conditions of uncertainty were examined. The decision-making problem under uncertainty was formalized. A modification of the mathematical decision support method under uncertainty via ontologies was proposed. A critical distinction of the developed method is ontology usage as its base elements. The goal of this work is a development of a decision-making method under criteria uncertainty with the use of ontologies in the area of multilayer board designing. This method is oriented to improvement of technical-economic values of the examined domain.

Risk-taking and decision-making in youth: relationships to addiction vulnerability

PubMed Central

Balogh, Kornelia N.; Mayes, Linda C.; Potenza, Marc N.

2013-01-01

Background Decision-making and risk-taking behavior undergo developmental changes during adolescence. Disadvantageous decision-making and increased risk-taking may lead to problematic behaviors such as substance use and abuse, pathological gambling and excessive internet use. Methods Based on MEDLINE searches, this article reviews the literature on decision-making and risk-taking and their relationship to addiction vulnerability in youth. Results Decision-making and risk-taking behaviors involve brain areas that undergoing developmental changes during puberty and young adulthood. Individual differences and peer pressure also relate importantly to decision-making and risk-taking. Conclusions Brain-based changes in emotional, motivational and cognitive processing may underlie risk-taking and decision-making propensities in adolescence, making this period a time of heightened vulnerability for engagement in additive behaviors. PMID:24294500

Do patients want to participate in medical decision making?

PubMed

Strull, W M; Lo, B; Charles, G

1984-12-07

Although shared decision making by patients and clinicians has been advocated, little is known about the degree of participation in decision making that patients actually prefer or about clinicians' appreciation of these preferences. We administered questionnaires about three aspects of decision making to 210 hypertensive outpatients and to their 50 clinicians, who represented three types of medical practices. We found that 41% of patients preferred more information about hypertension; clinicians underestimated patient preferences for discussion about therapy in 29% of cases and overestimated 11% (k = .22); and 53% of patients preferred to participate in making decisions, while clinicians believed that their patients desired to participate in 78% of cases. Many patients who preferred not to make initial therapeutic decisions did want to participate in ongoing evaluation of therapy. Thus, clinicians underestimate patients' desire for information and discussion but overestimate patients' desire to make decisions. Awareness of this discrepancy may facilitate communication and decision making.

Shared Problem Models and Crew Decision Making

NASA Technical Reports Server (NTRS)

Orasanu, Judith; Statler, Irving C. (Technical Monitor)

1994-01-01

The importance of crew decision making to aviation safety has been well established through NTSB accident analyses: Crew judgment and decision making have been cited as causes or contributing factors in over half of all accidents in commercial air transport, general aviation, and military aviation. Yet the bulk of research on decision making has not proven helpful in improving the quality of decisions in the cockpit. One reason is that traditional analytic decision models are inappropriate to the dynamic complex nature of cockpit decision making and do not accurately describe what expert human decision makers do when they make decisions. A new model of dynamic naturalistic decision making is offered that may prove more useful for training or aiding cockpit decision making. Based on analyses of crew performance in full-mission simulation and National Transportation Safety Board accident reports, features that define effective decision strategies in abnormal or emergency situations have been identified. These include accurate situation assessment (including time and risk assessment), appreciation of the complexity of the problem, sensitivity to constraints on the decision, timeliness of the response, and use of adequate information. More effective crews also manage their workload to provide themselves with time and resources to make good decisions. In brief, good decisions are appropriate to the demands of the situation and reflect the crew's metacognitive skill. Effective crew decision making and overall performance are mediated by crew communication. Communication contributes to performance because it assures that all crew members have essential information, but it also regulates and coordinates crew actions and is the medium of collective thinking in response to a problem. This presentation will examine the relation between communication that serves to build performance. Implications of these findings for crew training will be discussed.

Decision Making and Cancer

PubMed Central

Reyna, Valerie F.; Nelson, Wendy L.; Han, Paul K.; Pignone, Michael P.

2014-01-01

We review decision-making along the cancer continuum in the contemporary context of informed and shared decision making, in which patients are encouraged to take a more active role in their health care. We discuss challenges to achieving informed and shared decision making, including cognitive limitations and emotional factors, but argue that understanding the mechanisms of decision making offers hope for improving decision support. Theoretical approaches to decision making that explain cognition, emotion, and their interaction are described, including classical psychophysical approaches, dual-process approaches that focus on conflicts between emotion versus cognition (or reason), and modern integrative approaches such as fuzzy-trace theory. In contrast to the earlier emphasis on rote use of numerical detail, modern approaches emphasize understanding the bottom-line gist of options (which encompasses emotion and other influences on meaning) and retrieving relevant social and moral values to apply to those gist representations. Finally, research on interventions to support better decision making in clinical settings is reviewed, drawing out implications for future research on decision making and cancer. PMID:25730718

Relationship of external influence to parental distress in decision making regarding children with a life-threatening illness.

