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Sample records for surgical decision-making process

  1. Decision making in surgical oncology.

    PubMed

    Lamb, B; Green, J S A; Vincent, C; Sevdalis, N

    2011-09-01

    Decisions in surgical oncology are increasingly being made by multi-disciplinary teams (MDTs). Although MDTs have been widely accepted as the preferred model for cancer service delivery, the process of decision making has not been well described and there is little evidence pointing to the ideal structure of an MDT. Performance in surgery has been shown to depend on non-technical skills, such as decision making, as well as patient factors and the technical skills of the healthcare team. Application of this systems approach to MDT working allows the identification of factors that affect the quality of decision making for cancer patients. In this article we review the literature on decision making in surgical oncology and by drawing from the systems approach to surgical performance we provide a framework for understanding the process of decision making in MDTs. Technical factors that affect decision making include the information about patients, robust ICT and video-conferencing equipment, a minimum dataset with expert review of radiological and pathological information, implementation and recording of the MDTs decision. Non-technical factors with an impact on decision making include attendance of team members at meetings, leadership, teamwork, open discussion, consensus on decisions and communication with patients and primary care. Optimising these factors will strengthen the decision making process and raise the quality of care for cancer patients.

  2. Thinking like an expert: surgical decision making as a cyclical process of being aware

    PubMed Central

    Cristancho, Sayra M.; Apramian, Tavis; Vanstone, Meredith; Lingard, Lorelei; Ott, Michael; Forbes, Thomas; Novick, Richard

    2017-01-01

    BACKGROUND Education researchers are studying the practices of high-stake professionals as they learn how to better train for flexibility under uncertainty. This study explores the “Reconciliation Cycle” as the core element of an intraoperative decision-making model of how experienced surgeons assess and respond to challenges. METHODS We analyzed 32 semistructured interviews using constructivist grounded theory to develop a model of intraoperative decision making. Using constant comparison analysis, we built on this model with 9 follow-up interviews about the most challenging cases described in our dataset. RESULTS The Reconciliation Cycle constituted an iterative process of “gaining” and “transforming information.” The cyclical nature of surgeons’ decision making suggested that transforming information requires a higher degree of awareness, not yet accounted by current conceptualizations of situation awareness. CONCLUSIONS This study advances the notion of situation awareness in surgery. This characterization will support further investigations on how expert and nonexpert surgeons implement strategies to cope with unexpected events. PMID:26070378

  3. Thinking like an expert: surgical decision making as a cyclical process of being aware.

    PubMed

    Cristancho, Sayra M; Apramian, Tavis; Vanstone, Meredith; Lingard, Lorelei; Ott, Michael; Forbes, Thomas; Novick, Richard

    2016-01-01

    Education researchers are studying the practices of high-stake professionals as they learn how to better train for flexibility under uncertainty. This study explores the "Reconciliation Cycle" as the core element of an intraoperative decision-making model of how experienced surgeons assess and respond to challenges. We analyzed 32 semistructured interviews using constructivist grounded theory to develop a model of intraoperative decision making. Using constant comparison analysis, we built on this model with 9 follow-up interviews about the most challenging cases described in our dataset. The Reconciliation Cycle constituted an iterative process of "gaining" and "transforming information." The cyclical nature of surgeons' decision making suggested that transforming information requires a higher degree of awareness, not yet accounted by current conceptualizations of situation awareness. This study advances the notion of situation awareness in surgery. This characterization will support further investigations on how expert and nonexpert surgeons implement strategies to cope with unexpected events. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Evaluation of the Effect of Diagnostic Molecular Testing on the Surgical Decision-Making Process for Patients With Thyroid Nodules.

    PubMed

    Noureldine, Salem I; Najafian, Alireza; Aragon Han, Patricia; Olson, Matthew T; Genther, Dane J; Schneider, Eric B; Prescott, Jason D; Agrawal, Nishant; Mathur, Aarti; Zeiger, Martha A; Tufano, Ralph P

    2016-07-01

    Diagnostic molecular testing is used in the workup of thyroid nodules. While these tests appear to be promising in more definitively assigning a risk of malignancy, their effect on surgical decision making has yet to be demonstrated. To investigate the effect of diagnostic molecular profiling of thyroid nodules on the surgical decision-making process. A surgical management algorithm was developed and published after peer review that incorporated individual Bethesda System for Reporting Thyroid Cytopathology classifications with clinical, laboratory, and radiological results. This algorithm was created to formalize the decision-making process selected herein in managing patients with thyroid nodules. Between April 1, 2014, and March 31, 2015, a prospective study of patients who had undergone diagnostic molecular testing of a thyroid nodule before being seen for surgical consultation was performed. The recommended management undertaken by the surgeon was then prospectively compared with the corresponding one in the algorithm. Patients with thyroid nodules who did not undergo molecular testing and were seen for surgical consultation during the same period served as a control group. All pertinent treatment options were presented to each patient, and any deviation from the algorithm was recorded prospectively. To evaluate the appropriateness of any change (deviation) in management, the surgical histopathology diagnosis was correlated with the surgery performed. The study cohort comprised 140 patients who underwent molecular testing. Their mean (SD) age was 50.3 (14.6) years, and 75.0% (105 of 140) were female. Over a 1-year period, 20.3% (140 of 688) had undergone diagnostic molecular testing before surgical consultation, and 79.7% (548 of 688) had not undergone molecular testing. The surgical management deviated from the treatment algorithm in 12.9% (18 of 140) with molecular testing and in 10.2% (56 of 548) without molecular testing (P = .37). In the group with

  5. Decision Making: A Linear Process.

    ERIC Educational Resources Information Center

    Hewes, Dorothy W.

    1998-01-01

    Describes a linear process of decision making to enhance management skills of day care directors. Includes decision-processing flow chart compiled from several professional disciplines to help managers recognize flexibility of linear system. Provides analysis of flow-chart steps to balance both artistic and pragmatic considerations. (LBT)

  6. Surgical decision-making in acute appendicitis.

    PubMed

    Sandell, Eva; Berg, Maria; Sandblom, Gabriel; Sundman, Joar; Fränneby, Ulf; Boström, Lennart; Andrén-Sandberg, Åke

    2015-06-02

    Acute appendicitis is one of the most common acute abdominal conditions. Among other parameters, the decision to perform surgical exploration in suspected appendicitis involves diagnostic accuracy, patient age and co-morbidity, patient's own wishes, the surgeon's core medical values, expected natural course of non-operative treatment and priority considerations regarding the use of limited resources. Do objective clinical findings, such as radiology and laboratory results, have greater impact on decision-making than "soft" clinical variables? In this study we investigate the parameters that surgeons consider significant in decision-making in cases of suspected appendicitis; specifically we describe the process leading to surgical intervention in real settings. The purpose of the study was to explore the process behind the decision to undertake surgery on a patient with suspected appendicitis as a model for decision-making in surgery. All appendectomy procedures (n = 201) at the Department of Surgery at Karolinska University Hospital performed in 2009 were retrospectively evaluated. Every two consecutive patients seeking for abdominal pain after each case undergoing surgery were included as controls. Signs and symptoms documented in the medical records were registered according to a standardized protocol. The outcome of this retrospective review formed the basis of a prospective registration of patients undergoing appendectomy. During a three- month period in 2011, the surgeons who made the decision to perform acute appendectomy on 117 consecutive appendectomized patients at the Karolinska University Hospital, Huddinge, and Södersjukhuset, were asked to answer a questionnaire about symptoms, signs and diagnostic measures considered in their treatment decision. They were also asked which three symptoms, signs and diagnostic measures had the greatest impact on their decision to perform appendectomy. In the retrospective review, tenderness in the right fossa had the

  7. Decision Making Processes and Outcomes

    PubMed Central

    Hicks Patrick, Julie; Steele, Jenessa C.; Spencer, S. Melinda

    2013-01-01

    The primary aim of this study was to examine the contributions of individual characteristics and strategic processing to the prediction of decision quality. Data were provided by 176 adults, ages 18 to 93 years, who completed computerized decision-making vignettes and a battery of demographic and cognitive measures. We examined the relations among age, domain-specific experience, working memory, and three measures of strategic information search to the prediction of solution quality using a 4-step hierarchical linear regression analysis. Working memory and two measures of strategic processing uniquely contributed to the variance explained. Results are discussed in terms of potential advances to both theory and intervention efforts. PMID:24282638

  8. Thinking processes used by nurses in clinical decision making.

    PubMed

    Higuchi, Kathryn A Smith; Donald, Janet G

    2002-04-01

    Clinical decision making forms the basis of expert clinical practice. The purpose of this study was to investigate and document the thinking processes used by nurses in clinical decision making situations so the processes could guide educational practice. Clinical data was analyzed to reveal that clinical decision making is complex and requires a variety of thinking processes. Medical and surgical nurses used different thinking processes, showing the importance of context in clinical decision making. The nursing exemplars and working vocabulary developed in this study to describe the thinking processes used in clinical decision making can be used in nursing education.

  9. COGNITIVE PROCESSES IN CAREER DECISION-MAKING.

    ERIC Educational Resources Information Center

    HILTON, THOMAS L.; AND OTHERS

    THE PROBLEM OF THIS LONGITUDINAL STUDY WAS TO IDENTIFY THE COGNITIVE PROCESSES WHICH ARE INVOLVED IN CAREER DECISION-MAKING AND THE LONG-TERM EFFECTS OF THESE PROCESSES ON CAREER DEVELOPMENT. AREAS OF CONCERN WERE (1) IDENTIFICATION OF STRATEGIES BY WHICH AN INDIVIDUAL CAN OVERCOME DECISION-MAKING DIFFICULTY, (2) ASSESSMENT OF THE SHORT-TERM…

  10. Difficulties in Surgical Decision Making and Associated Factors Among Elective Surgical Patients in Taiwan.

    PubMed

    Lin, Mei-Ling; Chen, Ching-Huey

    2017-06-01

    Respect for the autonomy of patients is essential in life-threatening medical decisions such as surgery. Even if a patient has the competency to make decisions, many obstacles exist that may influence his or her willingness to participate in the surgical decision-making process. The aim of this study was to explore the perceived difficulties in surgical decision making and related factors among elective surgical patients. This was a cross-sectional correlational study. A convenience sampling method was used to recruit patients from a medical center in southern Taiwan. Patients who had received elective surgery, were older than 20 years old, and were competent to make medical decisions were invited to participate. A structured questionnaire was developed by the researchers to collect demographic data, decision patterns, and perceived difficulties in surgical decision making. Acceptable validity and reliability of the questionnaire were confirmed before data collection. Over 80% of the participants made the surgical decision by themselves or in collaboration with their family or physician. Less than 15% expected to make the surgical decision by themselves. Illness-related suffering was the greatest difficulty that participants faced. The patients who tended toward passive decision making faced greater difficulties in the dimensions of "do not understand information," "physician's lack of concern," and "difficulty in freely communicating with the physician" than their active decision-making peers. Male participants reported having more difficulty in communicating with their physician than their female peers. Age, education, and marital status were not significantly associated with perceived difficulties in surgical decision making. Family participation in the medical decision-making process is expected by most patients. Although less than 20% of the participants in this study were categorized as passive decision makers, this group reported more difficulties than the

  11. Thinking Processes Used by Nurses in Clinical Decision Making.

    ERIC Educational Resources Information Center

    Higuchi, Kathryn A. Smith; Donald, Janet G.

    2002-01-01

    Interviews with eight medical and surgical nurses and audits of patient charts investigated clinical decision-making processes. Predominant thinking processes were description of facts, selection of information, inference, syntheses, and verification, with differences between medical and surgical specialties. Exemplars of thinking processes…

  12. Surgical decision making in conservative mastectomies

    PubMed Central

    Rocco, Nicola; Nava, Maurizio Bruno

    2016-01-01

    We present some clinical advice to drive the decision process in performing conservative mastectomies. Several factors are taken into consideration to indicate these techniques. First of all, we need to identify patients who need a mastectomy due to the extension of the disease. In this case we suggest assessing patients anthropometric characteristics (breast volume—ptosis), and personal preferences regarding the extension of surgical treatment. Small, medium size, without ptosis or with moderate ptosis can be better served by standard nipple-sparing mastectomy. Large and ptotic breast can be removed and reconstructed performing a skin-reducing mastectomy. Mastectomies cannot replace breast conservation and should be discouraged whenever breast-conserving surgery can be performed with good results. However, in some selected cases, and especially in patients with small breast, conservative mastectomies with contralateral reshape can yield favourable results. PMID:26855911

  13. Cognitive processes in anesthesiology decision making.

    PubMed

    Stiegler, Marjorie Podraza; Tung, Avery

    2014-01-01

    The quality and safety of health care are under increasing scrutiny. Recent studies suggest that medical errors, practice variability, and guideline noncompliance are common, and that cognitive error contributes significantly to delayed or incorrect diagnoses. These observations have increased interest in understanding decision-making psychology.Many nonrational (i.e., not purely based in statistics) cognitive factors influence medical decisions and may lead to error. The most well-studied include heuristics, preferences for certainty, overconfidence, affective (emotional) influences, memory distortions, bias, and social forces such as fairness or blame.Although the extent to which such cognitive processes play a role in anesthesia practice is unknown, anesthesia care frequently requires rapid, complex decisions that are most susceptible to decision errors. This review will examine current theories of human decision behavior, identify effects of nonrational cognitive processes on decision making, describe characteristic anesthesia decisions in this context, and suggest strategies to improve decision making.

  14. International Students Decision-Making Process

    ERIC Educational Resources Information Center

    Cubillo, Jose Maria; Sanchez, Joaquin; Cervino, Julio

    2006-01-01

    Purpose--The purpose of this paper is to propose a theoretical model that integrates the different groups of factors which influence the decision-making process of international students, analysing different dimensions of this process and explaining those factors which determine students' choice. Design/methodology/approach--A hypothetical model…

  15. International Students Decision-Making Process

    ERIC Educational Resources Information Center

    Cubillo, Jose Maria; Sanchez, Joaquin; Cervino, Julio

    2006-01-01

    Purpose--The purpose of this paper is to propose a theoretical model that integrates the different groups of factors which influence the decision-making process of international students, analysing different dimensions of this process and explaining those factors which determine students' choice. Design/methodology/approach--A hypothetical model…

  16. The Delphi Decision-Making Process.

    ERIC Educational Resources Information Center

    Spinelli, Teri

    1983-01-01

    Reports generalizations about specific patterns emerging from a panel employing a decision-making Delphi process that attempted to forecast the long-range general environment for higher education in Michigan. Participating were 24 influential persons with knowledge of factors important within the state. (Author/RH)

  17. Nonrational Processes in Ethical Decision Making

    ERIC Educational Resources Information Center

    Rogerson, Mark D.; Gottlieb, Michael C.; Handelsman, Mitchell M.; Knapp, Samuel; Younggren, Jeffrey

    2011-01-01

    Most current ethical decision-making models provide a logical and reasoned process for making ethical judgments, but these models are empirically unproven and rely upon assumptions of rational, conscious, and quasi-legal reasoning. Such models predominate despite the fact that many nonrational factors influence ethical thought and behavior,…

  18. The Delphi Decision-Making Process.

    ERIC Educational Resources Information Center

    Spinelli, Teri

    1983-01-01

    Reports generalizations about specific patterns emerging from a panel employing a decision-making Delphi process that attempted to forecast the long-range general environment for higher education in Michigan. Participating were 24 influential persons with knowledge of factors important within the state. (Author/RH)

  19. Evacuation decision-making: process and uncertainty

    SciTech Connect

    Mileti, D.; Sorensen, J.; Bogard, W.

    1985-09-01

    The purpose was to describe the processes of evacuation decision-making, identify and document uncertainties in that process and discuss implications for federal assumption of liability for precautionary evacuations at nuclear facilities under the Price-Anderson Act. Four major categories of uncertainty are identified concerning the interpretation of hazard, communication problems, perceived impacts of evacuation decisions and exogenous influences. Over 40 historical accounts are reviewed and cases of these uncertainties are documented. The major findings are that all levels of government, including federal agencies experience uncertainties in some evacuation situations. Second, private sector organizations are subject to uncertainties at a variety of decision points. Third, uncertainties documented in the historical record have provided the grounds for liability although few legal actions have ensued. Finally it is concluded that if liability for evacuations is assumed by the federal government, the concept of a ''precautionary'' evacuation is not useful in establishing criteria for that assumption. 55 refs., 1 fig., 4 tabs.

  20. 44 CFR 9.6 - Decision-making process.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Decision-making process. 9.6... HOMELAND SECURITY GENERAL FLOODPLAIN MANAGEMENT AND PROTECTION OF WETLANDS § 9.6 Decision-making process... protection decision-making process to be followed by the Agency in applying the Orders to its actions. While...

  1. 44 CFR 9.6 - Decision-making process.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Decision-making process. 9.6... HOMELAND SECURITY GENERAL FLOODPLAIN MANAGEMENT AND PROTECTION OF WETLANDS § 9.6 Decision-making process... protection decision-making process to be followed by the Agency in applying the Orders to its actions. While...

  2. 44 CFR 9.6 - Decision-making process.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Decision-making process. 9.6... HOMELAND SECURITY GENERAL FLOODPLAIN MANAGEMENT AND PROTECTION OF WETLANDS § 9.6 Decision-making process... protection decision-making process to be followed by the Agency in applying the Orders to its actions. While...

  3. 44 CFR 9.6 - Decision-making process.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Decision-making process. 9.6... HOMELAND SECURITY GENERAL FLOODPLAIN MANAGEMENT AND PROTECTION OF WETLANDS § 9.6 Decision-making process... protection decision-making process to be followed by the Agency in applying the Orders to its actions. While...

  4. Information Processing in Decision-Making Systems

    PubMed Central

    van der Meer, Matthijs; Kurth-Nelson, Zeb; Redish, A. David

    2015-01-01

    Decisions result from an interaction between multiple functional systems acting in parallel to process information in very different ways, each with strengths and weaknesses. In this review, the authors address three action-selection components of decision-making: The Pavlovian system releases an action from a limited repertoire of potential actions, such as approaching learned stimuli. Like the Pavlovian system, the habit system is computationally fast but, unlike the Pavlovian system permits arbitrary stimulus-action pairings. These associations are a “forward” mechanism; when a situation is recognized, the action is released. In contrast, the deliberative system is flexible but takes time to process. The deliberative system uses knowledge of the causal structure of the world to search into the future, planning actions to maximize expected rewards. Deliberation depends on the ability to imagine future possibilities, including novel situations, and it allows decisions to be taken without having previously experienced the options. Various anatomical structures have been identified that carry out the information processing of each of these systems: hippocampus constitutes a map of the world that can be used for searching/imagining the future; dorsal striatal neurons represent situation-action associations; and ventral striatum maintains value representations for all three systems. Each system presents vulnerabilities to pathologies that can manifest as psychiatric disorders. Understanding these systems and their relation to neuroanatomy opens up a deeper way to treat the structural problems underlying various disorders. PMID:22492194

  5. Teacher Empowerment in the Decision Making Process

    ERIC Educational Resources Information Center

    Hicks, George E.; DeWalt, Cassandra Sligh

    2006-01-01

    According to Erlandson and Bifano (1987), teacher empowerment is a vital dimension of the school's organization. Lieberman (1989) defined teacher empowerment as "empowering teachers to participate in group decisions and to have real decision-making roles in the school community" (p. 24). Furthermore, Summers (2006) addressed the need for…

  6. Decision-Making Processes of Youth.

    ERIC Educational Resources Information Center

    Moore, J. William; And Others

    1990-01-01

    Undergraduates (n=142) participated in study on decision making in which prospective administrators made monetary commitments to long-term goals under varying conditions. Found significant negative correlation between anxiety level and commitments to previously chosen courses of action; no significant effects of job security on commitment; and…

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

    PubMed

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

    2017-07-01

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

  8. Surgical decision-making in immediate breast reconstruction.

    PubMed

    Musgrave, Kylie J; Bochner, Melissa; Kollias, James

    2010-12-01

    Immediate breast reconstruction has been accepted as safe and practical after mastectomy for breast cancer; factors limiting its use are patient comorbidities and potential complications caused by adjuvant therapies (particularly radiotherapy). The aim of this study was to identify factors considered by surgeons when deciding whether to offer immediate breast reconstruction, to determine the surgeon's accuracy when predicting postmastectomy radiotherapy, and to assess the impact of premastectomy investigations on decision-making. Four oncoplastic breast surgeons completed a survey for every mastectomy performed over an 11-month period. On the survey form they indicated reason for mastectomy, investigations available premastectomy, if they offered immediate reconstruction, and if not offered, why they did not offer it. Data on adjuvant therapies employed was also collected. A total of 157 women underwent mastectomy during the study period. Seventy-six (48.4%) were offered immediate reconstruction and 36 (22.9%) accepted. The most common reason for not offering immediate reconstruction was the predicted need for postmastectomy radiotherapy (56.8%). Of the 76 patients offered immediate reconstruction, 9 went onto be offered postmastectomy radiotherapy (11.8%). Decision-making was no more accurate in those women who had MRI, axillary staging, or excisional pathology available premastectomy. The most common reason for not offering immediate breast reconstruction is the need for postmastectomy radiotherapy and surgeons are able to predict this accurately. The addition of invasive and expensive staging investigations premastectomy does not appear to assist this decision-making process. Despite careful patient selection, a high rate of immediate reconstruction may be maintained.

  9. The impact of laser Doppler imaging on the early decision-making process for surgical intervention in adults with indeterminate burns.

    PubMed

    Park, Yoo Seok; Choi, Young Hwan; Lee, Hye Sun; Moon, Duk Ju; Kim, Seon Gyu; Lee, Jong Ho; Cho, Jin Kyung; Yoon, Cheon Jae

    2013-06-01

    We aimed to analyze whether laser Doppler imaging (LDI) can lead to earlier decision-making regarding the need for surgery in adults with indeterminate burns. In a retrospective cohort study, we developed a prediction model for surgery in adults with indeterminate burns. Patient data (n=101) from January 2007 to December 2009 were used for model development, and those (n=40) from January 2010 to October 2010 for external validation. Between non-surgical and surgical groups, there were significant differences for mean age (p=0.009), % total body surface area burn (p=0.016), site of burn wound (p=0.033), and mean perfusion units (PU) (p<0.001). Multiple logistic regression showed that only the mean PU differed significantly between the groups. The area under the curve (AUC) of the equation derived from multiple logistic regression was 0.938, which did not differ from that of the mean PU alone (0.931; p=0.453). Using a cut-off point of 154.7PU, the sensitivity of LDI was 78.3% and the specificity was 92.7%. This cut-off point also yielded a sensitivity of 77.8% and specificity of 95.5% in the external validation dataset. LDI can help make a decision for surgery in the early stages of care for adults with indeterminate burns. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  10. Dissolving decision making? Models and their roles in decision-making processes and policy at large.

    PubMed

    Zeiss, Ragna; van Egmond, Stans

    2014-12-01

    This article studies the roles three science-based models play in Dutch policy and decision making processes. Key is the interaction between model construction and environment. Their political and scientific environments form contexts that shape the roles of models in policy decision making. Attention is paid to three aspects of the wider context of the models: a) the history of the construction process; b) (changes in) the political and scientific environments; and c) the use in policy processes over longer periods of time. Models are more successfully used when they are constructed in a stable political and scientific environment. Stability and certainty within a scientific field seems to be a key predictor for the usefulness of models for policy making. The economic model is more disputed than the ecology-based model and the model that has its theoretical foundation in physics and chemistry. The roles models play in policy processes are too complex to be considered as straightforward technocratic powers.

  11. 44 CFR 9.6 - Decision-making process.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HOMELAND SECURITY GENERAL FLOODPLAIN MANAGEMENT AND PROTECTION OF WETLANDS § 9.6 Decision-making process. (a) Purpose. The purpose of this section is to set out the floodplain management and wetlands... the decision-making process was initially designed to address the floodplain Order's requirements,...

  12. Biomolecular decision-making process for self assembly.

    SciTech Connect

    Osbourn, Gordon Cecil

    2005-01-01

    The brain is often identified with decision-making processes in the biological world. In fact, single cells, single macromolecules (proteins) and populations of molecules also make simple decisions. These decision processes are essential to survival and to the biological self-assembly and self-repair processes that we seek to emulate. How do these tiny systems make effective decisions? How do they make decisions in concert with a cooperative network of other molecules or cells? How can we emulate the decision-making behaviors of small-scale biological systems to program and self-assemble microsystems? This LDRD supported research to answer these questions. Our work included modeling and simulation of protein populations to help us understand, mimic, and categorize molecular decision-making mechanisms that nonequilibrium systems can exhibit. This work is an early step towards mimicking such nanoscale and microscale biomolecular decision-making processes in inorganic systems.

  13. Time Management and the Military Decision Making Process

    DTIC Science & Technology

    1992-12-18

    This monograph analyzes the military decision making process in terms of time management in order to determine if a timeline will expedite the...process. The monograph begins by establishing the importance of time and time management in planning. This section provides a general discussion of time, an...Perhaps using some of the techniques that other armies use will facilitate time management .... Time management , Decision making, Timeline, Mission analysis, Wargaming, Courses of action, OPORD, Brigade OPS.

  14. How Expert Pilots Think Cognitive Processes in Expert Decision Making

    DTIC Science & Technology

    1993-02-01

    Dr. Lofaro’s extensive background in crew resource management, cognitive dissonance /consistence and non-linear decision making was critical to... cognitive dissonance associations are triggered. What is intended by the use of intuition in the decision making process is 43 a perception of the essential...specifically cognitive dissonance and consistence) and common psychology agree on one specific problem solving point. People, even pilots, will do

  15. Strategic decision-making processes in health care organizations.

    PubMed

    Rivers, P A; Glover, S H

    1998-01-01

    Health care represents a promising area of research due to its uniqueness. In recent years, considerable progress has been made in strategic decision-making processes research but not the study of health care strategy research. This article reviews strategic decision-making in health care domains. Adopting Rajagopalan, Rusheed, and Datta's (1993) framework, the authors evaluate the theoretical and empirical contributions of this research. The limitations and theoretical implications of these efforts are also explored.

  16. Facilitating Administrative Decision-Making and Organizational Change via a Decision-Making Process as Social Enterprise.

    ERIC Educational Resources Information Center

    Shapiro, Arthur S.; And Others

    This paper develops a theory-practice view of administrative and organizational decision making. Its goals are to improve administrative decision-making processes, facilitate organizational change through faculty involvement, and increase the potential for success in education reform efforts. The first sections discuss the nature of theory and…

  17. Evolution of quantum-like modeling in decision making processes

    NASA Astrophysics Data System (ADS)

    Khrennikova, Polina

    2012-12-01

    The application of the mathematical formalism of quantum mechanics to model behavioral patterns in social science and economics is a novel and constantly emerging field. The aim of the so called 'quantum like' models is to model the decision making processes in a macroscopic setting, capturing the particular 'context' in which the decisions are taken. Several subsequent empirical findings proved that when making a decision people tend to violate the axioms of expected utility theory and Savage's Sure Thing principle, thus violating the law of total probability. A quantum probability formula was devised to describe more accurately the decision making processes. A next step in the development of QL-modeling in decision making was the application of Schrödinger equation to describe the evolution of people's mental states. A shortcoming of Schrödinger equation is its inability to capture dynamics of an open system; the brain of the decision maker can be regarded as such, actively interacting with the external environment. Recently the master equation, by which quantum physics describes the process of decoherence as the result of interaction of the mental state with the environmental 'bath', was introduced for modeling the human decision making. The external environment and memory can be referred to as a complex 'context' influencing the final decision outcomes. The master equation can be considered as a pioneering and promising apparatus for modeling the dynamics of decision making in different contexts.

  18. Evolution of quantum-like modeling in decision making processes

    SciTech Connect

    Khrennikova, Polina

    2012-12-18

    The application of the mathematical formalism of quantum mechanics to model behavioral patterns in social science and economics is a novel and constantly emerging field. The aim of the so called 'quantum like' models is to model the decision making processes in a macroscopic setting, capturing the particular 'context' in which the decisions are taken. Several subsequent empirical findings proved that when making a decision people tend to violate the axioms of expected utility theory and Savage's Sure Thing principle, thus violating the law of total probability. A quantum probability formula was devised to describe more accurately the decision making processes. A next step in the development of QL-modeling in decision making was the application of Schroedinger equation to describe the evolution of people's mental states. A shortcoming of Schroedinger equation is its inability to capture dynamics of an open system; the brain of the decision maker can be regarded as such, actively interacting with the external environment. Recently the master equation, by which quantum physics describes the process of decoherence as the result of interaction of the mental state with the environmental 'bath', was introduced for modeling the human decision making. The external environment and memory can be referred to as a complex 'context' influencing the final decision outcomes. The master equation can be considered as a pioneering and promising apparatus for modeling the dynamics of decision making in different contexts.

  19. [Treatment Decision-Making Process of Cancer Patients].

    PubMed

    Lee, Shiu-Yu C Katie

    2016-10-01

    The decision-making process that is used by cancer patients to determine their treatment has become more multi-foci, difficult and complicated in recent years. This has in part been attributed to the increasing incidence rate of cancer in Taiwan and the rapid development of medical technologies and treatment modalities. Oncology nurses must assist patients and family to make informed and value-based treatment decisions. Decision-making is an information process that involves appraising one's own expectation and values based on his/her knowledge on cancer and treatment options. Because cancer treatment involves risks and uncertainties, and impacts quality of life, the treatment decision-making for cancer is often stressful, or even conflicting. This paper discusses the decision-making behaviors of cancer patients and the decisional conflict, participation, and informational needs that are involved in cancer treatment. The trend toward shared decision-making and decisional support will be also explored in order to facilitate the future development of appropriate clinical interventions and research.

  20. Privatized Student Housing and the Decision-Making Process

    ERIC Educational Resources Information Center

    Aska, Aaron C.

    2012-01-01

    This study will examine the decision-making process used to construct privatized student housing as well as the factors that contribute to that process among public four-year institutions in New Jersey. A growing number of public universities are exploring ways to develop successful public private partnerships (P3s) in an effort to improve…

  1. Privatized Student Housing and the Decision-Making Process

    ERIC Educational Resources Information Center

    Aska, Aaron C.

    2012-01-01

    This study will examine the decision-making process used to construct privatized student housing as well as the factors that contribute to that process among public four-year institutions in New Jersey. A growing number of public universities are exploring ways to develop successful public private partnerships (P3s) in an effort to improve…

  2. 24 CFR 55.20 - Decision making process.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Development FLOODPLAIN MANAGEMENT AND PROTECTION OF WETLANDS Procedures for Making Determinations on Floodplain Management and Protection of Wetlands § 55.20 Decision making process. Except for actions covered... wetlands. The steps to be followed in the decisionmaking process are as follows: (a) Step 1. Determine...

  3. PRODUCT OR PROCESS--IMPLICATIONS FOR DECISION-MAKING.

    ERIC Educational Resources Information Center

    HOSFORD, RAY E.

