A quantitative risk model for early lifecycle decision making

NASA Technical Reports Server (NTRS)

Feather, M. S.; Cornford, S. L.; Dunphy, J.; Hicks, K.

2002-01-01

Decisions made in the earliest phases of system development have the most leverage to influence the success of the entire development effort, and yet must be made when information is incomplete and uncertain. We have developed a scalable cost-benefit model to support this critical phase of early-lifecycle decision-making.

Patients’ priorities for treatment decision making during periods of incapacity: quantitative survey

PubMed Central

RID, ANNETTE; WESLEY, ROBERT; PAVLICK, MARK; MAYNARD, SHARON; ROTH, KATALIN; WENDLER, DAVID

2017-01-01

Objective Clinical practice aims to respect patient autonomy by basing treatment decisions for incapacitated patients on their own preferences. Yet many patients do not complete an advance directive, and those who do frequently just designate a family member to make decisions for them. This finding raises the concern that clinical practice may be based on a mistaken understanding of patient priorities. The present study aimed to collect systematic data on how patients prioritize the goals of treatment decision making. Method We employed a self-administered, quantitative survey of patients in a tertiary care center. Results Some 80% or more of the 1169 respondents (response rate = 59.8%) ranked six of eight listed goals for treatment decision making as important. When asked which goal was most important, 38.8% identified obtaining desired or avoiding unwanted treatments, 20.0% identified minimizing stress or financial burden on their family, and 14.6% identified having their family help to make treatment decisions. No single goal was designated as most important by 25.0% of participants. Significance of Results Patients endorsed three primary goals with respect to decision making during periods of incapacity: being treated consistent with their own preferences; minimizing the burden on their family; and involving their family in the decision-making process. However, no single goal was prioritized by a clear majority of patients. These findings suggest that advance care planning should not be limited to documenting patients’ treatment preferences. Clinicians should also discuss and document patients’ priorities for how decisions are to be made. Moreover, future research should evaluate ways to modify current practice to promote all three of patients primary goals for treatment decision making. PMID:25273677

Patients' priorities for treatment decision making during periods of incapacity: quantitative survey.

PubMed

Rid, Annette; Wesley, Robert; Pavlick, Mark; Maynard, Sharon; Roth, Katalin; Wendler, David

2015-10-01

Clinical practice aims to respect patient autonomy by basing treatment decisions for incapacitated patients on their own preferences. Yet many patients do not complete an advance directive, and those who do frequently just designate a family member to make decisions for them. This finding raises the concern that clinical practice may be based on a mistaken understanding of patient priorities. The present study aimed to collect systematic data on how patients prioritize the goals of treatment decision making. We employed a self-administered, quantitative survey of patients in a tertiary care center. Some 80% or more of the 1169 respondents (response rate = 59.8%) ranked six of eight listed goals for treatment decision making as important. When asked which goal was most important, 38.8% identified obtaining desired or avoiding unwanted treatments, 20.0% identified minimizing stress or financial burden on their family, and 14.6% identified having their family help to make treatment decisions. No single goal was designated as most important by 25.0% of participants. Patients endorsed three primary goals with respect to decision making during periods of incapacity: being treated consistent with their own preferences; minimizing the burden on their family; and involving their family in the decision-making process. However, no single goal was prioritized by a clear majority of patients. These findings suggest that advance care planning should not be limited to documenting patients' treatment preferences. Clinicians should also discuss and document patients' priorities for how decisions are to be made. Moreover, future research should evaluate ways to modify current practice to promote all three of patients primary goals for treatment decision making.

Reason, emotion and decision-making: risk and reward computation with feeling.

PubMed

Quartz, Steven R

2009-05-01

Many models of judgment and decision-making posit distinct cognitive and emotional contributions to decision-making under uncertainty. Cognitive processes typically involve exact computations according to a cost-benefit calculus, whereas emotional processes typically involve approximate, heuristic processes that deliver rapid evaluations without mental effort. However, it remains largely unknown what specific parameters of uncertain decision the brain encodes, the extent to which these parameters correspond to various decision-making frameworks, and their correspondence to emotional and rational processes. Here, I review research suggesting that emotional processes encode in a precise quantitative manner the basic parameters of financial decision theory, indicating a reorientation of emotional and cognitive contributions to risky choice.

The role of quantitative safety evaluation in regulatory decision making of drugs.

PubMed

Chakravarty, Aloka G; Izem, Rima; Keeton, Stephine; Kim, Clara Y; Levenson, Mark S; Soukup, Mat

2016-01-01

Evaluation of safety is a critical component of drug review at the US Food and Drug Administration (FDA). Statisticians are playing an increasingly visible role in quantitative safety evaluation and regulatory decision-making. This article reviews the history and the recent events relating to quantitative drug safety evaluation at the FDA. The article then focuses on five active areas of quantitative drug safety evaluation and the role Division of Biometrics VII (DBVII) plays in these areas, namely meta-analysis for safety evaluation, large safety outcome trials, post-marketing requirements (PMRs), the Sentinel Initiative, and the evaluation of risk from extended/long-acting opioids. This article will focus chiefly on developments related to quantitative drug safety evaluation and not on the many additional developments in drug safety in general.

ACL Return to Sport Guidelines and Criteria.

PubMed

Davies, George J; McCarty, Eric; Provencher, Matthew; Manske, Robert C

2017-09-01

Because of the epidemiological incidence of anterior cruciate ligament (ACL) injuries, the high reinjury rates that occur when returning back to sports, the actual number of patients that return to the same premorbid level of competition, the high incidence of osteoarthritis at 5-10-year follow-ups, and the effects on the long-term health of the knee and the quality of life for the patient, individualizing the return to sports after ACL reconstruction (ACL-R) is critical. However, one of the challenging but unsolved dilemmas is what criteria and clinical decision making should be used to return an athlete back to sports following an ACL-R. This article describes an example of a functional testing algorithm (FTA) as one method for clinical decision making based on quantitative and qualitative testing and assessment utilized to make informed decisions to return an athlete to their sports safely and without compromised performance. The methods were a review of the best current evidence to support a FTA. In order to evaluate all the complicated domains of the clinical decision making for individualizing the return to sports after ACL-R, numerous assessments need to be performed including the biopsychosocial concepts, impairment testing, strength and power testing, functional testing, and patient-reported outcomes (PROs). The optimum criteria to use for individualizing the return to sports after ACL-R remain elusive. However, since this decision needs to be made on a regular basis with the safety and performance factors of the patient involved, this FTA provides one method of quantitatively and qualitatively making the decisions. Admittedly, there is no predictive validity of this system, but it does provide practical guidelines to facilitate the clinical decision making process for return to sports. The clinical decision to return an athlete back into competition has significant implications ranging from the safety of the athlete, to performance factors and actual litigation issues. By using a multifactorial FTA, such as the one described, provides quantitative and qualitatively criteria to make an informed decision in the best interests of the athlete.

Difficult Decisions: A Qualitative Exploration of the Statistical Decision Making Process from the Perspectives of Psychology Students and Academics

PubMed Central

Allen, Peter J.; Dorozenko, Kate P.; Roberts, Lynne D.

2016-01-01

Quantitative research methods are essential to the development of professional competence in psychology. They are also an area of weakness for many students. In particular, students are known to struggle with the skill of selecting quantitative analytical strategies appropriate for common research questions, hypotheses and data types. To begin understanding this apparent deficit, we presented nine psychology undergraduates (who had all completed at least one quantitative methods course) with brief research vignettes, and asked them to explicate the process they would follow to identify an appropriate statistical technique for each. Thematic analysis revealed that all participants found this task challenging, and even those who had completed several research methods courses struggled to articulate how they would approach the vignettes on more than a very superficial and intuitive level. While some students recognized that there is a systematic decision making process that can be followed, none could describe it clearly or completely. We then presented the same vignettes to 10 psychology academics with particular expertise in conducting research and/or research methods instruction. Predictably, these “experts” were able to describe a far more systematic, comprehensive, flexible, and nuanced approach to statistical decision making, which begins early in the research process, and pays consideration to multiple contextual factors. They were sensitive to the challenges that students experience when making statistical decisions, which they attributed partially to how research methods and statistics are commonly taught. This sensitivity was reflected in their pedagogic practices. When asked to consider the format and features of an aid that could facilitate the statistical decision making process, both groups expressed a preference for an accessible, comprehensive and reputable resource that follows a basic decision tree logic. For the academics in particular, this aid should function as a teaching tool, which engages the user with each choice-point in the decision making process, rather than simply providing an “answer.” Based on these findings, we offer suggestions for tools and strategies that could be deployed in the research methods classroom to facilitate and strengthen students' statistical decision making abilities. PMID:26909064

Difficult Decisions: A Qualitative Exploration of the Statistical Decision Making Process from the Perspectives of Psychology Students and Academics.

PubMed

Allen, Peter J; Dorozenko, Kate P; Roberts, Lynne D

2016-01-01

Quantitative research methods are essential to the development of professional competence in psychology. They are also an area of weakness for many students. In particular, students are known to struggle with the skill of selecting quantitative analytical strategies appropriate for common research questions, hypotheses and data types. To begin understanding this apparent deficit, we presented nine psychology undergraduates (who had all completed at least one quantitative methods course) with brief research vignettes, and asked them to explicate the process they would follow to identify an appropriate statistical technique for each. Thematic analysis revealed that all participants found this task challenging, and even those who had completed several research methods courses struggled to articulate how they would approach the vignettes on more than a very superficial and intuitive level. While some students recognized that there is a systematic decision making process that can be followed, none could describe it clearly or completely. We then presented the same vignettes to 10 psychology academics with particular expertise in conducting research and/or research methods instruction. Predictably, these "experts" were able to describe a far more systematic, comprehensive, flexible, and nuanced approach to statistical decision making, which begins early in the research process, and pays consideration to multiple contextual factors. They were sensitive to the challenges that students experience when making statistical decisions, which they attributed partially to how research methods and statistics are commonly taught. This sensitivity was reflected in their pedagogic practices. When asked to consider the format and features of an aid that could facilitate the statistical decision making process, both groups expressed a preference for an accessible, comprehensive and reputable resource that follows a basic decision tree logic. For the academics in particular, this aid should function as a teaching tool, which engages the user with each choice-point in the decision making process, rather than simply providing an "answer." Based on these findings, we offer suggestions for tools and strategies that could be deployed in the research methods classroom to facilitate and strengthen students' statistical decision making abilities.

Risk manager formula for success: Influencing decision making.

PubMed

Midgley, Mike

2017-10-01

Providing the ultimate decision makers with a quantitative risk analysis based on thoughtful assessment by the organization's experts enables an efficient decision. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

Age-related quantitative and qualitative changes in decision making ability.

PubMed

Isella, Valeria; Mapelli, Cristina; Morielli, Nadia; Pelati, Oriana; Franceschi, Massimo; Appollonio, Ildebrando Marco

2008-01-01

The "frontal aging hypothesis" predicts that brain senescence affects predominantly the prefrontal regions. Preliminary evidence has recently been gathered in favour of an age-related change in a typically frontal process, i.e. decision making, using the Iowa Gambling Task (IGT), but overall findings have been conflicting. Following the traditional scoring method, coupled with a qualitative analysis, in the present study we compared IGT performance of 40 young (mean age: 27.9+/-4.7) and 40 old (mean age: 65.4+/-8.6) healthy adults and of 18 patients affected by frontal lobe dementia of mild severity (mean age: 65.1+/-7.4, mean MMSE score: 24.1+/-3.9). Quantitative findings support the notion that decision making ability declines with age; moreover, it approximates the impairment observed in executive dysfunction due to neurodegeneration. Results of the qualitative analysis did not reach statistical significance for the motivational and learning decision making components considered, but approached significance for the attentional component for elderly versus young normals, suggesting a possible decrease in the ability to maintain sustained attention during complex and prolonged tasks as the putative deficit underlying impaired decision making in normal aging.

QTest: Quantitative Testing of Theories of Binary Choice.

PubMed

Regenwetter, Michel; Davis-Stober, Clintin P; Lim, Shiau Hong; Guo, Ying; Popova, Anna; Zwilling, Chris; Cha, Yun-Shil; Messner, William

2014-01-01

The goal of this paper is to make modeling and quantitative testing accessible to behavioral decision researchers interested in substantive questions. We provide a novel, rigorous, yet very general, quantitative diagnostic framework for testing theories of binary choice. This permits the nontechnical scholar to proceed far beyond traditionally rather superficial methods of analysis, and it permits the quantitatively savvy scholar to triage theoretical proposals before investing effort into complex and specialized quantitative analyses. Our theoretical framework links static algebraic decision theory with observed variability in behavioral binary choice data. The paper is supplemented with a custom-designed public-domain statistical analysis package, the QTest software. We illustrate our approach with a quantitative analysis using published laboratory data, including tests of novel versions of "Random Cumulative Prospect Theory." A major asset of the approach is the potential to distinguish decision makers who have a fixed preference and commit errors in observed choices from decision makers who waver in their preferences.

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

PubMed

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

2017-01-01

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

Insights into the concept and measurement of health literacy from a study of shared decision-making in a low literacy population.

PubMed

Smith, Sian K; Nutbeam, Don; McCaffery, Kirsten J

2013-08-01

This article explores the concept and measurement of health literacy in the context of shared health decision-making. It draws upon a series of qualitative and quantitative studies undertaken in the development and evaluation of a bowel cancer screening decision aid for low literacy populations. The findings indicate that different types of health literacy (functional, interactive and critical) are required in decision-making and present a set of instruments to assess and discriminate between higher level health literacy skills required for engagement in decision-making. It concludes that greater sophistication in both the definition and measurement of health literacy in research is needed.

Structured decision making as a framework for linking quantitative decision support to community values

EPA Science Inventory

Community-level decisions can have large impacts on production and delivery of ecosystem services, which ultimately affects community well-being. But engaging stakeholders in a process to explore these impacts is a significant challenge. The principles of Structured Decision Ma...

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

PubMed

Wolf, Lisa

2013-02-01

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

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

Motivational salience signal in the basal forebrain is coupled with faster and more precise decision speed.

PubMed

Avila, Irene; Lin, Shih-Chieh

2014-03-01

The survival of animals depends critically on prioritizing responses to motivationally salient stimuli. While it is generally believed that motivational salience increases decision speed, the quantitative relationship between motivational salience and decision speed, measured by reaction time (RT), remains unclear. Here we show that the neural correlate of motivational salience in the basal forebrain (BF), defined independently of RT, is coupled with faster and also more precise decision speed. In rats performing a reward-biased simple RT task, motivational salience was encoded by BF bursting response that occurred before RT. We found that faster RTs were tightly coupled with stronger BF motivational salience signals. Furthermore, the fraction of RT variability reflecting the contribution of intrinsic noise in the decision-making process was actively suppressed in faster RT distributions with stronger BF motivational salience signals. Artificially augmenting the BF motivational salience signal via electrical stimulation led to faster and more precise RTs and supports a causal relationship. Together, these results not only describe for the first time, to our knowledge, the quantitative relationship between motivational salience and faster decision speed, they also reveal the quantitative coupling relationship between motivational salience and more precise RT. Our results further establish the existence of an early and previously unrecognized step in the decision-making process that determines both the RT speed and variability of the entire decision-making process and suggest that this novel decision step is dictated largely by the BF motivational salience signal. Finally, our study raises the hypothesis that the dysregulation of decision speed in conditions such as depression, schizophrenia, and cognitive aging may result from the functional impairment of the motivational salience signal encoded by the poorly understood noncholinergic BF neurons.

Motivational Salience Signal in the Basal Forebrain Is Coupled with Faster and More Precise Decision Speed

PubMed Central

Avila, Irene; Lin, Shih-Chieh

2014-01-01

The survival of animals depends critically on prioritizing responses to motivationally salient stimuli. While it is generally believed that motivational salience increases decision speed, the quantitative relationship between motivational salience and decision speed, measured by reaction time (RT), remains unclear. Here we show that the neural correlate of motivational salience in the basal forebrain (BF), defined independently of RT, is coupled with faster and also more precise decision speed. In rats performing a reward-biased simple RT task, motivational salience was encoded by BF bursting response that occurred before RT. We found that faster RTs were tightly coupled with stronger BF motivational salience signals. Furthermore, the fraction of RT variability reflecting the contribution of intrinsic noise in the decision-making process was actively suppressed in faster RT distributions with stronger BF motivational salience signals. Artificially augmenting the BF motivational salience signal via electrical stimulation led to faster and more precise RTs and supports a causal relationship. Together, these results not only describe for the first time, to our knowledge, the quantitative relationship between motivational salience and faster decision speed, they also reveal the quantitative coupling relationship between motivational salience and more precise RT. Our results further establish the existence of an early and previously unrecognized step in the decision-making process that determines both the RT speed and variability of the entire decision-making process and suggest that this novel decision step is dictated largely by the BF motivational salience signal. Finally, our study raises the hypothesis that the dysregulation of decision speed in conditions such as depression, schizophrenia, and cognitive aging may result from the functional impairment of the motivational salience signal encoded by the poorly understood noncholinergic BF neurons. PMID:24642480

Applying quantitative benefit-risk analysis to aid regulatory decision making in diagnostic imaging: methods, challenges, and opportunities.

PubMed

Agapova, Maria; Devine, Emily Beth; Bresnahan, Brian W; Higashi, Mitchell K; Garrison, Louis P

2014-09-01

Health agencies making regulatory marketing-authorization decisions use qualitative and quantitative approaches to assess expected benefits and expected risks associated with medical interventions. There is, however, no universal standard approach that regulatory agencies consistently use to conduct benefit-risk assessment (BRA) for pharmaceuticals or medical devices, including for imaging technologies. Economics, health services research, and health outcomes research use quantitative approaches to elicit preferences of stakeholders, identify priorities, and model health conditions and health intervention effects. Challenges to BRA in medical devices are outlined, highlighting additional barriers in radiology. Three quantitative methods--multi-criteria decision analysis, health outcomes modeling and stated-choice survey--are assessed using criteria that are important in balancing benefits and risks of medical devices and imaging technologies. To be useful in regulatory BRA, quantitative methods need to: aggregate multiple benefits and risks, incorporate qualitative considerations, account for uncertainty, and make clear whose preferences/priorities are being used. Each quantitative method performs differently across these criteria and little is known about how BRA estimates and conclusions vary by approach. While no specific quantitative method is likely to be the strongest in all of the important areas, quantitative methods may have a place in BRA of medical devices and radiology. Quantitative BRA approaches have been more widely applied in medicines, with fewer BRAs in devices. Despite substantial differences in characteristics of pharmaceuticals and devices, BRA methods may be as applicable to medical devices and imaging technologies as they are to pharmaceuticals. Further research to guide the development and selection of quantitative BRA methods for medical devices and imaging technologies is needed. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

Multi-objective decision-making under uncertainty: Fuzzy logic methods

NASA Technical Reports Server (NTRS)

Hardy, Terry L.

1995-01-01

Fuzzy logic allows for quantitative representation of vague or fuzzy objectives, and therefore is well-suited for multi-objective decision-making. This paper presents methods employing fuzzy logic concepts to assist in the decision-making process. In addition, this paper describes software developed at NASA Lewis Research Center for assisting in the decision-making process. Two diverse examples are used to illustrate the use of fuzzy logic in choosing an alternative among many options and objectives. One example is the selection of a lunar lander ascent propulsion system, and the other example is the selection of an aeration system for improving the water quality of the Cuyahoga River in Cleveland, Ohio. The fuzzy logic techniques provided here are powerful tools which complement existing approaches, and therefore should be considered in future decision-making activities.

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.

College Students' Scientific Epistemological Views and Thinking Patterns in Socioscientific Decision Making

ERIC Educational Resources Information Center

Liu, Shiang-Yao; Lin, Chuan-Shun; Tsai, Chin-Chung

2011-01-01

This study aims to test the nature of the assumption that there are relationships between scientific epistemological views (SEVs) and reasoning processes in socioscientific decision making. A mixed methodology that combines both qualitative and quantitative approaches of data collection and analysis was adopted not only to verify the assumption…

Influence of Transformational Leadership Style on Decision-Making Style and Technology Readiness: A Correlation Study

ERIC Educational Resources Information Center

Mueller, Crystal A.

2009-01-01

The research addressed the problem of technology initiatives failing to meet organizational objectives. The purpose of the quantitative correlation study was to determine the relationship between transformational leadership styles, decision-making styles, and technology readiness. The findings of the study answered research questions in three…

Fire Ground Decision-Making: Transferring Virtual Knowledge to the Physical Environment

ERIC Educational Resources Information Center

Gillespie, Steven

2013-01-01

The primary purpose of this quantitative study was to examine if simulation training correlated with the decision-making abilities of firefighters from two departments (one in a mountain state and one in a southwest state). The other purposes were to determine if firefighter demographics were correlated with the completion of the simulation…

Principals' Decision Making in Discipline Policy Implementation: The Lutheran Schools' Perspective

ERIC Educational Resources Information Center

Brandon, Katherine J.

2013-01-01

This quantitative study examines the relationship of philosophical beliefs of administrators of Lutheran schools and the influence of those beliefs on discipline decision-making styles, job satisfaction, and other factors. The study patterns the survey work from William Perry (1999) and other theorists regarding philosophy and ethics. A…

[Impact of shared-decision making on patient satisfaction].

PubMed

Suh, Won S; Lee, Chae Kyung

2010-01-01

The purpose of this research is to analyze the impact of shared-decision making on patient satisfaction. The study is significant since it focuses on developing appropriate methodologies and analyzing data to identify patient preferences, with the goals of optimizing treatment selection, and substantiating the relationship between such preferences and their impact on outcomes. A thorough literature review that developed the framework illustrating key dimensions of shared decision making was followed by a quantitative assessment and regression analysis of patient-perceived satisfaction, and the degree of shared-decision making. A positive association was evident between shared-decision making and patient satisfaction. The impact of shared decision making on patient satisfaction was greater than other variable including gender, education, and number of visits. Patients who participate in care-related decisions and who are given an explanation of their health problems are more likely to be satisfied with their care. It would benefit health care organizations to train their medical professionals in this communication method, and to include it in their practice guidelines.

QTest: Quantitative Testing of Theories of Binary Choice

PubMed Central

Regenwetter, Michel; Davis-Stober, Clintin P.; Lim, Shiau Hong; Guo, Ying; Popova, Anna; Zwilling, Chris; Cha, Yun-Shil; Messner, William

2014-01-01

The goal of this paper is to make modeling and quantitative testing accessible to behavioral decision researchers interested in substantive questions. We provide a novel, rigorous, yet very general, quantitative diagnostic framework for testing theories of binary choice. This permits the nontechnical scholar to proceed far beyond traditionally rather superficial methods of analysis, and it permits the quantitatively savvy scholar to triage theoretical proposals before investing effort into complex and specialized quantitative analyses. Our theoretical framework links static algebraic decision theory with observed variability in behavioral binary choice data. The paper is supplemented with a custom-designed public-domain statistical analysis package, the QTest software. We illustrate our approach with a quantitative analysis using published laboratory data, including tests of novel versions of “Random Cumulative Prospect Theory.” A major asset of the approach is the potential to distinguish decision makers who have a fixed preference and commit errors in observed choices from decision makers who waver in their preferences. PMID:24999495

Determinants of Propranolol's Selective Effect on Loss Aversion.

PubMed

Sokol-Hessner, Peter; Lackovic, Sandra F; Tobe, Russell H; Camerer, Colin F; Leventhal, Bennett L; Phelps, Elizabeth A

2015-07-01

Research on emotion and decision making has suggested that arousal mediates risky decisions, but several distinct and often confounded processes drive such choices. We used econometric modeling to separate and quantify the unique contributions of loss aversion, risk attitudes, and choice consistency to risky decision making. We administered the beta-blocker propranolol in a double-blind, placebo-controlled within-subjects study, targeting the neurohormonal basis of physiological arousal. Matching our intervention's pharmacological specificity with a quantitative model delineating decision-making components allowed us to identify the causal relationships between arousal and decision making that do and do not exist. Propranolol selectively reduced loss aversion in a baseline- and dose-dependent manner (i.e., as a function of initial loss aversion and body mass index), and did not affect risk attitudes or choice consistency. These findings provide evidence for a specific, modulatory, and causal relationship between precise components of emotion and risky decision making. © The Author(s) 2015.

Influencing Factors on Planning Decision-Making among Spanish In-Service Physical Education Teachers. A Population-Based Study

ERIC Educational Resources Information Center

Viciana, Jesús; Mayorga-Vega, Daniel

2017-01-01

Introduction: Traditionally, literature has contributed qualitative approaches for studying how to plan Physical Education (PE). To our knowledge there are not quantitative populationbased studies regarding the decision-making process among in-service Spanish PE teachers. The aim of this study was to analyze possible differences in the factors of…

Toward a Theoretical Model of Decision-Making and Resistance to Change among Higher Education Online Course Designers

ERIC Educational Resources Information Center

Dodd, Bucky J.

2013-01-01

Online course design is an emerging practice in higher education, yet few theoretical models currently exist to explain or predict how the diffusion of innovations occurs in this space. This study used a descriptive, quantitative survey research design to examine theoretical relationships between decision-making style and resistance to change…

Examining Data-Driven Decision Making in Private/Religious Schools

ERIC Educational Resources Information Center

Hanks, Jason Edward

2011-01-01

The purpose of this study was to investigate non-mandated data-driven decision making in private/religious schools. The school culture support of data use, teacher use of data, leader facilitation of using data, and the availability of data were investigated in three schools. A quantitative survey research design was used to explore the research…

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

Understanding Pre-Quantitative Risk in Projects

NASA Technical Reports Server (NTRS)

Cooper, Lynne P.

2011-01-01

Standard approaches to risk management in projects depend on the ability of teams to identify risks and quantify the probabilities and consequences of these risks (e.g., the 5 x 5 risk matrix). However, long before quantification does - or even can - occur, and long after, teams make decisions based on their pre-quantitative understanding of risk. These decisions can have long-lasting impacts on the project. While significant research has looked at the process of how to quantify risk, our understanding of how teams conceive of and manage pre-quantitative risk is lacking. This paper introduces the concept of pre-quantitative risk and discusses the implications of addressing pre-quantitative risk in projects.

[Patients' preferences and experience regarding participation in nursing care decisions in acute hospitals--an analysis of conformity of preferences and experience, and factors influencing different types of decision making].

PubMed

Smoliner, Andrea; Hantikainen, Virpi; Mayer, Hanna; Ponocny-Seliger, Elisabeth; Them, Christa

2009-12-01

Patients' preferences regarding their participation in nursing care decisions represent a key aspect of the concept of evidence-based nursing; nonetheless, very little quantitative research has been carried out in this area. The aim of the present study was to describe the patients' preferences and experience concerning their participation in nursing care decision-making processes in acute hospitals. A total of 967 patients in five hospitals in Vienna participated in this study by completing questionnaires. The results revealed that 38.5 % of patients preferred the paternalistic style of decision-making, 42.1 % wanted to make decisions together with the nursing staff and 5.7 % expressed a wish to make their own decisions. During their hospital stay, however, patients experienced paternalistic decision-making to a higher degree than they wished for. Age, sex, form of treatment and subjectively experienced health condition represented person-related characteristics that influenced preferences regarding the form of decision-making. The results of this study underline the importance of collecting data on patients' preferences in decision-making processes in order to meet the social, legal, and professional demands of patient-oriented nursing care based on the most recent scientific knowledge.

The influence of expert opinions on the selection of wastewater treatment alternatives: a group decision-making approach.

PubMed

Kalbar, Pradip P; Karmakar, Subhankar; Asolekar, Shyam R

2013-10-15

The application of multiple-attribute decision-making (MADM) to real life decision problems suggests that avoiding the loss of information through scenario-based approaches and including expert opinions in the decision-making process are two major challenges that require more research efforts. Recently, a wastewater treatment technology selection effort has been made with a 'scenario-based' method of MADM. This paper focuses on a novel approach to incorporate expert opinions into the scenario-based decision-making process, as expert opinions play a major role in the selection of treatment technologies. The sets of criteria and the indicators that are used consist of both qualitative and quantitative criteria. The group decision-making (GDM) approach that is implemented for aggregating expert opinions is based on an analytical hierarchy process (AHP), which is the most widely used MADM method. The pairwise comparison matrices (PCMs) for qualitative criteria are formed based on expert opinions, whereas, a novel approach is proposed for generating PCMs for quantitative criteria. It has been determined that the experts largely prefer natural treatment systems because they are more sustainable in any scenario. However, PCMs based on expert opinions suggest that advanced technologies such as the sequencing batch reactor (SBR) can also be appropriate for a given decision scenario. The proposed GDM approach is a rationalized process that will be more appropriate in realistic scenarios where multiple stakeholders with local and regional societal priorities are involved in the selection of treatment technology. Copyright © 2013 Elsevier Ltd. All rights reserved.

Don't bet on it! Wagering as a measure of awareness in decision making under uncertainty.

PubMed

Konstantinidis, Emmanouil; Shanks, David R

2014-12-01

Can our decisions be guided by unconscious or implicit influences? According to the somatic marker hypothesis, emotion-based signals can guide our decisions in uncertain environments outside awareness. Postdecision wagering, in which participants make wagers on the outcomes of their decisions, has been recently proposed as an objective and sensitive measure of conscious content. In 5 experiments we employed variations of a classic decision-making assessment, the Iowa Gambling Task, in combination with wagering in order to investigate the role played by unconscious influences. We examined the validity of postdecision wagering by comparing it with alternative measures of conscious knowledge, specifically confidence ratings and quantitative questions. Consistent with a putative role for unconscious influences, in Experiments 2 and 3 we observed a lag between choice accuracy and the onset of advantageous wagering. However, the lag was eliminated by a change in the wagering payoff matrix (Experiment 2) and by a switch from a binary wager response to either a binary or a 4-point confidence response (Experiment 3), and wagering underestimated awareness compared to explicit quantitative questions (Experiments 1 and 4). Our results demonstrate the insensitivity of postdecision wagering as a direct measure of conscious knowledge and challenge the claim that implicit processes influence decision making under uncertainty. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Physical mechanism of mind changes and tradeoffs among speed, accuracy, and energy cost in brain decision making: Landscape, flux, and path perspectives

NASA Astrophysics Data System (ADS)

Han, Yan; Kun, Zhang; Jin, Wang

2016-07-01

Cognitive behaviors are determined by underlying neural networks. Many brain functions, such as learning and memory, have been successfully described by attractor dynamics. For decision making in the brain, a quantitative description of global attractor landscapes has not yet been completely given. Here, we developed a theoretical framework to quantify the landscape associated with the steady state probability distributions and associated steady state curl flux, measuring the degree of non-equilibrium through the degree of detailed balance breaking for decision making. We quantified the decision-making processes with optimal paths from the undecided attractor states to the decided attractor states, which are identified as basins of attractions, on the landscape. Both landscape and flux determine the kinetic paths and speed. The kinetics and global stability of decision making are explored by quantifying the landscape topography through the barrier heights and the mean first passage time. Our theoretical predictions are in agreement with experimental observations: more errors occur under time pressure. We quantitatively explored two mechanisms of the speed-accuracy tradeoff with speed emphasis and further uncovered the tradeoffs among speed, accuracy, and energy cost. Our results imply that there is an optimal balance among speed, accuracy, and the energy cost in decision making. We uncovered the possible mechanisms of changes of mind and how mind changes improve performance in decision processes. Our landscape approach can help facilitate an understanding of the underlying physical mechanisms of cognitive processes and identify the key factors in the corresponding neural networks. Project supported by the National Natural Science Foundation of China (Grant Nos. 21190040, 91430217, and 11305176).

Deciding Factors: Do Factors beyond Achievement Influence Teachers' Student Placement Decisions?

ERIC Educational Resources Information Center

Riley, Tasha

2014-01-01

Since teachers' decisions potentially have consequences for learners' future educational and life opportunities, it is imperative to determine the basis of teachers' decision-making in order to determine whether it is discriminatory. This study combines qualitative and quantitative methods towards a multi-school, multi-region study of Australian…

Quantitative Market Research Regarding Funding of District 8 Construction Projects

DOT National Transportation Integrated Search

1995-05-01

The primary objective of this quantitative research is to provide information : for more effective decision making regarding the level of investment in various : transportation systems in District 8. : This objective was accomplished by establishing ...

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.

Consumer Decision-Making Styles for Sport Apparel: Gender Comparisons between College Consumers

ERIC Educational Resources Information Center

Bae, Sungwon; Miller, John

2009-01-01

The purpose of this study was to identify the decision-making styles of college students for sports apparel. Modifying the Consumer Style Inventory (CSI) developed by Sproles and Kendall (1986), a quantitative research design was developed to analyze the effect of seven factors. Eight-hundred and twenty-two subjects composed of 376 male and 446…

The Relationship of Business Intelligence Systems to Organizational Performance Benefits: A Structural Equation Modeling of Management Decision Making

ERIC Educational Resources Information Center

Sparks, Betsy H.

2014-01-01

Business Intelligence is a major expenditure in many organizations and necessary for competitive advantage. These expenditures do not result in maximum benefits for the organization if the information obtained from the Business Intelligence System (BIS) is not used in the management decision-making process. This quantitative research study used an…

Decision-Making Processes of SME in Cloud Computing Adoption to Create Disruptive Innovation: Mediating Effect of Collaboration

ERIC Educational Resources Information Center

Sonthiprasat, Rattanawadee

2014-01-01

THE PROBLEM. The purpose of this quantitative correlation study was to assess the relationship between different Cloud service levels of effective business innovation for SMEs. In addition, the new knowledge gained from the benefits of Cloud adoption with knowledge sharing would enhance the decision making process for businesses to consider the…

Speech, Sign, or Multilingualism for Children with Hearing Loss: Quantitative Insights into Caregivers' Decision Making

ERIC Educational Resources Information Center

Crowe, Kathryn; McLeod, Sharynne; McKinnon, David H.; Ching, Teresa Y. C.

2014-01-01

Purpose: The authors sought to investigate the influence of a comprehensive range of factors on the decision making of caregivers of children with hearing loss regarding the use of speech, the use of sign, spoken language multilingualism, and spoken language choice. This is a companion article to the qualitative investigation described in Crowe,…

Advanced Productivity Analysis Methods for Air Traffic Control Operations

DTIC Science & Technology

1976-12-01

Routine Work ............................... 37 4.2.2. Surveillance Work .......................... 40 4.2.3. Conflict Prcessing Work ................... 41...crossing and overtake conflicts) includes potential- conflict recognition, assessment, and resolution decision making and A/N voice communications...makers to utilize £ .quantitative and dynamic analysis as a tool for decision - making. 1.1.3 Types of Simulation Models Although there are many ways to

A multicriteria decision making approach based on fuzzy theory and credibility mechanism for logistics center location selection.

PubMed

Wang, Bowen; Xiong, Haitao; Jiang, Chengrui

2014-01-01

As a hot topic in supply chain management, fuzzy method has been widely used in logistics center location selection to improve the reliability and suitability of the logistics center location selection with respect to the impacts of both qualitative and quantitative factors. However, it does not consider the consistency and the historical assessments accuracy of experts in predecisions. So this paper proposes a multicriteria decision making model based on credibility of decision makers by introducing priority of consistency and historical assessments accuracy mechanism into fuzzy multicriteria decision making approach. In this way, only decision makers who pass the credibility check are qualified to perform the further assessment. Finally, a practical example is analyzed to illustrate how to use the model. The result shows that the fuzzy multicriteria decision making model based on credibility mechanism can improve the reliability and suitability of site selection for the logistics center.

A Multicriteria Decision Making Approach Based on Fuzzy Theory and Credibility Mechanism for Logistics Center Location Selection

PubMed Central

Wang, Bowen; Jiang, Chengrui

2014-01-01

As a hot topic in supply chain management, fuzzy method has been widely used in logistics center location selection to improve the reliability and suitability of the logistics center location selection with respect to the impacts of both qualitative and quantitative factors. However, it does not consider the consistency and the historical assessments accuracy of experts in predecisions. So this paper proposes a multicriteria decision making model based on credibility of decision makers by introducing priority of consistency and historical assessments accuracy mechanism into fuzzy multicriteria decision making approach. In this way, only decision makers who pass the credibility check are qualified to perform the further assessment. Finally, a practical example is analyzed to illustrate how to use the model. The result shows that the fuzzy multicriteria decision making model based on credibility mechanism can improve the reliability and suitability of site selection for the logistics center. PMID:25215319

The attentional drift-diffusion model extends to simple purchasing decisions.

PubMed

Krajbich, Ian; Lu, Dingchao; Camerer, Colin; Rangel, Antonio

2012-01-01

How do we make simple purchasing decisions (e.g., whether or not to buy a product at a given price)? Previous work has shown that the attentional drift-diffusion model (aDDM) can provide accurate quantitative descriptions of the psychometric data for binary and trinary value-based choices, and of how the choice process is guided by visual attention. Here we extend the aDDM to the case of purchasing decisions, and test it using an eye-tracking experiment. We find that the model also provides a reasonably accurate quantitative description of the relationship between choice, reaction time, and visual fixations using parameters that are very similar to those that best fit the previous data. The only critical difference is that the choice biases induced by the fixations are about half as big in purchasing decisions as in binary choices. This suggests that a similar computational process is used to make binary choices, trinary choices, and simple purchasing decisions.

The Attentional Drift-Diffusion Model Extends to Simple Purchasing Decisions

PubMed Central

Krajbich, Ian; Lu, Dingchao; Camerer, Colin; Rangel, Antonio

2012-01-01

How do we make simple purchasing decisions (e.g., whether or not to buy a product at a given price)? Previous work has shown that the attentional drift-diffusion model (aDDM) can provide accurate quantitative descriptions of the psychometric data for binary and trinary value-based choices, and of how the choice process is guided by visual attention. Here we extend the aDDM to the case of purchasing decisions, and test it using an eye-tracking experiment. We find that the model also provides a reasonably accurate quantitative description of the relationship between choice, reaction time, and visual fixations using parameters that are very similar to those that best fit the previous data. The only critical difference is that the choice biases induced by the fixations are about half as big in purchasing decisions as in binary choices. This suggests that a similar computational process is used to make binary choices, trinary choices, and simple purchasing decisions. PMID:22707945

The scientific management of volcanic crises

NASA Astrophysics Data System (ADS)

Marzocchi, Warner; Newhall, Christopher; Woo, Gordon

2012-12-01

Sound scientific management of volcanic crises is the primary tool to reduce significantly volcanic risk in the short-term. At present, a wide variety of qualitative or semi-quantitative strategies is adopted, and there is not yet a commonly accepted quantitative and general strategy. Pre-eruptive processes are extremely complicated, with many degrees of freedom nonlinearly coupled, and poorly known, so scientists must quantify eruption forecasts through the use of probabilities. On the other hand, this also forces decision-makers to make decisions under uncertainty. We review the present state of the art in this field in order to identify the main gaps of the existing procedures. Then, we put forward a general quantitative procedure that may overcome the present barriers, providing guidelines on how probabilities may be used to take rational mitigation actions. These procedures constitute a crucial link between science and society; they can be used to establish objective and transparent decision-making protocols and also clarify the role and responsibility of each partner involved in managing a crisis.

A quantitative risk-based model for reasoning over critical system properties

NASA Technical Reports Server (NTRS)

Feather, M. S.

2002-01-01

This position paper suggests the use of a quantitative risk-based model to help support reeasoning and decision making that spans many of the critical properties such as security, safety, survivability, fault tolerance, and real-time.

An integrated review of the correlation between critical thinking ability and clinical decision-making in nursing.

PubMed

Lee, Daphne Sk; Abdullah, Khatijah Lim; Subramanian, Pathmawathi; Bachmann, Robert Thomas; Ong, Swee Leong

2017-12-01

To explore whether there is a correlation between critical thinking ability and clinical decision-making among nurses. Critical thinking is currently considered as an essential component of nurses' professional judgement and clinical decision-making. If confirmed, nursing curricula may be revised emphasising on critical thinking with the expectation to improve clinical decision-making and thus better health care. Integrated literature review. The integrative review was carried out after a comprehensive literature search using electronic databases Ovid, EBESCO MEDLINE, EBESCO CINAHL, PROQuest and Internet search engine Google Scholar. Two hundred and 22 articles from January 1980 to end of 2015 were retrieved. All studies evaluating the relationship between critical thinking and clinical decision-making, published in English language with nurses or nursing students as the study population, were included. No qualitative studies were found investigating the relationship between critical thinking and clinical decision-making, while 10 quantitative studies met the inclusion criteria and were further evaluated using the Quality Assessment and Validity Tool. As a result, one study was excluded due to a low-quality score, with the remaining nine accepted for this review. Four of nine studies established a positive relationship between critical thinking and clinical decision-making. Another five studies did not demonstrate a significant correlation. The lack of refinement in studies' design and instrumentation were arguably the main reasons for the inconsistent results. Research studies yielded contradictory results as regard to the relationship between critical thinking and clinical decision-making; therefore, the evidence is not convincing. Future quantitative studies should have representative sample size, use critical thinking measurement tools related to the healthcare sector and evaluate the predisposition of test takers towards their willingness and ability to think. There is also a need for qualitative studies to provide a fresh approach in exploring the relationship between these variables uncovering currently unknown contributing factors. This review confirmed that evidence to support the existence of relationships between critical thinking and clinical decision-making is still unsubstantiated. Therefore, it serves as a call for nurse leaders and nursing academics to produce quality studies in order to firmly support or reject the hypothesis that there is a statistically significant correlation between critical thinking and clinical decision-making. © 2017 John Wiley & Sons Ltd.

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

Determinants of propranolol’s selective effect on loss aversion

PubMed Central

Sokol-Hessner, Peter; Lackovic, Sandra F.; Tobe, Russell H.; Camerer, Colin F.; Leventhal, Bennett L.; Phelps, Elizabeth A.

2015-01-01

Research on emotion and decision-making has suggested that arousal mediates risky decisions (e.g., Bechara et al., 1997), but several distinct and often confounded processes drive such choices. Here, we used econometric modeling to separate and quantify the unique contributions of loss aversion, risk sensitivity and choice consistency to risky decision-making. We administered the beta-blocker propranolol in a double-blind, placebo-controlled within-subjects study, targeting the neurohormonal basis of physiological arousal. Matching our intervention’s pharmacological specificity with a quantitative model delineating decision-making components allowed us to identify the causal relationships between arousal and decision-making that do and do not exist. Propranolol selectively reduced loss aversion in a baseline- and dose-dependent manner (i.e. as a function of initial loss aversion and body-mass index), and did not affect risk sensitivity or choice consistency. These findings provide evidence for a specific, modulatory, and causal relationship between precise components of both emotion and risky decision-making. PMID:26063441

Predictors of Shared Decision Making and Level of Agreement between Consumers and Providers in Psychiatric Care

PubMed Central

Fukui, Sadaaki; Salyers, Michelle P.; Matthias, Marianne S.; Collins, Linda; Thompson, John; Coffman, Melinda; Torrey, William C.

2014-01-01

The purpose of this study was to quantitatively examine elements of shared decision making (SDM), and to establish empirical evidence for factors correlated with SDM and the level of agreement between consumer and provider in psychiatric care. Transcripts containing 128 audio-recorded medication check-up visits with eight providers at three community mental health centers were rated using the Shared Decision Making scale, adapted from Braddock’s Informed Decision Making Scale (Braddock et al., 1997; 1999; 2008). Multilevel regression analyses revealed that greater consumer activity in the session and greater decision complexity significantly predicted the SDM score. The best predictor of agreement between consumer and provider was “exploration of consumer preference,” with a four-fold increase in full agreement when consumer preferences were discussed more completely. Enhancing active consumer participation, particularly by incorporating consumer preferences in the decision making process appears to be an important factor in SDM. PMID:23299226

Fuzzy approaches to supplier selection problem

NASA Astrophysics Data System (ADS)

Ozkok, Beyza Ahlatcioglu; Kocken, Hale Gonce

2013-09-01

Supplier selection problem is a multi-criteria decision making problem which includes both qualitative and quantitative factors. In the selection process many criteria may conflict with each other, therefore decision-making process becomes complicated. In this study, we handled the supplier selection problem under uncertainty. In this context; we used minimum criterion, arithmetic mean criterion, regret criterion, optimistic criterion, geometric mean and harmonic mean. The membership functions created with the help of the characteristics of used criteria, and we tried to provide consistent supplier selection decisions by using these memberships for evaluating alternative suppliers. During the analysis, no need to use expert opinion is a strong aspect of the methodology used in the decision-making.

Research on the decision-making model of land-use spatial optimization

NASA Astrophysics Data System (ADS)

He, Jianhua; Yu, Yan; Liu, Yanfang; Liang, Fei; Cai, Yuqiu

2009-10-01

Using the optimization result of landscape pattern and land use structure optimization as constraints of CA simulation results, a decision-making model of land use spatial optimization is established coupled the landscape pattern model with cellular automata to realize the land use quantitative and spatial optimization simultaneously. And Huangpi district is taken as a case study to verify the rationality of the model.

Sequential Sampling Models in Cognitive Neuroscience: Advantages, Applications, and Extensions.

PubMed

Forstmann, B U; Ratcliff, R; Wagenmakers, E-J

2016-01-01

Sequential sampling models assume that people make speeded decisions by gradually accumulating noisy information until a threshold of evidence is reached. In cognitive science, one such model--the diffusion decision model--is now regularly used to decompose task performance into underlying processes such as the quality of information processing, response caution, and a priori bias. In the cognitive neurosciences, the diffusion decision model has recently been adopted as a quantitative tool to study the neural basis of decision making under time pressure. We present a selective overview of several recent applications and extensions of the diffusion decision model in the cognitive neurosciences.

Using quantitative risk information in decisions about statins: a qualitative study in a community setting.

PubMed

Polak, Louisa; Green, Judith

2015-04-01

A large literature informs guidance for GPs about communicating quantitative risk information so as to facilitate shared decision making. However, relatively little has been written about how patients utilise such information in practice. To understand the role of quantitative risk information in patients' accounts of decisions about taking statins. This was a qualitative study, with participants recruited and interviewed in community settings. Semi-structured interviews were conducted with 34 participants aged >50 years, all of whom had been offered statins. Data were analysed thematically, using elements of the constant comparative method. Interviewees drew frequently on numerical test results to explain their decisions about preventive medication. In contrast, they seldom mentioned quantitative risk information, and never offered it as a rationale for action. Test results were spoken of as objects of concern despite an often-explicit absence of understanding, so lack of understanding seems unlikely to explain the non-use of risk estimates. Preventive medication was seen as 'necessary' either to treat test results, or because of personalised, unequivocal advice from a doctor. This study's findings call into question the assumption that people will heed and use numerical risk information once they understand it; these data highlight the need to consider the ways in which different kinds of knowledge are used in practice in everyday contexts. There was little evidence from this study that understanding probabilistic risk information was a necessary or valued condition for making decisions about statin use. © British Journal of General Practice 2015.

Using measurement uncertainty in decision-making and conformity assessment

NASA Astrophysics Data System (ADS)

Pendrill, L. R.

2014-08-01

Measurements often provide an objective basis for making decisions, perhaps when assessing whether a product conforms to requirements or whether one set of measurements differs significantly from another. There is increasing appreciation of the need to account for the role of measurement uncertainty when making decisions, so that a ‘fit-for-purpose’ level of measurement effort can be set prior to performing a given task. Better mutual understanding between the metrologist and those ordering such tasks about the significance and limitations of the measurements when making decisions of conformance will be especially useful. Decisions of conformity are, however, currently made in many important application areas, such as when addressing the grand challenges (energy, health, etc), without a clear and harmonized basis for sharing the risks that arise from measurement uncertainty between the consumer, supplier and third parties. In reviewing, in this paper, the state of the art of the use of uncertainty evaluation in conformity assessment and decision-making, two aspects in particular—the handling of qualitative observations and of impact—are considered key to bringing more order to the present diverse rules of thumb of more or less arbitrary limits on measurement uncertainty and percentage risk in the field. (i) Decisions of conformity can be made on a more or less quantitative basis—referred in statistical acceptance sampling as by ‘variable’ or by ‘attribute’ (i.e. go/no-go decisions)—depending on the resources available or indeed whether a full quantitative judgment is needed or not. There is, therefore, an intimate relation between decision-making, relating objects to each other in terms of comparative or merely qualitative concepts, and nominal and ordinal properties. (ii) Adding measures of impact, such as the costs of incorrect decisions, can give more objective and more readily appreciated bases for decisions for all parties concerned. Such costs are associated with a variety of consequences, such as unnecessary re-manufacturing by the supplier as well as various consequences for the customer, arising from incorrect measures of quantity, poor product performance and so on.

Decision-Oriented Health Technology Assessment: One Step Forward in Supporting the Decision-Making Process in Hospitals.

PubMed

Ritrovato, Matteo; Faggiano, Francesco C; Tedesco, Giorgia; Derrico, Pietro

2015-06-01

This article outlines the Decision-Oriented Health Technology Assessment: a new implementation of the European network for Health Technology Assessment Core Model, integrating the multicriteria decision-making analysis by using the analytic hierarchy process to introduce a standardized methodological approach as a valued and shared tool to support health care decision making within a hospital. Following the Core Model as guidance (European network for Health Technology Assessment. HTA core model for medical and surgical interventions. Available from: http://www.eunethta.eu/outputs/hta-core-model-medical-and-surgical-interventions-10r. [Accessed May 27, 2014]), it is possible to apply the analytic hierarchy process to break down a problem into its constituent parts and identify priorities (i.e., assigning a weight to each part) in a hierarchical structure. Thus, it quantitatively compares the importance of multiple criteria in assessing health technologies and how the alternative technologies perform in satisfying these criteria. The verbal ratings are translated into a quantitative form by using the Saaty scale (Saaty TL. Decision making with the analytic hierarchy process. Int J Serv Sci 2008;1:83-98). An eigenvectors analysis is used for deriving the weights' systems (i.e., local and global weights' system) that reflect the importance assigned to the criteria and the priorities related to the performance of the alternative technologies. Compared with the Core Model, this methodological approach supplies a more timely as well as contextualized evidence for a specific technology, making it possible to obtain data that are more relevant and easier to interpret, and therefore more useful for decision makers to make investment choices with greater awareness. We reached the conclusion that although there may be scope for improvement, this implementation is a step forward toward the goal of building a "solid bridge" between the scientific evidence and the final decision maker's choice. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Young adults' decision making surrounding heavy drinking: a multi-staged model of planned behaviour.

PubMed

Northcote, Jeremy

2011-06-01

This paper examines the real life contexts in which decisions surrounding heavy drinking are made by young adults (that is, on occasions when five or more alcoholic drinks are consumed within a few hours). It presents a conceptual model that views such decision making as a multi-faceted and multi-staged process. The mixed method study draws on purposive data gathered through direct observation of eight social networks consisting of 81 young adults aged between 18 and 25 years in Perth, Western Australia, including in-depth interviews with 31 participants. Qualitative and some basic quantitative data were gathered using participant observation and in-depth interviews undertaken over an eighteen month period. Participants explained their decision to engage in heavy drinking as based on a variety of factors. These elements relate to socio-cultural norms and expectancies that are best explained by the theory of planned behaviour. A framework is proposed that characterises heavy drinking as taking place in a multi-staged manner, with young adults having: 1. A generalised orientation to the value of heavy drinking shaped by wider influences and norms; 2. A short-term orientation shaped by situational factors that determines drinking intentions for specific events; and 3. An evaluative orientation shaped by moderating factors. The value of qualitative studies of decision making in real life contexts is advanced to complement the mostly quantitative research that dominates research on alcohol decision making. Copyright © 2011 Elsevier Ltd. All rights reserved.

A Bayesian paradigm for decision-making in proof-of-concept trials.

PubMed

Pulkstenis, Erik; Patra, Kaushik; Zhang, Jianliang

2017-01-01

Decision-making is central to every phase of drug development, and especially at the proof of concept stage where risk and evidence must be weighed carefully, often in the presence of significant uncertainty. The decision to proceed or not to large expensive Phase 3 trials has significant implications to both patients and sponsors alike. Recent experience has shown that Phase 3 failure rates remain high. We present a flexible Bayesian quantitative decision-making paradigm that evaluates evidence relative to achieving a multilevel target product profile. A framework for operating characteristics is provided that allows the drug developer to design a proof-of-concept trial in light of its ability to support decision-making rather than merely achieve statistical significance. Operating characteristics are shown to be superior to traditional p-value-based methods. In addition, discussion related to sample size considerations, application to interim futility analysis and incorporation of prior historical information is evaluated.

True Numerical Cognition in the Wild.

PubMed

Piantadosi, Steven T; Cantlon, Jessica F

2017-04-01

Cognitive and neural research over the past few decades has produced sophisticated models of the representations and algorithms underlying numerical reasoning in humans and other animals. These models make precise predictions for how humans and other animals should behave when faced with quantitative decisions, yet primarily have been tested only in laboratory tasks. We used data from wild baboons' troop movements recently reported by Strandburg-Peshkin, Farine, Couzin, and Crofoot (2015) to compare a variety of models of quantitative decision making. We found that the decisions made by these naturally behaving wild animals rely specifically on numerical representations that have key homologies with the psychophysics of human number representations. These findings provide important new data on the types of problems human numerical cognition was designed to solve and constitute the first robust evidence of true numerical reasoning in wild animals.

Adult patient decision-making regarding implantation of complex cardiac devices: a scoping review.

PubMed

Malecki-Ketchell, Alison; Marshall, Paul; Maclean, Joan

2017-10-01

Complex cardiac rhythm management device (CRMD) therapy provides an important treatment option for people at risk of sudden cardiac death. Despite the survival benefit, device implantation is associated with significant physical and psychosocial concerns presenting considerable challenges for the decision-making process surrounding CRMD implantation for patients and physicians. The purpose of this scoping review was to explore what is known about how adult (>16 years) patients make decisions regarding implantation of CRMD therapy. Published, peer reviewed, English language studies from 2000 to 2016 were identified in a search across eight healthcare databases. Eligible studies were concerned with patient decision-making for first time device implantation. Quality assessment was completed using the mixed methods appraisal tool for all studies meeting the inclusion criteria. The findings of eight qualitative and seven quantitative studies, including patients who accepted or declined primary or secondary sudden cardiac death prevention devices, were clustered into two themes: knowledge acquisition and the process of decision-making, exposing similarities and distinctions with the treatment decision-making literature. The review revealed some insight in to the way patients approach decision-making but also exposed a lack of clarity and research activity specific to CRMD patients. Further research is recommended to support the development and application of targeted decision support mechanisms.

Based on a multi-agent system for multi-scale simulation and application of household's LUCC: a case study for Mengcha village, Mizhi county, Shaanxi province.

PubMed

Chen, Hai; Liang, Xiaoying; Li, Rui

2013-01-01

Multi-Agent Systems (MAS) offer a conceptual approach to include multi-actor decision making into models of land use change. Through the simulation based on the MAS, this paper tries to show the application of MAS in the micro scale LUCC, and reveal the transformation mechanism of difference scale. This paper starts with a description of the context of MAS research. Then, it adopts the Nested Spatial Choice (NSC) method to construct the multi-scale LUCC decision-making model. And a case study for Mengcha village, Mizhi County, Shaanxi Province is reported. Finally, the potentials and drawbacks of the following approach is discussed and concluded. From our design and implementation of the MAS in multi-scale model, a number of observations and conclusions can be drawn on the implementation and future research directions. (1) The use of the LUCC decision-making and multi-scale transformation framework provides, according to us, a more realistic modeling of multi-scale decision making process. (2) By using continuous function, rather than discrete function, to construct the decision-making of the households is more realistic to reflect the effect. (3) In this paper, attempts have been made to give a quantitative analysis to research the household interaction. And it provides the premise and foundation for researching the communication and learning among the households. (4) The scale transformation architecture constructed in this paper helps to accumulate theory and experience for the interaction research between the micro land use decision-making and the macro land use landscape pattern. Our future research work will focus on: (1) how to rational use risk aversion principle, and put the rule on rotation between household parcels into model. (2) Exploring the methods aiming at researching the household decision-making over a long period, it allows us to find the bridge between the long-term LUCC data and the short-term household decision-making. (3) Researching the quantitative method and model, especially the scenario analysis model which may reflect the interaction among different household types.

Qualitatively Coherent Representation Makes Decision-Making Easier with Binary-Colored Multi-Attribute Tables: An Eye-Tracking Study

PubMed Central

Morii, Masahiro; Ideno, Takashi; Takemura, Kazuhisa; Okada, Mitsuhiro

2017-01-01

We aimed to identify the ways in which coloring cells affected decision-making in the context of binary-colored multi-attribute tables, using eye movement data. In our black-white attribute tables, the value of attributes was limited to two (with a certain threshold for each attribute) and each cell of the table was colored either black or white on the white background. We compared the two natural ways of systematic color assignment: “quantitatively coherent” ways and “qualitatively coherent” ways (namely, the ways in which the black-white distinction represented the quantitative amount distinction, and the ways in which the black-white distinction represented the quality distinction). The former consists of the following two types: (Type 1) “larger is black,” where the larger value-level was represented by black, and “smaller is white,” and (Type 2) “smaller is black.” The latter consisted of the following two types: (Type 3) “better is black,” and (Type 4) “worse is black.” We obtained the following two findings. [Result 1] The qualitatively coherent black-white tables (Types 3 and 4) made decision-making easier than the quantitatively coherent ones (Types 1 and 2). [Result 2] Among the two qualitatively coherent types, the “black is better” tables (Type 3) made decision making easier; in fact, the participants focused on the more important (black) cells in the case of “black is better” tables (Type 3) while they did not focus enough on the more important (white) ones in the case of the “white is better” tables (Type 4). We also examined some measures of eye movement patterns and showed that these measures supported our hypotheses. The data showed differences in the eye movement patterns between the first and second halves of each trial, which indicated the phased or combined decision strategies taken by the participants. PMID:28861020

Pest management in Douglas-fir seed orchards: a microcomputer decision method

Treesearch

James B. Hoy; Michael I. Haverty

1988-01-01

The computer program described provides a Douglas-fir seed orchard manager (user) with a quantitative method for making insect pest management decisions on a desk-top computer. The decision system uses site-specific information such as estimates of seed crop size, insect attack rates, insecticide efficacy and application costs, weather, and crop value. At sites where...

Multi-objective decision-making under uncertainty: Fuzzy logic methods

NASA Technical Reports Server (NTRS)

Hardy, Terry L.

1994-01-01

Selecting the best option among alternatives is often a difficult process. This process becomes even more difficult when the evaluation criteria are vague or qualitative, and when the objectives vary in importance and scope. Fuzzy logic allows for quantitative representation of vague or fuzzy objectives, and therefore is well-suited for multi-objective decision-making. This paper presents methods employing fuzzy logic concepts to assist in the decision-making process. In addition, this paper describes software developed at NASA Lewis Research Center for assisting in the decision-making process. Two diverse examples are used to illustrate the use of fuzzy logic in choosing an alternative among many options and objectives. One example is the selection of a lunar lander ascent propulsion system, and the other example is the selection of an aeration system for improving the water quality of the Cuyahoga River in Cleveland, Ohio. The fuzzy logic techniques provided here are powerful tools which complement existing approaches, and therefore should be considered in future decision-making activities.

The Importance Of Integrating Narrative Into Health Care Decision Making.

PubMed

Dohan, Daniel; Garrett, Sarah B; Rendle, Katharine A; Halley, Meghan; Abramson, Corey

2016-04-01

When making health care decisions, patients and consumers use data but also gather stories from family and friends. When advising patients, clinicians consult the medical evidence but also use professional judgment. These stories and judgments, as well as other forms of narrative, shape decision making but remain poorly understood. Furthermore, qualitative research methods to examine narrative are rarely included in health science research. We illustrate how narratives shape decision making and explain why it is difficult but necessary to integrate qualitative research on narrative into the health sciences. We draw on social-scientific insights on rigorous qualitative research and our ongoing studies of decision making by patients with cancer, and we describe new tools and approaches that link qualitative research findings with the predominantly quantitative health science scholarship. Finally, we highlight the benefits of more fully integrating qualitative research and narrative analysis into the medical evidence base and into evidence-based medical practice. Project HOPE—The People-to-People Health Foundation, Inc.

Universal size effects for populations in group-outcome decision-making problems

NASA Astrophysics Data System (ADS)

Borghesi, Christian; Hernández, Laura; Louf, Rémi; Caparros, Fabrice

2013-12-01

Elections constitute a paradigm of decision-making problems that have puzzled experts of different disciplines for decades. We study two decision-making problems, where groups make decisions that impact only themselves as a group. In both studied cases, participation in local elections and the number of democratic representatives at different scales (from local to national), we observe a universal scaling with the constituency size. These results may be interpreted as constituencies having a hierarchical structure, where each group of N agents, at each level of the hierarchy, is divided in about Nδ subgroups with δ≈1/3. Following this interpretation, we propose a phenomenological model of vote participation where abstention is related to the perceived link of an agent to the rest of the constituency and which reproduces quantitatively the observed data.

Analyzing Decision Logs to Understand Decision Making in Serious Crime Investigations.

PubMed

Dando, Coral J; Ormerod, Thomas C

2017-12-01

Objective To study decision making by detectives when investigating serious crime through the examination of decision logs to explore hypothesis generation and evidence selection. Background Decision logs are used to record and justify decisions made during serious crime investigations. The complexity of investigative decision making is well documented, as are the errors associated with miscarriages of justice and inquests. The use of decision logs has not been the subject of an empirical investigation, yet they offer an important window into the nature of investigative decision making in dynamic, time-critical environments. Method A sample of decision logs from British police forces was analyzed qualitatively and quantitatively to explore hypothesis generation and evidence selection by police detectives. Results Analyses revealed diversity in documentation of decisions that did not correlate with case type and identified significant limitations of the decision log approach to supporting investigative decision making. Differences emerged between experienced and less experienced officers' decision log records in exploration of alternative hypotheses, generation of hypotheses, and sources of evidential inquiry opened over phase of investigation. Conclusion The practical use of decision logs is highly constrained by their format and context of use. Despite this, decision log records suggest that experienced detectives display strategic decision making to avoid confirmation and satisficing, which affect less experienced detectives. Application Potential applications of this research include both training in case documentation and the development of new decision log media that encourage detectives, irrespective of experience, to generate multiple hypotheses and optimize the timely selection of evidence to test them.

[Involving patients, the insured and the general public in healthcare decision making].

PubMed

Mühlbacher, Axel C; Juhnke, Christin

2016-01-01

No doubt, the public should be involved in healthcare decision making, especially when decision makers from politics and self-government agencies are faced with the difficult task of setting priorities. There is a general consensus on the need for a stronger patient centeredness, even in HTA processes, and internationally different ways of public participation are discussed and tested in decision making processes. This paper describes how the public can be involved in different decision situations, and it shows how preference measurement methods are currently being used in an international context to support decision making. It distinguishes between different levels of decision making on health technologies: approval, assessment, pricing, and finally utilization. The range of participation efforts extends from qualitative surveys of patients' needs (Citizen Councils of NICE in the UK) to science-based documentation of quantitative patient preferences, such as in the current pilot projects of the FDA in the US and the EMA at the European level. Possible approaches for the elicitation and documentation of preference structures and trade-offs in relation to alternate health technologies are decision aids, such as multi-criteria decision analysis (MCDA), that provide the necessary information for weighting and prioritizing decision criteria. Copyright © 2015. Published by Elsevier GmbH.

Analysis and Management of Animal Populations: Modeling, Estimation and Decision Making

USGS Publications Warehouse

Williams, B.K.; Nichols, J.D.; Conroy, M.J.

2002-01-01

This book deals with the processes involved in making informed decisions about the management of animal populations. It covers the modeling of population responses to management actions, the estimation of quantities needed in the modeling effort, and the application of these estimates and models to the development of sound management decisions. The book synthesizes and integrates in a single volume the methods associated with these themes, as they apply to ecological assessment and conservation of animal populations. KEY FEATURES * Integrates population modeling, parameter estimation and * decision-theoretic approaches to management in a single, cohesive framework * Provides authoritative, state-of-the-art descriptions of quantitative * approaches to modeling, estimation and decision-making * Emphasizes the role of mathematical modeling in the conduct of science * and management * Utilizes a unifying biological context, consistent mathematical notation, * and numerous biological examples

Multiple methods for multiple futures: Integrating qualitative scenario planning and quantitative simulation modeling for natural resource decision making

USGS Publications Warehouse

Symstad, Amy J.; Fisichelli, Nicholas A.; Miller, Brian W.; Rowland, Erika; Schuurman, Gregor W.

2017-01-01

Scenario planning helps managers incorporate climate change into their natural resource decision making through a structured “what-if” process of identifying key uncertainties and potential impacts and responses. Although qualitative scenarios, in which ecosystem responses to climate change are derived via expert opinion, often suffice for managers to begin addressing climate change in their planning, this approach may face limits in resolving the responses of complex systems to altered climate conditions. In addition, this approach may fall short of the scientific credibility managers often require to take actions that differ from current practice. Quantitative simulation modeling of ecosystem response to climate conditions and management actions can provide this credibility, but its utility is limited unless the modeling addresses the most impactful and management-relevant uncertainties and incorporates realistic management actions. We use a case study to compare and contrast management implications derived from qualitative scenario narratives and from scenarios supported by quantitative simulations. We then describe an analytical framework that refines the case study’s integrated approach in order to improve applicability of results to management decisions. The case study illustrates the value of an integrated approach for identifying counterintuitive system dynamics, refining understanding of complex relationships, clarifying the magnitude and timing of changes, identifying and checking the validity of assumptions about resource responses to climate, and refining management directions. Our proposed analytical framework retains qualitative scenario planning as a core element because its participatory approach builds understanding for both managers and scientists, lays the groundwork to focus quantitative simulations on key system dynamics, and clarifies the challenges that subsequent decision making must address.