PubMed

Miller, Victoria A; Luce, Mary Frances; Nelson, Robert M

2011-01-01

To examine the relationship of external influence to parental distress when making a decision about research or treatment for a child with a life-threatening illness and to test potential moderators of this relationship. Parents (n = 219) who made a decision about research or treatment for a child completed measures of external influence, distress, decision-making preference, and coping. More external influence was associated with more hostility, uncertainty, and confusion. Decision-making preference and coping style moderated the relationship between external influence and distress: More external influence was associated with more distress when decision-making preference was low and task-focused coping was high. External influence appears to be related to distress in parents making research and treatment decisions for children with life-threatening illnesses. However, it is important to consider parent characteristics, such as decision-making preference and coping style, when examining the effects of contextual factors on distress during decision making.

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 decisionmaking 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

Risk perception & strategic decision making :general insights, a framework, and specific application to electricity generation using nuclear energy.

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

Brewer, Jeffrey D.

The objective of this report is to promote increased understanding of decision making processes and hopefully to enable improved decision making regarding high-consequence, highly sophisticated technological systems. This report brings together insights regarding risk perception and decision making across domains ranging from nuclear power technology safety, cognitive psychology, economics, science education, public policy, and neural science (to name a few). It forms them into a unique, coherent, concise framework, and list of strategies to aid in decision making. It is suggested that all decision makers, whether ordinary citizens, academics, or political leaders, ought to cultivate their abilities to separate themore » wheat from the chaff in these types of decision making instances. The wheat includes proper data sources and helpful human decision making heuristics; these should be sought. The chaff includes ''unhelpful biases'' that hinder proper interpretation of available data and lead people unwittingly toward inappropriate decision making ''strategies''; obviously, these should be avoided. It is further proposed that successfully accomplishing the wheat vs. chaff separation is very difficult, yet tenable. This report hopes to expose and facilitate navigation away from decision-making traps which often ensnare the unwary. Furthermore, it is emphasized that one's personal decision making biases can be examined, and tools can be provided allowing better means to generate, evaluate, and select among decision options. Many examples in this report are tailored to the energy domain (esp. nuclear power for electricity generation). The decision making framework and approach presented here are applicable to any high-consequence, highly sophisticated technological system.« less

Advancing the adaptive capacity of social-ecological systems to absorb climate extremes

NASA Astrophysics Data System (ADS)

Thonicke, Kirsten; Bahn, Michael; Bardgett, Richard; Bloemen, Jasper; Chabay, Ilan; Erb, Karlheinz; Giamberini, Mariasilvia; Gingrich, Simone; Lavorel, Sandra; Liehr, Stefan; Rammig, Anja

2017-04-01

The recent and projected increases in climate variability and the frequency of climate extremes are posing a profound challenge to society and the biosphere (IPCC 2012, IPCC 2013). Climate extremes can affect natural and managed ecosystems more severely than gradual warming. The ability of ecosystems to resist and recover from climate extremes is therefore of fundamental importance for society, which strongly relies on their ability to supply provisioning, regulating, supporting and cultural services. Society in turn triggers land-use and management decisions that affect ecosystem properties. Thus, ecological and socio-economic conditions are tightly coupled in what has been referred to as the social-ecological system. For ensuring human well-being in the light of climate extremes it is crucial to enhance the resilience of the social-ecological system (SES) across spatial, temporal and institutional scales. Stakeholders, such as resource managers, urban, landscape and conservation planners, decision-makers in agriculture and forestry, as well as natural hazards managers, require an improved knowledge base for better-informed decision making. To date the vulnerability and adaptive capacity of SESs to climate extremes is not well understood and large uncertainties exist as to the legacies of climate extremes on ecosystems and on related societal structures and processes. Moreover, we lack empirical evidence and incorporation of simulated future ecosystem and societal responses to support pro-active management and enhance social-ecological resilience. In our presentation, we outline the major research gaps and challenges to be addressed for understanding and enhancing the adaptive capacity of SES to absorb and adapt to climate extremes, including acquisition and elaboration of long-term monitoring data and improvement of ecological models to better project climate extreme effects and provide model uncertainties. We highlight scientific challenges and discuss conceptual and observational gaps that need to be overcome to advance this inter- and transdisciplinary topic.

Factors and outcomes of decision making for cancer clinical trial participation.