    THE IMPORTANCE OF ASSISTING STUDENTS IN THE DECISION-MAKING PROCESS IS EXPLORED. COUNSELORS ASSIST STUDENTS IN LEARNING HOW TO MAKE DECISIONS. A DECISION SHOULD BE EVALUATED IN TERMS OF THE PROCESS USED TO ARRIVE AT IT RATHER THAN IN TERMS OF THE RESULTING CHOICE. KNOWLEDGE OF ALTERNATIVES, POSSIBLE OUTCOMES, AND THE PROBABILITY FOR SUCCESS OF…

  4. The Career Decision-Making Process of Chinese American Youth

    ERIC Educational Resources Information Center

    Okubo, Yuki; Yeh, Christine J.; Lin, Pei-Ying; Fujita, Kotoko; Shea, J. Mun-Yi

    2007-01-01

    The authors investigated how negotiating two cultural expectations may influence the career decision-making process of Chinese youth. In-depth interviews were conducted with 8 participants addressing issues of role models, career interests, and individuals with whom they discussed career concerns. Consensual Qualitative Research (C. E. Hill, B. J.…

  5. The multiple resource inventory decision-making process

    Treesearch

    Victor A. Rudis

    1993-01-01

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

  6. Developing Holocaust Curricula: The Content Decision-Making Process

    ERIC Educational Resources Information Center

    Lindquist, David H.

    2008-01-01

    The content decision-making process involved in developing Holocaust curricula is unusually complex and problematic. Educators must consider factors such as historical accuracy, selection of topics covered, potential teaching materials (such as textbooks and literary texts), and graphic materials (such as films and photographs) as they plan their…

  7. Investigating the Decision-Making Process of Standard Setting Participants

    ERIC Educational Resources Information Center

    Papageorgiou, Spiros

    2010-01-01

    Despite the growing interest of the language testing community in standard setting, primarily due to the use of the Common European Framework of Reference (CEFR-Council of Europe, 2001), the participants' decision-making process in the CEFR standard setting context remains unexplored. This study attempts to fill in this gap by analyzing these…

  8. Demystifying the Data-Based Decision-Making Process

    ERIC Educational Resources Information Center

    Cramer, Elizabeth D.; Little, Mary E.; McHatton, Patricia Alvarez

    2014-01-01

    Across the United States, teachers and teacher educators are facing increased accountability for improved student achievement. Using assessment results to inform instruction provides a catalyst to improve student outcomes and is a key skill for preservice teacher candidates. The process of data-based decision making is integral to performance…

  9. Demystifying the Data-Based Decision-Making Process

    ERIC Educational Resources Information Center

    Cramer, Elizabeth D.; Little, Mary E.; McHatton, Patricia Alvarez

    2014-01-01

    Across the United States, teachers and teacher educators are facing increased accountability for improved student achievement. Using assessment results to inform instruction provides a catalyst to improve student outcomes and is a key skill for preservice teacher candidates. The process of data-based decision making is integral to performance…

  10. Decision-Making and Thought Processes among Poker Players

    ERIC Educational Resources Information Center

    St. Germain, Joseph; Tenenbaum, Gershon

    2011-01-01

    This study was aimed at delineating decision-making and thought processing among poker players who vary in skill-level. Forty-five participants, 15 in each group, comprised expert, intermediate, and novice poker players. They completed the Computer Poker Simulation Task (CPST) comprised of 60 hands of No-Limit Texas Hold 'Em. During the CPST, they…

  11. Problems in the decision making process: a review.

    PubMed

    Evans, D

    1990-12-01

    Decision making is an integral part of the intensive care nurse's role, but many factors can disrupt this process. It is important that the nurse has an understanding of how defective decision making patterns can develop. Experience, the role of the nurse, uncertainty and conflict all exert major influences on the decision making process. The conditions that determine what type of decision making pattern emerges are; the seriousness of the risks as a result of the decision; if there is hope of finding a better solution; and how much time is available to search for the solution. The patterns that may emerge include vigilance, complacency, defensive avoidance and hypervigilance. Vigilance is said to be the optimum pattern, this is when all alternatives to the decision are analysed and interpreted in an unbiased manner. Defensive avoidance is the decision makers attempt to avoid or postpone the stress of the decision. It is manifested by procrastination, shifting of responsibility or rationalisation. Hypervigilance, or panic, represents a frantic search for a solution and a shifting back and forth between alternatives with a failure to see obvious faults in the possible solutions.

  12. Dual processing model of medical decision-making

    PubMed Central

    2012-01-01

    Background Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease. Methods We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice. Results We show that physician’s beliefs about whether to treat at higher (lower) probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker’s threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice. Conclusions We have developed the first dual processing model of medical decision-making that has potential to enrich the current medical

  13. Telepathy: maximizing resident exposure to surgical pathology decision making.

    PubMed

    McLemore, Elisabeth C; Schlinkert, Richard T; Schlinkert, Denise K; Williams, James W; Bailey, David P

    2006-04-01

    General surgery residents are often not present for the critical intraoperative discussion between surgeon and pathologist regarding surgical pathology findings. A prospective pilot study analyzed general surgery resident exposure to surgical pathology. Thereafter, an operating room was equipped to view frozen section images in real time and verbally communicate with the pathologist (TelePATHy). Total operative cases, cases using frozen sections, and use of TelePATHy were recorded. Most residents (78%) reported they were exposed to frozen-section surgical pathology < or =10% of the time. Overall, 202 operations were performed over the 123-day period. Forty-four cases had frozen-section specimens. General surgery residents were present for 40 cases. TelePATHy was successfully used in 32 cases (80%). General surgery resident exposure to intraoperative pathology findings increased from a reported < or =10% to an observed 80%. TelePATHy is a novel intraoperative tool capable of maximizing the intraoperative experience of the surgical resident.

  14. [End-of-life decision-making process].

    PubMed

    Steinberg, Avraham

    2003-10-01

    Since time immemorial the attitude toward the dying patient has been one of the most difficult issues in medical ethics. The diversity of philosophical, religious, social and legal approaches does not enable one to reach a universal consensus to solve the many problems involved in end-of-life decisions. Within the health care system in Israel there is currently no consensual practice concerning the dying patient. Moreover, there is no published information on the actual decision-making processes within hospitals, hospices and geriatric facilities in Israel concerning the dying patient. A group of investigators in Shaare Zedek Medical Center in Jerusalem recently performed a prospective study to explore the decision-making process concerning DNR orders within this hospital. The results of this study demonstrated that the terminally-ill patients never take part in the decision-making process, they are never consulted about their wishes, and there is no effort to discover their previous wishes concerning their treatment at the terminal stages. Moreover, in many instances even the family was not consulted and did not take part in the decision-making process. In a significant minority, the final decision of a DNR order was undertaken by a single physician. This approach represents an extreme form of unethical paternalism, and it requires an urgent societal intervention to establish an ethically sound decision-making process. Recently, a national committee ("Steinberg Committee") formulated a widely agreed upon legislative proposal organizing all the fundamental and practical issues related to the dying patient. This proposal is based upon a balance between opposing values such as autonomy, life, quality-of-life, beneficence, non-maleficence and "slippery-slope" concerns. It relates to various treatment modalities, such as resuscitation, ventilation, dialysis, medication and sustenance. It establishes a clear position on euthanasia, physician-assisted suicide

  15. Use of PRA in Shuttle Decision Making Process

    NASA Technical Reports Server (NTRS)

    Boyer, Roger L.; Hamlin, Teri L.

    2010-01-01

    How do you use PRA to support an operating program? This presentation will explore how the Shuttle Program Management has used the Shuttle PRA in its decision making process. It will reveal how the PRA has evolved from a tool used to evaluate Shuttle upgrades like Electric Auxiliary Power Unit (EAPU) to a tool that supports Flight Readiness Reviews (FRR) and real-time flight decisions. Specific examples of Shuttle Program decisions that have used the Shuttle PRA as input will be provided including how it was used in the Hubble Space Telescope (HST) manifest decision. It will discuss the importance of providing management with a clear presentation of the analysis, applicable assumptions and limitations, along with estimates of the uncertainty. This presentation will show how the use of PRA by the Shuttle Program has evolved overtime and how it has been used in the decision making process providing specific examples.

  16. Use of PRA in Shuttle Decision Making Process

    NASA Technical Reports Server (NTRS)

    Boyer, Roger L.; Hamlin, Teri L.

    2010-01-01

    How do you use PRA to support an operating program? This presentation will explore how the Shuttle Program Management has used the Shuttle PRA in its decision making process. It will reveal how the PRA has evolved from a tool used to evaluate Shuttle upgrades like Electric Auxiliary Power Unit (EAPU) to a tool that supports Flight Readiness Reviews (FRR) and real-time flight decisions. Specific examples of Shuttle Program decisions that have used the Shuttle PRA as input will be provided including how it was used in the Hubble Space Telescope (HST) manifest decision. It will discuss the importance of providing management with a clear presentation of the analysis, applicable assumptions and limitations, along with estimates of the uncertainty. This presentation will show how the use of PRA by the Shuttle Program has evolved overtime and how it has been used in the decision making process providing specific examples.

  17. A decision-making process model of young online shoppers.

    PubMed

    Lin, Chin-Feng; Wang, Hui-Fang

    2008-12-01

    Based on the concepts of brand equity, means-end chain, and Web site trust, this study proposes a novel model called the consumption decision-making process of adolescents (CDMPA) to understand adolescents' Internet consumption habits and behavioral intention toward particular sporting goods. The findings of the CDMPA model can help marketers understand adolescents' consumption preferences and habits for developing effective Internet marketing strategies.

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

    PubMed

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

    2013-06-01

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

  19. Introduction of New Vaccines: Decision-making Process in Bangladesh

    PubMed Central

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

    2013-01-01

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

  20. Impact of Robotic Surgery on Decision Making: Perspectives of Surgical Teams

    PubMed Central

    Randell, Rebecca; Alvarado, Natasha; Honey, Stephanie; Greenhalgh, Joanne; Gardner, Peter; Gill, Arron; Jayne, David; Kotze, Alwyn; Pearman, Alan; Dowding, Dawn

    2015-01-01

    There has been rapid growth in the purchase of surgical robots in both North America and Europe in recent years. Whilst this technology promises many benefits for patients, the introduction of such a complex interactive system into healthcare practice often results in unintended consequences that are difficult to predict. Decision making by surgeons during an operation is affected by variables including tactile perception, visual perception, motor skill, and instrument complexity, all of which are changed by robotic surgery, yet the impact of robotic surgery on decision making has not been previously studied. Drawing on the approach of realist evaluation, we conducted a multi-site interview study across nine hospitals, interviewing 44 operating room personnel with experience of robotic surgery to gather their perspectives on how robotic surgery impacts surgeon decision making. The findings reveal both potential benefits and challenges of robotic surgery for decision making. PMID:26958244

  1. Impact of Robotic Surgery on Decision Making: Perspectives of Surgical Teams.

    PubMed

    Randell, Rebecca; Alvarado, Natasha; Honey, Stephanie; Greenhalgh, Joanne; Gardner, Peter; Gill, Arron; Jayne, David; Kotze, Alwyn; Pearman, Alan; Dowding, Dawn

    2015-01-01

    There has been rapid growth in the purchase of surgical robots in both North America and Europe in recent years. Whilst this technology promises many benefits for patients, the introduction of such a complex interactive system into healthcare practice often results in unintended consequences that are difficult to predict. Decision making by surgeons during an operation is affected by variables including tactile perception, visual perception, motor skill, and instrument complexity, all of which are changed by robotic surgery, yet the impact of robotic surgery on decision making has not been previously studied. Drawing on the approach of realist evaluation, we conducted a multi-site interview study across nine hospitals, interviewing 44 operating room personnel with experience of robotic surgery to gather their perspectives on how robotic surgery impacts surgeon decision making. The findings reveal both potential benefits and challenges of robotic surgery for decision making.

  2. Dissociating sensory from decision processes in human perceptual decision making

    PubMed Central

    Mostert, Pim; Kok, Peter; de Lange, Floris P.

    2015-01-01

    A key question within systems neuroscience is how the brain translates physical stimulation into a behavioral response: perceptual decision making. To answer this question, it is important to dissociate the neural activity underlying the encoding of sensory information from the activity underlying the subsequent temporal integration into a decision variable. Here, we adopted a decoding approach to empirically assess this dissociation in human magnetoencephalography recordings. We used a functional localizer to identify the neural signature that reflects sensory-specific processes, and subsequently traced this signature while subjects were engaged in a perceptual decision making task. Our results revealed a temporal dissociation in which sensory processing was limited to an early time window and consistent with occipital areas, whereas decision-related processing became increasingly pronounced over time, and involved parietal and frontal areas. We found that the sensory processing accurately reflected the physical stimulus, irrespective of the eventual decision. Moreover, the sensory representation was stable and maintained over time when it was required for a subsequent decision, but unstable and variable over time when it was task-irrelevant. In contrast, decision-related activity displayed long-lasting sustained components. Together, our approach dissects neuro-anatomically and functionally distinct contributions to perceptual decisions. PMID:26666393

  3. When surgeons face intraoperative challenges: a naturalistic model of surgical decision making.

    PubMed

    Cristancho, Sayra M; Vanstone, Meredith; Lingard, Lorelei; LeBel, Marie-Eve; Ott, Michael

    2013-02-01

    Surgery is an environment in which being an expert requires the ability to manage the unexpected. This feature has necessitated a shift in surgical decision-making research. The present study explores the processes by which surgeons assess and respond to nonroutine challenges in the operating room. We used a grounded theory methodology supported on intraoperative observations and postoperative interviews with 7 faculty surgeons from various specialties. A total of 32 cases were purposively sampled to compile a dataset of challenging situations. Thematic data analysis yielded 3 main themes that were linked in a cyclic model: assessing the situation, the reconciliation cycle, and implementing the planned course of action. These elements were connected through 2 points of transition (ie, active and confirmatory reconciliation), during which time the surgeons continue to act although they may change the course of their action. The proposed model builds on existing theories of naturalistic decision making from other high-stakes environments. This model elaborates on a theoretic language that accounts for the unique aspects of surgery, making it useful for teaching in the operating room. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. When surgeons face intraoperative challenges: a naturalistic model of surgical decision making

    PubMed Central

    Cristancho, Sayra M.; Vanstone, Meredith; Lingard, Lorelei; LeBel, Marie-Eve; Ott, Michael

    2017-01-01

    BACKGROUND Surgery is an environment in which being an expert requires the ability to manage the unexpected. This feature has necessitated a shift in surgical decision-making research. The present study explores the processes by which surgeons assess and respond to nonroutine challenges in the operating room. METHODS We used a grounded theory methodology supported on intraoperative observations and postoperative interviews with 7 faculty surgeons from various specialties. A total of 32 cases were purposively sampled to compile a dataset of challenging situations. RESULTS Thematic data analysis yielded 3 main themes that were linked in a cyclic model: assessing the situation, the reconciliation cycle, and implementing the planned course of action. These elements were connected through 2 points of transition (ie, active and confirmatory reconciliation), during which time the surgeons continue to act although they may change the course of their action. CONCLUSIONS The proposed model builds on existing theories of naturalistic decision making from other high-stakes environments. This model elaborates on a theoretic language that accounts for the unique aspects of surgery, making it useful for teaching in the operating room. PMID:23331980

  5. Decision-making processes: the case of collective movements.

    PubMed

    Petit, Odile; Bon, Richard

    2010-07-01

    Besides focusing on the adaptive significance of collective movements, it is crucial to study the mechanisms and dynamics of decision-making processes at the individual level underlying the higher-scale collective movements. It is now commonly admitted that collective decisions emerge from interactions between individuals, but how individual decisions are taken, i.e. how far they are modulated by the behaviour of other group members, is an under-investigated question. Classically, collective movements are viewed as the outcome of one individual's initiation (the leader) for departure, by which all or some of the other group members abide. Individuals assuming leadership have often been considered to hold a specific social status. This hierarchical or centralized control model has been challenged by recent theoretical and experimental findings, suggesting that leadership can be more distributed. Moreover, self-organized processes can account for collective movements in many different species, even in those that are characterized by high cognitive complexity. In this review, we point out that decision-making for moving collectively can be reached by a combination of different rules, i.e. individualized (based on inter-individual differences in physiology, energetic state, social status, etc.) and self-organized (based on simple response) ones for any species, context and group size.

  6. International Patients' Travel Decision Making Process- A Conceptual Framework.

    PubMed

    Khan, Mohammad Jamal; Chelliah, Shankar; Haron, Mahmod Sabri

    2016-02-01

    Role of information source, perceived benefits and risks, and destination image has significantly been examined in travel and tourism literature; however, in medical tourism it is yet to be examined thoroughly. The concept discussed in this article is drawn form well established models in tourism literature. The purpose of this research was to identify the source of information, travel benefits and perceived risks related to movement of international patients and develop a conceptual model based on well-established theory. Thorough database search (Science Direct, utmj.org, nih.gov, nchu.edu.tw, palgrave-journals, medretreat, Biomedcentral) was performed to fulfill the objectives of the study. International patients always concern about benefits and risks related to travel. These benefits and risks form images of destination in the minds of international patients. Different sources of information make international patients acquaint about the associated benefits and risks, which later leads to development of intention to visit. This conceptual paper helps in establishing model for decision-making process of international patients in developing visit intention. Ample amount of literature is available detailing different factors involved in travel decision making of international patients; however literature explaining relationship between these factors is scarce.

  7. International Patients’ Travel Decision Making Process- A Conceptual Framework

    PubMed Central

    KHAN, Mohammad Jamal; CHELLIAH, Shankar; HARON, Mahmod Sabri

    2016-01-01

    Background: Role of information source, perceived benefits and risks, and destination image has significantly been examined in travel and tourism literature; however, in medical tourism it is yet to be examined thoroughly. The concept discussed in this article is drawn form well established models in tourism literature. Methods: The purpose of this research was to identify the source of information, travel benefits and perceived risks related to movement of international patients and develop a conceptual model based on well-established theory. Thorough database search (Science Direct, utmj.org, nih.gov, nchu.edu.tw, palgrave-journals, medretreat, Biomedcentral) was performed to fulfill the objectives of the study. Results: International patients always concern about benefits and risks related to travel. These benefits and risks form images of destination in the minds of international patients. Different sources of information make international patients acquaint about the associated benefits and risks, which later leads to development of intention to visit. This conceptual paper helps in establishing model for decision-making process of international patients in developing visit intention. Conclusion: Ample amount of literature is available detailing different factors involved in travel decision making of international patients; however literature explaining relationship between these factors is scarce. PMID:27114978

  8. Qualitative modeling of the decision-making process using electrooculography.

    PubMed

    Marandi, Ramtin Zargari; Sabzpoushan, S H

    2015-12-01

    A novel method based on electrooculography (EOG) has been introduced in this work to study the decision-making process. An experiment was designed and implemented wherein subjects were asked to choose between two items from the same category that were presented within a limited time. The EOG and voice signals of the subjects were recorded during the experiment. A calibration task was performed to map the EOG signals to their corresponding gaze positions on the screen by using an artificial neural network. To analyze the data, 16 parameters were extracted from the response time and EOG signals of the subjects. Evaluation and comparison of the parameters, together with subjects' choices, revealed functional information. On the basis of this information, subjects switched their eye gazes between items about three times on average. We also found, according to statistical hypothesis testing-that is, a t test, t(10) = 71.62, SE = 1.25, p < .0001-that the correspondence rate of a subjects' gaze at the moment of selection with the selected item was significant. Ultimately, on the basis of these results, we propose a qualitative choice model for the decision-making task.

  9. Contingency Management and Deliberative Decision-Making Processes

    PubMed Central

    Regier, Paul S.; Redish, A. David

    2015-01-01

    Contingency management is an effective treatment for drug addiction. The current explanation for its success is rooted in alternative reinforcement theory. We suggest that alternative reinforcement theory is inadequate to explain the success of contingency management and produce a model based on demand curves that show how little the monetary rewards offered in this treatment would affect drug use. Instead, we offer an explanation of its success based on the concept that it accesses deliberative decision-making processes. We suggest that contingency management is effective because it offers a concrete and immediate alternative to using drugs, which engages deliberative processes, improves the ability of those deliberative processes to attend to non-drug options, and offsets more automatic action-selection systems. This theory makes explicit predictions that can be tested, suggests which users will be most helped by contingency management, and suggests improvements in its implementation. PMID:26082725

  10. Contingency Management and Deliberative Decision-Making Processes.

    PubMed

    Regier, Paul S; Redish, A David

    2015-01-01

    Contingency management is an effective treatment for drug addiction. The current explanation for its success is rooted in alternative reinforcement theory. We suggest that alternative reinforcement theory is inadequate to explain the success of contingency management and produce a model based on demand curves that show how little the monetary rewards offered in this treatment would affect drug use. Instead, we offer an explanation of its success based on the concept that it accesses deliberative decision-making processes. We suggest that contingency management is effective because it offers a concrete and immediate alternative to using drugs, which engages deliberative processes, improves the ability of those deliberative processes to attend to non-drug options, and offsets more automatic action-selection systems. This theory makes explicit predictions that can be tested, suggests which users will be most helped by contingency management, and suggests improvements in its implementation.

  11. Impact of a clinical decision making module on the attitudes and perceptions of surgical trainees.

    PubMed

    Bhatt, Nikita R; Doherty, Eva M; Mansour, Ehab; Traynor, Oscar; Ridgway, Paul F

    2016-09-01

    Decision making, a cognitive non-technical skill, is a key element for clinical practice in surgery. Specific teaching about methods in clinical decision making (CDM) is a very recent addition to surgical training curricula in the UK and Ireland. Baseline trainee opinion on decision-making modules is unknown. The Royal College of Surgeons in Ireland's postgraduate training boot camp inaugural CDM module was investigated to elucidate the impact on the attitudes of CDM naïf trainees. Three standardized two-hour workshops for three trainee groups were delivered. The trainees were assessed by an anonymous questionnaire before and after the module. Change in attitude of the trainees was determined by comparing Likert scale ratings using the Wilcoxon signed-rank test. Fifty-seven newly appointed basic surgical trainees attended these workshops. A statistically significant rise in the proportion of candidates recognizing the importance of being taught CDM skills (P == 0.002) revealed the positive impact of the module, as did the increased understanding of different aspects of CDM like shared decision making (P == 0.035) and different styles of decision making (P == 0.013). These observed positive changes in trainee understanding and attitude toward CDM teaching supports the adoption of standardized modules into the curricula. More study is needed to define whether these modules will have measurable sustained enhancements of CDM skills. © 2016 Royal Australasian College of Surgeons.

  12. Primary osseous tumors of the pediatric spinal column: review of pathology and surgical decision making.

    PubMed

    Ravindra, Vijay M; Eli, Ilyas M; Schmidt, Meic H; Brockmeyer, Douglas L

    2016-08-01

    Spinal column tumors are rare in children and young adults, accounting for only 1% of all spine and spinal cord tumors combined. They often present diagnostic and therapeutic challenges. In this article, the authors review the current management of primary osseous tumors of the pediatric spinal column and highlight diagnosis, management, and surgical decision making.

  13. Information processing as a paradigm for decision making.

    PubMed

    Oppenheimer, Daniel M; Kelso, Evan

    2015-01-03

    For decades, the dominant paradigm for studying decision making--the expected utility framework--has been burdened by an increasing number of empirical findings that question its validity as a model of human cognition and behavior. However, as Kuhn (1962) argued in his seminal discussion of paradigm shifts, an old paradigm cannot be abandoned until a new paradigm emerges to replace it. In this article, we argue that the recent shift in researcher attention toward basic cognitive processes that give rise to decision phenomena constitutes the beginning of that replacement paradigm. Models grounded in basic perceptual, attentional, memory, and aggregation processes have begun to proliferate. The development of this new approach closely aligns with Kuhn's notion of paradigm shift, suggesting that this is a particularly generative and revolutionary time to be studying decision science.

  14. The shared leadership process in decision-making teams.

    PubMed

    Bergman, Jacqueline Z; Rentsch, Joan R; Small, Erika E; Davenport, Shaun W; Bergman, Shawn M

    2012-01-01

    The present study examined the process of shared leadership in 45 ad hoc decision-making teams. Each team member's leadership behavior (n = 180) was assessed by behaviorally coding videotapes of the teams' discussions. The within-team patterns of leadership behavior were examined using cluster analysis. Results indicated that the likelihood of a team experiencing a full range of leadership behavior increased to the extent that multiple team members shared leadership, and that teams with shared leadership experienced less conflict, greater consensus, and higher intragroup trust and cohesion than teams without shared leadership. This study supports previous findings that shared leadership contributes to overall team functioning, and begins to delineate the extent to which team members may naturally share leadership.

  15. Use of Probabilistic Risk Assessment in Shuttle Decision Making Process

    NASA Technical Reports Server (NTRS)

    Boyer, Roger L.; Hamlin, Teri, L.

    2011-01-01

    This slide presentation reviews the use of Probabilistic Risk Assessment (PRA) to assist in the decision making for the shuttle design and operation. Probabilistic Risk Assessment (PRA) is a comprehensive, structured, and disciplined approach to identifying and analyzing risk in complex systems and/or processes that seeks answers to three basic questions: (i.e., what can go wrong? what is the likelihood of these occurring? and what are the consequences that could result if these occur?) The purpose of the Shuttle PRA (SPRA) is to provide a useful risk management tool for the Space Shuttle Program (SSP) to identify strengths and possible weaknesses in the Shuttle design and operation. SPRA was initially developed to support upgrade decisions, but has evolved into a tool that supports Flight Readiness Reviews (FRR) and near real-time flight decisions. Examples of the use of PRA for the shuttle are reviewed.

  16. Promoting emancipated decision-making for surgical treatment of early stage breast cancer among Jordanian women.

    PubMed

    Obeidat, Rana F

    2015-01-01

    To use the critical social theory as a framework to analyze the oppression of Jordanian women with early stage breast cancer in the decision-making process for surgical treatment and suggest strategies to emancipate these women to make free choices. This is a discussion paper utilizing the critical social theory as a framework for analysis. The sexist and paternalistic ideology that characterizes Jordanian society in general and the medical establishment in particular as well as the biomedical ideology are some of the responsible ideologies for the fact that many Jordanian women with early stage breast cancer are denied the right to choose a surgical treatment according to their own preferences and values. The financial and political power of Jordanian medical organizations (e.g., Jordan Medical Council), the weakness of nursing administration in the healthcare system, and the hierarchical organization of Jordanian society, where men are first and women are second, support these oppressing ideologies. Knowledge is a strong tool of power. Jordanian nurses could empower women with early stage breast cancer by enhancing their knowledge regarding their health and the options available for surgical treatment. To successfully emancipate patients, education alone may not be enough; there is also a need for health care providers' support and unconditional acceptance of choice. To achieve the aim of emancipating women with breast cancer from the oppression inherent in the persistence of mastectomy, Jordanian nurses need to recognize that they should first gain greater power and authority in the healthcare system.

  17. Promoting emancipated decision-making for surgical treatment of early stage breast cancer among Jordanian women

    PubMed Central

    Obeidat, Rana F.

    2015-01-01

    To use the critical social theory as a framework to analyze the oppression of Jordanian women with early stage breast cancer in the decision-making process for surgical treatment and suggest strategies to emancipate these women to make free choices. This is a discussion paper utilizing the critical social theory as a framework for analysis. The sexist and paternalistic ideology that characterizes Jordanian society in general and the medical establishment in particular as well as the biomedical ideology are some of the responsible ideologies for the fact that many Jordanian women with early stage breast cancer are denied the right to choose a surgical treatment according to their own preferences and values. The financial and political power of Jordanian medical organizations (e.g., Jordan Medical Council), the weakness of nursing administration in the healthcare system, and the hierarchical organization of Jordanian society, where men are first and women are second, support these oppressing ideologies. Knowledge is a strong tool of power. Jordanian nurses could empower women with early stage breast cancer by enhancing their knowledge regarding their health and the options available for surgical treatment. To successfully emancipate patients, education alone may not be enough; there is also a need for health care providers’ support and unconditional acceptance of choice. To achieve the aim of emancipating women with breast cancer from the oppression inherent in the persistence of mastectomy, Jordanian nurses need to recognize that they should first gain greater power and authority in the healthcare system. PMID:27981122

  18. Shared decision-making and choice for elective surgical care: A systematic review

    PubMed Central

    Boss, Emily F.; Mehta, Nishchay; Nagarajan, Neeraja; Links, Anne; Benke, James R.; Berger, Zackary; Espinel, Ali; Meier, Jeremy; Lipstein, Ellen A.

    2016-01-01

    Objective Shared Decision-Making (SDM), an integrative patient-provider communication process emphasizing discussion of scientific evidence and patient/family values, may improve quality care delivery, promote evidence-based practice, and reduce overuse of surgical care. Little is known however regarding SDM in elective surgical practice. The purpose of this systematic review is to synthesize findings of studies evaluating use and outcomes of SDM in elective surgery. Data Sources Pubmed, CochraneCENTRAL, EMBASE, CINAHL, and SCOPUS electronic databases Review Methods We searched for English-language studies (1/1/1990 to 8/9/2015) evaluating use of SDM in elective surgical care. Identified studies were independently screened by two reviewers in stages of title/abstract and full-text review. We abstracted data related to population, study design, clinical dilemma, use of SDM, outcomes, treatment choice, and bias. Results Of 10,929 identified articles, 24 met inclusion criteria. The most common area studied was spine (7/24) followed by joint (5/24) and gynecological surgery (4/24). Twenty studies used decision aids/support tools, including modalities that were multimedia/video (13/20), written (3/20), or personal coaching (4/20). Effect of SDM on preference for surgery were mixed across studies, showing a decrease in surgery (9/24), no difference (8/24), or increase (1/24). SDM tended to improve decision quality (3/3) as well as knowledge/preparation (4/6), while decreasing decision conflict (4/6). Conclusion SDM reduces decision conflict and improves decision quality for patients making choices about elective surgery. While net findings show that SDM may influence patients to choose surgery less often, the impact of SDM on surgical utilization cannot be clearly ascertained. PMID:26645531

  19. Space Launch System Complex Decision-Making Process

    NASA Technical Reports Server (NTRS)

    Lyles, Garry; Flores, Tim; Hundley, Jason; Monk, Timothy; Feldman,Stuart

    2012-01-01

    The Space Shuttle program has ended and elements of the Constellation Program have either been cancelled or transitioned to new NASA exploration endeavors. The National Aeronautics and Space Administration (NASA) has worked diligently to select an optimum configuration for the Space Launch System (SLS), a heavy lift vehicle that will provide the foundation for future beyond low earth orbit (LEO) large-scale missions for the next several decades. From Fall 2010 until Spring 2011, an SLS decision-making framework was formulated, tested, fully documented, and applied to multiple SLS vehicle concepts at NASA from previous exploration architecture studies. This was a multistep process that involved performing figure of merit (FOM)-based assessments, creating Pass/Fail gates based on draft threshold requirements, performing a margin-based assessment with supporting statistical analyses, and performing sensitivity analysis on each. This paper focuses on the various steps and methods of this process (rather than specific data) that allowed for competing concepts to be compared across a variety of launch vehicle metrics in support of the successful completion of the SLS Mission Concept Review (MCR) milestone.