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

PubMed

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

2016-12-01

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

Direct Allocation Costing: Informed Management Decisions in a Changing Environment.

ERIC Educational Resources Information Center

Mancini, Cesidio G.; Goeres, Ernest R.

1995-01-01

It is argued that colleges and universities can use direct allocation costing to provide quantitative information needed for decision making. This method of analysis requires institutions to modify traditional ideas of costing, looking to the private sector for examples of accurate costing techniques. (MSE)

77 FR 72831 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-06

... consumers to make better informed financial decisions. Together with the CFPB's Office of Research, OFE is also responsible for conducting ``research related to consumer financial education and counseling... quantitative data through in-person and telephone surveys. The information collected through quantitative...

Transforming clinical practice guidelines and clinical pathways into fast-and-frugal decision trees to improve clinical care strategies.

PubMed

Djulbegovic, Benjamin; Hozo, Iztok; Dale, William

2018-02-27

Contemporary delivery of health care is inappropriate in many ways, largely due to suboptimal Q5 decision-making. A typical approach to improve practitioners' decision-making is to develop evidence-based clinical practice guidelines (CPG) by guidelines panels, who are instructed to use their judgments to derive practice recommendations. However, mechanisms for the formulation of guideline judgments remains a "black-box" operation-a process with defined inputs and outputs but without sufficient knowledge of its internal workings. Increased explicitness and transparency in the process can be achieved by implementing CPG as clinical pathways (CPs) (also known as clinical algorithms or flow-charts). However, clinical recommendations thus derived are typically ad hoc and developed by experts in a theory-free environment. As any recommendation can be right (true positive or negative), or wrong (false positive or negative), the lack of theoretical structure precludes the quantitative assessment of the management strategies recommended by CPGs/CPs. To realize the full potential of CPGs/CPs, they need to be placed on more solid theoretical grounds. We believe this potential can be best realized by converting CPGs/CPs within the heuristic theory of decision-making, often implemented as fast-and-frugal (FFT) decision trees. This is possible because FFT heuristic strategy of decision-making can be linked to signal detection theory, evidence accumulation theory, and a threshold model of decision-making, which, in turn, allows quantitative analysis of the accuracy of clinical management strategies. Fast-and-frugal provides a simple and transparent, yet solid and robust, methodological framework connecting decision science to clinical care, a sorely needed missing link between CPGs/CPs and patient outcomes. We therefore advocate that all guidelines panels express their recommendations as CPs, which in turn should be converted into FFTs to guide clinical care. © 2018 John Wiley & Sons, Ltd.

Decision aid on radioactive iodine treatment for early stage papillary thyroid cancer: update to study protocol with follow-up extension.

PubMed

Sawka, Anna M; Straus, Sharon; Rodin, Gary; Thorpe, Kevin E; Ezzat, Shereen; Gafni, Amiram; Goldstein, David P

2015-07-14

Patient decision aids (P-DAs) are used to inform patients about healthcare choices, but there is limited knowledge about their longer term effects, beyond the time period of decision-making. We developed a computerized P-DA that explains the choice of radioactive iodine (RAI) adjuvant treatment or no RAI, for patients with low risk papillary thyroid cancer after total thyroidectomy. The original protocol for a randomized controlled trial, comparing the use of the P-DA (with usual care) to usual care alone, has been published in Trials http://www.trialsjournal.com/content/11/1/81. We found that P-DA (with usual care) significantly improved patients' medical knowledge at the time of decision-making (primary outcome) compared to usual care alone (control). In this update, we present the protocol for an extended follow-up study (15 to 23 months post-randomization), including qualitative and quantitative methods. The patient outcomes evaluated using quantitative questionnaires include: the degree to which patients feel well-informed about their RAI treatment choice, decision satisfaction, decision regret, cancer-related worry, mood, and trust in the treating physician. The qualitative component explores the experiences of RAI treatment decision-making, treatment satisfaction, and trial participation in a representative subgroup of patients. Extended follow-up study results will be described for the entire study population, and data will be compared between the P-DA and control groups. This mixed methods extended follow-up study will provide data on long term outcomes, relating to the use of a computerized P-DA in decision-making about adjuvant RAI treatment in early stage papillary thyroid cancer. Our results are intended to inform future research in this area, particularly relating to long term effects of the use of P-DAs in making healthcare choices. Clinicaltrials.gov identifier NCT01083550, registered 24 February 2010 and last updated 5 January 2015.

My Lived Experiences Are More Important Than Your Probabilities: The Role of Individualized Risk Estimates for Decision Making about Participation in the Study of Tamoxifen and Raloxifene (STAR).

PubMed

Holmberg, Christine; Waters, Erika A; Whitehouse, Katie; Daly, Mary; McCaskill-Stevens, Worta

2015-11-01

Decision-making experts emphasize that understanding and using probabilistic information are important for making informed decisions about medical treatments involving complex risk-benefit tradeoffs. Yet empirical research demonstrates that individuals may not use probabilities when making decisions. To explore decision making and the use of probabilities for decision making from the perspective of women who were risk-eligible to enroll in the Study of Tamoxifen and Raloxifene (STAR). We conducted narrative interviews with 20 women who agreed to participate in STAR and 20 women who declined. The project was based on a narrative approach. Analysis included the development of summaries of each narrative, and thematic analysis with developing a coding scheme inductively to code all transcripts to identify emerging themes. Interviewees explained and embedded their STAR decisions within experiences encountered throughout their lives. Such lived experiences included but were not limited to breast cancer family history, a personal history of breast biopsies, and experiences or assumptions about taking tamoxifen or medicines more generally. Women's explanations of their decisions about participating in a breast cancer chemoprevention trial were more complex than decision strategies that rely solely on a quantitative risk-benefit analysis of probabilities derived from populations In addition to precise risk information, clinicians and risk communicators should recognize the importance and legitimacy of lived experience in individual decision making. © The Author(s) 2015.

The Role of the Lateral Intraparietal Area in (the Study of) Decision Making.

PubMed

Huk, Alexander C; Katz, Leor N; Yates, Jacob L

2017-07-25

Over the past two decades, neurophysiological responses in the lateral intraparietal area (LIP) have received extensive study for insight into decision making. In a parallel manner, inferred cognitive processes have enriched interpretations of LIP activity. Because of this bidirectional interplay between physiology and cognition, LIP has served as fertile ground for developing quantitative models that link neural activity with decision making. These models stand as some of the most important frameworks for linking brain and mind, and they are now mature enough to be evaluated in finer detail and integrated with other lines of investigation of LIP function. Here, we focus on the relationship between LIP responses and known sensory and motor events in perceptual decision-making tasks, as assessed by correlative and causal methods. The resulting sensorimotor-focused approach offers an account of LIP activity as a multiplexed amalgam of sensory, cognitive, and motor-related activity, with a complex and often indirect relationship to decision processes. Our data-driven focus on multiplexing (and de-multiplexing) of various response components can complement decision-focused models and provides more detailed insight into how neural signals might relate to cognitive processes such as decision making.

Using multi-species occupancy models in structured decision making on managed lands

USGS Publications Warehouse

Sauer, John R.; Blank, Peter J.; Zipkin, Elise F.; Fallon, Jane E.; Fallon, Frederick W.

2013-01-01

Land managers must balance the needs of a variety of species when manipulating habitats. Structured decision making provides a systematic means of defining choices and choosing among alternative management options; implementation of a structured decision requires quantitative approaches to predicting consequences of management on the relevant species. Multi-species occupancy models provide a convenient framework for making structured decisions when the management objective is focused on a collection of species. These models use replicate survey data that are often collected on managed lands. Occupancy can be modeled for each species as a function of habitat and other environmental features, and Bayesian methods allow for estimation and prediction of collective responses of groups of species to alternative scenarios of habitat management. We provide an example of this approach using data from breeding bird surveys conducted in 2008 at the Patuxent Research Refuge in Laurel, Maryland, evaluating the effects of eliminating meadow and wetland habitats on scrub-successional and woodland-breeding bird species using summed total occupancy of species as an objective function. Removal of meadows and wetlands decreased value of an objective function based on scrub-successional species by 23.3% (95% CI: 20.3–26.5), but caused only a 2% (0.5, 3.5) increase in value of an objective function based on woodland species, documenting differential effects of elimination of meadows and wetlands on these groups of breeding birds. This approach provides a useful quantitative tool for managers interested in structured decision making.

How infants' reaches reveal principles of sensorimotor decision making

NASA Astrophysics Data System (ADS)

Dineva, Evelina; Schöner, Gregor

2018-01-01

In Piaget's classical A-not-B-task, infants repeatedly make a sensorimotor decision to reach to one of two cued targets. Perseverative errors are induced by switching the cue from A to B, while spontaneous errors are unsolicited reaches to B when only A is cued. We argue that theoretical accounts of sensorimotor decision-making fail to address how motor decisions leave a memory trace that may impact future sensorimotor decisions. Instead, in extant neural models, perseveration is caused solely by the history of stimulation. We present a neural dynamic model of sensorimotor decision-making within the framework of Dynamic Field Theory, in which a dynamic instability amplifies fluctuations in neural activation into macroscopic, stable neural activation states that leave memory traces. The model predicts perseveration, but also a tendency to repeat spontaneous errors. To test the account, we pool data from several A-not-B experiments. A conditional probabilities analysis accounts quantitatively how motor decisions depend on the history of reaching. The results provide evidence for the interdependence among subsequent reaching decisions that is explained by the model, showing that by amplifying small differences in activation and affecting learning, decisions have consequences beyond the individual behavioural act.

Decision Making in Health and Medicine

NASA Astrophysics Data System (ADS)

Hunink, Myriam; Glasziou, Paul; Siegel, Joanna; Weeks, Jane; Pliskin, Joseph; Elstein, Arthur; Weinstein, Milton C.

2001-11-01

Decision making in health care means navigating through a complex and tangled web of diagnostic and therapeutic uncertainties, patient preferences and values, and costs. In addition, medical therapies may include side effects, surgery may lead to undesirable complications, and diagnostic technologies may produce inconclusive results. In many clinical and health policy decisions it is necessary to counterbalance benefits and risks, and to trade off competing objectives such as maximizing life expectancy vs optimizing quality of life vs minimizing the required resources. This textbook plots a clear course through these complex and conflicting variables. It clearly explains and illustrates tools for integrating quantitative evidence-based data and subjective outcome values in making clinical and health policy decisions. An accompanying CD-ROM features solutions to the exercises, PowerPoint® presentations of the illustrations, and sample models and tables.

Predicting quantitative and qualitative values of recreation participation

Treesearch

Elwood L., Jr. Shafer; George Moeller

1971-01-01

If future recreation consumption and associated intangible values can be predicted, the problem of rapid decision making in recreation-resource management can be reduced, and the problems of implementing those decisions can be anticipated. Management and research responsibilities for meeting recreation demand are discussed, and proved methods for forecasting recreation...

Applying Generalizability Theory for Making Quantitative RTI Progress-Monitoring Decisions

ERIC Educational Resources Information Center

Fan, Chung-Hau; Hansmann, Paul R.

2015-01-01

Language in the Individuals With Disabilities Education Improvement Act (IDEIA) allows the use of response-to-intervention (RTI) methodology in the identification of specific learning disabilities. However, there is no consensus on decision rules using curriculum-based measurement of oral reading fluency (CBM-R) for defining responsiveness. The…

Qualitative and Quantitative Management Tools Used by Financial Officers in Public Research Universities

ERIC Educational Resources Information Center

Trexler, Grant Lewis

2012-01-01

This dissertation set out to identify effective qualitative and quantitative management tools used by financial officers (CFOs) in carrying out their management functions of planning, decision making, organizing, staffing, communicating, motivating, leading and controlling at a public research university. In addition, impediments to the use of…

Fuzzy Logic Approaches to Multi-Objective Decision-Making in Aerospace Applications

NASA Technical Reports Server (NTRS)

Hardy, Terry L.

1994-01-01

Fuzzy logic allows for the quantitative representation of multi-objective decision-making problems which have vague or fuzzy objectives and parameters. As such, fuzzy logic approaches are well-suited to situations where alternatives must be assessed by using criteria that are subjective and of unequal importance. This paper presents an overview of fuzzy logic and provides sample applications from the aerospace industry. Applications include an evaluation of vendor proposals, an analysis of future space vehicle options, and the selection of a future space propulsion system. On the basis of the results provided in this study, fuzzy logic provides a unique perspective on the decision-making process, allowing the evaluator to assess the degree to which each option meets the evaluation criteria. Future decision-making should take full advantage of fuzzy logic methods to complement existing approaches in the selection of alternatives.

Role-players in abortion decision-making in the Accra Metropolis, Ghana.

PubMed

Kumi-Kyereme, Akwasi; Gbagbo, Fred Yao; Amo-Adjei, Joshua

2014-09-16

Making the final decision to terminate a pregnancy can be influenced by different circumstances involving various individuals. This paper describes the key players involved in the decision-making process regarding abortions among women who elected to undergo an induced abortion in a cosmopolitan urban setting in Ghana. A retrospective cross-sectional mixed method study was conducted between January and December 2011. A total of 401 women with records in abortion logbooks were selected for an interviewer-administered questionnaire and an in-depth interview. Descriptive and multinomial logistic regression analyses were used to assess the quantitative data, and a thematic analysis was applied to the qualitative data. The findings of the study reveal that pregnant individuals, mothers of abortion-seekers, male partners, and "Others" (for example, friends, employers) were instrumental in making a decision to terminate unplanned/unwanted pregnancies. Several key factors influenced the decision-making processes, including aversion from the men responsible for the pregnancy, concerns about abnormalities/deformities in future births due to unprofessionally conducted abortions, and economic considerations. A number of individuals, such as friends, mothers, and male partners, influence the decision-making process regarding abortion among the participants of the study. Various targeted messages are needed for the various participants in the decision.

Psychopharmacology decision-making among pregnant and postpartum women and health providers: informing compassionate and collaborative care women's health.

PubMed

Price, Sarah Kye; Bentley, Kia J

2013-01-01

Psychopharmaceutical use by pregnant and postpartum women is complicated by the complexity of prescribing as well as the sociocultural context in which medication-related decisions are made. This study sought to advance understanding of decision-making processes and communication experiences regarding use of psychopharmaceuticals during pregnancy by considering both provider and consumer perspectives. An electronic survey was conducted with health care providers (N = 88) and women consumers (N = 83) from July 2010 through October 2011 regarding the perceived costs and benefits of taking mental health medication during and around the time of pregnancy. Descriptive analysis compared and contrasted experiences between the two groups regarding consumer-provider communication, critical incidents and triggers in decision-making, and response to case scenarios crafted around hypothetical client experiences. Both similarities and differences were evident among health care provider and women consumer responses regarding costs, benefits, communication experiences, and case scenario responses. Both quantitative and qualitative survey results indicated the need for more accurate, unbiased, and complete information exchange around mental health and medication. Study results suggested the centrality of the client-provider milieu to guide decision-making and emphasized the expressed need within both groups to create a shared decision-making practice environment characterized by authenticity, non-judgmental decision-making, compassion, humaneness, and reciprocity.

Gendered uncertainty and variation in physicians' decisions for coronary heart disease: the double-edged sword of "atypical symptoms".

PubMed

Welch, Lisa C; Lutfey, Karen E; Gerstenberger, Eric; Grace, Matthew

2012-09-01

Nonmedical factors and diagnostic certainty contribute to variation in clinical decision making, but the process by which this occurs remains unclear. We examine how physicians' interpretations of patient sex-gender affect diagnostic certainty and, in turn, decision making for coronary heart disease. Data are from a factorial experiment of 256 physicians who viewed 1 of 16 video vignettes with different patient-actors presenting the same symptoms of coronary heart disease. Physician participants completed a structured interview and provided a narrative about their decision-making processes. Quantitative analysis showed that diagnostic uncertainty reduces the likelihood that physicians will order tests and medications appropriate for an urgent cardiac condition in particular. Qualitative analysis revealed that a subset of physicians applied knowledge that women have "atypical symptoms" as a generalization, which engendered uncertainty for some. Findings are discussed in relation to social-psychological processes that underlie clinical decision making and the social framing of medical knowledge.

Gendered Uncertainty and Variation in Physicians’ Decisions for Coronary Heart Disease: The Double-Edged Sword of “Atypical Symptoms”*

PubMed Central

Welch, Lisa C.; Lutfey, Karen E.; Gerstenberger, Eric; Grace, Matthew

2013-01-01

Nonmedical factors and diagnostic certainty contribute to variation in clinical decision making, but the process by which this occurs remains unclear. We examine how physicians’ interpretations of patient sex/gender affect diagnostic certainty and, in turn, decision making for coronary heart disease (CHD). Data are from a factorial experiment of 256 physicians who viewed one of 16 video vignettes with different patient-actors presenting the same CHD symptoms. Physician participants completed a structured interview and provided a narrative about their decision-making processes. Quantitative analysis showed that diagnostic uncertainty reduces the likelihood that physicians will order tests and medications appropriate for an urgent cardiac condition in particular. Qualitative analysis revealed that a subset of physicians applied knowledge that women have “atypical symptoms” as a generalization, which engendered uncertainty for some. Findings are discussed in relation to social-psychological processes that underlie clinical decision making and the social framing of medical knowledge. PMID:22933590

A Benefit-Risk Analysis Approach to Capture Regulatory Decision-Making: Multiple Myeloma.

PubMed

Raju, G K; Gurumurthi, Karthik; Domike, Reuben; Kazandjian, Dickran; Landgren, Ola; Blumenthal, Gideon M; Farrell, Ann; Pazdur, Richard; Woodcock, Janet

2018-01-01

Drug regulators around the world make decisions about drug approvability based on qualitative benefit-risk analysis. In this work, a quantitative benefit-risk analysis approach captures regulatory decision-making about new drugs to treat multiple myeloma (MM). MM assessments have been based on endpoints such as time to progression (TTP), progression-free survival (PFS), and objective response rate (ORR) which are different than benefit-risk analysis based on overall survival (OS). Twenty-three FDA decisions on MM drugs submitted to FDA between 2003 and 2016 were identified and analyzed. The benefits and risks were quantified relative to comparators (typically the control arm of the clinical trial) to estimate whether the median benefit-risk was positive or negative. A sensitivity analysis was demonstrated using ixazomib to explore the magnitude of uncertainty. FDA approval decision outcomes were consistent and logical using this benefit-risk framework. © 2017 American Society for Clinical Pharmacology and Therapeutics.

The Quantitative Science of Evaluating Imaging Evidence.

PubMed

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

2017-03-01

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

Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study

PubMed Central

Schön, Ulla-Karin; Grim, Katarina; Wallin, Lars; Rosenberg, David; Svedberg, Petra

2018-01-01

ABSTRACT Purpose: Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions. The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden. Method: The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact. Results: The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations. Conclusion: The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures. PMID:29405889

Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study.

PubMed

Schön, Ulla-Karin; Grim, Katarina; Wallin, Lars; Rosenberg, David; Svedberg, Petra

2018-12-01

Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions. The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden. The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact. The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations. The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures.

Comparing and using assessments of the value of information to clinical decision-making.

PubMed Central

Urquhart, C J; Hepworth, J B

1996-01-01

This paper discusses the Value project, which assessed the value to clinical decision-making of information supplied by National Health Service (NHS) library and information services. The project not only showed how health libraries in the United Kingdom help clinicians in decision-making but also provided quality assurance guidelines for these libraries to help make their information services more effective. The paper reviews methods and results used in previous studies of the value of health libraries, noting that methodological differences appear to affect the results. The paper also discusses aspects of user involvement, categories of clinical decision-making, the value of information to present and future clinical decisions, and the combination of quantitative and qualitative assessments of value, as applied to the Value project and the studies reviewed. The Value project also demonstrated that the value placed on information depends in part on the career stage of the physician. The paper outlines the structure of the quality assurance tool kit, which is based on the findings and methods used in the Value project. PMID:8913550

Local public health resource allocation: limited choices and strategic decisions.

PubMed

Bekemeier, Betty; Chen, Anthony L-T; Kawakyu, Nami; Yang, Youngran

2013-12-01

Local health department leaders are expected to improve the health of their populations as they "use and contribute to" the evidence base for practice, but effectively providing and utilizing data and evidence for local public health decision making has proven difficult. This study was conducted in 2011 and initiated by Washington State's public health practice-based research network to identify factors influencing local resource allocation and programmatic decisions among public health leaders facing severe funding losses. Quantitative data informed sampling for the collection of interview data. Qualitative methods were used to capture diverse insights of Washington State's local public health leaders in making decisions regarding resource allocation. Local decision-making authority was perceived as greatly restricted by what public health activities were legally mandated and the categoric nature of funding sources, even as some leaders exercised deliberate strategic approaches. One's workforce and board of health were also influential in making decisions regarding resource allocations. Challenges were expressed regarding making use of data and research evidence for decision making. Data were analyzed in 2011-2012. Programmatic mandates, funding restrictions, local stakeholders, and workforce capacity appear to trump factors such as research evidence and perceived community need in public health resource allocation. Study findings highlight tensions between the literature descriptions of what "should" influence decision making in local public health and the realities of practice. Advancements in practice-based research and evidence-based decision making, however, provide opportunities for strengthening the development of evidence and research translation for local decision making to maximize resources and promote effective service provision. © 2013 American Journal of Preventive Medicine Published by American Journal of Preventive Medicine All rights reserved.

Development of a Model of Interprofessional Shared Clinical Decision Making in the ICU: A Mixed-Methods Study.

PubMed

DeKeyser Ganz, Freda; Engelberg, Ruth; Torres, Nicole; Curtis, Jared Randall

2016-04-01

To develop a model to describe ICU interprofessional shared clinical decision making and the factors associated with its implementation. Ethnographic (observations and interviews) and survey designs. Three ICUs (two in Israel and one in the United States). A convenience sample of nurses and physicians. None. Observations and interviews were analyzed using ethnographic and grounded theory methodologies. Questionnaires included a demographic information sheet and the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration. From observations and interviews, we developed a conceptual model of the process of shared clinical decision making that involves four stepped levels, proceeding from the lowest to the highest levels of collaboration: individual decision, information exchange, deliberation, and shared decision. This process is influenced by individual, dyadic, and system factors. Most decisions were made at the lower two levels. Levels of perceived collaboration were moderate with no statistically significant differences between physicians and nurses or between units. Both qualitative and quantitative data corroborated that physicians and nurses from all units were similarly and moderately satisfied with their level of collaboration and shared decision making. However, most ICU clinical decision making continues to take place independently, where there is some sharing of information but rarely are decisions made collectively. System factors, such as interdisciplinary rounds and unit culture, seem to have a strong impact on this process. This study provides a model for further study and improvement of interprofessional shared decision making.

Optimizing in a complex world: A statistician's role in decision making

DOE PAGES

Anderson-Cook, Christine M.

2016-08-09

As applied statisticians increasingly participate as active members of problem-solving and decision-making teams, our role continues to evolve. Historically, we may have been seen as those who can help with data collection strategies or answer a specific question from a set of data. Nowadays, we are or strive to be more deeply involved throughout the entire problem-solving process. An emerging role is to provide a set of leading choices from which subject matter experts and managers can choose to make informed decisions. A key to success is to provide vehicles for understanding the trade-offs between candidates and interpreting the meritsmore » of each choice in the context of the decision-makers priorities. To achieve this objective, it is helpful to be able (a) to help subject matter experts identify quantitative criteria that match their priorities, (b) eliminate non-competitive choices through the use of a Pareto front, and (c) provide summary tools from which the trade-offs between alternatives can be quantitatively evaluated and discussed. A structured but flexible process for contributing to team decisions is described for situations when all choices can easily be enumerated as well as when a search algorithm to explore a vast number of potential candidates is required. In conclusion, a collection of diverse examples ranging from model selection, through multiple response optimization, and designing an experiment illustrate the approach.« less

Optimizing in a complex world: A statistician's role in decision making

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

Anderson-Cook, Christine M.

As applied statisticians increasingly participate as active members of problem-solving and decision-making teams, our role continues to evolve. Historically, we may have been seen as those who can help with data collection strategies or answer a specific question from a set of data. Nowadays, we are or strive to be more deeply involved throughout the entire problem-solving process. An emerging role is to provide a set of leading choices from which subject matter experts and managers can choose to make informed decisions. A key to success is to provide vehicles for understanding the trade-offs between candidates and interpreting the meritsmore » of each choice in the context of the decision-makers priorities. To achieve this objective, it is helpful to be able (a) to help subject matter experts identify quantitative criteria that match their priorities, (b) eliminate non-competitive choices through the use of a Pareto front, and (c) provide summary tools from which the trade-offs between alternatives can be quantitatively evaluated and discussed. A structured but flexible process for contributing to team decisions is described for situations when all choices can easily be enumerated as well as when a search algorithm to explore a vast number of potential candidates is required. In conclusion, a collection of diverse examples ranging from model selection, through multiple response optimization, and designing an experiment illustrate the approach.« less

Human judgment vs. quantitative models for the management of ecological resources.

PubMed

Holden, Matthew H; Ellner, Stephen P

2016-07-01

Despite major advances in quantitative approaches to natural resource management, there has been resistance to using these tools in the actual practice of managing ecological populations. Given a managed system and a set of assumptions, translated into a model, optimization methods can be used to solve for the most cost-effective management actions. However, when the underlying assumptions are not met, such methods can potentially lead to decisions that harm the environment and economy. Managers who develop decisions based on past experience and judgment, without the aid of mathematical models, can potentially learn about the system and develop flexible management strategies. However, these strategies are often based on subjective criteria and equally invalid and often unstated assumptions. Given the drawbacks of both methods, it is unclear whether simple quantitative models improve environmental decision making over expert opinion. In this study, we explore how well students, using their experience and judgment, manage simulated fishery populations in an online computer game and compare their management outcomes to the performance of model-based decisions. We consider harvest decisions generated using four different quantitative models: (1) the model used to produce the simulated population dynamics observed in the game, with the values of all parameters known (as a control), (2) the same model, but with unknown parameter values that must be estimated during the game from observed data, (3) models that are structurally different from those used to simulate the population dynamics, and (4) a model that ignores age structure. Humans on average performed much worse than the models in cases 1-3, but in a small minority of scenarios, models produced worse outcomes than those resulting from students making decisions based on experience and judgment. When the models ignored age structure, they generated poorly performing management decisions, but still outperformed students using experience and judgment 66% of the time. © 2016 by the Ecological Society of America.

Risky Group Decision-Making Method for Distribution Grid Planning

NASA Astrophysics Data System (ADS)

Li, Cunbin; Yuan, Jiahang; Qi, Zhiqiang

2015-12-01

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

End-of-life decision-making for children with severe developmental disabilities: The parental perspective.

PubMed

Zaal-Schuller, I H; de Vos, M A; Ewals, F V P M; van Goudoever, J B; Willems, D L

2016-01-01

The objectives of this integrative review were to understand how parents of children with severe developmental disorders experience their involvement in end-of-life decision-making, how they prefer to be involved and what factors influence their decisions. We searched MEDLINE, EMBASE, CINAHL and PsycINFO. The search was limited to articles in English or Dutch published between January 2004 and August 2014. We included qualitative and quantitative original studies that directly investigated the experiences of parents of children aged 0-18 years with severe developmental disorders for whom an end-of-life decision had been considered or made. We identified nine studies that met all inclusion criteria. Reportedly, parental involvement in end-of-life decision-making varied widely, ranging from having no involvement to being the sole decision-maker. Most parents preferred to actively share in the decision-making process regardless of their child's specific diagnosis or comorbidity. The main factors that influenced parents in their decision-making were: their strong urge to advocate for their child's best interests and to make the best (possible) decision. In addition, parents felt influenced by their child's visible suffering, remaining quality of life and the will they perceived in their child to survive. Most parents of children with severe developmental disorders wish to actively share in the end-of-life decision-making process. An important emerging factor in this process is the parents' feeling that they have to stand up for their child's interests in conversations with the medical team. Copyright © 2015 Elsevier Ltd. All rights reserved.

Enhanced Decision-Making: The Use of a Videotape Decision-Aid for Patients with Prostate Cancer.

ERIC Educational Resources Information Center

Schapira, Marilyn M.; Meade, Cathy; Nattinger, Ann B.

1997-01-01

The development of a videotape for patients considering treatment options for clinically localized prostate cancer is described. The effectiveness of videotape in improving short-term recall of treatment options and outcomes was assessed quantitatively; qualitative analysis was used to assess the likelihood of patient's active participation in the…

76 FR 51442 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing of Proposed Rule Change To List...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-18

...-Adviser has designed the following quantitative stock selection rules to make allocation decisions and to..., the Sub-Adviser's investment process is quantitative. Based on extensive historical research, the Sub... open-end fund's portfolio composition must be subject to procedures designed to prevent the use and...

Evidence Accumulation and Choice Maintenance Are Dissociated in Human Perceptual Decision Making

PubMed Central

Pedersen, Mads Lund; Endestad, Tor; Biele, Guido

2015-01-01

Perceptual decision making in monkeys relies on decision neurons, which accumulate evidence and maintain choices until a response is given. In humans, several brain regions have been proposed to accumulate evidence, but it is unknown if these regions also maintain choices. To test if accumulator regions in humans also maintain decisions we compared delayed and self-paced responses during a face/house discrimination decision making task. Computational modeling and fMRI results revealed dissociated processes of evidence accumulation and decision maintenance, with potential accumulator activations found in the dorsomedial prefrontal cortex, right inferior frontal gyrus and bilateral insula. Potential maintenance activation spanned the frontal pole, temporal gyri, precuneus and the lateral occipital and frontal orbital cortices. Results of a quantitative reverse inference meta-analysis performed to differentiate the functions associated with the identified regions did not narrow down potential accumulation regions, but suggested that response-maintenance might rely on a verbalization of the response. PMID:26510176

Linking Effective Project Management to Business Strategy in Oil and Gas Industry through Decision-making Processes

NASA Astrophysics Data System (ADS)

Adeleke, Adeyinka

The construction project in the oil and gas industry covers the entire spectrum of hydrocarbon production from the wellhead (upstream) to downstream facilities. In each of these establishments, the activities in a construction project include: consulting, studies, front-end engineering, detail engineering, procurement, program management, construction, installation, commissioning and start-up. Efficient management of each of the activities involved in construction projects is one of the driving forces for the successful completion of the project. Optimizing the crucial factors in project management during each phase of a project in an oil and gas industry can assist managers to maximize the use of available resources and drive the project to successful conclusions. One of these factors is the decision-making process in the construction project. Current research effort investigated the relationship between decision-making processes and business strategy in oil and gas industry using employee surveys. I recruited employees of different races, age group, genders, and years of experience in order understand their influence on the implementation of the decision-making process in oil and gas industry through a quantitative survey. Decision-making was assessed using five decision measures: (a) rational, (b) intuitive, (c) dependent, (d) avoidant, and (e) spontaneous. The findings indicated gender, age, years of work experience and job titles as primary variables with a negative relationship with decision-making approach for employees working in a major oil and gas industry. The study results revealed that the two most likely decision-making methods in oil and gas industry include: making a decision in a logical and systematic way and seek assistance from others when making a decision. Additionally, the two leading management approaches to decision-making in the oil and gas industry include: decision analysis is part of organization culture and management is committed to the decision-making process. Some recommendations for future studies were presented based on the need to intensify the importance of the current study and enlarge the body of knowledge regarding decision-making process in oil and gas industry.

Uncertainty Estimation Cheat Sheet for Probabilistic Risk Assessment

NASA Technical Reports Server (NTRS)

Britton, Paul; Al Hassan, Mohammad; Ring, Robert

2017-01-01

Quantitative results for aerospace engineering problems are influenced by many sources of uncertainty. Uncertainty analysis aims to make a technical contribution to decision-making through the quantification of uncertainties in the relevant variables as well as through the propagation of these uncertainties up to the result. Uncertainty can be thought of as a measure of the 'goodness' of a result and is typically represented as statistical dispersion. This paper will explain common measures of centrality and dispersion; and-with examples-will provide guidelines for how they may be estimated to ensure effective technical contributions to decision-making.

Psychopharmacology Decision-Making Among Pregnant and Postpartum Women and Health Providers: Informing Compassionate and Collaborative Care Women's Health

PubMed Central

Price, Sarah Kye; Bentley, Kia J.

2013-01-01

Psychopharmaceutical use by pregnant and postpartum women is complicated by the complexity of prescribing as well as the sociocultural context in which medication-related decisions are made. This study sought to advance understanding of decision–making processes and communication experiences regarding use of psychopharmaceuticals during pregnancy by considering both provider and consumer perspectives. An electronic survey was conducted with health care providers (N = 88) and women consumers (N = 3) from July 2010 through October 2011 regarding the perceived costs and benefits of taking mental health medication during and around the time of pregnancy. Descriptive analysis compared and contrasted experiences between the two groups regarding consumer-provider communication, critical incidents and triggers in decision-making, and response to case scenarios crafted around hypothetical client experiences. Both similarities and differences were evident among health care provider and women consumer responses regarding costs, benefits, communication experiences, and case scenario responses. Both quantitative and qualitative survey results indicated the need for more accurate, unbiased, and complete information exchange around mental health and medication. Study results suggested the centrality of the client-provider milieu to guide decision-making and emphasized the expressed need within both groups to create a shared decision-making practice environment characterized by authenticity, non-judgmental decision-making, compassion, humaneness, and reciprocity. PMID:23517513

A methodology for eliciting, representing, and analysing stakeholder knowledge for decision making on complex socio-ecological systems: from cognitive maps to agent-based models.

PubMed

Elsawah, Sondoss; Guillaume, Joseph H A; Filatova, Tatiana; Rook, Josefine; Jakeman, Anthony J

2015-03-15

This paper aims to contribute to developing better ways for incorporating essential human elements in decision making processes for modelling of complex socio-ecological systems. It presents a step-wise methodology for integrating perceptions of stakeholders (qualitative) into formal simulation models (quantitative) with the ultimate goal of improving understanding and communication about decision making in complex socio-ecological systems. The methodology integrates cognitive mapping and agent based modelling. It cascades through a sequence of qualitative/soft and numerical methods comprising: (1) Interviews to elicit mental models; (2) Cognitive maps to represent and analyse individual and group mental models; (3) Time-sequence diagrams to chronologically structure the decision making process; (4) All-encompassing conceptual model of decision making, and (5) computational (in this case agent-based) Model. We apply the proposed methodology (labelled ICTAM) in a case study of viticulture irrigation in South Australia. Finally, we use strengths-weakness-opportunities-threats (SWOT) analysis to reflect on the methodology. Results show that the methodology leverages the use of cognitive mapping to capture the richness of decision making and mental models, and provides a combination of divergent and convergent analysis methods leading to the construction of an Agent Based Model. Copyright © 2014 Elsevier Ltd. All rights reserved.

A qualitative metasynthesis: family involvement in decision making for people with dementia in residential aged care.

PubMed

Petriwskyj, Andrea; Gibson, Alexandra; Parker, Deborah; Banks, Susan; Andrews, Sharon; Robinson, Andrew

2014-06-01

Involving people in decisions about their care is good practice and ensures optimal outcomes. Despite considerable research, in practice family involvement in decision making can be challenging for both care staff and families. The aim of this review was to identify and appraise existing knowledge about family involvement in decision making for people with dementia living in residential aged care. The present Joanna Briggs Institute meta-synthesis considered studies that investigate involvement of family members in decision making for people with dementia in residential aged care settings. While quantitative and qualitative studies were included in the review, this article presents the qualitative findings. A comprehensive search of studies was conducted in 15 electronic databases. The search was limited to papers published in English, from 1990 to 2013. Twenty-six studies were identified as relevant for this review; 16 were qualitative papers reporting on 15 studies. Two independent reviewers assessed the studies for methodological validity and extracted the data using the standardized Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). The findings were synthesized using JBI-QARI. The findings related to the decisions encountered and made by family surrogates, family perceptions of, and preferences for, their role/s, factors regarding treatment decisions and the collaborative decision-making process, and outcomes for family decision makers. Results indicate varied and complex experiences and multiple factors influencing decision making. Communication and contacts between staff and families and the support available for families should be addressed, as well as the role of different stakeholders in decisions.

A Monte-Carlo game theoretic approach for Multi-Criteria Decision Making under uncertainty

NASA Astrophysics Data System (ADS)

Madani, Kaveh; Lund, Jay R.

2011-05-01

Game theory provides a useful framework for studying Multi-Criteria Decision Making problems. This paper suggests modeling Multi-Criteria Decision Making problems as strategic games and solving them using non-cooperative game theory concepts. The suggested method can be used to prescribe non-dominated solutions and also can be used as a method to predict the outcome of a decision making problem. Non-cooperative stability definitions for solving the games allow consideration of non-cooperative behaviors, often neglected by other methods which assume perfect cooperation among decision makers. To deal with the uncertainty in input variables a Monte-Carlo Game Theory (MCGT) approach is suggested which maps the stochastic problem into many deterministic strategic games. The games are solved using non-cooperative stability definitions and the results include possible effects of uncertainty in input variables on outcomes. The method can handle multi-criteria multi-decision-maker problems with uncertainty. The suggested method does not require criteria weighting, developing a compound decision objective, and accurate quantitative (cardinal) information as it simplifies the decision analysis by solving problems based on qualitative (ordinal) information, reducing the computational burden substantially. The MCGT method is applied to analyze California's Sacramento-San Joaquin Delta problem. The suggested method provides insights, identifies non-dominated alternatives, and predicts likely decision outcomes.

An engineering approach to modelling, decision support and control for sustainable systems.

PubMed

Day, W; Audsley, E; Frost, A R

2008-02-12

Engineering research and development contributes to the advance of sustainable agriculture both through innovative methods to manage and control processes, and through quantitative understanding of the operation of practical agricultural systems using decision models. This paper describes how an engineering approach, drawing on mathematical models of systems and processes, contributes new methods that support decision making at all levels from strategy and planning to tactics and real-time control. The ability to describe the system or process by a simple and robust mathematical model is critical, and the outputs range from guidance to policy makers on strategic decisions relating to land use, through intelligent decision support to farmers and on to real-time engineering control of specific processes. Precision in decision making leads to decreased use of inputs, less environmental emissions and enhanced profitability-all essential to sustainable systems.

Making the case for evidence-based design in healthcare: a descriptive case study of organizational decision making.

PubMed

Shoemaker, Lorie K; Kazley, Abby Swanson; White, Andrea

2010-01-01

The aim of this study was to describe the organizational decision-making process used in the selection of evidence-based design (EBD) concepts, the criteria used to make these decisions, and the extent to which leadership style may have influenced the decision-making process. Five research questions were formulated to frame the direction of this study, including: (1) How did healthcare leaders learn of innovations in design? (2) How did healthcare leaders make decisions in the selection of healthcare design concepts? (3) What criteria did healthcare leaders use in the decision-making process? (4) How did healthcare leaders consider input from the staff in design decisions? and (5) To what extent did the leadership style of administrators affect the outcomes of the decision-making process? Current issues affecting healthcare in the community led the principal investigator's organization to undertake an ambitious facilities expansion project. As part of its planning process, the organization learned of EBD principles that seemingly had a positive impact on patient care and safety and staff working conditions. Although promising, a paucity of empirical research addressed the cost/benefit of incorporating many EBD concepts into one hospital setting, and there was no research that articulated the organizational decision-making process used by healthcare administrators when considering the use of EBD in expansion projects. A mixed-method, descriptive, qualitative, single-case study and quantitative design were used to address the five research questions. The Systems Research Organizing Model provided the theoretical framework. A variety of data collection methods was used, including interviews of key respondents, the review of documentary evidence, and the Multifactor Leadership Questionnaire. A participatory process was used throughout the design decision phases, involving staff at all levels of the organization. The Internet and architects facilitated learning about EBD. Financial considerations were a factor in decision making. The prevalence of the transformational leadership style among the organization's administrators exceeded the U.S. mean.

[Quantitative and qualitative research methods, can they coexist yet?].

PubMed

Hunt, Elena; Lavoie, Anne-Marise

2011-06-01

Qualitative design is gaining ground in Nursing research. In spite of a relative progress however, the evidence based practice movement continues to dominate and to underline the exclusive value of quantitative design (particularly that of randomized clinical trials) for clinical decision making. In the actual context convenient to those in power making utilitarian decisions on one hand, and facing nursing criticism of the establishment in favor of qualitative research on the other hand, it is difficult to chose a practical and ethical path that values the nursing role within the health care system, keeping us committed to quality care and maintaining researcher's integrity. Both qualitative and quantitative methods have advantages and disadvantages, and clearly, none of them can, by itself, capture, describe and explain reality adequately. Therefore, a balance between the two methods is needed. Researchers bare responsibility to society and science, and they should opt for the appropriate design susceptible to answering the research question, not promote the design favored by the research funding distributors.

Economic injury level for the coffee berry borer (Coleoptera: Curculionidae: Scolytinae) using attractive traps in Brazilian coffee fields.

PubMed

Fernandes, F L; Picanço, M C; Campos, S O; Bastos, C S; Chediak, M; Guedes, R N C; Silva, R S

2011-12-01

The currently existing sample procedures available for decision-making regarding the control of the coffee berry borer Hypothenemus hampei (Ferrari) (Coleoptera: Curculionidae: Scolytinae) are time-consuming, expensive, and difficult to perform, compromising their adoption. In addition, the damage functions incorporated in such decision levels only consider the quantitative losses, while dismissing the qualitative losses. Traps containing ethanol, methanol, and benzaldehyde may allow cheap and easy decision-making. Our objective was to determine the economic injury level (EIL) for the adults of the coffee berry borer by using attractant-baited traps. We considered both qualitative and quantitative losses caused by the coffee borer in estimating the EILs. These EILs were determined for conventional and organic coffee under high and average plant yield. When the quantitative losses caused by H. hampei were considered alone, the EILs ranged from 7.9 to 23.7% of bored berries for high and average-yield conventional crops, respectively. For high and average-yield organic coffee the ELs varied from 24.4 to 47.6% of bored berries, respectively. When qualitative and quantitative losses caused by the pest were considered together, the EIL was 4.3% of bored berries for both conventional and organic coffee. The EILs for H. hampei associated to the coffee plants in the flowering, pinhead fruit, and ripening fruit stages were 426, 85, and 28 adults per attractive trap, respectively.

Analytical group decision making in natural resources: Methodology and application

USGS Publications Warehouse

Schmoldt, D.L.; Peterson, D.L.

2000-01-01

Group decision making is becoming increasingly important in natural resource management and associated scientific applications, because multiple values are treated coincidentally in time and space, multiple resource specialists are needed, and multiple stakeholders must be included in the decision process. Decades of social science research on decision making in groups have provided insights into the impediments to effective group processes and on techniques that can be applied in a group context. Nevertheless, little integration and few applications of these results have occurred in resource management decision processes, where formal groups are integral, either directly or indirectly. A group decision-making methodology is introduced as an effective approach for temporary, formal groups (e.g., workshops). It combines the following three components: (1) brainstorming to generate ideas; (2) the analytic hierarchy process to produce judgments, manage conflict, enable consensus, and plan for implementation; and (3) a discussion template (straw document). Resulting numerical assessments of alternative decision priorities can be analyzed statistically to indicate where group member agreement occurs and where priority values are significantly different. An application of this group process to fire research program development in a workshop setting indicates that the process helps focus group deliberations; mitigates groupthink, nondecision, and social loafing pitfalls; encourages individual interaction; identifies irrational judgments; and provides a large amount of useful quantitative information about group preferences. This approach can help facilitate scientific assessments and other decision-making processes in resource management.

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

PubMed Central

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

2016-01-01

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

Development and field testing of a decision support tool to facilitate shared decision making in contraceptive counseling.

PubMed

Dehlendorf, Christine; Fitzpatrick, Judith; Steinauer, Jody; Swiader, Lawrence; Grumbach, Kevin; Hall, Cara; Kuppermann, Miriam

2017-07-01

We developed and formatively evaluated a tablet-based decision support tool for use by women prior to a contraceptive counseling visit to help them engage in shared decision making regarding method selection. Drawing upon formative work around women's preferences for contraceptive counseling and conceptual understanding of health care decision making, we iteratively developed a storyboard and then digital prototypes, based on best practices for decision support tool development. Pilot testing using both quantitative and qualitative data and cognitive testing was conducted. We obtained feedback from patient and provider advisory groups throughout the development process. Ninety-six percent of women who used the tool in pilot testing reported that it helped them choose a method, and qualitative interviews indicated acceptability of the tool's content and presentation. Compared to the control group, women who used the tool demonstrated trends toward increased likelihood of complete satisfaction with their method. Participant responses to cognitive testing were used in tool refinement. Our decision support tool appears acceptable to women in the family planning setting. Formative evaluation of the tool supports its utility among patients making contraceptive decisions, which can be further evaluated in a randomized controlled trial. Copyright © 2017 Elsevier B.V. All rights reserved.

Participatory modeling and structured decision making

USGS Publications Warehouse

Robinson, Kelly F.; Fuller, Angela K.

2016-01-01

Structured decision making (SDM) provides a framework for making sound decisions even when faced with uncertainty, and is a transparent, defensible, and replicable method used to understand complex problems. A hallmark of SDM is the explicit incorporation of values and science, which often includes participation from multiple stakeholders, helping to garner trust and ultimately result in a decision that is more likely to be implemented. The core steps in the SDM process are used to structure thinking about natural resources management choices, and include: (1) properly defining the problem and the decision context, (2) determining the objectives that help describe the aspirations of the decision maker, (3) devising management actions or alternatives that can achieve those objectives, (4) evaluating the outcomes or consequences of each alternative on each of the objectives, (5) evaluating trade-offs, and (6) implementing the decision. Participatory modeling for SDM includes engaging stakeholders in some or all of the steps of the SDM process listed above. In addition, participatory modeling often is crucial for creating qualitative and quantitative models of how the system works, providing data for these models, and eliciting expert opinion when data are unavailable. In these ways, SDM provides a framework for decision making in natural resources management that includes participation from stakeholder groups throughout the process, including the modeling phase.

Optimal multisensory decision-making in a reaction-time task.

PubMed

Drugowitsch, Jan; DeAngelis, Gregory C; Klier, Eliana M; Angelaki, Dora E; Pouget, Alexandre

2014-06-14

Humans and animals can integrate sensory evidence from various sources to make decisions in a statistically near-optimal manner, provided that the stimulus presentation time is fixed across trials. Little is known about whether optimality is preserved when subjects can choose when to make a decision (reaction-time task), nor when sensory inputs have time-varying reliability. Using a reaction-time version of a visual/vestibular heading discrimination task, we show that behavior is clearly sub-optimal when quantified with traditional optimality metrics that ignore reaction times. We created a computational model that accumulates evidence optimally across both cues and time, and trades off accuracy with decision speed. This model quantitatively explains subjects's choices and reaction times, supporting the hypothesis that subjects do, in fact, accumulate evidence optimally over time and across sensory modalities, even when the reaction time is under the subject's control.

A safety-based decision making architecture for autonomous systems

NASA Technical Reports Server (NTRS)

Musto, Joseph C.; Lauderbaugh, L. K.

1991-01-01

Engineering systems designed specifically for space applications often exhibit a high level of autonomy in the control and decision-making architecture. As the level of autonomy increases, more emphasis must be placed on assimilating the safety functions normally executed at the hardware level or by human supervisors into the control architecture of the system. The development of a decision-making structure which utilizes information on system safety is detailed. A quantitative measure of system safety, called the safety self-information, is defined. This measure is analogous to the reliability self-information defined by McInroy and Saridis, but includes weighting of task constraints to provide a measure of both reliability and cost. An example is presented in which the safety self-information is used as a decision criterion in a mobile robot controller. The safety self-information is shown to be consistent with the entropy-based Theory of Intelligent Machines defined by Saridis.

Development and Validation of a Quantitative Framework and Management Expectation Tool for the Selection of Bioremediation Approaches at Chlorinated Ethene Sites

DTIC Science & Technology

2015-12-01

FINAL REPORT Development and Validation of a Quantitative Framework and Management Expectation Tool for the Selection of Bioremediation ...TITLE AND SUBTITLE Development and Validation of a Quantitative Framework and Management Expectation Tool for the Selection of Bioremediation ...project ER-201129 was to develop and validate a framework used to make bioremediation decisions based on site-specific physical and biogeochemical

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

PubMed

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

2017-12-01

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

Decision-Making for Induced Abortion in the Accra Metropolis, Ghana.

PubMed

Gbagbo, Fred Yao; Amo-Adjei, Joshua; Laar, Amos

2015-06-01

Decision-making for induced abortion can be influenced by various circumstances including those surrounding onset of a pregnancy. There are various dimensions to induced abortion decision-making among women who had an elective induced abortion in a cosmopolitan urban setting in Ghana, which this paper examined. A cross-sectional mixed method study was conducted between January and December 2011 with 401 women who had undergone an abortion procedure in the preceding 12 months. Whereas the quantitative data were analysed with descriptive statistics, thematic analysis was applied to the qualitative data. The study found that women of various profiles have different reasons for undergoing abortion. Women considered the circumstances surrounding onset of pregnancy, person responsible for the pregnancy, gestational age at decision to terminate, and social, economic and medical considerations. Pressures from partners, career progression and reproductive intentions of women reinforced these reasons. First time pregnancies were mostly aborted regardless of gestational ages and partners' consent. Policies and programmes targeted at safe abortion care are needed to guide informed decisions on induced abortions.

A probabilistic, distributed, recursive mechanism for decision-making in the brain

PubMed Central

Gurney, Kevin N.

2018-01-01

Decision formation recruits many brain regions, but the procedure they jointly execute is unknown. Here we characterize its essential composition, using as a framework a novel recursive Bayesian algorithm that makes decisions based on spike-trains with the statistics of those in sensory cortex (MT). Using it to simulate the random-dot-motion task, we demonstrate it quantitatively replicates the choice behaviour of monkeys, whilst predicting losses of otherwise usable information from MT. Its architecture maps to the recurrent cortico-basal-ganglia-thalamo-cortical loops, whose components are all implicated in decision-making. We show that the dynamics of its mapped computations match those of neural activity in the sensorimotor cortex and striatum during decisions, and forecast those of basal ganglia output and thalamus. This also predicts which aspects of neural dynamics are and are not part of inference. Our single-equation algorithm is probabilistic, distributed, recursive, and parallel. Its success at capturing anatomy, behaviour, and electrophysiology suggests that the mechanism implemented by the brain has these same characteristics. PMID:29614077

Sustainable energy planning decision using the intuitionistic fuzzy analytic hierarchy process: choosing energy technology in Malaysia

NASA Astrophysics Data System (ADS)

Abdullah, Lazim; Najib, Liana

2016-04-01

Energy consumption for developing countries is sharply increasing due to the higher economic growth due to industrialisation along with population growth and urbanisation. The increasing demand of energy leads to global energy crisis. Selecting the best energy technology and conservation requires both quantitative and qualitative evaluation criteria. The fuzzy set-based approach is one of the well-known theories to handle fuzziness, uncertainty in decision-making and vagueness of information. This paper proposes a new method of intuitionistic fuzzy analytic hierarchy process (IF-AHP) to deal with the uncertainty in decision-making. The new IF-AHP is applied to establish a preference in the sustainable energy planning decision-making problem. Three decision-makers attached with Malaysian government agencies were interviewed to provide linguistic judgement prior to analysing with the new IF-AHP. Nuclear energy has been decided as the best alternative in energy planning which provides the highest weight among all the seven alternatives.

A Benefit-Risk Analysis Approach to Capture Regulatory Decision-Making: Non-Small Cell Lung Cancer.

PubMed

Raju, G K; Gurumurthi, K; Domike, R; Kazandjian, D; Blumenthal, G; Pazdur, R; Woodcock, J

2016-12-01

Drug regulators around the world make decisions about drug approvability based on qualitative benefit-risk analyses. There is much interest in quantifying regulatory approaches to benefit and risk. In this work the use of a quantitative benefit-risk analysis was applied to regulatory decision-making about new drugs to treat advanced non-small cell lung cancer (NSCLC). Benefits and risks associated with 20 US Food and Drug Administration (FDA) decisions associated with a set of candidate treatments submitted between 2003 and 2015 were analyzed. For benefit analysis, the median overall survival (OS) was used where available. When not available, OS was estimated based on overall response rate (ORR) or progression-free survival (PFS). Risks were analyzed based on magnitude (or severity) of harm and likelihood of occurrence. Additionally, a sensitivity analysis was explored to demonstrate analysis of systematic uncertainty. FDA approval decision outcomes considered were found to be consistent with the benefit-risk logic. © 2016 American Society for Clinical Pharmacology and Therapeutics.

Using Risk Assessment Methodologies to Meet Management Objectives

NASA Technical Reports Server (NTRS)

DeMott, D. L.

2015-01-01

Current decision making involves numerous possible combinations of technology elements, safety and health issues, operational aspects and process considerations to satisfy program goals. Identifying potential risk considerations as part of the management decision making process provides additional tools to make more informed management decision. Adapting and using risk assessment methodologies can generate new perspectives on various risk and safety concerns that are not immediately apparent. Safety and operational risks can be identified and final decisions can balance these considerations with cost and schedule risks. Additional assessments can also show likelihood of event occurrence and event consequence to provide a more informed basis for decision making, as well as cost effective mitigation strategies. Methodologies available to perform Risk Assessments range from qualitative identification of risk potential, to detailed assessments where quantitative probabilities are calculated. Methodology used should be based on factors that include: 1) type of industry and industry standards, 2) tasks, tools, and environment 3) type and availability of data and 4) industry views and requirements regarding risk & reliability. 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.

A proposed approach for quantitative benefit-risk assessment in diagnostic radiology guideline development: the American College of Radiology Appropriateness Criteria Example.

PubMed

Agapova, Maria; Bresnahan, Brian B; Higashi, Mitchell; Kessler, Larry; Garrison, Louis P; Devine, Beth

2017-02-01

The American College of Radiology develops evidence-based practice guidelines to aid appropriate utilization of radiological procedures. Panel members use expert opinion to weight trade-offs and consensus methods to rate appropriateness of imaging tests. These ratings include an equivocal range, assigned when there is disagreement about a technology's appropriateness and the evidence base is weak or for special circumstances. It is not clear how expert consensus merges with the evidence base to arrive at an equivocal rating. Quantitative benefit-risk assessment (QBRA) methods may assist decision makers in this capacity. However, many methods exist and it is not clear which methods are best suited for this application. We perform a critical appraisal of QBRA methods and propose several steps that may aid in making transparent areas of weak evidence and barriers to consensus in guideline development. We identify QBRA methods with potential to facilitate decision making in guideline development and build a decision aid for selecting among these methods. This study identified 2 families of QBRA methods suited to guideline development when expert opinion is expected to contribute substantially to decision making. Key steps to deciding among QBRA methods involve identifying specific benefit-risk criteria and developing a state-of-evidence matrix. For equivocal ratings assigned for reasons other than disagreement or weak evidence base, QBRA may not be needed. In the presence of disagreement but the absence of a weak evidence base, multicriteria decision analysis approaches are recommended; and in the presence of weak evidence base and the absence of disagreement, incremental net health benefit alone or combined with multicriteria decision analysis is recommended. Our critical appraisal further extends investigation of the strengths and limitations of select QBRA methods in facilitating diagnostic radiology clinical guideline development. The process of using the decision aid exposes and makes transparent areas of weak evidence and barriers to consensus. © 2016 John Wiley & Sons, Ltd.

Uncertainty Estimation Cheat Sheet for Probabilistic Risk Assessment

NASA Technical Reports Server (NTRS)

Britton, Paul T.; Al Hassan, Mohammad; Ring, Robert W.

2017-01-01

"Uncertainty analysis itself is uncertain, therefore, you cannot evaluate it exactly," Source Uncertain Quantitative results for aerospace engineering problems are influenced by many sources of uncertainty. Uncertainty analysis aims to make a technical contribution to decision-making through the quantification of uncertainties in the relevant variables as well as through the propagation of these uncertainties up to the result. Uncertainty can be thought of as a measure of the 'goodness' of a result and is typically represented as statistical dispersion. This paper will explain common measures of centrality and dispersion; and-with examples-will provide guidelines for how they may be estimated to ensure effective technical contributions to decision-making.

Lognormal Uncertainty Estimation for Failure Rates

NASA Technical Reports Server (NTRS)

Britton, Paul T.; Al Hassan, Mohammad; Ring, Robert W.

2017-01-01

"Uncertainty analysis itself is uncertain, therefore, you cannot evaluate it exactly," Source Uncertain. Quantitative results for aerospace engineering problems are influenced by many sources of uncertainty. Uncertainty analysis aims to make a technical contribution to decision-making through the quantification of uncertainties in the relevant variables as well as through the propagation of these uncertainties up to the result. Uncertainty can be thought of as a measure of the 'goodness' of a result and is typically represented as statistical dispersion. This presentation will explain common measures of centrality and dispersion; and-with examples-will provide guidelines for how they may be estimated to ensure effective technical contributions to decision-making.

Reported Influences on Restaurant-Type Food Selection Decision Making in a Grocery Store Chain.

PubMed

Bachman, Jessica Lynne; Arigo, Danielle

2018-06-01

To examine food decision-making priorities for restaurant-type foods at grocery stores and determine whether adding calorie information, as required by federal menu labeling laws, affected decision-making priorities. Natural experiment: intervention and control groups with baseline and follow-up. Regional grocery store chain with 9 locations. Participants (n = 393; mean age, 54.8 ± 15.1 years) were primarily women (71%) and Caucasian (95%). Data were collected before and after calorie information was added to restaurant-type foods at 4 intervention locations. Primary influencers of food selection decision making for restaurant-type foods and frequency of use of nutrition information. Quantitative analysis examined the top 3 influencers of food selections and chi-square goodness of fit test determined whether the calorie labeling intervention changed food decision-making priorities. Qualitative data were used to describe responses. Taste, cost, and convenience were the most frequently reported influencers of restaurant-type food selections; 20% of participants rated calories as influential. Calorie labeling did not affect food selection decision making; 16% of participants in intervention stores noticed calorie labels. Qualitative explanations confirmed these findings. Menu labeling laws increase access to calorie information; however, use of this information is limited. Additional interventions are needed to encourage healthier restaurant-type food selections in grocery stores. Copyright © 2018 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Adults' decision-making about the electronic waste issue: The role of the nature of science conceptualizations and moral concerns in socio-scientific decision-making

NASA Astrophysics Data System (ADS)

Yu, Yuqing

Socio-scientific issues have become increasingly important in Science-Technology-Society (STS) education as a means to make science learning more relevant to students' lives. This study used the e-waste issue as a context to investigate two aspects of socio-scientific decision-making: (1) the relationship between the nature of science (NOS) conceptualizations and decision-making; and (2) moral concerns involved in the process of decision-making. This study contributes to the field of socio-scientific issue research and STS education in the following ways. First, it is the first study that performed meta-analysis to seek the relationship between the NOS understanding and decision-making. This study concludes that valuable NOS conceptualizations that are highly related to the socio-scientific issue under investigation, rather than general NOS understanding, exert statistically significant influences on decision-making. Second, this study empirically examined the Multiple Responses Model (MRM), which enables the transfer of qualitative NOS responses into quantitative data, and hence, inferential statistics. The current study justifies the significance of unidimensionality to the application of the MRM. It addresses the limitations associated with the MRM and provides implications for future use of the MRM in other contexts. Finally, the study explores the role of moral concerns in socio-scientific decision-making. Eight participants engaged in interviews that were designed to elicit their reactions and feelings regarding the issue of exporting e-waste to poor countries. Qualitative analyses demonstrated that moral considerations were significant influences on decision-making. In addition, participants' action responses revealed that they were motivated to take action to help the environment. The study has implications for socio-scientific issue studies in other contexts and for teacher education programs that use socio-scientific issues to advance teachers' reasoning and discourse skills.

Parental Rights and the Foster Care System: A Glimpse of Decision Making in Virginia

ERIC Educational Resources Information Center

McWey, Lenore M.; Henderson, Tammy L.; Alexander, Jenny Burroughs

2008-01-01

Using ecological theory and a mixed-methods approach, the authors examined family-court interactions for foster care decisions made in Virginia across three policy periods: 1980 to 1993, 1994 to 1997, and 1997 to present (N = 95). For the first and last policy periods, quantitative analyses revealed significant differences in the rates at which…

Expert Assessment of Human-Human Stigmergy

DTIC Science & Technology

2005-10-01

paradigm for marker based stigmergy is the use of pheromones by certain social insects to coordinate their actions. Most insect species use a few...dozen distinct pheromone “flavors,” and thus use qualitative as well as quantitative decision-making. In engineered systems, stigmergic markers can...Gradient following in a single pheromone field Ant cemetery clustering Qualitative Decisions based on combinations of pheromones Wasp nest

Research on AHP decision algorithms based on BP algorithm

NASA Astrophysics Data System (ADS)

Ma, Ning; Guan, Jianhe

2017-10-01

Decision making is the thinking activity that people choose or judge, and scientific decision-making has always been a hot issue in the field of research. Analytic Hierarchy Process (AHP) is a simple and practical multi-criteria and multi-objective decision-making method that combines quantitative and qualitative and can show and calculate the subjective judgment in digital form. In the process of decision analysis using AHP method, the rationality of the two-dimensional judgment matrix has a great influence on the decision result. However, in dealing with the real problem, the judgment matrix produced by the two-dimensional comparison is often inconsistent, that is, it does not meet the consistency requirements. BP neural network algorithm is an adaptive nonlinear dynamic system. It has powerful collective computing ability and learning ability. It can perfect the data by constantly modifying the weights and thresholds of the network to achieve the goal of minimizing the mean square error. In this paper, the BP algorithm is used to deal with the consistency of the two-dimensional judgment matrix of the AHP.

Comparative-effectiveness research to aid population decision making by relating clinical outcomes and quality-adjusted life years.

PubMed

Campbell, Jonathan D; Zerzan, Judy; Garrison, Louis P; Libby, Anne M

2013-04-01

Comparative-effectiveness research (CER) at the population level is missing standardized approaches to quantify and weigh interventions in terms of their clinical risks, benefits, and uncertainty. We proposed an adapted CER framework for population decision making, provided example displays of the outputs, and discussed the implications for population decision makers. Building on decision-analytical modeling but excluding cost, we proposed a 2-step approach to CER that explicitly compared interventions in terms of clinical risks and benefits and linked this evidence to the quality-adjusted life year (QALY). The first step was a traditional intervention-specific evidence synthesis of risks and benefits. The second step was a decision-analytical model to simulate intervention-specific progression of disease over an appropriate time. The output was the ability to compare and quantitatively link clinical outcomes with QALYs. The outputs from these CER models include clinical risks, benefits, and QALYs over flexible and relevant time horizons. This approach yields an explicit, structured, and consistent quantitative framework to weigh all relevant clinical measures. Population decision makers can use this modeling framework and QALYs to aid in their judgment of the individual and collective risks and benefits of the alternatives over time. Future research should study effective communication of these domains for stakeholders. Copyright © 2013 Elsevier HS Journals, Inc. All rights reserved.

Exploring the link between environmental identity, behaviors and decision making

NASA Astrophysics Data System (ADS)

Freed, Allison

This study was conducted with undergraduate students at a large university to investigate the association between environmental identity, pro-environmental behaviors and environmental decision-making. This study explored how environmental identity as defined by Clayton (2003) influenced the type of pro-environmental behaviors individuals choose to participate in. Environmental decision-making based on Kahneman's (2003, 2011) System 1 and System 2 framework was also assessed in association with environmental identity. A survey including the Environmental Identity Survey (Clayton, 2003), the Environmentally Responsible Behaviors Index (Smith-Sebasto & D'Acosta, 1995), and a Decision Making Questionnaire were administered. After administering the surveys, eight participants were chosen for a 60-minute interview. The quantitative results of the study showed there was a significant relationship between environmental identity and participating in environmental behaviors more often. There was also a significant relation between environmental identity and making the decision to recycle in a fast and automatic way. The interview results showed that participants with both a strong and a weak environmental identity recycled often and thought it was a fast decision. The results of this study show that certain components of environmental identity are important, but other factors like the physical environment and social norms influence the thinking that goes into recycling more than environmental identity alone. This study provides evidence of the importance of social norms and environmental structures in fostering pro-environmental behaviors and influencing the type of thinking that goes into making environmental decisions. Keywords: environmental identity, environmental behaviors, System 1, System 2, recycling.

A quantitative flood risk analysis methodology for urban areas with integration of social research data

NASA Astrophysics Data System (ADS)

Escuder-Bueno, I.; Castillo-Rodríguez, J. T.; Zechner, S.; Jöbstl, C.; Perales-Momparler, S.; Petaccia, G.