PubMed

Biedrzycki, Barbara A

2011-09-01

To describe factors and outcomes related to the decision-making process regarding participation in a cancer clinical trial. Cross-sectional, descriptive. Urban, academic, National Cancer Institute-designated comprehensive cancer center in the mid-Atlantic United States. 197 patients with advanced gastrointestinal cancer. Mailed survey using one investigator-developed instrument, eight instruments used in published research, and a medical record review. disease context, sociodemographics, hope, quality of life, trust in healthcare system, trust in health professional, preference for research decision control, understanding risks, and information. decision to accept or decline research participation and satisfaction with this decision. All of the factors within the Research Decision Making Model together predicted cancer clinical trial participation and satisfaction with this decision. The most frequently preferred decision-making style for research participation was shared (collaborative) (83%). Multiple factors affect decision making for cancer clinical trial participation and satisfaction with this decision. Shared decision making previously was an unrecognized factor and requires further investigation. Enhancing the process of research decision making may facilitate an increase in cancer clinical trial enrollment rates. Oncology nurses have unique opportunities as educators and researchers to support shared decision making by those who prefer this method for deciding whether to accept or decline cancer clinical trial participation.

Decision Making in the Airplane

NASA Technical Reports Server (NTRS)

Orasanu, Judith; Shafto, Michael G. (Technical Monitor)

1995-01-01

The Importance of decision-making to safety in complex, dynamic environments like mission control centers, aviation, and offshore installations has been well established. NASA-ARC has a program of research dedicated to fostering safe and effective decision-making in the manned spaceflight environment. Because access to spaceflight is limited, environments with similar characteristics, including aviation and nuclear power plants, serve as analogs from which space-relevant data can be gathered and theories developed. Analyses of aviation accidents cite crew judgement and decision making as causes or contributing factors in over half of all accidents. Yet laboratory research on decision making has not proven especially helpful In improving the quality of decisions in these kinds of environments. One reason is that the traditional, analytic decision models are inappropriate to multi-dimensional, high-risk environments, and do not accurately describe what expert human decision makers do when they make decisions that have consequences. A new model of dynamic, naturalistic decision making is offered that may prove useful for improving decision making in complex, isolated, confined and high-risk environments. Based on analyses of crew performance in full-mission simulators and accident reports, features that define effective decision strategies in abnormal or emergency situations have been identified. These include accurate situation assessment (including time and risk assessment), appreciation of the complexity of the problem, sensitivity to constraints on the decision, timeliness of the response, and use of adequate information. More effective crews also manage their workload to provide themselves with time and resources to make good decisions. In brief, good decisions are appropriate to the demands of the situation. Effective crew decision making and overall performance are mediated by crew communication. Communication contributes to performance because it assures that all crew members have essential information, but it also regulates and coordinates crew actions and is the medium of collective thinking In response to a problem, This presentation will examine the relations between leadership, communication, decision making and overall crew performance. Implications of these findings for training will be discussed.

Correlates of healthcare and financial decision making among older adults without dementia.

PubMed

Stewart, Christopher C; Yu, Lei; Wilson, Robert S; Bennett, David A; Boyle, Patricia A

2018-03-22

Healthcare and financial decision making among older persons has been previously associated with cognition, health and financial literacy, and risk aversion; however, the manner by which these resources support decision making remains unclear, as past studies have not systematically investigated the pathways linking these resources with decision making. In the current study, we use path analysis to examine the direct and indirect pathways linking age, education, cognition, literacy, and risk aversion with decision making. We also decomposed literacy into its subcomponents, conceptual knowledge and numeracy, in order to examine their associations with decision making. Participants were 937 community-based older adults without dementia from the Rush Memory and Aging Project who completed a battery of cognitive tests and assessments of healthcare and financial decision making, health and financial literacy, and risk aversion. Age and education exerted effects on decision making, but nearly two thirds of their effects were indirect, working mostly through cognition and literacy. Cognition exerted a strong direct effect on decision making and a robust indirect effect working primarily through literacy. Literacy also exerted a powerful direct effect on decision making, as did its subcomponents, conceptual knowledge and numeracy. The direct effect of risk aversion was comparatively weak. In addition to cognition, health and financial literacy emerged as independent and primary correlates of healthcare and financial decision making. These findings suggest specific actions that might be taken to optimize healthcare and financial decision making and, by extension, improve health and well-being in advanced age. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Shared decision-making in home-care from the nurse's perspective: sitting at the kitchen table--a qualitative descriptive study.