  20. Learning Decision Making: Specifications to Guide Processes in Future Comprehensive High Schools.

    ERIC Educational Resources Information Center

    Pease, Virginia H.; Copa, George H.

    Three ways to think about decision making in public high schools are to think about the types of decisions that are made, the approaches to the decision-making process, and the principles underlying decision making. The Design Group for New Designs for the Comprehensive High School refers to a set of principles as design specifications. They have…

  1. Simulating the Foreign Policy Decision-Making Process in the Undergraduate Classroom

    ERIC Educational Resources Information Center

    Loggins, Julie A.

    2009-01-01

    A simulation of the foreign policy decision-making process, as described in this article, can assist an instructor in linking students' abstract understanding of complex political events, circumstances, and decision making to the real-world interplay of the multiple factors involved in decision making. It is this type of active learning that helps…

  2. Telecardiology: supporting the decision-making process in general practice.

    PubMed

    Shanit, D; Cheng, A; Greenbaum, R A

    1996-01-01

    To assess the initial phase of a telecardiology diagnostic service for general practitioners (GPs), we provided 93 GPs in 26 health centres with direct telephone access to a cardiologist, and equipped them with hand-held, automatic standard 12-lead electrocardiogram (ECG) transmitters for on-line cardiac consultations and ECG interpretation in their daily practice. Clinical details, reason for consultation and the ECG signal were transmitted from the GPs' practices or the patients' homes. A consultation followed and a full report, including ECG print-out, was then sent to the GP. During an 18-month study period, 2563 consultations were carried out. The system allowed the identification of 479 patients (19%) with urgent cardiac problems and the remaining 2084 (81%) in whom admission or outpatient investigation was unnecessary. Following the study, we distributed a questionnaire asking the GPs to rate the quality, define the use and consider the benefit of the service to their daily practice. We conclude that a telecardiology diagnosis and ECG interpretation service is simple, reliable and efficacious in routine primary care. It offers instant access to cardiac assessment and supports the decision-making process of GPs. A preliminary cost comparison with a conventional referral indicated that a teleconsultation was substantially cheaper. We expect that the future incorporation of teleechocardiography would expand the scope of telecardiology even further and allow comprehensive cardiology consultations.

  3. Mass Spectrometry Imaging as a Tool for Surgical Decision-Making

    PubMed Central

    Calligaris, David; Norton, Isaiah; Feldman, Daniel R.; Ide, Jennifer L.; Dunn, Ian F.; Eberlin, Livia S.; Cooks, R. Graham; Jolesz, Ferenc A.; Golby, Alexandra J.; Santagata, Sandro; Agar, Nathalie Y.

    2014-01-01

    Despite significant advances in image-guided therapy, surgeons are still too often left with uncertainty when deciding to remove tissue. This binary decision between removing and leaving tissue during surgery implies that the surgeon should be able to distinguish tumor from healthy tissue. In neurosurgery, current image-guidance approaches such as magnetic resonance imaging (MRI) combined with neuro-navigation offer a map as to where the tumor should be, but the only definitive method to characterize the tissue at stake is histopathology. While extremely valuable information is derived from this gold standard approach, it is limited to very few samples during surgery and is not practically used for the delineation of tumor margins. The development and implementation of faster, comprehensive and complementary approaches for tissue characterization are required to support surgical decision-making – an incremental and iterative process with tumor removed in multiple and often minute biopsies. The development of atmospheric pressure ionization sources makes it possible to analyze tissue specimens with little to no sample preparation. Here, we highlight the value of desorption electrospray ionization (DESI) as one of many available approaches for the analysis of surgical tissue. Twelve surgical samples resected from a patient during surgery were analyzed and diagnosed as glioblastoma (GBM) tumor or necrotic tissue by standard histopathology, and mass spectrometry results were further correlated to histopathology for critical validation of the approach. The use of a robust statistical approach reiterated results from the qualitative detection of potential biomarkers of these tissue types. The correlation of the MS and histopathology results to magnetic resonance images brings significant insight into tumor presentation that could not only serve to guide tumor resection, but that is worthy of more detailed studies on our understanding of tumor presentation on MRI. PMID

  4. Patient Participation in Surgical Treatment Decision Making from the Patients' Perspective: Validation of an Instrument

    PubMed Central

    Heggland, Liv-Helen; Øgaard, Torvald; Mikkelsen, Aslaug; Hausken, Kjell

    2012-01-01

    The aim of this paper is to describe the development of a new, brief, easy-to-administer self-reported instrument designed to assess patient participation in decision making in surgical treatment. We describe item generation, psychometric testing, and validity of the instrument. The final scale consisted of four factors: information dissemination (5 items), formulation of options (4 items), integration of information (4 items), and control (3 items). The analysis demonstrated a reasonable level of construct validity and reliability. The instrument applies to patients in surgical wards and can be used to identify the health services that are being provided and the areas that could strengthen patient participation. PMID:22830010

  5. Memory and Processing Limits in Decision-Making.

    ERIC Educational Resources Information Center

    Klapp, Stuart T.

    According to the classical working memory perspective, tasks such as command and control decision-making should be performed less effectively if extraneous material must be retained in short-term memory. Only marginal support for this prediction was obtained for a simulation involving scheduling trucking and transportation missions, although…

  6. When to cut? Using an objective structured clinical examination to evaluate surgical decision-making.

    PubMed

    Franzese, Christine

    2007-11-01

    To create an objective structured clinical examination (OSCE) tailored to surgical residents that uses surgical case scenarios appropriate for the experience level of the resident to evaluate whether residents understand the indications for a specific surgery, identify when indications are met, and make the appropriate decision to proceed with an operation. The surgical OSCE consisted of two case scenarios: a junior case created for postgraduate year (PGY) 2 to 3 level residents and a senior case created for PGY 4 to 5 level residents. Four senior residents and four junior residents in the otolaryngology department participated. Residents were instructed to proceed as if they had all the capabilities of the otolaryngology clinic. Recordings were made of each encounter and were reviewed by two separate faculty member with expertise in each case. Faculty evaluated whether surgical indications were elicited by history, whether certain physical examination or radiographic findings were recognized, whether residents made the correct diagnosis, and whether residents not only made the decision to proceed with surgery but also indicated the correct surgery. Seniors (100%) were better at obtaining needed surgical information and indications than juniors (25%). Seniors were more willing to make the decision to proceed with surgery (100%), whereas no juniors actually scheduled surgery. The reasons for this ranged from failure to elicit surgical indications to lack of surety in proceeding with surgery. All seniors recommended the appropriate surgery, but only 75% correctly identified the need for emergent intervention. Results of evaluations were reviewed with each resident individually. The surgical OSCE was successful in evaluating resident surgical decision-making. Juniors were not as capable as seniors in eliciting surgical indications and in "making the jump" to proceed with surgery. These results were used by our faculty to work with juniors on surgical history

  7. Analysis of the decision-making process of nurse managers: a collective reflection.

    PubMed

    Eduardo, Elizabete Araujo; Peres, Aida Maris; de Almeida, Maria de Lourdes; Roglio, Karina de Dea; Bernardino, Elizabeth

    2015-01-01

    to analyze the decision-making model adopted by nurses from the perspective of some decision-making process theories. qualitative approach, based on action research. Semi-structured questionnaires and seminars were conducted from April to June 2012 in order to understand the nature of decisions and the decision-making process of nine nurses in position of managers at a public hospital in Southern Brazil. Data were subjected to content analysis. data were classified in two categories: the current situation of decision-making, which showed a lack of systematization; the construction and collective decision-making, which emphasizes the need to develop a decision-making model. the decision-making model used by nurses is limited because it does not consider two important factors: the limits of human rationality, and the external and internal organizational environments that influence and determine right decisions.

  8. Force XXI Technology and the Cognitive Approach to the Military Decision Making Process (MDMP)

    DTIC Science & Technology

    2000-05-01

    Force XXI Technology and the Cognitive Approach to the Military Decision Making Process (MDMP) A Monograph By Lieutenant Colonel Michael C. Sevcik... Approach to the Military Decision Making Process (MDMP) by Michael C. Sevcik, US Army, 43 pages. The United States Army has invested millions of dollars...Michael C. Sevcik Title of Monograph: FXXI Technology and the Cognitive Approach to the Military Decision Making Process (MDMP) Approved by

  9. Molecular typing of Meningiomas by Desorption Electrospray Ionization Mass Spectrometry Imaging for Surgical Decision-Making

    PubMed Central

    Calligaris, David; Feldman, Daniel R.; Norton, Isaiah; Brastianos, Priscilla K.; Dunn, Ian F.; Santagata, Sandro; Agar, Nathalie Y. R.

    2014-01-01

    Meningiomas are the most frequent intracranial tumors. The majority is benign slow-growing tumors but they can be difficult to treat depending on their location and size. While meningiomas are well delineated on magnetic resonance imaging by their uptake of contrast, surgical limitations still present themselves from not knowing the extent of invasion of the dura matter by meningioma cells. The development of tools to characterize tumor tissue in real or near real time could prevent recurrence after tumor resection by allowing for more precise surgery, i.e. removal of tumor with preservation of healthy tissue. The development of ambient ionization mass spectrometry for molecular characterization of tissue and its implementation in the surgical decision-making workflow carry the potential to fulfill this need. Here, we present the characterization of meningioma and dura mater by desorption electrospray ionization mass spectrometry to validate the technique for the molecular assessment of surgical margins and diagnosis of meningioma from surgical tissue in real-time. Nine stereotactically resected surgical samples and three autopsy samples were analyzed by standard histopathology and mass spectrometry imaging. All samples indicated a strong correlation between results from both techniques. We then highlight the value of desorption electrospray ionization mass spectrometry for the molecular subtyping/subgrouping of meningiomas from a series of forty genetically characterized specimens. The minimal sample preparation required for desorption electrospray ionization mass spectrometry offers a distinct advantage for applications relying on real-time information such as surgical decision-making. The technology here was tested to distinguish meningioma from dura mater as an approach to precisely define surgical margins. In addition we classify meningiomas into fibroblastic and meningothelial subtypes and more notably recognize meningiomas with NF2 genetic aberrations. PMID

  10. Shared Surgical Decision-Making and Youth Resilience: Correlates of Satisfaction with Clinical Outcomes

    PubMed Central

    Kapp-Simon, Kathleen A; Edwards, Todd; Ruta, Caroline; Bellucci, Claudia Crilly; Aspirnall, Cassandra L.; Strauss, Ronald P; Topolski, Tari D.; Rumsey, Nichola J; Patrick, Donald L

    2015-01-01

    The aim of this study was to identify factors associated with youth satisfaction with surgical procedures performed to address oral cleft or craniofacial conditions (CFC). It was hypothesized that youth mental health, participation in decision-making, perceived consequences of living with a CFC, and coping strategies would be associated with satisfaction with past surgeries. Two hundred and three youth between the ages of 11 and 18 (Mean age = 14.5. SD = 2.0; 61% male; 78% oral cleft) completed a series of questionnaires measuring depression, self-esteem, participation in decision-making, condition severity, negative and positive consequences of having a CFC, coping, and satisfaction with past surgeries. Multiple Regression Analysis using boot-strapping techniques found that youth participation in decision making, youth perception of positive consequences of having a CFC, and coping accounted for 32% of the variance in satisfaction with past surgeries (p < .001). Youth age, sex, and assessment of condition severity were not significantly associated with satisfaction with surgical outcome. Depression, self-esteem, and negative consequences of having a CFC were not associated with satisfaction with past surgeries. Youth should be actively involved in the decision for craniofacial surgery. Youth who were more satisfied with their surgical outcomes also viewed themselves as having gained from the experience of living with a CFC. They felt that having a CFC made them stronger people and they believed that they were more accepting of others and more in touch with others’ feelings because of what they had been through. PMID:26114527

  11. Shared Surgical Decision Making and Youth Resilience Correlates of Satisfaction With Clinical Outcomes.

    PubMed

    Kapp-Simon, Kathleen A; Edwards, Todd; Ruta, Caroline; Bellucci, Claudia Crilly; Aspirnall, Cassandra L; Strauss, Ronald P; Topolski, Tari D; Rumsey, Nichola J; Patrick, Donald L

    2015-07-01

    The aim of this study was to identify factors associated with youth satisfaction with surgical procedures performed to address oral cleft or craniofacial conditions (CFCs). It was hypothesized that youth mental health, participation in decision making, perceived consequences of living with a CFC, and coping strategies would be associated with satisfaction with past surgeries. A total of 203 youth between the ages of 11 and 18 years (mean age = 14.5, standard deviation = 2.0, 61% male participants, 78% oral cleft) completed a series of questionnaires measuring depression, self-esteem, participation in decision making, condition severity, negative and positive consequences of having a CFC, coping, and satisfaction with past surgeries. Multiple regression analysis using boot-strapping techniques found that youth participation in decision making, youth perception of positive consequences of having a CFC, and coping accounted for 32% of the variance in satisfaction with past surgeries (P < 0.001). Youth age, sex, and assessment of condition severity were not significantly associated with satisfaction with surgical outcome. Depression, self-esteem, and negative consequences of having a CFC were not associated with satisfaction with past surgeries. Youth should be actively involved in the decision for craniofacial surgery. Youth who were more satisfied with their surgical outcomes also viewed themselves as having gained from the experience of living with a CFC. They felt that having a CFC made them stronger people and they believed that they were more accepting of others and more in touch with others' feelings because of what they had been through.

  12. Decision-making process for treatment of mandibular fractures among minority groups.

    PubMed

    Der-Martirosian, Claudia; Gironda, Melanie W; Black, Edward; Leathers, Richard; Atchison, Kathryn A

    2006-01-01

    While patients' preferences for medical care are widely studied, only a small number of studies have looked at the decision-making process for dental treatment of mandibular fracture. This study examines the decision-making process for treatment of mandibular fractures among minority groups. Study participants were asked to consider Maxillomandibular Fixation (MMF--a non-surgical approach of wiring the teeth for 4-8 weeks) or Rigid Internal Fixation (RIF--surgical placement of bone plate). A qualitative study of patients receiving care at an inner-city hospital for either 3rd molar extraction under general anesthesia or a mandibular fracture were recruited to participate in an hour-long focus group to discuss their preferences. The 3rd molar group was selected as a comparison group exemplifying experience with oral surgery and recovery from general anesthesia. Seven decision-making factors affecting choice of treatment were discussed by both jaw fracture and 3rd molar groups, including: side effects, effectiveness of each treatment, trusting doctor's recommendation, what to expect from each procedure, use of pictures from previous case studies, surgery location of scar/incision, and size of scar. Rigid Internal Fixation (RIF) participants discussed a different set of concerns compared to Maxillomandibular Fixation (MMF) participants. Regardless of gender, the treatment of choice for both 3rd molar and jaw fracture participants was the non-surgical method of wiring of the teeth for 4-8 weeks. The Phase II part of this study will systematically examine patient preferences among a larger sample of 3rd molar and jaw fracture patients by incorporating the patient-reported concerns about treatment of jaw fracture found in this inductive, phenomenological study.

  13. Evaluation of obstetricians' surgical decision making in the management of uterine rupture.

    PubMed

    Eze, Justus Ndulue; Anozie, Okechukwu Bonaventure; Lawani, Osaheni Lucky; Ndukwe, Emmanuel Okechukwu; Agwu, Uzoma Maryrose; Obuna, Johnson Akuma

    2017-06-08

    Uterine rupture is an obstetric calamity with surgery as its management mainstay. Uterine repair without tubal ligation leaves a uterus that is more prone to repeat rupture while uterine repair with bilateral tubal ligation (BTL) or (sub)total hysterectomy predispose survivors to psychosocial problems like marital disharmony. This study aims to evaluate obstetricians' perspectives on surgical decision making in managing uterine rupture. A questionnaire-based cross-sectional study of obstetricians at the 46th annual scientific conference of Society of Gynaecology and Obstetrics of Nigeria in 2012. Data was analysed by descriptive and inferential statistics. Seventy-nine out of 110 obstetricians (71.8%) responded to the survey, of which 42 (53.2%) were consultants, 60 (75.9%) practised in government hospitals and 67 (84.8%) in urban hospitals, and all respondents managed women with uterine rupture. Previous cesarean scars and injudicious use of oxytocic are the commonest predisposing causes, and uterine rupture carries very high incidences of maternal and perinatal mortality and morbidity. Uterine repair only was commonly performed by 38 (48.1%) and uterine repair with BTL or (sub) total hysterectomy by 41 (51.9%) respondents. Surgical management is guided mainly by patients' conditions and obstetricians' surgical skills. Obstetricians' distribution in Nigeria leaves rural settings starved of specialist for obstetric emergencies. Caesarean scars are now a rising cause of ruptures. The surgical management of uterine rupture and obstetricians' surgical preferences vary and are case scenario-dependent. Equitable redistribution of obstetricians and deployment of medical doctors to secondary hospitals in rural settings will make obstetric care more readily available and may reduce the prevalence and improve the outcome of uterine rupture. Obstetrician's surgical decision-making should be guided by the prevailing case scenario and the ultimate aim should be to avert

  14. An Assessment of Decision-Making Processes in Dual-Career Marriages.

    ERIC Educational Resources Information Center

    Kingsbury, Nancy M.

    As large numbers of women enter the labor force, decision making and power processes have assumed greater importance in marital relationships. A sample of 51 (N=101) dual-career couples were interviewed to assess independent variables predictive of process power, process outcome, and subjective outcomes of decision making in dual-career families.…

  15. Decision making for wildfires: A guide for applying a risk management process at the incident level

    Treesearch

    Mary A. Taber; Lisa M. Elenz; Paul G. Langowski

    2013-01-01

    This publication focuses on the thought processes and considerations surrounding a risk management process for decision making on wildfires. The publication introduces a six element risk management cycle designed to encourage sound risk-informed decision making in accordance with Federal wildland fire policy, although the process is equally applicable to non-Federal...

  16. Navigating the gray zone: a guideline for surgical decision making in obstetrical brachial plexus injuries.

    PubMed

    Bain, James R; Dematteo, Carol; Gjertsen, Deborah; Hollenberg, Robert D

    2009-03-01

    In the literature, the best recommendations are imprecise as to the timing and selection of infants with obstetrical brachial plexus injury (OBPI) for surgical intervention. There is a gray zone (GZ) in which the decision as to the benefits and risks of surgery versus no surgery is not clear. The authors propose to describe this category, and they have developed a guideline to assist surgical decision-making within this GZ. The authors first performed a critical review of the medical literature to determine the existence of a GZ in other clinical publications. In those reports, 47-89% of infants with OBPI fell within such a GZ. Complete recovery in those reported patients ranged from 9 to 59%. Using a prospective inception cohort design, all infants referred to the OBPI Clinic at McMaster Children's Hospital were systematically evaluated up to 3 years of age. The Active Movement Scale scores were compared for surgical and nonsurgical groups of infants in the GZ to identify any important trends that would guide surgical decision-making. In the authors' population of infants with OBPI, 81% fell within the GZ, of whom 44% achieved complete recovery. Mean scores differed significantly between surgery and no surgery groups in terms of total Active Movement Scale score and shoulder abduction and flexion at 6 months. Elbow flexion and external rotation differed at 3 months. There is compelling evidence that there is a group of infants with OBPI in whom the assessment of the risk/benefit ratio for surgical versus nonsurgical treatment is not evident. These infants reside within what the authors have called the GZ. Based on their results, a guideline was derived to assist clinicians working with infants with OBPI to navigate the GZ.

  17. Colon trauma--clinical staging for surgical decision making. Analysis of 119 cases.

    PubMed

    Morgado, P J; Alfaro, R; Morgado, P J; León, P

    1992-10-01

    A retrospective study is presented of 119 patients admitted to the Central Hospital of the Venezuelan Institute of Social Security, in Caracas, between 1982 and 1990, with the diagnosis of colon trauma. Several parameters including age, etiology, time elapsed between the accident or assault and hospital admission, preoperative and postoperative hemoglobin and diastolic blood pressure, associated lesions, procedure practiced, complication rate, and hospital mortality are reviewed. The second and third decades of life appear most often involved. Most patients reached the hospital within the first four hours of the accident or assault. Anemia, sustained diastolic hypotension, and number of organs involved in addition to the colon were important prognostic factors for complications. Apparently the surgical procedure, with simple suture or resection, mostly without "protective" colostomy, was not very relevant. Hospital mortality was 2.4 percent. A staging system based on clinical conditions for decision making in the operating room was used in an attempt to inject some objectivity into the surgical approach.

  18. Climate Change Scenario Planning in Alaska's National Parks: Stakeholder Involvement in the Decision-Making Process

    SciTech Connect

    Ernst, Kathleen M; Van Riemsdijk, Dr. Micheline

    2013-01-01

    This article studies the participation of stakeholders in climate change decision-making in Alaska s National Parks. We place stakeholder participation within literatures on environmental and climate change decision-making. We conducted participant observation and interviews in two planning workshops to investigate the decision-making process, and our findings are three-fold. First, the inclusion of diverse stakeholders expanded climate change decision-making beyond National Park Service (NPS) institutional constraints. Second, workshops of the Climate Change Scenario Planning Project (CCSPP) enhanced institutional understandings of participants attitudes towards climate change and climate change decision-making. Third, the geographical context of climate change influences the decision-making process. As the first regional approach to climate change decision-making within the NPS, the CCSPP serves as a model for future climate change planning in public land agencies. This study shows how the participation of stakeholders can contribute to robust decisions, may move climate change decision-making beyond institutional barriers, and can provide information about attitudes towards climate change decision-making.

  19. Naturalistic Decision-Making Task Processes in Multiprofessional Assessment of Disability.

    ERIC Educational Resources Information Center

    Bartolo, Paul A.; Dockrell, Julie; Lunt, Ingrid

    2001-01-01

    Studies the group decision-making process of the evaluation of preschool children with complex disabilities. Sequential application of processes was found to be influenced by the occurrence of a series of three cycles of decision making within each assessment and the decomposition of the assessment task into distinct subproblems. (Contains 67…

  20. Naturalistic Decision-Making Task Processes in Multiprofessional Assessment of Disability.

    ERIC Educational Resources Information Center

    Bartolo, Paul A.; Dockrell, Julie; Lunt, Ingrid

    2001-01-01

    Studies the group decision-making process of the evaluation of preschool children with complex disabilities. Sequential application of processes was found to be influenced by the occurrence of a series of three cycles of decision making within each assessment and the decomposition of the assessment task into distinct subproblems. (Contains 67…

  1. A Case Study of the Decision-Making Process of Educational Leaders When Considering Program Implementation

    ERIC Educational Resources Information Center

    Laird, Scott

    2012-01-01

    The purpose of this study was to discover what school leaders considered during the decision-making process when adding a transitional kindergarten program and how the decision was made. This study investigated the decision-making process for superintendents and principals by examining decisions made by rural, suburban, and large school…

  2. 44 CFR Appendix A to Part 9 - Decision-making Process for E.O. 11988

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Decision-making Process for E.O. 11988 A Appendix A to Part 9 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT..., App. A Appendix A to Part 9—Decision-making Process for E.O. 11988 EC02FE91.074 ...

  3. 44 CFR Appendix A to Part 9 - Decision-making Process for E.O. 11988

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Decision-making Process for E.O. 11988 A Appendix A to Part 9 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT..., App. A Appendix A to Part 9—Decision-making Process for E.O. 11988 EC02FE91.074 ...

  4. 24 CFR 55.11 - Applicability of subpart C decision making process.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Management § 55.11 Applicability of subpart C decision making process. (a) Before reaching the decision... table indicates the applicability, by location and type of action, of the decision making process for... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Applicability of subpart C decision...

  5. 24 CFR 55.11 - Applicability of subpart C decision making process.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Management § 55.11 Applicability of subpart C decision making process. (a) Before reaching the decision... table indicates the applicability, by location and type of action, of the decision making process for... 24 Housing and Urban Development 1 2013-04-01 2013-04-01 false Applicability of subpart C decision...

  6. 24 CFR 55.11 - Applicability of subpart C decision making process.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Management § 55.11 Applicability of subpart C decision making process. (a) Before reaching the decision... table indicates the applicability, by location and type of action, of the decision making process for... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Applicability of subpart C decision...

  7. 24 CFR 55.11 - Applicability of subpart C decision making process.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Management § 55.11 Applicability of subpart C decision making process. (a) Before reaching the decision... table indicates the applicability, by location and type of action, of the decision making process for... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 false Applicability of subpart C decision...

  8. 44 CFR Appendix A to Part 9 - Decision-making Process for E.O. 11988

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Decision-making Process for E.O. 11988 A Appendix A to Part 9 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT..., App. A Appendix A to Part 9—Decision-making Process for E.O. 11988 EC02FE91.074 ...

  9. 44 CFR Appendix A to Part 9 - Decision-making Process for E.O. 11988

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Decision-making Process for E.O. 11988 A Appendix A to Part 9 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT..., App. A Appendix A to Part 9—Decision-making Process for E.O. 11988 EC02FE91.074 ...

  10. 44 CFR Appendix A to Part 9 - Decision-making Process for E.O. 11988

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Decision-making Process for E.O. 11988 A Appendix A to Part 9 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT..., App. A Appendix A to Part 9—Decision-making Process for E.O. 11988 EC02FE91.074 ...

  11. Decision Dissonance: Evaluating an Approach to Measuring the Quality of Surgical Decision Making

    PubMed Central

    Fowler, Floyd J.; Gallagher, Patricia M.; Drake, Keith M.; Sepucha, Karen R.

    2013-01-01

    Background Good decision making has been increasingly cited as a core component of good medical care, and shared decision making is one means of achieving high decision quality. If it is to be a standard, good measures and protocols are needed for assessing the quality of decisions. Consistency with patient goals and concerns is one defining characteristic of a good decision. A new method for evaluating decision quality for major surgical decisions was examined, and a methodology for collecting the needed data was developed. Methods For a national probability sample of fee-for-service Medicare beneficiaries who had a coronary artery bypass graft (CABG), a lumpectomy or a mastectomy for breast cancer, or surgery for prostate cancer during the last half of 2008, a mail survey of selected patients was carried out about one year after the procedures. Patients’ goals and concerns, knowledge, key aspects of interactions with clinicians, and feelings about the decisions were assessed. A Decision Dissonance Score was created that measured the extent to which patient ratings of goals ran counter to the treatment received. The construct and predictive validity of the Decision Dissonance Score was then assessed. Results When data were averaged across all four procedures, patients with more knowledge and those who reported more involvement reported significantly lower Decision Dissonance Scores. Patients with lower Decision Dissonance Scores also reported more confidence in their decisions and feeling more positively about how the treatment turned out, and they were more likely to say that they would make the same decision again. Conclusions Surveying discharged surgery patients is a feasible way to evaluate decision making, and Decision Dissonance appears to be a promising approach to validly measuring decision quality. PMID:23516764

  12. Disciplined Decision Making in an Interdisciplinary Environment: Some Implications for Clinical Applications of Statistical Process Control.

    ERIC Educational Resources Information Center

    Hantula, Donald A.

    1995-01-01

    Clinical applications of statistical process control (SPC) in human service organizations are considered. SPC is seen as providing a standard set of criteria that serves as a common interface for data-based decision making, which may bring decision making under the control of established contingencies rather than the immediate contingencies of…

  13. The Use of Art in the Medical Decision-Making Process of Oncology Patients

    ERIC Educational Resources Information Center

    Czamanski-Cohen, Johanna

    2012-01-01

    The introduction of written informed consent in the 1970s created expectations of shared decision making between doctors and patients that has led to decisional conflict for some patients. This study utilized a collaborative, intrinsic case study approach to the decision-making process of oncology patients who participated in an open art therapy…

  14. Stakeholders' Perception of Who Influences the Decision-Making Processes in Ontario's Public Postsecondary Education Institutions

    ERIC Educational Resources Information Center

    Powell, Billroy

    2008-01-01

    This paper reports the findings of a study conducted on stakeholders' perception of who influences the decision-making processes in Ontario's public postsecondary education institutions. The study identified and interviewed representatives of those stakeholder groups that are frequently written about as the main forces behind decision making in…

  15. Examination of Children Decision Making Using Clues during the Logical Reasoning Process

    ERIC Educational Resources Information Center

    Çelik, Meryem

    2017-01-01

    Logical reasoning is the process of thinking about a problem and finding the most effective solution. Children's decision-making skills are part of their cognitive development and are also indicative. The purpose of this study was to examine children's decision-making skills using clues in logical reasoning based on various variables. The study…

  16. Parents and Peers: Their Importance in the Career Decision Making Process.

    ERIC Educational Resources Information Center

    Daniels, M. Harry; And Others

    This paper examines the role played by parents in their children's career decision-making process. Parents are identified as preeminent influences of adolescents' career decision making, a fact that has been largely unrecognized by career guidance personnel and school administrators, as evidenced by the lack of programs designed to enable parents…

  17. Stakeholders' Perception of Who Influences the Decision-Making Processes in Ontario's Public Postsecondary Education Institutions

    ERIC Educational Resources Information Center

    Powell, Billroy

    2008-01-01

    This paper reports the findings of a study conducted on stakeholders' perception of who influences the decision-making processes in Ontario's public postsecondary education institutions. The study identified and interviewed representatives of those stakeholder groups that are frequently written about as the main forces behind decision making in…

  18. The Use of Art in the Medical Decision-Making Process of Oncology Patients

    ERIC Educational Resources Information Center

    Czamanski-Cohen, Johanna

    2012-01-01

    The introduction of written informed consent in the 1970s created expectations of shared decision making between doctors and patients that has led to decisional conflict for some patients. This study utilized a collaborative, intrinsic case study approach to the decision-making process of oncology patients who participated in an open art therapy…

  19. Free-Choice Learning Suited to Women's Participation Needs in Environmental Decision-Making Processes

    ERIC Educational Resources Information Center

    Skanavis, Constantina; Sakellari, Maria

    2012-01-01

    United Nations mandates recognize the need to promote the full participation of women in environmental decision-making processes on the basis of gender equality. But, there remains a profound lack of effective women's participation in some sectors of environmental decision-making. Free-choice environmental learning offers an effective educational…

  20. Free-Choice Learning Suited to Women's Participation Needs in Environmental Decision-Making Processes

    ERIC Educational Resources Information Center

    Skanavis, Constantina; Sakellari, Maria

    2012-01-01

    United Nations mandates recognize the need to promote the full participation of women in environmental decision-making processes on the basis of gender equality. But, there remains a profound lack of effective women's participation in some sectors of environmental decision-making. Free-choice environmental learning offers an effective educational…

  1. Referral of surgical patients to an anaesthetic clinic: a decision-making analysis.

    PubMed

    Lee, A; Lum, M E; Hillman, K M; Bauman, A

    1994-10-01

    Effective utilization of an anaesthetic clinic depends on appropriate referral of high-risk surgical patients. The decision-making behaviour of anaesthetists and nurses was examined to identify factors that influence the referral of patients to an outpatient anaesthetic clinic. Eleven consultant anaesthetists, seven anaesthetic trainees and sixteen nurses working in anaesthetic areas estimated the likelihood that they would refer patients for each of the 30 scenarios presented. The relative importance of each factor influencing the decision to refer as determined by the 34 participants were: type of procedure (22%), co-morbidities (18%), fitness (13%), history of anaesthetic problems (12%), medications (11%), age (10%), obesity (8%) and anxiety (6%). Indicative risk factors identified were aged 65 years or over, unable to climb more than two flights of stairs, presence of significant medical problems, gross obesity, history of anaesthetic problems, taking regular medications, scheduled for major surgery and expressed anxiety about the anaesthetic. There were large variations in the decision-making behaviour among health professional groups.