2012-09-01

Risk analysis has become a top priority for authorities and stakeholders in many European countries, with the aim of reducing flooding risk, considering the population's needs and improving risk awareness. Within this context, two methodological pieces have been developed in the period 2009-2011 within the SUFRI project (Sustainable Strategies of Urban Flood Risk Management with non-structural measures to cope with the residual risk, 2nd ERA-Net CRUE Funding Initiative). First, the "SUFRI Methodology for pluvial and river flooding risk assessment in urban areas to inform decision-making" provides a comprehensive and quantitative tool for flood risk analysis. Second, the "Methodology for investigation of risk awareness of the population concerned" presents the basis to estimate current risk from a social perspective and identify tendencies in the way floods are understood by citizens. Outcomes of both methods are integrated in this paper with the aim of informing decision making on non-structural protection measures. The results of two case studies are shown to illustrate practical applications of this developed approach. The main advantage of applying the methodology herein presented consists in providing a quantitative estimation of flooding risk before and after investing in non-structural risk mitigation measures. It can be of great interest for decision makers as it provides rational and solid information.

EPA CENTER FOR EXPOSURE ASSESSMENT MODELING (CEAM)

EPA Science Inventory

The EPA Center for Exposure Assessment Modeling (CEAM) supports the Agency and professional community in environmental, risk-based decision-making by expanding their applications expertise for quantitatively assessing pollutant exposure via aquatic, terrestrial, and multimedia pa...

Cortical and Hippocampal Correlates of Deliberation during Model-Based Decisions for Rewards in Humans

PubMed Central

Bornstein, Aaron M.; Daw, Nathaniel D.

2013-01-01

How do we use our memories of the past to guide decisions we've never had to make before? Although extensive work describes how the brain learns to repeat rewarded actions, decisions can also be influenced by associations between stimuli or events not directly involving reward — such as when planning routes using a cognitive map or chess moves using predicted countermoves — and these sorts of associations are critical when deciding among novel options. This process is known as model-based decision making. While the learning of environmental relations that might support model-based decisions is well studied, and separately this sort of information has been inferred to impact decisions, there is little evidence concerning the full cycle by which such associations are acquired and drive choices. Of particular interest is whether decisions are directly supported by the same mnemonic systems characterized for relational learning more generally, or instead rely on other, specialized representations. Here, building on our previous work, which isolated dual representations underlying sequential predictive learning, we directly demonstrate that one such representation, encoded by the hippocampal memory system and adjacent cortical structures, supports goal-directed decisions. Using interleaved learning and decision tasks, we monitor predictive learning directly and also trace its influence on decisions for reward. We quantitatively compare the learning processes underlying multiple behavioral and fMRI observables using computational model fits. Across both tasks, a quantitatively consistent learning process explains reaction times, choices, and both expectation- and surprise-related neural activity. The same hippocampal and ventral stream regions engaged in anticipating stimuli during learning are also engaged in proportion to the difficulty of decisions. These results support a role for predictive associations learned by the hippocampal memory system to be recalled during choice formation. PMID:24339770

Decision-Making in Audiology: Balancing Evidence-Based Practice and Patient-Centered Care.

PubMed

Boisvert, Isabelle; Clemesha, Jennifer; Lundmark, Erik; Crome, Erica; Barr, Caitlin; McMahon, Catherine M

2017-01-01

Health-care service delivery models have evolved from a practitioner-centered approach toward a patient-centered ideal. Concurrently, increasing emphasis has been placed on the use of empirical evidence in decision-making to increase clinical accountability. The way in which clinicians use empirical evidence and client preferences to inform decision-making provides an insight into health-care delivery models utilized in clinical practice. The present study aimed to investigate the sources of information audiologists use when discussing rehabilitation choices with clients, and discuss the findings within the context of evidence-based practice and patient-centered care. To assess the changes that may have occurred over time, this study uses a questionnaire based on one of the few studies of decision-making behavior in audiologists, published in 1989. The present questionnaire was completed by 96 audiologists who attended the World Congress of Audiology in 2014. The responses were analyzed using qualitative and quantitative approaches. Results suggest that audiologists rank clinical test results and client preferences as the most important factors for decision-making. Discussion with colleagues or experts was also frequently reported as an important source influencing decision-making. Approximately 20% of audiologists mentioned utilizing research evidence to inform decision-making when no clear solution was available. Information shared at conferences was ranked low in terms of importance and reliability. This study highlights an increase in awareness of concepts associated with evidence-based practice and patient-centered care within audiology settings, consistent with current research-to-practice dissemination pathways. It also highlights that these pathways may not be sufficient for an effective clinical implementation of these practices.

Public preferences for engagement in Health Technology Assessment decision-making: protocol of a mixed methods study.

PubMed

Wortley, Sally; Tong, Allison; Lancsar, Emily; Salkeld, Glenn; Howard, Kirsten

2015-07-14

Much attention in recent years has been given to the topic of public engagement in health technology assessment (HTA) decision-making. HTA organizations spend substantial resources and time on undertaking public engagement, and numerous studies have examined challenges and barriers to engagement in the decision-making process however uncertainty remains as to optimal methods to incorporate the views of the public in HTA decision-making. Little research has been done to ascertain whether current engagement processes align with public preferences and to what extent their desire for engagement is dependent on the question being asked by decision-makers or the characteristics of the decision. This study will examine public preferences for engagement in Australian HTA decision-making using an exploratory mixed methods design. The aims of this study are to: 1) identify characteristics about HTA decisions that are important to the public in determining whether public engagement should be undertaken on a particular topic, 2) determine which decision characteristics influence public preferences for the extent, or type of public engagement, and 3) describe reasons underpinning these preferences. Focus group participants from the general community, aged 18-70 years, will be purposively sampled from the Australian population to ensure a wide range of demographic groups. Each focus group will include a general discussion on public engagement as well as a ranking exercise using a modified nominal group technique (NGT). The NGT will inform the design of a discrete choice study to quantitatively assess public preferences for engagement in HTA decision-making. The proposed research seeks to investigate under what circumstances and how the public would like their views and preferences to be considered in health technology assessments. HTA organizations regularly make decisions about when and how public engagement should occur but without consideration of the public's preferences on the method and extent of engagement. This information has the potential to assist decision-makers in tailoring engagement approaches, and may be particularly useful in decisions with potential for conflict where clarification of public values and preferences could strengthen the decision-making process.

To dialyse or delay: a qualitative study of older New Zealanders’ perceptions and experiences of decision-making, with stage 5 chronic kidney disease

PubMed Central

Lovell, Sarah; Walker, Robert J; Schollum, John B W; Marshall, Mark R; McNoe, Bronwen M; Derrett, Sarah

2017-01-01

Background Issues related to renal replacement therapy in elderly people with end stage kidney disease (ESKD) are complex. There is inadequate empirical data related to: decision-making by older populations, treatment experiences, implications of dialysis treatment and treatment modality on quality of life, and how these link to expectations of ageing. Study population Participants for this study were selected from a larger quantitative study of dialysis and predialysis patients aged 65 years or older recruited from three nephrology services across New Zealand. All participants had reached chronic kidney disease (CKD) stage 5 and had undergone dialysis education but had not started dialysis or recently started dialysis within the past 6 months. Methodology Serial qualitative interviews were undertaken to explore the decision-making processes and subsequent treatment experiences of patients with ESKD. Analytical approach: A framework method guided the iterative process of analysis. Decision-making codes were generated within NVivo software and then compared with the body of the interviews. Results Interviews were undertaken with 17 participants. We observed that decision-making was often a fluid process, rather than occurring at a single point in time, and was heavily influenced by perceptions of oneself as becoming old, social circumstances, life events and health status. Limitations This study focuses on participants' experiences of decision-making about treatment and does not include perspectives of their nephrologists or other members of the nephrology team. Conclusions Older patients often delay dialysis as an act of self-efficacy. They often do not commit to a dialysis decision following predialysis education. Delaying decision-making and initiating dialysis were common. This was not seen by participants as a final decision about therapy. Predialysis care and education should be different for older patients, who will delay decision-making until the time of facing obvious uraemic symptoms, threatening blood tests or paternalistic guidance from their nephrologist. Trial registration number Australasian Clinical Trials Registry ACTRN 12611000024943; results. PMID:28360253

Effect of an Integrated Instructional Counseling Program to Improve Vocational Decision-Making of Community College Youth. Final Report.

ERIC Educational Resources Information Center

Ryan, T. A.

A planned vocational guidance program incorporating instructional and counseling components in a community college setting was evaluated. The primary purpose of the program was to improve occupational choice-making of post-high school youth. Three hundred community college students whose verbal and quantitative scores on college entrance…

What are the decision-making preferences of patients in vascular surgery? A mixed-methods study.

PubMed

Santema, T B Katrien; Stoffer, E Anniek; Kunneman, Marleen; Koelemay, Mark J W; Ubbink, Dirk T

2017-02-10

Shared decision-making (SDM) has been advocated as the preferred method of choosing a suitable treatment option. However, patient involvement in treatment decision-making is not yet common practice in the field of vascular surgery. The aim of this mixed-methods study was to explore patients' decision-making preferences and to investigate which facilitators and barriers patients perceive as important for the application of SDM in vascular surgery. Patients were invited to participate after visiting the vascular surgical outpatient clinic of an Academic Medical Center in the Netherlands. A treatment decision was made during the consultation for an abdominal aortic aneurysm or peripheral arterial occlusive disease. Patients filled in a number of questionnaires (quantitative part) and a random subgroup of patients participated in an in-depth interview (qualitative part). A total of 67 patients participated in this study. 58 per cent of them (n=39) indicated that they preferred a shared role in decision-making. In more than half of the patients (55%; n=37) their preferred role was in disagreement with what they had experienced. 31 per cent of the patients (n=21) preferred a more active role in the decision-making process than they had experienced. Patients indicated a good patient-doctor relationship as an important facilitator for the application of SDM. The vast majority of vascular surgical patients preferred, but did not experience a shared role in the decision-making process, although the concept of SDM was insufficiently clear to some patients. This emphasises the importance of explaining the concept of SDM and implementing it in the clinical encounter. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The relationship between risk factors and aeronautical decision making in the flight training environment

NASA Astrophysics Data System (ADS)

Wetmore, Michael J.

The purpose of this applied dissertation was to investigate the relationship between risk factors and aeronautical decision making in the flight training environment using a quantitative, non-experimental, ex post facto research design. All 75 of the flight training accidents that involved a fatality from the years 2001-2003 were selected for study from the National Transportation Safety Board (NTSB) aviation accident database. Objective evidence from the Factual Reports was used to construct accident chains and to code and quantify total risk factors and total poor aeronautical decisions. The data were processed using correlational statistical tests at the 1% significance level. There was a statistically significant relationship between total risk factors per flight and poor decisions per flight. Liveware risks were the most prevalent risk factor category. More poor decisions were made during preflight than any other phase of flight. Pilots who made multiple poor decisions per flight had significantly higher risk factors per flight. A risk factor threat to decision making chart is presented for use by flight instructors and/or flight training organizations. The main threat to validity of this study was the NTSB accident investigation team investigative equality assumption.

Exploring power and sexual decision making among young Latinos residing in rural communities.

PubMed

Zukoski, Ann P; Harvey, S Marie; Oakley, Lisa; Branch, Meredith

2011-01-01

Studies of relationship power and sexual decision making related to contraceptive and condom use among Latinos in the United States are limited. This exploratory study provides insight into relationship power and reproductive decision making among a sample of young Latinos (n = 58) who live in rural communities in the Northwest. Using mixed methods approaches, we explored through in-depth interviews how Latino men and women define power, what makes them feel powerful, who has power, and who makes reproductive decisions within their sexual relationships. Descriptions of power and what makes Latinos feel powerful in their relationships reflected more widely accepted definitions and theories with important distinctions. Participants endorsed traditional domains of relationship power describing power as decision-making dominance and relationship control. However, smaller proportions of participants also described power as shared through joint decision making and equality. Themes related to the role of communication and relationship qualities also emerged. Based on quantitative measures, men and women reported that men have more relative power in relationships yet both reported high degrees of power within their own relationships. The majority of women and men believe that both members of a couple participated in decisions to use something to prevent pregnancy and to use condoms. Results underscore that young men and women in new settlement areas have traditional views of power while also identifying equality and interpersonal qualities to be important components of power dynamics within relationships. These findings have important implications for future research and the development of pregnancy and HIV/sexually transmitted infection prevention programs. Copyright © 2011 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Risk management for the Space Exploration Initiative

NASA Technical Reports Server (NTRS)

Buchbinder, Ben

1993-01-01

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

Predicting Team Performance through Human Behavioral Sensing and Quantitative Workflow Instrumentation

DTIC Science & Technology

2016-07-27

make risk-informed decisions during serious games . Statistical models of intra- game performance were developed to determine whether behaviors in...specific facets of the gameplay workflow were predictive of analytical performance and games outcomes. A study of over seventy instrumented teams revealed...more accurate game decisions. 2 Keywords: Humatics · Serious Games · Human-System Interaction · Instrumentation · Teamwork · Communication Analysis

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

PubMed

Pérez-Escudero, Alfonso; de Polavieja, Gonzalo G

2017-11-01

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

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.

MDCT quantification is the dominant parameter in decision–making regarding chest tube drainage for stable patients with traumatic pneumothorax

PubMed Central

Cai, Wenli; Lee, June-Goo; Fikry, Karim; Yoshida, Hiroyuki; Novelline, Robert; de Moya, Marc

2013-01-01

It is commonly believed that the size of a pneumothorax is an important determinant of treatment decision, in particular regarding whether chest tube drainage (CTD) is required. However, the volumetric quantification of pneumothoraces has not routinely been performed in clinics. In this paper, we introduced an automated computer-aided volumetry (CAV) scheme for quantification of volume of pneumothoraces in chest multi-detect CT (MDCT) images. Moreover, we investigated the impact of accurate volume of pneumothoraces in the improvement of the performance in decision-making regarding CTD in the management of traumatic pneumothoraces. For this purpose, an occurrence frequency map was calculated for quantitative analysis of the importance of each clinical parameter in the decision-making regarding CTD by a computer simulation of decision-making using a genetic algorithm (GA) and a support vector machine (SVM). A total of 14 clinical parameters, including volume of pneumothorax calculated by our CAV scheme, was collected as parameters available for decision-making. The results showed that volume was the dominant parameter in decision-making regarding CTD, with an occurrence frequency value of 1.00. The results also indicated that the inclusion of volume provided the best performance that was statistically significant compared to the other tests in which volume was excluded from the clinical parameters. This study provides the scientific evidence for the application of CAV scheme in MDCT volumetric quantification of pneumothoraces in the management of clinically stable chest trauma patients with traumatic pneumothorax. PMID:22560899

MDCT quantification is the dominant parameter in decision-making regarding chest tube drainage for stable patients with traumatic pneumothorax.

PubMed

Cai, Wenli; Lee, June-Goo; Fikry, Karim; Yoshida, Hiroyuki; Novelline, Robert; de Moya, Marc

2012-07-01

It is commonly believed that the size of a pneumothorax is an important determinant of treatment decision, in particular regarding whether chest tube drainage (CTD) is required. However, the volumetric quantification of pneumothoraces has not routinely been performed in clinics. In this paper, we introduced an automated computer-aided volumetry (CAV) scheme for quantification of volume of pneumothoraces in chest multi-detect CT (MDCT) images. Moreover, we investigated the impact of accurate volume of pneumothoraces in the improvement of the performance in decision-making regarding CTD in the management of traumatic pneumothoraces. For this purpose, an occurrence frequency map was calculated for quantitative analysis of the importance of each clinical parameter in the decision-making regarding CTD by a computer simulation of decision-making using a genetic algorithm (GA) and a support vector machine (SVM). A total of 14 clinical parameters, including volume of pneumothorax calculated by our CAV scheme, was collected as parameters available for decision-making. The results showed that volume was the dominant parameter in decision-making regarding CTD, with an occurrence frequency value of 1.00. The results also indicated that the inclusion of volume provided the best performance that was statistically significant compared to the other tests in which volume was excluded from the clinical parameters. This study provides the scientific evidence for the application of CAV scheme in MDCT volumetric quantification of pneumothoraces in the management of clinically stable chest trauma patients with traumatic pneumothorax. Copyright © 2012 Elsevier Ltd. All rights reserved.

Measuring and Modeling Behavioral Decision Dynamics in Collective Evacuation

PubMed Central

Carlson, Jean M.; Alderson, David L.; Stromberg, Sean P.; Bassett, Danielle S.; Craparo, Emily M.; Guiterrez-Villarreal, Francisco; Otani, Thomas

2014-01-01

Identifying and quantifying factors influencing human decision making remains an outstanding challenge, impacting the performance and predictability of social and technological systems. In many cases, system failures are traced to human factors including congestion, overload, miscommunication, and delays. Here we report results of a behavioral network science experiment, targeting decision making in a natural disaster. In a controlled laboratory setting, our results quantify several key factors influencing individual evacuation decision making in a controlled laboratory setting. The experiment includes tensions between broadcast and peer-to-peer information, and contrasts the effects of temporal urgency associated with the imminence of the disaster and the effects of limited shelter capacity for evacuees. Based on empirical measurements of the cumulative rate of evacuations as a function of the instantaneous disaster likelihood, we develop a quantitative model for decision making that captures remarkably well the main features of observed collective behavior across many different scenarios. Moreover, this model captures the sensitivity of individual- and population-level decision behaviors to external pressures, and systematic deviations from the model provide meaningful estimates of variability in the collective response. Identification of robust methods for quantifying human decisions in the face of risk has implications for policy in disasters and other threat scenarios, specifically the development and testing of robust strategies for training and control of evacuations that account for human behavior and network topologies. PMID:24520331

Attitudes to infant feeding decision-making--a mixed-methods study of Australian medical students and GP registrars.

PubMed

Brodribb, Wendy; Fallon, Tony; Jackson, Claire; Hegney, Desley

2010-03-01

Breastfeeding is an important public health issue. While medical practitioners can have a significant impact on breastfeeding initiation and duration, there are few studies investigating their views regarding women's infant feeding decisions. This mixed-methods study employed qualitative (focus groups and interviews) and quantitative (questionnaire) data collection techniques to investigate the attitudes and views of Australian medical students and GP registrars about infant feeding decision-making. Three approaches to infant feeding decisions were evident: 'the moral choice' (women were expected to breastfeed); 'the free choice' (doctors should not influence a woman's decision); and 'the equal choice' (the outcome of the decision was unimportant). Participants were uncertain about differences between artificial-feeding and breastfeeding outcomes, and there was some concern that advising a mother to breastfeed may lead to maternal feelings of guilt and failure. These findings, the first in an Australian setting, provide a foundation on which to base further educational interventions for medical practitioners.

Distinct effects of prefrontal and parietal cortex inactivations on an accumulation of evidence task in the rat

PubMed Central

Erlich, Jeffrey C; Brunton, Bingni W; Duan, Chunyu A; Hanks, Timothy D; Brody, Carlos D

2015-01-01

Numerous brain regions have been shown to have neural correlates of gradually accumulating evidence for decision-making, but the causal roles of these regions in decisions driven by accumulation of evidence have yet to be determined. Here, in rats performing an auditory evidence accumulation task, we inactivated the frontal orienting fields (FOF) and posterior parietal cortex (PPC), two rat cortical regions that have neural correlates of accumulating evidence and that have been proposed as central to decision-making. We used a detailed model of the decision process to analyze the effect of inactivations. Inactivation of the FOF induced substantial performance impairments that were quantitatively best described as an impairment in the output pathway of an evidence accumulator with a long integration time constant (>240 ms). In contrast, we found a minimal role for PPC in decisions guided by accumulating auditory evidence, even while finding a strong role for PPC in internally-guided decisions. DOI: http://dx.doi.org/10.7554/eLife.05457.001 PMID:25869470

Decision-Making in Audiology: Balancing Evidence-Based Practice and Patient-Centered Care

PubMed Central

Clemesha, Jennifer; Lundmark, Erik; Crome, Erica; Barr, Caitlin; McMahon, Catherine M.

2017-01-01

Health-care service delivery models have evolved from a practitioner-centered approach toward a patient-centered ideal. Concurrently, increasing emphasis has been placed on the use of empirical evidence in decision-making to increase clinical accountability. The way in which clinicians use empirical evidence and client preferences to inform decision-making provides an insight into health-care delivery models utilized in clinical practice. The present study aimed to investigate the sources of information audiologists use when discussing rehabilitation choices with clients, and discuss the findings within the context of evidence-based practice and patient-centered care. To assess the changes that may have occurred over time, this study uses a questionnaire based on one of the few studies of decision-making behavior in audiologists, published in 1989. The present questionnaire was completed by 96 audiologists who attended the World Congress of Audiology in 2014. The responses were analyzed using qualitative and quantitative approaches. Results suggest that audiologists rank clinical test results and client preferences as the most important factors for decision-making. Discussion with colleagues or experts was also frequently reported as an important source influencing decision-making. Approximately 20% of audiologists mentioned utilizing research evidence to inform decision-making when no clear solution was available. Information shared at conferences was ranked low in terms of importance and reliability. This study highlights an increase in awareness of concepts associated with evidence-based practice and patient-centered care within audiology settings, consistent with current research-to-practice dissemination pathways. It also highlights that these pathways may not be sufficient for an effective clinical implementation of these practices. PMID:28752808

Vulnerable patients' perceptions of health care quality and quality data.

PubMed

Raven, Maria Catherine; Gillespie, Colleen C; DiBennardo, Rebecca; Van Busum, Kristin; Elbel, Brian

2012-01-01

Little is known about how patients served by safety-net hospitals utilize and respond to hospital quality data. To understand how vulnerable, lower income patients make health care decisions and define quality of care and whether hospital quality data factor into such decisions and definitions. Mixed quantitative and qualitative methods were used to gather primary data from patients at an urban, tertiary-care safety-net hospital. The study hospital is a member of the first public hospital system to voluntarily post hospital quality data online for public access. Patients were recruited from outpatient and inpatient clinics. Surveys were used to collect data on participants' sociodemographic characteristics, health literacy, health care experiences, and satisfaction variables. Focus groups were used to explore a representative sample of 24 patients' health care decision making and views of quality. Data from focus group transcripts were iteratively coded and analyzed by the authors. Focus group participants were similar to the broader diverse, low-income clinic. Participants reported exercising choice in making decisions about where to seek health care. Multiple sources influenced decision-making processes including participants' own beliefs and values, social influences, and prior experiences. Hospital quality data were notably absent as a source of influence in health care decision making for this population largely because participants were unaware of its existence. Participants' views of hospital quality were influenced by the quality and efficiency of services provided (with an emphasis on the doctor-patient relationship) and patient centeredness. When presented with it, patients appreciated the hospital quality data and, with guidance, were interested in incorporating it into health care decision making. Results suggest directions for optimizing the presentation, content, and availability of hospital quality data. Future research will explore how similar populations form and make choices based on presentation of hospital quality data.

Historical Roots of the Spatial, Temporal, and Diversity Scales of Agricultural Decision-Making in Sierra de Santa Marta, Los Tuxtlas

NASA Astrophysics Data System (ADS)

Negrete-Yankelevich, Simoneta; Porter-Bolland, Luciana; Blanco-Rosas, José Luis; Barois, Isabelle

2013-07-01

Land degradation is a serious problem in tropical mountainous areas. Market prices, technological development, and population growth are often invoked as the prime causes. Using historical agrarian documents, literature sources, and historical population data, we (1) provide quantitative and qualitative evidence that the land degradation present at Sierra de Santa Marta (Los Tuxtlas, Mexico) has involved a historical reduction in the temporal, spatial, and diversity scales, in which individual farmers make management decisions, and has resulted in decreased maize productivity; and (2) analyze how these three scalar changes can be linked to policy, population growth, and agrarian history. We conclude that the historical reduction in the scales of land use decision-making and practices constitutes a present threat to indigenous agricultural heritage. The long-term viability of agriculture requires that initiatives consider incentives for co-responsibility with an initial focus on self-sufficiency.

Normalization is a general neural mechanism for context-dependent decision making

PubMed Central

Louie, Kenway; Khaw, Mel W.; Glimcher, Paul W.

2013-01-01

Understanding the neural code is critical to linking brain and behavior. In sensory systems, divisive normalization seems to be a canonical neural computation, observed in areas ranging from retina to cortex and mediating processes including contrast adaptation, surround suppression, visual attention, and multisensory integration. Recent electrophysiological studies have extended these insights beyond the sensory domain, demonstrating an analogous algorithm for the value signals that guide decision making, but the effects of normalization on choice behavior are unknown. Here, we show that choice models using normalization generate significant (and classically irrational) choice phenomena driven by either the value or number of alternative options. In value-guided choice experiments, both monkey and human choosers show novel context-dependent behavior consistent with normalization. These findings suggest that the neural mechanism of value coding critically influences stochastic choice behavior and provide a generalizable quantitative framework for examining context effects in decision making. PMID:23530203

Historical roots of the spatial, temporal, and diversity scales of agricultural decision-making in sierra de santa marta, los tuxtlas.

PubMed

Negrete-Yankelevich, Simoneta; Porter-Bolland, Luciana; Blanco-Rosas, José Luis; Barois, Isabelle

2013-07-01

Land degradation is a serious problem in tropical mountainous areas. Market prices, technological development, and population growth are often invoked as the prime causes. Using historical agrarian documents, literature sources, and historical population data, we (1) provide quantitative and qualitative evidence that the land degradation present at Sierra de Santa Marta (Los Tuxtlas, Mexico) has involved a historical reduction in the temporal, spatial, and diversity scales, in which individual farmers make management decisions, and has resulted in decreased maize productivity; and (2) analyze how these three scalar changes can be linked to policy, population growth, and agrarian history. We conclude that the historical reduction in the scales of land use decision-making and practices constitutes a present threat to indigenous agricultural heritage. The long-term viability of agriculture requires that initiatives consider incentives for co-responsibility with an initial focus on self-sufficiency.

An Alternative to Farmer Age as an Indicator of Life-Cycle Stage: The Case for a Farm Family Age Index

ERIC Educational Resources Information Center

Burton, Rob J. F.

2006-01-01

In studies of farming, the age of the principal decision-maker (PDM) has been associated with numerous farm structural and managerial features and has been widely accepted as a good indicator of the influence of life-cycle factors on decision-making. As such, it has become an important aspect of many quantitative studies of agricultural change.…

Impacts of High Variable Renewable Energy Futures on Wholesale Electricity Prices, and on Electric-Sector Decision Making

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

Seel, Joachim; Mills, Andrew D.; Wiser, Ryan H.

Increasing penetrations of variable renewable energy (VRE) can affect wholesale electricity price patterns and make them meaningfully different from past, traditional price patterns. Many long-lasting decisions for supply- and demand-side electricity infrastructure and programs are based on historical observations or assume a business-as-usual future with low shares of VRE. Our motivating question is whether certain electric-sector decisions that are made based on assumptions reflecting low VRE levels will still achieve their intended objective in a high VRE future. We qualitatively describe how various decisions may change with higher shares of VRE and outline an analytical framework for quantitatively evaluating themore » impacts of VRE on long-lasting decisions. We then present results from detailed electricity market simulations with capacity expansion and unit commitment models for multiple regions of the U.S. for low and high VRE futures. We find a general decrease in average annual hourly wholesale energy prices with more VRE penetration, increased price volatility and frequency of very low-priced hours, and changing diurnal price patterns. Ancillary service prices rise substantially and peak net-load hours with high capacity value are shifted increasingly into the evening, particularly for high solar futures. While in this report we only highlight qualitatively the possible impact of these altered price patterns on other demand- and supply-side electric sector decisions, the core set of electricity market prices derived here provides a foundation for later planned quantitative evaluations of these decisions in low and high VRE futures.« less

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.

Research Methods in Education

ERIC Educational Resources Information Center

Check, Joseph; Schutt, Russell K.

2011-01-01

"Research Methods in Education" introduces research methods as an integrated set of techniques for investigating questions about the educational world. This lively, innovative text helps students connect technique and substance, appreciate the value of both qualitative and quantitative methodologies, and make ethical research decisions.…

An assessment of the risk of foreign animal disease introduction into the United States of America through garbage from Alaskan cruise ships.

PubMed

McElvaine, M D; McDowell, R M; Fite, R W; Miller, L

1993-12-01

The United States Department of Agriculture, Animal and Plant Health Inspection Service (USDA-APHIS) has been exploring methods of quantitative risk assessment to support decision-making, provide risk management options and identify research needs. With current changes in world trade, regulatory decisions must have a scientific basis which is transparent, consistent, documentable and defensible. These quantitative risk assessment methods are described in an accompanying paper in this issue. In the present article, the authors provide an illustration by presenting an application of these methods. Prior to proposing changes in regulations, USDA officials requested an assessment of the risk of introduction of foreign animal disease to the United States of America through garbage from Alaskan cruise ships. The risk assessment team used a combination of quantitative and qualitative methods to evaluate this question. Quantitative risk assessment methods were used to estimate the amount of materials of foreign origin being sent to Alaskan landfills. This application of quantitative risk assessment illustrates the flexibility of the methods in addressing specific questions. By applying these methods, specific areas were identified where more scientific information and research were needed. Even with limited information, the risk assessment provided APHIS management with a scientific basis for a regulatory decision.

Controlling equine influenza: policy networks and decision-making during the 2007 Australian equine influenza outbreak.

PubMed

Schemann, K; Gillespie, J A; Toribio, J-A L M L; Ward, M P; Dhand, N K

2014-10-01

Rapid, evidence-based decision-making is critical during a disease outbreak response; however, compliance by stakeholders is necessary to ensure that such decisions are effective - especially if the response depends on voluntary action. This mixed method study evaluated technical policy decision-making processes during the 2007 outbreak of equine influenza in Australia by identifying and analysing the stakeholder network involved and the factors driving policy decision-making. The study started with a review of the outbreak literature and published policy documents. This identified six policy issues regarding policy modifications or differing interpretations by different state agencies. Data on factors influencing the decision-making process for these six issues and on stakeholder interaction were collected using a pre-tested, semi-structured questionnaire. Face-to-face interviews were conducted with 24 individuals representing 12 industry and government organizations. Quantitative data were analysed using social network analysis. Qualitative data were coded and patterns matched to test a pre-determined general theory using a method called theory-oriented process-tracing. Results revealed that technical policy decisions were framed by social, political, financial, strategic and operational considerations. Industry stakeholders had influence through formal pre-existing channels, yet specific gaps in stakeholder interaction were overcome by reactive alliances formed during the outbreak response but outside the established system. Overall, the crisis management system and response were seen as positive, and 75-100% of individuals interviewed were supportive of, had interest in and considered the outcome as good for the majority of policy decisions, yet only 46-75% of those interviewed considered that they had influence on these decisions. Training to increase awareness and knowledge of emergency animal diseases (EADs) and response systems will improve stakeholder participation in emergency disease management and preparedness for future EAD incursions. © 2012 Blackwell Verlag GmbH.

Teaching critical thinking.

PubMed

Holmes, N G; Wieman, Carl E; Bonn, D A

2015-09-08

The ability to make decisions based on data, with its inherent uncertainties and variability, is a complex and vital skill in the modern world. The need for such quantitative critical thinking occurs in many different contexts, and although it is an important goal of education, that goal is seldom being achieved. We argue that the key element for developing this ability is repeated practice in making decisions based on data, with feedback on those decisions. We demonstrate a structure for providing suitable practice that can be applied in any instructional setting that involves the acquisition of data and relating that data to scientific models. This study reports the results of applying that structure in an introductory physics laboratory course. Students in an experimental condition were repeatedly instructed to make and act on quantitative comparisons between datasets, and between data and models, an approach that is common to all science disciplines. These instructions were slowly faded across the course. After the instructions had been removed, students in the experimental condition were 12 times more likely to spontaneously propose or make changes to improve their experimental methods than a control group, who performed traditional experimental activities. The students in the experimental condition were also four times more likely to identify and explain a limitation of a physical model using their data. Students in the experimental condition also showed much more sophisticated reasoning about their data. These differences between the groups were seen to persist into a subsequent course taken the following year.

Teaching critical thinking

PubMed Central

Holmes, N. G.; Wieman, Carl E.; Bonn, D. A.

2015-01-01

The ability to make decisions based on data, with its inherent uncertainties and variability, is a complex and vital skill in the modern world. The need for such quantitative critical thinking occurs in many different contexts, and although it is an important goal of education, that goal is seldom being achieved. We argue that the key element for developing this ability is repeated practice in making decisions based on data, with feedback on those decisions. We demonstrate a structure for providing suitable practice that can be applied in any instructional setting that involves the acquisition of data and relating that data to scientific models. This study reports the results of applying that structure in an introductory physics laboratory course. Students in an experimental condition were repeatedly instructed to make and act on quantitative comparisons between datasets, and between data and models, an approach that is common to all science disciplines. These instructions were slowly faded across the course. After the instructions had been removed, students in the experimental condition were 12 times more likely to spontaneously propose or make changes to improve their experimental methods than a control group, who performed traditional experimental activities. The students in the experimental condition were also four times more likely to identify and explain a limitation of a physical model using their data. Students in the experimental condition also showed much more sophisticated reasoning about their data. These differences between the groups were seen to persist into a subsequent course taken the following year. PMID:26283351

The Mother's Autonomy in Decision Making (MADM) scale: Patient-led development and psychometric testing of a new instrument to evaluate experience of maternity care.

PubMed

Vedam, Saraswathi; Stoll, Kathrin; Martin, Kelsey; Rubashkin, Nicholas; Partridge, Sarah; Thordarson, Dana; Jolicoeur, Ganga

2017-01-01

To develop and validate a new instrument that assesses women's autonomy and role in decision making during maternity care. Through a community-based participatory research process, service users designed, content validated, and administered a cross-sectional quantitative survey, including 31 items on the experience of decision-making. Pregnancy experiences (n = 2514) were reported by 1672 women who saw a single type of primary maternity care provider in British Columbia. They described care by a midwife, family physician or obstetrician during 1, 2 or 3 maternity care cycles. We conducted psychometric testing in three separate samples. We assessed reliability, item-to-total correlations, and the factor structure of the The Mothers' Autonomy in Decision Making (MADM) scale. We report MADM scores by care provider type, length of prenatal appointments, preferences for role in decision-making, and satisfaction with experience of decision-making. The MADM scale measures a single construct: autonomy in decision-making during maternity care. Cronbach alphas for the scale exceeded 0.90 for all samples and all provider groups. All item-to-total correlations were replicable across three samples and exceeded 0.7. Eigenvalue and scree plots exhibited a clear 90-degree angle, and factor analysis generated a one factor scale. MADM median scores were highest among women who were cared for by midwives, and 10 or more points lower for those who saw physicians. Increased time for prenatal appointments was associated with higher scale scores, and there were significant differences between providers with respect to average time spent in prenatal appointments. Midwifery care was associated with higher MADM scores, even during short prenatal appointments (<15 minutes). Among women who preferred to lead decisions around their care (90.8%), and who were dissatisfied with their experience of decision making, MADM scores were very low (median 14). Women with physician carers were consistently more likely to report dissatisfaction with their involvement in decision making. The Mothers Autonomy in Decision Making (MADM) scale is a reliable instrument for assessment of the experience of decision making during maternity care. This new scale was developed and content validated by community members representing various populations of childbearing women in BC including women from vulnerable populations. MADM measures women's ability to lead decision making, whether they are given enough time to consider their options, and whether their choices are respected. Women who experienced midwifery care reported greater autonomy than women under physician care, when engaging in decision-making around maternity care options. Differences in models of care, professional education, regulatory standards, and compensation for prenatal visits between midwives and physicians likely affect the time available for these discussions and prioritization of a shared decision making process. The MADM scale reflects person-driven priorities, and reliably assesses interactions with maternity providers related to a person's ability to lead decision-making over the course of maternity care.

An index-based robust decision making framework for watershed management in a changing climate.

PubMed

Kim, Yeonjoo; Chung, Eun-Sung

2014-03-01

This study developed an index-based robust decision making framework for watershed management dealing with water quantity and quality issues in a changing climate. It consists of two parts of management alternative development and analysis. The first part for alternative development consists of six steps: 1) to understand the watershed components and process using HSPF model, 2) to identify the spatial vulnerability ranking using two indices: potential streamflow depletion (PSD) and potential water quality deterioration (PWQD), 3) to quantify the residents' preferences on water management demands and calculate the watershed evaluation index which is the weighted combinations of PSD and PWQD, 4) to set the quantitative targets for water quantity and quality, 5) to develop a list of feasible alternatives and 6) to eliminate the unacceptable alternatives. The second part for alternative analysis has three steps: 7) to analyze all selected alternatives with a hydrologic simulation model considering various climate change scenarios, 8) to quantify the alternative evaluation index including social and hydrologic criteria with utilizing multi-criteria decision analysis methods and 9) to prioritize all options based on a minimax regret strategy for robust decision. This framework considers the uncertainty inherent in climate models and climate change scenarios with utilizing the minimax regret strategy, a decision making strategy under deep uncertainty and thus this procedure derives the robust prioritization based on the multiple utilities of alternatives from various scenarios. In this study, the proposed procedure was applied to the Korean urban watershed, which has suffered from streamflow depletion and water quality deterioration. Our application shows that the framework provides a useful watershed management tool for incorporating quantitative and qualitative information into the evaluation of various policies with regard to water resource planning and management. Copyright © 2013 Elsevier B.V. All rights reserved.

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

Kiely, J Blanco; Olszanski, A; Both, S

Purpose: To develop a quantitative decision making metric for automatically detecting irregular breathing using a large patient population that received phase-sorted 4DCT. Methods: This study employed two patient cohorts. Cohort#1 contained 256 patients who received a phasesorted 4DCT. Cohort#2 contained 86 patients who received three weekly phase-sorted 4DCT scans. A previously published technique used a single abdominal surrogate to calculate the ratio of extreme inhalation tidal volume to normal inhalation tidal volume, referred to as the κ metric. Since a single surrogate is standard for phase-sorted 4DCT in radiation oncology clinical practice, tidal volume was not quantified. Without tidal volume,more » the absolute κ metric could not be determined, so a relative κ (κrel) metric was defined based on the measured surrogate amplitude instead of tidal volume. Receiver operator characteristic (ROC) curves were used to quantitatively determine the optimal cutoff value (jk) and efficiency cutoff value (τk) of κrel to automatically identify irregular breathing that would reduce the image quality of phase-sorted 4DCT. Discriminatory accuracy (area under the ROC curve) of κrel was calculated by a trapezoidal numeric integration technique. Results: The discriminatory accuracy of ?rel was found to be 0.746. The key values of jk and tk were calculated to be 1.45 and 1.72 respectively. For values of ?rel such that jk≤κrel≤τk, the decision to reacquire the 4DCT would be at the discretion of the physician. This accounted for only 11.9% of the patients in this study. The magnitude of κrel held consistent over 3 weeks for 73% of the patients in cohort#3. Conclusion: The decision making metric, ?rel, was shown to be an accurate classifier of irregular breathing patients in a large patient population. This work provided an automatic quantitative decision making metric to quickly and accurately assess the extent to which irregular breathing is occurring during phase-sorted 4DCT.« less

Supporting Students with Disabilities Entering the Science, Technology, Engineering, and Mathematics Field Disciplines

NASA Astrophysics Data System (ADS)

Dishauzi, Karen M.

Extensive research exists on female, African American, and Hispanic students pursuing Science, Technology, Engineering and Mathematics (STEM) field disciplines. However, little research evaluates students with disabilities and career decision-making relating to STEM field disciplines. This study explored the career decision-making experiences and self-efficacy for students with disabilities. The purpose of this research study was to document experiences and perceptions of students with disabilities who pursue, and may consider pursuing, careers in the STEM field disciplines by exploring the career decision-making self-efficacy of students with disabilities. This study documented the level of influence that the students with disabilities had or may not have had encountered from parents, friends, advisors, counselors, and instructors as they managed their decision-making choice relating to their academic major/career in the STEM or non-STEM field disciplines. A total of 85 respondents of approximately 340 students with disabilities at one Midwestern public university completed a quantitatively designed survey instrument. The Career Decision-Making Self-Efficacy Scale-Short Form by Betz and Hackett was the instrument used, and additional questions were included in the survey. Data analysis included descriptive statistics and analysis of variance. Based upon the results, college students with disabilities are not currently being influenced by individuals and groups of individuals to pursue the STEM field disciplines. This is a cohort of individuals who can be marketed to increase enrollment in STEM programs at academic institutions. This research further found that gender differences at the institution under study did not affect the career decision-making self-efficacy scores. The men did not score any higher in confidence in career decision-making than the women. Disability type did not significantly affect the relationship between the Career Decision-Making Self-Efficacy Total Scores or college major choice. Of the three disability types represented more frequently, the Mental Health disability was found to be a growing disability at the institution under study. This research was found to be beneficial in the documentation of specific levels of influence perceived by students with disabilities from parents, friends, advisors, counselors, and instructors that related to their career decision-making and academic major choices.

What failure in collective decision-making tells us about metacognition

PubMed Central

Bahrami, Bahador; Olsen, Karsten; Bang, Dan; Roepstorff, Andreas; Rees, Geraint; Frith, Chris

2012-01-01

Condorcet (1785) proposed that a majority vote drawn from individual, independent and fallible (but not totally uninformed) opinions provides near-perfect accuracy if the number of voters is adequately large. Research in social psychology has since then repeatedly demonstrated that collectives can and do fail more often than expected by Condorcet. Since human collective decisions often follow from exchange of opinions, these failures provide an exquisite opportunity to understand human communication of metacognitive confidence. This question can be addressed by recasting collective decision-making as an information-integration problem similar to multisensory (cross-modal) perception. Previous research in systems neuroscience shows that one brain can integrate information from multiple senses nearly optimally. Inverting the question, we ask: under what conditions can two brains integrate information about one sensory modality optimally? We review recent work that has taken this approach and report discoveries about the quantitative limits of collective perceptual decision-making, and the role of the mode of communication and feedback in collective decision-making. We propose that shared metacognitive confidence conveys the strength of an individual's opinion and its reliability inseparably. We further suggest that a functional role of shared metacognition is to provide substitute signals in situations where outcome is necessary for learning but unavailable or impossible to establish. PMID:22492752

Integrating NASA Earth Observations into the Global Indicator Framework for Monitoring the United Nations' Sustainable Development Goals

NASA Astrophysics Data System (ADS)

Crepps, G.; Gotschalk, E.; Childs-Gleason, L. M.; Favors, J.; Ruiz, M. L.; Allsbrook, K. N.; Rogers, L.; Ross, K. W.

2016-12-01

The NASA DEVELOP National Program conducts rapid 10-week feasibility projects that build decision makers' capacity to utilize NASA Earth observations in their decision making. Teams, in collaboration with partner organizations, conduct projects that create end products such as maps, analyses, and automated tools tailored for their partners' specific decision making needs. These projects illustrate the varied applications about which Earth observations can assist in making better informed decisions, such topics as land use changes, ecological forecasting, public health, and species habitats. As a capacity building program, DEVELOP is interested in understanding how these end products are utilized once the project is over and if Earth observations become a regular tool in the partner's decision making toolkit. While DEVELOP's niche is short-term projects, to assess the impacts of these projects, a longer-term scale is needed. As a result, DEVELOP has created a project strength metrics, and partner assessments, pre- and post-project, as well as a follow up form. This presentation explores the challenges in both quantitative and qualitative assessments of valuing the contributions of these Earth observation tools. This proposal lays out the assessment framework created within the program, and illustrates case studies in which projects have been assessed and long-term partner use of tools examined and quantified.

Ethical decision making in intensive care units: a burnout risk factor? Results from a multicentre study conducted with physicians and nurses.

PubMed

Teixeira, Carla; Ribeiro, Orquídea; Fonseca, António M; Carvalho, Ana Sofia

2014-02-01

Ethical decision making in intensive care is a demanding task. The need to proceed to ethical decision is considered to be a stress factor that may lead to burnout. The aim of this study is to explore the ethical problems that may increase burnout levels among physicians and nurses working in Portuguese intensive care units (ICUs). A quantitative, multicentre, correlational study was conducted among 300 professionals. The most crucial ethical decisions made by professionals working in ICU were related to communication, withholding or withdrawing treatments and terminal sedation. A positive relation was found between ethical decision making and burnout in nurses, namely, between burnout and the need to withdraw treatments (p=0.032), to withhold treatments (p=0.002) and to proceed to terminal sedation (p=0.005). This did not apply to physicians. Emotional exhaustion was the burnout subdimension most affected by the ethical decision. The nurses' lack of involvement in ethical decision making was identified as a risk factor. Nevertheless, in comparison with nurses (6%), it was the physicians (34%) who more keenly felt the need to proceed to ethical decisions in ICU. Ethical problems were reported at different levels by physicians and nurses. The type of ethical decisions made by nurses working in Portuguese ICUs had an impact on burnout levels. This did not apply to physicians. This study highlights the need for education in the field of ethics in ICUs and the need to foster inter-disciplinary discussion so as to encourage ethical team deliberation in order to prevent burnout.

Ethical dilemmas concerning decision-making within health care leadership: a systematic literature review.

PubMed

Zydziūnaite, Vilma; Suominen, Tarja; Astedt-Kurki, Päivi; Lepaite, Daiva

2010-01-01

The objective was to describe the research methods and research focuses on ethical dilemmas concerning decision-making within health care leadership. The search was conducted on Medline and PubMed databases (1998-2008). The systematic review included 21 selected articles. The ethical dilemmas concerning decision-making within health care leadership are related to three levels: institutional (particular organization), political and local interface (local governmental structure), and national (professional expertise and system). The terms that are used as adequate to the term of "ethical dilemma" are the following: "continuous balancing," "result of resource allocation," "gap between professional obligations and possibilities," "ethically controversial situation," "concern about interactions," "ethical difficulty," "outcome of medical choices," "concern about society access to health care resources," "ethically difficult/challenging situation," "(the consequence of) ethical concern/ethical issue." In qualitative studies, a semi-structured interview and qualitative content analysis are the most commonly applied methods; in quantitative studies, questionnaire surveys are employed. In the research literature, there is a lack of specification according to professional qualification of health care professionals concerning ethical dilemmas by decision-making within health care management/administration. The research on ethical dilemmas in health care leadership, management, and administration should integrate data about levels at which ethical dilemmas occur and investigate ethical dilemmas as complex phenomena because those are attached to decision-making and specific nuances of health care management/administration. In this article, the presented scientific problem requires extensive scientific discussions and research on ethical dilemmas concerning decision-making within health care leadership at various levels.

Geospatial decision support systems for societal decision making

USGS Publications Warehouse

Bernknopf, R.L.

2005-01-01

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

Applying multi-criteria decision-making to improve the waste reduction policy in Taiwan.

PubMed

Su, Jun-Pin; Hung, Ming-Lung; Chao, Chia-Wei; Ma, Hwong-wen

2010-01-01

Over the past two decades, the waste reduction problem has been a major issue in environmental protection. Both recycling and waste reduction policies have become increasingly important. As the complexity of decision-making has increased, it has become evident that more factors must be considered in the development and implementation of policies aimed at resource recycling and waste reduction. There are many studies focused on waste management excluding waste reduction. This study paid more attention to waste reduction. Social, economic, and management aspects of waste treatment policies were considered in this study. Further, a life-cycle assessment model was applied as an evaluation system for the environmental aspect. Results of both quantitative and qualitative analyses on the social, economic, and management aspects were integrated via the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method into the comprehensive decision-making support system of multi-criteria decision-making (MCDM). A case study evaluating the waste reduction policy in Taoyuan County is presented to demonstrate the feasibility of this model. In the case study, reinforcement of MSW sorting was shown to be the best practice. The model in this study can be applied to other cities faced with the waste reduction problems.

'Sometimes people let love conquer them': how love, intimacy, and trust in relationships between men who have sex with men influence perceptions of sexual risk and sexual decision-making.

PubMed

Goldenberg, Tamar; Finneran, Catherine; Andes, Karen L; Stephenson, Rob

2015-01-01

Men who have sex with men account for a disproportionate burden of HIV incidence in the USA. Although much research has examined the drivers of sexual risk-taking, the emotional contexts in which men make sexual decisions has received little attention. In this three-phase, 10-week longitudinal qualitative study involving 25 gay and bisexual men, we used timeline-based interviews and quantitative web-based diaries about sexual and/or dating partners to examine how emotions influence HIV risk perceptions and sexual decision-making. Participants described love, intimacy, and trust as reducing HIV risk perceptions and facilitating engagement in condomless anal intercourse. Lust was not as linked with risk perceptions, but facilitated non condom-use through an increased willingness to engage in condomless anal intercourse, despite perceptions of risk. Results indicate that gay and bisexual men do not make sexual decisions in an emotional vacuum. Emotions influence perceptions of risk so that they do not necessarily align with biological risk factors. Emotional influences, especially the type and context of emotions, are important to consider to improve HIV prevention efforts among gay and bisexual men.

QEEG-based neural correlates of decision making in a well-trained eight year-old chess player.

PubMed

Alipour, Abolfazl; Seifzadeh, Sahar; Aligholi, Hadi; Nami, Mohammad

2017-10-25

The neurocognitive substrates of decision making (DM) in the context of chess has appealed to researchers' interest for decades. Expert and beginner chess players are hypothesized to employ different brain functional networks when involved in episodes of critical DM upon chess. Cognitive capacities including, but not restricted to pattern recognition, visuospatial search, reasoning, planning and DM are perhaps the key determinants of rewarding and judgmental decisions in chess. Meanwhile, the precise neural correlates of DM in this context has largely remained elusive. The quantitative electroencephalography (QEEG) is an investigation tool possessing a proper temporal resolution in the study of neural correlates of cognitive tasks at cortical level. Here, we used a 22-channel EEG setup and digital polygraphy in a well-trained 8 year-old boy while engaged in playing chess against the computer. Quantitative analyses were done to map and source-localize the EEG signals. Our analyses indicated a lower power spectral density (PSD) for higher frequency bands in the right hemisphere upon DM-related epochs. Moreover, the information flow upon DM blocks in this particular case was more of posterior towards anterior brain regions.

What is the impact of the Internet on decision-making in pregnancy? A global study.

PubMed

Lagan, Briege M; Sinclair, Marlene; Kernohan, W George

2011-12-01

  Women need access to evidence-based information to make informed choices in pregnancy. A search for health information is one of the major reasons that people worldwide access the Internet. Recent years have witnessed an increase in Internet usage by women seeking pregnancy-related information. The aim of this study was to build on previous quantitative studies to explore women's experiences and perceptions of using the Internet for retrieving pregnancy-related information, and its influence on their decision-making processes.   This global study drew on the interpretive qualitative traditions together with a theoretical model on information seeking, adapted to understand Internet use in pregnancy and its role in relation to decision-making. Thirteen asynchronous online focus groups across five countries were conducted with 92 women who had accessed the Internet for pregnancy-related information over a 3-month period. Data were readily transferred and analyzed deductively.   The overall analysis indicates that the Internet is having a visible impact on women's decision making in regards to all aspects of their pregnancy. The key emergent theme was the great need for information. Four broad themes also emerged: "validate information,"empowerment,"share experiences," and "assisted decision-making." Women also reported how the Internet provided support, its negative and positive aspects, and as a source of accurate, timely information.   Health professionals have a responsibility to acknowledge that women access the Internet for support and pregnancy-related information to assist in their decision-making. Health professionals must learn to work in partnership with women to guide them toward evidence-based websites and be prepared to discuss the ensuing information. © 2011, Copyright the Authors. Journal compilation © 2011, Wiley Periodicals, Inc.

Design for sustainability of industrial symbiosis based on emergy and multi-objective particle swarm optimization.

PubMed

Ren, Jingzheng; Liang, Hanwei; Dong, Liang; Sun, Lu; Gao, Zhiqiu

2016-08-15

Industrial symbiosis provides novel and practical pathway to the design for the sustainability. Decision support tool for its verification is necessary for practitioners and policy makers, while to date, quantitative research is limited. The objective of this work is to present an innovative approach for supporting decision-making in the design for the sustainability with the implementation of industrial symbiosis in chemical complex. Through incorporating the emergy theory, the model is formulated as a multi-objective approach that can optimize both the economic benefit and sustainable performance of the integrated industrial system. A set of emergy based evaluation index are designed. Multi-objective Particle Swarm Algorithm is proposed to solve the model, and the decision-makers are allowed to choose the suitable solutions form the Pareto solutions. An illustrative case has been studied by the proposed method, a few of compromises between high profitability and high sustainability can be obtained for the decision-makers/stakeholders to make decision. Copyright © 2016 Elsevier B.V. All rights reserved.

The Sexual Stratification Hypothesis: Is the Decision to Arrest Influenced by the Victim/Suspect Racial/Ethnic Dyad?

PubMed

O'Neal, Eryn Nicole; Beckman, Laura O; Spohn, Cassia

2016-05-24

The sexual stratification hypothesis suggests that criminal justice responses to sexual victimization will differ depending on the victim/suspect racial/ethnic dyad. Previous research examining the sexual stratification hypothesis has primarily focused on court processes, and the small body of literature examining arrest decisions is dated. There remains substantial opportunity for testing the sexual stratification hypothesis at response stages apart from the court level (i.e., arrest). Using quantitative data on 655 sexual assault complaints that were reported to the Los Angeles County Sherriff's Department (LASD) and the Los Angeles Police Department (LAPD) in 2008, this study examines the effect of the victim/suspect racial/ethnic dyad on the decision to arrest. Findings suggest that police consider the victim/suspect racial/ethnic dyad when making arrest decisions. In addition, victim characteristics, strength of evidence indicators, and measures of case factors predict the police decision to make an arrest. © The Author(s) 2016.

Quantitation without Calibration: Response Profile as an Indicator of Target Amount.

PubMed

Debnath, Mrittika; Farace, Jessica M; Johnson, Kristopher D; Nesterova, Irina V

2018-06-21

Quantitative assessment of biomarkers is essential in numerous contexts from decision-making in clinical situations to food quality monitoring to interpretation of life-science research findings. However, appropriate quantitation techniques are not as widely addressed as detection methods. One of the major challenges in biomarker's quantitation is the need to have a calibration for correlating a measured signal to a target amount. The step complicates the methodologies and makes them less sustainable. In this work we address the issue via a new strategy: relying on position of response profile rather than on an absolute signal value for assessment of a target's amount. In order to enable the capability we develop a target-probe binding mechanism based on a negative cooperativity effect. A proof-of-concept example demonstrates that the model is suitable for quantitative analysis of nucleic acids over a wide concentration range. The general principles of the platform will be applicable toward a variety of biomarkers such as nucleic acids, proteins, peptides, and others.

The Development and Validation of a Generic Instrument, QoDoS, for Assessing the Quality of Decision Making.

PubMed

Donelan, Ronan; Walker, Stuart; Salek, Sam

2016-01-01

The impact of decision-making during the development and the regulatory review of medicines greatly influences the delivery of new medicinal products. Currently, there is no generic instrument that can be used to assess the quality of decision-making. This study describes the development of the Quality of Decision-Making Orientation Scheme QoDoS(©) instrument for appraising the quality of decision-making. Semi-structured interviews about decision-making were carried out with 29 senior decision makers from the pharmaceutical industry (10), regulatory authorities (9) and contract research organizations (10). The interviews offered a qualified understanding of the subjective decision-making approach, influences, behaviors and other factors that impact such processes for individuals and organizations involved in the delivery of new medicines. Thematic analysis of the transcribed interviews was carried out using NVivo8® software. Content validity was carried out using qualitative and quantitative data by an expert panel, which led to the developmental version of the QoDoS. Further psychometric evaluations were performed, including factor analysis, item reduction, reliability testing and construct validation. The thematic analysis of the interviews yielded a 94-item initial version of the QoDoS(©) with a 5-point Likert scale. The instrument was tested for content validity using a panel of experts for language clarity, completeness, relevance and scaling, resulting in a favorable agreement by panel members with an intra-class correlation coefficient value of 0.89 (95% confidence interval = 0.56, 0.99). A 76-item QoDoS(©) (version 2) emerged from content validation. Factor analysis produced a 47-item measure with four domains. The 47-item QoDoS(©) (version 3) showed high internal consistency (n = 120, Cronbach's alpha = 0.89), high reproducibility (n = 20, intra-class correlation = 0.77) and a mean completion time of 10 min. Reliability testing and construct validation was successfully performed. The QoDoS(©) is both reliable and valid for use. It has the potential for extensive use in medicines development by both the pharmaceutical industry and regulatory authorities. The QoDoS(©) can be used to assess the quality of decision-making and to inform decision makers of the factors that influence decision-making.

Study protocol: DEcisions in health Care to Introduce or Diffuse innovations using Evidence (DECIDE).

PubMed

Turner, Simon; Morris, Stephen; Sheringham, Jessica; Hudson, Emma; Fulop, Naomi J

2016-04-05

A range of evidence informs healthcare decision-making, from formal research findings to 'soft intelligence' or local data, as well as practical experience or tacit knowledge. However, cultural and organisational factors often prevent the translation of such evidence into practice. Using a multi-level framework, this project will analyse how interactions between the evidence available and processes at the micro (individual/group) and meso (organisational/system) levels influence decisions to introduce or diffuse innovations in acute and primary care within the National Health Service in the UK. This study will use a mixed methods design, combining qualitative and quantitative methods, and involves four interdependent work streams: (1) rapid evidence synthesis of relevant literature with stakeholder feedback; (2) in-depth case studies of 'real-world' decision-making in acute and primary care; (3) a national survey and discrete choice experiment; and (4) development of guidance for decision-makers and evaluators to support the use of evidence in decision-making. This study will enhance the understanding of decision-makers' use of diverse forms of evidence. The findings will provide insights into how and why some evidence does inform decisions to introduce healthcare innovations, and why barriers persist in other cases. It will also quantify decision-makers' preferences, including the 'tipping point' of evidence needed to shift stakeholders' views. Practical guidance will be shared with healthcare decision-makers and evaluators on uses of evidence to enable the introduction and diffusion of innovation.

Quantitative light-induced fluorescence (QLF): a tool for early occlusal dental caries detection and supporting decision making in vivo.

PubMed

Alammari, M R; Smith, P W; de Josselin de Jong, E; Higham, S M

2013-02-01

This study reports the development and assessment of a novel method using quantitative light-induced fluorescence (QLF), to determine whether QLF parameters ΔF and ΔQ were appropriate for aiding diagnosis and clinical decision making of early occlusal mineral loss by comparing QLF analysis with actual restorative management. Following ethical approval, 46 subjects attending a dental teaching hospital were enrolled. White light digital (WL) and QLF images/analyses of 46 unrestored posterior teeth with suspected occlusal caries were made after a clinical decision had already been taken to explore fissures operatively. WL and QLF imaging/analysis were repeated after initial cavity preparation. The type of restorative treatment was determined by the supervising clinician independent of any imaging performed. Actual restorative management carried out was recorded as fissure sealant/preventive resin restoration (F/P) or class I occlusal restoration (Rest.) thus reflecting the extent of intervention (=gold standard). All QLF images were analysed independently. The results showed statistically significant differences between the two treatment groups ΔF (p=0.002) (mean 22.60 - F/P and 28.80 - Rest.) and ΔQ (p=0.012) (mean 230.49 - F/P and 348.30 - Rest.). ΔF and ΔQ values may be useful in aiding clinical diagnosis and decision making in relation to the management of early mineral loss and restorative intervention of occlusal caries. QLF has the potential to be a valuable tool for caries diagnosis in clinical practice. Copyright © 2012 Elsevier Ltd. All rights reserved.

Applying Quantitative Approaches to the Formative Evaluation of Antismoking Campaign Messages

PubMed Central

Parvanta, Sarah; Gibson, Laura; Forquer, Heather; Shapiro-Luft, Dina; Dean, Lorraine; Freres, Derek; Lerman, Caryn; Mallya, Giridhar; Moldovan-Johnson, Mihaela; Tan, Andy; Cappella, Joseph; Hornik, Robert

2014-01-01

This article shares an in-depth summary of a formative evaluation that used quantitative data to inform the development and selection of promotional ads for the antismoking communication component of a social marketing campaign. A foundational survey provided cross-sectional data to identify beliefs about quitting smoking that campaign messages should target, as well as beliefs to avoid. Pretesting draft ads against quantitative indicators of message effectiveness further facilitated the selection and rejection of final campaign ads. Finally, we consider lessons learned from the process of balancing quantitative methods and judgment to make formative decisions about more and less promising persuasive messages for campaigns. PMID:24817829

The integration of quantitative information with an intelligent decision support system for residential energy retrofits

NASA Astrophysics Data System (ADS)

Mo, Yunjeong

The purpose of this research is to support the development of an intelligent Decision Support System (DSS) by integrating quantitative information with expert knowledge in order to facilitate effective retrofit decision-making. To achieve this goal, the Energy Retrofit Decision Process Framework is analyzed. Expert system shell software, a retrofit measure cost database, and energy simulation software are needed for developing the DSS; Exsys Corvid, the NREM database and BEopt were chosen for implementing an integration model. This integration model demonstrates the holistic function of a residential energy retrofit system for existing homes, by providing a prioritized list of retrofit measures with cost information, energy simulation and expert advice. The users, such as homeowners and energy auditors, can acquire all of the necessary retrofit information from this unified system without having to explore several separate systems. The integration model plays the role of a prototype for the finalized intelligent decision support system. It implements all of the necessary functions for the finalized DSS, including integration of the database, energy simulation and expert knowledge.

Focus Groups in Elderly Ophthalmologic Patients: Setting the Stage for Quantitative Preference Elicitation.

PubMed

Danner, Marion; Vennedey, Vera; Hiligsmann, Mickaël; Fauser, Sascha; Stock, Stephanie

2016-02-01

Patients suffering from age-related macular degeneration (AMD) are rarely actively involved in decision-making, despite facing preference-sensitive treatment decisions. This paper presents a qualitative study to prepare quantitative preference elicitation in AMD patients. The aims of this study were (1) to gain familiarity with and learn about the special requirements of the AMD patient population for quantitative data collection; and (2) to select/refine patient-relevant treatment attributes and levels, and gain insights into preference structures. Semi-structured focus group interviews were performed. An interview guide including preselected categories in the form of seven potentially patient-relevant treatment attributes was followed. To identify the most patient-relevant treatment attributes, a ranking exercise was performed. Deductive content analyses were done by two independent reviewers for each attribute to derive subcategories (potential levels of attributes) and depict preference trends. The focus group interviews included 21 patients. The interviews revealed that quantitative preference surveys in this population will have to be interviewer assisted to make the survey feasible for patients. The five most patient-relevant attributes were the effect on visual function [ranking score (RS): 139], injection frequency (RS: 101), approval status (RS: 83), side effects (RS: 79), and monitoring frequency (RS: 76). Attribute and level refinement was based on patients' statements. Preference trends and dependencies between attributes informed the quantitative instrument design. This study suggests that qualitative research is a very helpful step to prepare the design and administration of quantitative preference elicitation instruments. It especially facilitated familiarization with the target population and its preferences, and it supported attribute/level refinement.

Guidance for Product Category Rule Development, Version 1.0

EPA Science Inventory

Environmental claims based on life cycle assessment (LCA) can provide quantitative, full life cycle information on products in a format that can permit comparisons and thereby inform purchasing decisions. In recent years, a number of standards and guides have emerged for making b...

Wake Vortex Systems Cost/Benefits Analysis

NASA Technical Reports Server (NTRS)

Crisp, Vicki K.

1997-01-01

The goals of cost/benefit assessments are to provide quantitative and qualitative data to aid in the decision-making process. Benefits derived from increased throughput (or decreased delays) used to balance life-cycle costs. Packaging technologies together may provide greater gains (demonstrate higher return on investment).

Patient expectations of treatment for back pain: a systematic review of qualitative and quantitative studies.

PubMed

Verbeek, Jos; Sengers, Marie-José; Riemens, Linda; Haafkens, Joke

2004-10-15

A systematic review of qualitative and quantitative studies. To summarize evidence from studies among patients with low back pain on their expectations and satisfaction with treatment as part of practice guideline development. Patients are often dissatisfied with treatment for acute or chronic back pain. We searched the literature for studies on patient expectations and satisfaction with treatment for low back pain. Treatment aspects related to expectations or satisfaction were identified in qualitative studies. Percentages of dissatisfied patients were calculated from quantitative studies. Twelve qualitative and eight quantitative studies were found. Qualitative studies revealed the following aspects that patient expectation from treatment for back pain or with which they are dissatisfied. Patients want a clear diagnosis of the cause of their pain, information and instructions, pain relief, and a physical examination. Next, expectations are that there are more diagnostic tests, other therapy or referrals to specialists, and sickness certification. They expect confirmation from the healthcare provider that their pain is real. Like other patients, they want a confidence-based association that includes understanding, listening, respect, and being included in decision-making. The results from qualitative studies are confirmed by quantitative studies. Patients have explicit expectations on diagnosis, instructions, and interpersonal management. New strategies need to be developed in order to meet patients' expectations better. Practice guidelines should pay more attention to the best way of discussing the causes and diagnosis with the patient and should involve them in the decision-making process.