PubMed

Truglio-Londrigan, Marie

2013-10-01

To come to know, understand and describe the experience of shared decision-making in home-care from the nurse's perspective. The literature presents the concept of shared decision-making as a complex process characterised by a partnership between the healthcare provider and the patient, which is participatory and action oriented with education and negotiation leading to agreement. Few studies have been carried out to explore and describe the events that make up the experiences of shared decision-making in home-care from the nurse's perspective. A qualitative descriptive study was implemented. Semi structured interviews were performed with 10 home-care nurses who were asked to reflect on a time in their practice when they were involved in a shared decision-making process with their patient. All data were analysed using Colaizzi's method. The following Themes were uncovered: Begin where the patient is; Education for shared decision-making; The village and shared decision-making; and Whose decision is it? Each of the four Themes contained Subthemes. The findings of this study present shared decision-making as a complex, multidimensional and fluid process. A thorough understanding of shared decision-making is essential within the multiple contexts in which care is delivered. Nurses in clinical practice need to know and understand the events of the experience of shared decision-making. A more comprehensive understanding of these facts can assist home-care nurses in their practice with regard to the application of shared decision-making. © 2013 Blackwell Publishing Ltd.

Development of the Supported Decision Making Inventory System.

PubMed

Shogren, Karrie A; Wehmeyer, Michael L; Uyanik, Hatice; Heidrich, Megan

2017-12-01

Supported decision making has received increased attention as an alternative to guardianship and a means to enable people with intellectual and developmental disabilities to exercise their right to legal capacity. Assessments are needed that can used by people with disabilities and their systems of supports to identify and plan for needed supports to enable decision making. This article describes the steps taken to develop such an assessment tool, the Supported Decision Making Inventory System (SDMIS), and initial feedback received from self-advocates with intellectual disability. The three sections of the SDMIS (Supported Decision Making Personal Factors Inventory, Supported Decision Making Environmental Demands Inventory, and Decision Making Autonomy Inventory) are described and implications for future research, policy, and practice are discussed.

Competence and Quality in Real-Life Decision Making.

PubMed

Geisler, Martin; Allwood, Carl Martin

2015-01-01

What distinguishes a competent decision maker and how should the issue of decision quality be approached in a real-life context? These questions were explored in three studies. In Study 1, using a web-based questionnaire and targeting a community sample, we investigated the relationships between objective and subjective indicators of real-life decision-making success. In Study 2 and 3, targeting two different samples of professionals, we explored if the prevalent cognitively oriented definition of decision-making competence could be beneficially expanded by adding aspects of competence in terms of social skills and time-approach. The predictive power for each of these three aspects of decision-making competence was explored for different indicators of real-life decision-making success. Overall, our results suggest that research on decision-making competence would benefit by expanding the definition of competence, by including decision-related abilities in terms of social skills and time-approach. Finally, the results also indicate that individual differences in real-life decision-making success profitably can be approached and measured by different criteria.

Goal Setting and Decision Making by At-Risk Youth

ERIC Educational Resources Information Center

Galotti, Kathleen M.; Kozberg, Steven F.; Gustafon, Mary

2009-01-01

Typically, adolescence is a time when individuals begin to make consequential, life-framing decisions. However, much of the decision-making literature focuses on high-risk decisions, such as the use of drugs and alcohol, while much less is known about how adolescents make positive decisions, for example, regarding their educational or career…

The Career Decision-Making Competence: A New Construct for the Career Realm

ERIC Educational Resources Information Center

Ceschi, Andrea; Costantini, Arianna; Phillips, Susan D.; Sartori, Riccardo

2017-01-01

Purpose: This paper aims to link findings from laboratory-based decision-making research and decision-making competence (DMC) aspects that may be central for career-related decision-making processes. Past research has identified individual differences in rational responses in decision situations, which the authors refer to as DMC. Although there…

From Career Decision-Making Styles to Career Decision-Making Profiles: A Multidimensional Approach

ERIC Educational Resources Information Center

Gati, Itamar; Landman, Shiri; Davidovitch, Shlomit; Asulin-Peretz, Lisa; Gadassi, Reuma

2010-01-01

Previous research on individual differences in career decision-making processes has often focused on classifying individuals into a few types of decision-making "styles" based on the most dominant trait or characteristic of their approach to the decision process (e.g., rational, intuitive, dependent; Harren, 1979). In this research, an…

Surviving Surrogate Decision-Making: What Helps and Hampers the Experience of Making Medical Decisions for Others