  2. Climate change scenario planning in Alaska's National Parks: Stakeholder involvement in the decision-making process

    SciTech Connect

    Ernst, Kathleen M; Van Riemsdijk, Dr. Micheline

    2013-01-01

    This article studies the participation of stakeholders in climate change decision-making in Alaska s National Parks. We place stakeholder participation within literatures on environmental and climate change decision-making. We conducted participant observation and interviews in two planning workshops to investigate the decision-making process, and our findings are three-fold. First, the inclusion of diverse stakeholders expanded climate change decision-making beyond National Park Service (NPS) institutional constraints. Second, workshops of the Climate Change Scenario Planning Project (CCSPP) enhanced institutional understandings of participants attitudes towards climate change and climate change decision-making. Third, the geographical context of climate change influences the decisionmaking process. As the first regional approach to climate change decision-making within the NPS, the CCSPP serves as a model for future climate change planning in public land agencies. This study shows how the participation of stakeholders can contribute to robust decisions, may move climate change decision-making beyond institutional barriers, and can provide information about attitudes towards climate change decision-making.

  3. Influence of 1.5-Tesla intraoperative MR imaging on surgical decision making.

    PubMed

    Hall, W A; Liu, H; Maxwell, R E; Truwit, C L

    2003-01-01

    To determine the frequency that high-field magnetic resonance (MR) imaging sequences influenced surgical decision making during intraoperative MR-guided surgery. From January 1997 to February 2001, 346 MR-guided procedures were performed using a 1.5-Tesla MR system (NT-ACS, Philips Medical Systems). This system can perform functional MR imaging (fMRI), diffusion weighted imaging (DWI), MR spectroscopy (MRS), MR angiography (MRA), and MR venography (MRV) in addition to T1-weighted, T2-weighted, and turbo FLAIR (fluid-attenuated inversion recovery) imaging. FMRI was used to determine areas of brain activation for language, motor function, and memory. DWI was utilized after tumor resection to exclude cerebral ischemia or infarction. MRS was obtained to identify areas of elevated choline that were suspected to correlate with tumor presence. MRA and MRV localized vascular structures adjacent to tumors prior to resection. The intraoperative procedures performed included 140 brain biopsies of which 82 utilized a trajectory guide and prospective stereotaxy. MRS was used in 42 biopsies (30%), of which 29 had turbo spectroscopic imaging (TSI) and 21 had single voxel spectroscopy (SVS). In all biopsy cases, diagnostic tissue was obtained. There were 103 tumor resections of which 18 (17%) had MRS. Functional MRI was used in 17 cases; 3 biopsies (2%) and 14 planned resections (14%). Speech function was localized in 3 cases, memory function in 3, and motor function in 11. In one case where the motor function of the tongue was intimately involved with a low-grade glioma, resection was not attempted. DWI was used in less than 10% of tumor resections. MRA and MRV were performed in 3 (3%) and 2 (2%) of tumor resections, respectively. The imaging capabilities (i.e., fMRI, DWI, MRA, MRV) associated with high-field intraoperative MR influenced surgical decision making primarily for tumor resections. MRS influenced target selection during brain biopsy.

  4. The Computational Complexity of Valuation and Motivational Forces in Decision-Making Processes

    PubMed Central

    Schultheiss, Nathan W.; Carter, Evan C.

    2015-01-01

    The concept of value is fundamental to most theories of motivation and decision making. However, value has to be measured experimentally. Different methods of measuring value produce incompatible valuation hierarchies. Taking the agent’s perspective (rather than the experimenter’s), we interpret the different valuation measurement methods as accessing different decision-making systems and show how these different systems depend on different information processing algorithms. This identifies the translation from these multiple decision-making systems into a single action taken by a given agent as one of the most important open questions in decision making today. We conclude by looking at how these different valuation measures accessing different decision-making systems can be used to understand and treat decision dysfunction such as in addiction. PMID:25981912

  5. The Computational Complexity of Valuation and Motivational Forces in Decision-Making Processes.

    PubMed

    Redish, A David; Schultheiss, Nathan W; Carter, Evan C

    2016-01-01

    The concept of value is fundamental to most theories of motivation and decision making. However, value has to be measured experimentally. Different methods of measuring value produce incompatible valuation hierarchies. Taking the agent's perspective (rather than the experimenter's), we interpret the different valuation measurement methods as accessing different decision-making systems and show how these different systems depend on different information processing algorithms. This identifies the translation from these multiple decision-making systems into a single action taken by a given agent as one of the most important open questions in decision making today. We conclude by looking at how these different valuation measures accessing different decision-making systems can be used to understand and treat decision dysfunction such as in addiction.

  6. Decision making in the surgical treatment of meralgia paresthetica: neurolysis versus neurectomy.

    PubMed

    de Ruiter, Godard C W; Wurzer, Johannes A L; Kloet, Alfred

    2012-10-01

    Surgical treatment options for meralgia paresthetica include neurolysis and neurectomy procedures. Reported success rates for pain relief are generally higher after neurectomy, but an obvious disadvantage compared with neurolysis is the loss of sensation in the anterolateral part of the thigh. In this study we analyzed our results on pain relief after both procedures, and we determined the impact of loss of sensation with a questionnaire. Between 1999 and 2009, all patients with persistent symptoms of meralgia paresthetica who presented to our clinic after failure of conservative treatment were offered a neurectomy procedure. After this period, the surgical strategy was changed to first neurolysis followed by neurectomy in case of failure. We retrospectively analyzed our results for both strategies with a questionnaire that was focused on pain relief, numbness and the impact of numbness. Ten patients underwent a neurolysis with a 60 % pain relief rate compared to 87.5 % of the eight patients that primarily underwent a neurectomy. Most neurectomy patients (62.5 %) were not hindered by the numbness, 25 % sometimes and only one patient was frequently bothered, but was still satisfied with the outcome. The failures of neurolysis were secondarily treated by neurectomy, which resulted in pain relief in three out of four patients. This series confirms previous reports in the literature that have shown higher success rates for the neurectomy procedure. In addition, it shows that most patients are not bothered by the numbness following this procedure. These observations can be used in the surgical decision making for meralgia paresthetica.

  7. Decision making in the choice of surgical management for preauricular sinuses with different severities.

    PubMed

    Huang, Wan-Ju; Chu, Chia-Huei; Wang, Mao-Che; Kuo, Chin-Lung; Shiao, An-Suey

    2013-06-01

    The preauricular sinus is a common congenital abnormality of the preauricular soft tissues. Here, we demonstrate the decision making in the choice of surgical management of preauricular sinuses based on disease severity. In addition, a method termed figure 8 incision with extended fistulectomy is introduced. Case series with chart review. Tertiary care center. Between January 2003 and February 2010, a total of 90 patients (109 ears) underwent surgery for preauricular sinuses in our hospital. After controlling the infection, the patients received definite surgery. They were classified into 3 groups according to the operative methods. We recorded the clinical conditions and any recurrences during the follow-up period. Group I patients (48 ears) had a trace inflammatory condition and underwent a simple sinusectomy. The recurrence rate was 2.08%. Group II (31 ears) and group III (30 ears) patients had more highly inflamed tissue and underwent a local wide excision and a figure 8 incision with extended fistulectomy, respectively. The recurrence rate in group II was 22.58%. Meanwhile, none of the group III cases showed a recurrence. In our study, there were 8 recurrent cases in 109 ears, yielding a recurrence rate of 7.34%. Simple sinusectomy is an adequate surgical technique for preauricular sinuses with a mild inflammatory condition. For more severe cases, the figure 8 incision with extended fistulectomy can achieve adequate wound exposure for radical excision of the inflamed tissue and a satisfactory surgical outcome.

  8. Age Differences in Dual Information-Processing Modes: Implications for Cancer Decision Making

    PubMed Central

    Peters, Ellen; Diefenbach, Michael A.; Hess, Thomas M.; Västfjäll, Daniel

    2008-01-01

    Age differences in affective/experiential and deliberative processes have important theoretical implications for cancer decision making as cancer is often a disease of older adulthood. We examine evidence for adult age differences in affective and deliberative information processes, review the sparse evidence about age differences in decision making and introduce how dual process theories and their findings might be applied to cancer decision making. Age-related declines in the efficiency of deliberative processes predict poorer-quality decisions as we age, particularly when decisions are unfamiliar and the information is numeric. However, age-related adaptive processes, including an increased focus on emotional goals and greater experience, can influence decision making and potentially offset age-related declines. A better understanding of the mechanisms that underlie cancer decision processes in our aging population should ultimately allow us to help older adults to better help themselves. PMID:19058148

  9. [Decision-making process about sex assignment in the neonate with ambiguous genitalia].

    PubMed

    Shimada, Kenji; Matsumoto, Fumi; Tohda, Akira

    2004-02-01

    Although diagnoses and etiologies of underlying disorders of sexual differentiation can be carefully delineated through biochemical, imagine, and chromosomal analyses, the decision-making process about sex assignment in the newborn with ambiguous genitalia is in a state of controversy. The conventional way for the approach to these neonates consists of 4 principles; 1) Urgency of diagnosis and sex assignment, so that early surgical reconstruction could obviate the fear of the parents with each diaper change. 2) Adequacy of the phallus as a male. 3) Fertility, especially 46XX female are sex assigned female because of potential fertility. 4) Cosmetic appearance of the reconstructed genitalia based on the recognition that external female genitalia are generally easier to construct than male. Contrary to these conventional methods, some researchers insist on flexibility in the clinical approach to provide the best possible outcome. It is getting apparent that the quantity, timing, and duration of androgen exposure will play a role in determining the degree of masculinization of the brain, which may potentially decide gender identity before 18 months of age or even in utero, and may influence the psychosexual development of the child. Flexibility in decision-making will allow for options not to remove any tissues including gonads and internal sex organs, or to reconstruct the genitalia until he or she is sure of the gender. This new approach must be proved in the future.

  10. A Model for Comparing Game Theory and Artificial Intelligence Decision Making Processes

    DTIC Science & Technology

    1989-12-01

    Matrix 7.5 Summary This chapter discussed an initial comparison of the game theory and artiicial intelligence decision techniques. The measure of...00 DTIC V ELECTE INJ DEC 15 1989 ID A MODEL FOR COMPARING C;.GME THEORY AND ARTIFICIAL INTELLIGENCE DECISION MAKING PROCESSES THESIS ’A Paul R. Andr...lic release: distribution unlii ted A F IT/;SO/ENS,/89D- 1 A MODEL FOR COMPARING GAME THEORY AND ARTIFICIAL INTELLIGENCE DECISION MAKING PROCESSES

  11. Theory of mind and decision-making processes are impaired in Parkinson's disease.

    PubMed

    Xi, Chunhua; Zhu, Youling; Mu, Yanfang; Chen, Bing; Dong, Bin; Cheng, Huaidong; Hu, Panpan; Zhu, Chunyan; Wang, Kai

    2015-02-15

    Prefrontal cortex plays a vital role in the theory of mind (ToM) and decision making, as shown in functional brain imaging and lesion studies. Considering the primary neuropathology of Parkinson's disease (PD) involving the frontal lobe system, patients with PD are expected to exhibit deficits in ToM and social decision making. The aim of this study was to investigate affective ToM and decision making in patients with PD and healthy controls (HC) in a task assessing affective ToM (Reading the Mind in the Eyes, RME) and two decision-making tasks (Iowa Gambling Task, IGT; Game of Dice Task, GDT). Consistent with previous findings, patients with PD were impaired in the affective ToM task, and when making decisions under ambiguity and in risk situations. The score of emotion recognition in the RME task was negatively correlated with the severity of the disease and positively correlated with the total number of advantageous cards chosen in the IGT. However, the final capital in the GDT was correlated with memory impairment. The present study implies that affective ToM and decision making under ambiguity may share similar neural mechanisms, while decision making under ambiguity and decision making under risk may involve processing within different neural networks. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Value judgements in the decision-making process for the elderly patient.

    PubMed

    Ubachs-Moust, J; Houtepen, R; Vos, R; ter Meulen, R

    2008-12-01

    The question of whether old age should or should not play a role in medical decision-making for the elderly patient is regularly debated in ethics and medicine. In this paper we investigate exactly how age influences the decision-making process. To explore the normative argumentation in the decisions regarding an elderly patient we make use of the argumentation model advanced by Toulmin. By expanding the model in order to identify normative components in the argumentation process it is possible to analyse the way that age-related value judgements influence the medical decision-making process. We apply the model to practice descriptions made by medical students after they had attended consultations and meetings in medical practice during their clinical training. Our results show the pervasive character of age-related value judgements. They influence the physician's decision in several ways and at several points in the decision-making process. Such explicit value judgements were not exclusively used for arguments against further diagnosis or treatment of older patients. We found no systematic "ageist" pattern in the clinical decisions by physicians. Since age plays such an important, yet hidden role in the medical decision-making process, we make a plea for revealing such normative argumentation in order to gain transparency and accountability in this process. An explicit deliberative approach will make the medical decision-making process more transparent and improve the physician-patient relationship, creating confidence and trust, which are at the heart of medical practice.

  13. Theoretical aspects of cellular decision-making and information-processing.

    PubMed

    Kobayashi, Tetsuya J; Kamimura, Atsushi

    2012-01-01

    Microscopic biological processes have extraordinary complexity and variety at the sub-cellular, intra-cellular, and multi-cellular levels. In dealing with such complex phenomena, conceptual and theoretical frameworks are crucial, which enable us to understand seemingly different intra- and inter-cellular phenomena from unified viewpoints. Decision-making is one such concept that has attracted much attention recently. Since a number of cellular behavior can be regarded as processes to make specific actions in response to external stimuli, decision-making can cover and has been used to explain a broad range of different cellular phenomena [Balázsi et al. (Cell 144(6):910, 2011), Zeng et al. (Cell 141(4):682, 2010)]. Decision-making is also closely related to cellular information-processing because appropriate decisions cannot be made without exploiting the information that the external stimuli contain. Efficiency of information transduction and processing by intra-cellular networks determines the amount of information obtained, which in turn limits the efficiency of subsequent decision-making. Furthermore, information-processing itself can serve as another concept that is crucial for understanding of other biological processes than decision-making. In this work, we review recent theoretical developments on cellular decision-making and information-processing by focusing on the relation between these two concepts.

  14. Parallel Attack and the Enemy’s Decision Making Process

    DTIC Science & Technology

    1998-04-01

    definition of this asymptotic notation. 6 JaJa , Joseph, An Introduction to Parallel Algorithms, Addison-Wesley, 1992, p 158 7 Ibid, Chapter 1 8 Baker, Louis...the processes within the hierarchy for the bureaucratic and organizational process models take the same amount of computational time. Notes 1 JaJa ...Press, New York, 1991 J.F.C. Fuller, The Foundations of the Science of War, London, Hutchinson and Company, 1925, p314. JaJa , Joseph, An Introduction to

  15. Decision-Making in the Surgical Treatment of Breast Cancer: Factors Influencing Women’s Choices for Mastectomy and Breast Conserving Surgery

    PubMed Central

    Bellavance, Emily Catherine; Kesmodel, Susan Beth

    2016-01-01

    One of the most difficult decisions a woman can be faced with when choosing breast cancer treatment is whether or not to undergo breast conserving surgery or mastectomy. The factors that influence these treatment decisions are complex and involve issues regarding access to health care, concerns for cancer recurrence, and the impact of surgery on body image and sexuality. Understanding these factors will help practitioners to improve patient education and to better guide patients through this decision-making process. Although significant scientific and societal advances have been made in improving women’s choices for the breast cancer treatment, there are still deficits in the decision-making processes surrounding the surgical treatment of breast cancer. Further research is needed to define optimal patient education and shared decision-making practices in this area. PMID:27066455

  16. When Family Considerations Influence Work Decisions: Decision-Making Processes

    ERIC Educational Resources Information Center

    Powell, Gary N.; Greenhaus, Jeffrey H.

    2012-01-01

    The work-family literature has provided an abundance of evidence that various family factors are linked to various work decisions, suggesting that the "family-relatedness" of work decisions is a prevalent phenomenon (Greenhaus & Powell, 2012). However, the cognitive processes by which such linkages occur have received little attention. We offer a…

  17. Developing Teacher Decision-Making Through Process Interventions.

    ERIC Educational Resources Information Center

    Schmuck, Richard A.

    In a project to help all professional members of a junior high school staff improve their group processes, a series of training interventions were spaced throughout the school year to increase their organizational abilities. Two days of a six-day summer workshop were spent in structured game-like exercises designed to increase awareness of…

  18. Breaking the sound barrier: exploring parents' decision-making process of cochlear implants for their children.

    PubMed

    Chang, Pamara F

    2017-08-01

    To understand the dynamic experiences of parents undergoing the decision-making process regarding cochlear implants for their child(ren). Thirty-three parents of d/Deaf children participated in semi-structured interviews. Interviews were digitally recorded, transcribed, and coded using iterative and thematic coding. The results from this study reveal four salient topics related to parents' decision-making process regarding cochlear implantation: 1) factors parents considered when making the decision to get the cochlear implant for their child (e.g., desire to acculturate child into one community), 2) the extent to which parents' communities influence their decision-making (e.g., norms), 3) information sources parents seek and value when decision-making (e.g., parents value other parent's experiences the most compared to medical or online sources), and 4) personal experiences with stigma affecting their decision to not get the cochlear implant for their child. This study provides insights into values and perspectives that can be utilized to improve informed decision-making, when making risky medical decisions with long-term implications. With thorough information provisions, delineation of addressing parents' concerns and encompassing all aspects of the decision (i.e., medical, social and cultural), health professional teams could reduce the uncertainty and anxiety for parents in this decision-making process for cochlear implantation. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Decision-making processes for the self-management of persistent pain: a grounded theory study.

    PubMed

    Fenwick, Clare; Chaboyer, Wendy; St John, Winsome

    2012-08-01

    Persistent pain negatively impacts upon the individual suffering this condition. Almost all care related to persistent pain is self-managed. Decision-making is a critical skill of the self-manager and without these skills it would be improbable that effective self-management would emerge. However, current theories regarding decision-making and self-management have not adequately accounted for the many difficulties faced by individuals enduring persistent pain and the consequences of these experiences for the decision-maker. This grounded theory study revealed that individuals will transform into three distinct types of decision-makers using three different styles of decision-making in response to the many and varied problems related to the experience of persistent pain. These findings will provide nurses with valuable information to better equip individuals with persistent pain through the decision-making processes necessary for successful self-management.

  20. Individual Differences in Information Processing in Networked Decision Making

    DTIC Science & Technology

    2015-03-31

    processing in terms of their impact on the timeliness and accuracy of decisions. In this paper, we address this problem by introducing an agent-based model...for corroboration. Based on a novel way of modeling the degree of problem difficulty, we investigate the impact of individual differences in networked...agents mod- els have incorporated the notion of bounded rational- ity [Carley et al., 2009], the impact of individual differ- ences especially in the NC

  1. Detecting fast, online reasoning processes in clinical decision making.

    PubMed

    Flores, Amanda; Cobos, Pedro L; López, Francisco J; Godoy, Antonio

    2014-06-01

    In an experiment that used the inconsistency paradigm, experienced clinical psychologists and psychology students performed a reading task using clinical reports and a diagnostic judgment task. The clinical reports provided information about the symptoms of hypothetical clients who had been previously diagnosed with a specific mental disorder. Reading times of inconsistent target sentences were slower than those of control sentences, demonstrating an inconsistency effect. The results also showed that experienced clinicians gave different weights to different symptoms according to their relevance when fluently reading the clinical reports provided, despite the fact that all the symptoms were of equal diagnostic value according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The diagnostic judgment task yielded a similar pattern of results. In contrast to previous findings, the results of the reading task may be taken as direct evidence of the intervention of reasoning processes that occur very early, rapidly, and online. We suggest that these processes are based on the representation of mental disorders and that these representations are particularly suited to fast retrieval from memory and to making inferences. They may also be related to the clinicians' causal reasoning. The implications of these results for clinician training are also discussed.

  2. Age differences in decision making: a process methodology for examining strategic information processing.

    PubMed

    Johnson, M M

    1990-03-01

    This study explored the use of process tracing techniques in examining the decision-making processes of older and younger adults. Thirty-six college-age and thirty-six retirement-age participants decided which one of six cars they would purchase on the basis of computer-accessed data. They provided information search protocols. Results indicate that total time to reach a decision did not differ according to age. However, retirement-age participants used less information, spent more time viewing, and re-viewed fewer bits of information than college-age participants. Information search patterns differed markedly between age groups. Patterns of retirement-age adults indicated their use of noncompensatory decision rules which, according to decision-making literature (Payne, 1976), reduce cognitive processing demands. The patterns of the college-age adults indicated their use of compensatory decision rules, which have higher processing demands.

  3. Using narratives to understand older people's decision-making processes.

    PubMed

    Tetley, Josephine; Grant, Gordon; Davies, Susan

    2009-09-01

    Despite the availability of health and social care services designed to support people in their own homes, older people often underuse or refuse these services. It is now acknowledged that this phenomenon contributes to older people being admitted to hospital and long-term care in circumstances that could be avoided. To understand how the uptake of supportive and preventative services can be improved, the first author, supervised by the second and third authors, developed a constructivist inquiry to explore what factors enhance or bar service use. This article describes how narratives were used not only to help identify decision- and choice-making influences, but also as a way of enhancing the hermeneutic processes associated with constructivism.

  4. Radiologic Evaluation of Small Lepidic Adenocarcinomas to Guide Decision Making in Surgical Resection.

    PubMed

    Wilshire, Candice L; Louie, Brian E; Manning, Kristin A; Horton, Matthew P; Castiglioni, Massimo; Gorden, Jed A; Aye, Ralph W; Farivar, Alexander S; Vallières, Eric

    2015-09-01

    The International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification of pulmonary adenocarcinomas identifies indolent lesions associated with low recurrence, superior survival, and the potential for sublobar resection. The distinction, however, is determined on the pathologic evaluation, limiting preoperative surgical planning. We sought to determine whether preoperative computed tomography (CT) characteristics could guide decisions about the extent of the pulmonary resection. We reviewed the preoperative CT scans for 136 patients identified to have adenocarcinomas with lepidic features on the final pathologic evaluation. The solid component on CT was substituted for the invasive component, and patients were radiologically classified as adenocarcinoma in situ, 3 cm or less with no solid component; minimally invasive adenocarcinoma, 3 cm or less with a solid component of 5 mm or less; or invasive adenocarcinoma, exceeding 3 cm or solid component exceeding 5 mm, or both. Analysis of variance, t test, χ(2) test, and Kaplan-Meier methods were used for analysis. The radiologic classification identified 35 adenocarcinomas in situ (26%) and 12 minimally invasive (9%) and 89 invasive adenocarcinoma (65%) lesions. At a 32-month median follow-up, patient outcomes associated with the radiologic classification were similar to the pathologic-based classification: the radiologic classification identified 14 of 16 patients with recurrent disease and all 6 who died of lung cancer. In addition, patients with radiologic adenocarcinoma in situ and minimally invasive adenocarcinoma who underwent sublobar resections had no recurrence and 100% disease-free and overall survival at 5 years. The radiologic classification of patients with lepidic adenocarcinomas is associated with similar oncologic and survival outcomes compared with the pathologic classification and may guide decision making in the approach to surgical resection

  5. A decision-making process for planning patient education.

    PubMed

    Strodtman, L K

    1984-01-01

    Health professionals tend to resist incorporating education into their patient-care activities despite increasing evidence that educating patients in self-care management can favorably influence health outcomes. Moreover, health professionals often lack skill and expertise in developing patient- education plans. To remedy this situation a new method was developed for teaching health professionals how to integrate patient education into the patient's plan of care. Using the guided design approach, a project was adapted to teach health professionals how to plan patient education for the person with diabetes mellitus. In this method health professionals work as members of a team to address a particular patient's educational needs in a real-life situation. More than 250 health professionals have participated in a two-hour workshop utilizing this project. It provides participants with a systematic approach for planning patient education and gives them practice in writing an individualized patient-education plan that takes into consideration the patient's overall needs and goals. This instructional method not only has helped health professionals differentiate patient goals (outcomes) from health professional actions (process) but also has provided health professionals with the opportunity to learn how to work together. The benefit of the "team experience" was the one participants most often identified as having the greatest value. This paper includes a description of the project, a copy of the guided design tool, and specific instructions for its use to enable others to try this method.

  6. Validity evidence for Surgical Improvement of Clinical Knowledge Ops: a novel gaming platform to assess surgical decision making.

    PubMed

    Lin, Dana T; Park, Julia; Liebert, Cara A; Lau, James N

    2015-01-01

    Current surgical education curricula focus mainly on the acquisition of technical skill rather than clinical and operative judgment. SICKO (Surgical Improvement of Clinical Knowledge Ops) is a novel gaming platform developed to address this critical need. A pilot study was performed to collect validity evidence for SICKO as an assessment for surgical decision making. Forty-nine subjects stratified into 4 levels of expertise were recruited to play SICKO. Later, players were surveyed regarding the realism of the gaming platform as well as the clinical competencies required of them while playing SICKO. Each group of increasing expertise outperformed the less experienced groups. Mean total game scores for the novice, junior resident, senior resident, and expert groups were 5,461, 8,519, 11,404, and 13,913, respectively (P = .001). Survey results revealed high scores for realism and content. SICKO holds the potential to be not only an engaging and immersive educational tool, but also a valid assessment in the armamentarium of surgical educators. Published by Elsevier Inc.

  7. Fuzzy methods in decision making process - A particular approach in manufacturing systems

    NASA Astrophysics Data System (ADS)

    Coroiu, A. M.

    2015-11-01

    We are living in a competitive environment, so we can see and understand that the most of manufacturing firms do the best in order to accomplish meeting demand, increasing quality, decreasing costs, and delivery rate. In present a stake point of interest is represented by the development of fuzzy technology. A particular approach for this is represented through the development of methodologies to enhance the ability to managed complicated optimization and decision making aspects involving non-probabilistic uncertainty with the reason to understand, development, and practice the fuzzy technologies to be used in fields such as economic, engineering, management, and societal problems. Fuzzy analysis represents a method for solving problems which are related to uncertainty and vagueness; it is used in multiple areas, such as engineering and has applications in decision making problems, planning and production. As a definition for decision making process we can use the next one: result of mental processes based upon cognitive process with a main role in the selection of a course of action among several alternatives. Every process of decision making can be represented as a result of a final choice and the output can be represented as an action or as an opinion of choice. Different types of uncertainty can be discovered in a wide variety of optimization and decision making problems related to planning and operation of power systems and subsystems. The mixture of the uncertainty factor in the construction of different models serves for increasing their adequacy and, as a result, the reliability and factual efficiency of decisions based on their analysis. Another definition of decision making process which came to illustrate and sustain the necessity of using fuzzy method: the decision making is an approach of choosing a strategy among many different projects in order to achieve some purposes and is formulated as three different models: high risk decision, usual risk

  8. Information-seeking behaviours and decision-making process of parents of children with cancer.

    PubMed

    Kilicarslan-Toruner, Ebru; Akgun-Citak, Ebru

    2013-04-01

    This study aimed to explore the information-seeking behaviours, perceptions and decision-making experiences of parents of children with cancer by employing semi-structured interviews. A qualitative research design was used to assess the information-seeking behaviours, perceptions and decision-making processes used by parents in Turkey whose children have cancer. Interviews were conducted with 15 parents of children with cancer using a semi-structured interview schedule. The interviews were recorded and transcribed verbatim. Six main issues emerged. Issues were related to parents' information needs, the sources of information, difficulties that the parents encountered when seeking information, the decision-making process, the factors affecting decision-making, and expectations from the health team. Information resources for parents included medical doctors and nurses, the internet, friends and the parents of other children who were staying in the hospital. The parents mostly sought information about their child's illness, prognoses, treatment, side-effects and care giving issues. The parents expressed that they were directed primarily by health care providers during their decision-making process. Adequate and systematic information pertaining to illness, treatment, prognosis and child care must be provided by health care professionals throughout the illness process. In addition, individual guidance and spare time are key components to helping parents make decisions about their children with cancer. Copyright © 2012 Elsevier Ltd. All rights reserved.

  9. Patient participation in the medical decision-making process in haemato-oncology--a qualitative study.

    PubMed

    Ernst, J; Berger, S; Weißflog, G; Schröder, C; Körner, A; Niederwieser, D; Brähler, E; Singer, S

    2013-09-01

    Cancer patients are showing increased interest in shared decision-making. Patients with haematological illnesses, however, express considerably less desire for shared decision-making as compared with other oncological patient groups. The goal of the current project was to identify the reasons for the lower desire for shared decision-making among patients with haematological illness. We conducted qualitative, semi-structured interviews with 11 haematological patients (39-70 years old) after the beginning of therapy concerning the course and evaluation of medical shared decision-making. The patients were often overwhelmed by the complexity of the illness and the therapy and did not want to assume any responsibility in medical decision-making. They reported a great deal of distress and very traditional paternalistic role expectations with regards to their health care providers, which limited the patients' ability to partake in the decision-making process. In contrast to the socio-cultural support for many other oncological diseases, haematological diseases are not as well supported, e.g. there is a lack of self-help materials, systematic provision of information and support groups for patients, which may be related to a lower empowerment of this patient population. Results show the limits of patient participation in the context of highly complicated medical conditions. In addition to already researched preferences of the physicians and patients for shared decision-making, future research should pay greater attention to the process and other variables relevant to this aspect of the doctor-patient relationship. © 2013 John Wiley & Sons Ltd.

  10. Registered dietitians' roles in decision-making processes for PEG placement in the elderly.

    PubMed

    Szeto, Maria O P; Maillet, Julie O'Sullivan; Brody, Rebecca A; Parrott, J Scott

    2014-01-01

    The role of registered dietitians (RDs) in decision-making for percutaneous endoscopic gastrostomy (PEG) placement was explored. The ethical climate in their workplace and the relationship between decision-making and the ethical climate were examined. The survey included 67 RDs in complex continuing care and long-term care settings in Ontario. Descriptive statistics were used to describe roles, ethical climate, and professional characteristics. Pearson's and nonparametric correlations were used to examine relationships between roles, ethical climate, and professional characteristics. Among the respondents, 97% thought RDs had a role in decision-making processes. The majority of RDs were usually or always involved in two roles: identifying relevant nutrition issues (91.2%) and discussing feeding options and alternatives (80.7%). Dietitians' roles in decision-making processes were more extensive when their relationship with physicians was positive (r=0.321, P=0.016), they had adequate knowledge (r=0.465, P<0.001) and adequate skills (r=0.520, P<0.001), and they were more satisfied with their role (r=0.554, P<0.001). Registered dietitians performed a variety of roles in decision-making processes concerning PEG placement in the elderly. A positive working relationship with physicians, knowledge, skills, and role satisfaction significantly increase RDs' involvement with patients and families.