A quantitative benefit-risk assessment approach to improve decision making in drug development: Application of a multicriteria decision analysis model in the development of combination therapy for overactive bladder.

PubMed

de Greef-van der Sandt, I; Newgreen, D; Schaddelee, M; Dorrepaal, C; Martina, R; Ridder, A; van Maanen, R

2016-04-01

A multicriteria decision analysis (MCDA) approach was developed and used to estimate the benefit-risk of solifenacin and mirabegron and their combination in the treatment of overactive bladder (OAB). The objectives were 1) to develop an MCDA tool to compare drug effects in OAB quantitatively, 2) to establish transparency in the evaluation of the benefit-risk profile of various dose combinations, and 3) to quantify the added value of combination use compared to monotherapies. The MCDA model was developed using efficacy, safety, and tolerability attributes and the results of a phase II factorial design combination study were evaluated. Combinations of solifenacin 5 mg and mirabegron 25 mg and mirabegron 50 (5+25 and 5+50) scored the highest clinical utility and supported combination therapy development of solifenacin and mirabegron for phase III clinical development at these dose regimens. This case study underlines the benefit of using a quantitative approach in clinical drug development programs. © 2015 The American Society for Clinical Pharmacology and Therapeutics.

An integrated theory of attention and decision making in visual signal detection.

PubMed

Smith, Philip L; Ratcliff, Roger

2009-04-01

The simplest attentional task, detecting a cued stimulus in an otherwise empty visual field, produces complex patterns of performance. Attentional cues interact with backward masks and with spatial uncertainty, and there is a dissociation in the effects of these variables on accuracy and on response time. A computational theory of performance in this task is described. The theory links visual encoding, masking, spatial attention, visual short-term memory (VSTM), and perceptual decision making in an integrated dynamic framework. The theory assumes that decisions are made by a diffusion process driven by a neurally plausible, shunting VSTM. The VSTM trace encodes the transient outputs of early visual filters in a durable form that is preserved for the time needed to make a decision. Attention increases the efficiency of VSTM encoding, either by increasing the rate of trace formation or by reducing the delay before trace formation begins. The theory provides a detailed, quantitative account of attentional effects in spatial cuing tasks at the level of response accuracy and the response time distributions. (c) 2009 APA, all rights reserved

The Mother’s Autonomy in Decision Making (MADM) scale: Patient-led development and psychometric testing of a new instrument to evaluate experience of maternity care

PubMed Central

Vedam, Saraswathi; Stoll, Kathrin; Martin, Kelsey; Rubashkin, Nicholas; Partridge, Sarah; Thordarson, Dana; Jolicoeur, Ganga

2017-01-01

Shared decision making (SDM) is core to person-centered care and is associated with improved health outcomes. Despite this, there are no validated scales measuring women’s agency and ability to lead decision making during maternity care. Objective To develop and validate a new instrument that assesses women’s autonomy and role in decision making during maternity care. Design Through a community-based participatory research process, service users designed, content validated, and administered a cross-sectional quantitative survey, including 31 items on the experience of decision-making. Setting and participants Pregnancy experiences (n = 2514) were reported by 1672 women who saw a single type of primary maternity care provider in British Columbia. They described care by a midwife, family physician or obstetrician during 1, 2 or 3 maternity care cycles. We conducted psychometric testing in three separate samples. Main outcome measures We assessed reliability, item-to-total correlations, and the factor structure of the The Mothers’ Autonomy in Decision Making (MADM) scale. We report MADM scores by care provider type, length of prenatal appointments, preferences for role in decision-making, and satisfaction with experience of decision-making. Results The MADM scale measures a single construct: autonomy in decision-making during maternity care. Cronbach alphas for the scale exceeded 0.90 for all samples and all provider groups. All item-to-total correlations were replicable across three samples and exceeded 0.7. Eigenvalue and scree plots exhibited a clear 90-degree angle, and factor analysis generated a one factor scale. MADM median scores were highest among women who were cared for by midwives, and 10 or more points lower for those who saw physicians. Increased time for prenatal appointments was associated with higher scale scores, and there were significant differences between providers with respect to average time spent in prenatal appointments. Midwifery care was associated with higher MADM scores, even during short prenatal appointments (<15 minutes). Among women who preferred to lead decisions around their care (90.8%), and who were dissatisfied with their experience of decision making, MADM scores were very low (median 14). Women with physician carers were consistently more likely to report dissatisfaction with their involvement in decision making. Discussion The Mothers Autonomy in Decision Making (MADM) scale is a reliable instrument for assessment of the experience of decision making during maternity care. This new scale was developed and content validated by community members representing various populations of childbearing women in BC including women from vulnerable populations. MADM measures women’s ability to lead decision making, whether they are given enough time to consider their options, and whether their choices are respected. Women who experienced midwifery care reported greater autonomy than women under physician care, when engaging in decision-making around maternity care options. Differences in models of care, professional education, regulatory standards, and compensation for prenatal visits between midwives and physicians likely affect the time available for these discussions and prioritization of a shared decision making process. Conclusion The MADM scale reflects person-driven priorities, and reliably assesses interactions with maternity providers related to a person’s ability to lead decision-making over the course of maternity care. PMID:28231285

What Is True Halving in the Payoff Matrix of Game Theory?

PubMed Central

Hasegawa, Eisuke; Yoshimura, Jin

2016-01-01

In game theory, there are two social interpretations of rewards (payoffs) for decision-making strategies: (1) the interpretation based on the utility criterion derived from expected utility theory and (2) the interpretation based on the quantitative criterion (amount of gain) derived from validity in the empirical context. A dynamic decision theory has recently been developed in which dynamic utility is a conditional (state) variable that is a function of the current wealth of a decision maker. We applied dynamic utility to the equal division in dove-dove contests in the hawk-dove game. Our results indicate that under the utility criterion, the half-share of utility becomes proportional to a player’s current wealth. Our results are consistent with studies of the sense of fairness in animals, which indicate that the quantitative criterion has greater validity than the utility criterion. We also find that traditional analyses of repeated games must be reevaluated. PMID:27487194

What Is True Halving in the Payoff Matrix of Game Theory?

PubMed

Ito, Hiromu; Katsumata, Yuki; Hasegawa, Eisuke; Yoshimura, Jin

2016-01-01

In game theory, there are two social interpretations of rewards (payoffs) for decision-making strategies: (1) the interpretation based on the utility criterion derived from expected utility theory and (2) the interpretation based on the quantitative criterion (amount of gain) derived from validity in the empirical context. A dynamic decision theory has recently been developed in which dynamic utility is a conditional (state) variable that is a function of the current wealth of a decision maker. We applied dynamic utility to the equal division in dove-dove contests in the hawk-dove game. Our results indicate that under the utility criterion, the half-share of utility becomes proportional to a player's current wealth. Our results are consistent with studies of the sense of fairness in animals, which indicate that the quantitative criterion has greater validity than the utility criterion. We also find that traditional analyses of repeated games must be reevaluated.

When is enough evidence enough? - Using systematic decision analysis and value-of-information analysis to determine the need for further evidence.

PubMed

Siebert, Uwe; Rochau, Ursula; Claxton, Karl

2013-01-01

Decision analysis (DA) and value-of-information (VOI) analysis provide a systematic, quantitative methodological framework that explicitly considers the uncertainty surrounding the currently available evidence to guide healthcare decisions. In medical decision making under uncertainty, there are two fundamental questions: 1) What decision should be made now given the best available evidence (and its uncertainty)?; 2) Subsequent to the current decision and given the magnitude of the remaining uncertainty, should we gather further evidence (i.e., perform additional studies), and if yes, which studies should be undertaken (e.g., efficacy, side effects, quality of life, costs), and what sample sizes are needed? Using the currently best available evidence, VoI analysis focuses on the likelihood of making a wrong decision if the new intervention is adopted. The value of performing further studies and gathering additional evidence is based on the extent to which the additional information will reduce this uncertainty. A quantitative framework allows for the valuation of the additional information that is generated by further research, and considers the decision maker's objectives and resource constraints. Claxton et al. summarise: "Value of information analysis can be used to inform a range of policy questions including whether a new technology should be approved based on existing evidence, whether it should be approved but additional research conducted or whether approval should be withheld until the additional evidence becomes available." [Claxton K. Value of information entry in Encyclopaedia of Health Economics, Elsevier, forthcoming 2014.] The purpose of this tutorial is to introduce the framework of systematic VoI analysis to guide further research. In our tutorial article, we explain the theoretical foundations and practical methods of decision analysis and value-of-information analysis. To illustrate, we use a simple case example of a foot ulcer (e.g., with diabetes) as well as key references from the literature, including examples for the use of the decision-analytic VoI framework by health technology assessment agencies to guide further research. These concepts may guide stakeholders involved or interested in how to determine whether or not and, if so, which additional evidence is needed to make decisions. Copyright © 2013. Published by Elsevier GmbH.

The drift diffusion model as the choice rule in reinforcement learning.

PubMed

Pedersen, Mads Lund; Frank, Michael J; Biele, Guido

2017-08-01

Current reinforcement-learning models often assume simplified decision processes that do not fully reflect the dynamic complexities of choice processes. Conversely, sequential-sampling models of decision making account for both choice accuracy and response time, but assume that decisions are based on static decision values. To combine these two computational models of decision making and learning, we implemented reinforcement-learning models in which the drift diffusion model describes the choice process, thereby capturing both within- and across-trial dynamics. To exemplify the utility of this approach, we quantitatively fit data from a common reinforcement-learning paradigm using hierarchical Bayesian parameter estimation, and compared model variants to determine whether they could capture the effects of stimulant medication in adult patients with attention-deficit hyperactivity disorder (ADHD). The model with the best relative fit provided a good description of the learning process, choices, and response times. A parameter recovery experiment showed that the hierarchical Bayesian modeling approach enabled accurate estimation of the model parameters. The model approach described here, using simultaneous estimation of reinforcement-learning and drift diffusion model parameters, shows promise for revealing new insights into the cognitive and neural mechanisms of learning and decision making, as well as the alteration of such processes in clinical groups.

The drift diffusion model as the choice rule in reinforcement learning

PubMed Central

Frank, Michael J.

2017-01-01

Current reinforcement-learning models often assume simplified decision processes that do not fully reflect the dynamic complexities of choice processes. Conversely, sequential-sampling models of decision making account for both choice accuracy and response time, but assume that decisions are based on static decision values. To combine these two computational models of decision making and learning, we implemented reinforcement-learning models in which the drift diffusion model describes the choice process, thereby capturing both within- and across-trial dynamics. To exemplify the utility of this approach, we quantitatively fit data from a common reinforcement-learning paradigm using hierarchical Bayesian parameter estimation, and compared model variants to determine whether they could capture the effects of stimulant medication in adult patients with attention-deficit hyper-activity disorder (ADHD). The model with the best relative fit provided a good description of the learning process, choices, and response times. A parameter recovery experiment showed that the hierarchical Bayesian modeling approach enabled accurate estimation of the model parameters. The model approach described here, using simultaneous estimation of reinforcement-learning and drift diffusion model parameters, shows promise for revealing new insights into the cognitive and neural mechanisms of learning and decision making, as well as the alteration of such processes in clinical groups. PMID:27966103

Development of a decision aid for energy resource management for the Navajo Nation incorporating environmental cultural values

NASA Astrophysics Data System (ADS)

Necefer, Len Edward

Decision-making surrounding pathways of future energy resource management are complexity and requires balancing tradeoffs of multiple environmental, social, economic, and technical outcomes. Technical decision aid can provide a framework for informed decision making, allowing individuals to better understand the tradeoff between resources, technology, energy services, and prices. While technical decision aid have made significant advances in evaluating these quantitative aspects of energy planning and performance, they have not been designed to incorporate human factors, such as preferences and behavior that are informed by cultural values. Incorporating cultural values into decision tools can provide not only an improved decision framework for the Navajo Nation, but also generate new insights on how these perspective can improve decision making on energy resources. Ensuring these aids are a cultural fit for each context has the potential to increase trust and promote understanding of the tradeoffs involved in energy resource management. In this dissertation I present the development of a technical tool that explicitly addresses cultural and spiritual values and experimentally assesses their influence on the preferences and decision making of Navajo citizens. Chapter 2 describes the results of a public elicitation effort to gather information about stakeholder views and concerns related to energy development in the Navajo Nation in order to develop a larger sample survey and a decision-support tool that links techno-economic energy models with sociocultural attributes. Chapter 3 details the methods of developing the energy decision aid and its underlying assumptions for alternative energy projects and their impacts. This tool also provides an alternative to economic valuation of cultural impacts based upon an ordinal index tied to environmental impacts. Chapter 4 details the the influence of various cultural, environmental, and economic outcome information provided through the developed decision aid on beliefs and preferences related to the type and scale of energy development, trust of decision makers, and larger concern for environmental protection. Finally, chapter 5 presents concluding thoughts future research and on how technical-social decision tools can provide a means ensuring effective decision making on the Navajo Nation and other American Indian communities.

Adapting to Uncertainty: Comparing Methodological Approaches to Climate Adaptation and Mitigation Policy

NASA Astrophysics Data System (ADS)

Huda, J.; Kauneckis, D. L.

2013-12-01

Climate change adaptation represents a number of unique policy-making challenges. Foremost among these is dealing with the range of future climate impacts to a wide scope of inter-related natural systems, their interaction with social and economic systems, and uncertainty resulting from the variety of downscaled climate model scenarios and climate science projections. These cascades of uncertainty have led to a number of new approaches as well as a reexamination of traditional methods for evaluating risk and uncertainty in policy-making. Policy makers are required to make decisions and formulate policy irrespective of the level of uncertainty involved and while a debate continues regarding the level of scientific certainty required in order to make a decision, incremental change in the climate policy continues at multiple governance levels. This project conducts a comparative analysis of the range of methodological approaches that are evolving to address uncertainty in climate change policy. It defines 'methodologies' to include a variety of quantitative and qualitative approaches involving both top-down and bottom-up policy processes that attempt to enable policymakers to synthesize climate information into the policy process. The analysis examines methodological approaches to decision-making in climate policy based on criteria such as sources of policy choice information, sectors to which the methodology has been applied, sources from which climate projections were derived, quantitative and qualitative methods used to deal with uncertainty, and the benefits and limitations of each. A typology is developed to better categorize the variety of approaches and methods, examine the scope of policy activities they are best suited for, and highlight areas for future research and development.

A Decision Support System for Concrete Bridge Maintenance

NASA Astrophysics Data System (ADS)

Rashidi, Maria; Lemass, Brett; Gibson, Peter

2010-05-01

The maintenance of bridges as a key element in transportation infrastructure has become a major concern for asset managers and society due to increasing traffic volumes, deterioration of existing bridges and well-publicised bridge failures. A pivotal responsibility for asset managers in charge of bridge remediation is to identify the risks and assess the consequences of remediation programs to ensure that the decisions are transparent and lead to the lowest predicted losses in recognized constraint areas. The ranking of bridge remediation treatments can be quantitatively assessed using a weighted constraint approach to structure the otherwise ill-structured phases of problem definition, conceptualization and embodiment [1]. This Decision Support System helps asset managers in making the best decision with regards to financial limitations and other dominant constraints imposed upon the problem at hand. The risk management framework in this paper deals with the development of a quantitative intelligent decision support system for bridge maintenance which has the ability to provide a source for consistent decisions through selecting appropriate remediation treatments based upon cost, service life, product durability/sustainability, client preferences, legal and environmental constraints. Model verification and validation through industry case studies is ongoing.

Ignorance is not bliss: Statistical power is not probability of trial success.

PubMed

Zierhut, M L; Bycott, P; Gibbs, M A; Smith, B P; Vicini, P

2016-04-01

The purpose of this commentary is to place probability of trial success, or assurance, in the context of decision making in drug development, and to illustrate its properties in an intuitive manner for the readers of Clinical Pharmacology and Therapeutics. The hope is that this will stimulate a dialog on how assurance should be incorporated into a quantitative decision approach for clinical development and trial design that uses all available information. © 2015 ASCPT.

TIES for Dummies 3rd Edition (Technology Identification, Evaluation, and Selection) Basic how to's to implement the TIES method

NASA Technical Reports Server (NTRS)

Kirby, Michelle R.

2002-01-01

The TIES method is a forecasting environment whereby the decision-maker has the ability to easily assess and trade-off the impact of various technologies without sophisticated and time-consuming mathematical formulations. TIES provides a methodical approach where technically feasible alternatives can be identified with accuracy and speed to reduce design cycle time, and subsequently, life cycle costs, and was achieved through the use of various probabilistic methods, such as Response Surface Methodology and Monte Carlo Simulations. Furthermore, structured and systematic techniques are utilized from other fields to identify possible concepts and evaluation criteria by which comparisons can be made. This objective is achieved by employing the use of Morphological Matrices and Multi-Attribute Decision Making techniques. Through the execution of each step, a family of design alternatives for a given set of customer requirements can be identified and assessed subjectively or objectively. This methodology allows for more information (knowledge) to be brought into the earlier phases of the design process and will have direct implications on the affordability of the system. The increased knowledge allows for optimum allocation of company resources and quantitative justification for program decisions. Finally, the TIES method provided novel results and quantitative justification to facilitate decision making in the early stages of design so as to produce affordable and quality products.

Benefits and limitations of using decision analytic tools to assess uncertainty and prioritize Landscape Conservation Cooperative information needs

USGS Publications Warehouse

Post van der Burg, Max; Cullinane Thomas, Catherine; Holcombe, Tracy R.; Nelson, Richard D.

2016-01-01

The Landscape Conservation Cooperatives (LCCs) are a network of partnerships throughout North America that are tasked with integrating science and management to support more effective delivery of conservation at a landscape scale. In order to achieve this integration, some LCCs have adopted the approach of providing their partners with better scientific information in an effort to facilitate more effective and coordinated conservation decisions. Taking this approach has led many LCCs to begin funding research to provide the information for improved decision making. To ensure that funding goes to research projects with the highest likelihood of leading to more integrated broad scale conservation, some LCCs have also developed approaches for prioritizing which information needs will be of most benefit to their partnerships. We describe two case studies in which decision analytic tools were used to quantitatively assess the relative importance of information for decisions made by partners in the Plains and Prairie Potholes LCC. The results of the case studies point toward a few valuable lessons in terms of using these tools with LCCs. Decision analytic tools tend to help shift focus away from research oriented discussions and toward discussions about how information is used in making better decisions. However, many technical experts do not have enough knowledge about decision making contexts to fully inform the latter type of discussion. When assessed in the right decision context, however, decision analyses can point out where uncertainties actually affect optimal decisions and where they do not. This helps technical experts understand that not all research is valuable in improving decision making. But perhaps most importantly, our results suggest that decision analytic tools may be more useful for LCCs as way of developing integrated objectives for coordinating partner decisions across the landscape, rather than simply ranking research priorities.

78 FR 69839 - Building Technologies Office Prioritization Tool

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-21

... innovative and cost-effective energy saving solutions: Supporting research and development of high impact... Description The tool was designed to inform programmatic decision-making and facilitate the setting of... quantitative analysis to assure only the highest impact measures are the focus of further effort. The approach...

Effective implementation of ground penetrating radar (GPR) for condition assessment & monitoring of critical infrastructure components of bridges and highways.

DOT National Transportation Integrated Search

2015-01-01

Recently Maryland State Highway Administration (SHA) started to explore use of Ground Penetrating Radar : (GPR) technology to provide quantitative information for improved decision making and reduced operating : costs. To take full advantage of the G...

Compromise Programming in forest management

Treesearch

Boris A. Poff; Aregai Tecle; Daniel G. Neary; Brian Geils

2010-01-01

Multi-objective decision-making (MODM) is an appropriate approach for evaluating a forest management scenario involving multiple interests. Today's land managers must accommodate commercial as well as non-commercial objectives that may be expressed quantitatively and/or qualitatively, and respond to social, political, economic and cultural changes. The spatial and...

Networked Resources, Assessment and Collection Development

ERIC Educational Resources Information Center

Samson, Sue; Derry, Sebastian; Eggleston, Holly

2004-01-01

This project provides a critical evaluation of networked resources as they relate to the library's collection development policy, identifies areas of the curriculum not well represented, establishes a reliable method of assessing usage across all resources, and develops a framework of quantitative data for collection development decision making.

Application of stakeholder-based and modelling approaches for supporting robust adaptation decision making under future climatic uncertainty and changing urban-agricultural water demand

NASA Astrophysics Data System (ADS)

Bhave, Ajay; Dessai, Suraje; Conway, Declan; Stainforth, David

2016-04-01

Deep uncertainty in future climate change and socio-economic conditions necessitates the use of assess-risk-of-policy approaches over predict-then-act approaches for adaptation decision making. Robust Decision Making (RDM) approaches embody this principle and help evaluate the ability of adaptation options to satisfy stakeholder preferences under wide-ranging future conditions. This study involves the simultaneous application of two RDM approaches; qualitative and quantitative, in the Cauvery River Basin in Karnataka (population ~23 million), India. The study aims to (a) determine robust water resources adaptation options for the 2030s and 2050s and (b) compare the usefulness of a qualitative stakeholder-driven approach with a quantitative modelling approach. For developing a large set of future scenarios a combination of climate narratives and socio-economic narratives was used. Using structured expert elicitation with a group of climate experts in the Indian Summer Monsoon, climatic narratives were developed. Socio-economic narratives were developed to reflect potential future urban and agricultural water demand. In the qualitative RDM approach, a stakeholder workshop helped elicit key vulnerabilities, water resources adaptation options and performance criteria for evaluating options. During a second workshop, stakeholders discussed and evaluated adaptation options against the performance criteria for a large number of scenarios of climatic and socio-economic change in the basin. In the quantitative RDM approach, a Water Evaluation And Planning (WEAP) model was forced by precipitation and evapotranspiration data, coherent with the climatic narratives, together with water demand data based on socio-economic narratives. We find that compared to business-as-usual conditions options addressing urban water demand satisfy performance criteria across scenarios and provide co-benefits like energy savings and reduction in groundwater depletion, while options reducing agricultural water demand significantly affect downstream water availability. Water demand options demonstrate potential to improve environmental flow conditions and satisfy legal water supply requirements for downstream riparian states. On the other hand, currently planned large scale infrastructural projects demonstrate reduced value in certain scenarios, illustrating the impacts of lock-in effects of large scale infrastructure. From a methodological perspective, we find that while the stakeholder-driven approach revealed robust options in a resource-light manner and helped initiate much needed interaction amongst stakeholders, the modelling approach provides complementary quantitative information. The study reveals robust adaptation options for this important basin and provides a strong methodological basis for carrying out future studies that support adaptation decision making.

Improving the Slum Planning Through Geospatial Decision Support System

NASA Astrophysics Data System (ADS)

Shekhar, S.

2014-11-01

In India, a number of schemes and programmes have been launched from time to time in order to promote integrated city development and to enable the slum dwellers to gain access to the basic services. Despite the use of geospatial technologies in planning, the local, state and central governments have only been partially successful in dealing with these problems. The study on existing policies and programmes also proved that when the government is the sole provider or mediator, GIS can become a tool of coercion rather than participatory decision-making. It has also been observed that local level administrators who have adopted Geospatial technology for local planning continue to base decision-making on existing political processes. In this juncture, geospatial decision support system (GSDSS) can provide a framework for integrating database management systems with analytical models, graphical display, tabular reporting capabilities and the expert knowledge of decision makers. This assists decision-makers to generate and evaluate alternative solutions to spatial problems. During this process, decision-makers undertake a process of decision research - producing a large number of possible decision alternatives and provide opportunities to involve the community in decision making. The objective is to help decision makers and planners to find solutions through a quantitative spatial evaluation and verification process. The study investigates the options for slum development in a formal framework of RAY (Rajiv Awas Yojana), an ambitious program of Indian Government for slum development. The software modules for realizing the GSDSS were developed using the ArcGIS and Community -VIZ software for Gulbarga city.

Decision-making process of patients with gynecological cancer regarding their cancer treatment choices using the analytic hierarchy process.

PubMed

Kitamura, Yuko

2010-12-01

In order to support patients' decision-making regarding cancer treatments, it is important to clarify which criteria that cancer patients use to set priorities in their treatment choices. Using the analytic hierarchy process (AHP), a mathematical decision-making method, this article investigates the criteria and the priorities of patients with gynecological cancer. In the AHP, multiple and hierarchical criteria in the decision-making process were organized by a repeated pairwise judgment of the participants so as to serialize the alternatives along with the rational order of the priorities. For the alternatives "to receive treatment" and "to not receive treatment," the following five criteria were set: "anxiety about relapse and metastasis", "distress about side-effects", "advice of family", "advice of medical staff", and "economic burden". The participants determined a pairwise priority scale, as well as a priority scale between the alternatives for every criterion. The logical consistency of their answers was checked by a consistency index (CI). The participants were 31 patients with ovarian or endometrial cancer who were being followed up after undergoing surgery and adjuvant chemotherapy. Of the participants who answered the questionnaire, 17 satisfied the logical consistency. Of the five criteria for the treatment choices, "anxiety about relapse and metastasis" and "advice of medical staff" were found to be the important factors for treatment choice; however, the weight attached to the priority criteria differed much among the patients. The AHP made it possible to support patients' decision-making in order to clarify their priority criteria and to quantitatively present their decision-making process. © 2010 The Author. Journal compilation © 2010 Japan Academy of Nursing Science.

The feminist approach in the decision-making process for treatment of women with breast cancer.

PubMed

Szumacher, Ewa

2006-09-01

The principal aim of this review was to investigate a feminist approach to the decision-making process for women with breast cancer. Empirical research into patient preferences for being informed about and participating in healthcare decisions has some limitations because it is mostly quantitative and designed within the dominant medical culture. Indigenous medical knowledge and alternative medical treatments are not widely accepted because of the lack of confirmed efficacy of such treatments in evidence-based literature. While discussing their treatment options with oncologists, women with breast cancer frequently express many concerns regarding treatment side effects, and sometimes decline conventional treatment when the risks are too high. A search of all relevant literary sources, including Pub-Med, ERIC, Medline, and the Ontario Institute for Studies in Education at the University of Toronto was conducted. The key words for selection of the articles were "feminism," "decision-making," "patients preferences for treatment," and "breast cancer." Fifty-one literary sources were selected. The review was divided into the following themes: (1) limitations of the patient decision-making process in conventional medicine; (2) participation of native North American patients in healthcare decisions; (3) towards a feminist approach to breast cancer; and (4) towards a feminist theory of breast cancer. This article discusses the importance of a feminist approach to the decision-making process for treatment of patients with breast cancer. As the literature suggests, the needs of minority patients are not completely fulfilled in Western medical culture. Introducing feminist theory into evidence-based medicine will help patients to be better informed about treatment choices and will assist them to select treatment according to their own beliefs and values.

Encapsulation of a Decision-Making Model to Optimize Supplier Selection via Structural Equation Modeling (SEM)

NASA Astrophysics Data System (ADS)

Sahul Hameed, Ruzanna; Thiruchelvam, Sivadass; Nasharuddin Mustapha, Kamal; Che Muda, Zakaria; Mat Husin, Norhayati; Ezanee Rusli, Mohd; Yong, Lee Choon; Ghazali, Azrul; Itam, Zarina; Hakimie, Hazlinda; Beddu, Salmia; Liyana Mohd Kamal, Nur

2016-03-01

This paper proposes a conceptual framework to compare criteria/factor that influence the supplier selection. A mixed methods approach comprising qualitative and quantitative survey will be used. The study intend to identify and define the metrics that key stakeholders at Public Works Department (PWD) believed should be used for supplier. The outcomes would foresee the possible initiatives to bring procurement in PWD to a strategic level. The results will provide a deeper understanding of drivers for supplier’s selection in the construction industry. The obtained output will benefit many parties involved in the supplier selection decision-making. The findings provides useful information and greater understanding of the perceptions that PWD executives hold regarding supplier selection and the extent to which these perceptions are consistent with findings from prior studies. The findings from this paper can be utilized as input for policy makers to outline any changes in the current procurement code of practice in order to enhance the degree of transparency and integrity in decision-making.

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

PubMed

Chapagain, Matrika

2005-02-01

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

Predicting long-term performance of engineered geologic carbon dioxide storage systems to inform decisions amidst uncertainty

NASA Astrophysics Data System (ADS)

Pawar, R.

2016-12-01

Risk assessment and risk management of engineered geologic CO2 storage systems is an area of active investigation. The potential geologic CO2 storage systems currently under consideration are inherently heterogeneous and have limited to no characterization data. Effective risk management decisions to ensure safe, long-term CO2 storage requires assessing and quantifying risks while taking into account the uncertainties in a storage site's characteristics. The key decisions are typically related to definition of area of review, effective monitoring strategy and monitoring duration, potential of leakage and associated impacts, etc. A quantitative methodology for predicting a sequestration site's long-term performance is critical for making key decisions necessary for successful deployment of commercial scale geologic storage projects where projects will require quantitative assessments of potential long-term liabilities. An integrated assessment modeling (IAM) paradigm which treats a geologic CO2 storage site as a system made up of various linked subsystems can be used to predict long-term performance. The subsystems include storage reservoir, seals, potential leakage pathways (such as wellbores, natural fractures/faults) and receptors (such as shallow groundwater aquifers). CO2 movement within each of the subsystems and resulting interactions are captured through reduced order models (ROMs). The ROMs capture the complex physical/chemical interactions resulting due to CO2 movement and interactions but are computationally extremely efficient. The computational efficiency allows for performing Monte Carlo simulations necessary for quantitative probabilistic risk assessment. We have used the IAM to predict long-term performance of geologic CO2 sequestration systems and to answer questions related to probability of leakage of CO2 through wellbores, impact of CO2/brine leakage into shallow aquifer, etc. Answers to such questions are critical in making key risk management decisions. A systematic uncertainty quantification approach can been used to understand how uncertain parameters associated with different subsystems (e.g., reservoir permeability, wellbore cement permeability, wellbore density, etc.) impact the overall site performance predictions.

Cognitive Mechanisms in Decision-Making in Patients With Mild Alzheimer Disease.

PubMed

Alameda-Bailen, Jose Ramon; Salguero-Alcaniz, Maria Pilar; Merchan-Clavellino, Ana; Paino-Quesada, Susana

2017-01-01

Alzheimer's dementia is characterized by significant cortical and subcortical atrophy, causing diverse neuropsychological deficits. According to the somatic marker hypothesis, the areas responsible for generating the somatic markers that anticipate the consequences of a decision and thereby optimize the process would be affected in these patients. The aim of this experiment is to study the decision-making processes in Alzheimer type dementia patients to determine potential deficits in these processes as a result of the disease, aside from the cognitive impairment that is typical of aging. In addition, we wish to determine the defining characteristics of decision-making in these patients, on the basis of the prospect valence-learning parameters. We evaluated 30 patients with Alzheimer's disease and a control group of 30 healthy subjects. A short version of the Iowa Gambling Task was used. The results showed that patients made less advantageous choices than did controls. Group differences were quantitative and qualitative, as significant differences in cognitive mechanisms identified in the prospect valence-learning decisions were observed. These results are consistent with evidence from neuroimaging studies as well as with work carried out with amnesic patients. That problems in our patients' decision-making could be due to the characteristic memory deficits of this disease, which prevents them from establishing new stimulus-reward relationships and eliminating previously learned responses as a result of the parietal and temporal atrophy they present. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Attitudes toward Infection Prophylaxis in Pediatric Oncology: A Qualitative Approach

PubMed Central

Diorio, Caroline; Tomlinson, Deborah; Boydell, Katherine M.; Regier, Dean A.; Ethier, Marie-Chantal; Alli, Amanda; Alexander, Sarah; Gassas, Adam; Taylor, Jonathan; Kellow, Charis; Mills, Denise; Sung, Lillian

2012-01-01

Background The risks and benefits of infection prophylaxis are uncertain in children with cancer and thus, preferences should be considered in decision making. The purpose of this report was to describe the attitudes of parents, children and healthcare professionals to infection prophylaxis in pediatric oncology. Methods The study was completed in three phases: 1) An initial qualitative pilot to identify the main attributes influencing the decision to use infection prophylaxis, which were then incorporated into a discrete choice experiment; 2) A think aloud during the discrete choice experiment in which preferences for infection prophylaxis were elicited quantitatively; and 3) In-depth follow up interviews. Interviews were recorded verbatim and analyzed using an iterative, thematic analysis. Final themes were selected using a consensus approach. Results A total of 35 parents, 22 children and 28 healthcare professionals participated. All three groups suggested that the most important factor influencing their decision making was the effect of prophylaxis on reducing the chance of death. Themes of importance to the three groups included antimicrobial resistance, side effects of medications, the financial impact of outpatient prophylaxis and the route and schedule of administration. Conclusion Effect of prophylaxis on risk of death was a key factor in decision making. Other identified factors were antimicrobial resistance, side effects of medication, financial impact and administration details. Better understanding of factors driving decision making for infection prophylaxis will help facilitate future implementation of prophylactic regiments. PMID:23112849

[The role of epidemiology in the process of decision-making].

PubMed

Prost, A

1997-01-01

Epidemiology is the method of choice for quantifying and interpreting health phenomena, placing them into perspective to allow trend analysis and projections. It is a tool for analysis, evaluation and forecasting and is thus indispensable in the decision-making process. However, this comprehensive technique has its limitations since health is the result of complex interactions: individual requirements do not always correspond to the overall needs of the community; consideration has to be given to solidarity and the necessity for cost-sharing; and the decision process is strongly influenced by social, cultural, religious and political factors which defy quantification and, on occasion, any rational course of action. Each indicator only takes into account one aspect of the situation and the pertinent indicator should therefore be carefully selected. At the same time, any choice implicitly signifies value judgements-often unnoticed-which need to be balanced and validated in relation to the ethical values of the community in order to be of any assistance to decision-making. Decision-making is a qualitative political process which, although based on the quantitative analysis supplied by epidemiology, cannot be limited to it. Each approach enhance the other, but they should not be confused if freedom to act is to be preserved from being locked into some kind of mechanical process that is unacceptable both to man and to society.

The determinants of medical technology adoption in different decisional systems: A systematic literature review.

PubMed

Varabyova, Yauheniya; Blankart, Carl Rudolf; Greer, Ann Lennarson; Schreyögg, Jonas

2017-03-01

Studies of determinants of adoption of new medical technology have failed to coalesce into coherent knowledge. A flaw obscuring strong patterns may be a common habit of treating a wide range of health care innovations as a generic technology. We postulate three decisional systems that apply to different medical technologies with distinctive expertise, interest, and authority: medical-individualistic, fiscal-managerial, and strategic-institutional decisional systems. This review aims to examine the determinants of the adoption of medical technologies based on the corresponding decision-making system. We included quantitative and qualitative studies that analyzed factors facilitating or inhibiting the adoption of medical technologies. In total, 65 studies published between 1974 and 2014 met our inclusion criteria. These studies contained 688 occurrences of variables that were used to examine the adoption decisions, and we subsequently condensed these variables to 62 determinants in four main categories: organizational, individual, environmental, and innovation-related. The determinants and their empirical association with adoption were grouped and analyzed by the three decision-making systems. Although we did not identify substantial differences across the decision-making systems in terms of the direction of the determinants' influence on adoption, a clear pattern emerged in terms of the categories of determinants that were targeted in different decision-making systems. Copyright © 2017 Elsevier B.V. All rights reserved.

Attitudes toward infection prophylaxis in pediatric oncology: a qualitative approach.

PubMed

Diorio, Caroline; Tomlinson, Deborah; Boydell, Katherine M; Regier, Dean A; Ethier, Marie-Chantal; Alli, Amanda; Alexander, Sarah; Gassas, Adam; Taylor, Jonathan; Kellow, Charis; Mills, Denise; Sung, Lillian

2012-01-01

The risks and benefits of infection prophylaxis are uncertain in children with cancer and thus, preferences should be considered in decision making. The purpose of this report was to describe the attitudes of parents, children and healthcare professionals to infection prophylaxis in pediatric oncology. THE STUDY WAS COMPLETED IN THREE PHASES: 1) An initial qualitative pilot to identify the main attributes influencing the decision to use infection prophylaxis, which were then incorporated into a discrete choice experiment; 2) A think aloud during the discrete choice experiment in which preferences for infection prophylaxis were elicited quantitatively; and 3) In-depth follow up interviews. Interviews were recorded verbatim and analyzed using an iterative, thematic analysis. Final themes were selected using a consensus approach. A total of 35 parents, 22 children and 28 healthcare professionals participated. All three groups suggested that the most important factor influencing their decision making was the effect of prophylaxis on reducing the chance of death. Themes of importance to the three groups included antimicrobial resistance, side effects of medications, the financial impact of outpatient prophylaxis and the route and schedule of administration. Effect of prophylaxis on risk of death was a key factor in decision making. Other identified factors were antimicrobial resistance, side effects of medication, financial impact and administration details. Better understanding of factors driving decision making for infection prophylaxis will help facilitate future implementation of prophylactic regiments.

Interactive Video Usage on Autism Spectrum Disorder Training in Medical Education

ERIC Educational Resources Information Center

Taslibeyaz, Elif; Dursun, Onur Burak; Karaman, Selcuk

2017-01-01

This study aimed to compare the effects of interactive and non-interactive videos concerning the autism spectrum disorder on medical students' achievement. It also evaluated the relation between the interactive videos' interactivity and the students' decision-making process. It used multiple methods, including quantitative and qualitative methods.…

Examining Construct Validity of the Quantitative Literacy VALUE Rubric in College-Level STEM Assignments

ERIC Educational Resources Information Center

Gray, Julie S.; Brown, Melissa A.; Connolly, John P.

2017-01-01

Data-driven decision making is increasingly viewed as essential in a globally competitive society. Initiatives to augment standardized testing with performance-based assessment have increased as educators progressively respond to mandates for authentic measurement of student attainment. To meet this challenge, multidisciplinary rubrics were…

Quantitative AOP linking aromatase inhibition to impaired reproduction: A case study in predictive ecotoxicology

EPA Science Inventory

The adverse outcome pathway (AOP) framework is intended to help support greater use of mechanistic toxicology data as a basis for risk assessment and/or regulatory decision-making. While there have been clear advances in the ability to rapidly generate mechanistically-oriented da...

Effective implementation of ground penetrating radar (GPR) for condition assessment & monitoring of critical infrastructure components of bridges and highways : [research summary].

DOT National Transportation Integrated Search

2015-01-01

Recently Maryland State Highway Administration (SHA) started to explore use of Ground : Penetrating Radar (GPR) technology to provide quantitative information for improved : decision making and reduced operating costs. To take full advantage of the G...

Developing and Assessing E-Learning Techniques for Teaching Forecasting

ERIC Educational Resources Information Center

Gel, Yulia R.; O'Hara Hines, R. Jeanette; Chen, He; Noguchi, Kimihiro; Schoner, Vivian

2014-01-01

In the modern business environment, managers are increasingly required to perform decision making and evaluate related risks based on quantitative information in the face of uncertainty, which in turn increases demand for business professionals with sound skills and hands-on experience with statistical data analysis. Computer-based training…

The Employer Perspective: A Survey of Employer Participation in Structured Workplace Learning, 2000.

ERIC Educational Resources Information Center

AMR Interactive (Australia).

In 2000, a quantitative telephone survey of 2,098 businesses in Australia determined employer awareness of and participation in structured workplace learning (SWL) programs. It explored "drivers" of participation and employers' decision-making process. Comparisons with a 1998 survey identified changes in employer awareness, attitudes,…

Interpreting energy scenarios

NASA Astrophysics Data System (ADS)

Iyer, Gokul; Edmonds, James

2018-05-01

Quantitative scenarios from energy-economic models inform decision-making about uncertain futures. Now, research shows the different ways these scenarios are subsequently used by users not involved in their initial development. In the absence of clear guidance from modellers, users may place too much or too little confidence in scenario assumptions and results.

Forest Service Resource Inventories: An Overview

Treesearch

USDA Forest Service

1992-01-01

Forest and related resource inventories are conducted by the US. Forest Service to provide the quantitative base necessary for making sound management, conservation, and stewardship decisions affecting these valuable resources. Inventory information has guided the management of 191 million acres (77.3 million ha) of publicly-owned National Forest land. Forest...

"Earthquake!"--A Cooperative Learning Experience.

ERIC Educational Resources Information Center

Hodder, A. Peter W.

2001-01-01

Presents an exercise designed as a team building experience for managers that can be used to demonstrate to science students the potential benefit of group decision-making. Involves the ranking of options for surviving a large earthquake. Yields quantitative measures of individual student knowledge and how well the groups function. (Author/YDS)

Developing a Quantitative Tool for Sustainability Assessment of HEIs

ERIC Educational Resources Information Center

Waheed, Bushra; Khan, Faisal I.; Veitch, Brian

2011-01-01

Purpose: Implementation of a sustainability paradigm demands new choices and innovative ways of thinking. The main objective of this paper is to provide a meaningful sustainability assessment tool for make informed decisions, which is applied to higher education institutions (HEIs). Design/methodology/approach: The objective is achieved by…

Toward Brief "Red Flags" for Autism Screening: The Short Autism Spectrum Quotient and the Short Quantitative Checklist in 1,000 Cases and 3,000 Controls

ERIC Educational Resources Information Center

Allison, Carrie; Auyeung, Bonnie; Baron-Cohen, Simon

2012-01-01

Objective: Frontline health professionals need a "red flag" tool to aid their decision making about whether to make a referral for a full diagnostic assessment for an autism spectrum condition (ASC) in children and adults. The aim was to identify 10 items on the Autism Spectrum Quotient (AQ) (Adult, Adolescent, and Child versions) and on…

Exploration of how women make treatment decisions after a breast cancer diagnosis.

PubMed

Spittler, Cheryl A; Pallikathayil, Leonie; Bott, Marjorie

2012-09-01

To examine the information needs of women after receiving a diagnosis of breast cancer, investigate how decisions about treatment options are made, and assess personal responses to the decisions made. Mixed-methods approach using quantitative and qualitative data. The University of Kansas Medical Center and Quinn Plastic Surgery Center, both in the midwestern United States. 102 breast cancer survivors who had completed all forms of treatment for at least three months and less than five years. Phase I participants completed five questionnaires about informational needs, confidence and satisfaction with the decision, decisional regret, and conflict. In phase II, 15 participants were purposively sampled from the 102 survivors to participate in a focus group session. Data analysis included frequencies and multiple regression for phase I and qualitative content analysis for phase II. Informational needs, confidence and satisfaction with the decision, and decisional regret and conflict. The variables (widowed, confidence and satisfaction with decision, and decisional conflict and regret) significantly (p = 0.01) accounted for 14% of the variance in informational needs. Two themes emerged from the study: (a) feelings, thoughts, and essential factors that impact treatment considerations, and (b) tips for enhancing treatment consideration options. The study's results show that women viewed informational needs as very important in making treatment decisions after being diagnosed with breast cancer. The treatment team should provide the information, with consideration of the patient's personal preferences, that will assist women to make informed, confident, and satisfied decisions about treatment choices.

Informed choice in bowel cancer screening: a qualitative study to explore how adults with lower education use decision aids

PubMed Central

Smith, Sian K; Kearney, Paul; Trevena, Lyndal; Barratt, Alexandra; Nutbeam, Don; McCaffery, Kirsten J

2012-01-01

Abstract Background  Offering informed choice in screening is increasingly advocated, but little is known about how evidence‐based information about the benefits and harms of screening influences understanding and participation in screening. Objective  We aimed to explore how a bowel cancer screening decision aid influenced decision making and screening behaviour among adults with lower education and literacy. Methods  Twenty‐one men and women aged 55–64 years with lower education levels were interviewed about using a decision aid to make their screening decision. Participants were purposively selected to include those who had and had not made an informed choice. Results  Understanding the purpose of the decision aid was an important factor in whether participants made an informed choice about screening. Participants varied in how they understood and integrated quantitative risk information about the benefits and harms of screening into their decision making; some read it carefully and used it to justify their screening decision, whereas others dismissed it because they were sceptical of it or lacked confidence in their own numeracy ability. Participants’ prior knowledge and beliefs about screening influenced how they made sense of the information. Discussion and conclusions  Participants valued information that offered them a choice in a non‐directive way, but were concerned that it would deter people from screening. Healthcare providers need to be aware that people respond to screening information in diverse ways involving a range of literacy skills and cognitive processes. PMID:22512746

‘Sometimes people let love conquer them’: how love, intimacy, and trust in relationships between men who have sex with men influence perceptions of sexual risk and sexual decision-making

PubMed Central

Goldenberg, Tamar; Finneran, Catherine; Andes, Karen L.; Stephenson, Rob

2015-01-01

Men who have sex with men account for a disproportionate burden of HIV incidence in the USA. Although much research has examined the drivers of sexual risk-taking, the emotional contexts in which men make sexual decisions has received little attention. In this three-phase, 10-week longitudinal qualitative study involving 25 gay and bisexual men, we used timeline-based interviews and quantitative web-based diaries about sexual and/or dating partners to examine how emotions influence HIV risk perceptions and sexual decision-making. Participants described love, intimacy, and trust as reducing HIV risk perceptions and facilitating engagement in condomless anal intercourse. Lust was not as linked with risk perceptions, but facilitated non condom-use through an increased willingness to engage in condomless anal intercourse, despite perceptions of risk. Results indicate that gay and bisexual men do not make sexual decisions in an emotional vacuum. Emotions influence perceptions of risk so that they do not necessarily align with biological risk factors. Emotional influences, especially the type and context of emotions, are important to consider to improve HIV prevention efforts among gay and bisexual men. PMID:25465292

An extreme events laboratory to provide network centric collaborative situation assessment and decision making

NASA Astrophysics Data System (ADS)

Panulla, Brian J.; More, Loretta D.; Shumaker, Wade R.; Jones, Michael D.; Hooper, Robert; Vernon, Jeffrey M.; Aungst, Stanley G.

2009-05-01

Rapid improvements in communications infrastructure and sophistication of commercial hand-held devices provide a major new source of information for assessing extreme situations such as environmental crises. In particular, ad hoc collections of humans can act as "soft sensors" to augment data collected by traditional sensors in a net-centric environment (in effect, "crowd-sourcing" observational data). A need exists to understand how to task such soft sensors, characterize their performance and fuse the data with traditional data sources. In order to quantitatively study such situations, as well as study distributed decision-making, we have developed an Extreme Events Laboratory (EEL) at The Pennsylvania State University. This facility provides a network-centric, collaborative situation assessment and decision-making capability by supporting experiments involving human observers, distributed decision making and cognition, and crisis management. The EEL spans the information chain from energy detection via sensors, human observations, signal and image processing, pattern recognition, statistical estimation, multi-sensor data fusion, visualization and analytics, and modeling and simulation. The EEL command center combines COTS and custom collaboration tools in innovative ways, providing capabilities such as geo-spatial visualization and dynamic mash-ups of multiple data sources. This paper describes the EEL and several on-going human-in-the-loop experiments aimed at understanding the new collective observation and analysis landscape.

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

NASA Technical Reports Server (NTRS)

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

2003-01-01

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

Decision-making, sensitivity to reward, and attrition in weight-management

PubMed Central

Koritzky, Gilly; Dieterle, Camille; Rice, Chantelle; Jordan, Katie; Bechara, Antoine

2014-01-01

Objective Attrition is a common problem in weight-management. Understanding the risk factors for attrition should enhance professionals’ ability to increase completion rates and improve health outcomes for more individuals. We propose a model that draws upon neuropsychological knowledge on reward-sensitivity in obesity and overeating to predict attrition. Design & Methods 52 participants in a weight-management program completed a complex decision-making task.Decision-making characteristics – including sensitivity to reward – were further estimated using a quantitative model. Impulsivity and risk-taking measures were also administered. Results Consistent with the hypothesis that sensitivity to reward predicted attrition, program dropouts had higher sensitivity to reward than completers (p < 0.03). No differences were observed between completers and dropouts in initial BMI, age, employment status, or the number of prior weight-loss attempts (p ≥ 0.07). Completers had a slightly higher education level than dropouts, but its inclusion in the model did not increase predictive power. Impulsivity, delay of gratification, and risk-taking did not predict attrition, either. Conclusions Findings link attrition in weight-management to the neural mechanisms associated with reward-seeking and related influences on decision-making. Individual differences in the magnitude of response elicited by rewards may account for the relative difficulty experienced by dieters in adhering to treatment. PMID:24771588

Using Discrete Choice Experiments to Inform the Benefit-Risk Assessment of Medicines: Are We Ready Yet?

PubMed

Vass, Caroline M; Payne, Katherine

2017-09-01

There is emerging interest in the use of discrete choice experiments as a means of quantifying the perceived balance between benefits and risks (quantitative benefit-risk assessment) of new healthcare interventions, such as medicines, under assessment by regulatory agencies. For stated preference data on benefit-risk assessment to be used in regulatory decision making, the methods to generate these data must be valid, reliable and capable of producing meaningful estimates understood by decision makers. Some reporting guidelines exist for discrete choice experiments, and for related methods such as conjoint analysis. However, existing guidelines focus on reporting standards, are general in focus and do not consider the requirements for using discrete choice experiments specifically for quantifying benefit-risk assessments in the context of regulatory decision making. This opinion piece outlines the current state of play in using discrete choice experiments for benefit-risk assessment and proposes key areas needing to be addressed to demonstrate that discrete choice experiments are an appropriate and valid stated preference elicitation method in this context. Methodological research is required to establish: how robust the results of discrete choice experiments are to formats and methods of risk communication; how information in the discrete choice experiment can be presented effectually to respondents; whose preferences should be elicited; the correct underlying utility function and analytical model; the impact of heterogeneity in preferences; and the generalisability of the results. We believe these methodological issues should be addressed, alongside developing a 'reference case', before agencies can safely and confidently use discrete choice experiments for quantitative benefit-risk assessment in the context of regulatory decision making for new medicines and healthcare products.

The experiences of relatives with the practice of palliative sedation: a systematic review.

PubMed

Bruinsma, Sophie M; Rietjens, Judith A C; Seymour, Jane E; Anquinet, Livia; van der Heide, Agnes

2012-09-01

Guidelines about palliative sedation typically include recommendations to protect the well-being of relatives. The aim of this study was to systematically review evidence on the experiences of relatives with the practice of palliative sedation. PubMed, Embase, Web of Science, PsycINFO, and CINAHL were searched for empirical studies on relatives' experiences with palliative sedation. We investigated relatives' involvement in the decision-making and sedation processes, whether they received adequate information and support, and relatives' emotions. Of the 564 studies identified, 39 were included. The studies (30 quantitative, six qualitative, and three mixed methods) were conducted in 16 countries; three studies were based on relatives' reports, 26 on physicians' and nurses' proxy reports, seven on medical records, and three combined different sources. The 39 studies yielded a combined total of 8791 respondents or studied cases. Caregivers involved relatives in the decision making in 69%-100% of all cases (19 quantitative studies), and in 60%-100% of all cases, relatives were reported to have received adequate information (five quantitative studies). Only two quantitative studies reported on relatives' involvement in the provision of sedation. Despite the fact that the majority of relatives were reported to be comfortable with the use of palliative sedation (seven quantitative studies, four qualitative studies), several studies found that relatives were distressed by the use of sedation (five quantitative studies, five qualitative studies). No studies reported specifically about the support provided to the relatives. Relatives' experiences with palliative sedation are mainly studied from the perspective of proxies, mostly professional caregivers. The majority of relatives seems to be comfortable with the use of palliative sedation; however, they may experience substantial distress by the use of sedation. Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness analysis and formulary decision making in England: findings from research.

PubMed

Williams, Iestyn P; Bryan, Stirling

2007-11-01

In a context of rapid technological advances in health care and increasing demand for expensive treatments, local formulary committees are key players in the management of scarce resources. However, little is known about the information and processes used when making decisions on the inclusion of new treatments. This paper reports research on the use of economic evaluations in technology coverage decisions in England, although the findings have a relevance to other health care systems with devolved responsibility for resource allocation. It reports a study of four local formulary committees in which both qualitative and quantitative data were collected. Our main research finding is that it is an exception for cost-effectiveness analysis to inform technology coverage decisions. Barriers to use include access and expertise levels, concerns relating to the independence of analyses and problems with implementation of study recommendations. Further barriers derive from the constraints on decision makers, a lack of clarity over functions and aims of local committees, and the challenge of disinvestment in medical technologies. The relative weakness of the research-practice dynamics in this context suggests the need for a rethinking of the role of both analysts and decision makers. Our research supports the view that in order to be useful, analysis needs to better reflect the constraints of the local decision-making environment. We also recommend that local decision-making committees and bodies in the National Health Service more clearly identify the 'problems' which they are charged with solving and how their outputs contribute to broader finance and commissioning functions. This would help to establish the ways in which the routine use of cost-effectiveness analysis might become a reality.

Clinicians' perceptions of decision making regarding discharge from public hospitals to in-patient rehabilitation following trauma.

PubMed

Kimmel, Lara A; Holland, Anne E; Lannin, Natasha; Edwards, Elton R; Page, Richard S; Bucknill, Andrew; Hau, Raphael; Gabbe, Belinda J

2017-05-01

Objective The aim of the present study was to investigate the perceptions of consultant surgeons, allied health clinicians and rehabilitation consultants regarding discharge destination decision making from the acute hospital following trauma. Methods A qualitative study was performed using individual in-depth interviews of clinicians in Victoria (Australia) between April 2013 and September 2014. Thematic analysis was used to derive important themes. Case studies provided quantitative information to enhance the information gained via interviews. Results Thirteen rehabilitation consultants, eight consultant surgeons and 13 allied health clinicians were interviewed. Key themes that emerged included the importance of financial considerations as drivers of decision making and the perceived lack of involvement of medical staff in decisions regarding discharge destination following trauma. Other themes included the lack of consistency of factors thought to be important drivers of discharge and the difficulty in acting on trauma patients' requests in terms of discharge destination. Importantly, as the complexity of the patient increases in terms of acquired brain injury, the options for rehabilitation become scarcer. Conclusions The information gained in the present study highlights the large variation in discharge practises between and within clinical groups. Further consultation with stakeholders involved in the care of trauma patients, as well as government bodies involved in hospital funding, is needed to derive a more consistent approach to discharge destination decision making. What is known about the topic? Little is known about the drivers for referral to, or acceptance at, in-patient rehabilitation following acute hospital care for traumatic injury in Victoria, Australia, including who makes these decisions of behalf of patients and how these decisions are made. What does this paper add? This paper provides information regarding the perceptions of acute hospital consultant surgeons and allied health, as well as rehabilitation clinicians, in terms of discharge destination decision making from the acute hospital following trauma. The use of case studies further highlights differences between, and within, these specialities with regard to this decision making. This research also highlights the importance of financial considerations as drivers of decision making, and the lack of consistency of the factors thought to be important drivers of discharge between these different clinical groupings. What are the implications for practitioners? This research shows that financial factors are significant drivers of discharge destination decision making for trauma patients. The present study highlights opportunities to engage with stakeholders (acute care, rehabilitation, administration, government and patients) to develop more consistent discharge processes that optimise the use of rehabilitation resources for those patients who could benefit from in-patient rehabilitation.

Evaluation of a decision support system for pressure ulcer prevention and management: preliminary findings.

PubMed

Zielstorff, R D; Estey, G; Vickery, A; Hamilton, G; Fitzmaurice, J B; Barnett, G O

1997-01-01

A decision support system for prevention and management of pressure ulcers was developed based on AHCPR guidelines and other sources. The system was implemented for 21 weeks on a 20-bed clinical care unit. Fifteen nurses on that unit volunteered as subjects of the intervention to see whether use of the system would have a positive effect on their knowledge about pressure ulcers and on their decision-making skills related to this topic. A similar care unit was used as a control. In addition, the system was evaluated by experts for its instructional adequacy, and by end users for their satisfaction with the system. Preliminary results show no effect on knowledge about pressure ulcers and no effect on clinical decision making skills. The system was rated positively for instructional adequacy, and positively for user satisfaction. User interviews related to satisfaction supplemented the quantitative findings. A discussion of the issues of conducting experiments like this in today's clinical environment is included.

Quantitative prediction of perceptual decisions during near-threshold fear detection

NASA Astrophysics Data System (ADS)

Pessoa, Luiz; Padmala, Srikanth

2005-04-01

A fundamental goal of cognitive neuroscience is to explain how mental decisions originate from basic neural mechanisms. The goal of the present study was to investigate the neural correlates of perceptual decisions in the context of emotional perception. To probe this question, we investigated how fluctuations in functional MRI (fMRI) signals were correlated with behavioral choice during a near-threshold fear detection task. fMRI signals predicted behavioral choice independently of stimulus properties and task accuracy in a network of brain regions linked to emotional processing: posterior cingulate cortex, medial prefrontal cortex, right inferior frontal gyrus, and left insula. We quantified the link between fMRI signals and behavioral choice in a whole-brain analysis by determining choice probabilities by means of signal-detection theory methods. Our results demonstrate that voxel-wise fMRI signals can reliably predict behavioral choice in a quantitative fashion (choice probabilities ranged from 0.63 to 0.78) at levels comparable to neuronal data. We suggest that the conscious decision that a fearful face has been seen is represented across a network of interconnected brain regions that prepare the organism to appropriately handle emotionally challenging stimuli and that regulate the associated emotional response. decision making | emotion | functional MRI

Attitudes and decision-making about early-infant versus early-adolescent male circumcision: Demand-side insights for sustainable HIV prevention strategies in Zambia and Zimbabwe.

PubMed

Sgaier, Sema K; Sharma, Sunny; Eletskaya, Maria; Prasad, Ram; Mugurungi, Owen; Tambatamba, Bushimbwa; Ncube, Getrude; Xaba, Sinokuthemba; Nanga, Alice; Gumede-Moyo, Sehlulekile; Kretschmer, Steve

2017-01-01

As countries approach their scale-up targets for the voluntary medical male circumcision program for HIV prevention, they are strategizing and planning for the sustainability phase to follow. Global guidance recommends circumcising adolescent (below 14 years) and/or early infant boys (aged 0-60 days), and countries need to consider several factors before prioritizing a cohort for their sustainability phase. We provide community and healthcare provider-side insights on attitudes and decision-making process as a key input for this strategic decision in Zambia and Zimbabwe. We studied expectant parents, parents of infant boys (aged 0-60 days), family members and neo-natal and ante-natal healthcare providers in Zambia and Zimbabwe. Our integrated methodology consisted of in-depth qualitative and quantitative one-on-one interviews, and a simulated-decision-making game, to uncover attitudes towards, and the decision-making process for, early adolescent or early infant medical circumcision (EAMC or EIMC). In both countries, parents viewed early infancy and early adolescence as equally ideal ages for circumcision (38% EIMC vs. 37% EAMC in Zambia; 24% vs. 27% in Zimbabwe). If offered for free, about half of Zambian parents and almost 2 in 5 Zimbabwean parents indicated they would likely circumcise their infant boy; however, half of parents in each country perceived that the community would not accept EIMC. Nurses believed their facilities currently could not absorb EIMC services and that they would have limited ability to influence fathers, who were seen as having the primary decision-making authority. Our analysis suggests that EAMC is more accepted by the community than EIMC and is the path of least resistance for the sustainability phase of VMMC. However, parents or community members do not reject EIMC. Should countries choose to prioritize this cohort for their sustainability phase, a number of barriers around information, decision-making by parents, and supply side will need to be addressed.

Attitudes and decision-making about early-infant versus early-adolescent male circumcision: Demand-side insights for sustainable HIV prevention strategies in Zambia and Zimbabwe

PubMed Central

Sgaier, Sema K.; Sharma, Sunny; Eletskaya, Maria; Prasad, Ram; Mugurungi, Owen; Tambatamba, Bushimbwa; Ncube, Getrude; Xaba, Sinokuthemba; Nanga, Alice; Gumede-Moyo, Sehlulekile; Kretschmer, Steve

2017-01-01

As countries approach their scale-up targets for the voluntary medical male circumcision program for HIV prevention, they are strategizing and planning for the sustainability phase to follow. Global guidance recommends circumcising adolescent (below 14 years) and/or early infant boys (aged 0–60 days), and countries need to consider several factors before prioritizing a cohort for their sustainability phase. We provide community and healthcare provider-side insights on attitudes and decision-making process as a key input for this strategic decision in Zambia and Zimbabwe. We studied expectant parents, parents of infant boys (aged 0–60 days), family members and neo-natal and ante-natal healthcare providers in Zambia and Zimbabwe. Our integrated methodology consisted of in-depth qualitative and quantitative one-on-one interviews, and a simulated-decision-making game, to uncover attitudes towards, and the decision-making process for, early adolescent or early infant medical circumcision (EAMC or EIMC). In both countries, parents viewed early infancy and early adolescence as equally ideal ages for circumcision (38% EIMC vs. 37% EAMC in Zambia; 24% vs. 27% in Zimbabwe). If offered for free, about half of Zambian parents and almost 2 in 5 Zimbabwean parents indicated they would likely circumcise their infant boy; however, half of parents in each country perceived that the community would not accept EIMC. Nurses believed their facilities currently could not absorb EIMC services and that they would have limited ability to influence fathers, who were seen as having the primary decision-making authority. Our analysis suggests that EAMC is more accepted by the community than EIMC and is the path of least resistance for the sustainability phase of VMMC. However, parents or community members do not reject EIMC. Should countries choose to prioritize this cohort for their sustainability phase, a number of barriers around information, decision-making by parents, and supply side will need to be addressed. PMID:28749979

Clinician and cancer patient views on patient participation in treatment decision-making: a quantitative and qualitative exploration

PubMed Central

Pieterse, A H; Baas-Thijssen, M C M; Marijnen, C A M; Stiggelbout, A M

2008-01-01

Patient participation in treatment decision-making is being increasingly advocated, although cancer treatments are often guideline-driven. Trade-offs between benefits and side effects underlying guidelines are made by clinicians. Evidence suggests that clinicians are inaccurate at predicting patient values. The aim was to assess what role oncologists and cancer patients prefer in deciding about treatment, and how they view patient participation in treatment decision-making. Seventy disease-free cancer patients and 60 oncologists (surgical, radiation, and medical) were interviewed about their role preferences using the Control Preferences Scale (CPS) and about their views on patient participation using closed- and open-ended questions. Almost all participants preferred treatment decisions to be the outcome of a shared process. Clinicians viewed participation more often as reaching an agreement, whereas 23% of patients defined participation exclusively as being informed. Of the participants, ⩾81% thought not all patients are able to participate and ⩾74% thought clinicians are not always able to weigh the pros and cons of treatment for patients, especially not quality as compared with length of life. Clinicians seemed reluctant to share probability information on the likely impact of adjuvant treatment. Clinicians should acknowledge the legitimacy of patients' values in treatment decisions. Guidelines should recommend elicitation of patient values at specific decision points. PMID:18781148

What parents think and feel about deep brain stimulation in paediatric secondary dystonia including cerebral palsy: A qualitative study of parental decision-making.

PubMed

Austin, Allana; Lin, Jean-Pierre; Selway, Richard; Ashkan, Keyoumars; Owen, Tamsin

2017-01-01

Dystonia is characterised by involuntary movements and postures. Deep Brain Stimulation (DBS) is effective in reducing dystonic symptoms in primary dystonia in childhood and to lesser extent in secondary dystonia. How families and children decide to choose DBS surgery has never been explored. To explore parental decision-making for DBS in paediatric secondary dystonia. Data was gathered using semi-structured interviews with eight parents of children with secondary dystonia who had undergone DBS. Interviews were analysed using Interpretative Phenomenological Analysis. For all parents the decision was viewed as significant, with life altering consequences for the child. These results suggested that parents were motivated by a hope for a better life and parental duty. This was weighed against consideration of risks, what the child had to lose, and uncertainty of DBS outcome. Decisions were also influenced by the perspectives of their child and professionals. The decision to undergo DBS was an ongoing process for parents, who ultimately were struggling in the face of uncertainty whilst trying to do their best as parents for their children. These findings have important clinical implications given the growing referrals for consideration of DBS childhood dystonia, and highlights the importance of further quantitative research to fully establish the efficacy of DBS in secondary dystonia to enhance informed decision-making. Copyright © 2016. Published by Elsevier Ltd.

Response time distributions in rapid chess: a large-scale decision making experiment.

PubMed

Sigman, Mariano; Etchemendy, Pablo; Slezak, Diego Fernández; Cecchi, Guillermo A

2010-01-01

Rapid chess provides an unparalleled laboratory to understand decision making in a natural environment. In a chess game, players choose consecutively around 40 moves in a finite time budget. The goodness of each choice can be determined quantitatively since current chess algorithms estimate precisely the value of a position. Web-based chess produces vast amounts of data, millions of decisions per day, incommensurable with traditional psychological experiments. We generated a database of response times (RTs) and position value in rapid chess games. We measured robust emergent statistical observables: (1) RT distributions are long-tailed and show qualitatively distinct forms at different stages of the game, (2) RT of successive moves are highly correlated both for intra- and inter-player moves. These findings have theoretical implications since they deny two basic assumptions of sequential decision making algorithms: RTs are not stationary and can not be generated by a state-function. Our results also have practical implications. First, we characterized the capacity of blunders and score fluctuations to predict a player strength, which is yet an open problem in chess softwares. Second, we show that the winning likelihood can be reliably estimated from a weighted combination of remaining times and position evaluation.