PubMed Central

Starks, Helene; Taylor, Janelle S.; Hopley, Elizabeth K.; Fryer-Edwards, Kelly

2007-01-01

BACKGROUND A majority of end-of-life medical decisions are made by surrogate decision-makers who have varying degrees of preparation and comfort with their role. Having a seriously ill family member is stressful for surrogates. Moreover, most clinicians have had little training in working effectively with surrogates. OBJECTIVES To better understand the challenges of decision-making from the surrogate’s perspective. DESIGN Semistructured telephone interview study of the experience of surrogate decision-making. PARTICIPANTS Fifty designated surrogates with previous decision-making experience. APPROACH We asked surrogates to describe and reflect on their experience of making medical decisions for others. After coding transcripts, we conducted a content analysis to identify and categorize factors that made decision-making more or less difficult for surrogates. RESULTS Surrogates identified four types of factors: (1) surrogate characteristics and life circumstances (such as coping strategies and competing responsibilities), (2) surrogates’ social networks (such as intrafamily discord about the “right” decision), (3) surrogate–patient relationships and communication (such as difficulties with honoring known preferences), and (4) surrogate–clinician communication and relationship (such as interacting with a single physician whom the surrogate recognizes as the clinical spokesperson vs. many clinicians). CONCLUSIONS These data provide insights into the challenges that surrogates encounter when making decisions for loved ones and indicate areas where clinicians could intervene to facilitate the process of surrogate decision-making. Clinicians may want to include surrogates in advance care planning prior to decision-making, identify and address surrogate stressors during decision-making, and designate one person to communicate information about the patient’s condition, prognosis, and treatment options. PMID:17619223

Shared decision-making during surgical consultation for gallstones at a safety-net hospital.

PubMed

Mueck, Krislynn M; Leal, Isabel M; Wan, Charlie C; Goldberg, Braden F; Saunders, Tamara E; Millas, Stefanos G; Liang, Mike K; Ko, Tien C; Kao, Lillian S

2018-04-01

Understanding patient perspectives regarding shared decision-making is crucial to providing informed, patient-centered care. Little is known about perceptions of vulnerable patients regarding shared decision-making during surgical consultation. The purpose of this study was to evaluate whether a validated tool reflects perceptions of shared decision-making accurately among patients seeking surgical consultation for gallstones at a safety-net hospital. A mixed methods study was conducted in a sample of adult patients with gallstones evaluated at a safety-net surgery clinic between May to July 2016. Semi-structured interviews were conducted after their initial surgical consultation and analyzed for emerging themes. Patients were administered the Shared Decision-Making Questionnaire and Autonomy Preference Scale. Univariate analyses were performed to identify factors associated with shared decision-making and to compare the results of the surveys to those of the interviews. The majority of patients (N = 30) were female (90%), Hispanic (80%), Spanish-speaking (70%), and middle-aged (45.7 ± 16 years). The proportion of patients who perceived shared decision-making was greater in the Shared Decision-Making Questionnaire versus the interviews (83% vs 27%, P < .01). Age, sex, race/ethnicity, primary language, diagnosis, Autonomy Preference Scale score, and decision for operation was not associated with shared decision-making. Contributory factors to this discordance include patient unfamiliarity with shared decision-making, deference to surgeon authority, lack of discussion about different treatments, and confusion between aligned versus shared decisions. Available questionnaires may overestimate shared decision-making in vulnerable patients suggesting the need for alternative or modifications to existing methods. Furthermore, such metrics should be assessed for correlation with patient-reported outcomes, such as satisfaction with decisions and health status. Copyright © 2017 Elsevier Inc. All rights reserved.

Shared Decision Making Interventions: Theoretical and Empirical Evidence with Implications for Health Literacy.

PubMed

Stacey, Dawn; Hill, Sophie; McCaffery, Kirsten; Boland, Laura; Lewis, Krystina B; Horvat, Lidia

2017-01-01

Basic health literacy is required for making health decisions. The aim of this chapter is to discuss the use of shared decision making interventions for supporting patient involvement in making health decisions. The chapter provides a definition of shared decision making and discusses the link between shared decision making and the three levels of health literacy: functional, communicative/interactive, and critical. The Interprofessional Shared Decision Making Model is used to identify the various players involved: the patient, the family/surrogate/significant others, decision coach, and health care professionals. When patients are involved in shared decision making, they have better health outcomes, better healthcare experiences, and likely lower costs. Yet, their degree of involvement is influenced by their level of health literacy. Interventions to facilitate shared decision making are patient decision aids, decision coaching, and question prompt lists. Patient decision aids have been shown to improve knowledge, accurate risk perceptions, and chosen options congruent with patients' values. Decision coaching improves knowledge and patient satisfaction. Question prompts also improve satisfaction. When shared decision making interventions have been evaluated with patients presumed to have lower health literacy, they appeared to be more beneficial to disadvantaged groups compared to those with higher literacy or better socioeconomic status. However, special attention needs to be applied when designing these interventions for populations with lower literacy. Two case exemplars are provided to illustrate the design and choice of interventions to better support patients with varying levels of health literacy. Despite evidence indicating these interventions are effective for involving patients in shared decision making, few are used in routine clinical practice. To increase their uptake, implementation strategies need to overcome barriers interfering with their use. Implementation strategies include training health care professionals, adopting SDM interventions that target patients, such as patient decision aids, and monitor patients' decisional comfort using the SURE test. Integrating health literacy principles is important when developing interventions that facilitate shared decision making and essential to avoid inadvertently producing higher inequalities between patients with varying levels of health literacy.