  11. Toward a Model of Human Information Processing for Decision-Making and Skill Acquisition in Laparoscopic Colorectal Surgery.

    PubMed

    White, Eoin J; McMahon, Muireann; Walsh, Michael T; Coffey, J Calvin; O Sullivan, Leonard

    2017-10-03

    To create a human information-processing model for laparoscopic surgery based on already established literature and primary research to enhance laparoscopic surgical education in this context. We reviewed the literature for information-processing models most relevant to laparoscopic surgery. Our review highlighted the necessity for a model that accounts for dynamic environments, perception, allocation of attention resources between the actions of both hands of an operator, and skill acquisition and retention. The results of the literature review were augmented through intraoperative observations of 7 colorectal surgical procedures, supported by laparoscopic video analysis of 12 colorectal procedures. The Wickens human information-processing model was selected as the most relevant theoretical model to which we make adaptions for this specific application. We expanded the perception subsystem of the model to involve all aspects of perception during laparoscopic surgery. We extended the decision-making system to include dynamic decision-making to account for case/patient-specific and surgeon-specific deviations. The response subsystem now includes dual-task performance and nontechnical skills, such as intraoperative communication. The memory subsystem is expanded to include skill acquisition and retention. Surgical decision-making during laparoscopic surgery is the result of a highly complex series of processes influenced not only by the operator's knowledge, but also patient anatomy and interaction with the surgical team. Newer developments in simulation-based education must focus on the theoretically supported elements and events that underpin skill acquisition and affect the cognitive abilities of novice surgeons. The proposed human information-processing model builds on established literature regarding information processing, accounting for a dynamic environment of laparoscopic surgery. This revised model may be used as a foundation for a model describing robotic

  12. An Assessment of Decision-Making Styles/Processes of Consumer Education Students.

    ERIC Educational Resources Information Center

    Bertelson, Catherine L.

    1986-01-01

    Reports on a study to determine the decision-making processes and styles used by consumer education students when confronted with a consumer credit problem. Tests were administered to 27 secondary students. Findings revealed that gender determines to a great extent the process and style used. (Author/CH)

  13. A Dual-Process Approach to Health Risk Decision Making: The Prototype Willingness Model

    ERIC Educational Resources Information Center

    Gerrard, Meg; Gibbons, Frederick X.; Houlihan, Amy E.; Stock, Michelle L.; Pomery, Elizabeth A.

    2008-01-01

    Although dual-process models in cognitive, personality, and social psychology have stimulated a large body of research about analytic and heuristic modes of decision making, these models have seldom been applied to the study of adolescent risk behaviors. In addition, the developmental course of these two kinds of information processing, and their…

  14. A Dual-Process Approach to Health Risk Decision Making: The Prototype Willingness Model

    ERIC Educational Resources Information Center

    Gerrard, Meg; Gibbons, Frederick X.; Houlihan, Amy E.; Stock, Michelle L.; Pomery, Elizabeth A.

    2008-01-01

    Although dual-process models in cognitive, personality, and social psychology have stimulated a large body of research about analytic and heuristic modes of decision making, these models have seldom been applied to the study of adolescent risk behaviors. In addition, the developmental course of these two kinds of information processing, and their…

  15. Utilising Benchmarking to Inform Decision-Making at the Institutional Level: A Research-Informed Process

    ERIC Educational Resources Information Center

    Booth, Sara

    2013-01-01

    Benchmarking has traditionally been viewed as a way to compare data only; however, its utilisation as a more investigative, research-informed process to add rigor to decision-making processes at the institutional level is gaining momentum in the higher education sector. Indeed, with recent changes in the Australian quality environment from the…

  16. Age, Time, and Decision Making: From Processing Speed to Global Time Horizons

    PubMed Central

    Löckenhoff, Corinna E.

    2013-01-01

    Time and time perceptions are integral to decision making because any meaningful choice is embedded in a temporal context and requires the evaluation of future preferences and outcomes. The present review examines the influence of chronological age on time perceptions and horizons and discusses implications for decision making across the life span. Time influences and interacts with decision making in multiple ways. Specifically, this review examines the following topic areas: (1) processing speed and decision time, (2) internal clocks and time estimation, (3) mental representations of future time and intertemporal choice, and (4) global time horizons. For each aspect, patterns of age differences and implications for decision strategies and quality are discussed. The conclusion proposes frameworks to integrate different lines of research and identifies promising avenues for future inquiry. PMID:22023567

  17. Patients' preferences for involvement in the decision-making process for treating diabetic retinopathy.

    PubMed

    Marahrens, Lydia; Kern, Raimar; Ziemssen, Tjalf; Fritsche, Andreas; Martus, Peter; Ziemssen, Focke; Roeck, Daniel

    2017-08-09

    To assess factors associated with the preferred role of the attending ophthalmologist in the decision-making processes before treating diabetic retinopathy (DR). Cross-sectional study of 810 adults attending secondary diabetes care centers (NCT02311504). Diabetes patients were classified using a validated questionnaire in an ophthalmologist-dominant decision-making (ODM), shared decision-making (SDM) and patient-dominant decision-making (PDM) style. Multivariate logistic regression was performed to determine factors associated with the decision-making process. A majority of 74.3% patients preferred SDM between ophthalmologist and patient, 17.4% patients wanted ODM, delegating the decision-making process to the ophthalmologist, 8.3% preferred the autonomous style of PDM. Patients wanting ODM were older (OR = 1.2 per decade, p = 0.013), had a lower level of education (OR = 1.4, p = 0.001) and had a higher frequency of consultations per year (OR = 1.3, p = 0.022). Patients with better basic knowledge in DR and memorizing their HbA1c level showed a higher propensity for SDM (OR = 1.1, p = 0.037). Patients wanting PDM had a significantly higher education (OR = 1.3, p = 0.036) and a greater desire for receiving information from self-help groups (OR = 1.3, p = 0.015). The first evaluation of the general patient wishes for the treatment of DR confirmed the concept of SDM, which was favored by three quarters. In particular, older patients with low educational attainment wanted to delegate the decision-making process to the ophthalmologist. Amelioration of ophthalmologic education in diabetic programs might take up patients' propensity for SDM. Regardless of the decision-making group, nearly all patients wanted the medical and scientific information to be transferred by and shared with the ophthalmologist. The study was registered on www.clinicaltrials.gov (identifier: NCT02311504) on December 4th 2014.

  18. Decision making, procedural compliance, and outcomes definition in U.S. forest service planning processes

    SciTech Connect

    Stern, Marc J.; Predmore, S. Andrew

    2011-04-15

    The National Environmental Policy Act (NEPA) dictates a process of analyzing and disclosing the likely impacts of proposed agency actions on the human environment. This study addresses two key questions related to NEPA implementation in the U.S. Forest Service: 1) how do Interdisciplinary (ID) team leaders and decision makers conceptualize the outcomes of NEPA processes? And 2), how does NEPA relate to agency decision making? We address these questions through two separate online surveys that posed questions about recently completed NEPA processes - the first with the ID team leaders tasked with carrying out the processes, and the second with the line officers responsible for making the processes' final decisions. Outcomes of NEPA processes include impacts on public relations, on employee morale and team functioning, on the achievement of agency goals, and on the achievement of NEPA's procedural requirements (disclosure) and substantive intent (minimizing negative environmental impacts). Although both tended to view public relations outcomes as important, decision makers' perceptions of favorable outcomes were more closely linked to the achievement of agency goals and process efficiency than was the case for ID team leaders. While ID team leaders' responses suggest that they see decision making closely integrated with the NEPA process, decision makers more commonly decoupled decision making from the NEPA process. These findings suggest a philosophical difference between ID team leaders and decision makers that may pose challenges for both the implementation and the evaluation of agency NEPA. We discuss the pros and cons of integrating NEPA with decision making or separating the two. We conclude that detaching NEPA from decision making poses greater risks than integrating them.

  19. The decision-making processes of nurses when extubating patients following cardiac surgery: an ethnographic study.

    PubMed

    Hancock, Helen C; Easen, Patrick R

    2006-08-01

    The movement towards research and evidence-based practice in health care demands that the best available evidence is applied to practice. At the same time, changes to role boundaries mean that nurses are assuming increased responsibility, especially in relation to decision making. While increasing, there has been limited consideration about the application of best evidence and decision making by nurses in the context of their clinical work. This study sought to explore the realities of research and evidence-based practice through an examination of the decision making of nurses when extubating patients following cardiac surgery. The tradition of qualitative research and, more specifically, ethnography were used for the study. Data were gathered over an 18-month period during 1998 and 1999 within a Cardiothoracic Intensive Care Unit (CICU). The sample comprised 43 nursing, 16 medical and two managerial staff. A purposive sample of five nurses, a cardiac surgeon, intensivist, CICU manager and Deputy Divisional Manager were included in interviews. All staff were included in participant observation. Semi-structured interviews were conducted with a purposive sample of nurses during the 6th and 14th months and with a purposive sample of other staff during the 16th month. Data were analysed using progressive focusing, data source triangulation and sensitising concepts to identify themes and categories. The findings indicated that, despite the use of an unwritten physiologically based protocol for weaning and extubation, factors other than best evidence were significant in nurses' decision making. A range of personal, cultural and contextual factors including relationships, hierarchy, power, leadership, education, experience and responsibility influenced their decision making. This study revealed, often disregarded, cultural, contextual and personal characteristics which combined to form a complex process of decision making. Providing new insight into research and evidence

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

    PubMed Central

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

    2011-01-01

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

  1. The use of research evidence in public health decision making processes: systematic review.

    PubMed

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

    2011-01-01

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

  2. Inferential Judgments Affecting the Decision-Making Process in the Attorney General's Commission on Pornography.

    ERIC Educational Resources Information Center

    Gouran, Dennis S.

    Although the Attorney General's Commission on Pornography, also known as the Meese Commission, has been criticized excessively at times for threatening freedom of speech and press and individual rights to privacy, an analysis of its "Final Report" reveals numerous deficiencies in the Commission's decision-making process. These…

  3. Decision-Making Processes in Texas School Districts That Arm Personnel

    ERIC Educational Resources Information Center

    Domain, Melinda Willoughby

    2014-01-01

    This qualitative phenomenological study employed narrative inquiry to describe the decision-making processes that Texas school districts followed in enacting firearms policies that allow school employees to carry concealed weapons on district property. Exploration of the lived experiences of eight Texas superintendents in such schools contributed…

  4. Occupational/Career Decision-Making Thought Processes of Adolescents of High Intellectual Ability

    ERIC Educational Resources Information Center

    Jung, Jae Yup

    2017-01-01

    Three competing models of the career decision-making thought processes of adolescents of high intellectual ability were tested in this study. Survey data were collected from 664 intellectually gifted Australian adolescents and analyzed using structural equation modeling procedures. The finally accepted, optimal model suggested that, regardless of…

  5. Multiple Case Studies of Public Library Systems in New York State: Service Decision-Making Processes

    ERIC Educational Resources Information Center

    Ren, Xiaoai

    2012-01-01

    This research examined the functions and roles of public library systems in New York State and the services they provide for individual libraries and the public. The dissertation further studied the service decision-making processes at three selected New York State cooperative public library systems. Public library systems have played an important…

  6. Auburn, Maine Curriculum Improvement Model. Processes and Procedures for Decision Making. No. 163.

    ERIC Educational Resources Information Center

    Goddu, Roland

    This paper outlines the decision-making processes and procedures that affect curriculum and identifies the leadership role of different school personnel and the steps involved in making decisions. The following areas of curriculum planning are discussed: (1) what is to be taught to different learners and in what order; (2) what textbooks, media,…

  7. Child Care Decision Making: Understanding Priorities and Processes Used by Low-Income Families in Minnesota

    ERIC Educational Resources Information Center

    Forry, Nicole; Isner, Tabitha K.; Daneri, Maria P.; Tout, Kathryn

    2014-01-01

    Research Findings: Few studies have described parents' child care decision-making process, yet understanding how parents make child care choices is fundamental to developing effective services to promote the selection of high-quality care. This study used latent profile analysis to distinguish subgroups of low-income parents identified as having…

  8. Occupational/Career Decision-Making Thought Processes of Adolescents of High Intellectual Ability

    ERIC Educational Resources Information Center

    Jung, Jae Yup

    2017-01-01

    Three competing models of the career decision-making thought processes of adolescents of high intellectual ability were tested in this study. Survey data were collected from 664 intellectually gifted Australian adolescents and analyzed using structural equation modeling procedures. The finally accepted, optimal model suggested that, regardless of…

  9. Domestic Abuse and Child Contact: Positioning Children in the Decision-Making Process

    ERIC Educational Resources Information Center

    Holt, Stephanie

    2011-01-01

    Drawing on a three-year Irish research study, this paper focuses on the decision-making process in child contact, specifically the assessment and management of risk of continuing abuse to young people previously exposed to domestic abuse. A mixed methodological approach involved the completion of survey questionnaires by 219 mothers and the…

  10. Quantifying Japanese Residents' Preferences for Public Meetings in Watershed Decision-Making Process

    ERIC Educational Resources Information Center

    Sakagami, Masaji; Ohno, Tomohiko; Tanaka, Takuya

    2010-01-01

    In this article, we quantified Japanese residents' potential preferences for public participation, specifically public meetings, concerning regional environmental issues in Yodo River watershed decision-making process. We conducted a choice experiments (CE) survey in the Yodo River watershed in Japan. Our findings confirmed that residents assign a…

  11. Quantifying Japanese Residents' Preferences for Public Meetings in Watershed Decision-Making Process

    ERIC Educational Resources Information Center

    Sakagami, Masaji; Ohno, Tomohiko; Tanaka, Takuya

    2010-01-01

    In this article, we quantified Japanese residents' potential preferences for public participation, specifically public meetings, concerning regional environmental issues in Yodo River watershed decision-making process. We conducted a choice experiments (CE) survey in the Yodo River watershed in Japan. Our findings confirmed that residents assign a…

  12. Special Education Eligibility: An Examination of the Decision-Making Process

    ERIC Educational Resources Information Center

    Kirkland, Erin K. B.

    2012-01-01

    The purpose of this study was to investigate the influence of private practitioner and educational advocate opinions on school-based administrators' decision-making thought processes when making a recommendation for special education eligibility. Special education eligibility is a school-based team decision that involves multiple…

  13. Decision Making and Information Processing under Various Uncertainty Conditions. Final Report.

    ERIC Educational Resources Information Center

    Schipper, Lowell M.; Doherty, Michael

    Seven experiments were conducted concerning decision making and information processing under conditions of uncertainty. Several different experimental tasks were used; all presented the subject with multiple independent sources of information regarding the likelihood that some event would occur. Study 1 subjects were Air Force pilots; all other…

  14. THE DECISION-MAKING PROCESS OF SCHOOL DISTRICTS REGARDING VOCATIONAL EDUCATION AND TRAINING PROGRAMS.

    ERIC Educational Resources Information Center

    BEAL, GEORGE M.; AND OTHERS

    THE SUPERINTENDENTS OF 195 OF 209 SCHOOL DISTRICTS HOLDING BOND ISSUE ELECTIONS DURING A 5-YEAR PERIOD RESPONDED TO A QUESTIONNAIRE. OF THESE, 20 OF THE 24 WHOSE BOND ISSUES INVOLVED VOCATIONAL EDUCATION WERE INTERVIEWED IN A TWO-PHASE STUDY TO ANALYZE THE DECISION MAKING PROCESS, IDENTIFY THE VARIABLES ASSOCIATED WITH SUCCESS OR FAILURE, AND TO…

  15. Decision-Making Processes in Texas School Districts That Arm Personnel

    ERIC Educational Resources Information Center

    Domain, Melinda Willoughby

    2014-01-01

    This qualitative phenomenological study employed narrative inquiry to describe the decision-making processes that Texas school districts followed in enacting firearms policies that allow school employees to carry concealed weapons on district property. Exploration of the lived experiences of eight Texas superintendents in such schools contributed…

  16. Child Care Decision Making: Understanding Priorities and Processes Used by Low-Income Families in Minnesota

    ERIC Educational Resources Information Center

    Forry, Nicole; Isner, Tabitha K.; Daneri, Maria P.; Tout, Kathryn

    2014-01-01

    Research Findings: Few studies have described parents' child care decision-making process, yet understanding how parents make child care choices is fundamental to developing effective services to promote the selection of high-quality care. This study used latent profile analysis to distinguish subgroups of low-income parents identified as having…

  17. Participation of the Poor in the Community Decision-Making Process.

    ERIC Educational Resources Information Center

    Office of Economic Opportunity, Washington, DC. Community Action Program.

    This paper identifies key factors which promote participation of the poor (resident participation) through group action and community decision making processes, programs, and activities; and describes techniques which Community Action Program (CAP) grantees have used successfully to enhance such participation. Kinds of CAP grantee and community…

  18. The Decision Making Process: An Instructional Project for Sixth Grade Students At-Risk.

    ERIC Educational Resources Information Center

    McCarthy, Anna

    This report presents an examination of the analysis, design, implementation, and evaluation of an instructional unit designed to help high risk sixth grade students become better problem solvers through the teaching of the decision-making process. The systems approach outlined in the Instructional Systems Design (ISD) Model was used to formulate…

  19. Factors Affecting Long-Term-Care Residents' Decision-Making Processes as They Formulate Advance Directives

    ERIC Educational Resources Information Center

    Lambert, Heather C.; McColl, Mary Ann; Gilbert, Julie; Wong, Jiahui; Murray, Gale; Shortt, Samuel E. D.

    2005-01-01

    Purpose: The purpose of this study was to describe factors contributing to the decision-making processes of elderly persons as they formulate advance directives in long-term care. Design and Methods: This study was qualitative, based on grounded theory. Recruitment was purposive and continued until saturation was reached. Nine residents of a…

  20. Amotivation and Indecision in the Decision-Making Processes Associated with University Entry

    ERIC Educational Resources Information Center

    Jung, Jae Yup

    2013-01-01

    This study developed and tested two models that examined the decision-making processes of adolescents relating to entry into university, in terms of the extent to which they may be amotivated and undecided. The models incorporated variables derived from self-determination theory, expectancy-value theory, and research on occupational indecision. A…

  1. Multiple Case Studies of Public Library Systems in New York State: Service Decision-Making Processes

    ERIC Educational Resources Information Center

    Ren, Xiaoai

    2012-01-01

    This research examined the functions and roles of public library systems in New York State and the services they provide for individual libraries and the public. The dissertation further studied the service decision-making processes at three selected New York State cooperative public library systems. Public library systems have played an important…

  2. Examining the Underlying Values of Turkish and German Mathematics Teachers' Decision Making Processes in Group Studies

    ERIC Educational Resources Information Center

    Dede, Yuksel

    2013-01-01

    The purpose of this study was to explore the values underlying the decision-making processes in group studies for Turkish and German mathematics teachers. This study presented a small part of a wider study investigating German and Turkish mathematics teachers' and their students' values (Values in Mathematics Teaching in Turkey and Germany…

  3. Improving the Process of Career Decision Making: An Action Research Approach

    ERIC Educational Resources Information Center

    Greenbank, Paul

    2011-01-01

    Purpose: This study adopts an action research approach with the aim of improving the process of career decision making among undergraduates in a business school at a "new" university in the UK. Design/methodology/approach: The study utilised unfreezing techniques, multiple case studies in conjunction with the principle of analogical…

  4. Domestic Abuse and Child Contact: Positioning Children in the Decision-Making Process

    ERIC Educational Resources Information Center

    Holt, Stephanie

    2011-01-01

    Drawing on a three-year Irish research study, this paper focuses on the decision-making process in child contact, specifically the assessment and management of risk of continuing abuse to young people previously exposed to domestic abuse. A mixed methodological approach involved the completion of survey questionnaires by 219 mothers and the…

  5. Amotivation and Indecision in the Decision-Making Processes Associated with University Entry

    ERIC Educational Resources Information Center

    Jung, Jae Yup

    2013-01-01

    This study developed and tested two models that examined the decision-making processes of adolescents relating to entry into university, in terms of the extent to which they may be amotivated and undecided. The models incorporated variables derived from self-determination theory, expectancy-value theory, and research on occupational indecision. A…

  6. Categorization = Decision Making + Generalization

    PubMed Central

    Seger, Carol A; Peterson, Erik J.

    2013-01-01

    We rarely, if ever, repeatedly encounter exactly the same situation. This makes generalization crucial for real world decision making. We argue that categorization, the study of generalizable representations, is a type of decision making, and that categorization learning research would benefit from approaches developed to study the neuroscience of decision making. Similarly, methods developed to examine generalization and learning within the field of categorization may enhance decision making research. We first discuss perceptual information processing and integration, with an emphasis on accumulator models. We then examine learning the value of different decision making choices via experience, emphasizing reinforcement learning modeling approaches. Next we discuss how value is combined with other factors in decision making, emphasizing the effects of uncertainty. Finally, we describe how a final decision is selected via thresholding processes implemented by the basal ganglia and related regions. We also consider how memory related functions in the hippocampus may be integrated with decision making mechanisms and contribute to categorization. PMID:23548891

  7. Exploring the decision-making process in the delivery of physiotherapy in a stroke unit.

    PubMed

    McGlinchey, Mark P; Davenport, Sally

    2015-01-01

    The aim of this study was to explore the decision-making process in the delivery of physiotherapy in a stroke unit. A focused ethnographical approach involving semi-structured interviews and observations of clinical practice was used. A purposive sample of seven neurophysiotherapists and four patients participated in semi-structured interviews. From this group, three neurophysiotherapists and four patients were involved in observation of practice. Data from interviews and observations were analysed to generate themes. Three themes were identified: planning the ideal physiotherapy delivery, the reality of physiotherapy delivery and involvement in the decision-making process. Physiotherapists used a variety of clinical reasoning strategies and considered many factors to influence their decision-making in the planning and delivery of physiotherapy post-stroke. These factors included the therapist's clinical experience, patient's presentation and response to therapy, prioritisation, organisational constraints and compliance with organisational practice. All physiotherapists highlighted the importance to involve patients in planning and delivering their physiotherapy. However, there were varying levels of patient involvement observed in this process. The study has generated insight into the reality of decision-making in the planning and delivery of physiotherapy post-stroke. Further research involving other stroke units is required to gain a greater understanding of this aspect of physiotherapy. Implications for Rehabilitation Physiotherapists need to consider multiple patient, therapist and organisational factors when planning and delivering physiotherapy in a stroke unit. Physiotherapists should continually reflect upon how they provide physiotherapy, with respect to the duration, frequency and time of day sessions are delivered, in order to guide current and future physiotherapy delivery. As patients may demonstrate varying levels of participation in deciding and

  8. Neural Signatures of Controlled and Automatic Retrieval Processes in Memory-based Decision-making.

    PubMed

    Khader, Patrick H; Pachur, Thorsten; Weber, Lilian A E; Jost, Kerstin

    2016-01-01

    Decision-making often requires retrieval from memory. Drawing on the neural ACT-R theory [Anderson, J. R., Fincham, J. M., Qin, Y., & Stocco, A. A central circuit of the mind. Trends in Cognitive Sciences, 12, 136-143, 2008] and other neural models of memory, we delineated the neural signatures of two fundamental retrieval aspects during decision-making: automatic and controlled activation of memory representations. To disentangle these processes, we combined a paradigm developed to examine neural correlates of selective and sequential memory retrieval in decision-making with a manipulation of associative fan (i.e., the decision options were associated with one, two, or three attributes). The results show that both the automatic activation of all attributes associated with a decision option and the controlled sequential retrieval of specific attributes can be traced in material-specific brain areas. Moreover, the two facets of memory retrieval were associated with distinct activation patterns within the frontoparietal network: The dorsolateral prefrontal cortex was found to reflect increasing retrieval effort during both automatic and controlled activation of attributes. In contrast, the superior parietal cortex only responded to controlled retrieval, arguably reflecting the sequential updating of attribute information in working memory. This dissociation in activation pattern is consistent with ACT-R and constitutes an important step toward a neural model of the retrieval dynamics involved in memory-based decision-making.

  9. Know the risk, take the win: how executive functions and probability processing influence advantageous decision making under risk conditions.

    PubMed

    Brand, Matthias; Schiebener, Johannes; Pertl, Marie-Theres; Delazer, Margarete

    2014-01-01

    Recent models on decision making under risk conditions have suggested that numerical abilities are important ingredients of advantageous decision-making performance, but empirical evidence is still limited. The results of our first study show that logical reasoning and basic mental calculation capacities predict ratio processing and that ratio processing predicts decision making under risk. In the second study, logical reasoning together with executive functions predicted probability processing (numeracy and probability knowledge), and probability processing predicted decision making under risk. These findings suggest that increasing an individual's understanding of ratios and probabilities should lead to more advantageous decisions under risk conditions.

  10. “And I think that we can fix it”: Mental Models used in High-Risk Surgical Decision Making

    PubMed Central

    Kruser, Jacqueline M; Pecanac, Kristen E; Brasel, Karen J; Cooper, Zara; Steffens, Nicole; McKneally, Martin; Schwarze, Margaret L

    2014-01-01

    Objective To examine how surgeons use the “fix-it” model to communicate with patients before high-risk operations. Background The “fix-it” model characterizes disease as an isolated abnormality that can be restored to normal form and function through medical intervention. This mental model is familiar to patients and physicians, but it is ineffective for chronic conditions and treatments that cannot achieve normalcy. Overuse may lead to permissive decision making favoring intervention. Efforts to improve surgical decision making will need to consider how mental models function in clinical practice, including “fix-it”. Methods We observed surgeons who routinely perform high-risk surgery during preoperative discussions with patients. We used qualitative content analysis to explore the use of “fix-it” in 48 audio-recorded conversations. Results Surgeons used the “fix-it” model for two separate purposes during preoperative conversations; 1) as an explanatory tool to facilitate patient understanding of disease and surgery and 2) as a deliberation framework to assist in decision making. Although surgeons commonly used “fix-it” as an explanatory model, surgeons explicitly discussed limitations of the “fix-it” model as an independent rationale for operating as they deliberated about the value of surgery. Conclusions While the use of “fix-it” is familiar for explaining medical information to patients, surgeons recognize that the model can be problematic for determining the value of an operation. Whether patients can transition between understanding how their disease is fixed with surgery to a subsequent deliberation about whether they should have surgery is unclear and may have broader implications for surgical decision making. PMID:25749396

  11. Health technology funding decision-making processes around the world: the same, yet different.

    PubMed

    Stafinski, Tania; Menon, Devidas; Philippon, Donald J; McCabe, Christopher

    2011-06-01

    All healthcare systems routinely make resource allocation decisions that trade off potential health gains to different patient populations. However, when such trade-offs relate to the introduction of new, promising health technologies, perceived 'winners' and 'losers' are more apparent. In recent years, public scrutiny over such decisions has intensified, raising the need to better understand how they are currently made and how they might be improved. The objective of this paper is to critically review and compare current processes for making health technology funding decisions at the regional, state/provincial and national level in 20 countries. A comprehensive search for published, peer-reviewed and grey literature describing actual national, state/provincial and regional/institutional technology decision-making processes was conducted. Information was extracted by two independent reviewers and tabulated to facilitate qualitative comparative analyses. To identify strengths and weaknesses of processes identified, websites of corresponding organizations were searched for commissioned reviews/evaluations, which were subsequently analysed using standard qualitative methods. A total of 21 national, four provincial/state and six regional/institutional-level processes were found. Although information on each one varied, they could be grouped into four sequential categories: (i) identification of the decision problem; (ii) information inputs; (iii) elements of the decision-making process; and (iv) public accountability and decision implementation. While information requirements of all processes appeared substantial and decision-making factors comprehensive, the way in which they were utilized was often unclear, as were approaches used to incorporate social values or equity arguments into decisions. A comprehensive inventory of approaches to implementing the four main components of all technology funding decision-making processes was compiled, from which areas for future

  12. Determinants of judgment and decision making quality: the interplay between information processing style and situational factors.

    PubMed

    Ayal, Shahar; Rusou, Zohar; Zakay, Dan; Hochman, Guy

    2015-01-01

    A framework is presented to better characterize the role of individual differences in information processing style and their interplay with contextual factors in determining decision making quality. In Experiment 1, we show that individual differences in information processing style are flexible and can be modified by situational factors. Specifically, a situational manipulation that induced an analytical mode of thought improved decision quality. In Experiment 2, we show that this improvement in decision quality is highly contingent on the compatibility between the dominant thinking mode and the nature of the task. That is, encouraging an intuitive mode of thought led to better performance on an intuitive task but hampered performance on an analytical task. The reverse pattern was obtained when an analytical mode of thought was encouraged. We discuss the implications of these results for the assessment of decision making competence, and suggest practical directions to help individuals better adjust their information processing style to the situation at hand and make optimal decisions.

  13. Information Technology Process Improvement Decision-Making: An Exploratory Study from the Perspective of Process Owners and Process Managers

    ERIC Educational Resources Information Center

    Lamp, Sandra A.

    2012-01-01

    There is information available in the literature that discusses information technology (IT) governance and investment decision making from an executive-level perception, yet there is little information available that offers the perspective of process owners and process managers pertaining to their role in IT process improvement and investment…

  14. Information Technology Process Improvement Decision-Making: An Exploratory Study from the Perspective of Process Owners and Process Managers

    ERIC Educational Resources Information Center

    Lamp, Sandra A.

    2012-01-01

    There is information available in the literature that discusses information technology (IT) governance and investment decision making from an executive-level perception, yet there is little information available that offers the perspective of process owners and process managers pertaining to their role in IT process improvement and investment…

  15. [Nurses' subjectivity production and the decision-making in the process of care].

    PubMed

    Busanello, Josefine; Lunardi Filho, Wilson Danilo; Kerber, Nalú Pereira da Costa

    2013-06-01

    This study aimed to understand the relationship between Nurse's production of subjectivity and the decision-making in the process of Nursing care. A qualitative design of research was conducted. The investigation was carried out with twelve nurses who work at the Associação de Caridade Santa Casa do Rio Grande, a hospital located in Rio Grande, RS, Brazil. For data collection, focus group technique was used three meetings were conducted in december 2011. The results were presented in semantic categories: Capitalist System: maintenance of employment bond; Submission System: institutionalized culture and vision of society; Nursing Hierarchical System; and Values System: feeling of guilt and lack of professional recognition. The capitalist system mediates, mainly, the behavior that prevails in the decision-making process in Nursing care.