A Design Pattern for Decentralised Decision Making

PubMed Central

Valentini, Gabriele; Fernández-Oto, Cristian; Dorigo, Marco

2015-01-01

The engineering of large-scale decentralised systems requires sound methodologies to guarantee the attainment of the desired macroscopic system-level behaviour given the microscopic individual-level implementation. While a general-purpose methodology is currently out of reach, specific solutions can be given to broad classes of problems by means of well-conceived design patterns. We propose a design pattern for collective decision making grounded on experimental/theoretical studies of the nest-site selection behaviour observed in honeybee swarms (Apis mellifera). The way in which honeybee swarms arrive at consensus is fairly well-understood at the macroscopic level. We provide formal guidelines for the microscopic implementation of collective decisions to quantitatively match the macroscopic predictions. We discuss implementation strategies based on both homogeneous and heterogeneous multiagent systems, and we provide means to deal with spatial and topological factors that have a bearing on the micro-macro link. Finally, we exploit the design pattern in two case studies that showcase the viability of the approach. Besides engineering, such a design pattern can prove useful for a deeper understanding of decision making in natural systems thanks to the inclusion of individual heterogeneities and spatial factors, which are often disregarded in theoretical modelling. PMID:26496359

Response Time Distributions in Rapid Chess: A Large-Scale Decision Making Experiment

PubMed Central

Sigman, Mariano; Etchemendy, Pablo; Slezak, Diego Fernández; Cecchi, Guillermo A.

2010-01-01

Rapid chess provides an unparalleled laboratory to understand decision making in a natural environment. In a chess game, players choose consecutively around 40 moves in a finite time budget. The goodness of each choice can be determined quantitatively since current chess algorithms estimate precisely the value of a position. Web-based chess produces vast amounts of data, millions of decisions per day, incommensurable with traditional psychological experiments. We generated a database of response times (RTs) and position value in rapid chess games. We measured robust emergent statistical observables: (1) RT distributions are long-tailed and show qualitatively distinct forms at different stages of the game, (2) RT of successive moves are highly correlated both for intra- and inter-player moves. These findings have theoretical implications since they deny two basic assumptions of sequential decision making algorithms: RTs are not stationary and can not be generated by a state-function. Our results also have practical implications. First, we characterized the capacity of blunders and score fluctuations to predict a player strength, which is yet an open problem in chess softwares. Second, we show that the winning likelihood can be reliably estimated from a weighted combination of remaining times and position evaluation. PMID:21031032

Collection of Medical Original Data with Search Engine for Decision Support.

PubMed

Orthuber, Wolfgang

2016-01-01

Medicine is becoming more and more complex and humans can capture total medical knowledge only partially. For specific access a high resolution search engine is demonstrated, which allows besides conventional text search also search of precise quantitative data of medical findings, therapies and results. Users can define metric spaces ("Domain Spaces", DSs) with all searchable quantitative data ("Domain Vectors", DSs). An implementation of the search engine is online in http://numericsearch.com. In future medicine the doctor could make first a rough diagnosis and check which fine diagnostics (quantitative data) colleagues had collected in such a case. Then the doctor decides about fine diagnostics and results are sent (half automatically) to the search engine which filters a group of patients which best fits to these data. In this specific group variable therapies can be checked with associated therapeutic results, like in an individual scientific study for the current patient. The statistical (anonymous) results could be used for specific decision support. Reversely the therapeutic decision (in the best case with later results) could be used to enhance the collection of precise pseudonymous medical original data which is used for better and better statistical (anonymous) search results.

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

PubMed

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

2017-10-01

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

Psychosocial Factors of Health Professionals’ Intention to Use a Decision Aid for Down Syndrome Screening: Cross-Sectional Quantitative Study

PubMed Central

Abbasgholizadeh Rahimi, Samira; Lépine, Johanie; Croteau, Jordie; Robitaille, Hubert; Giguere, Anik MC; Wilson, Brenda J; Rousseau, François; Lévesque, Isabelle

2018-01-01

Background Decisions about prenatal screening for Down syndrome are difficult for women, as they entail risk, potential loss, and regret. Shared decision making increases women’s knowledge of their choices and better aligns decisions with their values. Patient decision aids foster shared decision making but are rarely used in this context. Objective One of the most promising strategies for implementing shared decision making is distribution of decision aids by health professionals. We aimed to identify factors influencing their intention to use a DA during prenatal visit for decisions about Down syndrome screening. Methods We conducted a cross-sectional quantitative study. Using a Web panel, we conducted a theory-based survey of health professionals in Quebec province (Canada). Eligibility criteria were as follows: (1) family physicians, midwives, obstetrician-gynecologists, or trainees in these professions; (2) involved in prenatal care; and (3) working in Quebec province. Participants watched a video depicting a health professional using a decision aid during a prenatal consultation with a woman and her partner, and then answered a questionnaire based on an extended version of the theory of planned behavior, including some of the constructs of the theoretical domains framework. The questionnaire assessed 8 psychosocial constructs (attitude, anticipated regret, subjective norm, self-identity, moral norm, descriptive norm, self-efficacy, and perceived control), 7 related sets of behavioral beliefs (advantages, disadvantages, emotions, sources of encouragement or discouragement, incentives, facilitators, and barriers), and sociodemographic data. We performed descriptive, bivariate, and multiple linear regression analyses to identify factors influencing health professionals’ intention to use a decision aid. Results Among 330 health professionals who completed the survey, 310 met the inclusion criteria: family physicians, 55.2% (171/310); obstetrician-gynecologists, 33.8% (105/310); and midwives, 11.0% (34/310). Of these, 80.9% were female (251/310). Mean age was 39.6 (SD 11.5) years. Less than half were aware of any decision aids at all. In decreasing order of importance, factors influencing their intention to use a decision aid for Down syndrome prenatal screening were as follows: self-identity (beta=.325, P<.001), attitude (beta=.297, P<.001), moral norm (beta=.288, P<.001), descriptive norm (beta=.166, P<.001), and anticipated regret (beta=.099, P=.003). Underlying behavioral beliefs significantly related to intention were that the use of a decision aid would promote decision making (beta=.117, 95% CI 0.043-0.190), would reassure health professionals (beta=.100, 95% CI 0.024-0.175), and might require more time than planned for the consultation (beta=−.077, 95% CI −0.124 to −0.031). Conclusions We identified psychosocial factors that could influence health professionals’ intention to use a decision aid about Down syndrome screening. Strategies should remind them of the following: (1) using a decision aid for this purpose should be a common practice, (2) it would be expected of someone in their societal role, (3) the experience of using it will be satisfying and reassuring, and (4) it is likely to be compatible with their moral values. PMID:29695369

Testing decision rules for categorizing species' extinction risk to help develop quantitative listing criteria for the U.S. Endangered Species Act.

PubMed

Regan, Tracey J; Taylor, Barbara L; Thompson, Grant G; Cochrane, Jean Fitts; Ralls, Katherine; Runge, Michael C; Merrick, Richard

2013-08-01

Lack of guidance for interpreting the definitions of endangered and threatened in the U.S. Endangered Species Act (ESA) has resulted in case-by-case decision making leaving the process vulnerable to being considered arbitrary or capricious. Adopting quantitative decision rules would remedy this but requires the agency to specify the relative urgency concerning extinction events over time, cutoff risk values corresponding to different levels of protection, and the importance given to different types of listing errors. We tested the performance of 3 sets of decision rules that use alternative functions for weighting the relative urgency of future extinction events: a threshold rule set, which uses a decision rule of x% probability of extinction over y years; a concave rule set, where the relative importance of future extinction events declines exponentially over time; and a shoulder rule set that uses a sigmoid shape function, where relative importance declines slowly at first and then more rapidly. We obtained decision cutoffs by interviewing several biologists and then emulated the listing process with simulations that covered a range of extinction risks typical of ESA listing decisions. We evaluated performance of the decision rules under different data quantities and qualities on the basis of the relative importance of misclassification errors. Although there was little difference between the performance of alternative decision rules for correct listings, the distribution of misclassifications differed depending on the function used. Misclassifications for the threshold and concave listing criteria resulted in more overprotection errors, particularly as uncertainty increased, whereas errors for the shoulder listing criteria were more symmetrical. We developed and tested the framework for quantitative decision rules for listing species under the U.S. ESA. If policy values can be agreed on, use of this framework would improve the implementation of the ESA by increasing transparency and consistency. Conservation Biology © 2013 Society for Conservation Biology No claim to original US government works.

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

PubMed

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

2016-06-01

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

A Neuropsychological Approach to Understanding Risk-Taking for Potential Gains and Losses

PubMed Central

Levin, Irwin P.; Xue, Gui; Weller, Joshua A.; Reimann, Martin; Lauriola, Marco; Bechara, Antoine

2012-01-01

Affective neuroscience has helped guide research and theory development in judgment and decision-making by revealing the role of emotional processes in choice behavior, especially when risk is involved. Evidence is emerging that qualitatively and quantitatively different processes may be involved in risky decision-making for gains and losses. We start by reviewing behavioral work by Kahneman and Tversky (1979) and others, which shows that risk-taking differs for potential gains and potential losses. We then turn to the literature in decision neuroscience to support the gain versus loss distinction. Relying in part on data from a new task that separates risky decision-making for gains and losses, we test a neural model that assigns unique mechanisms for risky decision-making involving potential losses. Included are studies using patients with lesions to brain areas specified as important in the model and studies with healthy individuals whose brains are scanned to reveal activation in these and other areas during risky decision-making. In some cases, there is evidence that gains and losses are processed in different regions of the brain, while in other cases the same region appears to process risk in a different manner for gains and losses. At a more general level, we provide strong support for the notion that decisions involving risk-taking for gains and decisions involving risk-taking for losses represent different psychological processes. At a deeper level, we present mounting evidence that different neural structures play different roles in guiding risky choices in these different domains. Some structures are differentially activated by risky gains and risky losses while others respond uniquely in one domain or the other. Taken together, these studies support a clear functional dissociation between risk-taking for gains and risk-taking for losses, and further dissociation at the neural level. PMID:22347161

Public attitudes and values in priority setting.

PubMed

Peacock, Stuart J

2015-01-01

There is growing recognition that critical decisions concerning investments in new health care technologies and services should incorporate society's values along with the scientific evidence. From a normative perspective, public engagement can help realize the democratic ideals of legitimacy, transparency, and accountability. On a more pragmatic level, public engagement can help stakeholders understand the degree of popular support for policy options, and may enhance public trust in decision-making processes. To better understand public attitudes and values relating to priority setting in health care, researchers and decision-makers will have to employ a range of quantitative and qualitative approaches, drawing on different disciplines and methodological traditions.

The once and future application of cost-effectiveness analysis.

PubMed

Berger, M L

1999-09-01

Cost-effectiveness analysis (CEA) is used by payers to make coverage decisions, by providers to make formulary decisions, and by large purchasers/employers and policymakers to choose health care performance measures. However, it continues to be poorly utilized in the marketplace because of overriding financial imperatives to control costs and a low apparent willingness to pay for quality. There is no obvious relationship between the cost-effectiveness of life-saving interventions and their application. Health care decision makers consider financial impact, safety, and effectiveness before cost-effectiveness. WHY IS CEA NOT MORE WIDELY APPLIED? Most health care providers have a short-term parochial financial perspective, whereas CEA takes a long-term view that captures all costs, benefits, and hazards, regardless of to whom they accrue. In addition, a history of poor standardization of methods, unrealistic expectations that CEA could answer fundamental ethical and political issues, and society's failure to accept the need for allocating scarce resources more judiciously, have contributed to relatively little use of the method by decision makers. HOW WILL CEA FIND GREATER UTILITY IN THE FUTURE? As decision makers take a longer-term view and understand that CEA can provide a quantitative perspective on important resource allocation decisions, including the distributional consequences of alternative choices, CEA is likely to find greater use. However, it must be embedded within a framework that promotes confidence in the social justice of health care decision making through ongoing dialogue about how the value of health and health care are defined.

Comparative Effectiveness of Context-Based and Traditional Approaches in Teaching Genetics: Student Views and Achievement

ERIC Educational Resources Information Center

Kazeni, Monde; Onwu, Gilbert

2013-01-01

The study aimed to determine the comparative effectiveness of context-based and traditional teaching approaches in enhancing student achievement in genetics, problem-solving, science inquiry and decision-making skills, and attitude towards the study of life sciences. A mixed method but essentially quantitative research approach involving a…

Evaluation of safe routes to school programs : qualitative and quantitative analysis of parental decision-making.

DOT National Transportation Integrated Search

2011-08-01

In the United States, walking to school declined from 42% of 5-18 year olds in 1969 to 16% in 20011. The US : Department of Transportation has responded to this dramatic decrease by funding the Safe Routes to School program : for $612 million in SAFE...

Battered Women's Concern for Their Pets: A Closer Look

ERIC Educational Resources Information Center

Strand, Elizabeth B.; Faver, Catherine A.

2005-01-01

Building on the foundation of previous research about battered women's experiences with animal abuse, this study takes a closer look at: (1) the factors associated with battered women's concern for their pets and (2) decision making associated with this concern. Quantitative survey data of in-shelter domestic violence victims as well as…

Statistical Significance and Effect Size: Two Sides of a Coin.

ERIC Educational Resources Information Center

Fan, Xitao

This paper suggests that statistical significance testing and effect size are two sides of the same coin; they complement each other, but do not substitute for one another. Good research practice requires that both should be taken into consideration to make sound quantitative decisions. A Monte Carlo simulation experiment was conducted, and a…

Campbell's Law and the Ethics of Immensurability

ERIC Educational Resources Information Center

Sidorkin, Alexander M.

2016-01-01

The paper examines "Campbell's Law": "The more any quantitative social indicator is used for social decision-making, the more subject it will be to corruption pressures and the more apt it will be to distort and corrupt the social processes it is intended to monitor." The examination of measurability leads to explaining the…

The Intransitivity of Educational Preferences

ERIC Educational Resources Information Center

Smith, Debra Candace

2013-01-01

This study sought to answer the question of whether the existence of cycles in education are random events, or if cycles in education are likely to be expected on a regular basis due to intransitive decision-making patterns of stakeholders. This was a quantitative study, modeled after two previously conducted studies (Davis, 1958/59; May, 1954),…

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

ERIC Educational Resources Information Center

Herrera, Cheryl

2013-01-01

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

Efficiency Analysis: Enhancing the Statistical and Evaluative Power of the Regression-Discontinuity Design.

ERIC Educational Resources Information Center

Madhere, Serge

An analytic procedure, efficiency analysis, is proposed for improving the utility of quantitative program evaluation for decision making. The three features of the procedure are explained: (1) for statistical control, it adopts and extends the regression-discontinuity design; (2) for statistical inferences, it de-emphasizes hypothesis testing in…

Risk Assessment: Evidence Base

NASA Technical Reports Server (NTRS)

Johnson-Throop, Kathy A.

2007-01-01

Human systems PRA (Probabilistic Risk Assessment: a) Provides quantitative measures of probability, consequence, and uncertainty; and b) Communicates risk and informs decision-making. Human health risks rated highest in ISS PRA are based on 1997 assessment of clinical events in analog operational settings. Much work remains to analyze remaining human health risks identified in Bioastronautics Roadmap.

Validation of the Quantitative Diagnostic Thinking Inventory for Athletic Training: A Pilot Study

ERIC Educational Resources Information Center

Kicklighter, Taz; Barnum, Mary; Geisler, Paul R.; Martin, Malissa

2016-01-01

Context: The cognitive process of making a clinical decision lies somewhere on a continuum between novices using hypothetico-deductive reasoning and experts relying more on case pattern recognition. Although several methods exist for measuring facets of clinical reasoning in specific situations, none have been experimentally applied, as of yet, to…

Operational seasonal forecasting of crop performance.

PubMed

Stone, Roger C; Meinke, Holger

2005-11-29

Integrated, interdisciplinary crop performance forecasting systems, linked with appropriate decision and discussion support tools, could substantially improve operational decision making in agricultural management. Recent developments in connecting numerical weather prediction models and general circulation models with quantitative crop growth models offer the potential for development of integrated systems that incorporate components of long-term climate change. However, operational seasonal forecasting systems have little or no value unless they are able to change key management decisions. Changed decision making through incorporation of seasonal forecasting ultimately has to demonstrate improved long-term performance of the cropping enterprise. Simulation analyses conducted on specific production scenarios are especially useful in improving decisions, particularly if this is done in conjunction with development of decision-support systems and associated facilitated discussion groups. Improved management of the overall crop production system requires an interdisciplinary approach, where climate scientists, agricultural scientists and extension specialists are intimately linked with crop production managers in the development of targeted seasonal forecast systems. The same principle applies in developing improved operational management systems for commodity trading organizations, milling companies and agricultural marketing organizations. Application of seasonal forecast systems across the whole value chain in agricultural production offers considerable benefits in improving overall operational management of agricultural production.

Operational seasonal forecasting of crop performance

PubMed Central

Stone, Roger C; Meinke, Holger

2005-01-01

Integrated, interdisciplinary crop performance forecasting systems, linked with appropriate decision and discussion support tools, could substantially improve operational decision making in agricultural management. Recent developments in connecting numerical weather prediction models and general circulation models with quantitative crop growth models offer the potential for development of integrated systems that incorporate components of long-term climate change. However, operational seasonal forecasting systems have little or no value unless they are able to change key management decisions. Changed decision making through incorporation of seasonal forecasting ultimately has to demonstrate improved long-term performance of the cropping enterprise. Simulation analyses conducted on specific production scenarios are especially useful in improving decisions, particularly if this is done in conjunction with development of decision-support systems and associated facilitated discussion groups. Improved management of the overall crop production system requires an interdisciplinary approach, where climate scientists, agricultural scientists and extension specialists are intimately linked with crop production managers in the development of targeted seasonal forecast systems. The same principle applies in developing improved operational management systems for commodity trading organizations, milling companies and agricultural marketing organizations. Application of seasonal forecast systems across the whole value chain in agricultural production offers considerable benefits in improving overall operational management of agricultural production. PMID:16433097

Wishful Thinking? Inside the Black Box of Exposure Assessment.

PubMed

Money, Annemarie; Robinson, Christine; Agius, Raymond; de Vocht, Frank

2016-05-01

Decision-making processes used by experts when undertaking occupational exposure assessment are relatively unknown, but it is often assumed that there is a common underlying method that experts employ. However, differences in training and experience of assessors make it unlikely that one general method for expert assessment would exist. Therefore, there are concerns about formalizing, validating, and comparing expert estimates within and between studies that are difficult, if not impossible, to characterize. Heuristics on the other hand (the processes involved in decision making) have been extensively studied. Heuristics are deployed by everyone as short-cuts to make the often complex process of decision-making simpler, quicker, and less burdensome. Experts' assessments are often subject to various simplifying heuristics as a way to reach a decision in the absence of sufficient data. Therefore, investigating the underlying heuristics or decision-making processes involved may help to shed light on the 'black box' of exposure assessment. A mixed method study was conducted utilizing both a web-based exposure assessment exercise incorporating quantitative and semiqualitative elements of data collection, and qualitative semi-structured interviews with exposure assessors. Qualitative data were analyzed using thematic analysis. Twenty-five experts completed the web-based exposure assessment exercise and 8 of these 25 were randomly selected to participate in the follow-up interview. Familiar key themes relating to the exposure assessment exercise emerged; 'intensity'; 'probability'; 'agent'; 'process'; and 'duration' of exposure. However, an important aspect of the detailed follow-up interviews revealed a lack of structure and order with which participants described their decision making. Participants mostly described some form of an iterative process, heavily relying on the anchoring and adjustment heuristic, which differed between experts. In spite of having undertaken comparable training (in occupational hygiene or exposure assessment), experts use different methods to assess exposure. Decision making appears to be an iterative process with heavy reliance on the key heuristic of anchoring and adjustment. Using multiple experts to assess exposure while providing some form of anchoring scenario to build from, and additional training in understanding the impact of simple heuristics on the process of decision making, is likely to produce a more methodical approach to assessment; thereby improving consistency and transparency in expert exposure assessment. © The Author 2016. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

Wishful Thinking? Inside the Black Box of Exposure Assessment

PubMed Central

Money, Annemarie; Robinson, Christine; Agius, Raymond; de Vocht, Frank

2016-01-01

Background: Decision-making processes used by experts when undertaking occupational exposure assessment are relatively unknown, but it is often assumed that there is a common underlying method that experts employ. However, differences in training and experience of assessors make it unlikely that one general method for expert assessment would exist. Therefore, there are concerns about formalizing, validating, and comparing expert estimates within and between studies that are difficult, if not impossible, to characterize. Heuristics on the other hand (the processes involved in decision making) have been extensively studied. Heuristics are deployed by everyone as short-cuts to make the often complex process of decision-making simpler, quicker, and less burdensome. Experts’ assessments are often subject to various simplifying heuristics as a way to reach a decision in the absence of sufficient data. Therefore, investigating the underlying heuristics or decision-making processes involved may help to shed light on the ‘black box’ of exposure assessment. Methods: A mixed method study was conducted utilizing both a web-based exposure assessment exercise incorporating quantitative and semiqualitative elements of data collection, and qualitative semi-structured interviews with exposure assessors. Qualitative data were analyzed using thematic analysis. Results: Twenty-five experts completed the web-based exposure assessment exercise and 8 of these 25 were randomly selected to participate in the follow-up interview. Familiar key themes relating to the exposure assessment exercise emerged; ‘intensity’; ‘probability’; ‘agent’; ‘process’; and ‘duration’ of exposure. However, an important aspect of the detailed follow-up interviews revealed a lack of structure and order with which participants described their decision making. Participants mostly described some form of an iterative process, heavily relying on the anchoring and adjustment heuristic, which differed between experts. Conclusion: In spite of having undertaken comparable training (in occupational hygiene or exposure assessment), experts use different methods to assess exposure. Decision making appears to be an iterative process with heavy reliance on the key heuristic of anchoring and adjustment. Using multiple experts to assess exposure while providing some form of anchoring scenario to build from, and additional training in understanding the impact of simple heuristics on the process of decision making, is likely to produce a more methodical approach to assessment; thereby improving consistency and transparency in expert exposure assessment. PMID:26764244

Nurse-led immunotreatment DEcision Coaching In people with Multiple Sclerosis (DECIMS) - Feasibility testing, pilot randomised controlled trial and mixed methods process evaluation.

PubMed

Rahn, A C; Köpke, S; Backhus, I; Kasper, J; Anger, K; Untiedt, B; Alegiani, A; Kleiter, I; Mühlhauser, I; Heesen, C

2018-02-01

Treatment decision-making is complex for people with multiple sclerosis. Profound information on available options is virtually not possible in regular neurologist encounters. The "nurse decision coach model" was developed to redistribute health professionals' tasks in supporting immunotreatment decision-making following the principles of informed shared decision-making. To test the feasibility of a decision coaching programme and recruitment strategies to inform the main trial. Feasibility testing and parallel pilot randomised controlled trial, accompanied by a mixed methods process evaluation. Two German multiple sclerosis university centres. People with suspected or relapsing-remitting multiple sclerosis facing immunotreatment decisions on first line drugs were recruited. Randomisation to the intervention (n = 38) or control group (n = 35) was performed on a daily basis. Quantitative and qualitative process data were collected from people with multiple sclerosis, nurses and physicians. We report on the development and piloting of the decision coaching programme. It comprises a training course for multiple sclerosis nurses and the coaching intervention. The intervention consists of up to three structured nurse-led decision coaching sessions, access to an evidence-based online information platform (DECIMS-Wiki) and a final physician consultation. After feasibility testing, a pilot randomised controlled trial was performed. People with multiple sclerosis were randomised to the intervention or control group. The latter had also access to the DECIMS-Wiki, but received otherwise care as usual. Nurses were not blinded to group assignment, while people with multiple sclerosis and physicians were. The primary outcome was 'informed choice' after six months including the sub-dimensions' risk knowledge (after 14 days), attitude concerning immunotreatment (after physician consultation), and treatment uptake (after six months). Quantitative process evaluation data were collected via questionnaires. Qualitative interviews were performed with all nurses and a convenience sample of nine people with multiple sclerosis. 116 people with multiple sclerosis fulfilled the inclusion criteria and 73 (63%) were included. Groups were comparable at baseline. Data of 51 people with multiple sclerosis (70%) were available for the primary endpoint. In the intervention group 15 of 31 (48%) people with multiple sclerosis achieved an informed choice after six months and 6 of 20 (30%) in the control group. Process evaluation data illustrated a positive response towards the coaching programme as well as good acceptance. The pilot-phase showed promising results concerning acceptability and feasibility of the intervention, which was well perceived by people with multiple sclerosis, most nurses and physicians. Delegating parts of the immunotreatment decision-making process to trained nurses has the potential to increase informed choice and participation as well as effectiveness of patient-physician consultations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Dual Processes in Decision Making and Developmental Neuroscience: A Fuzzy-Trace Model.

PubMed

Reyna, Valerie F; Brainerd, Charles J

2011-09-01

From Piaget to the present, traditional and dual-process theories have predicted improvement in reasoning from childhood to adulthood, and improvement has been observed. However, developmental reversals-that reasoning biases emerge with development -have also been observed in a growing list of paradigms. We explain how fuzzy-trace theory predicts both improvement and developmental reversals in reasoning and decision making. Drawing on research on logical and quantitative reasoning, as well as on risky decision making in the laboratory and in life, we illustrate how the same small set of theoretical principles apply to typical neurodevelopment, encompassing childhood, adolescence, and adulthood, and to neurological conditions such as autism and Alzheimer's disease. For example, framing effects-that risk preferences shift when the same decisions are phrases in terms of gains versus losses-emerge in early adolescence as gist-based intuition develops. In autistic individuals, who rely less on gist-based intuition and more on verbatim-based analysis, framing biases are attenuated (i.e., they outperform typically developing control subjects). In adults, simple manipulations based on fuzzy-trace theory can make framing effects appear and disappear depending on whether gist-based intuition or verbatim-based analysis is induced. These theoretical principles are summarized and integrated in a new mathematical model that specifies how dual modes of reasoning combine to produce predictable variability in performance. In particular, we show how the most popular and extensively studied model of decision making-prospect theory-can be derived from fuzzy-trace theory by combining analytical (verbatim-based) and intuitive (gist-based) processes.

The effects of fatigue on decision making and shooting skill performance in water polo players.

PubMed

Royal, Kylie A; Farrow, Damian; Mujika, Iñigo; Halson, Shona L; Pyne, David; Abernethy, Bruce

2006-08-01

The aim of this study was to assess the effects of fatigue on decision making and goal shooting skill in water polo. Fourteen junior elite male players (age 17.2 +/- 0.5 years; mass 84.2 +/- 7.6 kg; height 1.85 +/- 0.05 m) completed four sets of eight repetitions of an approximately 18 s maximal water polo specific drill. Progressively declining rest ratios for each successive set of the drill were employed to induce increasing fatigue and reflect the demands of match-play. A video-based temporally occluded decision-making task (verbalized response to various tactical situations) or goal shooting skill test (qualitative and quantitative analysis of goal shooting) was performed after each set. Heart rate, rating of perceived exertion (RPE) and blood lactate concentration were recorded. Heart rate (159 +/- 12, 168 +/- 13, 176 +/- 12, 181 +/- 12 Deats min-1; P < 0.001) and RPE (13.1 +/- 2.2, 15.5 +/- 1.7, 17.3 +/- 1.6, 19.1 +/- 1.1; P < 0.001) increased with declining rest ratios. At very high fatigue, decision-making accuracy was 18.0 +/- 21.8% better than at low fatigue (P = 0.008). Shooting accuracy and velocity were unaffected by incremental fatigue; however, skill proficiency (technique) decreased by 43 +/- 24% between the pre-test and high-fatigue conditions (P < 0.001). In conclusion, incremental increases in fatigue differentially influenced decision making (improved) relative to the technical performance (declined), accuracy and speed of the ball (unchanged) of a water polo goal shot.

Nonmonetary Decision-Making Indices Discriminate Between Different Behavioral Components of Gambling.

PubMed

Navas, Juan F; Torres, Ana; Vilar, Raquel; Verdejo-García, Antonio; Catena, Andrés; Perales, José C

2015-12-01

Recent research has proposed that altered reward and punishment sensitivity, heightened impulsivity, and faulty dynamic decision-making are at the core of disordered gambling. However, each of these traits and cognitive aspects dimensionally vary in the normal population, such that the link between individual differences in these dimensions and gambling use can be ultimately informative to explain disordered gambling. The main aim of the present study was to investigate the contribution of such decision-making-related indices to gambling use parameters in a community sample of college students. Assessment included punishment and reward sensitivity (as measured by the shortened Sensitivity to Punishment and Sensitivity to Reward Questionnaire), impulsivity (as measured by the UPPS-P model and a motor inhibition Go/No-go task), and dynamic decision-making [as measured by the probabilistic reversal learning task (PRLT)]. A structured interview was conducted to explore quantitative aspects of the participants gambling habits (gambling presence, gambling frequency, and average amount of money spent in gambling per unit of time). Our results showed the existence of a decision-making profile of gambling, as it naturally occurs in college students, in which sensation seeking is directly and specifically related to gambling presence (gambling, or not gambling at all), punishment sensitivity is inversely related to gambling frequency, and inflexibility in the PRLT specifically predicts the losses accrued because of gambling. These results are compatible with the idea that sensation seeking and punishment insensitivity could increase exposure to gambling activities, whereas reversal learning inflexibility, in people who already gamble, could boost the risk to accumulate losses.

Health sector decentralization and local decision-making: Decision space, institutional capacities and accountability in Pakistan.

PubMed

Bossert, Thomas John; Mitchell, Andrew David

2011-01-01

Health sector decentralization has been widely adopted to improve delivery of health services. While many argue that institutional capacities and mechanisms of accountability required to transform decentralized decision-making into improvements in local health systems are lacking, few empirical studies exist which measure or relate together these concepts. Based on research instruments administered to a sample of 91 health sector decision-makers in 17 districts of Pakistan, this study analyzes relationships between three dimensions of decentralization: decentralized authority (referred to as "decision space"), institutional capacities, and accountability to local officials. Composite quantitative indicators of these three dimensions were constructed within four broad health functions (strategic and operational planning, budgeting, human resources management, and service organization/delivery) and on an overall/cross-function basis. Three main findings emerged. First, district-level respondents report varying degrees of each dimension despite being under a single decentralization regime and facing similar rules across provinces. Second, within dimensions of decentralization-particularly decision space and capacities-synergies exist between levels reported by respondents in one function and those reported in other functions (statistically significant coefficients of correlation ranging from ρ=0.22 to ρ=0.43). Third, synergies exist across dimensions of decentralization, particularly in terms of an overall indicator of institutional capacities (significantly correlated with both overall decision space (ρ=0.39) and accountability (ρ=0.23)). This study demonstrates that decentralization is a varied experience-with some district-level officials making greater use of decision space than others and that those who do so also tend to have more capacity to make decisions and are held more accountable to elected local officials for such choices. These findings suggest that Pakistan's decentralization policy should focus on synergies among dimensions of decentralization to encouraging more use of de jure decision space, work toward more uniform institutional capacity, and encourage greater accountability to local elected officials. Copyright © 2010 Elsevier Ltd. All rights reserved.

Evolution and Evaluation of ECG Interpretation Systems-An Illustration of the Validation of Decision Support Systems

PubMed Central

van Bemmel, Jan H.; Kors, Jan A.; Willems, Jos L.; van Herpen, Gerard

1990-01-01

The last decade has shown a growing interest in medical decision making, strongly stimulated by the advent of artificial intelligence. This wave of interest is not the first one; it was preceded by other models and approaches to medical decision support. However, not all developments have resulted in equally successful decision support systems. Positive exceptions are the interpretation systems for ECGs that evolved all the way from very primitive attempts to well-accepted and highly-computerized clinical systems for which a major evaluation study (CSE, Common Standards for Quantitative Electrocardiography) is finalized in 1990. The evolution and the evaluation of the systems that took part in this study, is the subject of this paper.

PAlliative Care in chronic Kidney diSease: the PACKS study--quality of life, decision making, costs and impact on carers in people managed without dialysis.

PubMed

Noble, Helen Rose; Agus, Ashley; Brazil, Kevin; Burns, Aine; Goodfellow, Nicola A; Guiney, Mary; McCourt, Fiona; McDowell, Cliona; Normand, Charles; Roderick, Paul; Thompson, Colin; Maxwell, A P; Yaqoob, M M

2015-07-11

The number of patients with advanced chronic kidney disease opting for conservative management rather than dialysis is unknown but likely to be growing as increasingly frail patients with advanced renal disease present to renal services. Conservative kidney management includes ongoing medical input and support from a multidisciplinary team. There is limited evidence concerning patient and carer experience of this choice. This study will explore quality of life, symptoms, cognition, frailty, performance decision making, costs and impact on carers in people with advanced chronic kidney disease managed without dialysis and is funded by the National Institute of Health Research in the UK. In this prospective, multicentre, longitudinal study, patients will be recruited in the UK, by renal research nurses, once they have made the decision not to embark on dialysis. Carers will be asked to 'opt-in' with consent from patients. The approach includes longitudinal quantitative surveys of quality of life, symptoms, decision making and costs for patients and quality of life and costs for carers, with questionnaires administered quarterly over 12 months. Additionally, the decision making process will be explored via qualitative interviews with renal physicians/clinical nurse specialists. The study is designed to capture patient and carer profiles when conservative kidney management is implemented, and understand trajectories of care-receiving and care-giving with the aim of optimising palliative care for this population. It will explore the interactions that lead to clinical care decisions and the impact of these decisions on informal carers with the intention of improving clinical outcomes for patients and the experiences of care givers.

Application of Multi-Criteria Decision Making (MCDM) Technique for Gradation of Jute Fibres

NASA Astrophysics Data System (ADS)

Choudhuri, P. K.

2014-12-01

Multi-Criteria Decision Making is a branch of Operation Research (OR) having a comparatively short history of about 40 years. It is being popularly used in the field of engineering, banking, fixing policy matters etc. It can also be applied for taking decisions in daily life like selecting a car to purchase, selecting bride or groom and many others. Various MCDM methods namely Weighted Sum Model (WSM), Weighted Product Model (WPM), Analytic Hierarchy Process (AHP), Technique for Order Preference by Similarity to Ideal Solutions (TOPSIS) and Elimination and Choice Translating Reality (ELECTRE) are there to solve many decision making problems, each having its own limitations. However it is very difficult to decide which MCDM method is the best. MCDM methods are prospective quantitative approaches for solving decision problems involving finite number of alternatives and criteria. Very few research works in textiles have been carried out with the help of this technique particularly where decision taking among several alternatives becomes the major problem based on some criteria which are conflicting in nature. Gradation of jute fibres on the basis of the criteria like strength, root content, defects, colour, density, fineness etc. is an important task to perform. The MCDM technique provides enough scope to be applied for the gradation of jute fibres or ranking among several varieties keeping in view a particular object and on the basis of some selection criteria and their relative weightage. The present paper is an attempt to explore the scope of applying the multiplicative AHP method of multi-criteria decision making technique to determine the quality values of selected jute fibres on the basis of some above stated important criteria and ranking them accordingly. A good agreement in ranking is observed between the existing Bureau of Indian Standards (BIS) grading and proposed method.

Quantitating Organoleptic Volatile Phenols in Smoke-Exposed Vitis vinifera Berries.

PubMed

Noestheden, Matthew; Thiessen, Katelyn; Dennis, Eric G; Tiet, Ben; Zandberg, Wesley F

2017-09-27

Accurate methods for quantitating volatile phenols (i.e., guaiacol, syringol, 4-ethylphenol, etc.) in smoke-exposed Vitis vinifera berries prior to fermentation are needed to predict the likelihood of perceptible smoke taint following vinification. Reported here is a complete, cross-validated analytical workflow to accurately quantitate free and glycosidically bound volatile phenols in smoke-exposed berries using liquid-liquid extraction, acid-mediated hydrolysis, and gas chromatography-tandem mass spectrometry. The reported workflow addresses critical gaps in existing methods for volatile phenols that impact quantitative accuracy, most notably the effect of injection port temperature and the variability in acid-mediated hydrolytic procedures currently used. Addressing these deficiencies will help the wine industry make accurate, informed decisions when producing wines from smoke-exposed berries.

The Effects of Emotive Reasoning on Secondary School Students' Decision-Making in the Context of Socioscientific Issues

NASA Astrophysics Data System (ADS)

Powell, Wardell A.

The discrepancy between what students are being taught within K-12 science classrooms and what they experience in the real world has been well documented. This study sought to explore the ways a high school biology curriculum, which integrates socioscientific issues, impacts students' emotive reasoning and their ability to evaluate evidence, make informed decisions on contemporary scientific dilemmas, and integrate scientific content knowledge in their reasoning on SSI. Both quantitative and qualitative methods were used to examine differences within and between an SSI treatment group and a comparison group as well as individual differences among students' responses over a semester of high school biology. Results indicated students used emotions largely to evaluate evidence and make decisions on contentious scientific dilemmas. In addition, the results showed students used newly gained scientific content knowledge to make logical predictions on contentious scientific issues. Statistical significance was found between groups of students in regard to their interest in the use of embryonic stem cell treatments to restore rats' vision, as well as students' abilities to evaluate evidence. Theoretical implications regarding the use of SSI in the classroom are presented.

Precautionary principles: a jurisdiction-free framework for decision-making under risk.

PubMed

Ricci, Paolo F; Cox, Louis A; MacDonald, Thomas R

2004-12-01

Fundamental principles of precaution are legal maxims that ask for preventive actions, perhaps as contingent interim measures while relevant information about causality and harm remains unavailable, to minimize the societal impact of potentially severe or irreversible outcomes. Such principles do not explain how to make choices or how to identify what is protective when incomplete and inconsistent scientific evidence of causation characterizes the potential hazards. Rather, they entrust lower jurisdictions, such as agencies or authorities, to make current decisions while recognizing that future information can contradict the scientific basis that supported the initial decision. After reviewing and synthesizing national and international legal aspects of precautionary principles, this paper addresses the key question: How can society manage potentially severe, irreversible or serious environmental outcomes when variability, uncertainty, and limited causal knowledge characterize their decision-making? A decision-analytic solution is outlined that focuses on risky decisions and accounts for prior states of information and scientific beliefs that can be updated as subsequent information becomes available. As a practical and established approach to causal reasoning and decision-making under risk, inherent to precautionary decision-making, these (Bayesian) methods help decision-makers and stakeholders because they formally account for probabilistic outcomes, new information, and are consistent and replicable. Rational choice of an action from among various alternatives--defined as a choice that makes preferred consequences more likely--requires accounting for costs, benefits and the change in risks associated with each candidate action. Decisions under any form of the precautionary principle reviewed must account for the contingent nature of scientific information, creating a link to the decision-analytic principle of expected value of information (VOI), to show the relevance of new information, relative to the initial (and smaller) set of data on which the decision was based. We exemplify this seemingly simple situation using risk management of BSE. As an integral aspect of causal analysis under risk, the methods developed in this paper permit the addition of non-linear, hormetic dose-response models to the current set of regulatory defaults such as the linear, non-threshold models. This increase in the number of defaults is an important improvement because most of the variants of the precautionary principle require cost-benefit balancing. Specifically, increasing the set of causal defaults accounts for beneficial effects at very low doses. We also show and conclude that quantitative risk assessment dominates qualitative risk assessment, supporting the extension of the set of default causal models.

Expectant parents' views of factors influencing infant feeding decisions in the antenatal period: A systematic review.

PubMed

Roll, Coralie L; Cheater, Francine

2016-08-01

To explore the factors that influence expectant parents' infant feeding decisions in the antenatal period. Mixed method systematic review focussing on participant views data. CINAHL, Medline, Embase and PsychInfo databases were interrogated using initial keywords and then refined terms to elicit relevant studies. Reference lists were checked and hand-searching was undertaken for 2 journals ('Midwifery' and 'Social Science and Medicine') covering a 3 year time period (January 2011-March 2014). Key inclusion criteria: studies reflecting expectant parents' views of the factors influencing their infant feeding decisions in the antenatal period; Studies in the English language published after 1990, from developed countries and of qualitative, quantitative or mixed method design. A narrative interpretive synthesis of the views data from studies of qualitative, quantitative and mixed method design. Data were extracted on study characteristics and parents' views, using the Social Ecological Model to support data extraction and thematic synthesis. Synthesis was influenced by the Evidence for Policy and Practice Information and Co-Ordinating Centre approach to mixed method reviews. Of the 409 studies identified through search methods, 17 studies met the inclusion criteria for the review. Thematic synthesis identified 9 themes: Bonding/Attachment; Body Image; Self Esteem/Confidence; Female Role Models; Family and Support Network; Lifestyle; Formal Information Sources; Knowledge; and Feeding in front of others/Public. The review identified a significant bias in the data towards negative factors relating to the breastfeeding decision, suggesting that infant feeding was not a choice between two feeding options, but rather a process of weighing reasons for and against breastfeeding. Findings reflected the perception of the maternal role as intrinsic to the expectant mothers' infant feeding decisions. Cultural perceptions permeated personal, familial and social influences on the decision-making process. Expectant mothers were sensitive to the way professionals attempted to support and inform them about infant feeding choices. By taking a Social Ecological perspective, we were able to explore and demonstrate the multiple influences impacting on expectant parents in the decision-making process. A better understanding of expectant parents' views and experiences in making infant feeding decisions in the prenatal and antenatal periods will inform public health policy and the coordination of service provision to support infant feeding activities. Copyright © 2016 Elsevier Ltd. All rights reserved.

Decision theory applied to image quality control in radiology.

PubMed

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

2008-11-13

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

Predictors of food decision making: A systematic interdisciplinary mapping (SIM) review.

PubMed

Symmank, Claudia; Mai, Robert; Hoffmann, Stefan; Stok, F Marijn; Renner, Britta; Lien, Nanna; Rohm, Harald

2017-03-01

The number of publications on consumer food decision making and its predictors and correlates has been steadily increasing over the last three decades. Given that different scientific disciplines illuminate this topic from different perspectives, it is necessary to develop an interdisciplinary overview. The aim of this study is to conduct a systematic interdisciplinary mapping (SIM) review by using rapid review techniques to explore the state-of-the-art, and to identify hot topics and research gaps in this field. This interdisciplinary review includes 1,820 publications in 485 different journals and other types of publications from more than ten disciplines (including nutritional science, medicine/health science, psychology, food science and technology, business research, etc.) across a period of 60 years. The identified predictors of food decision making were categorized in line with the recently proposed DONE (Determinants Of Nutrition and Eating behavior) framework. After applying qualitative and quantitative analyses, this study reveals that most of the research emphasizes biological, psychological, and product-related predictors, whereas policy-related influences on food choice are scarcely considered. Copyright © 2016 Elsevier Ltd. All rights reserved.

Decisions reduce sensitivity to subsequent information.

PubMed

Bronfman, Zohar Z; Brezis, Noam; Moran, Rani; Tsetsos, Konstantinos; Donner, Tobias; Usher, Marius

2015-07-07

Behavioural studies over half a century indicate that making categorical choices alters beliefs about the state of the world. People seem biased to confirm previous choices, and to suppress contradicting information. These choice-dependent biases imply a fundamental bound of human rationality. However, it remains unclear whether these effects extend to lower level decisions, and only little is known about the computational mechanisms underlying them. Building on the framework of sequential-sampling models of decision-making, we developed novel psychophysical protocols that enable us to dissect quantitatively how choices affect the way decision-makers accumulate additional noisy evidence. We find robust choice-induced biases in the accumulation of abstract numerical (experiment 1) and low-level perceptual (experiment 2) evidence. These biases deteriorate estimations of the mean value of the numerical sequence (experiment 1) and reduce the likelihood to revise decisions (experiment 2). Computational modelling reveals that choices trigger a reduction of sensitivity to subsequent evidence via multiplicative gain modulation, rather than shifting the decision variable towards the chosen alternative in an additive fashion. Our results thus show that categorical choices alter the evidence accumulation mechanism itself, rather than just its outcome, rendering the decision-maker less sensitive to new information. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

Multialternative drift-diffusion model predicts the relationship between visual fixations and choice in value-based decisions.

PubMed

Krajbich, Ian; Rangel, Antonio

2011-08-16

How do we make decisions when confronted with several alternatives (e.g., on a supermarket shelf)? Previous work has shown that accumulator models, such as the drift-diffusion model, can provide accurate descriptions of the psychometric data for binary value-based choices, and that the choice process is guided by visual attention. However, the computational processes used to make choices in more complicated situations involving three or more options are unknown. We propose a model of trinary value-based choice that generalizes what is known about binary choice, and test it using an eye-tracking experiment. We find that the model provides a quantitatively accurate description of the relationship between choice, reaction time, and visual fixation data using the same parameters that were estimated in previous work on binary choice. Our findings suggest that the brain uses similar computational processes to make binary and trinary choices.

Quantitative and qualitative methods in medical education research: AMEE Guide No 90: Part II.

PubMed

Tavakol, Mohsen; Sandars, John

2014-10-01

Abstract Medical educators need to understand and conduct medical education research in order to make informed decisions based on the best evidence, rather than rely on their own hunches. The purpose of this Guide is to provide medical educators, especially those who are new to medical education research, with a basic understanding of how quantitative and qualitative methods contribute to the medical education evidence base through their different inquiry approaches and also how to select the most appropriate inquiry approach to answer their research questions.

Quantitative and qualitative methods in medical education research: AMEE Guide No 90: Part I.

PubMed

Tavakol, Mohsen; Sandars, John

2014-09-01

Medical educators need to understand and conduct medical education research in order to make informed decisions based on the best evidence, rather than rely on their own hunches. The purpose of this Guide is to provide medical educators, especially those who are new to medical education research, with a basic understanding of how quantitative and qualitative methods contribute to the medical education evidence base through their different inquiry approaches and also how to select the most appropriate inquiry approach to answer their research questions.

Genetic toxicology at the crossroads-from qualitative hazard evaluation to quantitative risk assessment.

PubMed

White, Paul A; Johnson, George E

2016-05-01

Applied genetic toxicology is undergoing a transition from qualitative hazard identification to quantitative dose-response analysis and risk assessment. To facilitate this change, the Health and Environmental Sciences Institute (HESI) Genetic Toxicology Technical Committee (GTTC) sponsored a workshop held in Lancaster, UK on July 10-11, 2014. The event included invited speakers from several institutions and the contents was divided into three themes-1: Point-of-departure Metrics for Quantitative Dose-Response Analysis in Genetic Toxicology; 2: Measurement and Estimation of Exposures for Better Extrapolation to Humans and 3: The Use of Quantitative Approaches in Genetic Toxicology for human health risk assessment (HHRA). A host of pertinent issues were discussed relating to the use of in vitro and in vivo dose-response data, the development of methods for in vitro to in vivo extrapolation and approaches to use in vivo dose-response data to determine human exposure limits for regulatory evaluations and decision-making. This Special Issue, which was inspired by the workshop, contains a series of papers that collectively address topics related to the aforementioned themes. The Issue includes contributions that collectively evaluate, describe and discuss in silico, in vitro, in vivo and statistical approaches that are facilitating the shift from qualitative hazard evaluation to quantitative risk assessment. The use and application of the benchmark dose approach was a central theme in many of the workshop presentations and discussions, and the Special Issue includes several contributions that outline novel applications for the analysis and interpretation of genetic toxicity data. Although the contents of the Special Issue constitutes an important step towards the adoption of quantitative methods for regulatory assessment of genetic toxicity, formal acceptance of quantitative methods for HHRA and regulatory decision-making will require consensus regarding the relationships between genetic damage and disease, and the concomitant ability to use genetic toxicity results per se. © Her Majesty the Queen in Right of Canada 2016. Reproduced with the permission of the Minister of Health.

Has Lean improved organizational decision making?

PubMed

Simons, Pascale; Benders, Jos; Bergs, Jochen; Marneffe, Wim; Vandijck, Dominique

2016-06-13

Purpose - Sustainable improvement is likely to be hampered by ambiguous objectives and uncertain cause-effect relations in care processes (the organization's decision-making context). Lean management can improve implementation results because it decreases ambiguity and uncertainties. But does it succeed? Many quality improvement (QI) initiatives are appropriate improvement strategies in organizational contexts characterized by low ambiguity and uncertainty. However, most care settings do not fit this context. The purpose of this paper is to investigate whether a Lean-inspired change program changed the organization's decision-making context, making it more amenable for QI initiatives. Design/methodology/approach - In 2014, 12 professionals from a Dutch radiotherapy institute were interviewed regarding their perceptions of a Lean program in their organization and the perceived ambiguous objectives and uncertain cause-effect relations in their clinical processes. A survey (25 questions), addressing the same concepts, was conducted among the interviewees in 2011 and 2014. The structured interviews were analyzed using a deductive approach. Quantitative data were analyzed using appropriate statistics. Findings - Interviewees experienced improved shared visions and the number of uncertain cause-effect relations decreased. Overall, more positive (99) than negative Lean effects (18) were expressed. The surveys revealed enhanced process predictability and standardization, and improved shared visions. Practical implications - Lean implementation has shown to lead to greater transparency and increased shared visions. Originality/value - Lean management decreased ambiguous objectives and reduced uncertainties in clinical process cause-effect relations. Therefore, decision making benefitted from Lean increasing QI's sustainability.

The Iowa Gambling Task in Parkinson's disease: A meta-analysis on effects of disease and medication.

PubMed

Evens, Ricarda; Hoefler, Michael; Biber, Karolina; Lueken, Ulrike

2016-10-01

Decision-making under uncertainty as measured by the Iowa Gambling Task has frequently been studied in Parkinson's disease. The dopamine overdose hypothesis assumes that dopaminergic effects follow an inverted U-shaped function, restoring some cognitive functions while overdosing others. The present work quantitatively summarizes disease and medication effects on task performance and evaluates evidence for the dopamine overdose hypothesis of impaired decision-making in Parkinson's disease. A systematic literature search was performed to identify studies examining the Iowa Gambling Task in patients with Parkinson's disease. Outcomes were quantitatively combined, with separate estimates for the clinical (patients ON medication vs. healthy controls), disease (patients OFF medication vs. healthy controls), and medication effects (patients ON vs. OFF medication). Furthermore, using meta-regression analysis it was explored whether the study characteristics drug level, disease duration, and motor symptoms explained heterogeneous performance between studies. Patients with Parkinson's disease ON dopaminergic medication showed significantly impaired Iowa Gambling Task performance compared to healthy controls. This impairment was not normalized by short-term withdrawal of medication. Heterogeneity across studies was not explained by dopaminergic drug levels, disease durations or motor symptoms. While this meta-analysis showed significantly impaired decision-making performance in Parkinson's disease, there was no evidence that this impairment was related to dopamine overdosing. However, only very few studies assessed patients OFF medication and future studies are needed to concentrate on the modulation of dopaminergic drug levels and pay particular attention to problems related to repeated testing. Furthermore, short- vs. long-term medication effects demand further in-depth investigation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Brain responses to social norms: Meta-analyses of fMRI studies.

PubMed

Zinchenko, Oksana; Arsalidou, Marie

2018-02-01

Social norms have a critical role in everyday decision-making, as frequent interaction with others regulates our behavior. Neuroimaging studies show that social-based and fairness-related decision-making activates an inconsistent set of areas, which sometimes includes the anterior insula, anterior cingulate cortex, and others lateral prefrontal cortices. Social-based decision-making is complex and variability in findings may be driven by socio-cognitive activities related to social norms. To distinguish among social-cognitive activities related to social norms, we identified 36 eligible articles in the functional magnetic resonance imaging (fMRI) literature, which we separate into two categories (a) social norm representation and (b) norm violations. The majority of original articles (>60%) used tasks associated with fairness norms and decision-making, such as ultimatum game, dictator game, or prisoner's dilemma; the rest used tasks associated to violation of moral norms, such as scenarios and sentences of moral depravity ratings. Using quantitative meta-analyses, we report common and distinct brain areas that show concordance as a function of category. Specifically, concordance in ventromedial prefrontal regions is distinct to social norm representation processing, whereas concordance in right insula, dorsolateral prefrontal, and dorsal cingulate cortices is distinct to norm violation processing. We propose a neurocognitive model of social norms for healthy adults, which could help guide future research in social norm compliance and mechanisms of its enforcement. © 2017 Wiley Periodicals, Inc.

Bayesian adaptive survey protocols for resource management

USGS Publications Warehouse

Halstead, Brian J.; Wylie, Glenn D.; Coates, Peter S.; Casazza, Michael L.

2011-01-01

Transparency in resource management decisions requires a proper accounting of uncertainty at multiple stages of the decision-making process. As information becomes available, periodic review and updating of resource management protocols reduces uncertainty and improves management decisions. One of the most basic steps to mitigating anthropogenic effects on populations is determining if a population of a species occurs in an area that will be affected by human activity. Species are rarely detected with certainty, however, and falsely declaring a species absent can cause improper conservation decisions or even extirpation of populations. We propose a method to design survey protocols for imperfectly detected species that accounts for multiple sources of uncertainty in the detection process, is capable of quantitatively incorporating expert opinion into the decision-making process, allows periodic updates to the protocol, and permits resource managers to weigh the severity of consequences if the species is falsely declared absent. We developed our method using the giant gartersnake (Thamnophis gigas), a threatened species precinctive to the Central Valley of California, as a case study. Survey date was negatively related to the probability of detecting the giant gartersnake, and water temperature was positively related to the probability of detecting the giant gartersnake at a sampled location. Reporting sampling effort, timing and duration of surveys, and water temperatures would allow resource managers to evaluate the probability that the giant gartersnake occurs at sampled sites where it is not detected. This information would also allow periodic updates and quantitative evaluation of changes to the giant gartersnake survey protocol. Because it naturally allows multiple sources of information and is predicated upon the idea of updating information, Bayesian analysis is well-suited to solving the problem of developing efficient sampling protocols for species of conservation concern.

The role of emotion in clinical decision making: an integrative literature review.

PubMed

Kozlowski, Desirée; Hutchinson, Marie; Hurley, John; Rowley, Joanne; Sutherland, Joanna

2017-12-15

Traditionally, clinical decision making has been perceived as a purely rational and cognitive process. Recently, a number of authors have linked emotional intelligence (EI) to clinical decision making (CDM) and calls have been made for an increased focus on EI skills for clinicians. The objective of this integrative literature review was to identify and synthesise the empirical evidence for a role of emotion in CDM. A systematic search of the bibliographic databases PubMed, PsychINFO, and CINAHL (EBSCO) was conducted to identify empirical studies of clinician populations. Search terms were focused to identify studies reporting clinician emotion OR clinician emotional intelligence OR emotional competence AND clinical decision making OR clinical reasoning. Twenty three papers were retained for synthesis. These represented empirical work from qualitative, quantitative, and mixed-methods approaches and comprised work with a focus on experienced emotion and on skills associated with emotional intelligence. The studies examined nurses (10), physicians (7), occupational therapists (1), physiotherapists (1), mixed clinician samples (3), and unspecified infectious disease experts (1). We identified two main themes in the context of clinical decision making: the subjective experience of emotion; and, the application of emotion and cognition in CDM. Sub-themes under the subjective experience of emotion were: emotional response to contextual pressures; emotional responses to others; and, intentional exclusion of emotion from CDM. Under the application of emotion and cognition in CDM, sub-themes were: compassionate emotional labour - responsiveness to patient emotion within CDM; interdisciplinary tension regarding the significance and meaning of emotion in CDM; and, emotion and moral judgement. Clinicians' experienced emotions can and do affect clinical decision making, although acknowledgement of that is far from universal. Importantly, this occurs in the in the absence of a clear theoretical framework and educational preparation may not reflect the importance of emotional competence to effective CDM.

A fuzzy stochastic framework for managing hydro-environmental and socio-economic interactions under uncertainty

NASA Astrophysics Data System (ADS)

Subagadis, Yohannes Hagos; Schütze, Niels; Grundmann, Jens

2014-05-01

An amplified interconnectedness between a hydro-environmental and socio-economic system brings about profound challenges of water management decision making. In this contribution, we present a fuzzy stochastic approach to solve a set of decision making problems, which involve hydrologically, environmentally, and socio-economically motivated criteria subjected to uncertainty and ambiguity. The proposed methodological framework combines objective and subjective criteria in a decision making procedure for obtaining an acceptable ranking in water resources management alternatives under different type of uncertainty (subjective/objective) and heterogeneous information (quantitative/qualitative) simultaneously. The first step of the proposed approach involves evaluating the performance of alternatives with respect to different types of criteria. The ratings of alternatives with respect to objective and subjective criteria are evaluated by simulation-based optimization and fuzzy linguistic quantifiers, respectively. Subjective and objective uncertainties related to the input information are handled through linking fuzziness and randomness together. Fuzzy decision making helps entail the linguistic uncertainty and a Monte Carlo simulation process is used to map stochastic uncertainty. With this framework, the overall performance of each alternative is calculated using an Order Weighted Averaging (OWA) aggregation operator accounting for decision makers' experience and opinions. Finally, ranking is achieved by conducting pair-wise comparison of management alternatives. This has been done on the basis of the risk defined by the probability of obtaining an acceptable ranking and mean difference in total performance for the pair of management alternatives. The proposed methodology is tested in a real-world hydrosystem, to find effective and robust intervention strategies for the management of a coastal aquifer system affected by saltwater intrusion due to excessive groundwater extraction for irrigated agriculture and municipal use. The results show that the approach gives useful support for robust decision-making and is sensitive to the decision makers' degree of optimism.

Carbon innumeracy.

PubMed

Grinstein, Amir; Kodra, Evan; Chen, Stone; Sheldon, Seth; Zik, Ory

2018-01-01

Individuals must have a quantitative understanding of the carbon footprint tied to their everyday decisions to make efficient sustainable decisions. We report research of the innumeracy of individuals as it relates to their carbon footprint. In three studies that varied in terms of scale and sample, respondents estimate the quantity of CO2 released when combusting a gallon of gasoline in comparison to several well-known metrics including food calories and travel distance. Consistently, respondents estimated the quantity of CO2 from gasoline compared to other metrics with significantly less accuracy while exhibiting a tendency to underestimate CO2. Such relative absence of carbon numeracy of even a basic consumption habit may limit the effectiveness of environmental policies and campaigns aimed at changing individual behavior. We discuss several caveats as well as opportunities for policy design that could aid the improvement of people's quantitative understanding of their carbon footprint.

Reviewing Quantitative Research To Inform Educational Policy Processes. Fundamentals of Educational Planning.

ERIC Educational Resources Information Center

Hite, Seven J.

Educational planners and policymakers are rarely able to base their decision-making on sound information and research, according to this book. Because the situation is even more difficult in developing countries, educational policy often is based on research conducted in others parts of the world. This book provides a practical framework that can…

Experienced EFL Teachers' Professional Practical Knowledge, Reasoning and Classroom Decision Making in Egypt: Views from the Inside Out

ERIC Educational Resources Information Center

Abdelhafez, Ahmed

2014-01-01

This study aimed to investigate the areas that constituted the professional practical knowledge of experienced English as a Foreign Language teachers in Egypt and how their knowledge informed their classroom practice. Quantitative and qualitative data were collected from 236 preparatory and secondary school teachers in 38 schools through…

Capital Budgeting Guidelines: How to Decide Whether to Fund a New Dorm or an Upgraded Computer Lab.

ERIC Educational Resources Information Center

Swiger, John; Klaus, Allen

1996-01-01

A process for college and university decision making and budgeting for capital outlays that focuses on evaluating the qualitative and quantitative benefits of each proposed project is described and illustrated. The process provides a means to solicit suggestions from those involved and provide detailed information for cost-benefit analysis. (MSE)

The Role of Ethics in the Professional Development, Academic Preparation, and Decision-Making Processes of High School Leaders

ERIC Educational Resources Information Center

Platts, James Anthony

2017-01-01

This non-experimental quantitative study sought to examine high school principals' perceptions of their academic preparation program, ethical philosophies, and actions related to leadership. A 26-item "Principals' Perception Related to Ethics" survey that included an Ethical Trait chart and five open-ended questions used a five choice…

Students' High School Organizational Leadership Opportunities and Their Influences on Academic Achievement and Civic Participation

ERIC Educational Resources Information Center

Elemen, Jennifer E.

2015-01-01

The purpose of this quantitative study was to analyze high school leadership praxis for its inclusion of students in organizational leadership dialogue and decision-making and the influences of these factors on student achievement and civic participation. Survey questionnaire data were provided by 215 full-time enrolled undergraduate students from…

The Influence of Culture on Strategic Decision Making in Japan and China

DTIC Science & Technology

2011-09-01

literature, with classic studies arguing that military dictatorships are actually 33 Naoko Sajima...prone than non- dictatorships .36 Recent research, however, contends this hypothesis, with quantitative analysis showing that states with strong civilian... dictatorship naturally creates conditions where the military position and solutions have precedence over civilian leadership. By that basic definition, any

The Inevitable Corruption of Indicators and Educators through High-Stakes Testing

ERIC Educational Resources Information Center

Nichols, Sharon L.; Berliner, David C.

2005-01-01

This research provides lengthy proof of a principle of social science known as Campbell's law: "The more any quantitative social indicator is used for social decision-making, the more subject it will be to corruption pressures and the more apt it will be to distort and corrupt the social processes it is intended to monitor." Applying…

Development, Validity, and Reliability of the Preservice Teachers' Attitude toward Educational Research (P-TATER) Scale

ERIC Educational Resources Information Center

Gonyea, Nathan E.

2013-01-01

While there is a growing emphasis on the use of data in educational decision making and research to select educational interventions, there is still limited research on the attitudes of teachers toward research and even less research on preservice teachers' attitudes. Additionally, there are few quantitative instruments designed to measure…

Teaching Inferential Statistics to Social Work Students: A Decision-Making Flow Chart

ERIC Educational Resources Information Center

Calderwood, Kimberly A.

2012-01-01

Given that social work research courses are typically built on modernist principles of teaching and content, it is not surprising that the majority of social work students dread these courses. Few attempts have been made to better align the modernist content of quantitative research with the postmodern philosophy and values inherent in current…

A Data Warehouse Model for Micro-Level Decision Making in Higher Education

ERIC Educational Resources Information Center

van Dyk, Liezl

2008-01-01

An abundance of research, by educational researchers and scholars of teaching and learning alike, can be found on the use of ICT to plan design and deliver learning activities and assessment activities. The first steps of the instructional design process are covered quite thoroughly by this. However, the use of ICT and quantitative methods to…

One of These Things Is Not Like the Others: The Idea of Precedence in Health Technology Assessment and Coverage Decisions

PubMed Central

Giacomini, Mita

2005-01-01

Health plans often deliberate covering technologies with challenging purposes, effects, or costs. They must integrate quantitative evidence (e.g., how well a technology works) with qualitative, normative assessments (e.g., whether it works well enough for a worthwhile purpose). Arguments from analogy and precedent help integrate these criteria and establish standards for their policy application. Examples of arguments are described for three technologies (ICSI, genetic tests, and Viagra). Drawing lessons from law, ethics, philosophy, and the social sciences, a framework is developed for case-based evaluation of new technologies. The decision-making cycle includes (1) taking stock of past decisions and formulating precedents, (2) deciding new cases, and (3) assimilating decisions into the case history and evaluation framework. Each stage requires distinctive decision maker roles, information, and methods. PMID:15960769

Evaluating the impact of HIA on urban reconstruction decision-making. Who manages whose risks?

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

Bekker, Marleen P.M.; Putters, Kim; Grinten, Tom E.D. van der

2005-10-15

Practitioners and academic researchers increasingly look to evaluation of health impact assessment (HIA) to improve its practice, its efficiency and its legitimacy. Evaluation is also used to account to policy-makers, who express doubts that the benefits of HIA justify its costs. Until recently evaluation of HIA focused on instrument design and procedures but now the focus needs to shift to analysis of the interaction of HIA and decision-making. Multiple case studies have been applied to identify the conditions in which HIA produces the desired benefits. These studies used analytical concepts derived from the literature on evaluation, knowledge utilization, science ofmore » sociology and knowledge management. This paper describes a case study in which the strategic motives of the decision-makers affected the impact of an HIA. This HIA comprised of a quantitative environmental model 'City and Environment' that was used to assess environmental health impacts of an urban reconstruction plan in a Dutch city. The evaluation of the HIA shows that the decision to follow the recommendations of the HIA was part of a damage control strategy. The more HIA goals deviate from the policy problem and the less HIA is embedded in institutional procedures, then the more HIA impact will be subject to strategic decision-making behaviour. Appropriate cognitive and social strategies are needed to avoid 'negative learning' in those the HIA seeks to influence.« less

Integrated catchment modelling within a strategic planning and decision making process: Werra case study

NASA Astrophysics Data System (ADS)

Dietrich, Jörg; Funke, Markus

Integrated water resources management (IWRM) redefines conventional water management approaches through a closer cross-linkage between environment and society. The role of public participation and socio-economic considerations becomes more important within the planning and decision making process. In this paper we address aspects of the integration of catchment models into such a process taking the implementation of the European Water Framework Directive (WFD) as an example. Within a case study situated in the Werra river basin (Central Germany), a systems analytic decision process model was developed. This model uses the semantics of the Unified Modeling Language (UML) activity model. As an example application, the catchment model SWAT and the water quality model RWQM1 were applied to simulate the effect of phosphorus emissions from non-point and point sources on water quality. The decision process model was able to guide the participants of the case study through the interdisciplinary planning and negotiation of actions. Further improvements of the integration framework include tools for quantitative uncertainty analyses, which are crucial for real life application of models within an IWRM decision making toolbox. For the case study, the multi-criteria assessment of actions indicates that the polluter pays principle can be met at larger scales (sub-catchment or river basin) without significantly compromising cost efficiency for the local situation.