Decision-Making Under Risk: Integrating Perspectives From Biology, Economics, and Psychology.

PubMed

Mishra, Sandeep

2014-08-01

Decision-making under risk has been variably characterized and examined in many different disciplines. However, interdisciplinary integration has not been forthcoming. Classic theories of decision-making have not been amply revised in light of greater empirical data on actual patterns of decision-making behavior. Furthermore, the meta-theoretical framework of evolution by natural selection has been largely ignored in theories of decision-making under risk in the human behavioral sciences. In this review, I critically examine four of the most influential theories of decision-making from economics, psychology, and biology: expected utility theory, prospect theory, risk-sensitivity theory, and heuristic approaches. I focus especially on risk-sensitivity theory, which offers a framework for understanding decision-making under risk that explicitly involves evolutionary considerations. I also review robust empirical evidence for individual differences and environmental/situational factors that predict actual risky decision-making that any general theory must account for. Finally, I offer steps toward integrating various theoretical perspectives and empirical findings on risky decision-making. © 2014 by the Society for Personality and Social Psychology, Inc.

Incentivizing shared decision making in the USA--where are we now?

PubMed

Durand, Marie-Anne; Barr, Paul J; Walsh, Thom; Elwyn, Glyn

2015-06-01

The Affordable Care Act raised significant interest in the process of shared decision making, the role of patient decision aids, and incentivizing their utilization. However, it has not been clear how best to put incentives into practice, and how the implementation of shared decision making and the use of patient decision aids would be measured. Our goal was to review developments and proposals put forward. We performed a qualitative document analysis following a pragmatic search of Medline, Google, Google Scholar, Business Source Complete (Ebscohost), and LexisNexis from 2009-2013 using the following key words: "Patient Protection and Affordable Care Act", "Decision Making", "Affordable Care Act", "Shared Decision Making", "measurement", "incentives", and "payment." We observed a lack of clarity about how to measure shared decision making, about how best to reward the use of patient decisions aids, and therefore how best to incentivize the process. Many documents clearly imply that providing and disseminating patient decision aids might be equivalent to shared decision making. However, there is little evidence that these tools, when used by patients in advance of clinical encounters, lead to significant change in patient-provider communication. The assessment of shared decision making for performance management remains challenging. Efforts to incentivize shared decision making are at risk of being limited to the promotion of patient decision aids, passing over the opportunity to influence the communication processes between patients and providers. Copyright © 2014 Elsevier Inc. All rights reserved.

Beyond shared decision-making: Collaboration in the age of recovery from serious mental illness.

PubMed

Treichler, Emily B H; Spaulding, William D

2017-01-01

The role that people with serious mental illness (SMI) play in making decisions about their own treatment and rehabilitation is attracting increasing attention and scrutiny. This attention is embedded in a broader social/consumer movement, the recovery movement , whose agenda includes extensive reform of the mental health system and advancing respect for the dignity and autonomy of people with SMI. Shared decision-making (SDM) is an approach for enhancing consumer participation in health-care decision-making. SDM translates straightforwardly to specific clinical procedures that systematically identify domains of decision-making and guide the practitioner and consumer through making the decisions. In addition, Collaborative decision-making (CDM) is a set of guiding principles that avoids the connotations and limitations of SDM. CDM looks broadly at the range of decisions to be made in mental health care, and assigns consumers and providers equal responsibility and power in the decision-making process. It recognizes the diverse history, knowledge base, and values of each consumer by assuming patients can lead and contribute to decision-making, contributing both value-based information and technical information. This article further discusses the importance of CDM for people with SMI. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

A Common Mechanism Underlying Food Choice and Social Decisions.

PubMed

Krajbich, Ian; Hare, Todd; Bartling, Björn; Morishima, Yosuke; Fehr, Ernst

2015-10-01

People make numerous decisions every day including perceptual decisions such as walking through a crowd, decisions over primary rewards such as what to eat, and social decisions that require balancing own and others' benefits. The unifying principles behind choices in various domains are, however, still not well understood. Mathematical models that describe choice behavior in specific contexts have provided important insights into the computations that may underlie decision making in the brain. However, a critical and largely unanswered question is whether these models generalize from one choice context to another. Here we show that a model adapted from the perceptual decision-making domain and estimated on choices over food rewards accurately predicts choices and reaction times in four independent sets of subjects making social decisions. The robustness of the model across domains provides behavioral evidence for a common decision-making process in perceptual, primary reward, and social decision making.