  16. How the elderly and young adults differ in the decision making process of nonprescription medication purchases.

    PubMed

    Sansgiry, S S; Cady, P S

    1996-01-01

    The study compared elderly and young adults in their behavior and involvement in the decision making process of over-the-counter (OTC) medication purchases. Elderly subjects were more involved in the decision making process to purchase OTC medications compared to young adults. The elderly not only purchase and spend more money on medications but also read OTC labels completely. They requested help from the pharmacist more frequently than young adults. Needs of the elderly in making an OTC medication purchase were different compared to young adults. The two age groups differed on importance rating for several attributes regarding OTC medications, such as; ease of opening the package, child resistant package, side effects of medicine, manufacturer of medicine, print size on package labels, and greater choice of medicine.

  17. The web-surfing bariatic patient: the role of the internet in the decision-making process.

    PubMed

    Paolino, Luca; Genser, Laurent; Fritsch, Sylvie; De' Angelis, Nicola; Azoulay, Daniel; Lazzati, Andrea

    2015-04-01

    Health-related information on the Internet is constantly increasing, but its quality and accountability are difficult to assess. Patients browse the Net to get more information, but the impact of the Internet on their decisions about surgical techniques, referral centers, or surgeon choice are still not clear. This study aimed to describe the role of the Internet in the decision-making process of obese patients seeking bariatric surgery. Two hundred and twelve candidates for bariatric surgery were asked to answer a questionnaire evaluating their access to the Internet, the usefulness and trustworthiness of Internet-retrieved information, the verification of the information, and the role of the information in the decision-making process. Two hundred and twelve patients answered the questionnaire. Of these, 95.1% had access to the Internet and 77.8% reported having researched about bariatric surgery. Their main interests were the surgical techniques (81.4%) and other patients' experiences (72.3%). The favorite Web sites were those affiliated to public hospitals or edited by other patients. The accountability of the e-information was mainly evaluated by discussion with the general practitioner (GP) (83.0%) or family members and friends (46.8%). One patient in four decided to undergo bariatric surgery mainly based on e-information, while discussion about treatment options with the GP and the hospital reputation were taken into account in 77.8 and 51.7% of cases, respectively. Most patients seeking bariatric surgery search for health information online. E-information seems to have an important role in the decision-making process of patients who are candidates for bariatric surgery.

  18. 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

  19. Digitized Chaos: Is Our Military Decision Making Process Ready for the Information Age?

    DTIC Science & Technology

    2007-11-02

    DIGITIZED CHAOS: IS OUR MILITARY DECISION MAKING PROCESS READY FOR THE INFORMATION AGE ? A MONOGRAPH BY Major John W. Charlton Infantry SETCLAVIS COR...FOR THE INFORMATION AGE ? By Major John W. Charlton, USA, 70 Pages. The integration of new technologies has always been important to the military. The...must accompany the new technology in order to exploit its full capabilities. Today the Army is looking at ways to integrate information age , or digital

  20. The decision-making process of young adult women with cancer who considered fertility cryopreservation.

    PubMed

    Hershberger, Patricia E; Finnegan, Lorna; Pierce, Penny F; Scoccia, Bert

    2013-01-01

    To provide an in-depth description of the decision-making process that women who are diagnosed with cancer undergo as they decide whether to accept or decline fertility cryopreservation. A qualitative, grounded theory approach. Twenty-seven women (mean age = 29 years) who were diagnosed with cancer and were eligible for egg, embryo, or ovarian tissue cryopreservation were recruited from the Internet and two university centers. Each woman participated in a semistructured interview by phone (n = 21) or e-mail (n = 6). Data were analyzed using the constant-comparative method to inductively ascertain the women's decision-making process. NVivo 8 software was used to assist with data retrieval and analysis. The decision-making process consists of four major phases that women experience to actively formulate a decision: identify, contemplate, resolve, and engage. In the identify phase, women acquire knowledge and experience a "double hit" scenario that is often devastating. Within the contemplate phase, five interrelated dimensions emerged including constructing and/or endorsing preferences and values and undergoing decisional debriefing sessions. A decision is reached in the resolve phase and carried out in the engage phase. Among the participants, 14 declined fertility cryopreservation and 13 accepted egg and/or embryo cryopreservation. The descriptive theoretical framework clarifies the underlying processes that women with cancer undergo to decide about fertility cryopreservation. Quality of care for women with cancer can be improved by implementing appropriately timed information and tailored developmental and contextual counseling to support decision making. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  1. The Decision-Making Process of Young Adult Women with Cancer who Considered Fertility Cryopreservation

    PubMed Central

    Hershberger, Patricia E.; Finnegan, Lorna; Pierce, Penny F.; Scoccia, Bert

    2014-01-01

    Objective To provide an in-depth description of the decision-making process that women who are diagnosed with cancer undergo as they decide whether to accept or decline fertility cryopreservation. Design A qualitative, grounded theory approach. Setting and Participants Twenty-seven women (mean age = 29 years) who were diagnosed with cancer and were eligible for egg, embryo, or ovarian tissue cryopreservation were recruited from the Internet and two university centers. Methods Each woman participated in a semi-structured interview by phone (n = 21) or email (n = 6). Data were analyzed using the constant-comparative method to inductively ascertain the women’s decision-making process. NVivo 8 software was used to assist with data retrieval and analysis. Results The decision-making process consists of four major phases that women experience to actively formulate a decision: identify, contemplate, resolve, and engage. In the identify phase, women acquire knowledge and experience a double hit scenario that is often devastating. Within the contemplate phase, five interrelated dimensions emerged including constructing and/or endorsing preferences and values and undergoing decisional debriefing sessions. A decision is reached in the resolve phase and carried out in the engage phase. Among the participants, 14 declined fertility cryopreservation and 13 accepted egg and/or embryo cryopreservation. Conclusion The descriptive theoretical framework clarifies the underlying processes that women with cancer undergo to decide about fertility cryopreservation. Quality of care for women with cancer can be improved by implementing appropriately timed information and tailored developmental and contextual counseling to support decision making. PMID:23167639

  2. A simple weighted scoring system to guide surgical decision-making in patients with parapneumonic pleural effusion

    PubMed Central

    Chang, Che-Chia; Chen, Tzu-Ping; Yeh, Chi-Hsiao; Huang, Pin-Fu; Wang, Yao-Chang

    2016-01-01

    Background The selection of ideal candidates for surgical intervention among patients with parapneumonic pleural effusion remains challenging. In this retrospective study, we sought to identify the main predictors of surgical treatment and devise a simple scoring system to guide surgical decision-making. Method Between 2005 and 2014, we identified 276 patients with parapneumonic pleural effusion. Patients in the training set (n=201) were divided into two groups according to their treatment modality (non-surgery vs. surgery). Using multivariable logistic regression analysis, we devised a scoring system to guide surgical decision-making. The score was subsequently validated in an independent set of 75 patients. Results A white blood cell count >13,500/µL, pleuritic pain, loculations, and split pleura sign were identified as independent predictors of surgical treatment. A weighted score based on these factors was devised, as follows: white blood cell count >13,500/µL (one point), pleuritic pain (one point), loculations (two points), and split pleura sign (three points). A score >4 was associated with a surgical approach with a sensitivity of 93.4%, a specificity of 82.4%, and an area under curve (AUC) of 0.879 (95% confidence interval: 0.828−0.930). In the validation set, a sensitivity of 94.3% and a specificity of 79.6% were found (AUC=0.869). Conclusions The proposed scoring system reliably identifies patients with parapneumonic pleural effusion who are candidates for surgery. Pending independent external validation, our score may inform the appropriate use of surgical interventions in this clinical setting. PMID:28066596

  3. Challenging Operations: An Ethical Framework to Assist Humanitarian Aid Workers in their Decision-making Processes.

    PubMed

    Clarinval, Caroline; Biller-Andorno, Nikola

    2014-06-23

    This paper aims to raise awareness regarding ethical issues in the context of humanitarian action, and to offer a framework for systematically and effectively addressing such issues. Several cases highlight ethical issues that humanitarian aid workers are confronted with at different levels over the course of their deployments. The first case discusses a situation at a macro-level concerning decisions being made at the headquarters of a humanitarian organization. The second case looks at meso-level issues that need to be solved at a country or regional level. The third case proposes an ethical dilemma at the micro-level of the individual patient-provider relationship. These real-life cases have been selected to illustrate the ethical dimension of conflicts within the context of humanitarian action that might remain unrecognized in everyday practice. In addition, we propose an ethical framework to assist humanitarian aid workers in their decision-making process. The framework draws on the principles and values that guide humanitarian action and public health ethics more generally. Beyond identifying substantive core values, the framework also includes a ten-step process modelled on tools used in the clinical setting that promotes a transparent and clear decision-making process and improves the monitoring and evaluation of aid interventions. Finally, we recommend organizational measures to implement the framework effectively. This paper uses a combination of public health/clinical ethics concepts and practices and applies them to the decision-making challenges encountered in relief operations in the humanitarian aid context.

  4. Decision making software for effective selection of treatment train alternative for wastewater using analytical hierarchy process.

    PubMed

    Prasad, A D; Tembhurkar, A R

    2013-10-01

    Proper selection of treatment process and synthesis of treatment train is complex engineering activity requires crucial decision making during planning and designing of any Wastewater Treatment Plant (WWTP). Earlier studies on process selection mainly considered cost as the most important selection criteria and number of studies focused on cost optimization models using dynamic programming, geometric programming and nonlinear programming. However, it has been noticed that traditional cost analysis alone cannot be applied to evaluate Treatment Train (TT) alternatives, as number of important non-tangible factors cannot be easily expressed in monetary units. Recently researches focus on use of multi-criteria technique for selection of treatment process. AHP provides a powerful tool for multi-hierarchy and multi-variable system overcoming limitation of traditional techniques. The AHP model designed to facilitate proper decision making and reduce the margin of errors during optimization due to number of parameters in the hierarchy levels has been used in this study. About 14 important factors and 13 sub factors were identified for the selection of treatment alternatives for wastewater and sludge stream although cost is one of the most important selection criteria. The present paper provides details of developing a soft-tool called "ProSelArt" using an AHP model aiding for proper decision making.

  5. Decision-making Processes as Predictors of Relapse and Subsequent Use in Stimulant Dependent Patients

    PubMed Central

    Adinoff, Bryon; Carmody, Thomas J.; Walker, Robrina; Donovan, Dennis M.; Brigham, Gregory S.; Winhusen, Theresa

    2016-01-01

    Background Decision-making processes have been posited to affect treatment outcome in addicted patients. Objective The present multi-site study assessed whether two measures of decision-making predicted relapse and subsequent use in stimulant-dependent patients. Methods 160 methamphetamine- or cocaine-dependent patients participating in a multi-site clinical trial evaluating a modified 12-step facilitation intervention for stimulant-dependent patients (STAGE-12) were assessed. Decision-making processes of risk and delay [Iowa Gambling Task (IGT)] and response reversal [Wisconsin Card Sorting Task (WCST)] were obtained shortly after treatment admission followed by assessment of stimulant use over the next six months. The relationships of the IGT and WCST (Perseverative Errors) with relapse (yes/no) and days of stimulant use during the 6-month period following post-randomization were evaluated. Results Performance on the IGT and WCST did not significantly predict relapse status or time to relapse. Unexpectedly, better performance on the IGT was associated with a fewer number of stimulant use days (p = 0.001). In contrast, worse performance on the WCST (more perseverative errors) was associated with a greater number of stimulant use days (p = 0.0003). The predictive effects of perseverative errors on subsequent use were confined to methamphetamine-dependent and Minority participants. Conclusions Decision-making processes, as measured in the current study, do not uniformly predict relapse or subsequent use. A decrease in the salience attribution of nondrug reinforcers may explain the positive relationship between IGT performance and post-relapse use. More comprehensive and global measures of impulsiveness may better assess relapse risk and use. PMID:26743586

  6. Backcountry snowmobilers' risk perceptions, avalanche related information seeking behaviours, preparedness and decision-making processes

    NASA Astrophysics Data System (ADS)

    Baker, Jennifer

    Although there has been substantial research on the avoidance of risk, much less has been completed on voluntary risk. This study examined backcountry snowmobilers' risk perceptions, avalanche related information seeking behaviours, and decision-making processes when dealing with avalanches and backcountry risk in Canada. To accomplish this, in-depth, semi-structured interviews were conducted with 17 participants who were involved in backcountry snowmobiling. Interviews were done both in person and by telephone. The results of this study show that, unlike previous research on snowmobilers, the participants of this study were well prepared and knowledgeable about backcountry risks. All 17 participants stated that they carried a shovel, probe, and transceiver with them on each backcountry trip, and 10 participants had taken an avalanche safety course. Group dynamics and positive peer pressure were influential in promoting safe backcountry behaviour. KEYWORDS: Backcountry snowmobiling, Avalanches, Voluntary Risk, Preparedness, Decision-Making.

  7. Disciplined decision making in an interdisciplinary environment: some implications for clinical applications of statistical process control.

    PubMed Central

    Hantula, D A

    1995-01-01

    This paper explores some of the implications the statistical process control (SPC) methodology described by Pfadt and Wheeler (1995) may have for analyzing more complex performances and contingencies in human services or health care environments at an organizational level. Service delivery usually occurs in an organizational system that is characterized by functional structures, high levels of professionalism, subunit optimization, and organizational suboptimization. By providing a standard set of criteria and decision rules, SPC may provide a common interface for data-based decision making, may bring decision making under the control of the contigencies that are established by these rules rather than the immediate contingencies of data fluctuation, and may attenuate escalation of failing treatments. SPC is culturally consistent with behavior analysis, sharing an emphasis on data-based decisions, measurement over time, and graphic analysis of data, as well as a systemic view of organizations. PMID:7592155

  8. Workshop on using natural language processing applications for enhancing clinical decision making: an executive summary.

    PubMed

    Pai, Vinay M; Rodgers, Mary; Conroy, Richard; Luo, James; Zhou, Ruixia; Seto, Belinda

    2014-02-01

    In April 2012, the National Institutes of Health organized a two-day workshop entitled 'Natural Language Processing: State of the Art, Future Directions and Applications for Enhancing Clinical Decision-Making' (NLP-CDS). This report is a summary of the discussions during the second day of the workshop. Collectively, the workshop presenters and participants emphasized the need for unstructured clinical notes to be included in the decision making workflow and the need for individualized longitudinal data tracking. The workshop also discussed the need to: (1) combine evidence-based literature and patient records with machine-learning and prediction models; (2) provide trusted and reproducible clinical advice; (3) prioritize evidence and test results; and (4) engage healthcare professionals, caregivers, and patients. The overall consensus of the NLP-CDS workshop was that there are promising opportunities for NLP and CDS to deliver cognitive support for healthcare professionals, caregivers, and patients.

  9. The Rational Adolescent: Strategic Information Processing during Decision Making Revealed by Eye Tracking

    PubMed Central

    Kwak, Youngbin; Payne, John W.; Cohen, Andrew L.; Huettel, Scott A.

    2015-01-01

    Adolescence is often viewed as a time of irrational, risky decision-making – despite adolescents' competence in other cognitive domains. In this study, we examined the strategies used by adolescents (N=30) and young adults (N=47) to resolve complex, multi-outcome economic gambles. Compared to adults, adolescents were more likely to make conservative, loss-minimizing choices consistent with economic models. Eye-tracking data showed that prior to decisions, adolescents acquired more information in a more thorough manner; that is, they engaged in a more analytic processing strategy indicative of trade-offs between decision variables. In contrast, young adults' decisions were more consistent with heuristics that simplified the decision problem, at the expense of analytic precision. Collectively, these results demonstrate a counter-intuitive developmental transition in economic decision making: adolescents' decisions are more consistent with rational-choice models, while young adults more readily engage task-appropriate heuristics. PMID:26388664

  10. The detrimental effects of emotional process dysregulation on decision-making in substance dependence

    PubMed Central

    Murphy, Anna; Taylor, Eleanor; Elliott, Rebecca

    2012-01-01

    Substance dependence is complex and multifactorial, with many distinct pathways involved in both the development and subsequent maintenance of addictive behaviors. Various cognitive mechanisms have been implicated, including impulsivity, compulsivity, and impaired decision-making. These mechanisms are modulated by emotional processes, resulting in increased likelihood of initial drug use, sustained substance dependence, and increased relapse during periods of abstinence. Emotional traits, such as sensation-seeking, are risk factors for substance use, and chronic drug use can result in further emotional dysregulation via effects on reward, motivation, and stress systems. We will explore theories of hyper and hypo sensitivity of the brain reward systems that may underpin motivational abnormalities and anhedonia. Disturbances in these systems contribute to the biasing of emotional processing toward cues related to drug use at the expense of natural rewards, which serves to maintain addictive behavior, via enhanced drug craving. We will additionally focus on the sensitization of the brain stress systems that result in negative affect states that continue into protracted abstinence that is may lead to compulsive drug-taking. We will explore how these emotional dysregulations impact upon decision-making controlled by goal-directed and habitual action selections systems, and, in combination with a failure of prefrontal inhibitory control, mediate maladaptive decision-making observed in substance dependent individuals such that they continue drug use in spite of negative consequences. An understanding of the emotional impacts on cognition in substance dependent individuals may guide the development of more effective therapeutic interventions. PMID:23162443

  11. Temporal dynamics of prediction error processing during reward-based decision making.

    PubMed

    Philiastides, Marios G; Biele, Guido; Vavatzanidis, Niki; Kazzer, Philipp; Heekeren, Hauke R

    2010-10-15

    Adaptive decision making depends on the accurate representation of rewards associated with potential choices. These representations can be acquired with reinforcement learning (RL) mechanisms, which use the prediction error (PE, the difference between expected and received rewards) as a learning signal to update reward expectations. While EEG experiments have highlighted the role of feedback-related potentials during performance monitoring, important questions about the temporal sequence of feedback processing and the specific function of feedback-related potentials during reward-based decision making remain. Here, we hypothesized that feedback processing starts with a qualitative evaluation of outcome-valence, which is subsequently complemented by a quantitative representation of PE magnitude. Results of a model-based single-trial analysis of EEG data collected during a reversal learning task showed that around 220ms after feedback outcomes are initially evaluated categorically with respect to their valence (positive vs. negative). Around 300ms, and parallel to the maintained valence-evaluation, the brain also represents quantitative information about PE magnitude, thus providing the complete information needed to update reward expectations and to guide adaptive decision making. Importantly, our single-trial EEG analysis based on PEs from an RL model showed that the feedback-related potentials do not merely reflect error awareness, but rather quantitative information crucial for learning reward contingencies.

  12. Planetary protection, legal ambiguity and the decision making process for Mars sample return

    NASA Technical Reports Server (NTRS)

    Race, M. S.

    1996-01-01

    As scientists and mission planners develop planetary protection requirements for future Mars sample return missions, they must recognize the socio-political context in which decisions about the mission will be made and pay careful attention to public concerns about potential back contamination of Earth. To the extent that planetary protection questions are unresolved or unaddressed at the time of an actual mission, they offer convenient footholds for public challenges in both legal and decision making realms, over which NASA will have little direct control. In this paper, two particular non-scientific areas of special concern are discussed in detail: 1) legal issues and 2) the decision making process. Understanding these areas is critical for addressing legitimate public concerns as well as for fulfilling procedural requirements regardless whether sample return evokes public controversy. Legal issues with the potential to complicate future missions include: procedural review under National Environmental Policy Act (NEPA); uncertainty about institutional control and authority; conflicting regulations and overlapping jurisdictions; questions about international treaty obligations and large scale impacts; uncertanities about the nature of the organism; and constitutional and regulatory concerns about quarantine, public health and safety. In light of these important legal issues, it is critical that NASA consider the role and timing of public involvement in the decision making process as a way of anticipating problem areas and preparing for legitimate public questions and challenges to sample return missions.

  13. Planetary protection, legal ambiguity and the decision making process for Mars sample return

    NASA Technical Reports Server (NTRS)

    Race, M. S.

    1996-01-01

    As scientists and mission planners develop planetary protection requirements for future Mars sample return missions, they must recognize the socio-political context in which decisions about the mission will be made and pay careful attention to public concerns about potential back contamination of Earth. To the extent that planetary protection questions are unresolved or unaddressed at the time of an actual mission, they offer convenient footholds for public challenges in both legal and decision making realms, over which NASA will have little direct control. In this paper, two particular non-scientific areas of special concern are discussed in detail: 1) legal issues and 2) the decision making process. Understanding these areas is critical for addressing legitimate public concerns as well as for fulfilling procedural requirements regardless whether sample return evokes public controversy. Legal issues with the potential to complicate future missions include: procedural review under National Environmental Policy Act (NEPA); uncertainty about institutional control and authority; conflicting regulations and overlapping jurisdictions; questions about international treaty obligations and large scale impacts; uncertanities about the nature of the organism; and constitutional and regulatory concerns about quarantine, public health and safety. In light of these important legal issues, it is critical that NASA consider the role and timing of public involvement in the decision making process as a way of anticipating problem areas and preparing for legitimate public questions and challenges to sample return missions.

  14. Planetary protection, legal ambiguity and the decision making process for Mars sample return

    NASA Astrophysics Data System (ADS)

    Race, M. S.

    As scientists and mission planners develop planetary protection requirements for future Mars sample return missions, they must recognize the socio-political context in which decisions about the mission will be made and pay careful attention to public concerns about potential back contamination of Earth. To the extent that planetary protection questions are unresolved or unaddressed at the time of an actual mission, they offer convenient footholds for public challenges in both legal and decision making realms, over which NASA will have little direct control. In this paper, two particular non-scientific areas of special concern are discussed in detail: 1) legal issues and 2) the decision making process. Understanding these areas is critical for addressing legitimate public concerns as well as for fulfilling procedural requirements regardless whether sample return evokes public controversy. Legal issues with the potential to complicate future missions include: procedural review under NEPA; uncertainty about institutional control and authority; conflicting regulations and overlapping jurisdictions; questions about international treaty obligations and large scale impacts; uncertainties about the nature of the organism; and constitutional and regulatory concerns about quarantine, public health and safety. In light of these important legal issues, it is critical that NASA consider the role and timing of public involvement in the decision making process as a way of anticipating problem areas and preparing for legitimate public questions and challenges to sample return missions.

  15. Planetary protection, legal ambiguity and the decision making process for Mars sample return.

    PubMed

    Race, M S

    1996-01-01

    As scientists and mission planners develop planetary protection requirements for future Mars sample return missions, they must recognize the socio-political context in which decisions about the mission will be made and pay careful attention to public concerns about potential back contamination of Earth. To the extent that planetary protection questions are unresolved or unaddressed at the time of an actual mission, they offer convenient footholds for public challenges in both legal and decision making realms, over which NASA will have little direct control. In this paper, two particular non-scientific areas of special concern are discussed in detail: 1) legal issues and 2) the decision making process. Understanding these areas is critical for addressing legitimate public concerns as well as for fulfilling procedural requirements regardless whether sample return evokes public controversy. Legal issues with the potential to complicate future missions include: procedural review under National Environmental Policy Act (NEPA); uncertainty about institutional control and authority; conflicting regulations and overlapping jurisdictions; questions about international treaty obligations and large scale impacts; uncertanities about the nature of the organism; and constitutional and regulatory concerns about quarantine, public health and safety. In light of these important legal issues, it is critical that NASA consider the role and timing of public involvement in the decision making process as a way of anticipating problem areas and preparing for legitimate public questions and challenges to sample return missions.

  16. Diffusion Modelling Reveals the Decision Making Processes Underlying Negative Judgement Bias in Rats.

    PubMed

    Hales, Claire A; Robinson, Emma S J; Houghton, Conor J

    2016-01-01

    Human decision making is modified by emotional state. Rodents exhibit similar biases during interpretation of ambiguous cues that can be altered by affective state manipulations. In this study, the impact of negative affective state on judgement bias in rats was measured using an ambiguous-cue interpretation task. Acute treatment with an anxiogenic drug (FG7142), and chronic restraint stress and social isolation both induced a bias towards more negative interpretation of the ambiguous cue. The diffusion model was fit to behavioural data to allow further analysis of the underlying decision making processes. To uncover the way in which parameters vary together in relation to affective state manipulations, independent component analysis was conducted on rate of information accumulation and distances to decision threshold parameters for control data. Results from this analysis were applied to parameters from negative affective state manipulations. These projected components were compared to control components to reveal the changes in decision making processes that are due to affective state manipulations. Negative affective bias in rodents induced by either FG7142 or chronic stress is due to a combination of more negative interpretation of the ambiguous cue, reduced anticipation of the high reward and increased anticipation of the low reward.

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

    PubMed

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

    2015-11-01

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

  18. The Effects of Reciprocal Peer Tutoring on the Enhancement of Career Decision Making Process among Secondary School Adolescents

    ERIC Educational Resources Information Center

    Obiunu, Jude J.

    2008-01-01

    The study investigated the effects of reciprocal peer tutoring in the enhancement of career decision making process among secondary school adolescent students. The interaction of sex with treatment on career decision making process of secondary school adolescent students was also investigated. 120 students from two co-educational secondary schools…

  19. An Assessment of Decision-Making Processes: Evaluation of Where Land Protection Planning Can Incorporate Climate Change Information (Final Report)

    EPA Science Inventory

    EPA announced the availability of the final report, An Assessment of Decision-Making Processes: Evaluation of Where Land Protection Planning Can Incorporate Climate Change Information. This report is a review of decision-making processes of selected land protection prog...

  20. An Assessment of Decision-Making Processes: Evaluation of Where Land Protection Planning Can Incorporate Climate Change Information (Final Report)

    EPA Science Inventory

    EPA announced the availability of the final report, An Assessment of Decision-Making Processes: Evaluation of Where Land Protection Planning Can Incorporate Climate Change Information. This report is a review of decision-making processes of selected land protection prog...

  1. Decision Making Under Uncertainty: A Neural Model Based on Partially Observable Markov Decision Processes

    PubMed Central

    Rao, Rajesh P. N.

    2010-01-01

    A fundamental problem faced by animals is learning to select actions based on noisy sensory information and incomplete knowledge of the world. It has been suggested that the brain engages in Bayesian inference during perception but how such probabilistic representations are used to select actions has remained unclear. Here we propose a neural model of action selection and decision making based on the theory of partially observable Markov decision processes (POMDPs). Actions are selected based not on a single “optimal” estimate of state but on the posterior distribution over states (the “belief” state). We show how such a model provides a unified framework for explaining experimental results in decision making that involve both information gathering and overt actions. The model utilizes temporal difference (TD) learning for maximizing expected reward. The resulting neural architecture posits an active role for the neocortex in belief computation while ascribing a role to the basal ganglia in belief representation, value computation, and action selection. When applied to the random dots motion discrimination task, model neurons representing belief exhibit responses similar to those of LIP neurons in primate neocortex. The appropriate threshold for switching from information gathering to overt actions emerges naturally during reward maximization. Additionally, the time course of reward prediction error in the model shares similarities with dopaminergic responses in the basal ganglia during the random dots task. For tasks with a deadline, the model learns a decision making strategy that changes with elapsed time, predicting a collapsing decision threshold consistent with some experimental studies. The model provides a new framework for understanding neural decision making and suggests an important role for interactions between the neocortex and the basal ganglia in learning the mapping between probabilistic sensory representations and actions that maximize

  2. African-Centered Education in Middle Schools: The Decision-Making Process in a Parental Engagement Model

    ERIC Educational Resources Information Center

    Hicks Dunn, Latrice N.

    2012-01-01

    The ways in which key stakeholders influencing decision-making processes in African-centered schools in urban areas are qualitatively different from that of parental involvement in mainstream schools; these perceived differences influence decision-making in various ways. The purpose of this research is to investigate ways in which parents,…

  3. Particle Decision Making Processes in Fractured Media: The Battle Between Models

    NASA Astrophysics Data System (ADS)

    Sund, N. L.; Parashar, R.; Pham, H. V.

    2016-12-01

    During a random walk through a discrete fracture network, a particle moves at a constant velocity through a fracture segment and when it arrives at a fracture intersection it chooses a path, changes velocity, and repeats the process. The set of possible velocities the particle may choose depends on which intersection it is at, inducing a correlation between its current and next velocity. This process of traveling at a constant velocity then choosing a new velocity is also a good approximation to transport in (non-fractured) porous media.For times greater than the Taylor time scale (L^2/D, where L is the length scale over which a particle must travel to sample the full range of velocities in the system and D is the diffusion coefficient), the particle's decision making process can be neglected. In fractured and highly heterogeneous porous media, however, this length scale (and time scale consequently) can be prohibitively long. Even for field scale applications, it's possible that this decision making process may not be neglected. Several upscaled models have been developed that either explicitly or implicitly model this decision making process, including continuous time random walk with a coupled space and time step distribution, multi-rate mass transfer models, the spatial Markov model, and a hybrid approach based on the Boltzmann transport equation. We ask: how do these models perform in predicting transport at scales of interest? To answer this question, we upscale transport using a variety of models in simple 2D discrete fracture networks, where transport through each fracture is purely advective (no longitudinal diffusion), yet fully mixed (infinite transverse diffusion) and there is no mass exchange between the fracture network and the rock matrix it is embedded in. This simplified testing ground reveals whether the question of "how" to model the decision process is as important as "whether" to model it.

  4. Preoperative evaluation and surgical decision-making in pediatric epilepsy surgery

    PubMed Central

    Ducis, Katrina; Guan, Jian; Karsy, Michael

    2016-01-01

    Epilepsy is a common disease in the pediatric population, and the majority of cases are controlled with medications and lifestyle modification. For the children whose seizures are pharmacoresistant, continued epileptic activity can have a severely detrimental impact on cognitive development. Early referral of children with drug-resistant seizures to a pediatric epilepsy surgery center for evaluation is critical to achieving optimal patient outcomes. There are several components to a thorough presurgical evaluation, including a detailed medical history and physical examination, noninvasive testing including electroencephalogram, magnetic resonance imaging (MRI) of the brain, and often metabolic imaging. When necessary, invasive diagnostic testing using intracranial monitoring can be used. The identification of an epileptic focus may allow resection or disconnection from normal brain structures, with the ultimate goal of complete seizure remission. Additional operative measures can decrease seizure frequency and/or intensity if a clear epileptic focus cannot be identified. In this review, we will discuss the nuances of presurgical evaluation and decision-making in the management of children with drug-resistant epilepsy (DRE). PMID:27709099

  5. Preoperative evaluation and surgical decision-making in pediatric epilepsy surgery.

    PubMed

    Ducis, Katrina; Guan, Jian; Karsy, Michael; Bollo, Robert J

    2016-07-01

    Epilepsy is a common disease in the pediatric population, and the majority of cases are controlled with medications and lifestyle modification. For the children whose seizures are pharmacoresistant, continued epileptic activity can have a severely detrimental impact on cognitive development. Early referral of children with drug-resistant seizures to a pediatric epilepsy surgery center for evaluation is critical to achieving optimal patient outcomes. There are several components to a thorough presurgical evaluation, including a detailed medical history and physical examination, noninvasive testing including electroencephalogram, magnetic resonance imaging (MRI) of the brain, and often metabolic imaging. When necessary, invasive diagnostic testing using intracranial monitoring can be used. The identification of an epileptic focus may allow resection or disconnection from normal brain structures, with the ultimate goal of complete seizure remission. Additional operative measures can decrease seizure frequency and/or intensity if a clear epileptic focus cannot be identified. In this review, we will discuss the nuances of presurgical evaluation and decision-making in the management of children with drug-resistant epilepsy (DRE).