In the teeth of the evidence: the curious case of evidence-based medicine.

PubMed

Davidoff, F

1999-03-01

For a very long time, evidence from research has contributed to clinical decision making. Over the past 50 years, however, the nature of clinical research evidence has drastically changed compared with previous eras: its standards are higher, the tools for assembling and analyzing it are more powerful, and the context in which it is used is less authoritarian. The consequence has been a shift in both the concept and the practice of clinical decision making known as evidence-based medicine. Evidence-based decisions, by definition, use the strongest available evidence, are often more quantitatively informed than decisions made in the traditional fashion; and sometimes run counter to expert opinion. The techniques of evidence-based medicine are also helpful in resolving conflicting opinions. Evidence-based medicine did not simply appear in vacuo; its roots extend back at least as far as the great French Encyclopedia of the 18th century, and the subsequent work of Pierre Louis in Paris in the early 19th century. The power of the evidence-based approach has been enhanced in recent years by the development of the techniques of systematic review and meta-analysis. While this approach has its critics, we would all want the best available evidence used in making decisions about our care if we got sick. It is only fair that the patients under our care receive nothing less.

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

PubMed

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

2014-06-01

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

The Attentional Drift Diffusion Model of Simple Perceptual Decision-Making.

PubMed

Tavares, Gabriela; Perona, Pietro; Rangel, Antonio

2017-01-01

Perceptual decisions requiring the comparison of spatially distributed stimuli that are fixated sequentially might be influenced by fluctuations in visual attention. We used two psychophysical tasks with human subjects to investigate the extent to which visual attention influences simple perceptual choices, and to test the extent to which the attentional Drift Diffusion Model (aDDM) provides a good computational description of how attention affects the underlying decision processes. We find evidence for sizable attentional choice biases and that the aDDM provides a reasonable quantitative description of the relationship between fluctuations in visual attention, choices and reaction times. We also find that exogenous manipulations of attention induce choice biases consistent with the predictions of the model.

Psychosocial Working Conditions and Cognitive Complaints among Swedish Employees

PubMed Central

Stenfors, Cecilia U. D.; Magnusson Hanson, Linda; Oxenstierna, Gabriel; Theorell, Töres; Nilsson, Lars-Göran

2013-01-01

Background Cognitive complaints involving problems with concentration, memory, decision-making and thinking are relatively common in the work force. The sensitivity of both subjective and objective cognitive functioning to common psychiatric conditions, stress levels and to cognitive load makes it plausible that psychosocial working conditions play a role in cognitive complaints. Thus, this study aimed to test the associations between psychosocial work factors and cognitive complaints in nationally representative samples of the Swedish work force. Cross-sectional (n = 9751) and prospective (n = 3644; two time points two years apart) sequential multiple regression analyses were run, adjusting for general confounders, depressive- and sleeping problems. Additional prospective analyses were run adjusting for baseline cognitive complaints. Cross-sectional results High quantitative demands, information and communication technology (ICT) demands, underqualification and conflicts were positively associated with cognitive complaints, while social support, good resources at work and overqualification were negatively associated with cognitive complaints in all models. Skill discretion and decision authority were weakly associated with cognitive complaints. Conflicts were more strongly associated with cognitive complaints in women than in men, after adjustment for general confounders. Prospective results Quantitative job demands, ICT demands and underqualification were positively associated with future cognitive complaints in all models, including when adjusted for baseline cognitive complaints. Decision authority was weakly positively associated with future cognitive complaints, only after adjustment for depressive- and sleeping problems respectively. Social support was negatively associated with future cognitive complaints after adjustment for general confounders and baseline cognitive complaints. Skill discretion and resources were negatively associated with future cognitive complaints after adjustment for general confounders. The associations between quantitative demands and future cognitive complaints were stronger in women. Discussion/Conclusions The findings indicate that psychosocial working conditions should be taken into account when considering cognitive complaints among employees. PMID:23560101

Psychosocial Factors of Health Professionals' Intention to Use a Decision Aid for Down Syndrome Screening: Cross-Sectional Quantitative Study.

PubMed

Abbasgholizadeh Rahimi, Samira; Lépine, Johanie; Croteau, Jordie; Robitaille, Hubert; Giguere, Anik Mc; Wilson, Brenda J; Rousseau, François; Lévesque, Isabelle; Légaré, France

2018-04-25

Decisions about prenatal screening for Down syndrome are difficult for women, as they entail risk, potential loss, and regret. Shared decision making increases women's knowledge of their choices and better aligns decisions with their values. Patient decision aids foster shared decision making but are rarely used in this context. One of the most promising strategies for implementing shared decision making is distribution of decision aids by health professionals. We aimed to identify factors influencing their intention to use a DA during prenatal visit for decisions about Down syndrome screening. We conducted a cross-sectional quantitative study. Using a Web panel, we conducted a theory-based survey of health professionals in Quebec province (Canada). Eligibility criteria were as follows: (1) family physicians, midwives, obstetrician-gynecologists, or trainees in these professions; (2) involved in prenatal care; and (3) working in Quebec province. Participants watched a video depicting a health professional using a decision aid during a prenatal consultation with a woman and her partner, and then answered a questionnaire based on an extended version of the theory of planned behavior, including some of the constructs of the theoretical domains framework. The questionnaire assessed 8 psychosocial constructs (attitude, anticipated regret, subjective norm, self-identity, moral norm, descriptive norm, self-efficacy, and perceived control), 7 related sets of behavioral beliefs (advantages, disadvantages, emotions, sources of encouragement or discouragement, incentives, facilitators, and barriers), and sociodemographic data. We performed descriptive, bivariate, and multiple linear regression analyses to identify factors influencing health professionals' intention to use a decision aid. Among 330 health professionals who completed the survey, 310 met the inclusion criteria: family physicians, 55.2% (171/310); obstetrician-gynecologists, 33.8% (105/310); and midwives, 11.0% (34/310). Of these, 80.9% were female (251/310). Mean age was 39.6 (SD 11.5) years. Less than half were aware of any decision aids at all. In decreasing order of importance, factors influencing their intention to use a decision aid for Down syndrome prenatal screening were as follows: self-identity (beta=.325, P<.001), attitude (beta=.297, P<.001), moral norm (beta=.288, P<.001), descriptive norm (beta=.166, P<.001), and anticipated regret (beta=.099, P=.003). Underlying behavioral beliefs significantly related to intention were that the use of a decision aid would promote decision making (beta=.117, 95% CI 0.043-0.190), would reassure health professionals (beta=.100, 95% CI 0.024-0.175), and might require more time than planned for the consultation (beta=-.077, 95% CI -0.124 to -0.031). We identified psychosocial factors that could influence health professionals' intention to use a decision aid about Down syndrome screening. Strategies should remind them of the following: (1) using a decision aid for this purpose should be a common practice, (2) it would be expected of someone in their societal role, (3) the experience of using it will be satisfying and reassuring, and (4) it is likely to be compatible with their moral values. ©Samira Abbasgholizadeh Rahimi, Johanie Lépine, Jordie Croteau, Hubert Robitaille, Anik MC Giguere, Brenda J Wilson, François Rousseau, Isabelle Lévesque, France Légaré. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 25.04.2018.

Decision-Making About Upper Limb Tendon Transfer Surgery by People With Tetraplegia for More Than 10 Years.

PubMed

Dunn, Jennifer A; Hay-Smith, E Jean; Keeling, Sally; Sinnott, K Anne

2016-06-01

To quantify time from spinal cord injury to upper limb reconstructive surgery for individuals with tetraplegia; to explore influences on decision-making about surgery for persons with long-standing (>10y) tetraplegia; and to determine the applicability of our previously developed conceptual framework that described the decision-making processes for people with tetraplegia of <5 years. Quantitative-qualitative mixed-methods study. Community based in New Zealand. People (N=9) living with tetraplegia for >10 years. Not applicable. An audit of time frames between injury, assessment, and surgery for people with tetraplegia was undertaken. Interviews of people with tetraplegia were analyzed using constructivist grounded theory. Sixty-two percent of people with tetraplegia assessed for surgery had upper limb reconstructive surgery. Most were assessed within the first 3 years of spinal cord injury. Over half had surgery within 4 years after injury; however, 20% waited >10 years. Changes in prioritized activities, and the identification of tasks possible with surgery, were influential in the decision-making process. Participants were aware of surgery, but required a reoffer from health professionals before proceeding. The influence of peers was prominent in reinforcing the improvement in prioritized activities possible after surgery. Findings confirmed that the previously developed conceptual framework for decision-making about upper limb reconstructive surgery was applicable for people with tetraplegia of >10 years. Similarities were seen in the influence of goals and priorities (although the nature of these might change) and information from peers (although this influence was greater for those injured longer). Repeat offers for surgery were required to allow for changes in circumstances over time. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Introducing StatHand: A Cross-Platform Mobile Application to Support Students' Statistical Decision Making.

PubMed

Allen, Peter J; Roberts, Lynne D; Baughman, Frank D; Loxton, Natalie J; Van Rooy, Dirk; Rock, Adam J; Finlay, James

2016-01-01

Although essential to professional competence in psychology, quantitative research methods are a known area of weakness for many undergraduate psychology students. Students find selecting appropriate statistical tests and procedures for different types of research questions, hypotheses and data types particularly challenging, and these skills are not often practiced in class. Decision trees (a type of graphic organizer) are known to facilitate this decision making process, but extant trees have a number of limitations. Furthermore, emerging research suggests that mobile technologies offer many possibilities for facilitating learning. It is within this context that we have developed StatHand, a free cross-platform application designed to support students' statistical decision making. Developed with the support of the Australian Government Office for Learning and Teaching, StatHand guides users through a series of simple, annotated questions to help them identify a statistical test or procedure appropriate to their circumstances. It further offers the guidance necessary to run these tests and procedures, then interpret and report their results. In this Technology Report we will overview the rationale behind StatHand, before describing the feature set of the application. We will then provide guidelines for integrating StatHand into the research methods curriculum, before concluding by outlining our road map for the ongoing development and evaluation of StatHand.

[Governance in Guatemalan municipal development councils: an analysis of actors and power relationships].

PubMed

Flores, Walter; Gómez-Sánchez, Ismael

2010-01-01

Decentralisation and other public policies have created public spaces for participation in most Latin-American countries where community representatives, together with municipal authorities and other public functionaries, decide on social investment plans, including health services and infrastructure. The municipal development council system constitutes such public space in Guatemala. This study analysed such system's governance in a sample of 6 rural municipalities. A descriptive design was used, applying qualitative and quantitative techniques to study three central categories: the strategic actors, the rules of the game and power asymmetry levels amongst actors. The findings revealed inconsistencies amongst the actors who had to participate according to the legal framework and those actors who actually did so in practice. Divergent interests were also identified for participating which affected the possibility of reaching consensus during decision-making. Analysing the rules of the game led to identifying formal and non-formal mechanisms favouring some actors' ability to influence decisions. Analysing power asymmetry levels led to identifying that community representatives had fewer power resources than institutional representatives (local government and other government organisations). Community representatives also face different barriers blocking their participation and perceive a lesser capacity to influence decision-making. Existing barriers and fewer power resources experienced by community representatives reduce their abilities to influence decision-making in municipal development councils.

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

PubMed Central

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

2016-01-01

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

Patients' Non-Medical Characteristics Contribute to Collective Medical Decision-Making at Multidisciplinary Oncological Team Meetings.

PubMed

Restivo, Léa; Apostolidis, Thémis; Bouhnik, Anne-Déborah; Garciaz, Sylvain; Aurran, Thérèse; Julian-Reynier, Claire

2016-01-01

The contribution of patients' non-medical characteristics to individual physicians' decision-making has attracted considerable attention, but little information is available on this topic in the context of collective decision-making. Medical decision-making at cancer centres is currently carried out using a collective approach, at MultiDisciplinary Team (MDT) meetings. The aim of this study was to determine how patients' non-medical characteristics are presented at MDT meetings and how this information may affect the team's final medical decisions. Observations were conducted at a French Cancer Centre during MDT meetings at which non-standard cases involving some uncertainty were discussed from March to May 2014. Physicians' verbal statements and predefined contextual parameters were collected with a non-participant observational approach. Non numerical data collected in the form of open notes were then coded for quantitative analysis. Univariate and multivariate statistical analyses were performed. In the final sample of patients' records included and discussed (N = 290), non-medical characteristics were mentioned in 32.8% (n = 95) of the cases. These characteristics corresponded to demographics in 22.8% (n = 66) of the cases, psychological data in 11.7% (n = 34), and relational data in 6.2% (n = 18). The patient's age and his/her "likeability" were the most frequently mentioned characteristics. In 17.9% of the cases discussed, the final decision was deferred: this outcome was positively associated with the patients' non-medical characteristics and with uncertainty about the outcome of the therapeutic options available. The design of the study made it difficult to draw definite cause-and-effect conclusions. The Social Representations approach suggests that patients' non-medical characteristics constitute a kind of tacit professional knowledge that may be frequently mobilised in physicians' everyday professional practice. The links observed between patients' attributes and the medical decisions made at these meetings show that these attributes should be taken into account in order to understand how medical decisions are reached in difficult situations of this kind.

Dual Processes in Decision Making and Developmental Neuroscience: A Fuzzy-Trace Model

PubMed Central

Reyna, Valerie F.; Brainerd, Charles J.

2011-01-01

From Piaget to the present, traditional and dual-process theories have predicted improvement in reasoning from childhood to adulthood, and improvement has been observed. However, developmental reversals—that reasoning biases emerge with development —have also been observed in a growing list of paradigms. We explain how fuzzy-trace theory predicts both improvement and developmental reversals in reasoning and decision making. Drawing on research on logical and quantitative reasoning, as well as on risky decision making in the laboratory and in life, we illustrate how the same small set of theoretical principles apply to typical neurodevelopment, encompassing childhood, adolescence, and adulthood, and to neurological conditions such as autism and Alzheimer's disease. For example, framing effects—that risk preferences shift when the same decisions are phrases in terms of gains versus losses—emerge in early adolescence as gist-based intuition develops. In autistic individuals, who rely less on gist-based intuition and more on verbatim-based analysis, framing biases are attenuated (i.e., they outperform typically developing control subjects). In adults, simple manipulations based on fuzzy-trace theory can make framing effects appear and disappear depending on whether gist-based intuition or verbatim-based analysis is induced. These theoretical principles are summarized and integrated in a new mathematical model that specifies how dual modes of reasoning combine to produce predictable variability in performance. In particular, we show how the most popular and extensively studied model of decision making—prospect theory—can be derived from fuzzy-trace theory by combining analytical (verbatim-based) and intuitive (gist-based) processes. PMID:22096268

Mentor judgements and decision-making in the assessment of student nurse competence in practice: A mixed-methods study.

PubMed

Burden, Sarah; Topping, Anne Elizabeth; O'Halloran, Catherine

2018-05-01

To investigate how mentors form judgements and reach summative assessment decisions regarding student competence in practice. Competence assessment is a significant component of pre-registration nursing programmes in the United Kingdom. Concerns exist that assessments are subjective, lack consistency and that mentors fail to judge student performance as unsatisfactory. A two-stage sequential embedded mixed-methods design. Data collected 2012-2013. This study involved a whole student cohort completing a UK undergraduate adult nursing programme (N = 41). Stage 1: quantitative data on mentor conduct of assessment interviews and the final decision recorded (N = 330 from 270 mentors) were extracted from student Practice Assessment Documents (PADs). Stage 2: mentor feedback in student PADs was used in Stimulated Recall interviews with a purposive sample of final placement mentors (N = 17). These were thematically analysed. Findings were integrated to develop a theoretically driven model of mentor decision-making. Course assessment strategies and documentation had limited effect in framing mentor judgements and decisions. Rather, mentors amassed impressions, moderated by expectations of an "idealized student" by practice area and programme stage that influenced their management and outcome of the assessment process. These impressions were accumulated and combined into judgements that informed the final decision. This process can best be understood and conceptualized through the Brunswik's lens model of social judgement. Mentor decisions were reasoned and there was a shared understanding of judgement criteria and their importance. This impression-based nature of mentor decision-making questions the reliability and validity of competency-based assessments used in nursing pre-registration programmes. © 2017 John Wiley & Sons Ltd.

Spatially explicit multi-criteria decision analysis for managing vector-borne diseases

PubMed Central

2011-01-01

The complex epidemiology of vector-borne diseases creates significant challenges in the design and delivery of prevention and control strategies, especially in light of rapid social and environmental changes. Spatial models for predicting disease risk based on environmental factors such as climate and landscape have been developed for a number of important vector-borne diseases. The resulting risk maps have proven value for highlighting areas for targeting public health programs. However, these methods generally only offer technical information on the spatial distribution of disease risk itself, which may be incomplete for making decisions in a complex situation. In prioritizing surveillance and intervention strategies, decision-makers often also need to consider spatially explicit information on other important dimensions, such as the regional specificity of public acceptance, population vulnerability, resource availability, intervention effectiveness, and land use. There is a need for a unified strategy for supporting public health decision making that integrates available data for assessing spatially explicit disease risk, with other criteria, to implement effective prevention and control strategies. Multi-criteria decision analysis (MCDA) is a decision support tool that allows for the consideration of diverse quantitative and qualitative criteria using both data-driven and qualitative indicators for evaluating alternative strategies with transparency and stakeholder participation. Here we propose a MCDA-based approach to the development of geospatial models and spatially explicit decision support tools for the management of vector-borne diseases. We describe the conceptual framework that MCDA offers as well as technical considerations, approaches to implementation and expected outcomes. We conclude that MCDA is a powerful tool that offers tremendous potential for use in public health decision-making in general and vector-borne disease management in particular. PMID:22206355

Cognitive niches: an ecological model of strategy selection.

PubMed

Marewski, Julian N; Schooler, Lael J

2011-07-01

How do people select among different strategies to accomplish a given task? Across disciplines, the strategy selection problem represents a major challenge. We propose a quantitative model that predicts how selection emerges through the interplay among strategies, cognitive capacities, and the environment. This interplay carves out for each strategy a cognitive niche, that is, a limited number of situations in which the strategy can be applied, simplifying strategy selection. To illustrate our proposal, we consider selection in the context of 2 theories: the simple heuristics framework and the ACT-R (adaptive control of thought-rational) architecture of cognition. From the heuristics framework, we adopt the thesis that people make decisions by selecting from a repertoire of simple decision strategies that exploit regularities in the environment and draw on cognitive capacities, such as memory and time perception. ACT-R provides a quantitative theory of how these capacities adapt to the environment. In 14 simulations and 10 experiments, we consider the choice between strategies that operate on the accessibility of memories and those that depend on elaborate knowledge about the world. Based on Internet statistics, our model quantitatively predicts people's familiarity with and knowledge of real-world objects, the distributional characteristics of the associated speed of memory retrieval, and the cognitive niches of classic decision strategies, including those of the fluency, recognition, integration, lexicographic, and sequential-sampling heuristics. In doing so, the model specifies when people will be able to apply different strategies and how accurate, fast, and effortless people's decisions will be.

Student evaluations of teaching: teaching quantitative courses can be hazardous to one’s career

PubMed Central

Smibert, Dylan

2017-01-01

Anonymous student evaluations of teaching (SETs) are used by colleges and universities to measure teaching effectiveness and to make decisions about faculty hiring, firing, re-appointment, promotion, tenure, and merit pay. Although numerous studies have found that SETs correlate with various teaching effectiveness irrelevant factors (TEIFs) such as subject, class size, and grading standards, it has been argued that such correlations are small and do not undermine the validity of SETs as measures of professors’ teaching effectiveness. However, previous research has generally used inappropriate parametric statistics and effect sizes to examine and to evaluate the significance of TEIFs on personnel decisions. Accordingly, we examined the influence of quantitative vs. non-quantitative courses on SET ratings and SET based personnel decisions using 14,872 publicly posted class evaluations where each evaluation represents a summary of SET ratings provided by individual students responding in each class. In total, 325,538 individual student evaluations from a US mid-size university contributed to theses class evaluations. The results demonstrate that class subject (math vs. English) is strongly associated with SET ratings, has a substantial impact on professors being labeled satisfactory vs. unsatisfactory and excellent vs. non-excellent, and the impact varies substantially depending on the criteria used to classify professors as satisfactory vs. unsatisfactory. Professors teaching quantitative courses are far more likely not to receive tenure, promotion, and/or merit pay when their performance is evaluated against common standards. PMID:28503380

Student evaluations of teaching: teaching quantitative courses can be hazardous to one's career.

PubMed

Uttl, Bob; Smibert, Dylan

2017-01-01

Anonymous student evaluations of teaching (SETs) are used by colleges and universities to measure teaching effectiveness and to make decisions about faculty hiring, firing, re-appointment, promotion, tenure, and merit pay. Although numerous studies have found that SETs correlate with various teaching effectiveness irrelevant factors (TEIFs) such as subject, class size, and grading standards, it has been argued that such correlations are small and do not undermine the validity of SETs as measures of professors' teaching effectiveness. However, previous research has generally used inappropriate parametric statistics and effect sizes to examine and to evaluate the significance of TEIFs on personnel decisions. Accordingly, we examined the influence of quantitative vs. non-quantitative courses on SET ratings and SET based personnel decisions using 14,872 publicly posted class evaluations where each evaluation represents a summary of SET ratings provided by individual students responding in each class. In total, 325,538 individual student evaluations from a US mid-size university contributed to theses class evaluations. The results demonstrate that class subject (math vs. English) is strongly associated with SET ratings, has a substantial impact on professors being labeled satisfactory vs. unsatisfactory and excellent vs. non-excellent, and the impact varies substantially depending on the criteria used to classify professors as satisfactory vs. unsatisfactory. Professors teaching quantitative courses are far more likely not to receive tenure, promotion, and/or merit pay when their performance is evaluated against common standards.

Election Turnout Statistics in Many Countries: Similarities, Differences, and a Diffusive Field Model for Decision-Making

PubMed Central

Borghesi, Christian; Raynal, Jean-Claude; Bouchaud, Jean-Philippe

2012-01-01

We study in details the turnout rate statistics for 77 elections in 11 different countries. We show that the empirical results established in a previous paper for French elections appear to hold much more generally. We find in particular that the spatial correlation of turnout rates decay logarithmically with distance in all cases. This result is quantitatively reproduced by a decision model that assumes that each voter makes his mind as a result of three influence terms: one totally idiosyncratic component, one city-specific term with short-ranged fluctuations in space, and one long-ranged correlated field which propagates diffusively in space. A detailed analysis reveals several interesting features: for example, different countries have different degrees of local heterogeneities and seem to be characterized by a different propensity for individuals to conform to the cultural norm. We furthermore find clear signs of herding (i.e., strongly correlated decisions at the individual level) in some countries, but not in others. PMID:22615762

Openness initiative

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

Duncan, S.S.

1995-12-31

Although antinuclear campaigns seem to be effective, public communication and education efforts on low-level radioactive waste have mixed results. Attempts at public information programs on low-level radioactive waste still focus on influencing public opinion. A question then is: {open_quotes}Is it preferable to have a program focus on public education that will empower individuals to make informed decisions rather than trying to influence them in their decisions?{close_quotes} To address this question, a case study with both quantitative and qualitative data will be used. The Ohio Low-Level Radioactive Waste Education Program has a goal to provide people with information they want/need tomore » make their own decisions. The program initiated its efforts by conducting a statewide survey to determine information needed by people and where they turned for that information. This presentation reports data from the survey and then explores the program development process in which programs were designed and presented using the information. Pre and post data from the programs reveal attitude and knowledge shifts.« less

Probabilistic Exposure Analysis for Chemical Risk Characterization

PubMed Central

Bogen, Kenneth T.; Cullen, Alison C.; Frey, H. Christopher; Price, Paul S.

2009-01-01

This paper summarizes the state of the science of probabilistic exposure assessment (PEA) as applied to chemical risk characterization. Current probabilistic risk analysis methods applied to PEA are reviewed. PEA within the context of risk-based decision making is discussed, including probabilistic treatment of related uncertainty, interindividual heterogeneity, and other sources of variability. Key examples of recent experience gained in assessing human exposures to chemicals in the environment, and other applications to chemical risk characterization and assessment, are presented. It is concluded that, although improvements continue to be made, existing methods suffice for effective application of PEA to support quantitative analyses of the risk of chemically induced toxicity that play an increasing role in key decision-making objectives involving health protection, triage, civil justice, and criminal justice. Different types of information required to apply PEA to these different decision contexts are identified, and specific PEA methods are highlighted that are best suited to exposure assessment in these separate contexts. PMID:19223660

Content-Related Issues Pertaining to Teaching Statistics: Making Decisions about Educational Objectives in Statistics Courses.

ERIC Educational Resources Information Center

Bliss, Leonard B.; Tashakkori, Abbas

This paper discusses the objectives that would be appropriate for statistics classes for students who are not majoring in statistics, evaluation, or quantitative research design. These "non-majors" should be able to choose appropriate analytical methods for specific sets of data based on the research question and the nature of the data, and they…

Scores Assigned by Inexpert EFL Raters to Different Quality EFL Compositions, and the Raters' Decision-Making Behaviors

ERIC Educational Resources Information Center

Han, Turgay

2017-01-01

The aim of this study is to examine the variability in and reliability of scores assigned to different quality EFL compositions by EFL instructors and their rating behaviors. Using a mixed research design, quantitative data were collected from EFL instructors' ratings of 30 compositions of three different qualities using a holistic scoring rubric.…

Perceptions of Online Degrees by Hiring Managers at AACSB and IACBE Accredited Schools in the Mid-Atlantic Region of the United States

ERIC Educational Resources Information Center

Key, Damon L.

2017-01-01

The purpose of this quantitative cross-sectional study was to examine the current perceptions of online graduate degrees by academic hiring managers when making hiring decisions. The population studied consisted of deans, department chairs, human resource directors, and faculty at colleges and universities with AACSB and IACBE business program…

Health-related quality of life of young people and adults with primary or recurrent episodes of genital herpes: a mixed methods systematic review protocol.

PubMed

Bennett, Clare; Rebafka, Anne; Carrier, Judith; Edwards, Deborah; Jones, Jonathan

2018-05-01

The review questions are:The specific objectives are:This mixed methods review seeks to develop an aggregated synthesis of quantitative and qualitative data on the HRQOL implications of genital herpes for the individual in order to derive conclusions and recommendations for clinical practice and policy decision making.

The Inevitable Corruption of Indicators and Educators through High-Stakes Testing. Executive Summary

ERIC Educational Resources Information Center

Nichols, Sharon L.; Berliner, David C.

2005-01-01

This research provides lengthy proof of a principle of social science known as Campbell's law: "The more any quantitative social indicator is used for social decision-making, the more subject it will be to corruption pressures and the more apt it will be to distort and corrupt the social processes it is intended to monitor." Applying…

Sustainable Urban Forestry Potential Based Quantitative And Qualitative Measurement Using Geospatial Technique

NASA Astrophysics Data System (ADS)

Rosli, A. Z.; Reba, M. N. M.; Roslan, N.; Room, M. H. M.

2014-02-01

In order to maintain the stability of natural ecosystems around urban areas, urban forestry will be the best initiative to maintain and control green space in our country. Integration between remote sensing (RS) and geospatial information system (GIS) serves as an effective tool for monitoring environmental changes and planning, managing and developing a sustainable urbanization. This paper aims to assess capability of the integration of RS and GIS to provide information for urban forest potential sites based on qualitative and quantitative by using priority parameter ranking in the new township of Nusajaya. SPOT image was used to provide high spatial accuracy while map of topography, landuse, soils group, hydrology, Digital Elevation Model (DEM) and soil series data were applied to enhance the satellite image in detecting and locating present attributes and features on the ground. Multi-Criteria Decision Making (MCDM) technique provides structural and pair wise quantification and comparison elements and criteria for priority ranking for urban forestry purpose. Slope, soil texture, drainage, spatial area, availability of natural resource, and vicinity of urban area are criteria considered in this study. This study highlighted the priority ranking MCDM is cost effective tool for decision-making in urban forestry planning and landscaping.

Decision making around living and deceased donor kidney transplantation: a qualitative study exploring the importance of expected relationship changes.

PubMed

de Groot, Ingrid B; Schipper, Karen; van Dijk, Sandra; van der Boog, Paul J M; Stiggelbout, Anne M; Baranski, Andrzej G; Marang-van de Mheen, Perla J

2012-09-07

Limited data exist on the impact of living kidney donation on the donor-recipient relationship. Purpose of this study was to explore motivations to donate or accept a (living donor) kidney, whether expected relationship changes influence decision making and whether relationship changes are actually experienced. We conducted 6 focus groups in 47 of 114 invited individuals (41%), asking retrospectively about motivations and decision making around transplantation. We used qualitative and quantitative methods to analyze the focus group transcripts. Most deceased donor kidney recipients had a potential living donor available which they refused or did not want. They mostly waited for a deceased donor because of concern for the donor's health (75%). They more often expected negative relationship changes than living donor kidney recipients (75% vs. 27%, p = 0.01) who also expected positive changes. Living donor kidney recipients mostly accepted the kidney to improve their own quality of life (47%). Donors mostly donated a kidney because transplantation would make the recipient less dependent (25%). After transplantation both positive and negative relationship changes are experienced. Expected relationship changes and concerns about the donor's health lead some kidney patients to wait for a deceased donor, despite having a potential living donor available. Further research is needed to assess whether this concerns a selected group.

Does accountability for reasonableness work? A protocol for a mixed methods study using an audit tool to evaluate the decision-making of clinical commissioning groups in England.

PubMed

Kieslich, Katharina; Littlejohns, Peter

2015-07-10

Clinical commissioning groups (CCGs) in England are tasked with making difficult decisions on which healthcare services to provide against the background of limited budgets. The question is how to ensure that these decisions are fair and legitimate. Accounts of what constitutes fair and legitimate priority setting in healthcare include Daniels' and Sabin's accountability for reasonableness (A4R) and Clark's and Weale's framework for the identification of social values. This study combines these accounts and asks whether the decisions of those CCGs that adhere to elements of such accounts are perceived as fairer and more legitimate by key stakeholders. The study addresses the empirical gap arising from a lack of research on whether frameworks such as A4R hold what they promise. It aims to understand the criteria that feature in CCG decision-making. Finally, it examines the usefulness of a decision-making audit tool (DMAT) in identifying the process and content criteria that CCGs apply when making decisions. The adherence of a sample of CCGs to criteria emerging from theories of fair priority setting will be examined using the DMAT developed by PL. The results will be triangulated with data from semistructured interviews with key stakeholders in the CCG sample to ascertain whether there is a correlation between those CCGs that performed well in the DMAT exercise and those whose decisions are perceived positively by interviewees. Descriptive statistical methods will be used to analyse the DMAT data. A combination of quantitative and qualitative content analysis methods will be used to analyse the interview transcripts. Full ethics approval was received by the King's College London Biomedical Sciences, Dentistry, Medicine and Natural and Mathematical Sciences Research Ethics Subcommittee. The results of the study will be disseminated through publications in peer review journals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Hierarchy of non-glucose sugars in Escherichia coli.

PubMed

Aidelberg, Guy; Towbin, Benjamin D; Rothschild, Daphna; Dekel, Erez; Bren, Anat; Alon, Uri

2014-12-24

Understanding how cells make decisions, and why they make the decisions they make, is of fundamental interest in systems biology. To address this, we study the decisions made by E. coli on which genes to express when presented with two different sugars. It is well-known that glucose, E. coli's preferred carbon source, represses the uptake of other sugars by means of global and gene-specific mechanisms. However, less is known about the utilization of glucose-free sugar mixtures which are found in the natural environment of E. coli and in biotechnology. Here, we combine experiment and theory to map the choices of E. coli among 6 different non-glucose carbon sources. We used robotic assays and fluorescence reporter strains to make precise measurements of promoter activity and growth rate in all pairs of these sugars. We find that the sugars can be ranked in a hierarchy: in a mixture of a higher and a lower sugar, the lower sugar system shows reduced promoter activity. The hierarchy corresponds to the growth rate supported by each sugar- the faster the growth rate, the higher the sugar on the hierarchy. The hierarchy is 'soft' in the sense that the lower sugar promoters are not completely repressed. Measurement of the activity of the master regulator CRP-cAMP shows that the hierarchy can be quantitatively explained based on differential activation of the promoters by CRP-cAMP. Comparing sugar system activation as a function of time in sugar pair mixtures at sub-saturating concentrations, we find cases of sequential activation, and also cases of simultaneous expression of both systems. Such simultaneous expression is not predicted by simple models of growth rate optimization, which predict only sequential activation. We extend these models by suggesting multi-objective optimization for both growing rapidly now and preparing the cell for future growth on the poorer sugar. We find a defined hierarchy of sugar utilization, which can be quantitatively explained by differential activation by the master regulator cAMP-CRP. The present approach can be used to understand cell decisions when presented with mixtures of conditions.

Evaluating the decision accuracy and speed of clinical data visualizations.

PubMed

Pieczkiewicz, David S; Finkelstein, Stanley M

2010-01-01

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

Carbon innumeracy

PubMed Central

Kodra, Evan; Chen, Stone; Sheldon, Seth; Zik, Ory

2018-01-01

Individuals must have a quantitative understanding of the carbon footprint tied to their everyday decisions to make efficient sustainable decisions. We report research of the innumeracy of individuals as it relates to their carbon footprint. In three studies that varied in terms of scale and sample, respondents estimate the quantity of CO2 released when combusting a gallon of gasoline in comparison to several well-known metrics including food calories and travel distance. Consistently, respondents estimated the quantity of CO2 from gasoline compared to other metrics with significantly less accuracy while exhibiting a tendency to underestimate CO2. Such relative absence of carbon numeracy of even a basic consumption habit may limit the effectiveness of environmental policies and campaigns aimed at changing individual behavior. We discuss several caveats as well as opportunities for policy design that could aid the improvement of people’s quantitative understanding of their carbon footprint. PMID:29723206

A novel evaluation method for building construction project based on integrated information entropy with reliability theory.

PubMed

Bai, Xiao-ping; Zhang, Xi-wei

2013-01-01

Selecting construction schemes of the building engineering project is a complex multiobjective optimization decision process, in which many indexes need to be selected to find the optimum scheme. Aiming at this problem, this paper selects cost, progress, quality, and safety as the four first-order evaluation indexes, uses the quantitative method for the cost index, uses integrated qualitative and quantitative methodologies for progress, quality, and safety indexes, and integrates engineering economics, reliability theories, and information entropy theory to present a new evaluation method for building construction project. Combined with a practical case, this paper also presents detailed computing processes and steps, including selecting all order indexes, establishing the index matrix, computing score values of all order indexes, computing the synthesis score, sorting all selected schemes, and making analysis and decision. Presented method can offer valuable references for risk computing of building construction projects.

Beyond the group mind: a quantitative review of the interindividual-intergroup discontinuity effect.

PubMed

Wildschut, Tim; Pinter, Brad; Vevea, Jack L; Insko, Chester A; Schopler, John

2003-09-01

This quantitative review of 130 comparisons of interindividual and intergroup interactions in the context of mixed-motive situations reveals that intergroup interactions are generally more competitive than interindividual interactions. The authors identify 4 moderators of this interindividual-intergroup discontinuity effect, each based on the theoretical perspective that the discontinuity effect flows from greater fear and greed in intergroup relative to interindividual interactions. Results reveal that each moderator shares a unique association with the magnitude of the discontinuity effect. The discontinuity effect is larger when (a) participants interact with an opponent whose behavior is unconstrained by the experimenter or constrained by the experimenter to be cooperative rather than constrained by the experimenter to be reciprocal, (b) group members make a group decision rather than individual decisions, (c) unconstrained communication between participants is present rather than absent, and (d) conflict of interest is severe rather than mild.

Prospect theory on the brain? Toward a cognitive neuroscience of decision under risk.

PubMed

Trepel, Christopher; Fox, Craig R; Poldrack, Russell A

2005-04-01

Most decisions must be made without advance knowledge of their consequences. Economists and psychologists have devoted much attention to modeling decisions made under conditions of risk in which options can be characterized by a known probability distribution over possible outcomes. The descriptive shortcomings of classical economic models motivated the development of prospect theory (D. Kahneman, A. Tversky, Prospect theory: An analysis of decision under risk. Econometrica, 4 (1979) 263-291; A. Tversky, D. Kahneman, Advances in prospect theory: Cumulative representation of uncertainty. Journal of Risk and Uncertainty, 5 (4) (1992) 297-323) the most successful behavioral model of decision under risk. In the prospect theory, subjective value is modeled by a value function that is concave for gains, convex for losses, and steeper for losses than for gains; the impact of probabilities are characterized by a weighting function that overweights low probabilities and underweights moderate to high probabilities. We outline the possible neural bases of the components of prospect theory, surveying evidence from human imaging, lesion, and neuropharmacology studies as well as animal neurophysiology studies. These results provide preliminary suggestions concerning the neural bases of prospect theory that include a broad set of brain regions and neuromodulatory systems. These data suggest that focused studies of decision making in the context of quantitative models may provide substantial leverage towards a fuller understanding of the cognitive neuroscience of decision making.

Cancer multidisciplinary team meetings in practice: Results from a multi-institutional quantitative survey and implications for policy change.

PubMed

Rankin, Nicole M; Lai, Michelle; Miller, Danielle; Beale, Philip; Spigelman, Allan; Prest, Gabrielle; Turley, Kim; Simes, John

2018-02-01

Multidisciplinary care is advocated as best practice in cancer care. Relatively little is documented about multidisciplinary team (MDT) meeting functioning, decision making and the use of evidence to support decision making in Australia. This descriptive study aimed to examine team functioning, the role of team meetings and evidence use in MDTs whose institutions are members of Sydney Catalyst Translational Cancer Research Centre. We designed a structured 40-item survey instrument about topics that included meeting purpose, organization, resources and documentation; caseload estimates; use of evidence and quality assurance; patient involvement and supportive care needs; and open-ended items about the MDTs strengths and weaknesses. Participants were invited to participate via email and the survey was administered online. Data were analyzed using descriptive and comparative statistics. Thirty-seven MDTs from seven hospitals participated (100% response) and represented common (70%) and rare tumor groups (30%). MDT meeting purpose was reported as treatment (100%) or diagnostic decision making (88%), or for education purposes (70%). Most MDTs based treatment decisions on group consensus (92%), adherence to clinical practice guidelines (57%) or other evidence-based medicine sources (33%). The majority of MDTs discussed only a proportion of new patients at each meeting emphasizing the importance of educational aspects for other cases. Barriers exist in the availability of data to enable audit and reflection on evidence-based practice. MDT strengths included collaboration and quality discussion about patients. MDT meetings focus on treatment decision making, with group consensus playing a significant role in translating research evidence from guidelines into clinical decision making. With a varying proportion of patients discussed in each MDT meeting, a wider audit of multidisciplinary care would enable more accurate assessments of whether treatment recommendations are in accordance with best-practice evidence. © 2017 John Wiley & Sons Australia, Ltd.

Status and future of Quantitative Microbiological Risk Assessment in China

PubMed Central

Dong, Q.L.; Barker, G.C.; Gorris, L.G.M.; Tian, M.S.; Song, X.Y.; Malakar, P.K.

2015-01-01

Since the implementation of the Food Safety Law of the People's Republic of China in 2009 use of Quantitative Microbiological Risk Assessment (QMRA) has increased. QMRA is used to assess the risk posed to consumers by pathogenic bacteria which cause the majority of foodborne outbreaks in China. This review analyses the progress of QMRA research in China from 2000 to 2013 and discusses 3 possible improvements for the future. These improvements include planning and scoping to initiate QMRA, effectiveness of microbial risk assessment utility for risk management decision making, and application of QMRA to establish appropriate Food Safety Objectives. PMID:26089594

Development of a Search and Rescue Simulation to Study the Effects of Prolonged Isolation on Team Decision Making

NASA Technical Reports Server (NTRS)

Entin, Elliot E.; Kerrigan, Caroline; Serfaty, Daniel; Young, Philip

1998-01-01

The goals of this project were to identify and investigate aspects of team and individual decision-making and risk-taking behaviors hypothesized to be most affected by prolonged isolation. A key premise driving our research approach is that effects of stressors that impact individual and team cognitive processes in an isolated, confined, and hazardous environment will be projected onto the performance of a simulation task. To elicit and investigate these team behaviors we developed a search and rescue task concept as a scenario domain that would be relevant for isolated crews. We modified the Distributed Dynamic Decision-making (DDD) simulator, a platform that has been extensively used for empirical research in team processes and taskwork performance, to portray the features of a search and rescue scenario and present the task components incorporated into that scenario. The resulting software is called DD-Search and Rescue (Version 1.0). To support the use of the DDD-Search and Rescue simulator in isolated experiment settings, we wrote a player's manual for teaching team members to operate the simulator and play the scenario. We then developed a research design and experiment plan that would allow quantitative measures of individual and team decision making skills using the DDD-Search and Rescue simulator as the experiment platform. A description of these activities and the associated materials that were produced under this contract are contained in this report.

Economic decision-making in psychopathy: a comparison with ventromedial prefrontal lesion patients.

PubMed

Koenigs, Michael; Kruepke, Michael; Newman, Joseph P

2010-06-01

Psychopathy, which is characterized by a constellation of antisocial behavioral traits, may be subdivided on the basis of etiology: "primary" (low-anxious) psychopathy is viewed as a direct consequence of some core intrinsic deficit, whereas "secondary" (high-anxious) psychopathy is viewed as an indirect consequence of environmental factors or other psychopathology. Theories on the neurobiology of psychopathy have targeted dysfunction within ventromedial prefrontal cortex (vmPFC) as a putative mechanism, yet the relationship between vmPFC function and psychopathy subtype has not been fully explored. In this study, we administered two laboratory decision-making tasks (the Ultimatum Game and the Dictator Game) to a group of prisoners (n=47) to determine whether the different subtypes of psychopathy (primary vs. secondary) are associated with characteristic patterns of economic decision-making, and furthermore, whether either subtype exhibits similar performance to patients with vmPFC lesions. Comparing primary psychopaths (n=6) to secondary psychopaths (n=6) and non-psychopaths (n=22), we found that primary psychopathy was associated with significantly lower acceptance rates of unfair Ultimatum offers and lower offer amounts in the Dictator Game. Moreover, primary psychopaths were quantitatively similar to vmPFC lesion patients in their response patterns. These results support the purported connection between psychopathy and vmPFC dysfunction, bolster the distinction between primary and secondary psychopathy, and demonstrate the utility of laboratory economic decision-making tests in differentiating clinical subgroups. Copyright 2010 Elsevier Ltd. All rights reserved.

Agent-based modeling of deforestation in southern Yucatán, Mexico, and reforestation in the Midwest United States

PubMed Central

Manson, Steven M.; Evans, Tom

2007-01-01

We combine mixed-methods research with integrated agent-based modeling to understand land change and economic decision making in the United States and Mexico. This work demonstrates how sustainability science benefits from combining integrated agent-based modeling (which blends methods from the social, ecological, and information sciences) and mixed-methods research (which interleaves multiple approaches ranging from qualitative field research to quantitative laboratory experiments and interpretation of remotely sensed imagery). We test assumptions of utility-maximizing behavior in household-level landscape management in south-central Indiana, linking parcel data, land cover derived from aerial photography, and findings from laboratory experiments. We examine the role of uncertainty and limited information, preferences, differential demographic attributes, and past experience and future time horizons. We also use evolutionary programming to represent bounded rationality in agriculturalist households in the southern Yucatán of Mexico. This approach captures realistic rule of thumb strategies while identifying social and environmental factors in a manner similar to econometric models. These case studies highlight the role of computational models of decision making in land-change contexts and advance our understanding of decision making in general. PMID:18093928

Intelligent Soft Computing on Forex: Exchange Rates Forecasting with Hybrid Radial Basis Neural Network

PubMed Central

Marcek, Dusan; Durisova, Maria

2016-01-01

This paper deals with application of quantitative soft computing prediction models into financial area as reliable and accurate prediction models can be very helpful in management decision-making process. The authors suggest a new hybrid neural network which is a combination of the standard RBF neural network, a genetic algorithm, and a moving average. The moving average is supposed to enhance the outputs of the network using the error part of the original neural network. Authors test the suggested model on high-frequency time series data of USD/CAD and examine the ability to forecast exchange rate values for the horizon of one day. To determine the forecasting efficiency, they perform a comparative statistical out-of-sample analysis of the tested model with autoregressive models and the standard neural network. They also incorporate genetic algorithm as an optimizing technique for adapting parameters of ANN which is then compared with standard backpropagation and backpropagation combined with K-means clustering algorithm. Finally, the authors find out that their suggested hybrid neural network is able to produce more accurate forecasts than the standard models and can be helpful in eliminating the risk of making the bad decision in decision-making process. PMID:26977450

Intelligent Soft Computing on Forex: Exchange Rates Forecasting with Hybrid Radial Basis Neural Network.

PubMed

Falat, Lukas; Marcek, Dusan; Durisova, Maria

2016-01-01

This paper deals with application of quantitative soft computing prediction models into financial area as reliable and accurate prediction models can be very helpful in management decision-making process. The authors suggest a new hybrid neural network which is a combination of the standard RBF neural network, a genetic algorithm, and a moving average. The moving average is supposed to enhance the outputs of the network using the error part of the original neural network. Authors test the suggested model on high-frequency time series data of USD/CAD and examine the ability to forecast exchange rate values for the horizon of one day. To determine the forecasting efficiency, they perform a comparative statistical out-of-sample analysis of the tested model with autoregressive models and the standard neural network. They also incorporate genetic algorithm as an optimizing technique for adapting parameters of ANN which is then compared with standard backpropagation and backpropagation combined with K-means clustering algorithm. Finally, the authors find out that their suggested hybrid neural network is able to produce more accurate forecasts than the standard models and can be helpful in eliminating the risk of making the bad decision in decision-making process.

Decision-Making in the Ventral Premotor Cortex Harbinger of Action

PubMed Central

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

2011-01-01

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

Quantitative evaluation of translational medicine based on scientometric analysis and information extraction.

PubMed

Zhang, Yin; Diao, Tianxi; Wang, Lei

2014-12-01

Designed to advance the two-way translational process between basic research and clinical practice, translational medicine has become one of the most important areas in biomedicine. The quantitative evaluation of translational medicine is valuable for the decision making of global translational medical research and funding. Using the scientometric analysis and information extraction techniques, this study quantitatively analyzed the scientific articles on translational medicine. The results showed that translational medicine had significant scientific output and impact, specific core field and institute, and outstanding academic status and benefit. While it is not considered in this study, the patent data are another important indicators that should be integrated in the relevant research in the future. © 2014 Wiley Periodicals, Inc.

Parental views on withdrawing life-sustaining therapies in critically ill children.

PubMed

Michelson, Kelly Nicole; Koogler, Tracy; Sullivan, Christine; Ortega, María del Pilar; Hall, Emily; Frader, Joel

2009-11-01

To broaden existing knowledge of pediatric end-of-life decision making by exploring factors described by parents of patients in the pediatric intensive care unit (PICU) as important/influential if they were to consider withdrawing life-sustaining therapies. Quantitative and qualitative analysis of semi-structured one-on-one interviews. The PICUs at 2 tertiary care hospitals. English- or Spanish-speaking parents who were older than 17 years and whose child was admitted to the PICU for more than 24 hours to up to 1 week. Semi-structured one-on-one interviews. Forty of 70 parents (57%) interviewed said they could imagine a situation in which they would consider withdrawing life-sustaining therapies. When asked if specific factors might influence their decision making, 64% of parents said they would consider withdrawing life-sustaining therapies if their child were suffering; 51% would make such a decision based on quality-of-life considerations; 43% acknowledged the influence of physician-estimated prognosis in their decision; and 7% said financial burden would affect their consideration. Qualitative analysis of their subsequent comments identified 9 factors influential to parents when considering withdrawing life-sustaining therapies: quality of life, suffering, ineffective treatments, faith, time, financial considerations, general rejection of withdrawing life-sustaining therapies, mistrust/doubt toward physicians, and reliance on self/intuition. Parents describe a broad range of views regarding possible consideration of withdrawing life-sustaining therapies for their children and what factors might influence such a decision.

Parental Views on Withdrawing Life-Sustaining Therapies in Critically Ill Children

PubMed Central

Michelson, Kelly Nicole; Koogler, Tracy; Sullivan, Christine; del Pilar Ortega, María; Hall, Emily; Frader, Joel

2009-01-01

Objective To broaden existing knowledge of pediatric end-of-life decision making by exploring factors described by parents of patients in the pediatric intensive care unit (PICU) as important/influential if they were to consider withdrawing life-sustaining therapies. Design Quantitative and qualitative analysis of semi-structured one-on-one interviews. Setting The PICUs at 2 tertiary care hospitals. Participants English- or Spanish-speaking parents who were older than 17 years and whose child was admitted to the PICU for more than 24 hours to up to 1 week. Intervention Semi-structured one-on-one interviews. Results Forty of 70 parents (57%) interviewed said they could imagine a situation in which they would consider withdrawing life-sustaining therapies. When asked if specific factors might influence their decision making, 64% of parents said they would consider withdrawing life-sustaining therapies if their child were suffering; 51% would make such a decision based on quality-of-life considerations; 43% acknowledged the influence of physician-estimated prognosis in their decision; and 7% said financial burden would affect their consideration. Qualitative analysis of their subsequent comments identified 9 factors influential to parents when considering withdrawing life-sustaining therapies: quality of life, suffering, ineffective treatments, faith, time, financial considerations, general rejection of withdrawing life-sustaining therapies, mistrust/doubt toward physicians, and reliance on self/intuition. Conclusion Parents describe a broad range of views regarding possible consideration of withdrawing life-sustaining therapies for their children and what factors might influence such a decision. PMID:19884588

Validation workflow for a clinical Bayesian network model in multidisciplinary decision making in head and neck oncology treatment.

PubMed

Cypko, Mario A; Stoehr, Matthaeus; Kozniewski, Marcin; Druzdzel, Marek J; Dietz, Andreas; Berliner, Leonard; Lemke, Heinz U

2017-11-01

Oncological treatment is being increasingly complex, and therefore, decision making in multidisciplinary teams is becoming the key activity in the clinical pathways. The increased complexity is related to the number and variability of possible treatment decisions that may be relevant to a patient. In this paper, we describe validation of a multidisciplinary cancer treatment decision in the clinical domain of head and neck oncology. Probabilistic graphical models and corresponding inference algorithms, in the form of Bayesian networks, can support complex decision-making processes by providing a mathematically reproducible and transparent advice. The quality of BN-based advice depends on the quality of the model. Therefore, it is vital to validate the model before it is applied in practice. For an example BN subnetwork of laryngeal cancer with 303 variables, we evaluated 66 patient records. To validate the model on this dataset, a validation workflow was applied in combination with quantitative and qualitative analyses. In the subsequent analyses, we observed four sources of imprecise predictions: incorrect data, incomplete patient data, outvoting relevant observations, and incorrect model. Finally, the four problems were solved by modifying the data and the model. The presented validation effort is related to the model complexity. For simpler models, the validation workflow is the same, although it may require fewer validation methods. The validation success is related to the model's well-founded knowledge base. The remaining laryngeal cancer model may disclose additional sources of imprecise predictions.

Exposure Models for the Prior Distribution in Bayesian Decision Analysis for Occupational Hygiene Decision Making

PubMed Central

Lee, Eun Gyung; Kim, Seung Won; Feigley, Charles E.; Harper, Martin

2015-01-01

This study introduces two semi-quantitative methods, Structured Subjective Assessment (SSA) and Control of Substances Hazardous to Health (COSHH) Essentials, in conjunction with two-dimensional Monte Carlo simulations for determining prior probabilities. Prior distribution using expert judgment was included for comparison. Practical applications of the proposed methods were demonstrated using personal exposure measurements of isoamyl acetate in an electronics manufacturing facility and of isopropanol in a printing shop. Applicability of these methods in real workplaces was discussed based on the advantages and disadvantages of each method. Although these methods could not be completely independent of expert judgments, this study demonstrated a methodological improvement in the estimation of the prior distribution for the Bayesian decision analysis tool. The proposed methods provide a logical basis for the decision process by considering determinants of worker exposure. PMID:23252451

Research on the use of data fusion technology to evaluate the state of electromechanical equipment

NASA Astrophysics Data System (ADS)

Lin, Lin

2018-04-01

Aiming at the problems of different testing information modes and the coexistence of quantitative and qualitative information in the state evaluation of electromechanical equipment, the paper proposes the use of data fusion technology to evaluate the state of electromechanical equipment. This paper introduces the state evaluation process of mechanical and electrical equipment in detail, uses the D-S evidence theory to fuse the decision-making layers of mechanical and electrical equipment state evaluation and carries out simulation tests. The simulation results show that it is feasible and effective to apply the data fusion technology to the state evaluation of the mechatronic equipment. After the multiple decision-making information provided by different evaluation methods are fused repeatedly and the useful information is extracted repeatedly, the fuzziness of judgment can be reduced and the state evaluation Credibility.

A serious game for improving the decision making skills and knowledge levels of Turkish football referees according to the laws of the game.

PubMed

Gulec, Ulas; Yilmaz, Murat

2016-01-01

Digital game-based learning environments provide emerging opportunities to overcome learning barriers by combining newly developed technologies and traditional game design. This study proposes a quantitative research approach supported by expert validation interviews to designing a game-based learning framework. The goal is to improve the learning experience and decision-making skills of soccer referees in Turkey. A serious game was developed and tested on a group of referees (N = 54). The assessment results of these referees were compared with two sample t-test and the Wilcoxon signed-ranked test for both the experimental group and the control group. The findings of the current study confirmed that a game-based learning environment has greater merit over the paper-based alternatives.

Framing of Uncertainty in Scientific Publications: Towards Recommendations for Decision Support

NASA Astrophysics Data System (ADS)

Guillaume, J. H. A.; Helgeson, C.; Elsawah, S.; Jakeman, A. J.; Kummu, M.

2016-12-01

Uncertainty is recognised as an essential issue in environmental decision making and decision support. As modellers, we notably use a variety of tools and techniques within an analysis, for example related to uncertainty quantification and model validation. We also address uncertainty by how we present results. For example, experienced modellers are careful to distinguish robust conclusions from those that need further work, and the precision of quantitative results is tailored to their accuracy. In doing so, the modeller frames how uncertainty should be interpreted by their audience. This is an area which extends beyond modelling to fields such as philosophy of science, semantics, discourse analysis, intercultural communication and rhetoric. We propose that framing of uncertainty deserves greater attention in the context of decision support, and that there are opportunities in this area for fundamental research, synthesis and knowledge transfer, development of teaching curricula, and significant advances in managing uncertainty in decision making. This presentation reports preliminary results of a study of framing practices. Specifically, we analyse the framing of uncertainty that is visible in the abstracts from a corpus of scientific articles. We do this through textual analysis of the content and structure of those abstracts. Each finding that appears in an abstract is classified according to the uncertainty framing approach used, using a classification scheme that was iteratively revised based on reflection and comparison amongst three coders. This analysis indicates how frequently the different framing approaches are used, and provides initial insights into relationships between frames, how the frames relate to interpretation of uncertainty, and how rhetorical devices are used by modellers to communicate uncertainty in their work. We propose initial hypotheses for how the resulting insights might influence decision support, and help advance decision making to better address uncertainty.

[Legal decisions on access to medicines in Pernambuco, Northeastern Brazil].

PubMed

Stamford, Artur; Cavalcanti, Maísa

2012-10-01

To analyze decisions from the legal system concerning the population's access to medicines within the Brazilian Public Health System through judicial channels, with regard to decision-making criteria and possible political and economic pressure. This was a descriptive retrospective study on documents with a quantitative and qualitative approach. Data were gathered from the State of Pernambuco Superintendency for Pharmaceutical Care, and the data sources used were 105 lawsuits and administrative reports between January and June 2009. It was ascertained which medications have a patent or patent request in the database of the Brazilian Patent Office (INPI), in order to identify the frequency with which patents feature in lawsuits. The data obtained were classified according to Anatomical and Therapeutic Chemical System. To analyze the judicial decisions, the theory of autopoietic social systems was used. There were lawsuits involving 134 medications, with an estimated value of R$ 4.5 million for attending the treatments requested. 70.9% of the medications had a patent or a patent request and they were concentrated in three therapeutic classes: antineoplastic and immunomodulating agents; digestive tract and metabolism; and sensory organs. Six central ideas within judges' decision-making criteria were identified (the federal constitution and medical prescriptions), along with pressure between the legal, economic and political systems concerning access to medications. The analysis on judicial decisions based on the theory of autopoietic social systems made it possible to identify mutual stimulation (dependency) between the legal system and other social systems in relation to the issue of citizens' access to medications. This dependency was represented by the federal constitution and intellectual property. The federal constitution and medical prescription were identified as decision-making criteria in lawsuits. Intellectual property represented possible political and economic pressure, especially in cases of launching medications into the market.

Policy, practice and decision making for zoonotic disease management: water and Cryptosporidium.

PubMed

Austin, Zoë; Alcock, Ruth E; Christley, Robert M; Haygarth, Philip M; Heathwaite, A Louise; Latham, Sophia M; Mort, Maggie; Oliver, David M; Pickup, Roger; Wastling, Jonathan M; Wynne, Brian

2012-04-01

Decision making for zoonotic disease management should be based on many forms of appropriate data and sources of evidence. However, the criteria and timing for policy response and the resulting management decisions are often altered when a disease outbreak occurs and captures full media attention. In the case of waterborne disease, such as the robust protozoa, Cryptosporidium spp, exposure can cause significant human health risks and preventing exposure by maintaining high standards of biological and chemical water quality remains a priority for water companies in the UK. Little has been documented on how knowledge and information is translated between the many stakeholders involved in the management of Cryptosporidium, which is surprising given the different drivers that have shaped management decisions. Such information, coupled with the uncertainties that surround these data is essential for improving future management strategies that minimise disease outbreaks. Here, we examine the interplay between scientific information, the media, and emergent government and company policies to examine these issues using qualitative and quantitative data relating to Cryptosporidium management decisions by a water company in the North West of England. Our results show that political and media influences are powerful drivers of management decisions if fuelled by high profile outbreaks. Furthermore, the strength of the scientific evidence is often constrained by uncertainties in the data, and in the way knowledge is translated between policy levels during established risk management procedures. In particular, under or over-estimating risk during risk assessment procedures together with uncertainty regarding risk factors within the wider environment, was found to restrict the knowledge-base for decision-making in Cryptosporidium management. Our findings highlight some key current and future challenges facing the management of such diseases that are widely applicable to other risk management situations. Copyright © 2011 Elsevier Ltd. All rights reserved.

Contact with the baby following stillbirth and parental mental health and well-being: a systematic review

PubMed Central

Hennegan, Julie M; Henderson, Jane; Redshaw, Maggie

2015-01-01

Objective To collate and critically appraise extant evidence for the impact of contact with the stillborn infant on parental mental health, well-being and satisfaction. Design Systematic review. Data sources A structured systematic search was conducted in 13 databases, complemented by hand-searching. Study eligibility criteria English language studies providing quantitative comparison of outcomes for parents who held their baby or engaged in other memory-making activities, such as having photos and handprints, compared to those who did not, were eligible for inclusion. Outcome measures Primary outcomes included clinically diagnosed mental health issues, standardised assessment of mental health issues or self-reported psychological distress. Secondary outcomes included poor health, relationship difficulties and satisfaction with the decision to have contact with the baby. Results Two authors independently screened abstracts, selected potentially eligible studies, extracted data and evaluated the quality of included papers. 11 eligible studies, reported in 18 papers, were included. Studies were heterogeneous, precluding quantitative synthesis, thus a narrative synthesis is presented. Studies presented high risks of bias, particularly in regard to sample representativeness, and confounder identification and adjustment. Results were mixed concerning the impact of holding the stillborn baby on mental health and well-being. One study found no significant effects, and two studies reported no impact on depression. Conflicting effects were found for anxiety and post-traumatic stress. Other memory-making activities were not found to have a significant association with mental health or well-being outcomes. Across studies, mothers were satisfied with their decision to hold their baby or engage in other memory making. Conclusions Evidence for the impact of holding the stillborn baby on mental health and well-being is sparse, and of poor quality. High-quality research guided by a priori hypotheses, with attention to potential confounders and moderating effects, is needed to provide more rigorous evidence to guide practitioners’ and parents’ decision-making for care following stillbirth. Review protocol number PROSPERO CRD42014013890. PMID:26614620

The role of economic evaluation in the decision-making process of family physicians: design and methods of a qualitative embedded multiple-case study

PubMed Central

Lessard, Chantale; Contandriopoulos, André-Pierre; Beaulieu, Marie-Dominique

2009-01-01

Background A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all studies on the use of economic evaluation in decision-making used a quantitative approach, and few investigated decision-making at the clinical level. An important question is whether economic evaluations affect clinical practice. The project is an intervention research study designed to understand the role of economic evaluation in the decision-making process of family physicians (FPs). The contributions of the project will be from the perspective of Pierre Bourdieu's sociological theory. Methods/design A qualitative research strategy is proposed. We will conduct an embedded multiple-case study design. Ten case studies will be performed. The FPs will be the unit of analysis. The sampling strategies will be directed towards theoretical generalization. The 10 selected cases will be intended to reflect a diversity of FPs. There will be two embedded units of analysis: FPs (micro-level of analysis) and field of family medicine (macro-level of analysis). The division of the determinants of practice/behaviour into two groups, corresponding to the macro-structural level and the micro-individual level, is the basis for Bourdieu's mode of analysis. The sources of data collection for the micro-level analysis will be 10 life history interviews with FPs, documents and observational evidence. The sources of data collection for the macro-level analysis will be documents and 9 open-ended, focused interviews with key informants from medical associations and academic institutions. The analytic induction approach to data analysis will be used. A list of codes will be generated based on both the original framework and new themes introduced by the participants. We will conduct within-case and cross-case analyses of the data. Discussion The question of the role of economic evaluation in FPs' decision-making is of great interest to scientists, health care practitioners, managers and policy-makers, as well as to consultants, industry, and society. It is believed that the proposed research approach will make an original contribution to the development of knowledge, both empirical and theoretical. PMID:19210787

DECISION-COMPONENTS OF NICE'S TECHNOLOGY APPRAISALS ASSESSMENT FRAMEWORK.

PubMed

de Folter, Joost; Trusheim, Mark; Jonsson, Pall; Garner, Sarah

2018-01-01

Value assessment frameworks have gained prominence recently in the context of U.S. healthcare. Such frameworks set out a series of factors that are considered in funding decisions. The UK's National Institute of Health and Care Excellence (NICE) is an established health technology assessment (HTA) agency. We present a novel application of text analysis that characterizes NICE's Technology Appraisals in the context of the newer assessment frameworks and present the results in a visual way. A total of 243 documents of NICE's medicines guidance from 2007 to 2016 were analyzed. Text analysis was used to identify a hierarchical set of decision factors considered in the assessments. The frequency of decision factors stated in the documents was determined and their association with terms related to uncertainty. The results were incorporated into visual representations of hierarchical factors. We identified 125 decision factors, and hierarchically grouped these into eight domains: Clinical Effectiveness, Cost Effectiveness, Condition, Current Practice, Clinical Need, New Treatment, Studies, and Other Factors. Textual analysis showed all domains appeared consistently in the guidance documents. Many factors were commonly associated with terms relating to uncertainty. A series of visual representations was created. This study reveals the complexity and consistency of NICE's decision-making processes and demonstrates that cost effectiveness is not the only decision-criteria. The study highlights the importance of processes and methodology that can take both quantitative and qualitative information into account. Visualizations can help effectively communicate this complex information during the decision-making process and subsequently to stakeholders.

Decision analysis in formulary decision making.

PubMed

Schechter, C B

1993-06-01

Although decision making about what drugs to include in an institutional formulary appears to lend itself readily to quantitative techniques such as decision analysis and cost-benefit analysis, a review of the literature reveals that very little has been published in this area. Several of the published decision analyses use non-standard techniques that are, at best, of unproved validity, and may seriously distort the underlying issues through covert under-counting or double-counting of various drug attributes. Well executed decision analyses have contributed to establishing that drug acquisition costs are not an adequate measure of the total economic impact of formulary decisions and that costs of labour and materials associated with drug administration must be calculated on an institution-specific basis to reflect unique staffing patterns, bulk purchasing practices, and the availability of surplus capacity within the institution which might be mobilised at little marginal cost. Clinical studies of newly introduced drugs frequently fail to answer the questions that weigh most heavily on the structuring of a formal assessment of a proposed formulary acquisition. Studies comparing a full spectrum of therapeutically equivalent drugs are rarely done, and individual studies of particular pairs of drugs can rarely be used together because of differences in methodology or patient populations studied. Gathering of institution-specific economic and clinical data is a daunting, labour-intensive task. In many institutions, incentive and reward structures discourage behaviour that takes the broad institutional perspective that is intrinsic to a good decision analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

A recurrent network mechanism of time integration in perceptual decisions.