A Common Mechanism Underlying Food Choice and Social Decisions

PubMed Central

Krajbich, Ian; Hare, Todd; Bartling, Björn; Morishima, Yosuke; Fehr, Ernst

2015-01-01

People make numerous decisions every day including perceptual decisions such as walking through a crowd, decisions over primary rewards such as what to eat, and social decisions that require balancing own and others’ benefits. The unifying principles behind choices in various domains are, however, still not well understood. Mathematical models that describe choice behavior in specific contexts have provided important insights into the computations that may underlie decision making in the brain. However, a critical and largely unanswered question is whether these models generalize from one choice context to another. Here we show that a model adapted from the perceptual decision-making domain and estimated on choices over food rewards accurately predicts choices and reaction times in four independent sets of subjects making social decisions. The robustness of the model across domains provides behavioral evidence for a common decision-making process in perceptual, primary reward, and social decision making. PMID:26460812

Proactive tobacco treatment and population-level cessation: a pragmatic randomized clinical trial.

PubMed

Fu, Steven S; van Ryn, Michelle; Sherman, Scott E; Burgess, Diana J; Noorbaloochi, Siamak; Clothier, Barbara; Taylor, Brent C; Schlede, Carolyn M; Burke, Randy S; Joseph, Anne M

2014-05-01

Current tobacco use treatment approaches require smokers to request treatment or depend on the provider to initiate smoking cessation care and are therefore reactive. Most smokers do not receive evidence-based treatments for tobacco use that include both behavioral counseling and pharmacotherapy. To assess the effect of a proactive, population-based tobacco cessation care model on use of evidence-based tobacco cessation treatments and on population-level smoking cessation rates (ie, abstinence among all smokers including those who use and do not use treatment) compared with usual care among a diverse population of current smokers. The Veterans Victory Over Tobacco Study, a pragmatic randomized clinical trial involving a population-based registry of current smokers aged 18 to 80 years. A total of 6400 current smokers, identified using the Department of Veterans Affairs (VA) electronic medical record, were randomized prior to contact to evaluate both the reach and effectiveness of the proactive care intervention. Current smokers were randomized to usual care or proactive care. Proactive care combined (1) proactive outreach and (2) offer of choice of smoking cessation services (telephone or in-person). Proactive outreach included mailed invitations followed by telephone outreach to motivate smokers to seek treatment with choice of services. The primary outcome was 6-month prolonged smoking abstinence at 1 year and was assessed by a follow-up survey among all current smokers regardless of interest in quitting or treatment utilization. A total of 5123 participants were included in the primary analysis. The follow-up survey response rate was 66%. The population-level, 6-month prolonged smoking abstinence rate at 1 year was 13.5% for proactive care compared with 10.9% for usual care (P = .02). Logistic regression mixed model analysis showed a significant effect of the proactive care intervention on 6-month prolonged abstinence (odds ratio [OR], 1.27 [95% CI, 1.03-1.57]). In analyses accounting for nonresponse using likelihood-based not-missing-at-random models, the effect of proactive care on 6-month prolonged abstinence persisted (OR, 1.33 [95% CI, 1.17-1.51]). Proactive, population-based tobacco cessation care using proactive outreach to connect smokers to evidence-based telephone or in-person smoking cessation services is effective for increasing long-term population-level cessation rates. clinicaltrials.gov Identifier: NCT00608426.

The use of decision analysis to examine ethical decision making by critical care nurses.

PubMed

Hughes, K K; Dvorak, E M

1997-01-01

To examine the extent to which critical care staff nurses make ethical decisions that coincide with those recommended by a decision analytic model. Nonexperimental, ex post facto. Midwestern university-affiliated 500 bed tertiary care medical center. One hundred critical care staff nurses randomly selected from seven critical care units. Complete responses were obtained from 82 nurses (for a final response rate of 82%). The dependent variable--consistent decision making--was measured as staff nurses' abilities to make ethical decisions that coincided with those prescribed by the decision model. Subjects completed two instruments, the Ethical Decision Analytic Model, a computer-administered instrument designed to measure staff nurses' abilities to make consistent decisions about a chemically-impaired colleague; and a Background Inventory. The results indicate marked consensus among nurses when informal methods were used. However, there was little consistency between the nurses' informal decisions and those recommended by the decision analytic model. Although 50% (n = 41) of all nurses chose a course of action that coincided with the model's least optimal alternative, few nurses agreed with the model as to the most optimal course of action. The findings also suggest that consistency was unrelated (p > 0.05) to the nurses' educational background or years of clinical experience; that most subjects reported receiving little or no education in decision making during their basic nursing education programs; but that exposure to decision-making strategies was related to years of nursing experience (p < 0.05). The findings differ from related studies that have found a moderate degree of consistency between nurses and decision analytic models for strictly clinical decision tasks, especially when those tasks were less complex. However, the findings partially coincide with other findings that decision analysis may not be particularly well-suited to the critical care environment. Additional research is needed to determine whether critical care nurses use the same decision-making methods as do other nurses; and to clarify the effects of decision task (clinical versus ethical) on nurses' decision making. It should not be assumed that methods used to study nurses' clinical decision making are applicable for all nurses or all types of decisions, including ethical decisions.