  6. An analytical hierarchy process for decision making of high-level-waste management

    SciTech Connect

    Wang, J.H.C.; Jang, W.

    1995-12-01

    To prove the existence value of nuclear technology for the world of post cold war, demonstration of safe rad-waste disposal is essential. High-level-waste (HLW) certainly is the key issue to be resolved. To assist a rational and persuasive process on various disposal options, an Analytical Hierarchy Process (AHP) for the decision making of HLW management is presented. The basic theory and rationale are discussed, and applications are shown to illustrate the usefulness of the AHP. The authors wish that the AHP can provide a better direction for the current doomed situations of Taiwan nuclear industry, and to exchange with other countries for sharing experiences on the HLW management.

  7. Intelligent decision making in disassembly process based on fuzzy reasoning petri nets.

    PubMed

    Gao, Meimei; Zhou, MengChu; Tang, Ying

    2004-10-01

    Practical disassembly process planning is extremely important for efficient material recycling and components reuse. The research work for the process planning in literature focuses on the generation of optimal sequences based on the predictive information of products. The used products, unfortunately, exhibit high uncertainty since products may experience very different conditions during their use stage. The indeterminate characteristics associated to used products often makes the predetermined plan unrealistic. Their disassembly process has to be decided dynamically adaptive to the products' specific status. To be able to deal with uncertainty in a dynamic decision making process, this paper presents a fuzzy reasoning Petri net (FRPN) model to represent related decision making rules in disassembly process. Using the proposed fuzzy reasoning algorithm based on the FRPN model, the multicriterion disassembly rules can be considered in the parallel way to make the decision automatically and quickly. Instead of producing the disassembly sequences before disassembling a whole product, the proposed method makes intelligent decisions based on dynamically updated status of components in the product at each disassembly step. Therefore, it is adaptive to the changes that arise during the process. Finally, an example is used to illustrate the application of the proposed methodology.

  8. Development of a computer application to help in the decision-making process in teaching dentistry.

    PubMed

    Ríos Santos, Jose Vicente; Castelló Castañeda, Coral; Bullón, Pedro

    2008-01-01

    This article describes the development of a computer application, Asiodint 1.0, whose objective is principally to help students and also newly qualified graduates in the decision-making process in a variety of clinical situations. The tree starts with an initial identification, naming the problem to be solved. It then follows a path via various stages (nodes), according to the responses to the variables which are important in this decision-making process, configuring a final outcome. A population of 90 individuals was chosen, divided without any specific criteria into three groups: A) students, B) qualified dentists with at least 2 years' and at most 5 years' professional experience, C) qualified dentists with more than 10 years' professional experience. Two clinical cases were designed for the themes used in the program (evaluation of an abutment tooth and treatment of an extracted tooth). The participants answered questions on the two cases first based on their knowledge and then with the help of the program, and were able to check the degree of agreement between their opinion and that offered by the program. Finally each individual had to fill in a questionnaire on their opinion of the program, additionally describing the advantages and drawbacks they found in the application and whether discrepancies were due to a fault in the program's data base, an error by the individual or other reasons. 100% of the participants stated that they would like to have this tool as an aid and 96.7% thought that it could be used to improve teaching. This program may be used repeatedly and at any time by students and teachers who so wish. This offers the advantage that it can be reviewed to reinforce information learnt by the students. The teaching staff can, however, if they so desire, design any theme they wish, increasing the efficiency and support capabilities of the program. Development of a computer application to help in the decision-making process in teaching dentistry

  9. [The Decision-Making Processes in Taiwanese Women With Repeat Caesarean Deliveries].

    PubMed

    Chen, Shu-Wen

    2016-10-01

    Repeat caesarean delivery (RCD) ranks as the top reason for the high caesarean rates in Taiwan. More than 90% of Taiwanese women who have had a previous caesarean delivery chose RCD following their next pregnancy. To explore the decision-making processes regarding RCD in Taiwanese women. A qualitative approach with grounded theory was used to conduct this research. Participants were recruited from a private medical centre in northern Taiwan. Methods of data collection include in-depth interviews, observation, and field notes. Constant comparative analytical techniques were employed for data analysis. A total of 16 women chose RCD. Ensuring the well-being of mother and fetus was the core theme. Women's decisions were influenced by both internal factors (previous negative experience of birth, concern about uterine rupture, fixing the scar of previous caesarean and current pregnancy situation) and external factors (obstetrician's recommendation, the experience of female significant others, an inaccurate information from internet and the unconditional financial coverage from Health National Insurance). Decision-making processes involved searching information regarding mode of birth, evaluating vaginal birth risk, trusting obstetricians' professional judgment, and a lack of progress during the course of labour. The well-being of mother and fetus is the major concern affecting mothers' decisions regarding RCD. The majority of Taiwanese women participate passively in the decision-making process regarding their options for mode of birth. In the present study, women choices were primarily guided by reducing the risk of uterine rupture. Hospitals should reduce unnecessary induction interventions. Obstetricians should inform women of the risks and benefits of various birth modes. The government could establish a website that provides a clear explanation of the criteria for the government to financially cover the costs of RCD in order to assist women to make optimal birth

  10. Understanding the pregnancy decision-making process among couples seeking induced abortion.

    PubMed

    Costescu, Dustin J; Lamont, John A

    2013-10-01

    The role of partners in the abortion experience is complex and poorly understood. We sought to examine how women and their partners navigate the pregnancy decision-making process. Thirty couples presenting for abortion completed questionnaires exploring experiences leading to the abortion. Participants were sequestered from their partners during completion of the study, and booklets were coded to allow comparison within couples. This portion of the study explored partner involvement in the decision-making process. One half of women had decided on abortion before informing their partner of the pregnancy. Of those who were undecided at the time of disclosure, all sought their partner's advice. Most participants (84%) were happy with the amount of discussion that took place with their partners, although one fifth of women and nearly one third of men could have discussed it more. More women than men were happy with the discussions that took place (96.6% vs. 70.4%). Two thirds of respondents viewed the decision to have an abortion as being made by both partners, one quarter viewed the decision as being mostly the woman's choice, and 5% viewed the decision as being mostly the male partner's choice. Although making the choice to have an abortion rests with the woman, her partner may play a role in the decision-making process, particularly when the woman is undecided. For many couples presenting for abortion, the decision is seen as being made jointly by both partners. Further research may identify opportunities to foster greater partner support throughout a woman's abortion experience.

  11. Factors Affecting the Corporate Decision-Making Process of Air Transport Manufacturers

    NASA Technical Reports Server (NTRS)

    Ollila, R. G.; Hill, J. D.; Noton, B. R.; Duffy, M. A.; Epstein, M. M.

    1976-01-01

    Fuel economy is a pivotal question influencing the future sale and utilization of commercial aircraft. The NASA Aircraft Energy Efficiency (ACEE) Program Office has a program intended to accelerate the readiness of advanced technologies for energy efficient aircraft. Because the decision to develop a new airframe or engine is a major financial hazard for manufacturers, it is important to know what factors influence the decision making process. A method is described for identifying and ranking individuals and organizations involved at each stage of commercial air transport development, and the barriers that must be overcome in adopting new technologies.

  12. Using a computer simulation program to assess the decision-making process in child health care.

    PubMed

    Lauri, S

    1992-01-01

    The purpose of this paper was to describe the development and testing of a computer simulation program designed to assess the decision-making process in the public health nurses' work in child health care. The work was based primarily on theories of problem-solving and decision making; on knowledge of child development, health care, and education; and on the soft systems methodology. An authoring program and two simulations were designed and produced at the University of Turku by a team of two nurse researchers, a computer specialist, and three public health nurses. The simulations presented two typical situations encountered by the public health nurses' work in child health care. A total of 61 public health nurses from 11 health centers in the southwestern part of Finland completed the simulations. The public health nurses responded positively to the simulations and the program worked very well. The results revealed some inconsistencies in the decision-making process of the public health nurses with respect to the needs of the child and the family. The public health nurses' decisions were more closely related to the developmental stage of the child than to the unique needs of each family. The simulation is acting to test the public health nurses' ability to make decisions "here and now" but not about caring it forward. These shortcomings can be corrected by asking them to explain their decisions and thoughts after each stage and by tape recording their answers. The findings gave many answers to the question of how the computer simulation program can be developed.

  13. Emerging role of pharmacoeconomics in the research and development decision-making process.

    PubMed

    DiMasi, J A; Caglarcan, E; Wood-Armany, M

    2001-01-01

    This study examines the organisational structure of pharmacoeconomics departments in major pharmaceutical and biotechnology companies, the impediments to optimal use of pharmacoeconomic evaluations by companies and the integration of pharmacoeconomic analysis with research and development decision making. The heads of the pharmacoeconomics departments of 40 companies were surveyed on the structure of pharmacoeconomics departments in their companies, the roles that pharmacoeconomic analyses are playing in the new drug development decision-making process, and the initiation of pharmacoeconomic studies during the development process for a random sample of their companies' investigational new drugs. 45 department heads from 31 parent companies responded to the survey. The pharmacoeconomics function in pharmaceutical and biotechnology companies is relatively new and growing rapidly. Most pharmacoeconomics department heads preferred a different reporting structure than what they currently have and indicated that the strategic role that pharmacoeconomics can play is not well understood within the organisation. Pharmacoeconomic analyses have been increasingly initiated early in clinical development and have been a factor in clinical trial design and in key decisions made during the development process. Given the continued emphasis on containing healthcare costs worldwide, demand will increase for evidence that drugs provide good value for the money spent on them. Companies will likely respond not only with more economic evaluations for purchasers, but also with greater use of pharmacoeconomics early in the development process to aid in rationalising key research and development decisions, and in guiding final pricing decisions and reimbursement planning, thereby improving resource allocations.

  14. Information Processing at Successive Stages of Decision Making: Need for Cognition and Inclusion-Exclusion Effects.

    PubMed

    Levin; Huneke; Jasper

    2000-07-01

    Levin and Jasper's (1995) phased narrowing technique for tracking changes in information usage across successive stages of the decision-making process was combined with Huneke's (1996) "pull-down menu" extension of Payne, Bettman, and Johnson's (1988) software package for generating measures of information processing. Because this technique provided considerable data for each individual subject at each stage, we were able to focus on individual differences in information processing across stages, most notably differences related to need for cognition (NC; Cacioppo & Petty, 1982). In a computerized information search and decision task, 60 college students were first asked to narrow their options for purchasing a notebook computer to form a consideration set and were then asked to make a final choice from this set. At the consideration set formation stage, half the subjects were instructed to adopt a mindset to include options while the other half were asked to exclude options. Especially in the inclusion condition where subjects showed greater narrowing of options, high NC subjects processed information in a more focused manner with greater depth and breadth than did low NC subjects, and the quality of their selections tended to be higher. There was no evidence of widespread shifts in strategy as individuals moved from set formation to final choice but, as a group, high NC subjects were more successful at adaptive decision making. Copyright 2000 Academic Press.

  15. Markov Decision Processes: A Tool for Sequential Decision Making under Uncertainty

    PubMed Central

    Alagoz, Oguzhan; Hsu, Heather; Schaefer, Andrew J.; Roberts, Mark S.

    2011-01-01

    We provide a tutorial on the construction and evaluation of Markov decision processes (MDPs), which are powerful analytical tools used for sequential decision making under uncertainty that have been widely used in many industrial and manufacturing applications but are underutilized in medical decision making (MDM). We demonstrate the use of an MDP to solve a sequential clinical treatment problem under uncertainty. Markov decision processes generalize standard Markov models in that a decision process is embedded in the model and multiple decisions are made over time. Furthermore, they have significant advantages over standard decision analysis. We compare MDPs to standard Markov-based simulation models by solving the problem of the optimal timing of living-donor liver transplantation using both methods. Both models result in the same optimal transplantation policy and the same total life expectancies for the same patient and living donor. The computation time for solving the MDP model is significantly smaller than that for solving the Markov model. We briefly describe the growing literature of MDPs applied to medical decisions. PMID:20044582

  16. Modification of the Decision-Making Capability in the Social Force Model for the Evacuation Process

    NASA Astrophysics Data System (ADS)

    Zainuddin, Zarita; Shuaib, Mohammed

    2010-01-01

    The Social Force Model is one of the most successful microscopic pedestrian models that represent the well-organized phenomena of the pedestrian flow. The model has been modified for evacuation process by incorporating physical forces when contact exists, on one hand, and incorporating factors into the preferred velocity to govern the individual's behavior corresponding to the situation under consideration (normal or evacuation) on the other hand. The latter incorporation has enhanced the ability of the model to represent the decision-making process of pedestrians. However, the variety of pedestrian's abilities to make decisions in emergency situations has not been incorporated properly into the model. In this article we enhance the decision-making capability of the independent pedestrians first by improving the assessment process of selecting an exit from the set of exits available in the physical environment by considering a new factor (crowd at exits); and second, by incorporating following crowds as a new feature for those who are independent. A simulation of an emergency situation inside a room is performed to validate our work.

  17. Determinants of judgment and decision making quality: the interplay between information processing style and situational factors

    PubMed Central

    Ayal, Shahar; Rusou, Zohar; Zakay, Dan; Hochman, Guy

    2015-01-01

    A framework is presented to better characterize the role of individual differences in information processing style and their interplay with contextual factors in determining decision making quality. In Experiment 1, we show that individual differences in information processing style are flexible and can be modified by situational factors. Specifically, a situational manipulation that induced an analytical mode of thought improved decision quality. In Experiment 2, we show that this improvement in decision quality is highly contingent on the compatibility between the dominant thinking mode and the nature of the task. That is, encouraging an intuitive mode of thought led to better performance on an intuitive task but hampered performance on an analytical task. The reverse pattern was obtained when an analytical mode of thought was encouraged. We discuss the implications of these results for the assessment of decision making competence, and suggest practical directions to help individuals better adjust their information processing style to the situation at hand and make optimal decisions. PMID:26284011

  18. Markov decision processes: a tool for sequential decision making under uncertainty.

    PubMed

    Alagoz, Oguzhan; Hsu, Heather; Schaefer, Andrew J; Roberts, Mark S

    2010-01-01

    We provide a tutorial on the construction and evaluation of Markov decision processes (MDPs), which are powerful analytical tools used for sequential decision making under uncertainty that have been widely used in many industrial and manufacturing applications but are underutilized in medical decision making (MDM). We demonstrate the use of an MDP to solve a sequential clinical treatment problem under uncertainty. Markov decision processes generalize standard Markov models in that a decision process is embedded in the model and multiple decisions are made over time. Furthermore, they have significant advantages over standard decision analysis. We compare MDPs to standard Markov-based simulation models by solving the problem of the optimal timing of living-donor liver transplantation using both methods. Both models result in the same optimal transplantation policy and the same total life expectancies for the same patient and living donor. The computation time for solving the MDP model is significantly smaller than that for solving the Markov model. We briefly describe the growing literature of MDPs applied to medical decisions.

  19. Decision-Making Processes in the Workplace: How Exhaustion, Lack of Resources and Job Demands Impair Them and Affect Performance.

    PubMed

    Ceschi, Andrea; Demerouti, Evangelia; Sartori, Riccardo; Weller, Joshua

    2017-01-01

    The present study aims to connect more the I/O and the decision-making psychological domains, by showing how some common components across jobs interfere with decision-making and affecting performance. Two distinct constructs that can contribute to positive workplace performance have been considered: decision-making competency (DMCy) and decision environment management (DEM). Both factors are presumed to involve self-regulatory mechanisms connected to decision processes by influencing performance in relation to work environment conditions. In the framework of the job demands-resources (JD-R) model, the present study tested how such components as job demands, job resources and exhaustion can moderate decision-making processes and performance, where high resources are advantageous for decision-making processes and performance at work, while the same effect happens with low job demands and/or low exhaustion. In line with the formulated hypotheses, results confirm the relations between both the decision-making competences, performance (i.e., in-role and extra-role) and moderators considered. In particular, employees with low levels of DMCy show to be more sensitive to job demands toward in-role performance, whereas high DEM levels increase the sensitivity of employees toward job resources and exhaustion in relation to extra-role performance. These findings indicate that decision-making processes, as well as work environment conditions, are jointly related to employee functioning.

  20. Decision-Making Processes in the Workplace: How Exhaustion, Lack of Resources and Job Demands Impair Them and Affect Performance

    PubMed Central

    Ceschi, Andrea; Demerouti, Evangelia; Sartori, Riccardo; Weller, Joshua

    2017-01-01

    The present study aims to connect more the I/O and the decision-making psychological domains, by showing how some common components across jobs interfere with decision-making and affecting performance. Two distinct constructs that can contribute to positive workplace performance have been considered: decision-making competency (DMCy) and decision environment management (DEM). Both factors are presumed to involve self-regulatory mechanisms connected to decision processes by influencing performance in relation to work environment conditions. In the framework of the job demands-resources (JD-R) model, the present study tested how such components as job demands, job resources and exhaustion can moderate decision-making processes and performance, where high resources are advantageous for decision-making processes and performance at work, while the same effect happens with low job demands and/or low exhaustion. In line with the formulated hypotheses, results confirm the relations between both the decision-making competences, performance (i.e., in-role and extra-role) and moderators considered. In particular, employees with low levels of DMCy show to be more sensitive to job demands toward in-role performance, whereas high DEM levels increase the sensitivity of employees toward job resources and exhaustion in relation to extra-role performance. These findings indicate that decision-making processes, as well as work environment conditions, are jointly related to employee functioning. PMID:28529491

  1. Decision making.

    PubMed

    Chambers, David W

    2011-01-01

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

  2. Decision-making in the referral process of sonographers in primary care screening centers.

    PubMed

    Oosterhuis, Jolande J; Gillissen, Ada; Snijder, Claudia A; Stiggelbout, Anne; Haak, Monique C

    2016-06-01

    To explore the decision-making process (whether or not to refer) of sonographers performing the 20 weeks standard anomaly scan (SAS) in the screening setting. A survey was sent to SAS-sonographers; it assessed experience, training, volume, type of practice, perceived difficulty per organ system, feelings after missing anomalies and reasons for uncertainty and doubt concerning referral. The response rate was 50%. Sonographers tend to seek reasons for uncertainty in patient factors and not in their skills or difficulty of the scan. Most mentioned reasons to refer in case of doubt were repeated visualization of a possible abnormality (98%). We hypothesize that the need of repeated imaging of an abnormality might partly explain why some fetal anomalies are still being missed. Sonographers with limited experience and low volume SAS more often revised, referred and asked colleagues for help than experienced sonographers with high volume SAS. In cases of a missed diagnosis, sonographers frequently blamed internal factors (personal failure 71%). Level of experience and volume of SAS influence revision and referral rates. Personal factors seem to play a role in the decision-making process of screening sonographers. Future research should focus on these personal factors, to optimize screening ultrasound programs. © 2016 John Wiley & Sons, Ltd. © 2016 John Wiley & Sons, Ltd.

  3. The integration of surface electromyography in the clinical decision making process: a case report

    PubMed Central

    Nicholson, W Reg

    1998-01-01

    Objective: To demonstrate how the findings of surface electromyography (S.E.M.G.) were integrated into the clinical decision-making process. Clinical Features: This is a retrospective review of the file of a 27-year-old male suffering from mechanical low back pain. He was evaluated on 3 separate occasions over a 3 year period. History, radiography, functional outcome studies, visual-numerical pain score, pain drawing, physical examination and surface electromyography were utilized in evaluating this patient. Intervention and Outcome: The two clinical interventions of spinal manipulative therapy (S.M.T.) had positive results in that the patient achieved an asymptomatic state and returned to his position of employment. The S.E.M.G. data collected during the industrial assessment, did not provide the outcome that the patient had anticipated. Conclusion: Surface electromyography is a useful clinical tool in the author’s decision-making process for the treatment of mechanical lower back pain. Therapeutic intervention by S.M.T., therapeutic exercises and rating risk factors were influenced by the S.E.M.G. findings.

  4. Understanding and shifting drug-related decisions: Contributions of automatic decision-making processes

    PubMed Central

    Carpenter, Kenneth M.; Bedi, Gillinder; Vadhan, Nehal P.

    2015-01-01

    While substance use is common, only a minority of individuals who use drugs or alcohol develop problematic use. An understanding of the factors underlying the transition from substance use to misuse may improve prevention and intervention efforts. A key feature of substance misuse is ongoing decisions to use drugs or alcohol despite escalating negative consequences. Research findings highlight the importance of both relatively automatic, associative cognitive processes and relatively controlled, deliberative, and rational-analytic cognitive processes, for understanding situational decisions to use drugs. In this review, we discuss several cognitive component processes that may contribute to decision-making that promotes substance use and misuse, with a focus on more automatic processes. A growing body of evidence indicates that relative differences in the strength of these component processes can account for individual differences in the transition from substance use to misuse, and may offer important avenues for developing novel intervention strategies. PMID:26084667

  5. Similar Processes Despite Divergent Behavior in Two Commonly Used Measures of Risky Decision Making

    PubMed Central

    BISHARA, ANTHONY J.; PLESKAC, TIMOTHY J.; FRIDBERG, DANIEL J.; YECHIAM, ELDAD; LUCAS, JESOLYN; BUSEMEYER, JEROME R.; FINN, PETER R.; STOUT, JULIE C.

    2011-01-01

    Performance on complex decision-making tasks may depend on a multitude of processes. Two such tasks, the Iowa Gambling Task (IGT) and Balloon Analog Risk Task (BART), are of particular interest because they are associated with real world risky behavior, including illegal drug use. We used cognitive models to disentangle underlying processes in both tasks. Whereas behavioral measures from the IGT and BART were uncorrelated, cognitive models revealed two reliable cross-task associations. Results suggest that the tasks similarly measure loss aversion and decision-consistency processes, but not necessarily the same learning process. Additionally, substance-using individuals (and especially stimulant users) performed worse on the IGT than healthy controls did, and this pattern could be explained by reduced decision consistency. PMID:21836771

  6. Real-Time Internet Connections: Implications for Surgical Decision Making in Laparoscopy

    PubMed Central

    Broderick, Timothy J.; Harnett, Brett M.; Doarn, Charles R.; Rodas, Edgar B.; Merrell, Ronald C.

    2001-01-01

    Objective To determine whether a low-bandwidth Internet connection can provide adequate image quality to support remote real-time surgical consultation. Summary Background Data Telemedicine has been used to support care at a distance through the use of expensive equipment and broadband communication links. In the past, the operating room has been an isolated environment that has been relatively inaccessible for real-time consultation. Recent technological advances have permitted videoconferencing over low-bandwidth, inexpensive Internet connections. If these connections are shown to provide adequate video quality for surgical applications, low-bandwidth telemedicine will open the operating room environment to remote real-time surgical consultation. Methods Surgeons performing a laparoscopic cholecystectomy in Ecuador or the Dominican Republic shared real-time laparoscopic images with a panel of surgeons at the parent university through a dial-up Internet account. The connection permitted video and audio teleconferencing to support real-time consultation as well as the transmission of real-time images and store-and-forward images for observation by the consultant panel. A total of six live consultations were analyzed. In addition, paired local and remote images were “grabbed” from the video feed during these laparoscopic cholecystectomies. Nine of these paired images were then placed into a Web-based tool designed to evaluate the effect of transmission on image quality. Results The authors showed for the first time the ability to identify critical anatomic structures in laparoscopy over a low-bandwidth connection via the Internet. The consultant panel of surgeons correctly remotely identified biliary and arterial anatomy during six laparoscopic cholecystectomies. Within the Web-based questionnaire, 15 surgeons could not blindly distinguish the quality of local and remote laparoscopic images. Conclusions Low-bandwidth, Internet-based telemedicine is inexpensive

  7. New vaccine adoption: qualitative study of national decision-making processes in seven low- and middle-income countries.

    PubMed

    Burchett, H E D; Mounier-Jack, S; Griffiths, U K; Biellik, R; Ongolo-Zogo, P; Chavez, E; Sarma, H; Uddin, J; Konate, M; Kitaw, Y; Molla, M; Wakasiaka, S; Gilson, L; Mills, A

    2012-05-01

    As more new and improved vaccines become available, decisions on which to adopt into routine programmes become more frequent and complex. This qualitative study aimed to explore processes of national decision-making around new vaccine adoption and to understand the factors affecting these decisions. Ninety-five key informant interviews were conducted in seven low- and middle-income countries: Bangladesh, Cameroon, Ethiopia, Guatemala, Kenya, Mali and South Africa. Framework analysis was used to explore issues both within and between countries. The underlying driver for adoption decisions in GAVI-eligible countries was the desire to seize GAVI windows of opportunity for funding. By contrast, in South Africa and Guatemala, non-GAVI-eligible countries, the decision-making process was more rooted in internal and political dynamics. Decisions to adopt new vaccines are, by nature, political. The main drivers influencing decisions were the availability of funding, political prioritization of vaccination or the vaccine-preventable disease and the burden of disease. Other factors, such as financial sustainability and feasibility of introduction, were not as influential. Although GAVI procedures have established more formality in decision-making, they did not always result in consideration of all relevant factors. As familiarity with GAVI procedures increased, questioning by decision-makers about whether a country should apply for funding appeared to have diminished. This is one of the first studies to empirically investigate national processes of new vaccine adoption decision-making using rigorous methods. Our findings show that previous decision-making frameworks (developed to guide or study national decision-making) bore little resemblance to real-life decisions, which were dominated by domestic politics. Understanding the realities of vaccine policy decision-making is critical for developing strategies to encourage improved evidence-informed decision-making about new

  8. Trade off relationships: incorporating ecosystem spatial scale and timing issues into the decision making process

    NASA Astrophysics Data System (ADS)

    Beevers, Lindsay; Tilmant, Amaury; Mwelwa, Elenestina

    2010-05-01

    In large hydropower-dominated river basins, reservoirs are mainly operated so as to maximize revenues from energy generation regardless of the consequences of reduced flow fluctuation on downstream ecosystems. Revenue from hydropower plants is essential to a country's economy; however the impact on ecosystems downstream can be large-scale. The timing of flow releases does not mimic natural systems, which has impacts over different temporal and physio-spatial scales to the ecosystem. To inform decision making often hydro-economic modeling is used and it is essential that the response of the system is understood and incorporated adequately into assessment design, to allow for trade-offs to be identified. This requires issues of timing and spatial scale to be understood and incorporated over different planning horizons. Nesting these issues of scale into decisions is complex; where decisions are made on timescales from hours to months and spatially within a basin depending on the operation of the system. Up-scaling the most critical interactions between flow, form and ecosystem into the decision making process, for different time horizons or planning scales, is essential. A proposed framework is illustrated with the Zambezi basin.

  9. Ethically-based clinical decision-making in physical therapy: process and issues.

    PubMed

    Finch, Elspeth; Geddes, E Lynne; Larin, Hélène

    2005-01-01

    The identification and consideration of relevant ethical issues in clinical decision-making, and the education of health care professionals (HCPs) in these skills are key factors in providing quality health care. This qualitative study explores the way in which physical therapists (PTs) integrate ethical issues into clinical practice decisions and identifies ethical themes used by PTs. A purposive sample of eight PTs was asked to describe a recent ethically-based clinical decision. Transcribed interviews were coded and themes identified related to the following categories: 1) the integration of ethical issues in the clinical decision-making process, 2) patient welfare, 3) professional ethos of the PT, and 4) health care economics and business practices. Participants readily described clinical situations involving ethical issues but rarely identified specific conflicting ethical issues in their description. Ethical dilemmas were more frequently resolved when there were fewer emotional sequelae associated with the dilemma, and the PT had a clear understanding of professional ethos, valued patient autonomy, and explored a variety of alternative actions before implementing one. HCP students need to develop a clear professional ethos and an increased understanding of the economic factors that will present ethical issues in practice.

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

    PubMed Central

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

    2016-01-01

    Dopamine and serotonin have opponent interactions on aspects of impulsivity. Therefore we wanted to test the hypothesis that dopamine and serotonin would have opposing effects on speed-accuracy trade-offs in a perceptual decision making task. Unlike other behavioral measures of impulsivity, perceptual decision making allows us to determine whether decreasing premature responses, often interpreted as decreased impulsivity, corresponds to increased behavioral performance. We administered GBR-12909 (a dopamine transporter blocker), escitalopram (a serotonin transporter blocker) or saline in separate sessions to three rhesus macaques. We found that animals had slower reaction times on escitalopram than on GBR-12909 or saline. However, they were also least accurate on escitalopram. Animals were faster, although non-significantly, on GBR than saline and had equivalent accuracy. Administration of GBR-12909 did cause animals to be faster in error trials than correct trials. Therefore, from the point of view of reaction times the animals were less impulsive on escitalopram. However, the decreased accuracy shows that they were not able to make use of the slower response time to make more accurate decisions. Therefore, impulsivity was reduced on escitalopram, but at the expense of information processing rate in the perceptual inference task. PMID:27513807

  11. Approach of decision making based on the analytic hierarchy process for urban landscape management.

    PubMed

    Srdjevic, Zorica; Lakicevic, Milena; Srdjevic, Bojan

    2013-03-01

    This paper proposes a two-stage group decision making approach to urban landscape management and planning supported by the analytic hierarchy process. The proposed approach combines an application of the consensus convergence model and the weighted geometric mean method. The application of the proposed approach is shown on a real urban landscape planning problem with a park-forest in Belgrade, Serbia. Decision makers were policy makers, i.e., representatives of several key national and municipal institutions, and experts coming from different scientific fields. As a result, the most suitable management plan from the set of plans is recognized. It includes both native vegetation renewal in degraded areas of park-forest and continued maintenance of its dominant tourism function. Decision makers included in this research consider the approach to be transparent and useful for addressing landscape management tasks. The central idea of this paper can be understood in a broader sense and easily applied to other decision making problems in various scientific fields.

  12. When parsimony is not enough: Considering dual processes and dual levels of influence in sexual decision making

    PubMed Central

    Rendina, H. Jonathon

    2015-01-01

    The literature on sexual decision making that has been used to understand behaviors relevant to HIV and STI risk has relied primarily on cognitive antecedents of behavior. In contrast, several prominent models of decision making outside of the sexual behavior literature rely on dual process models, in which both affective and cognitive processing are considered important precursors to behavior. Moreover, much of the literature on sexual behavior utilizes individual-level traits and characteristics to predict aggregated sexual behavior, despite decision making itself being a situational or event-level process. This paper proposes a framework for understanding sexual decision making as the result of dual processes (affective and cognitive) operating at dual level of influence (individual and situational). Finally, the paper ends with a discussion of the conceptual and methodological benefits and challenges to its use and future directions for research. PMID:26168978

  13. When parsimony is not enough: considering dual processes and dual levels of influence in sexual decision making.

    PubMed

    Rendina, H Jonathon

    2015-10-01

    The literature on sexual decision making that has been used to understand behaviors relevant to HIV and STI risk has relied primarily on cognitive antecedents of behavior. In contrast, several prominent models of decision making outside of the sexual behavior literature rely on dual process models, in which both affective and cognitive processing are considered as important precursors to behavior. Moreover, much of the literature on sexual behavior utilizes individual-level traits and characteristics to predict aggregated sexual behavior, despite decision making itself being a situational or event-level process. This article proposes a framework for understanding sexual decision making as the result of dual processes (affective and cognitive) operating at dual level of influence (individual and situational). Finally, this article ends with a discussion of the conceptual and methodological benefits and challenges to its use and future directions for research.