PubMed

Wong, Kong-Fatt; Wang, Xiao-Jing

2006-01-25

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

Inconclusive quantum measurements and decisions under uncertainty

NASA Astrophysics Data System (ADS)

Yukalov, Vyacheslav; Sornette, Didier

2016-04-01

We give a mathematical definition for the notion of inconclusive quantum measurements. In physics, such measurements occur at intermediate stages of a complex measurement procedure, with the final measurement result being operationally testable. Since the mathematical structure of Quantum Decision Theory has been developed in analogy with the theory of quantum measurements, the inconclusive quantum measurements correspond, in Quantum Decision Theory, to intermediate stages of decision making in the process of taking decisions under uncertainty. The general form of the quantum probability for a composite event is the sum of a utility factor, describing a rational evaluation of the considered prospect, and of an attraction factor, characterizing irrational, subconscious attitudes of the decision maker. Despite the involved irrationality, the probability of prospects can be evaluated. This is equivalent to the possibility of calculating quantum probabilities without specifying hidden variables. We formulate a general way of evaluation, based on the use of non-informative priors. As an example, we suggest the explanation of the decoy effect. Our quantitative predictions are in very good agreement with experimental data.

Differences in Eighth Grade Science Student and Teacher Perceptions of Students' Level of Input into Academic Planning and Decision Making

ERIC Educational Resources Information Center

Chapman, Jarrett Michael

2014-01-01

Teachers are expected to improve their planning, instruction, and assessment as they progress through their career. An important component to teachers knowing what to modify in their teaching style is being able to solicit meaningful feedback from students. This mixed-methods study was conducted to provide teachers with a quantitative method to…

What Does Research Say about the Ideal Condition for Students Learning Mathematics?--A "Baker's Dozen" Articles to Inform Secondary Teaching

ERIC Educational Resources Information Center

Jones, Karrie A.; Vermette, Paul J.; Jones, Jennifer L.

2012-01-01

In seeking to align the everyday decision-making and lesson delivery of secondary teachers to current research in mathematics education, this piece provides an application of theory into classroom practice. By focusing on a sample of 13 quantitative and qualitative research studies of pedagogical best practice published since 2000, a set of…

From Data Poor, Information Poor to Data Rich, Information Rich Decision-Making: Design and Implementation of a Student Information System

ERIC Educational Resources Information Center

Burger, John M.; Nadirova, Anna

2013-01-01

In this paper, we report on the design and implementation of a state of the art Student Information System (SIS) being developed in a moderate size Alberta, Canada school jurisdiction. The SIS design is premised upon transparency, balanced, comprehensive, and multi-method assessments that links qualitative and quantitative data in support of…

An ecological framework for informing permitting decisions on scientific activities in protected areas

PubMed Central

Saarman, Emily T.; Owens, Brian; Murray, Steven N.; Weisberg, Stephen B.; Field, John C.; Nielsen, Karina J.

2018-01-01

There are numerous reasons to conduct scientific research within protected areas, but research activities may also negatively impact organisms and habitats, and thus conflict with a protected area’s conservation goals. We developed a quantitative ecological decision-support framework that estimates these potential impacts so managers can weigh costs and benefits of proposed research projects and make informed permitting decisions. The framework generates quantitative estimates of the ecological impacts of the project and the cumulative impacts of the proposed project and all other projects in the protected area, and then compares the estimated cumulative impacts of all projects with policy-based acceptable impact thresholds. We use a series of simplified equations (models) to assess the impacts of proposed research to: a) the population of any targeted species, b) the major ecological assemblages that make up the community, and c) the physical habitat that supports protected area biota. These models consider both targeted and incidental impacts to the ecosystem and include consideration of the vulnerability of targeted species, assemblages, and habitats, based on their recovery time and ecological role. We parameterized the models for a wide variety of potential research activities that regularly occur in the study area using a combination of literature review and expert judgment with a precautionary approach to uncertainty. We also conducted sensitivity analyses to examine the relationships between model input parameters and estimated impacts to understand the dominant drivers of the ecological impact estimates. Although the decision-support framework was designed for and adopted by the California Department of Fish and Wildlife for permitting scientific studies in the state-wide network of marine protected areas (MPAs), the framework can readily be adapted for terrestrial and freshwater protected areas. PMID:29920527

Characterizing the Role of U.S. Surgeons in the Provision of Palliative Care: A Systematic Review and Mixed-Methods Meta-Synthesis.

PubMed

Suwanabol, Pasithorn A; Kanters, Arielle E; Reichstein, Ari C; Wancata, Lauren M; Dossett, Lesly A; Rivet, Emily B; Silveira, Maria J; Morris, Arden M

2018-04-01

The provision of palliative care varies appropriately by clinical factors such as patient age and severity of disease and also varies by provider practice and specialty. Surgical patients are persistently less likely to receive palliative care than their medical counterparts for reasons that are not clear. We sought to characterize surgeon-specific determinants of palliative care in seriously ill and dying patients. We performed a systematic review of the literature focused on surgery and palliative care within PubMed, CINAHL, EMBASE, Scopus, and Ovid Medline databases from January 1, 2000 through December 31, 2016 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quantitative and qualitative studies with primary data evaluating surgeons' attitudes, knowledge, and behaviors or experiences in care for seriously ill and dying patients were selected for full review by at least two study team members based on predefined inclusion criteria. Data were extracted based on a predetermined instrument and compared across studies using thematic analysis in a meta-synthesis of qualitative and quantitative findings. A total of 2589 abstracts were identified and screened, and 35 articles (26 quantitative and nine qualitative) fulfilled criteria for full review. Among these, 17 articles explored practice and attitudes of surgeons regarding palliative and end-of-life care, 11 articles assessed training in palliative care, five characterized surgical decision making, one described behaviors of surgeons caring for seriously ill and dying patients, and one explicitly identified barriers to use of palliative care. Four major themes across studies affected receipt of palliative care for surgical patients: 1) surgeons' experience and knowledge, 2) surgeons' attitudes, 3) surgeons' preferences and decision making for treatment, and 4) perceived barriers. Among the articles reviewed, surgeons overall demonstrated insight into the benefits of palliative care but reported limited knowledge and comfort as well as a multitude of challenges to introducing palliative care to their patients. These findings indicate a need for wider implementation of strategies that allow optimal integration of palliative care with surgical decision making. Published by Elsevier Inc.

Protocol for a pre-implementation and post-implementation study on shared decision-making in the surgical treatment of women with early-stage breast cancer.

PubMed

Savelberg, Wilma; Moser, Albine; Smidt, Marjolein; Boersma, Liesbeth; Haekens, Christel; van der Weijden, Trudy

2015-03-31

The majority of patients diagnosed with early-stage breast cancer are in a position to choose between having a mastectomy or lumpectomy with radiation therapy (breast-conserving therapy). Since the long-term survival rates for mastectomy and for lumpectomy with radiation therapy are comparable, patients' informed preferences are important for decision-making. Although most clinicians believe that they do include patients in the decision-making process, the information that women with breast cancer receive regarding the surgical options is often rather subjective, and does not invite patients to express their preferences. Shared decision-making (SDM) is meant to help patients clarify their preferences, resulting in greater satisfaction with their final choice. Patient decision aids can be very supportive in SDM. We present the protocol of a study to β test a patient decision aid and optimise strategies for the implementation of SDM regarding the treatment of early-stage breast cancer in the actual clinical setting. This paper concerns a pre-implementation and post-implementation study, lasting from October 2014 to June 2015. The intervention consists of implementing SDM using a patient decision aid. The intervention will be evaluated using qualitative and quantitative measures, acquired prior to, during and after the implementation of SDM. Outcome measures are knowledge about treatment, perceived SDM and decisional conflict. We will also conduct face-to-face interviews with a sample of these patients and their care providers, to assess their experiences with the implementation of SDM and the patient decision aid. This protocol was approved by the Maastricht University Medical Centre (MUMC) ethics committee. The findings will be disseminated through peer-reviewed journal articles and presentations at national conferences. Findings will be used to finalise a multi-faceted implementation strategy to test the implementation of SDM and a patient decision aid in terms of cost-effectiveness, in a multicentre cluster randomised controlled trial (RCT). NTR4879. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Non-equilibrium physics of neural networks for leaning, memory and decision making: landscape and flux perspectives

NASA Astrophysics Data System (ADS)

Wang, Jin

Cognitive behaviors are determined by underlying neural networks. Many brain functions, such as learning and memory, can be described by attractor dynamics. We developed a theoretical framework for global dynamics by quantifying the landscape associated with the steady state probability distributions and steady state curl flux, measuring the degree of non-equilibrium through detailed balance breaking. We found the dynamics and oscillations in human brains responsible for cognitive processes and physiological rhythm regulations are determined not only by the landscape gradient but also by the flux. We found that the flux is closely related to the degrees of the asymmetric connections in neural networks and is the origin of the neural oscillations. The neural oscillation landscape shows a closed-ring attractor topology. The landscape gradient attracts the network down to the ring. The flux is responsible for coherent oscillations on the ring. We suggest the flux may provide the driving force for associations among memories. Both landscape and flux determine the kinetic paths and speed of decision making. The kinetics and global stability of decision making are explored by quantifying the landscape topography through the barrier heights and the mean first passage time. The theoretical predictions are in agreement with experimental observations: more errors occur under time pressure. We quantitatively explored two mechanisms of the speed-accuracy tradeoff with speed emphasis and further uncovered the tradeoffs among speed, accuracy, and energy cost. Our results show an optimal balance among speed, accuracy, and the energy cost in decision making. We uncovered possible mechanisms of changes of mind and how mind changes improve performance in decision processes. Our landscape approach can help facilitate an understanding of the underlying physical mechanisms of cognitive processes and identify the key elements in neural networks.

Incorporating patient-preference evidence into regulatory decision making.

PubMed

Ho, Martin P; Gonzalez, Juan Marcos; Lerner, Herbert P; Neuland, Carolyn Y; Whang, Joyce M; McMurry-Heath, Michelle; Hauber, A Brett; Irony, Telba

2015-10-01

Patients have a unique role in deciding what treatments should be available for them and regulatory agencies should take their preferences into account when making treatment approval decisions. This is the first study designed to obtain quantitative patient-preference evidence to inform regulatory approval decisions by the Food and Drug Administration Center for Devices and Radiological Health. Five-hundred and forty United States adults with body mass index (BMI) ≥ 30 kg/m(2) evaluated tradeoffs among effectiveness, safety, and other attributes of weight-loss devices in a scientific survey. Discrete-choice experiments were used to quantify the importance of safety, effectiveness, and other attributes of weight-loss devices to obese respondents. A tool based on these measures is being used to inform benefit-risk assessments for premarket approval of medical devices. Respondent choices yielded preference scores indicating their relative value for attributes of weight-loss devices in this study. We developed a tool to estimate the minimum weight loss acceptable by a patient to receive a device with a given risk profile and the maximum mortality risk tolerable in exchange for a given weight loss. For example, to accept a device with 0.01 % mortality risk, a risk tolerant patient will require about 10 % total body weight loss lasting 5 years. Patient preference evidence was used make regulatory decision making more patient-centered. In addition, we captured the heterogeneity of patient preferences allowing market approval of effective devices for risk tolerant patients. CDRH is using the study tool to define minimum clinical effectiveness to evaluate new weight-loss devices. The methods presented can be applied to a wide variety of medical products. This study supports the ongoing development of a guidance document on incorporating patient preferences into medical-device premarket approval decisions.

Decision makers' experiences of prioritisation and views about how to finance healthcare costs.

PubMed

Werntoft, Elisabet; Edberg, Anna-Karin

2009-10-01

Prioritisation in healthcare is an issue of growing importance due to scarcity of resources. The aims of this study were firstly to describe decision makers' experience of prioritisation and their views concerning willingness to pay and how to finance healthcare costs. An additional aim was to compare the views of politicians and physicians. The study was a cross-sectional study based on a questionnaire administered to 700 Swedish politicians and physicians. This was analysed using both quantitative and qualitative methods. A majority of the decision makers (55%) suggested that increasing costs should be financed through higher taxation but more physicians than politicians thought that higher patient fees, private health insurance and a reduction in social expenditure were better alternatives. Prioritisation aroused anxiety; politicians were afraid of displeasing voters while physicians were afraid of making medically incorrect decisions. This study do not answer the question about how to make prioritisation in health care but the result highlights the different ways that the decision makers view the subject and thereby elicit that publicly elected politicians and physicians perhaps not always work with the same goal ahead. There are needs for more research but also more media focus on the subject so the citizens will be aware and take part in the debate.

Understanding information synthesis in oral surgery for the design of systems for clinical information technology.

PubMed

Suebnukarn, Siriwan; Chanakarn, Piyawadee; Phisutphatthana, Sirada; Pongpatarat, Kanchala; Wongwaithongdee, Udom; Oupadissakoon, Chanekrid

2015-12-01

An understanding of the processes of clinical decision-making is essential for the development of health information technology. In this study we have analysed the acquisition of information during decision-making in oral surgery, and analysed cognitive tasks using a "think-aloud" protocol. We studied the techniques of processing information that were used by novices and experts as they completed 4 oral surgical cases modelled from data obtained from electronic hospital records. We studied 2 phases of an oral surgeon's preoperative practice including the "diagnosis and planning of treatment" and "preparing for a procedure". A framework analysis approach was used to analyse the qualitative data, and a descriptive statistical analysis was made of the quantitative data. The results showed that novice surgeons used hypotheticodeductive reasoning, whereas experts recognised patterns to diagnose and manage patients. Novices provided less detail when they prepared for a procedure. Concepts regarding "signs", "importance", "decisions", and "process" occurred most often during acquisition of information by both novices and experts. Based on these results, we formulated recommendations for the design of clinical information technology that would help to improve the acquisition of clinical information required by oral surgeons at all levels of expertise in their clinical decision-making. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Decision Making on Regional Landfill Site Selection in Hormozgan Province Using Smce

NASA Astrophysics Data System (ADS)

Majedi, A. S.; Kamali, B. M.; Maghsoudi, R.

2015-12-01

Landfill site selection and suitable conditions to bury hazardous wastes are among the most critical issues in modern societies. Taking several factors and limitations into account along with true decision making requires application of different decision techniques. To this end, current paper aims to make decisions about regional landfill site selection in Hormozgan province and utilizes SMCE technique combined with qualitative and quantitative criteria to select the final alternatives. To this respect, we first will describe the existing environmental situation in our study area and set the goals of our study in the framework of SMCE and will analyze the effective factors in regional landfill site selection. Then, methodological procedure of research was conducted using Delphi approach and questionnaires (in order to determine research validity, Chronbach Alpha (0.94) method was used). Spatial multi-criteria analysis model was designed in the form of criteria tree in SMCE using IL WIS software. Prioritization of respective spatial alternatives included: Bandar Abbas city with total 4 spatial alternatives (one zone with 1st priority, one zone with 3rd priority and two zones with 4thpriority) was considered the first priority, Bastak city with total 3 spatial alternatives (one zone with 2nd priority, one zone with 3rdpriorit and one zone with 4th priority) was the second priority and Bandar Abbas, Minab, Jask and Haji Abad cities were considered as the third priority.

WHAT IS THE ROLE OF COMMUNITY PREFERENCE INFORMATION IN HEALTH TECHNOLOGY ASSESSMENT DECISION MAKING? A CASE STUDY OF COLORECTAL CANCER SCREENING.

PubMed

Wortley, Sally; Flitcroft, Kathy; Howard, Kirsten

2015-01-01

The aim of this study was to determine the role of community preference information from discrete choice studies of colorectal cancer (CRC) screening in health technology assessment (HTA) reports and subsequent policy decisions. We undertook a systematic review of discrete choice studies of CRC screening. Included studies were reviewed to assess the policy context of the research. For those studies that cited a recent or pending review of CRC screening, further searches were undertaken to determine the extent to which community preference information was incorporated into the HTA decision-making process. Eight discrete choice studies that evaluated preferences for CRC screening were identified. Four of these studies referred to a national or local review of CRC screening in three countries: Australia, Canada, and the Netherlands. Our review of subsequently released health policy documents showed that while consideration was given to community views on CRC, policy was not informed by discrete choice evidence. Preferences and values of patients are increasingly being considered "evidence" to be incorporated into HTA reports. Discrete choice methodology is a rigorous quantitative method for eliciting preferences and while as a methodology it is growing in profile, it would appear that the results of such research are not being systematically translated or integrated into HTA reports. A formalized approach is needed to incorporate preference literature into the HTA decision-making process.

Decision-making ability of Physarum polycephalum enhanced by its coordinated spatiotemporal oscillatory dynamics.

PubMed

Iwayama, Koji; Zhu, Liping; Hirata, Yoshito; Aono, Masashi; Hara, Masahiko; Aihara, Kazuyuki

2016-04-12

An amoeboid unicellular organism, a plasmodium of the true slime mold Physarum polycephalum, exhibits complex spatiotemporal oscillatory dynamics and sophisticated information processing capabilities while deforming its amorphous body. We previously devised an 'amoeba-based computer (ABC),' that implemented optical feedback control to lead this amoeboid organism to search for a solution to the traveling salesman problem (TSP). In the ABC, the shortest TSP route (the optimal solution) is represented by the shape of the organism in which the body area (nutrient absorption) is maximized while the risk of being exposed to aversive light stimuli is minimized. The shortness of the TSP route found by ABC, therefore, serves as a quantitative measure of the optimality of the decision made by the organism. However, it remains unclear how the decision-making ability of the organism originates from the oscillatory dynamics of the organism. We investigated the number of coexisting traveling waves in the spatiotemporal patterns of the oscillatory dynamics of the organism. We show that a shorter TSP route can be found when the organism exhibits a lower number of traveling waves. The results imply that the oscillatory dynamics are highly coordinated throughout the global body. Based on the results, we discuss the fact that the decision-making ability of the organism can be enhanced not by uncorrelated random fluctuations, but by its highly coordinated oscillatory dynamics.

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.

Evidence-based health policy-making, hospital funding and health insurance.

PubMed

Palmer, G R

2000-02-07

An important goal of health services research is to improve the efficiency and effectiveness of health services through a quantitative and evidence-based approach. There are many limitations to the use of evidence in health policy-making, such as differences in what counts as evidence between the various disciplines involved, and a heavy reliance on theory in social science disciplines. Community and interest group values, ideological positions and political assessments inevitably intrude into government health policy-making. The importance of these factors is accentuated by the current absence of evidence on the impact of policy options for improving the health status of the community, and ensuring that efficiency and equity objectives for health services are also met. Analysis of recent hospital funding and private health insurance initiatives shows the limited role of evidence in the making of these decisions. Decision-making about health policy might be improved in the future by initiatives such as greater exposure of health professionals to educational inputs with a policy focus; increased contribution of doctors to health services research via special postgraduate programs; and establishing a national, multidisciplinary centre for health policy research and evaluation.

Combining disparate data for decision making

NASA Astrophysics Data System (ADS)

Gettings, M. E.

2010-12-01

Combining information of disparate types from multiple data or model sources is a fundamental task in decision making theory. Procedures for combining and utilizing quantitative data with uncertainties are well-developed in several approaches, but methods for including qualitative and semi-quantitative data are much less so. Possibility theory offers an approach to treating all three data types in an objective and repeatable way. In decision making, biases are frequently present in several forms, including those arising from data quality, data spatial and temporal distribution, and the analyst's knowledge and beliefs as to which data or models are most important. The latter bias is particularly evident in the case of qualitative data and there are numerous examples of analysts feeling that a qualitative dataset is more relevant than a quantified one. Possibility theory and fuzzy logic now provide fairly general rules for quantifying qualitative and semi-quantitative data in ways that are repeatable and minimally biased. Once a set of quantified data and/or model layers is obtained, there are several methods of combining them to obtain insight useful in decision making. These include: various combinations of layers using formal fuzzy logic (for example, layer A and (layer B or layer C) but not layer D); connecting the layers with varying influence links in a Fuzzy Cognitive Map; and using the set of layers for the universe of discourse for agent based model simulations. One example of logical combinations that have proven useful is the definition of possible habitat for valley fever fungus (Coccidioides sp.) using variables such as soil type, altitude, aspect, moisture and temperature. A second example is the delineation of the lithology and possible mineralization of several areas beneath basin fill in southern Arizona. A Fuzzy Cognitive Map example is the impacts of development and operation of a hypothetical mine in an area adjacent to a city. In this model variables such as water use, environmental quality measures (visual and geochemical), deposit quality, rate of development, and commodity price combine in complex ways to yield frequently counter-intuitive results. By varying the interaction strengths linking the variables, insight into the complex interactions of the system can be gained. An example using agent-based modeling is a model designed to test the hypothesis that new valley fever fungus sites could be established from existing sites by wind transport of fungal spores. The variables include layers simulating precipitation, temperature, soil moisture, and soil chemistry based on historical climate records and studies of known valley fever habitat. Numerous agent-based model runs show that the system is self organizing to the extent that there will be new sites established by wind transport over decadal scales. Possibility theory provides a framework for gaining insight into the interaction of known or suspected variables in a complex system. Once the data layers are quantified into possibility functions, varying hypotheses of the relative importance of variables and processes can be obtained by repeated combinations with varying weights. This permits an evaluation of the effects of various data layers, their uncertainties, and biases from the layers, all of which improve the objectivity of decision making.

Making sense of personal health information: challenges for information visualization.

PubMed

Faisal, Sarah; Blandford, Ann; Potts, Henry W W

2013-09-01

This article presents a systematic review of the literature on information visualization for making sense of personal health information. Based on this review, five application themes were identified: treatment planning, examination of patients' medical records, representation of pedigrees and family history, communication and shared decision making, and life management and health monitoring. While there are recognized design challenges associated with each of these themes, such as how best to represent data visually and integrate qualitative and quantitative information, other challenges and opportunities have received little attention to date. In this article, we highlight, in particular, the opportunities for supporting people in better understanding their own illnesses and making sense of their health conditions in order to manage them more effectively.

Talking with parents about end-of-life decisions for their children.

PubMed

de Vos, Mirjam A; Bos, Albert P; Plötz, Frans B; van Heerde, Marc; de Graaff, Bert M; Tates, Kiek; Truog, Robert D; Willems, Dick L

2015-02-01

Retrospective studies show that most parents prefer to share in decisions to forgo life-sustaining treatment (LST) from their children. We do not yet know how physicians and parents communicate about these decisions and to what extent parents share in the decision-making process. We conducted a prospective exploratory study in 2 Dutch University Medical Centers. Overall, 27 physicians participated, along with 37 parents of 19 children for whom a decision to withhold or withdraw LST was being considered. Forty-seven conversations were audio recorded, ranging from 1 to 8 meetings per patient. By means of a coding instrument we quantitatively and qualitatively analyzed physicians' and parents' communicative behaviors. On average, physicians spoke 67% of the time, parents 30%, and nurses 3%. All physicians focused primarily on providing medical information, explaining their preferred course of action, and informing parents about the decision being reached by the team. Only in 2 cases were parents asked to share in the decision-making. Despite their intense emotions, most parents made great effort to actively participate in the conversation. They did this by asking for clarifications, offering their preferences, and reacting to the decision being proposed (mostly by expressing their assent). In the few cases where parents strongly preferred LST to be continued, the physicians either gave parents more time or revised the decision. We conclude that parents are able to handle a more active role than they are currently being given. Parents' greatest concern is that their child might suffer. Copyright © 2015 by the American Academy of Pediatrics.

What makes it so difficult for nurses to coach patients in shared decision making? A process evaluation.

PubMed

Lenzen, Stephanie Anna; Daniëls, Ramon; van Bokhoven, Marloes Amantia; van der Weijden, Trudy; Beurskens, Anna

2018-04-01

Primary care nurses play a crucial role in coaching patients in shared decision making about goals and actions. This presents a challenge to practice nurses, who are frequently used to protocol-based working routines. Therefore, an approach was developed to support nurses to coach patients in shared decision making. To investigate how the approach was implemented and experienced by practice nurses and patients. A process evaluation was conducted using quantitative and qualitative methods. Fifteen female practice nurses (aged between 28 and 55 years), working with people suffering from diabetes, COPD, asthma and/or cardiovascular diseases, participated. Nurses were asked to apply the approach to their chronically ill patients and to recruit patients (n = 10) willing to participate in an interview or an audio-recording of a consultation (n = 13); patients (13 women, 10 men) were aged between 41 and 88 years and suffered from diabetes, COPD or cardiovascular diseases. The approach involved a framework for shared decision making about goals and actions, a tool to explore the patient perspective, a patient profiles model and a training course. Interviews (n = 15) with nurses, a focus group with nurses (n = 9) and interviews with patients (n = 10) were conducted. Nurses filled in a questionnaire about their work routine before, during and after the training course. They were asked to deliver audiotapes of their consultations (n = 13). Overall, nurses felt that the approach supported them to coach patients in shared decision making. Nurses had become more aware of their own attitudes and learning needs and reported to have had more in-depth discussions with patients. The on-the-job coaching was experienced as valuable. However, nurses struggled to integrate the approach in routine care. They experienced the approach as different to their protocol-based routines and expressed the importance of receiving support and the need for integration of the approach into the family physician practice. This study shows that changing practice nurses' role from medical experts to coaches in shared decision making is very complex and requires paying attention to skills and attitudes, as well as to contextual factors. Our results indicate that more time and training might be needed for this role transition. Moreover, it might be worthwhile to focus on organizational learning, in order to increase an organization's capacity to change work routines in a collaborative process. Future research into the development and evaluation of health coaching approaches, focusing on shared decision making, is necessary. Copyright © 2017 Elsevier Ltd. All rights reserved.

Three quantitative approaches to the diagnosis of abdominal pain in children: practical applications of decision theory.

PubMed

Klein, M D; Rabbani, A B; Rood, K D; Durham, T; Rosenberg, N M; Bahr, M J; Thomas, R L; Langenburg, S E; Kuhns, L R

2001-09-01

The authors compared 3 quantitative methods for assisting clinicians in the differential diagnosis of abdominal pain in children, where the most common important endpoint is whether the patient has appendicitis. Pretest probability in different age and sex groups were determined to perform Bayesian analysis, binary logistic regression was used to determine which variables were statistically significantly likely to contribute to a diagnosis, and recursive partitioning was used to build decision trees with quantitative endpoints. The records of all children (1,208) seen at a large urban emergency department (ED) with a chief complaint of abdominal pain were immediately reviewed retrospectively (24 to 72 hours after the encounter). Attempts were made to contact all the patients' families to determine an accurate final diagnosis. A total of 1,008 (83%) families were contacted. Data were analyzed by calculation of the posttest probability, recursive partitioning, and binary logistic regression. In all groups the most common diagnosis was abdominal pain (ICD-9 Code 789). After this, however, the order of the most common final diagnoses for abdominal pain varied significantly. The entire group had a pretest probability of appendicitis of 0.06. This varied with age and sex from 0.02 in boys 2 to 5 years old to 0.16 in boys older than 12 years. In boys age 5 to 12, recursive partitioning and binary logistic regression agreed on guarding and anorexia as important variables. Guarding and tenderness were important in girls age 5 to 12. In boys age greater than 12, both agreed on guarding and anorexia. Using sensitivities and specificities from the literature, computed tomography improved the posttest probability for the group from.06 to.33; ultrasound improved it from.06 to.48; and barium enema improved it from.06 to.58. Knowing the pretest probabilities in a specific population allows the physician to evaluate the likely diagnoses first. Other quantitative methods can help judge how much importance a certain criterion should have in the decision making and how much a particular test is likely to influence the probability of a correct diagnosis. It now should be possible to make these sophisticated quantitative methods readily available to clinicians via the computer. Copyright 2001 by W.B. Saunders Company.

A hierarchical-multiobjective framework for risk management

NASA Technical Reports Server (NTRS)

Haimes, Yacov Y.; Li, Duan

1991-01-01

A broad hierarchical-multiobjective framework is established and utilized to methodologically address the management of risk. United into the framework are the hierarchical character of decision-making, the multiple decision-makers at separate levels within the hierarchy, the multiobjective character of large-scale systems, the quantitative/empirical aspects, and the qualitative/normative/judgmental aspects. The methodological components essentially consist of hierarchical-multiobjective coordination, risk of extreme events, and impact analysis. Examples of applications of the framework are presented. It is concluded that complex and interrelated forces require an analysis of trade-offs between engineering analysis and societal preferences, as in the hierarchical-multiobjective framework, to successfully address inherent risk.

Bedside to Bench: Integrating Quantitative Clinical Pharmacology and Reverse Translation to Optimize Drug Development.

PubMed

Gibbs, John P; Menon, Rajeev; Kasichayanula, Sreeneeranj

2018-02-01

With so much emphasis on reducing attrition and becoming more efficient in the delivery of healthcare, there are many opportunities to leverage existing clinical data in drug development and to foster the practice of reverse translation. The application of quantitative approaches to convert clinical trial and real-world data to knowledge will continue to drive innovation. Herein we discuss recent examples of reverse translation and consider future opportunities to capture critical clinical knowledge to inform decision-making in drug development. © 2017 The Authors. Clinical Pharmacology & Therapeutics published by Wiley Periodicals, Inc. on behalf of American Society for Clinical Pharmacology and Therapeutics.

BCR-ABL PCR testing in chronic myelogenous leukemia: molecular diagnosis for targeted cancer therapy and monitoring.

PubMed

Luu, Martin H; Press, Richard D

2013-09-01

The use of tyrosine kinase inhibitors (TKIs) to treat chronic myeloid leukemia (CML) represents the paradigm for modern targeted cancer therapy. Importantly, molecular monitoring using BCR-ABL real-time quantitative reverse transcription polymerase chain reaction (RQ-PCR) for assessing treatment efficacy and quantitating minimal residual disease is a major determinate of practical therapeutic decision-making in the long-term management of this now chronic disease. Herein, we present an overview of CML and the use of TKIs for targeted CML therapy, with an emphasis on the role, application and future aspects of PCR-based molecular monitoring.

SPECT Myocardial Blood Flow Quantitation Concludes Equivocal Myocardial Perfusion SPECT Studies to Increase Diagnostic Benefits.

PubMed

Chen, Lung-Ching; Lin, Chih-Yuan; Chen, Ing-Jou; Ku, Chi-Tai; Chen, Yen-Kung; Hsu, Bailing

2016-01-01

Recently, myocardial blood flow quantitation with dynamic SPECT/CT has been reported to enhance the detection of coronary artery disease in human. This advance has created important clinical applications to coronary artery disease diagnosis and management for areas where myocardial perfusion PET tracers are not available. We present 2 clinical cases that undergone a combined test of 1-day rest/dipyridamole-stress dynamic SPECT and ECG-gated myocardial perfusion SPECT scans using an integrated imaging protocol and demonstrate that flow parameters are capable to conclude equivocal myocardial perfusion SPECT studies, therefore increasing diagnostic benefits to add value in making clinical decisions.

HIV-related stigma acting as predictors of unemployment of people living with HIV/AIDS.

PubMed

Liu, Ying; Canada, Kelli; Shi, Kan; Corrigan, Patrick

2012-01-01

Obtaining employment is an important part of recovery for many people living with HIV/AIDS (PLHA). However, this population often faces barriers in their attempt to reenter the workplace. One potential barrier lies in the decision-making of employers. Little is known about what influences employers' decision to hire PLHA. The current paper addresses this gap with findings from 156 quantitative interviews with employers across Chicago, Beijing, and Hong Kong regarding the hiring of people with HIV/AIDS. Hierarchical regression analysis showed that both fear of contagion and perceived incompetence are important factors in employers' decision to interview even after controlling for variables related to the employers' business size, their education level, and the provision of health benefits. These two variables accounted for 42% of the variance in employers' decision to interview. Implications of these findings are considered for better understanding of HIV-related employment stigma and further intervention for employing PLHA.

The four principles: Can they be measured and do they predict ethical decision making?

PubMed Central

2012-01-01

Background The four principles of Beauchamp and Childress - autonomy, non-maleficence, beneficence and justice - have been extremely influential in the field of medical ethics, and are fundamental for understanding the current approach to ethical assessment in health care. This study tests whether these principles can be quantitatively measured on an individual level, and then subsequently if they are used in the decision making process when individuals are faced with ethical dilemmas. Methods The Analytic Hierarchy Process was used as a tool for the measurement of the principles. Four scenarios, which involved conflicts between the medical ethical principles, were presented to participants who then made judgments about the ethicality of the action in the scenario, and their intentions to act in the same manner if they were in the situation. Results Individual preferences for these medical ethical principles can be measured using the Analytic Hierarchy Process. This technique provides a useful tool in which to highlight individual medical ethical values. On average, individuals have a significant preference for non-maleficence over the other principles, however, and perhaps counter-intuitively, this preference does not seem to relate to applied ethical judgements in specific ethical dilemmas. Conclusions People state they value these medical ethical principles but they do not actually seem to use them directly in the decision making process. The reasons for this are explained through the lack of a behavioural model to account for the relevant situational factors not captured by the principles. The limitations of the principles in predicting ethical decision making are discussed. PMID:22606995

The four principles: can they be measured and do they predict ethical decision making?

PubMed

Page, Katie

2012-05-20

The four principles of Beauchamp and Childress--autonomy, non-maleficence, beneficence and justice--have been extremely influential in the field of medical ethics, and are fundamental for understanding the current approach to ethical assessment in health care. This study tests whether these principles can be quantitatively measured on an individual level, and then subsequently if they are used in the decision making process when individuals are faced with ethical dilemmas. The Analytic Hierarchy Process was used as a tool for the measurement of the principles. Four scenarios, which involved conflicts between the medical ethical principles, were presented to participants who then made judgments about the ethicality of the action in the scenario, and their intentions to act in the same manner if they were in the situation. Individual preferences for these medical ethical principles can be measured using the Analytic Hierarchy Process. This technique provides a useful tool in which to highlight individual medical ethical values. On average, individuals have a significant preference for non-maleficence over the other principles, however, and perhaps counter-intuitively, this preference does not seem to relate to applied ethical judgements in specific ethical dilemmas. People state they value these medical ethical principles but they do not actually seem to use them directly in the decision making process. The reasons for this are explained through the lack of a behavioural model to account for the relevant situational factors not captured by the principles. The limitations of the principles in predicting ethical decision making are discussed.

Community sensitization and decision-making for trial participation: a mixed-methods study from The Gambia.

PubMed

Dierickx, Susan; O'Neill, Sarah; Gryseels, Charlotte; Immaculate Anyango, Edna; Bannister-Tyrrell, Melanie; Okebe, Joseph; Mwesigwa, Julia; Jaiteh, Fatou; Gerrets, René; Ravinetto, Raffaella; D'Alessandro, Umberto; Peeters Grietens, Koen

2017-08-16

Ensuring individual free and informed decision-making for research participation is challenging. It is thought that preliminarily informing communities through 'community sensitization' procedures may improve individual decision-making. This study set out to assess the relevance of community sensitization for individual decision-making in research participation in rural Gambia. This anthropological mixed-methods study triangulated qualitative methods and quantitative survey methods in the context of an observational study and a clinical trial on malaria carried out by the Medical Research Council Unit Gambia. Although 38.7% of the respondents were present during sensitization sessions, 91.1% of the respondents were inclined to participate in the trial when surveyed after the sensitization and prior to the informed consent process. This difference can be explained by the informal transmission of information within the community after the community sensitization, expectations such as the benefits of participation based on previous research experiences, and the positive reputation of the research institute. Commonly mentioned barriers to participation were blood sampling and the potential disapproval of the household head. Community sensitization is effective in providing first-hand, reliable information to communities as the information is cascaded to those who could not attend the sessions. However, further research is needed to assess how the informal spread of information further shapes people's expectations, how the process engages with existing social relations and hierarchies (e.g. local political power structures; permissions of heads of households) and how this influences or changes individual consent. © 2017 The Authors Developing World Bioethics Published by John Wiley & Sons Ltd.

Treatment decision-making among Canadian youth with severe haemophilia: a qualitative approach.

PubMed

Lane, S J; Walker, I; Chan, A K; Heddle, N M; Poon, M-C; Minuk, L; Jardine, L; Arnold, E; Sholapur, N; Webert, K E

2015-03-01

The first generation of young men using primary prophylaxis is coming of age. Important questions regarding the management of severe haemophilia with prophylaxis persist: Can prophylaxis be stopped? At what age? To what effect? Can the regimen be individualized? The reasons why some individuals discontinue or poorly comply with prophylaxis are not well understood. These issues have been explored using predominantly quantitative research approaches, yielding little insight into treatment decision-making from the perspectives of persons with haemophilia (PWH). Positioning the PWH as a source of expertise about their condition and its management, we undertook a qualitative study: (i) to explore and understand the lived experience of young men with severe haemophilia A or B and (ii) to identify the factors and inter-relationships between factors that affect young men's treatment decision-making. This manuscript reports primarily on the second objective. A modified Straussian, grounded theory methodology was used for data collection (interviews) and preliminary analysis. The study sample, youth aged 15-29, with severe haemophilia A or B, was chosen selectively and recruited through three Canadian Haemophilia Treatment Centres. We found treatment decision-making to be multi-factorial and used the Framework method to analyze the inter-relationships between factors. A typology of four distinct approaches to treatment was identified: lifestyle routine prophylaxis, situational prophylaxis, strict routine prophylaxis and no prophylaxis. Standardized treatment definitions (i.e.: 'primary' and 'secondary', 'prophylaxis') do not adequately describe the ways participants treat. Naming the variation of approaches documented in this study can improve PWH/provider communication, treatment planning and education. © 2014 John Wiley & Sons Ltd.

A dynamic dual process model of risky decision making.

PubMed

Diederich, Adele; Trueblood, Jennifer S

2018-03-01

Many phenomena in judgment and decision making are often attributed to the interaction of 2 systems of reasoning. Although these so-called dual process theories can explain many types of behavior, they are rarely formalized as mathematical or computational models. Rather, dual process models are typically verbal theories, which are difficult to conclusively evaluate or test. In the cases in which formal (i.e., mathematical) dual process models have been proposed, they have not been quantitatively fit to experimental data and are often silent when it comes to the timing of the 2 systems. In the current article, we present a dynamic dual process model framework of risky decision making that provides an account of the timing and interaction of the 2 systems and can explain both choice and response-time data. We outline several predictions of the model, including how changes in the timing of the 2 systems as well as time pressure can influence behavior. The framework also allows us to explore different assumptions about how preferences are constructed by the 2 systems as well as the dynamic interaction of the 2 systems. In particular, we examine 3 different possible functional forms of the 2 systems and 2 possible ways the systems can interact (simultaneously or serially). We compare these dual process models with 2 single process models using risky decision making data from Guo, Trueblood, and Diederich (2017). Using this data, we find that 1 of the dual process models significantly outperforms the other models in accounting for both choices and response times. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Decision making in healthy participants on the Iowa Gambling Task: new insights from an operant approach.

PubMed

Bull, Peter N; Tippett, Lynette J; Addis, Donna Rose

2015-01-01

The Iowa Gambling Task (IGT) has contributed greatly to the study of affective decision making. However, researchers have observed high inter-study and inter-individual variability in IGT performance in healthy participants, and many are classified as impaired using standard criteria. Additionally, while decision-making deficits are often attributed to atypical sensitivity to reward and/or punishment, the IGT lacks an integrated sensitivity measure. Adopting an operant perspective, two experiments were conducted to explore these issues. In Experiment 1, 50 healthy participants completed a 200-trial version of the IGT which otherwise closely emulated Bechara et al.'s (1999) original computer task. Group data for Trials 1-100 closely replicated Bechara et al.'s original findings of high net scores and preferences for advantageous decks, suggesting that implementations that depart significantly from Bechara's standard IGT contribute to inter-study variability. During Trials 101-200, mean net scores improved significantly and the percentage of participants meeting the "impaired" criterion was halved. An operant-style stability criterion applied to individual data revealed this was likely related to individual differences in learning rate. Experiment 2 used a novel operant card task-the Auckland Card Task (ACT)-to derive quantitative estimates of sensitivity using the generalized matching law. Relative to individuals who mastered the IGT, persistent poor performers on the IGT exhibited significantly lower sensitivity to magnitudes (but not frequencies) of rewards and punishers on the ACT. Overall, our findings demonstrate the utility of operant-style analysis of IGT data and the potential of applying operant concurrent-schedule procedures to the study of human decision making.

Instruments to assess the perception of physicians in the decision-making process of specific clinical encounters: a systematic review

PubMed Central

Légaré, France; Moher, David; Elwyn, Glyn; LeBlanc, Annie; Gravel, Karine

2007-01-01

Background The measurement of processes and outcomes that reflect the complexity of the decision-making process within specific clinical encounters is an important area of research to pursue. A systematic review was conducted to identify instruments that assess the perception physicians have of the decision-making process within specific clinical encounters. Methods For every year available up until April 2007, PubMed, PsycINFO, Current Contents, Dissertation Abstracts and Sociological Abstracts were searched for original studies in English or French. Reference lists from retrieved studies were also consulted. Studies were included if they reported a self-administered instrument evaluating physicians' perceptions of the decision-making process within specific clinical encounters, contained sufficient description to permit critical appraisal and presented quantitative results based on administering the instrument. Two individuals independently assessed the eligibility of the instruments and abstracted information on their conceptual underpinnings, main evaluation domain, development, format, reliability, validity and responsiveness. They also assessed the quality of the studies that reported on the development of the instruments with a modified version of STARD. Results Out of 3431 records identified and screened for evaluation, 26 potentially relevant instruments were assessed; 11 met the inclusion criteria. Five instruments were published before 1995. Among those published after 1995, five offered a corresponding patient version. Overall, the main evaluation domains were: satisfaction with the clinical encounter (n = 2), mutual understanding between health professional and patient (n = 2), mental workload (n = 1), frustration with the clinical encounter (n = 1), nurse-physician collaboration (n = 1), perceptions of communication competence (n = 2), degree of comfort with a decision (n = 1) and information on medication (n = 1). For most instruments (n = 10), some reliability and validity criteria were reported in French or English. Overall, the mean number of items on the modified version of STARD was 12.4 (range: 2 to 18). Conclusion This systematic review provides a critical appraisal and repository of instruments that assess the perception physicians have of the decision-making process within specific clinical encounters. More research is needed to pursue the validation of the existing instruments and the development of patient versions. This will help researchers capture the complexity of the decision-making process within specific clinical encounters. PMID:17937801

How to introduce medical ethics at the bedside - Factors influencing the implementation of an ethical decision-making model.

PubMed

Meyer-Zehnder, Barbara; Albisser Schleger, Heidi; Tanner, Sabine; Schnurrer, Valentin; Vogt, Deborah R; Reiter-Theil, Stella; Pargger, Hans

2017-02-23

As the implementation of new approaches and procedures of medical ethics is as complex and resource-consuming as in other fields, strategies and activities must be carefully planned to use the available means and funds responsibly. Which facilitators and barriers influence the implementation of a medical ethics decision-making model in daily routine? Up to now, there has been little examination of these factors in this field. A medical ethics decision-making model called METAP was introduced on three intensive care units and two geriatric wards. An evaluation study was performed from 7 months after deployment of the project until two and a half years. Quantitative and qualitative methods including a questionnaire, semi-structured face-to-face and group-interviews were used. Sixty-three participants from different professional groups took part in 33 face-to-face and 9 group interviews, and 122 questionnaires could be analysed. The facilitating factors most frequently mentioned were: acceptance and presence of the model, support given by the medical and nursing management, an existing or developing (explicit) ethics culture, perception of a need for a medical ethics decision-making model, and engaged staff members. Lack of presence and acceptance, insufficient time resources and staff, poor inter-professional collaboration, absence of ethical competence, and not recognizing ethical problems were identified as inhibiting the implementation of the METAP model. However, the results of the questionnaire as well as of explicit inquiry showed that the respondents stated to have had enough time and staff available to use METAP if necessary. Facilitators and barriers of the implementation of a medical ethics decision-making model are quite similar to that of medical guidelines. The planning for implementing an ethics model or guideline can, therefore, benefit from the extensive literature and experience concerning the implementation of medical guidelines. Lack of time and staff can be overcome when people are convinced that the benefits justify the effort.

Developing a conceptual model for the application of patient and public involvement in the healthcare system in Iran.

PubMed

Azmal, Mohammad; Sari, Ali Akbari; Foroushani, Abbas Rahimi; Ahmadi, Batoul

2016-06-01

Patient and public involvement is engaging patients, providers, community representatives, and the public in healthcare planning and decision-making. The purpose of this study was to develop a model for the application of patient and public involvement in decision making in the Iranian healthcare system. A mixed qualitative-quantitative approach was used to develop a conceptual model. Thirty three key informants were purposely recruited in the qualitative stage, and 420 people (patients and their companions) were included in a protocol study that was implemented in five steps: 1) Identifying antecedents, consequences, and variables associated with the patient and the publics' involvement in healthcare decision making through a comprehensive literature review; 2) Determining the main variables in the context of Iran's health system using conceptual framework analysis; 3) Prioritizing and weighting variables by Shannon entropy; 4) designing and validating a tool for patient and public involvement in healthcare decision making; and 5) Providing a conceptual model of patient and the public involvement in planning and developing healthcare using structural equation modeling. We used various software programs, including SPSS (17), Max QDA (10), EXCEL, and LISREL. Content analysis, Shannon entropy, and descriptive and analytic statistics were used to analyze the data. In this study, seven antecedents variable, five dimensions of involvement, and six consequences were identified. These variables were used to design a valid tool. A logical model was derived that explained the logical relationships between antecedent and consequent variables and the dimensions of patient and public involvement as well. Given the specific context of the political, social, and innovative environments in Iran, it was necessary to design a model that would be compatible with these features. It can improve the quality of care and promote the patient and the public satisfaction with healthcare and legitimate the representative of people they served for. This model can provide a practical guide for managers and policy makers to involve people in making the decisions that influence their lives.

Improved hybridization of Fuzzy Analytic Hierarchy Process (FAHP) algorithm with Fuzzy Multiple Attribute Decision Making - Simple Additive Weighting (FMADM-SAW)

NASA Astrophysics Data System (ADS)

Zaiwani, B. E.; Zarlis, M.; Efendi, S.

2018-03-01

In this research, the improvement of hybridization algorithm of Fuzzy Analytic Hierarchy Process (FAHP) with Fuzzy Technique for Order Preference by Similarity to Ideal Solution (FTOPSIS) in selecting the best bank chief inspector based on several qualitative and quantitative criteria with various priorities. To improve the performance of the above research, FAHP algorithm hybridization with Fuzzy Multiple Attribute Decision Making - Simple Additive Weighting (FMADM-SAW) algorithm was adopted, which applied FAHP algorithm to the weighting process and SAW for the ranking process to determine the promotion of employee at a government institution. The result of improvement of the average value of Efficiency Rate (ER) is 85.24%, which means that this research has succeeded in improving the previous research that is equal to 77.82%. Keywords: Ranking and Selection, Fuzzy AHP, Fuzzy TOPSIS, FMADM-SAW.

Method for matching customer and manufacturer positions for metal product parameters standardization

NASA Astrophysics Data System (ADS)

Polyakova, Marina; Rubin, Gennadij; Danilova, Yulija

2018-04-01

Decision making is the main stage of regulation the relations between customer and manufacturer during the design the demands of norms in standards. It is necessary to match the positions of the negotiating sides in order to gain the consensus. In order to take into consideration the differences of customer and manufacturer estimation of the object under standardization process it is obvious to use special methods of analysis. It is proposed to establish relationships between product properties and its functions using functional-target analysis. The special feature of this type of functional analysis is the consideration of the research object functions and properties. It is shown on the example of hexagonal head crew the possibility to establish links between its functions and properties. Such approach allows obtaining a quantitative assessment of the closeness the positions of customer and manufacturer at decision making during the standard norms establishment.

Gender issues in livestock production: a case study of Zimbabwe.

PubMed

Mupawaenda, Anna C; Chawatama, Shingirai; Muvavarirwa, Plaxidia

2009-10-01

The importance of main streaming gender issues in development programmes is now recognized by governments and development agents. This paper evaluates the role of gender in smallholder livestock production using Zimbabwe as a case study. It draws on several studies and assesses the gender dimension in terms of access and control, decision making and, division of labour. It is shown that for mainly traditional and historical reasons men continue to dominate livestock production although the situation is gradually changing. Men eclipse women in terms of ownership of more valuable stock, the making of decisions and the control of livestock production. This suggests that gender is important in livestock production and must be considered among other factors. The complexity of the system is noted but more gender disaggregated quantitative data is required if gender is to be effectively mainstreamed in livestock development programmes.

Experiences of intervertebral motion palpation in osteopathic practice - A qualitative interview study among Swedish osteopaths.

PubMed

Sposato, Niklas S; Bjerså, Kristofer

2017-01-01

Assessment in manual therapy includes quantitative and qualitative procedures, and intervertebral motion palpation (IMP) is one of the core assessment methods in osteopathic practice. The aim of this study was to explore osteopathic practitioners' experiences of clinical decision-making and IMP as a diagnostic tool for planning and evaluation of osteopathic interventions. The study was conducted with semi-structured interviews that included eight informants. Content analysis was used as the analytical procedure. In total, three categories emerged from the analysis: strategic decision-making, diagnostic usability of IMP, and treatment applicability of IMP. The study indicated that IMP was considered relevant and was given particular importance in cases where IMP findings confirmed clinical information attained from other stages in the diagnostic process as a whole. However, IMP findings were experienced as less important if they were not correlated to other findings. Copyright © 2016 Elsevier Ltd. All rights reserved.

Evaluating Risk Communication After the Fukushima Disaster Based on Nudge Theory.

PubMed

Murakami, Michio; Tsubokura, Masaharu

2017-03-01

Using nudge theory and some examples of risk communication that followed the Fukushima disaster, this article discusses the influences and justifications of risk communication, in addition to how risk communication systems are designed. To assist people in making decisions based on their own value systems, we provide three suggestions, keeping in mind that people can be influenced (ie, "nudged") depending on how risk communication takes place: (1) accumulate knowledge on the process of evaluating how the method of risk communication and a system's default design could impact people; (2) clarify the purpose and outcomes of risk communication; and (3) see what risk communication might be ethically unjustifiable. Quantitative studies on risk communication and collective narratives will provide some ideas for how to design better risk communication systems and to help people make decisions. Furthermore, we have shown examples of unjustifiable risk communication.

Patients’ Non-Medical Characteristics Contribute to Collective Medical Decision-Making at Multidisciplinary Oncological Team Meetings

PubMed Central

Restivo, Léa; Apostolidis, Thémis; Bouhnik, Anne-Déborah; Garciaz, Sylvain; Aurran, Thérèse; Julian-Reynier, Claire

2016-01-01

Background The contribution of patients’ non-medical characteristics to individual physicians’ decision-making has attracted considerable attention, but little information is available on this topic in the context of collective decision-making. Medical decision-making at cancer centres is currently carried out using a collective approach, at MultiDisciplinary Team (MDT) meetings. The aim of this study was to determine how patients’ non-medical characteristics are presented at MDT meetings and how this information may affect the team’s final medical decisions. Design Observations were conducted at a French Cancer Centre during MDT meetings at which non-standard cases involving some uncertainty were discussed from March to May 2014. Physicians’ verbal statements and predefined contextual parameters were collected with a non-participant observational approach. Non numerical data collected in the form of open notes were then coded for quantitative analysis. Univariate and multivariate statistical analyses were performed. Results In the final sample of patients’ records included and discussed (N = 290), non-medical characteristics were mentioned in 32.8% (n = 95) of the cases. These characteristics corresponded to demographics in 22.8% (n = 66) of the cases, psychological data in 11.7% (n = 34), and relational data in 6.2% (n = 18). The patient’s age and his/her “likeability” were the most frequently mentioned characteristics. In 17.9% of the cases discussed, the final decision was deferred: this outcome was positively associated with the patients’ non-medical characteristics and with uncertainty about the outcome of the therapeutic options available. Limitations The design of the study made it difficult to draw definite cause-and-effect conclusions. Conclusion The Social Representations approach suggests that patients’ non-medical characteristics constitute a kind of tacit professional knowledge that may be frequently mobilised in physicians’ everyday professional practice. The links observed between patients’ attributes and the medical decisions made at these meetings show that these attributes should be taken into account in order to understand how medical decisions are reached in difficult situations of this kind. PMID:27167521

A streamlined sustainability assessment tool for improved decision making in the urban water industry.

PubMed

Schulz, Matthias; Short, Michael D; Peters, Gregory M

2012-01-01

Water supply is a key consideration in sustainable urban planning. Ideally, detailed quantitative sustainability assessments are undertaken during the planning stage to inform the decision-making process. In reality, however, the significant time and cost associated with undertaking such detailed environmental and economic assessments is often cited as a barrier to wider implementation of these key decision support tools, particularly for decisions made at the local or regional government level. In an attempt to overcome this barrier of complexity, 4 water service providers in Melbourne, Australia, funded the development of a publicly available streamlined Environmental Sustainability Assessment Tool, which is aimed at a wide range of decision makers to assist them in broadening the type and number of water servicing options that can be considered for greenfield or backlog developments. The Environmental Sustainability Assessment Tool consists of a simple user interface and draws on life cycle inventory data to allow for rapid estimation of the environmental and economic performance of different water servicing scenarios. Scenario options can then be further prioritized by means of an interactive multicriteria analysis. The intent of this article is to identify the key issues to be considered in a streamlined sustainability assessment tool for the urban water industry, and to demonstrate the feasibility of generating accurate life cycle assessments and life cycle costings, using such a tool. We use a real-life case study example consisting of 3 separate scenarios for a planned urban development to show that this kind of tool can emulate life cycle assessments and life cycle costings outcomes obtained through more detailed studies. This simplified approach is aimed at supporting "sustainability thinking" early in the decision-making process, thereby encouraging more sustainable water and sewerage infrastructure solutions. Copyright © 2011 SETAC.

Understanding spearfishing in a coral reef fishery: Fishers’ opportunities, constraints, and decision-making

PubMed Central

Pavlowich, Tyler; Kapuscinski, Anne R.

2017-01-01

Social and ecological systems come together during the act of fishing. However, we often lack a deep understanding of the fishing process, despite its importance for understanding and managing fisheries. A quantitative, mechanistic understanding of the opportunities fishers encounter, the constraints they face, and how they make decisions within the context of opportunities and constraints will enhance the design of fisheries management strategies to meet linked ecological and social objectives and will improve scientific capacity to predict impacts of different strategies. We examined the case of spearfishing in a Caribbean coral reef fishery. We mounted cameras on fishers’ spearguns to observe the fish they encountered, what limited their ability to catch fish, and how they made decisions about which fish to target. We observed spearfishers who dove with and without the assistance of compressed air, and compared the fishing process of each method using content analysis of videos and decision models of fishers’ targeting selections. Compressor divers encountered more fish, took less time to catch each fish, and had a higher rate of successful pursuits. We also analyzed differences among taxa in this multispecies fishery, because some taxa are known to be ecologically or economically more valuable than others. Parrotfish are ecologically indispensable for healthy coral reefs, and they were encountered and captured more frequently than any other taxon. Fishers made decisions about which fish to target based on a fish’s market value, proximity to the fisher, and taxon. The information uncovered on fishers’ opportunities, constraints, and decision making has implications for managing this fishery and others. Moreover, it demonstrates the value of pursuing an improved understanding of the fishing process from the perspective of the fishers. PMID:28750077

Understanding spearfishing in a coral reef fishery: Fishers' opportunities, constraints, and decision-making.

PubMed

Pavlowich, Tyler; Kapuscinski, Anne R

2017-01-01

Social and ecological systems come together during the act of fishing. However, we often lack a deep understanding of the fishing process, despite its importance for understanding and managing fisheries. A quantitative, mechanistic understanding of the opportunities fishers encounter, the constraints they face, and how they make decisions within the context of opportunities and constraints will enhance the design of fisheries management strategies to meet linked ecological and social objectives and will improve scientific capacity to predict impacts of different strategies. We examined the case of spearfishing in a Caribbean coral reef fishery. We mounted cameras on fishers' spearguns to observe the fish they encountered, what limited their ability to catch fish, and how they made decisions about which fish to target. We observed spearfishers who dove with and without the assistance of compressed air, and compared the fishing process of each method using content analysis of videos and decision models of fishers' targeting selections. Compressor divers encountered more fish, took less time to catch each fish, and had a higher rate of successful pursuits. We also analyzed differences among taxa in this multispecies fishery, because some taxa are known to be ecologically or economically more valuable than others. Parrotfish are ecologically indispensable for healthy coral reefs, and they were encountered and captured more frequently than any other taxon. Fishers made decisions about which fish to target based on a fish's market value, proximity to the fisher, and taxon. The information uncovered on fishers' opportunities, constraints, and decision making has implications for managing this fishery and others. Moreover, it demonstrates the value of pursuing an improved understanding of the fishing process from the perspective of the fishers.

An Empirical Study of the Application of Decision Making Model Using Judgement in the Allocation of Resources to Competing Educational Programs. Final Report.

ERIC Educational Resources Information Center

Tuscher, Leroy J.

The purpose of the study was to provide "baseline" data for determining the feasibility of further investigation into the use of quantitive judgmental data in evaluating school programs for determining program budget allocations. The specific objectives were to: 1) Apply a Cost-Utility Model to a "real world" situation in a public secondary…

Dynamic Decision Making under Uncertainty and Partial Information

DTIC Science & Technology

2013-11-14

integral under the natural filtration generated by the Brownian motions . This compact expression potentially enables us to design sub- optimal penalties...bounds on bermudan option price under jump diffusion processes. Quantitative Finance , 2013. Under review, available at http://arxiv.org/abs/1305.4321... Finance , 19:53 – 71, 2009. [3] D.P. Bertsekas. Dynamic Programming and Optimal Control. Athena Scientific, 4th edition, 2012. [4] D.B. Brown and J.E

Artificial Intelligence (Al) Center of Excellence at the University of Pennsylvania

DTIC Science & Technology

1995-07-01

Approach and repel behaviors were implemented in order to study higher level behavioral simulation . Parallel algorithms for motion planning (as a...of decision-making accuracy can be specified for this graph-reduction process. We have also developed a mixed qualitative/quantitative simulation ...system, called QobiSIM. QobiSIM has been used to develop a cardiovascular simulation to be incorporated into the TraumAID system. This cardiovascular

When Information Improves Information Security

NASA Astrophysics Data System (ADS)

Grossklags, Jens; Johnson, Benjamin; Christin, Nicolas

This paper presents a formal, quantitative evaluation of the impact of bounded-rational security decision-making subject to limited information and externalities. We investigate a mixed economy of an individual rational expert and several naïve near-sighted agents. We further model three canonical types of negative externalities (weakest-link, best shot and total effort), and study the impact of two information regimes on the threat level agents are facing.

Practical experiences of adopting assurance as a quantitative framework to support decision making in drug development.

PubMed

Crisp, Adam; Miller, Sam; Thompson, Douglas; Best, Nicky

2018-04-10

All clinical trials are designed for success of their primary objectives. Hence, evaluating the probability of success (PoS) should be a key focus at the design stage both to support funding approval from sponsor governance boards and to inform trial design itself. Use of assurance-that is, expected success probability averaged over a prior probability distribution for the treatment effect-to quantify PoS of a planned study has grown across the industry in recent years, and has now become routine within the authors' company. In this paper, we illustrate some of the benefits of systematically adopting assurance as a quantitative framework to support decision making in drug development through several case-studies where evaluation of assurance has proved impactful in terms of trial design and in supporting governance-board reviews of project proposals. In addition, we describe specific features of how the assurance framework has been implemented within our company, highlighting the critical role that prior elicitation plays in this process, and illustrating how the overall assurance calculation may be decomposed into a sequence of conditional PoS estimates which can provide greater insight into how and when different development options are able to discharge risk. Copyright © 2018 John Wiley & Sons, Ltd.

Landslide hazard assessment: recent trends and techniques.

PubMed

Pardeshi, Sudhakar D; Autade, Sumant E; Pardeshi, Suchitra S

2013-01-01

Landslide hazard assessment is an important step towards landslide hazard and risk management. There are several methods of Landslide Hazard Zonation (LHZ) viz. heuristic, semi quantitative, quantitative, probabilistic and multi-criteria decision making process. However, no one method is accepted universally for effective assessment of landslide hazards. In recent years, several attempts have been made to apply different methods of LHZ and to compare results in order to find the best suited model. This paper presents the review of researches on landslide hazard mapping published in recent years. The advanced multivariate techniques are proved to be effective in spatial prediction of landslides with high degree of accuracy. Physical process based models also perform well in LHZ mapping even in the areas with poor database. Multi-criteria decision making approach also play significant role in determining relative importance of landslide causative factors in slope instability process. Remote Sensing and Geographical Information System (GIS) are powerful tools to assess landslide hazards and are being used extensively in landslide researches since last decade. Aerial photographs and high resolution satellite data are useful in detection, mapping and monitoring landslide processes. GIS based LHZ models helps not only to map and monitor landslides but also to predict future slope failures. The advancements in Geo-spatial technologies have opened the doors for detailed and accurate assessment of landslide hazards.

Measurement of smaller colon polyp in CT colonography images using morphological image processing.

PubMed

Manjunath, K N; Siddalingaswamy, P C; Prabhu, G K

2017-11-01

Automated measurement of the size and shape of colon polyps is one of the challenges in Computed tomography colonography (CTC). The objective of this retrospective study was to improve the sensitivity and specificity of smaller polyp measurement in CTC using image processing techniques. A domain knowledge-based method has been implemented with hybrid method of colon segmentation, morphological image processing operators for detecting the colonic structures, and the decision-making system for delineating the smaller polyp-based on a priori knowledge. The method was applied on 45 CTC dataset. The key finding was that the smaller polyps were accurately measured. In addition to 6-9 mm range, polyps of even <5 mm were also detected. The results were validated qualitatively and quantitatively using both 2D MPR and 3D view. Implementation was done on a high-performance computer with parallel processing. It takes [Formula: see text] min for measuring the smaller polyp in a dataset of 500 CTC images. With this method, [Formula: see text] and [Formula: see text] were achieved. The domain-based approach with morphological image processing has given good results. The smaller polyps were measured accurately which helps in making right clinical decisions. Qualitatively and quantitatively the results were acceptable when compared to the ground truth at [Formula: see text].

An exploratory study of relational, persuasive, and nonverbal communication in requests for tissue donation.

PubMed

Siminoff, Laura A; Traino, Heather M; Gordon, Nahida H

2011-10-01

This study explores the effects of tissue requesters' relational, persuasive, and nonverbal communication on families' final donation decisions. One thousand sixteen (N = 1,016) requests for tissue donation were audiotaped and analyzed using the Siminoff Communication Content and Affect Program, a computer application specifically designed to code and assist with the quantitative analysis of communication data. This study supports the important role of communication strategies in health-related decision making. Families were more likely to consent to tissue donation when confirmational messages (e.g., messages that expressed validation or acceptance) or persuasive tactics such as credibility, altruism, or esteem were used during donation discussions. Consent was also more likely when family members exhibited nonverbal immediacy or disclosed private information about themselves or the patient. The results of a hierarchical log-linear regression revealed that the use of relational communication during requests directly predicted family consent. The results provide information about surrogate decision making in end-of-life situations and may be used to guide future practice in obtaining family consent to tissue donation.

An Exploratory Study of Relational, Persuasive, and Nonverbal Communication in Requests for Tissue Donation

PubMed Central

SIMINOFF, LAURA A.; TRAINO, HEATHER M.; GORDON, NAHIDA H.

2011-01-01

This study explores the effects of tissue requesters’ relational, persuasive, and nonverbal communication on families’ final donation decisions. One thousand sixteen (N=1,016) requests for tissue donation were audiotaped and analyzed using the Siminoff Communication Content and Affect Program, a computer application specifically designed to code and assist with the quantitative analysis of communication data. This study supports the important role of communication strategies in health-related decision making. Families were more likely to consent to tissue donation when confirmational messages (e.g., messages that expressed validation or acceptance) or persuasive tactics such as credibility, altruism, or esteem were used during donation discussions. Consent was also more likely when family members exhibited nonverbal immediacy or disclosed private information about themselves or the patient. The results of a hierarchical log-linear regression revealed that the use of relational communication during requests directly predicted family consent. The results provide information about surrogate decision making in end-of-life situations and may be used to guide future practice in obtaining family consent to tissue donation. PMID:21512935

Supporting Clinical Cognition: A Human-Centered Approach to a Novel ICU Information Visualization Dashboard.