The Impact of Multifaceted Osteoporosis Group Education on Patients' Decision-Making regarding Treatment Options and Lifestyle Changes.

PubMed

Jensen, Annesofie L; Wind, Gitte; Langdahl, Bente Lomholt; Lomborg, Kirsten

2018-01-01

Patients with chronic diseases like osteoporosis constantly have to make decisions related to their disease. Multifaceted osteoporosis group education (GE) may support patients' decision-making. This study investigated multifaceted osteoporosis GE focusing on the impact of GE on patients' decision-making related to treatment options and lifestyle. An interpretive description design using ethnographic methods was utilized with 14 women and three men diagnosed with osteoporosis who attended multifaceted GE. Data consisted of participant observation during GE and individual interviews. Attending GE had an impact on the patients' decision-making in all educational themes. Patients decided on new ways to manage osteoporosis and made decisions regarding bone health and how to implement a lifestyle ensuring bone health. During GE, teachers and patients shared evidence-based knowledge and personal experiences and preferences, respectively, leading to a two-way exchange of information and deliberation about recommendations. Though teachers and patients explored the implications of the decisions and shared their preferences, teachers stressed that the patients ultimately had to make the decision. Teachers therefore refrained from participating in the final step of the decision-making process. Attending GE has an impact on the patients' decision-making as it can initiate patient reflection and support decision-making.

Perspectives of adolescents on decision making about participation in a biobank study: a pilot study.

PubMed

Grootens-Wiegers, Petronella; Visser, Eline G; van Rossum, Annemarie M C; van Waardhuizen, Claudia N; de Wildt, Saskia N; Sweep, Boudewijn; van den Broek, Jos M; de Vries, Martine C

2017-01-01

To be able to truly involve adolescents in decision making about clinical research participation, we need more insight in the perspective of adolescents themselves. To this end, adolescents in an ongoing biobank study were consulted to test a tentative decision assessment tool. The perspectives of adolescents (n=8) concerning participation in decision making for research participation were explored in interviews with a tentative tool, which covered six topics: information material usage, understanding, disease perceptions, anxiety, decision-making process and role sharing. All adolescents unequivocally expressed the desire to be involved in decision making, but also wanted advice from their parents. The extent of the preferred role of adolescent versus parents varied between individuals. In decision making, adolescents relied on parents for information. More than half hardly used the information material. Adolescents in our study preferred a shared decision-making process. The extent of sharing varied between individuals. The decision assessment tool was a fruitful starting point to discuss adolescents' perspectives and may aid in tailoring the situation to the individual to achieve optimal participation practices. Consulting adolescents about their preferences concerning decision making using the tool will facilitate tailoring of the shared decision-making process and optimising the developing autonomy of minors.

[A study on participation in clinical decision making by home healthcare nurses].

PubMed

Kim, Se Young

2010-12-01

This study was done to identify participation by home healthcare nurses in clinical decision making and factors influencing clinical decision making. A descriptive survey was used to collect data from 68 home healthcare nurses in 22 hospital-based home healthcare services in Korea. To investigate participation, the researcher developed 3 scenarios through interviews with 5 home healthcare nurses. A self-report questionnaire composed of tools for characteristics, factors of clinical decision making, and participation was used. Participation was relatively high, but significantly lower in the design phase (F=3.51, p=.032). Competency in clinical decision making (r=.45, p<.001), perception of the decision maker role (r=.47, p<.001), and perception of the utility of clinical practice guidelines (r=.25, p=.043) were significantly correlated with participation. Competency in clinical decision making (Odds ratio [OR]=41.79, p=.007) and perception of the decision maker role (OR=15.09, p=.007) were significant factors predicting participation in clinical decision making by home healthcare nurses. In order to encourage participation in clinical decision making, education programs should be provided to home healthcare nurses. Official clinical practice guidelines should be used to support home healthcare nurses' participation in clinical decision making in cases where they can identify and solve the patient health problems.