PubMed

Faiola, Anthony; Srinivas, Preethi; Duke, Jon

2015-01-01

Advances in intensive care unit bedside displays/interfaces and electronic medical record (EMR) technology have not adequately addressed the topic of visual clarity of patient data/information to further reduce cognitive load during clinical decision-making. We responded to these challenges with a human-centered approach to designing and testing a decision-support tool: MIVA 2.0 (Medical Information Visualization Assistant, v.2). Envisioned as an EMR visualization dashboard to support rapid analysis of real-time clinical data-trends, our primary goal originated from a clinical requirement to reduce cognitive overload. In the study, a convenience sample of 12 participants were recruited, in which quantitative and qualitative measures were used to compare MIVA 2.0 with ICU paper medical-charts, using time-on-task, post-test questionnaires, and interviews. Findings demonstrated a significant difference in speed and accuracy with the use of MIVA 2.0. Qualitative outcomes concurred, with participants acknowledging the potential impact of MIVA 2.0 for reducing cognitive load and enabling more accurate and quicker decision-making.

The application of decision analysis to life support research and technology development

NASA Technical Reports Server (NTRS)

Ballin, Mark G.

1994-01-01

Applied research and technology development is often characterized by uncertainty, risk, and significant delays before tangible returns are obtained. Decision making regarding which technologies to advance and what resources to devote to them is a challenging but essential task. In the application of life support technology to future manned space flight, new technology concepts typically are characterized by nonexistent data and rough approximations of technology performance, uncertain future flight program needs, and a complex, time-intensive process to develop technology to a flight-ready status. Decision analysis is a quantitative, logic-based discipline that imposes formalism and structure to complex problems. It also accounts for the limits of knowledge that may be available at the time a decision is needed. The utility of decision analysis to life support technology R & D was evaluated by applying it to two case studies. The methodology was found to provide insight that is not possible from more traditional analysis approaches.

Patients' attitudes to their embryos and their destiny: social conditioning?

PubMed

de Lacey, Sheryl

2007-02-01

The clinical management of embryo storage and disposal is dynamic and subject to changes in the cultural context such as public debate and the implementation of public policy. Studies of the decisions made by patient couples for their embryos, and trends in decision-making over time and in relation to issues arising in the cultural context are rare. Studies of the attitudes that patient couples have towards their frozen embryos have largely focused on measuring patients' intentions in relation to publicly contentious outcomes. A small but expanding number of interview studies are illuminating the meaning that couples attribute to frozen embryos and how this influences decisions for their destiny. This chapter maps both quantitative and qualitative studies of patients' attitudes and decisions illuminating similarities and contradictions in study findings, and ultimately highlights the range of attitudes in patients, clinics and the community towards what is evidently a difficult and morally challenging decision to end the storage of frozen embryos.

How are Treatment Decisions Made about Artificial Nutrition for Individuals at Risk of Lacking Capacity? A Systematic Literature Review

PubMed Central

Clarke, Gemma; Harrison, Katy; Holland, Anthony; Kuhn, Isla; Barclay, Stephen

2013-01-01

Background Worldwide, the number of individuals lacking the mental capacity to participate in decisions about their own healthcare is increasing. Due to the ageing global population and advancing medical treatments, there are now many more people living longer with neurological disorders, such as dementia, acquired brain injuries, and intellectual disabilities. Many of these individuals have feeding difficulties and may require artificial nutrition. However, little is known about the decision-making process; the evidence base is uncertain and often ethically complex. Using the exemplar of artificial nutrition, the objective of this review is to examine how treatment decisions are made when patients are at risk of lacking capacity. Methods and Findings We undertook a systematic review according to PRISMA guidelines to determine who was involved in decisions, and what factors were considered. We searched PubMed, AMED, CINAHL, EMBASE, PsychINFO, and OpenSigle for quantitative and qualitative studies (1990–2011). Citation, reference, hand searches and expert consultation were also undertaken. Data extraction and quality assessment were undertaken independently and in duplicate. We utilised Thomas and Harden’s ‘Thematic Synthesis’ for analysis. Sixty-six studies met inclusion criteria, comprising data from 40 countries and 34,649 patients, carers and clinicians. Six themes emerged: clinical indications were similar across countries but were insufficient alone for determining outcomes; quality of life was the main decision-making factor but its meaning varied; prolonging life was the second most cited factor; patient’s wishes were influential but not determinative; families had some influence but were infrequently involved in final recommendations; clinicians often felt conflicted about their roles. Conclusions When individuals lack mental capacity, decisions must be made on their behalf. Dynamic interactive factors, such as protecting right to life, not unnecessarily prolonging suffering, and individual preferences, need to be addressed and balanced. These findings provide an outline to aid clinical practice and develop decision-making guidelines. PMID:23613857

A Sensitivity Model (SM) approach to analyze urban development in Taiwan based on sustainability indicators

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

Huang Shuli; Yeh Chiatsung; Budd, William W.

2009-02-15

Sustainability indicators have been widely developed to monitor and assess sustainable development. They are expected to guide political decision-making based on their capability to represent states and trends of development. However, using indicators to assess the sustainability of urban strategies and policies has limitations - as they neither reflect the systemic interactions among them, nor provide normative indications in what direction they should be developed. This paper uses a semi-quantitative systematic model tool (Sensitivity Model Tools, SM) to analyze the role of urban development in Taiwan's sustainability. The results indicate that the natural environment in urban area is one ofmore » the most critical components and the urban economic production plays a highly active role in affecting Taiwan's sustainable development. The semi-quantitative simulation model integrates sustainability indicators and urban development policy to provide decision-makers with information about the impacts of their decisions on urban development. The system approach incorporated by this paper can be seen as a necessary, but not sufficient, condition for a sustainability assessment. The participatory process of expert participants for providing judgments on the relations between indicator variables is also discussed.« less

Using detailed inter-network simulation and model abstraction to investigate and evaluate joint battlespace infosphere (JBI) support technologies

NASA Astrophysics Data System (ADS)

Green, David M.; Dallaire, Joel D.; Reaper, Jerome H.

2004-08-01

The Joint Battlespace Infosphere (JBI) program is performing a technology investigation into global communications, data mining and warehousing, and data fusion technologies by focusing on techniques and methodologies that support twenty first century military distributed collaboration. Advancement of these technologies is vitally important if military decision makers are to have the right data, in the right format, at the right time and place to support making the right decisions within available timelines. A quantitative understanding of individual and combinational effects arising from the application of technologies within a framework is presently far too complex to evaluate at more than a cursory depth. In order to facilitate quantitative analysis under these circumstances, the Distributed Information Enterprise Modeling and Simulation (DIEMS) team was formed to apply modeling and simulation (M&S) techniques to help in addressing JBI analysis challenges. The DIEMS team has been tasked utilizing collaborative distributed M&S architectures to quantitatively evaluate JBI technologies and tradeoffs. This paper first presents a high level view of the DIEMS project. Once this approach has been established, a more concentrated view of the detailed communications simulation techniques used in generating the underlying support data sets is presented.

Critical factors in career decision making for women medical graduates.

PubMed

Lawrence, Joanna; Poole, Phillippa; Diener, Scott

2003-04-01

Within the next 30 years there will be equal numbers of women and men in the medical workforce. Indications are that women are increasing their participation in specialties other than general practice, although at a slower rate than their participation in the workforce as a whole. To inform those involved in training and employment of medical women, this study investigated the influencing factors in career decision making for female medical graduates. A total of 305 women medical graduates from the University of Auckland responded to a mail survey (73% response rate) which examined influences on decision making, in both qualitative and quantitative ways, as part of a larger survey. Most women were satisfied with their careers. The principal component analysis of the influencing factors identified four distinct factors important in career choice - interest, flexibility, women friendliness and job security, although the first two of these were rated more highly than the others. Barriers to full participation by medical women in training and employment need to be systematically examined and removed. This is not only to allow women themselves to reach their full potential, but for workforce and socio-economic reasons. Initiatives that allow and value more flexible training and work practices, particularly through the years of child raising, are necessary for women and the health care workforce at large.

Test- and behavior-specific genetic factors affect WKY hypoactivity in tests of emotionality.

PubMed

Baum, Amber E; Solberg, Leah C; Churchill, Gary A; Ahmadiyeh, Nasim; Takahashi, Joseph S; Redei, Eva E

2006-05-15

Inbred Wistar-Kyoto rats consistently display hypoactivity in tests of emotional behavior. We used them to test the hypothesis that the genetic factors underlying the behavioral decision-making process will vary in different environmental contexts. The contexts used were the open-field test (OFT), a novel environment with no explicit threats present, and the defensive-burying test (DB), a habituated environment into which a threat has been introduced. Rearing, a voluntary behavior was measured in both tests, and our study was the first to look for genetic loci affecting grooming, a relatively automatic, stress-responsive stereotyped behavior. Quantitative trait locus analysis was performed on a population of 486 F2 animals bred from reciprocal inter-crosses. The genetic architectures of DB and OFT rearing, and of DB and OFT grooming, were compared. There were no common loci affecting grooming behavior in both tests. These different contexts produced the stereotyped behavior via different pathways, and genetic factors seem to influence the decision-making pathways and not the expression of the behavior. Three loci were found that affected rearing behavior in both tests. However, in both contexts, other loci had greater effects on the behavior. Our results imply that environmental context's effects on decision-making vary depending on the category of behavior.

Medical communication and technology: a video-based process study of the use of decision aids in primary care consultations.

PubMed

Kaner, Eileen; Heaven, Ben; Rapley, Tim; Murtagh, Madeleine; Graham, Ruth; Thomson, Richard; May, Carl

2007-01-10

Much of the research on decision-making in health care has focused on consultation outcomes. Less is known about the process by which clinicians and patients come to a treatment decision. This study aimed to quantitatively describe the behaviour shown by doctors and patients during primary care consultations when three types of decision aids were used to promote treatment decision-making in a randomised controlled trial. A video-based study set in an efficacy trial which compared the use of paper-based guidelines (control) with two forms of computer-based decision aids (implicit and explicit versions of DARTS II). Treatment decision concerned warfarin anti-coagulation to reduce the risk of stroke in older patients with atrial fibrillation. Twenty nine consultations were video-recorded. A ten-minute 'slice' of the consultation was sampled for detailed content analysis using existing interaction analysis protocols for verbal behaviour and ethological techniques for non-verbal behaviour. Median consultation times (quartiles) differed significantly depending on the technology used. Paper-based guidelines took 21 (19-26) minutes to work through compared to 31 (16-41) minutes for the implicit tool; and 44 (39-55) minutes for the explicit tool. In the ten minutes immediately preceding the decision point, GPs dominated the conversation, accounting for 64% (58-66%) of all utterances and this trend was similar across all three arms of the trial. Information-giving was the most frequent activity for both GPs and patients, although GPs did this at twice the rate compared to patients and at higher rates in consultations involving computerised decision aids. GPs' language was highly technically focused and just 7% of their conversation was socio-emotional in content; this was half the socio-emotional content shown by patients (15%). However, frequent head nodding and a close mirroring in the direction of eye-gaze suggested that both parties were active participants in the conversation Irrespective of the arm of the trial, both patients' and GPs' behaviour showed that they were reciprocally engaged in these consultations. However, even in consultations aimed at promoting shared decision-making, GPs' were verbally dominant, and they worked primarily as information providers for patients. In addition, computer-based decision aids significantly prolonged the consultations, particularly the later phases. These data suggest that decision aids may not lead to more 'sharing' in treatment decision-making and that, in their current form, they may take too long to negotiate for use in routine primary care.

Towards more effective online information support for mammography screening decisions.

PubMed

Martucci, Jessica; Schmidt, Harald

2018-06-01

We sought to determine the extent to which web-based patient-directed resources of U.S. public health agencies and professional groups offer consistent and relevant information on the benefits and harms of mammography screening. Between August 2016-February 2017, we identified, collected and analyzed information about mammography screening from the websites of 14 well-known governmental public health agencies and professional groups. We recorded and compared the qualitative and quantitative information the sites offered on (1) breast cancer mortality; (2) false-positive results; (3) unnecessary biopsy; and (4) overdetection. Our results show considerable variation on which benefits and harms are mentioned, whether they are discussed in qualitative and/or quantitative terms, and how this information is delivered and framed. We argue that it is ethically problematic that benefit and harm information is presented in inconsistent and incomplete ways, and we suggest that organizations work towards the adoption of uniform categories to genuinely support preference-sensitive decision making. Copyright © 2017 Elsevier Inc. All rights reserved.

Utility of qualitative research findings in evidence-based public health practice.

PubMed

Jack, Susan M

2006-01-01

Epidemiological data, derived from quantitative studies, provide important information about the causes, prevalence, risk correlates, treatment and prevention of diseases, and health issues at a population level. However, public health issues are complex in nature and quantitative research findings are insufficient to support practitioners and administrators in making evidence-informed decisions. Upshur's Synthetic Model of Evidence (2001) situates qualitative research findings as a credible source of evidence for public health practice. This article answers the following questions: (1) where does qualitative research fit within the paradigm of evidence-based practice and (2) how can qualitative research be used by public health professionals? Strategies for using qualitative research findings instrumentally, conceptually, and symbolically are identified by applying Estabrooks' (1999) conceptual structure of research utilization. Different research utilization strategies are illustrated through the use of research examples from the field of work on intimate partner violence against women. Recommendations for qualitative researchers disseminating findings and for public health practitioners/policy makers considering the use of qualitative findings as evidence to inform decisions are provided.

Statistical Mechanics of the US Supreme Court

NASA Astrophysics Data System (ADS)

Lee, Edward D.; Broedersz, Chase P.; Bialek, William

2015-07-01

We build simple models for the distribution of voting patterns in a group, using the Supreme Court of the United States as an example. The maximum entropy model consistent with the observed pairwise correlations among justices' votes, an Ising spin glass, agrees quantitatively with the data. While all correlations (perhaps surprisingly) are positive, the effective pairwise interactions in the spin glass model have both signs, recovering the intuition that ideologically opposite justices negatively influence each another. Despite the competing interactions, a strong tendency toward unanimity emerges from the model, organizing the voting patterns in a relatively simple "energy landscape." Besides unanimity, other energy minima in this landscape, or maxima in probability, correspond to prototypical voting states, such as the ideological split or a tightly correlated, conservative core. The model correctly predicts the correlation of justices with the majority and gives us a measure of their influence on the majority decision. These results suggest that simple models, grounded in statistical physics, can capture essential features of collective decision making quantitatively, even in a complex political context.

Towards a differentiated understanding of active travel behaviour: Using social theory to explore everyday commuting

PubMed Central

Guell, C.; Panter, J.; Jones, N.R.; Ogilvie, D.

2012-01-01

Fostering physical activity is an established public health priority for the primary prevention of a variety of chronic diseases. One promising population approach is to seek to embed physical activity in everyday lives by promoting walking and cycling to and from work (‘active commuting’) as an alternative to driving. Predominantly quantitative epidemiological studies have investigated travel behaviours, their determinants and how they may be changed towards more active choices. This study aimed to depart from narrow behavioural approaches to travel and investigate the social context of commuting with qualitative social research methods. Within a social practice theory framework, we explored how people describe their commuting experiences and make commuting decisions, and how travel behaviour is embedded in and shaped by commuters' complex social worlds. Forty-nine semi-structured interviews and eighteen photo-elicitation interviews with accompanying field notes were conducted with a subset of the Commuting and Health in Cambridge study cohort, based in the UK. The findings are discussed in terms of three particularly pertinent facets of the commuting experience. Firstly, choice and decisions are shaped by the constantly changing and fluid nature of commuters' social worlds. Secondly, participants express ambiguities in relation to their reasoning, ambitions and identities as commuters. Finally, commuting needs to be understood as an embodied and emotional practice. With this in mind, we suggest that everyday decision-making in commuting requires the tactical negotiation of these complexities. This study can help to explain the limitations of more quantitative and static models and frameworks in predicting travel behaviour and identify future research directions. PMID:22486840

Measuring use of research evidence in public health policy: a policy content analysis

PubMed Central

2014-01-01

Background There are few Australian studies showing how research evidence is used to inform the development of public health policy. International research has shown that compensation for injury rehabilitation can have negative impacts on health outcomes. This study examined transport injury compensation policy in the Australian state of Victoria to: determine type and purpose of reference to information sources; and to identify the extent of reference to academic research evidence in transport related injury rehabilitation compensation policy. Methods Quantitative content analysis of injury rehabilitation compensation policies (N = 128) from the Victorian state government transport accident compensation authority. Results The most commonly referenced types of information were Internal Policy (median = 6 references per policy), Clinical/Medical (2.5), and Internal Legislation (1). Academic Research Evidence was the least often referenced source of information. The main purpose of reference to information was to support injury treatment and rehabilitation compensation claims decision-making. Conclusions Transport injury compensation policy development is complex; with multiple sources of information cited including legislation, internal policy, external policy and clinical/medical evidence. There is limited use of academic research evidence in Victorian state government injury treatment and rehabilitation compensation policies. Decisions regarding compensation for injury treatment and rehabilitation services could benefit from greater use of academic research evidence. This study is one of the first to examine the use of research evidence in existing Australian public health policy decision-making using rigorous quantitative methods. It provides a practical example of how use of research evidence in public health policy can be objectively measured. PMID:24886092

Machine Learning in Medical Imaging.

PubMed

Giger, Maryellen L

2018-03-01

Advances in both imaging and computers have synergistically led to a rapid rise in the potential use of artificial intelligence in various radiological imaging tasks, such as risk assessment, detection, diagnosis, prognosis, and therapy response, as well as in multi-omics disease discovery. A brief overview of the field is given here, allowing the reader to recognize the terminology, the various subfields, and components of machine learning, as well as the clinical potential. Radiomics, an expansion of computer-aided diagnosis, has been defined as the conversion of images to minable data. The ultimate benefit of quantitative radiomics is to (1) yield predictive image-based phenotypes of disease for precision medicine or (2) yield quantitative image-based phenotypes for data mining with other -omics for discovery (ie, imaging genomics). For deep learning in radiology to succeed, note that well-annotated large data sets are needed since deep networks are complex, computer software and hardware are evolving constantly, and subtle differences in disease states are more difficult to perceive than differences in everyday objects. In the future, machine learning in radiology is expected to have a substantial clinical impact with imaging examinations being routinely obtained in clinical practice, providing an opportunity to improve decision support in medical image interpretation. The term of note is decision support, indicating that computers will augment human decision making, making it more effective and efficient. The clinical impact of having computers in the routine clinical practice may allow radiologists to further integrate their knowledge with their clinical colleagues in other medical specialties and allow for precision medicine. Copyright © 2018. Published by Elsevier Inc.

Informal information for web-based engineering catalogues

NASA Astrophysics Data System (ADS)

Allen, Richard D.; Culley, Stephen J.; Hicks, Ben J.

2001-10-01

Success is highly dependent on the ability of a company to efficiently produce optimal designs. In order to achieve this companies must minimize time to market and possess the ability to make fully informed decisions at the early phase of the design process. Such decisions may include the choice of component and suppliers, as well as cost and maintenance considerations. Computer modeling and electronic catalogues are becoming the preferred medium for the selection and design of mechanical components. In utilizing these techniques, the designer demands the capability to identify, evaluate and select mechanical components both quantitatively and qualitatively. Quantitative decisions generally encompass performance data included in the formal catalogue representation. It is in the area of qualitative decisions that the use of what the authors call 'Informal Information' is of crucial importance. Thus, 'Informal Information' must often be incorporated into the selection process and selection systems. This would enable more informed decisions to be made quicker, without the need for information retrieval via discussion with colleagues in the design environment. This paper provides an overview of the use of electronic information in the design of mechanical systems, including a discussion of limitations of current technology. The importance of Informal Information is discussed and the requirements for association with web based electronic catalogues are developed. This system is based on a flexible XML schema and enables the storage, classification and recall of Informal Information packets. Furthermore, a strategy for the inclusion of Informal Information is proposed, and an example case is used to illustrate the benefits.

Combining probabilistic hazard assessment with cost-benefit analysis to support decision making in a volcanic crisis from the Auckland Volcanic Field, New Zealand

NASA Astrophysics Data System (ADS)

Sandri, Laura; Jolly, Gill; Lindsay, Jan; Howe, Tracy; Marzocchi, Warner

2010-05-01

One of the main challenges of modern volcanology is to provide the public with robust and useful information for decision-making in land-use planning and in emergency management. From the scientific point of view, this translates into reliable and quantitative long- and short-term volcanic hazard assessment and eruption forecasting. Because of the complexity in characterizing volcanic events, and of the natural variability of volcanic processes, a probabilistic approach is more suitable than deterministic modeling. In recent years, two probabilistic codes have been developed for quantitative short- and long-term eruption forecasting (BET_EF) and volcanic hazard assessment (BET_VH). Both of them are based on a Bayesian Event Tree, in which volcanic events are seen as a chain of logical steps of increasing detail. At each node of the tree, the probability is computed by taking into account different sources of information, such as geological and volcanological models, past occurrences, expert opinion and numerical modeling of volcanic phenomena. Since it is a Bayesian tool, the output probability is not a single number, but a probability distribution accounting for aleatory and epistemic uncertainty. In this study, we apply BET_VH in order to quantify the long-term volcanic hazard due to base surge invasion in the region around Auckland, New Zealand's most populous city. Here, small basaltic eruptions from monogenetic cones pose a considerable risk to the city in case of phreatomagmatic activity: evidence for base surges are not uncommon in deposits from past events. Currently, we are particularly focussing on the scenario simulated during Exercise Ruaumoko, a national disaster exercise based on the build-up to an eruption in the Auckland Volcanic Field. Based on recent papers by Marzocchi and Woo, we suggest a possible quantitative strategy to link probabilistic scientific output and Boolean decision making. It is based on cost-benefit analysis, in which all costs and benefits of mitigation actions have to be evaluated and compared, weighting them with the probability of occurrence of a specific threatening volcanic event. An action should be taken when the benefit of that action outweighs the costs. It is worth remarking that this strategy does not guarantee to recommend a decision that we would have taken with the benefit of hindsight. However, this strategy will be successful over the long-tem. Furthermore, it has the overwhelming advantage of providing a quantitative decision rule that is set before any emergency, and thus it will be justifiable at any stage of the process. In our present application, we are trying to set up a cost-benefit scheme for the call of an evacuation to protect people in the Auckland Volcanic Field against base surge invasion. Considering the heterogeneity of the urban environment and the size of the region at risk, we propose a cost-benefit scheme that is space dependent, to take into account higher costs when an eruption threatens sensible sites for the city and/or the nation, such as the international airport or the harbour. Finally, we compare our findings with the present Contingency Plan for Auckland.

Use of the Analytic Hierarchy Process for Medication Decision-Making in Type 2 Diabetes

PubMed Central

Maruthur, Nisa M.; Joy, Susan M.; Dolan, James G.; Shihab, Hasan M.; Singh, Sonal

2015-01-01

Aim To investigate the feasibility and utility of the Analytic Hierarchy Process (AHP) for medication decision-making in type 2 diabetes. Methods We conducted an AHP with nine diabetes experts using structured interviews to rank add-on therapies (to metformin) for type 2 diabetes. During the AHP, participants compared treatment alternatives relative to eight outcomes (hemoglobin A1c-lowering and seven potential harms) and the relative importance of the different outcomes. The AHP model and instrument were pre-tested and pilot-tested prior to use. Results were discussed and an evaluation of the AHP was conducted during a group session. We conducted the quantitative analysis using Expert Choice software with the ideal mode to determine the priority of treatment alternatives. Results Participants judged exenatide to be the best add-on therapy followed by sitagliptin, sulfonylureas, and then pioglitazone. Maximizing benefit was judged 21% more important than minimizing harm. Minimizing severe hypoglycemia was judged to be the most important harm to avoid. Exenatide was the best overall alternative if the importance of minimizing harms was prioritized completely over maximizing benefits. Participants reported that the AHP improved transparency, consistency, and an understanding of others’ perspectives and agreed that the results reflected the views of the group. Conclusions The AHP is feasible and useful to make decisions about diabetes medications. Future studies which incorporate stakeholder preferences should evaluate other decision contexts, objectives, and treatments. PMID:26000636

A Woman's Decision to Choose Bilateral Mastectomy.

PubMed

Jerome-D'Emilia, Bonnie; Suplee, Patricia D; Boiler, Jennifer L K; D'Emilia, John C

2015-01-01

Rates of bilateral mastectomy as treatment for unilateral breast cancer have been rising. Quantitative analyses have resulted in assumptions about why women choose this procedure, without confirmation from the women. The objective of this study was to explore a woman's decision making in the choice of bilateral mastectomy as a treatment for unilateral breast cancer, regardless of stage. A qualitative descriptive design was used. In-depth interviews were conducted by 2 researchers using a semistructured interview guide to elicit data, which were coded and analyzed using thematic analysis. Twenty-three women were interviewed. Five themes were identified that address specific determinants of the decision-making process: finding something, collecting evidence, perceived level of risk, identifying priorities, and making the decision. Nine women reported that their physicians recommended bilateral mastectomy. Women who recalled being advised of their risk of recurrence reported overestimates of that risk. The reasons women chose bilateral mastectomy were to avoid a lifetime of follow-up screenings with the subsequent fear of hearing that the breast cancer had returned and wanting to stay alive and well for their children and families. Except for women carrying genetic susceptibility to breast cancer, bilateral mastectomy is not considered the standard of care. Yet women are being offered or choosing this procedure. Nurses can be advocates for women by speaking positively about how women have the right to choose their treatment based on best evidence and personal choice. This evidence should include benefits and risks of the treatment.

An integrative formal model of motivation and decision making: The MGPM*.

PubMed

Ballard, Timothy; Yeo, Gillian; Loft, Shayne; Vancouver, Jeffrey B; Neal, Andrew

2016-09-01

We develop and test an integrative formal model of motivation and decision making. The model, referred to as the extended multiple-goal pursuit model (MGPM*), is an integration of the multiple-goal pursuit model (Vancouver, Weinhardt, & Schmidt, 2010) and decision field theory (Busemeyer & Townsend, 1993). Simulations of the model generated predictions regarding the effects of goal type (approach vs. avoidance), risk, and time sensitivity on prioritization. We tested these predictions in an experiment in which participants pursued different combinations of approach and avoidance goals under different levels of risk. The empirical results were consistent with the predictions of the MGPM*. Specifically, participants pursuing 1 approach and 1 avoidance goal shifted priority from the approach to the avoidance goal over time. Among participants pursuing 2 approach goals, those with low time sensitivity prioritized the goal with the larger discrepancy, whereas those with high time sensitivity prioritized the goal with the smaller discrepancy. Participants pursuing 2 avoidance goals generally prioritized the goal with the smaller discrepancy. Finally, all of these effects became weaker as the level of risk increased. We used quantitative model comparison to show that the MGPM* explained the data better than the original multiple-goal pursuit model, and that the major extensions from the original model were justified. The MGPM* represents a step forward in the development of a general theory of decision making during multiple-goal pursuit. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Evaluating the impact of an intensive education workshop on evidence-informed decision making knowledge, skills, and behaviours: a mixed methods study.

PubMed

Yost, Jennifer; Ciliska, Donna; Dobbins, Maureen

2014-01-17

Health professionals require a unique set of knowledge and skills in order to meet increasing expectations to use research evidence to inform practice and policy decisions. They need to be able to find, access, interpret, and apply the best available research evidence, along with information about patient preferences, clinical expertise, and the clinical context and resources, to such decisions. This study determined preferences for continuing education following an intensive educational workshop and evaluated the impact of the workshop on evidence informed decision making (EIDM) knowledge, skills, and behaviours. An explanatory mixed methods, longitudinal study design was implemented among a convenience sample of various health care professionals attending the workshop. EIDM knowledge, skills, and behaviours were quantitatively measured at baseline and six month follow-up, with EIDM knowledge and skills measured additionally immediately following the educational workshop (post-test measurement). To determine participants preferences for continuing education, data were collected using quantitative survey (post-test measurement) and qualitative (individual telephone interviews after six-month follow-up) methods. EIDM knowledge and skills increased significantly from baseline to immediately following the intervention [5.6, 95% CI (3.7, 7.4), P < 0.001] and from baseline to six-month follow-up [3.7, 95% CI (2.1, 5.3), P < 0.001], with a significant decrease from immediately following the intervention to six-month follow-up [-1.9, 95% CI (-3.5, -0.3), P 0.018]. EIDM behaviours increased, but not significantly, from baseline to six-month follow-up [1.7, 95% CI (-0.3, 3.8), P 0.095]. At baseline and six-month follow-up there was a weak, non-significant positive correlation between EIDM knowledge and skills and EIDM behaviours (r = 0.29, P 0.069 and r = 0.24, P 0.136, respectively). Over time there was a shift in preferences for timing and frequency of online continuing education strategies. Willingness to participate in continuing education, however, remained evident. An intensive educational workshop shows promise for increasing EIDM knowledge and skills. Increasing EIDM knowledge and skills may promote the capacity of health professionals to use research evidence when making practice and policy decisions and, in turn, lead to positive patient outcomes.

Decision making in childbirth: the influence of traditional structures in a Ghanaian village.

PubMed

Jansen, I

2006-03-01

The regional health administration of the Brong-Ahafo Region in Ghana identified that although informed about the advantages of both aspects of care, pregnant women made use of antenatal services but not of the supervised delivery. Quantitative studies have identified economic factors that influence the decisions of pregnant women. To describe and understand the traditional structures of childbirth in Kwame Danso/Ghana and to explore why the pregnant women do not make use of supervised deliveries in the modern institutions. A mini-ethnographic study, using participant observation and ethnographic interviews. Cultural and social factors have a significant influence on the decisions related to childbirth. One of the most important factors identified was that the responsible persons for decisions related to a delivery were the older female relatives, rather than the mothers themselves. Older females used rational judgements to weigh up the possibilities of risks, interests and advantages related to their cultural, spiritual and social system. Other factors were staff behaviour that was characterized as unfriendly and lacking for respect as to the living conditions and thinking of the pregnant women in the village. Ethnographic research provided an understanding of traditional structures that have an influence on the decisions and behaviour of the community related to childbirth. Appreciation of these structures enabled health promotion and structured health services to be delivered in a more culturally appropriate way.

A simple way to unify multicriteria decision analysis (MCDA) and stochastic multicriteria acceptability analysis (SMAA) using a Dirichlet distribution in benefit-risk assessment.

PubMed

Saint-Hilary, Gaelle; Cadour, Stephanie; Robert, Veronique; Gasparini, Mauro

2017-05-01

Quantitative methodologies have been proposed to support decision making in drug development and monitoring. In particular, multicriteria decision analysis (MCDA) and stochastic multicriteria acceptability analysis (SMAA) are useful tools to assess the benefit-risk ratio of medicines according to the performances of the treatments on several criteria, accounting for the preferences of the decision makers regarding the relative importance of these criteria. However, even in its probabilistic form, MCDA requires the exact elicitations of the weights of the criteria by the decision makers, which may be difficult to achieve in practice. SMAA allows for more flexibility and can be used with unknown or partially known preferences, but it is less popular due to its increased complexity and the high degree of uncertainty in its results. In this paper, we propose a simple model as a generalization of MCDA and SMAA, by applying a Dirichlet distribution to the weights of the criteria and by making its parameters vary. This unique model permits to fit both MCDA and SMAA, and allows for a more extended exploration of the benefit-risk assessment of treatments. The precision of its results depends on the precision parameter of the Dirichlet distribution, which could be naturally interpreted as the strength of confidence of the decision makers in their elicitation of preferences. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Forest management and economics

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

Buongiorno, J.; Gilless, J.K.

1987-01-01

This volume provides a survey of quantitative methods, guiding the reader through formulation and analysis of models that address forest management problems. The authors use simple mathematics, graphics, and short computer programs to explain each method. Emphasizing applications, they discuss linear, integer, dynamic, and goal programming; simulation; network modeling; and econometrics, as these relate to problems of determining economic harvest schedules in even-aged and uneven-aged forests, the evaluation of forest policies, multiple-objective decision making, and more.

The Quantitative Evaluation of the Clinical and Translational Science Awards (CTSA) Program Based on Science Mapping and Scientometric Analysis

PubMed Central

Zhang, Yin; Wang, Lei

2013-01-01

Abstract The Clinical and Translational Science Awards (CTSA) program is one of the most important initiatives in translational medical funding. The quantitative evaluation of the efficiency and performance of the CTSA program has a significant referential meaning for the decision making of global translational medical funding. Using science mapping and scientometric analytic tools, this study quantitatively analyzed the scientific articles funded by the CTSA program. The results of the study showed that the quantitative productivities of the CTSA program had a stable increase since 2008. In addition, the emerging trends of the research funded by the CTSA program covered clinical and basic medical research fields. The academic benefits from the CTSA program were assisting its members to build a robust academic home for the Clinical and Translational Science and to attract other financial support. This study provided a quantitative evaluation of the CTSA program based on science mapping and scientometric analysis. Further research is required to compare and optimize other quantitative methods and to integrate various research results. PMID:24330689

Quantitative imaging methods in osteoporosis.

PubMed

Oei, Ling; Koromani, Fjorda; Rivadeneira, Fernando; Zillikens, M Carola; Oei, Edwin H G

2016-12-01

Osteoporosis is characterized by a decreased bone mass and quality resulting in an increased fracture risk. Quantitative imaging methods are critical in the diagnosis and follow-up of treatment effects in osteoporosis. Prior radiographic vertebral fractures and bone mineral density (BMD) as a quantitative parameter derived from dual-energy X-ray absorptiometry (DXA) are among the strongest known predictors of future osteoporotic fractures. Therefore, current clinical decision making relies heavily on accurate assessment of these imaging features. Further, novel quantitative techniques are being developed to appraise additional characteristics of osteoporosis including three-dimensional bone architecture with quantitative computed tomography (QCT). Dedicated high-resolution (HR) CT equipment is available to enhance image quality. At the other end of the spectrum, by utilizing post-processing techniques such as the trabecular bone score (TBS) information on three-dimensional architecture can be derived from DXA images. Further developments in magnetic resonance imaging (MRI) seem promising to not only capture bone micro-architecture but also characterize processes at the molecular level. This review provides an overview of various quantitative imaging techniques based on different radiological modalities utilized in clinical osteoporosis care and research.

The quantitative evaluation of the Clinical and Translational Science Awards (CTSA) program based on science mapping and scientometric analysis.

PubMed

Zhang, Yin; Wang, Lei; Diao, Tianxi

2013-12-01

The Clinical and Translational Science Awards (CTSA) program is one of the most important initiatives in translational medical funding. The quantitative evaluation of the efficiency and performance of the CTSA program has a significant referential meaning for the decision making of global translational medical funding. Using science mapping and scientometric analytic tools, this study quantitatively analyzed the scientific articles funded by the CTSA program. The results of the study showed that the quantitative productivities of the CTSA program had a stable increase since 2008. In addition, the emerging trends of the research funded by the CTSA program covered clinical and basic medical research fields. The academic benefits from the CTSA program were assisting its members to build a robust academic home for the Clinical and Translational Science and to attract other financial support. This study provided a quantitative evaluation of the CTSA program based on science mapping and scientometric analysis. Further research is required to compare and optimize other quantitative methods and to integrate various research results. © 2013 Wiley Periodicals, Inc.

Policy impacts of ecosystem services knowledge

PubMed Central

Posner, Stephen M.; McKenzie, Emily; Ricketts, Taylor H.

2016-01-01

Research about ecosystem services (ES) often aims to generate knowledge that influences policies and institutions for conservation and human development. However, we have limited understanding of how decision-makers use ES knowledge or what factors facilitate use. Here we address this gap and report on, to our knowledge, the first quantitative analysis of the factors and conditions that explain the policy impact of ES knowledge. We analyze a global sample of cases where similar ES knowledge was generated and applied to decision-making. We first test whether attributes of ES knowledge themselves predict different measures of impact on decisions. We find that legitimacy of knowledge is more often associated with impact than either the credibility or salience of the knowledge. We also examine whether predictor variables related to the science-to-policy process and the contextual conditions of a case are significant in predicting impact. Our findings indicate that, although many factors are important, attributes of the knowledge and aspects of the science-to-policy process that enhance legitimacy best explain the impact of ES science on decision-making. Our results are consistent with both theory and previous qualitative assessments in suggesting that the attributes and perceptions of scientific knowledge and process within which knowledge is coproduced are important determinants of whether that knowledge leads to action. PMID:26831101

Measuring decision weights in recognition experiments with multiple response alternatives: comparing the correlation and multinomial-logistic-regression methods.

PubMed

Dai, Huanping; Micheyl, Christophe

2012-11-01

Psychophysical "reverse-correlation" methods allow researchers to gain insight into the perceptual representations and decision weighting strategies of individual subjects in perceptual tasks. Although these methods have gained momentum, until recently their development was limited to experiments involving only two response categories. Recently, two approaches for estimating decision weights in m-alternative experiments have been put forward. One approach extends the two-category correlation method to m > 2 alternatives; the second uses multinomial logistic regression (MLR). In this article, the relative merits of the two methods are discussed, and the issues of convergence and statistical efficiency of the methods are evaluated quantitatively using Monte Carlo simulations. The results indicate that, for a range of values of the number of trials, the estimated weighting patterns are closer to their asymptotic values for the correlation method than for the MLR method. Moreover, for the MLR method, weight estimates for different stimulus components can exhibit strong correlations, making the analysis and interpretation of measured weighting patterns less straightforward than for the correlation method. These and other advantages of the correlation method, which include computational simplicity and a close relationship to other well-established psychophysical reverse-correlation methods, make it an attractive tool to uncover decision strategies in m-alternative experiments.

Evaluation of risk communication in a mammography patient decision aid.

PubMed

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

2016-07-01

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

Themes in the literature related to cardiovascular disease risk reduction.

PubMed

Cohen, Shannon Munro; Kataoka-Yahiro, Merle

2009-01-01

This article aimed to identify themes in the literature related to patient-healthcare provider beliefs, barriers to adherence, and interventions pertaining to cardiovascular disease risk reduction. Twenty quantitative and qualitative primary research studies including 2 meta-analyses published between 1995 and 2008 were analyzed for themes and practice implications to synthesize existing research on cardiovascular disease risk reduction. Databases searched included EBSCO, CINAHL, MEDLINE, ScienceDirect, HealthSource, and PsychLit using the search terms patient- provider adherence, adherence and shared decision making, adherence and decision support, patient- provider goal setting, and cardiovascular disease risk reduction. The emergent themes found in this literature review included (1) complex medication regimens; (2) risk perception, quality of life, and competing priorities; (3) motivation for change; (4) provider clinical inertia; and (5) goal setting, feedback, and reminders. Studies reporting the highest rates of adherence to cardiovascular disease risk reduction recommendations incorporated patient-provider goal setting and decision support, self-management techniques, and personalized printed communication. Goal setting in cardiovascular disease risk reduction is a relatively unexplored area and is an important component of shared decision making and adherence to cardiovascular disease health recommendations. The following review will address the 5 themes identified in more detail and provide a basis for improved clinical practice.

Evaluation of risk communication in a mammography patient decision aid

PubMed Central

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

2016-01-01

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

Providing Quantitative Information and a Nudge to Undergo Stool Testing in a Colorectal Cancer Screening Decision Aid: A Randomized Clinical Trial.

PubMed

Schwartz, Peter H; Perkins, Susan M; Schmidt, Karen K; Muriello, Paul F; Althouse, Sandra; Rawl, Susan M

2017-08-01

Guidelines recommend that patient decision aids should provide quantitative information about probabilities of potential outcomes, but the impact of this information is unknown. Behavioral economics suggests that patients confused by quantitative information could benefit from a "nudge" towards one option. We conducted a pilot randomized trial to estimate the effect sizes of presenting quantitative information and a nudge. Primary care patients (n = 213) eligible for colorectal cancer screening viewed basic screening information and were randomized to view (a) quantitative information (quantitative module), (b) a nudge towards stool testing with the fecal immunochemical test (FIT) (nudge module), (c) neither a nor b, or (d) both a and b. Outcome measures were perceived colorectal cancer risk, screening intent, preferred test, and decision conflict, measured before and after viewing the decision aid, and screening behavior at 6 months. Patients viewing the quantitative module were more likely to be screened than those who did not ( P = 0.012). Patients viewing the nudge module had a greater increase in perceived colorectal cancer risk than those who did not ( P = 0.041). Those viewing the quantitative module had a smaller increase in perceived risk than those who did not ( P = 0.046), and the effect was moderated by numeracy. Among patients with high numeracy who did not view the nudge module, those who viewed the quantitative module had a greater increase in intent to undergo FIT ( P = 0.028) than did those who did not. The limitations of this study were the limited sample size and single healthcare system. Adding quantitative information to a decision aid increased uptake of colorectal cancer screening, while adding a nudge to undergo FIT did not increase uptake. Further research on quantitative information in decision aids is warranted.

Evidence-based dentistry: fundamentals for the dentist.

PubMed

Bauer, Janet; Chiappelli, Francesco; Spackman, Sue; Prolo, Paolo; Stevenson, Richard

2006-06-01

This article explains the fundamentals of evidence-based dentistry for the dentist. Evidence-based dentistry is a discipline whose primary participant is the translational researcher. Recent developments have emphasized the importance of this discipline (clinical and translational research) for improving health care. The process of evidence-based dentistry is the reciprocation of new and existing evidence between dentists and quantitative and qualitative researchers, facilitated by the translational researcher. The product of this reciprocation is the clinical practice guideline, or best evidence, that provides the patient options in choosing treatments or services. These options are quantified and qualified by decision, utility, and cost data. Using shared decision-making, the dentist and patient arrive at a mutual understanding of which option best meets an acceptable and preferred treatment course that is cost effective. This option becomes the clinical decision.

The Role of Ethics Committees and Ethics Consultation in Allocation Decisions

PubMed Central

Strech, Daniel; Hurst, Samia; Danis, Marion

2013-01-01

Background Decisions about the allocation and rationing of medical interventions likely occur in all health care systems worldwide. So far very little attention has been given to the question of what role ethics consultation and ethics committees could or should play in questions of allocation at the hospital level. Objectives and Methods This article argues for the need for ethics consultation in rationing decisions using empirical data about the status quo and the inherent nature of bedside rationing. Subsequently, it introduces a 4-stage process for establishing and conducting ethics consultation in rationing questions with systematic reference to core elements of procedural justice. Results Qualitative and quantitative findings show a significant demand for ethics consultation expressed directly by doctors, as well as additional indirect evidence of such a need as indicated by ethically challenging circumstances of inconsistent and structurally disadvantaging rationing decisions. To address this need, we suggest 4 stages for establishing and conducting ethics consultation in rationing questions we recommend: (1) training, (2) identifying actual scarcity-related problems at clinics, (3) supporting decision-making, and (4) evaluation. Conclusion This process of ethics consultation regarding rationing decisions would facilitate the achievement of several practical goals: (i) encouragement of an awareness and understanding of ethical problems in bedside rationing, (ii) encouragement of achieving efficiency along with rationing, (iii) reinforcement of consistency in inter- and intraindvidual decision-making, (iv) encouragement of explicit reflection and justification of the prioritization criteria taken into consideration, (v) improvement in internal (in-house) and external transparency, and (vi) prevention of the misuse of the corresponding consulting structures. PMID:20706163

Interventions for promoting participation in shared decision-making for children with cancer.

PubMed

Coyne, Imelda; O'Mathúna, Dónal P; Gibson, Faith; Shields, Linda; Leclercq, Edith; Sheaf, Greg

2016-11-29

This is an update of the Cochrane systematic review of shared decision-making (SMD) making published in 2013. Children's rights to have their views heard in matters that affect their lives are now well established since the publication of the UN Convention treaty (1989). Children with cancer generally prefer to be involved in decision-making and consider it important that they have the opportunity to take part in decision-making concerning their health care, even in end-of-life decisions. There is considerable support for involving children in healthcare decision-making at a level commensurate with their experience, age and abilities. Thus, healthcare professionals and parents need to know how they should involve children in decision-making and what interventions are most effective in promoting SDM for children with cancer. To examine the effects of SDM interventions on the process of SDM for children with cancer who are aged four to 18 years. We searched the following sources for the review: Cochrane Central Register of Controlled Studies (CENTRAL) (the Cochrane Library 2016, Issue 1); PubMed (NLM) (1946 to February 2016); Embase (Ovid) (1974 to February 2016); CINAHL (EBSCO) (1982 to February 2016); ERIC (ProQuest) (1966 to February 2016); PsycINFO (EBSCO) (1806 to February 2016); BIOSIS (Thomson Reuters) (1980 to December 2009 - subscription ceased at that date); ProQuest Dissertations and Theses (1637 to February 2016); and Sociological Abstracts (ProQuest) (1952 to February 2016). In addition we searched the reference lists of relevant articles and review articles and the following conference proceedings (2005 up to and including 2015): American Academy on Communication in Healthcare (AACH), European Society for Medical Oncology (ESMO), European CanCer Organisation (ECCO), European Association for Communication in Healthcare (EACH), International Conference on Communication in Healthcare (ICCH), International Shared Decision Making Conference (ISDM), Annual Conference of the International Society for Paediatric Oncology (SIOP) and Annual Scientific Meeting of the Society for Medical Decision Making (SMDM). We scanned the ISRCTN (International Standard Randomised Controlled Trial Number) register and the National Institutes of Health (NIH) Register for ongoing trials on 29 February 2016. For this update, we included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of SDM interventions for children with cancer aged four to 18 years. The types of decisions included were: treatment, health care and research participation decisions. The primary outcome was SDM as measured with any validated scale. Two review authors undertook the searches, and three review authors independently assessed the studies obtained. We contacted study authors for additional information. No studies met the inclusion criteria, and hence no analysis could be undertaken. No conclusions can be made on the effects of interventions to promote SDM for children with cancer aged four to 18 years. This review has highlighted the dearth of high-quality quantitative research on interventions to promote participation in SDM for children with cancer. There are many potential reasons for the lack of SDM intervention studies with children. Attitudes towards children's participation are slowly changing in society and such changes may take time to be translated or adopted in healthcare settings. The priority may be on developing interventions that promote children's participation in communication interactions since information-sharing is a prerequisite for SDM. Restricting this review to RCTs was a limitation and extending the review to non-randomised studies (NRS) may have produced more evidence. For this update, we included only RCTs and CCTs. Clearly more research is needed.

Life cycle impact assessment weights to support environmentally preferable purchasing in the United States.

PubMed

Gloria, Thomas P; Lippiatt, Barbara C; Cooper, Jennifer

2007-11-01

LCA is a quantitative method for understanding the environmental impacts of a product, yet all product purchasing decisions are ultimately subjective. Weights are the nexus between the quantitative results of LCA and the values-based, subjective choices of decision makers. In May 2007, NIST introduced a new optional weight set in Version 4.0 of the BEES software. Three key points about this new optional weight set are the basis for discussion in this paper: The new weight set was created specifically in the context of BEES. It is intended to support a practical method to assist environmentally preferable purchasing in the United States based on LCIA results. This is in contrast to the weight sets currently in BEES, which are based on generalist perspectives. The new weight set was created by a multi-stakeholder panel via the AHP method, and is a synthesis of panelists' perspectives on the relative importance of each environmental impact category in BEES. The weight set draws on each panelist's personal and professional understanding of, and value attributed to, each impact category. While the synthesized weight set may not equally satisfy each panelist's view of impact importance, it does reflect contemporary values in applying LCAto real world decisions, and represents one approach others can learn from in producing weight sets. The new weight set offers BEES users an additional option for synthesizing and comparing the environmental performance of building products and making purchasing decisions. In so doing, it strengthens the decision-making process, which is important when making product comparisons in the public domain. The Weight Set: Across all panelists and with explicit consideration of all time horizons, anthropogenic contributions to global warming, weighted at 29%, was judged most important, yet not so important that decisions can be made solely on the basis of this impact. A strong tail of other concerns include fossil fuel depletion (10%), criteria air pollutants (9%), water intake/use (8%), human health cancerous effects (8%), ecological toxicity (7%), eutrophication of water bodies (6%), land use (6%), and human health noncancerous effects (5%). Also of interest are the identified impact areas of concern assigned the lowest weights: smog formation (4%), indoor air quality (3%), acidification (3%), and ozone depletion (2%). Their low weights may indicate that there is not as much immediate concern or that the remedial actions associated with the impact for the most part are underway.

Conflicting Cultural Values, Gender Role Attitudes, and Acculturation: Exploring the Context of Reproductive and Mental Health of Asian-Indian Immigrant Women in the US.

PubMed

Mann, Semran K; Roberts, Lisa R; Montgomery, Susanne

2017-04-01

Asian-Indians, one of the fastest growing US immigrant groups, experience depression and anxiety, particularly among women. In this mixed-methods study, quantitative (n = 217) and qualitative (n = 36) data explored egalitarian vs. traditional views regarding women's roles and rights. Bicultural integration, family planning decision-making ability, and anxiety were associated with more egalitarian views, while Punjabi language preference, depression, and more births were associated with traditional views. Health care professionals serving this population need to be aware of the potential cultural values conflicts and gender role expectations that influence decisions around reproductive health and mental health care for Asian-Indian immigrant women.

Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers.

PubMed

Trevena, Lyndal J; Zikmund-Fisher, Brian J; Edwards, Adrian; Gaissmaier, Wolfgang; Galesic, Mirta; Han, Paul K J; King, John; Lawson, Margaret L; Linder, Suzanne K; Lipkus, Isaac; Ozanne, Elissa; Peters, Ellen; Timmermans, Danielle; Woloshin, Steven

2013-01-01

Making evidence-based decisions often requires comparison of two or more options. Research-based evidence may exist which quantifies how likely the outcomes are for each option. Understanding these numeric estimates improves patients' risk perception and leads to better informed decision making. This paper summarises current "best practices" in communication of evidence-based numeric outcomes for developers of patient decision aids (PtDAs) and other health communication tools. An expert consensus group of fourteen researchers from North America, Europe, and Australasia identified eleven main issues in risk communication. Two experts for each issue wrote a "state of the art" summary of best evidence, drawing on the PtDA, health, psychological, and broader scientific literature. In addition, commonly used terms were defined and a set of guiding principles and key messages derived from the results. The eleven key components of risk communication were: 1) Presenting the chance an event will occur; 2) Presenting changes in numeric outcomes; 3) Outcome estimates for test and screening decisions; 4) Numeric estimates in context and with evaluative labels; 5) Conveying uncertainty; 6) Visual formats; 7) Tailoring estimates; 8) Formats for understanding outcomes over time; 9) Narrative methods for conveying the chance of an event; 10) Important skills for understanding numerical estimates; and 11) Interactive web-based formats. Guiding principles from the evidence summaries advise that risk communication formats should reflect the task required of the user, should always define a relevant reference class (i.e., denominator) over time, should aim to use a consistent format throughout documents, should avoid "1 in x" formats and variable denominators, consider the magnitude of numbers used and the possibility of format bias, and should take into account the numeracy and graph literacy of the audience. A substantial and rapidly expanding evidence base exists for risk communication. Developers of tools to facilitate evidence-based decision making should apply these principles to improve the quality of risk communication in practice.

Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers

PubMed Central

2013-01-01

Background Making evidence-based decisions often requires comparison of two or more options. Research-based evidence may exist which quantifies how likely the outcomes are for each option. Understanding these numeric estimates improves patients’ risk perception and leads to better informed decision making. This paper summarises current “best practices” in communication of evidence-based numeric outcomes for developers of patient decision aids (PtDAs) and other health communication tools. Method An expert consensus group of fourteen researchers from North America, Europe, and Australasia identified eleven main issues in risk communication. Two experts for each issue wrote a “state of the art” summary of best evidence, drawing on the PtDA, health, psychological, and broader scientific literature. In addition, commonly used terms were defined and a set of guiding principles and key messages derived from the results. Results The eleven key components of risk communication were: 1) Presenting the chance an event will occur; 2) Presenting changes in numeric outcomes; 3) Outcome estimates for test and screening decisions; 4) Numeric estimates in context and with evaluative labels; 5) Conveying uncertainty; 6) Visual formats; 7) Tailoring estimates; 8) Formats for understanding outcomes over time; 9) Narrative methods for conveying the chance of an event; 10) Important skills for understanding numerical estimates; and 11) Interactive web-based formats. Guiding principles from the evidence summaries advise that risk communication formats should reflect the task required of the user, should always define a relevant reference class (i.e., denominator) over time, should aim to use a consistent format throughout documents, should avoid “1 in x” formats and variable denominators, consider the magnitude of numbers used and the possibility of format bias, and should take into account the numeracy and graph literacy of the audience. Conclusion A substantial and rapidly expanding evidence base exists for risk communication. Developers of tools to facilitate evidence-based decision making should apply these principles to improve the quality of risk communication in practice. PMID:24625237

Time to Update and Quantitative Changes in the Results of Cochrane Pregnancy and Childbirth Reviews

PubMed Central

Jaidee, Wanlop; Moher, David; Laopaiboon, Malinee

2010-01-01

Background The recommended interval between updates for systematic reviews included in The Cochrane Library is 2 years. However, it is unclear whether this interval is always appropriate. Whereas excessive updating wastes time and resources, insufficient updating allows out-of-date or incomplete evidence to guide clinical decision-making. We set out to determine, for Cochrane pregnancy and childbirth reviews, the frequency of updates, factors associated with updating, and whether updating frequency was appropriate. Methodology/Principal Findings Cochrane pregnancy and childbirth reviews published in Issue 3, 2007 of the Cochrane Database of Systematic Reviews were retrieved, and data were collected from their original and updated versions. Quantitative changes were determined for one of the primary outcomes (mortality, or the outcome of greatest clinical significance). Potential factors associated with time to update were assessed using the Cox proportional hazard model. Among the 101 reviews in our final sample, the median time before the first update was 3.3 years (95% CI 2.7–3.8). Only 32.7% had been updated within the recommended interval of 2 years. In 75.3% (76/101), a median of 3 new trials with a median of 576 additional participants were included in the updated versions. There were quantitative changes in 71% of the reviews that included new trials (54/76): the median change in effect size was 18.2%, and the median change in 95% CI width was 30.8%. Statistical significance changed in 18.5% (10/54) of these reviews, but conclusions were revised in only 3.7% (2/54). A shorter time to update was associated with the same original review team at updating. Conclusions/Significance Most reviews were updated less frequently than recommended by Cochrane policy, but few updates had revised conclusions. Prescribed time to update should be reconsidered to support improved decision-making while making efficient use of limited resources. PMID:20644625

Decision making in healthy participants on the Iowa Gambling Task: new insights from an operant approach

PubMed Central

Bull, Peter N.; Tippett, Lynette J.; Addis, Donna Rose

2015-01-01

The Iowa Gambling Task (IGT) has contributed greatly to the study of affective decision making. However, researchers have observed high inter-study and inter-individual variability in IGT performance in healthy participants, and many are classified as impaired using standard criteria. Additionally, while decision-making deficits are often attributed to atypical sensitivity to reward and/or punishment, the IGT lacks an integrated sensitivity measure. Adopting an operant perspective, two experiments were conducted to explore these issues. In Experiment 1, 50 healthy participants completed a 200-trial version of the IGT which otherwise closely emulated Bechara et al.'s (1999) original computer task. Group data for Trials 1–100 closely replicated Bechara et al.'s original findings of high net scores and preferences for advantageous decks, suggesting that implementations that depart significantly from Bechara's standard IGT contribute to inter-study variability. During Trials 101–200, mean net scores improved significantly and the percentage of participants meeting the “impaired” criterion was halved. An operant-style stability criterion applied to individual data revealed this was likely related to individual differences in learning rate. Experiment 2 used a novel operant card task—the Auckland Card Task (ACT)—to derive quantitative estimates of sensitivity using the generalized matching law. Relative to individuals who mastered the IGT, persistent poor performers on the IGT exhibited significantly lower sensitivity to magnitudes (but not frequencies) of rewards and punishers on the ACT. Overall, our findings demonstrate the utility of operant-style analysis of IGT data and the potential of applying operant concurrent-schedule procedures to the study of human decision making. PMID:25904884

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

USGS Publications Warehouse

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

2018-01-01

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

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

PubMed

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

2018-02-13

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

New Elements To Consider When Modeling the Hazards Associated with Botulinum Neurotoxin in Food.

PubMed

Ihekwaba, Adaoha E C; Mura, Ivan; Malakar, Pradeep K; Walshaw, John; Peck, Michael W; Barker, G C

2016-01-15

Botulinum neurotoxins (BoNTs) produced by the anaerobic bacterium Clostridium botulinum are the most potent biological substances known to mankind. BoNTs are the agents responsible for botulism, a rare condition affecting the neuromuscular junction and causing a spectrum of diseases ranging from mild cranial nerve palsies to acute respiratory failure and death. BoNTs are a potential biowarfare threat and a public health hazard, since outbreaks of foodborne botulism are caused by the ingestion of preformed BoNTs in food. Currently, mathematical models relating to the hazards associated with C. botulinum, which are largely empirical, make major contributions to botulinum risk assessment. Evaluated using statistical techniques, these models simulate the response of the bacterium to environmental conditions. Though empirical models have been successfully incorporated into risk assessments to support food safety decision making, this process includes significant uncertainties so that relevant decision making is frequently conservative and inflexible. Progression involves encoding into the models cellular processes at a molecular level, especially the details of the genetic and molecular machinery. This addition drives the connection between biological mechanisms and botulism risk assessment and hazard management strategies. This review brings together elements currently described in the literature that will be useful in building quantitative models of C. botulinum neurotoxin production. Subsequently, it outlines how the established form of modeling could be extended to include these new elements. Ultimately, this can offer further contributions to risk assessments to support food safety decision making. Copyright © 2015 Ihekwaba et al.

Revealing, Reducing, and Representing Uncertainties in New Hydrologic Projections for Climate-changed Futures

NASA Astrophysics Data System (ADS)

Arnold, Jeffrey; Clark, Martyn; Gutmann, Ethan; Wood, Andy; Nijssen, Bart; Rasmussen, Roy

2016-04-01

The United States Army Corps of Engineers (USACE) has had primary responsibility for multi-purpose water resource operations on most of the major river systems in the U.S. for more than 200 years. In that time, the USACE projects and programs making up those operations have proved mostly robust against the range of natural climate variability encountered over their operating life spans. However, in some watersheds and for some variables, climate change now is known to be shifting the hydroclimatic baseline around which that natural variability occurs and changing the range of that variability as well. This makes historical stationarity an inappropriate basis for assessing continued project operations under climate-changed futures. That means new hydroclimatic projections are required at multiple scales to inform decisions about specific threats and impacts, and for possible adaptation responses to limit water-resource vulnerabilities and enhance operational resilience. However, projections of possible future hydroclimatologies have myriad complex uncertainties that require explicit guidance for interpreting and using them to inform those decisions about climate vulnerabilities and resilience. Moreover, many of these uncertainties overlap and interact. Recent work, for example, has shown the importance of assessing the uncertainties from multiple sources including: global model structure [Meehl et al., 2005; Knutti and Sedlacek, 2013]; internal climate variability [Deser et al., 2012; Kay et al., 2014]; climate downscaling methods [Gutmann et al., 2012; Mearns et al., 2013]; and hydrologic models [Addor et al., 2014; Vano et al., 2014; Mendoza et al., 2015]. Revealing, reducing, and representing these uncertainties is essential for defining the plausible quantitative climate change narratives required to inform water-resource decision-making. And to be useful, such quantitative narratives, or storylines, of climate change threats and hydrologic impacts must sample from the full range of uncertainties associated with all parts of the simulation chain, from global climate models with simulations of natural climate variability, through regional climate downscaling, and on to modeling of affected hydrologic processes and downstream water resources impacts. This talk will present part of the work underway now both to reveal and reduce some important uncertainties and to develop explicit guidance for future generation of quantitative hydroclimatic storylines. Topics will include: 1- model structural and parameter-set limitations of some methods widely used to quantify climate impacts to hydrologic processes [Gutmann et al., 2014; Newman et al., 2015]; 2- development and evaluation of new, spatially consistent, U.S. national-scale climate downscaling and hydrologic simulation capabilities directly relevant at the multiple scales of water-resource decision-making [Newman et al., 2015; Mizukami et al., 2015; Gutmann et al., 2016]; and 3- development and evaluation of advanced streamflow forecasting methods to reduce and represent integrated uncertainties in a tractable way [Wood et al., 2014; Wood et al., 2015]. A key focus will be areas where climatologic and hydrologic science is currently under-developed to inform decisions - or is perhaps wrongly scaled or misapplied in practice - indicating the need for additional fundamental science and interpretation.

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

PubMed

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

2017-07-01

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

Distributed decision-making in electric power system transmission maintenance scheduling using multi-agent systems (MAS)

NASA Astrophysics Data System (ADS)

Zhang, Zhong

In this work, motivated by the need to coordinate transmission maintenance scheduling among a multiplicity of self-interested entities in restructured power industry, a distributed decision support framework based on multiagent negotiation systems (MANS) is developed. An innovative risk-based transmission maintenance optimization procedure is introduced. Several models for linking condition monitoring information to the equipment's instantaneous failure probability are presented, which enable quantitative evaluation of the effectiveness of maintenance activities in terms of system cumulative risk reduction. Methodologies of statistical processing, equipment deterioration evaluation and time-dependent failure probability calculation are also described. A novel framework capable of facilitating distributed decision-making through multiagent negotiation is developed. A multiagent negotiation model is developed and illustrated that accounts for uncertainty and enables social rationality. Some issues of multiagent negotiation convergence and scalability are discussed. The relationships between agent-based negotiation and auction systems are also identified. A four-step MAS design methodology for constructing multiagent systems for power system applications is presented. A generic multiagent negotiation system, capable of inter-agent communication and distributed decision support through inter-agent negotiations, is implemented. A multiagent system framework for facilitating the automated integration of condition monitoring information and maintenance scheduling for power transformers is developed. Simulations of multiagent negotiation-based maintenance scheduling among several independent utilities are provided. It is shown to be a viable alternative solution paradigm to the traditional centralized optimization approach in today's deregulated environment. This multiagent system framework not only facilitates the decision-making among competing power system entities, but also provides a tool to use in studying competitive industry relative to monopolistic industry.

Assessing the acceptability and usability of an interactive serious game in aiding treatment decisions for patients with localized prostate cancer.

PubMed

Reichlin, Lindsey; Mani, Nithya; McArthur, Kara; Harris, Amy M; Rajan, Nithin; Dacso, Clifford C

2011-01-12

Men diagnosed with localized prostate cancer face a potentially life-altering treatment decision that can be overwhelming. Enhancing patient knowledge through education can significantly reduce feelings of uncertainty while simultaneously increasing confidence in decision making. Serious games have been shown in other populations to increase health knowledge and assist with the health decision-making process. We developed an interactive serious game, Time After Time, which translates evidence-based treatment outcome data into an accessible and understandable format that men can utilize in their prostate cancer treatment decision-making process. The game specifically aims to raise men's awareness and understanding of the impact of health-related quality of life issues associated with the major treatment options and to enrich their conversations with their health care providers. This study determined the acceptability and usability of the alpha version of Time After Time, an interactive decision aid for men diagnosed with localized prostate cancer, in order to inform future iterations of the serious game. The study employed a mixed methods approach to assess the acceptability and usability of the Time After Time serious game using qualitative focus groups and a quantitative Likert scale survey. A total of 13 men who had already completed treatment for localized prostate cancer completed the survey and participated in focus group meetings. The majority of the study participants rated Time After Time as an appropriate decision tool for localized prostate cancer and verified that it meets its goals of increasing focus on side effects and generating questions for the patient's health care team. However, participants also expressed concerns about game usability and the diversity of information covered regarding treatment options and potential treatment outcomes. Serious games are a promising approach to health education and decision support for older men. Participants were receptive to the idea of a serious game as a decision aid in localized prostate cancer. However, usability issues are a major concern for this demographic, as is clarity and transparency of data sources.

Assessing the Acceptability and Usability of an Interactive Serious Game in Aiding Treatment Decisions for Patients with Localized Prostate Cancer

PubMed Central

2011-01-01

Background Men diagnosed with localized prostate cancer face a potentially life-altering treatment decision that can be overwhelming. Enhancing patient knowledge through education can significantly reduce feelings of uncertainty while simultaneously increasing confidence in decision making. Serious games have been shown in other populations to increase health knowledge and assist with the health decision-making process. We developed an interactive serious game, Time After Time, which translates evidence-based treatment outcome data into an accessible and understandable format that men can utilize in their prostate cancer treatment decision-making process. The game specifically aims to raise men’s awareness and understanding of the impact of health-related quality of life issues associated with the major treatment options and to enrich their conversations with their health care providers. Objective This study determined the acceptability and usability of the alpha version of Time After Time, an interactive decision aid for men diagnosed with localized prostate cancer, in order to inform future iterations of the serious game. Methods The study employed a mixed methods approach to assess the acceptability and usability of the Time After Time serious game using qualitative focus groups and a quantitative Likert scale survey. Results A total of 13 men who had already completed treatment for localized prostate cancer completed the survey and participated in focus group meetings. The majority of the study participants rated Time After Time as an appropriate decision tool for localized prostate cancer and verified that it meets its goals of increasing focus on side effects and generating questions for the patient’s health care team. However, participants also expressed concerns about game usability and the diversity of information covered regarding treatment options and potential treatment outcomes. Conclusions Serious games are a promising approach to health education and decision support for older men. Participants were receptive to the idea of a serious game as a decision aid in localized prostate cancer. However, usability issues are a major concern for this demographic, as is clarity and transparency of data sources. PMID:21239374

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

PubMed

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

2007-01-01

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