  14. 76 FR 58807 - An Assessment of Decision-Making Processes: Evaluation of Where Land Protection Planning Can...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-22

    ... Incorporate Climate Change Information-- Release of Final Report AGENCY: Environmental Protection Agency (EPA... Decision-Making Processes: Evaluation of Where Land Protection Planning can Incorporate Climate Change... planning can incorporate climate change impacts information into programs. The assessment revealed that...

  15. Clinical intuition in the nursing process and decision-making-A mixed-studies review.

    PubMed

    Melin-Johansson, Christina; Palmqvist, Rebecca; Rönnberg, Linda

    2017-03-22

    To review what is characteristic of registered nurses' intuition in clinical settings, in relationships and in the nursing process. Intuition is a controversial concept and nurses believe that there are difficulties in how they should explain their nursing actions or decisions based on intuition. Much of the evidence from the body of research indicates that nurses value their intuition in a variety of clinical settings. More information on how nurses integrate intuition as a core element in daily clinical work would contribute to an improved understanding on how they go about this. Intuition deserves a place in evidence-based activities, where intuition is an important component associated with the nursing process. An integrative review strengthened with a mixed-studies review. Literature searches were conducted in the databases CINAHL, PubMed and PsycINFO, and literature published 1985-2016 were included. The findings in the studies were analysed with content analysis, and the synthesis process entailed a reasoning between the authors. After a quality assessment, 16 studies were included. The analysis and synthesis resulted in three categories. The characteristics of intuition in the nurse's daily clinical activities include application, assertiveness and experiences; in the relationships with patients' intuition include unique connections, mental and bodily responses, and personal qualities; and in the nursing process include support and guidance, component and clues in decision-making, and validating decisions. Intuition is more than simply a "gut feeling," and it is a process based on knowledge and care experience and has a place beside research-based evidence. Nurses integrate both analysis and synthesis of intuition alongside objective data when making decisions. They should rely on their intuition and use this knowledge in clinical practice as a support in decision-making, which increases the quality and safety of patient care. We find that intuition plays a

  16. Trait urgency and gambling problems in young people by age: the mediating role of decision-making processes.

    PubMed

    Canale, Natale; Vieno, Alessio; Griffiths, Mark D; Rubaltelli, Enrico; Santinello, Massimo

    2015-07-01

    Although the personality trait of urgency has been linked to problem gambling, less is known about psychological mechanisms that mediate the relationship between urgency and problem gambling. One individual variable of potential relevance to impulsivity and addictive disorders is age. The aims of this study were to examine: (i) a theoretical model associating urgency and gambling problems, (ii) the mediating effects of decision-making processes (operationalized as preference for small/immediate rewards and lower levels of deliberative decision-making); and (iii) age differences in these relationships. Participants comprised 986 students (64% male; mean age=19.51 years; SD=2.30) divided into three groups: 16-17 years, 18-21 years, and 22-25 years. All participants completed measures of urgency, problem gambling, and a delay-discounting questionnaire involving choices between a smaller amount of money received immediately and a larger amount of money received later. Participants were also asked to reflect on their decision-making process. Compared to those aged 16-17 years and 22-25 years, participants aged 18-21 years had a higher level of gambling problems and decreased scores on lower levels of deliberative decision-making. Higher levels of urgency were associated with higher levels of gambling problems. The association was mediated by a lower level of deliberative decision-making and preference for an immediate/small reward. A distinct pathway was observed for lower levels of deliberative decision-making. Young people who tend to act rashly in response to extreme moods, had lower levels of deliberative decision-making, that in turn were positively related to gambling problems. This study highlights unique decision-making pathways through which urgency trait may operate, suggesting that those developing prevention and/or treatment strategies may want to consider the model's variables, including urgency, delay discounting, and deliberative decision-making

  17. Force Protection of Maritime Units: The Decision-Making Process of the Italian Navy - The Holistic Approach

    DTIC Science & Technology

    2006-09-25

    process. Incidentally, our approach is in line with two pieces of research that have been recently published in the Harvard Business Review : • the...decision making process • In line with research recently published in Harvard Business Review DECISION MAKING STYLES DECISIVE This decision style is...shifting situations. In public, this flexible style comes across as highly social and responsive. Source: Harvard Business Review , February 2006 issue

  18. Cervical spondylotic myelopathy: a review of surgical indications and decision making.

    PubMed Central

    Law, M. D.; Bernhardt, M.; White, A. A.

    1993-01-01

    Cervical spondylotic myelopathy (CSM) is frequently underdiagnosed and undertreated. The key to the initial diagnosis is a careful neurologic examination. The physical findings may be subtle, thus a high index of suspicion is helpful. Poor prognostic indicators and, therefore, absolute indications for surgery are: 1. Progression of signs and symptoms. 2. Presence of myelopathy for six months or longer. 3. Compression ratio approaching 0.4 or transverse area of the spinal cord of 40 square millimeters or less. Improvement is unusual with nonoperative treatment and almost all patients progressively worsen. Surgical intervention is the most predictable way to prevent neurologic deterioration. The recommended decompression is anterior when there is anterior compression at one or two levels and no significant developmental narrowing of the canal. For compression at more than two levels, developmental narrowing of the canal, posterior compression, and ossification of the posterior longitudinal ligament, we recommend posterior decompression. In order for posterior decompression to be effective there must be lordosis of the cervical spine. If kyphosis is present, anterior decompression is needed. Kyphosis associated with a developmentally narrow canal or posterior compression may require combined anterior and posterior approaches. Fusion is required for instability. Images Figure 1 PMID:8209553

  19. THE IMPACT OF BREAST MRI ON SURGICAL DECISION-MAKING: ARE PATIENTS AT RISK FOR MASTECTOMY?

    PubMed Central

    Pettit, Kelli; Swatske, Mary Ellen; Gao, Feng; Salavaggione, Lorena; Gillanders, William E.; Aft, Rebecca L.; Monsees, Barbara S.; Eberlein, Timothy J.; Margenthaler, Julie A.

    2014-01-01

    Background and Objectives The goal of the current study was to determine whether MRI impacts multidisciplinary treatment planning and if it leads to increased mastectomy rates. Methods A retrospective review was conducted of 441 patients treated for breast cancer between January 2005 and May 2008 who underwent breast MRI. Data included number of additional findings and their imaging and pathologic work-up. This was analyzed to determine impact of MRI on treatment planning. Results Of 441 patients, 45% had ≥1 additional finding on MRI. Of 410 patients with complete records, 29% had changes in the treatment plan, including 36 patients who were initially considered for breast conservation but proceeded directly to mastectomy based on MRI findings of suspected multicentricity. Twenty-three of those patients did not have a biopsy of the MRI lesion, with 87% having unicentric disease on final pathology. Overall, the mastectomy rate was 44%, which was significantly increased compared to patients not undergoing MRI (32%, p<0.05). Conclusions Breast MRI alters the treatment planning for many patients with newly-diagnosed breast cancer. Mastectomy rates are increased when MRI results alone direct surgical planning. Biopsy of MRI-identified lesions should be performed to avoid over-treatment. PMID:19757442

  20. Visual anticipation biases conscious decision making but not bottom-up visual processing

    PubMed Central

    Mathews, Zenon; Cetnarski, Ryszard; Verschure, Paul F. M. J.

    2015-01-01

    Prediction plays a key role in control of attention but it is not clear which aspects of prediction are most prominent in conscious experience. An evolving view on the brain is that it can be seen as a prediction machine that optimizes its ability to predict states of the world and the self through the top-down propagation of predictions and the bottom-up presentation of prediction errors. There are competing views though on whether prediction or prediction errors dominate the formation of conscious experience. Yet, the dynamic effects of prediction on perception, decision making and consciousness have been difficult to assess and to model. We propose a novel mathematical framework and a psychophysical paradigm that allows us to assess both the hierarchical structuring of perceptual consciousness, its content and the impact of predictions and/or errors on conscious experience, attention and decision-making. Using a displacement detection task combined with reverse correlation, we reveal signatures of the usage of prediction at three different levels of perceptual processing: bottom-up fast saccades, top-down driven slow saccades and consciousnes decisions. Our results suggest that the brain employs multiple parallel mechanism at different levels of perceptual processing in order to shape effective sensory consciousness within a predicted perceptual scene. We further observe that bottom-up sensory and top-down predictive processes can be dissociated through cognitive load. We propose a probabilistic data association model from dynamical systems theory to model the predictive multi-scale bias in perceptual processing that we observe and its role in the formation of conscious experience. We propose that these results support the hypothesis that consciousness provides a time-delayed description of a task that is used to prospectively optimize real time control structures, rather than being engaged in the real-time control of behavior itself. PMID:25741290

  1. Decision Making and Cancer

    PubMed Central

    Reyna, Valerie F.; Nelson, Wendy L.; Han, Paul K.; Pignone, Michael P.

    2014-01-01

    We review decision-making along the cancer continuum in the contemporary context of informed and shared decision making, in which patients are encouraged to take a more active role in their health care. We discuss challenges to achieving informed and shared decision making, including cognitive limitations and emotional factors, but argue that understanding the mechanisms of decision making offers hope for improving decision support. Theoretical approaches to decision making that explain cognition, emotion, and their interaction are described, including classical psychophysical approaches, dual-process approaches that focus on conflicts between emotion versus cognition (or reason), and modern integrative approaches such as fuzzy-trace theory. In contrast to the earlier emphasis on rote use of numerical detail, modern approaches emphasize understanding the bottom-line gist of options (which encompasses emotion and other influences on meaning) and retrieving relevant social and moral values to apply to those gist representations. Finally, research on interventions to support better decision making in clinical settings is reviewed, drawing out implications for future research on decision making and cancer. PMID:25730718

  2. Teacher Participation in the Decision-Making Process: Reality and Repercussions in Indian Higher Education

    ERIC Educational Resources Information Center

    Mehta, Deepa; Gardia, Alok; Rathore, H. C. S.

    2010-01-01

    The study reported here focused on comparing teachers' actual and desired participation in different decision-making situations and examined how participation in decision making differs in Indian higher educational institutions. The paper provides a comparison of findings with similar studies conducted in Western settings regarding the…

  3. Preferences and Utilities for Prostate Cancer Screening and Treatment: Assessment of the Underlying Decision Making Process

    DTIC Science & Technology

    2006-01-01

    STATEMENT Approved for Public Release; Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Prospect Theory (PT), with risk-attitudes, helps...the groups studied. Background: Expected Utility theory (EU) and its psychologically more accurate extension, Prospect Theory (PT), have...recently moved from the realm of economic decision making into healthcare decision making. These theories underlie several cost-utility analyses (CUA

  4. Elective surgical referral guidelines - background educational material or essential shared decision making tool? A survey of GPs' in England

    PubMed Central

    2011-01-01

    Background To investigate general practitioners' (GPs') attitudes to guidelines for elective surgical referral in England. To understand their use of guidelines, and attitudes to shared decision making in the referral decision. Methods A questionnaire was developed which investigated attitudes to and use of guidelines. It was given to a stratified random sample 30% (n = 310) drawn from GP lists of 10 English health districts (primary care trusts (PCTs)). GPs were invited to respond online, by telephone, fax or post. Data were analysed using descriptive statistics and backwards stepwise logistic regression. Results Responses were representative of GPs in England, but (despite up to 6 contacts per non-responder) the overall response rate was 41.6% (n = 129; with the range across PCTs of 25-61%). Most responding GPs indicated support for referral guidelines but 18% reported that they had never used them. Less than three per cent reported use for most or all referral decisions. The odds of using guidelines decreased with increasing age, with a ten year increase in age associated with halving odds of use (OR = 0.53, 95%CI = 0.29-0.90). Over 50% of GPs wanted good access to electronic guidelines with expert information and advice on guideline availability. Almost all (>89%) GPs agreed with sharing referral decisions with patients. Female doctors (OR = 5.2, 95%CI: 1.02-26.3) were more likely to agree with this than male GPs as were those working in larger compared to small or single handed practices (OR = 5.3, 95%CI: 1.4-19.9). Conclusions This group of responding GPs was supportive of guidelines but used them in different ways. Referral guidelines should have an educational component for background reading; include key messages for internalisation and application; and incorporate mechanisms to facilitate accessibility and appropriate shared decision making with patients. PMID:21878103

  5. Elective surgical referral guidelines--background educational material or essential shared decision making tool? A survey of GPs' in England.

    PubMed

    Blundell, Naomi; Taylor-Phillips, Sian; Spitzer, David; Martin, Steven; Forde, Ian; Clarke, Aileen

    2011-08-30

    To investigate general practitioners' (GPs') attitudes to guidelines for elective surgical referral in England. To understand their use of guidelines, and attitudes to shared decision making in the referral decision. A questionnaire was developed which investigated attitudes to and use of guidelines. It was given to a stratified random sample 30% (n = 310) drawn from GP lists of 10 English health districts (primary care trusts (PCTs)). GPs were invited to respond online, by telephone, fax or post. Data were analysed using descriptive statistics and backwards stepwise logistic regression. Responses were representative of GPs in England, but (despite up to 6 contacts per non-responder) the overall response rate was 41.6% (n = 129; with the range across PCTs of 25-61%). Most responding GPs indicated support for referral guidelines but 18% reported that they had never used them. Less than three per cent reported use for most or all referral decisions. The odds of using guidelines decreased with increasing age, with a ten year increase in age associated with halving odds of use (OR = 0.53, 95%CI = 0.29-0.90). Over 50% of GPs wanted good access to electronic guidelines with expert information and advice on guideline availability. Almost all (>89%) GPs agreed with sharing referral decisions with patients. Female doctors (OR = 5.2, 95%CI: 1.02-26.3) were more likely to agree with this than male GPs as were those working in larger compared to small or single handed practices (OR = 5.3, 95%CI: 1.4-19.9). This group of responding GPs was supportive of guidelines but used them in different ways. Referral guidelines should have an educational component for background reading; include key messages for internalisation and application; and incorporate mechanisms to facilitate accessibility and appropriate shared decision making with patients.

  6. Understanding the decision-making process for health promotion programming at small to midsized businesses.

    PubMed

    Hughes, M Courtney; Patrick, Donald L; Hannon, Peggy A; Harris, Jeffrey R; Ghosh, Donetta L

    2011-07-01

    This study explores the decision-making process for implementing and continuing health promotion programs at small to midsized businesses to inform health promotion practitioners and researchers as they market their services to these businesses. Qualitative interviews are conducted with 24 employers located in the Pacific Northwest ranging in size from 75 to 800 employees, with the majority having between 100 and 200 employees. Small to midsized employers depend most on company success-related factors rather than on humanitarian motives when deciding whether to adopt workplace health promotion programs. They rely heavily on health insurers for health promotion and desire more information about the actual costs and cost-benefits of programs. To increase health promotion adoption at small to midsized businesses, health promotion practitioners should appeal to overall company success-related factors, use the insurance channel, and target their information to both human resource personnel and senior management.

  7. Analytic hierarchy process as module for productivity evaluation and decision-making of the operation theater

    PubMed Central

    Ezzat, Abdelrahman E. M.; Hamoud, Hesham S.

    2016-01-01

    The analytic hierarchy process (AHP) is a theory of measurement through pairwise comparisons and relies on the judgments of experts to derive priority scales, these scales that measure intangibles in relative terms. The aim of the article was to develop a model for productivity measurement of the operation theater (OT), which could be applied as a model for quality improvement and decision-making. AHP is used in this article to evolve such a model. The steps consist of identifying the critical success factors for measuring the productivity of OT, identifying subfactors that inflauence the critical factors, comparing the pairwise, deriving their relative importance and ratings, and calculating the cumulative effect according to the attributes in OT. The cumulative productivitycan be calculated by the end and can be compared Ideal productivity to measure the productive of OT in percentage fraction. Hence, the productivity could be calculated. Hence, AHP is a very useful model to measure the productivity in OT. PMID:26955599

  8. Analytic hierarchy process as module for productivity evaluation and decision-making of the operation theater.

    PubMed

    Ezzat, Abdelrahman E M; Hamoud, Hesham S

    2016-01-01

    The analytic hierarchy process (AHP) is a theory of measurement through pairwise comparisons and relies on the judgments of experts to derive priority scales, these scales that measure intangibles in relative terms. The aim of the article was to develop a model for productivity measurement of the operation theater (OT), which could be applied as a model for quality improvement and decision-making. AHP is used in this article to evolve such a model. The steps consist of identifying the critical success factors for measuring the productivity of OT, identifying subfactors that inflauence the critical factors, comparing the pairwise, deriving their relative importance and ratings, and calculating the cumulative effect according to the attributes in OT. The cumulative productivitycan be calculated by the end and can be compared Ideal productivity to measure the productive of OT in percentage fraction. Hence, the productivity could be calculated. Hence, AHP is a very useful model to measure the productivity in OT.

  9. Life cycle assessment in management, product and process design, and policy decision making: a conference report.

    PubMed

    Cooper, Joyce; Vigon, Bruce; Curran, Mary Ann; Franklin, Bill

    2005-01-01

    On 24 September 2003, life cycle assessment (LCA) practitioners and decision makers gathered at the InLCA/LCM Conference in Seattle, Washington, USA (see http://www.lcacenter.org/InLCA-LCM03/index.html) to discuss the role of LCA in management, product design, process development, and regulatory/policy development decisions and to compare life cycle-based methods and tools with traditional product evaluation methods and tools. This article is a summary of that meeting and was prepared by the organizers as an overview of the many different technical, regulatory policy, and decision-making policy perspectives presented to an international gathering of participants representing academia and the industrial and regulatory communities.

  10. Group decision making with the analytic hierarchy process in benefit-risk assessment: a tutorial.

    PubMed

    Hummel, J Marjan; Bridges, John F P; IJzerman, Maarten J

    2014-01-01

    The analytic hierarchy process (AHP) has been increasingly applied as a technique for multi-criteria decision analysis in healthcare. The AHP can aid decision makers in selecting the most valuable technology for patients, while taking into account multiple, and even conflicting, decision criteria. This tutorial illustrates the procedural steps of the AHP in supporting group decision making about new healthcare technology, including (1) identifying the decision goal, decision criteria, and alternative healthcare technologies to compare, (2) structuring the decision criteria, (3) judging the value of the alternative technologies on each decision criterion, (4) judging the importance of the decision criteria, (5) calculating group judgments, (6) analyzing the inconsistency in judgments, (7) calculating the overall value of the technologies, and (8) conducting sensitivity analyses. The AHP is illustrated via a hypothetical example, adapted from an empirical AHP analysis on the benefits and risks of tissue regeneration to repair small cartilage lesions in the knee.

  11. Health professionals' perceptions about the decision-making process in the care of pediatric patients.

    PubMed

    Trotta, Eliana de Andrade; Scarpa, Fernanda Cristina; Halal, Michel George El; Goldim, José Roberto; Carvalho, Paulo Roberto Antonacci

    2016-09-01

    To evaluate the perceptions of physicians, nurses and nursing technicians of their participation in the decision-making process surrounding life support limitation in terminally ill pediatric patients, with comparisons by professional category. A cross-sectional study was conducted in the pediatric intensive care unit of a tertiary public university hospital with the participation of physicians, nurses and nursing technicians. The MacArthur Admission Experience Survey Voice Scale was used to assess and quantify the perceptions of professionals who assisted 17 pediatric patients with life support limitation within 24 hours after the outcome of each patient was determined. All professionals working in the unit (n = 117) who were potentially eligible for the study received a free and informed consent form prior to the occurrence of the cases studied. Study participants included 25/40 (62.5%) physicians, 10/17 (58.8%) nurses and 41/60 (68.3%) nursing technicians, representing 65% of the eligible professionals identified. The questionnaire return rate was higher for physicians than technicians (p = 0.0258). A perceived lack of voice was reported in all three professional categories at varying rates that were lower for physicians than for nurses and nursing technicians (p < 0.00001); there was no difference between the latter (p = 0.7016). In the three professional categories studied, three subscale items were reported. For two of the three statements, there were significant differences between physicians and nurses (p = 0.004) and between physicians and nursing technicians (p = 0.001). For one of the statements, there was no difference among the three professional categories. Respondents perceived a lack of voice in the decision-making process at varying rates across the three categories of studied professionals who assisted terminally ill pediatric patients with life support limitation, with physicians expressing lowered rates of perceived coercion.

  12. Health professionals' perceptions about the decision-making process in the care of pediatric patients

    PubMed Central

    Trotta, Eliana de Andrade; Scarpa, Fernanda Cristina; Halal, Michel George El; Goldim, José Roberto; Carvalho, Paulo Roberto Antonacci

    2016-01-01

    Objective To evaluate the perceptions of physicians, nurses and nursing technicians of their participation in the decision-making process surrounding life support limitation in terminally ill pediatric patients, with comparisons by professional category. Methods A cross-sectional study was conducted in the pediatric intensive care unit of a tertiary public university hospital with the participation of physicians, nurses and nursing technicians. The MacArthur Admission Experience Survey Voice Scale was used to assess and quantify the perceptions of professionals who assisted 17 pediatric patients with life support limitation within 24 hours after the outcome of each patient was determined. All professionals working in the unit (n = 117) who were potentially eligible for the study received a free and informed consent form prior to the occurrence of the cases studied. Results Study participants included 25/40 (62.5%) physicians, 10/17 (58.8%) nurses and 41/60 (68.3%) nursing technicians, representing 65% of the eligible professionals identified. The questionnaire return rate was higher for physicians than technicians (p = 0.0258). A perceived lack of voice was reported in all three professional categories at varying rates that were lower for physicians than for nurses and nursing technicians (p < 0.00001); there was no difference between the latter (p = 0.7016). In the three professional categories studied, three subscale items were reported. For two of the three statements, there were significant differences between physicians and nurses (p = 0.004) and between physicians and nursing technicians (p = 0.001). For one of the statements, there was no difference among the three professional categories. Conclusion Respondents perceived a lack of voice in the decision-making process at varying rates across the three categories of studied professionals who assisted terminally ill pediatric patients with life support limitation, with physicians expressing lowered rates of

  13. Cancer treatment decision-making processes for older patients with complex needs: a qualitative study

    PubMed Central

    Hughes, Jane; Farrington, Naomi; Richardson, Alison

    2015-01-01

    Objectives Although older people can experience complex health and social care needs alongside a primary cancer diagnosis, little is understood about how cancer treatment decisions are made for this population. This study aimed to investigate how cancer treatment decisions are formulated for older people with complex health and social care needs and the factors that shape these processes. Design Qualitative study involving semistructured interviews and non-participant observations. Framework approach used for data analysis. Setting Breast and colorectal cancer services in five English NHS hospital trusts. Participants Interviews: purposive sample of 22 clinicians directly involved in a face-to-face clinical role with patients regarding cancer treatment and care, maximising variation across clinical roles, tumour types and trusts. Observations: purposive sample of five cancer multidisciplinary meetings, maximising variation across location, team size and tumour type. Results The initial stages of cancer treatment decision-making are team-based, medically dominated and focused on the cancer. For patients with complex health and social care needs that extend beyond cancer pathology, later and less visible stages in the decision-making process are more haphazard and may result in less effective and workable treatment plans, as individual clinicians struggle to devise and deliver these plans without breaching time-based targets. Conclusions Service targets that focus resources solely on the presenting disease can disadvantage older patients with complex health and social care needs that extend beyond this primary diagnosis. Care should be taken to ensure time-based targets do not disincentivise thorough and timely assessment that can lead to the formulation of treatment plans tailored to individual needs and circumstances. PMID:26667015

  14. The neural processes underlying perceptual decision making in humans: recent progress and future directions.

    PubMed

    Kelly, Simon P; O'Connell, Redmond G

    2015-01-01

    In the last two decades, animal neurophysiology research has made great strides towards explaining how the brain can enable adaptive action in the face of noisy sensory information. In particular, this work has identified neural signals that perform the role of a 'decision variable' which integrates sensory information in favor of a particular outcome up to an action-triggering threshold, consistent with long-standing predictions from mathematical psychology. This has provoked an intensive search for similar neural processes at work in the human brain. In this paper we review the progress that has been made in tracing the dynamics of perceptual decision formation in humans using functional imaging and electrophysiology. We highlight some of the limitations that non-invasive recording techniques place on our ability to make definitive judgments regarding the role that specific signals play in decision making. Finally, we provide an overview of our own work in this area which has focussed on two perceptual tasks - intensity change detection and motion discrimination - performed under continuous-monitoring conditions, and highlight the insights gained thus far. We show that through simple paradigm design features such as avoiding sudden intensity transients at evidence onset, a neural instantiation of the theoretical decision variable can be directly traced in the form of a centro-parietal positivity (CPP) in the standard event-related potential (ERP). We recapitulate evidence for the domain-general nature of the CPP process, being divorced from the sensory and motor requirements of the task, and re-plot data of both tasks highlighting this aspect as well as its relationship to decision outcome and reaction time. We discuss the implications of these findings for mechanistically principled research on normal and abnormal decision making in humans.

  15. Adolescent and Young Women's Contraceptive Decision-Making Processes: Choosing "The Best Method for Her".

    PubMed

    Melo, Juliana; Peters, Marissa; Teal, Stephanie; Guiahi, Maryam

    2015-08-01

    To evaluate influences on adolescent and young women's contraceptive decision-making processes. We conducted 21 individual interviews with women who presented to an adolescent-focused Title X family planning clinic seeking a new contraceptive method. Data were collected using a semi-structured interview guide, audio-taped and transcribed. Three researchers independently coded the transcripts using grounded theory; codes were organized into overarching themes and discrepancies were resolved. After identification of themes, we organized the conceptual framework of the decision-making process using the transtheoretical model of behavior change in which participants move through 4 stages: (1) contemplation, (2) preparation, (3) action, and (4) maintenance. When contemplating contraception, most of our participants were highly motivated to avoid pregnancy. During preparation, participants gathered information related to their contraceptive concerns. Participants cited peers as primary informants and healthcare providers as experts in the field. Participants integrated information received with their personal concerns about contraception initiation; the most common concerns were effectiveness, method duration, convenience, and side effects. When participants acted on choosing a contraceptive method they described how it fit their individual needs. They considered their contraceptive experiences unique and not necessarily applicable to others. During maintenance, they acted as informants for other peers, but most commonly expressed that each individual must choose "the best method for her." When adolescent and young women select a contraceptive method they balance the benefits and risks of available methods portrayed by peers and provider in the context of their personal concerns. Peer influence appeared to be greatest when participants shared contraceptive concerns and goals. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by

  16. 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

  17. Mothers' involvement in decision making during the birthing process: a quantitative analysis of women's online birth stories.

    PubMed

    Bylund, Carma L

    2005-01-01

    This article reports on a study of 551 women's birth stories that were posted on a birth stories Web site. These online stories were analyzed for the communication and decision making that takes place between patients and clinicians during the birthing process. In more than half of the stories, the women wrote about at least 1 decision that was made. Further analyses were performed on the 285 stories in which decisions were made. According to this analysis, overall, women were involved in decision making about 57% of the time. The most frequent decision was about painkillers. Making decisions about painkillers and having a midwife as a primary clinician predicted a woman's increased involvement in decision making. Women's involvement in decision making correlated positively with the use of positive emotion words and negatively with the use of negative emotion words in the online birth stories.

  18. How Effective Is a Virtual Consultation Process in Facilitating Multidisciplinary Decision-Making for Malignant Epidural Spinal Cord Compression?

    SciTech Connect

    Fitzpatrick, David; Grabarz, Daniel; Wang, Lisa; Bezjak, Andrea; Fehlings, Michael G.; Fosker, Christopher; Rampersaud, Raja; Wong, Rebecca K.S.

    2012-10-01

    Purpose: The purpose of this study was to assess the accuracy of a virtual consultation (VC) process in determining treatment strategy for patients with malignant epidural spinal cord compression (MESCC). Methods and Materials: A prospective clinical database was maintained for patients with MESCC. A virtual consultation process (involving exchange of key predetermined clinical information and diagnostic imaging) facilitated rapid decision-making between oncologists and spinal surgeons. Diagnostic imaging was reviewed retrospectively (by R.R.) for surgical opinions in all patients. The primary outcome was the accuracy of virtual consultation opinion in predicting the final treatment recommendation. Results: After excluding 20 patients who were referred directly to the spinal surgeon, 125 patients were eligible for virtual consultation. Of the 46 patients who had a VC, surgery was recommended in 28 patients and actually given to 23. A retrospective review revealed that 5/79 patients who did not have a VC would have been considered surgical candidates. The overall accuracy of the virtual consultation process was estimated at 92%. Conclusion: The VC process for MESCC patients provides a reliable means of arriving at a multidisciplinary opinion while minimizing patient transfer. This can potentially shorten treatment decision time and enhance clinical outcomes.

  19. Patchy ‘coherence’: using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC)

    PubMed Central

    2013-01-01

    Background Implementing shared decision making into routine practice is proving difficult, despite considerable interest from policy-makers, and is far more complex than merely making decision support interventions available to patients. Few have reported successful implementation beyond research studies. MAking Good Decisions In Collaboration (MAGIC) is a multi-faceted implementation program, commissioned by The Health Foundation (UK), to examine how best to put shared decision making into routine practice. In this paper, we investigate healthcare professionals’ perspectives on implementing shared decision making during the MAGIC program, to examine the work required to implement shared decision making and to inform future efforts. Methods The MAGIC program approached implementation of shared decision making by initiating a range of interventions including: providing workshops; facilitating development of brief decision support tools (Option Grids); initiating a patient activation campaign (‘Ask 3 Questions’); gathering feedback using Decision Quality Measures; providing clinical leads meetings, learning events, and feedback sessions; and obtaining executive board level support. At 9 and 15 months (May and November 2011), two rounds of semi-structured interviews were conducted with healthcare professionals in three secondary care teams to explore views on the impact of these interventions. Interview data were coded by two reviewers using a framework derived from the Normalization Process Theory. Results A total of 54 interviews were completed with 31 healthcare professionals. Partial implementation of shared decision making could be explained using the four components of the Normalization Process Theory: ‘coherence,’ ‘cognitive participation,’ ‘collective action,’ and ‘reflexive monitoring.’ Shared decision making was integrated into routine practice when clinical teams shared coherent views of role and purpose (‘coherence’). Shared

  20. Patchy 'coherence': using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC).

    PubMed

    Lloyd, Amy; Joseph-Williams, Natalie; Edwards, Adrian; Rix, Andrew; Elwyn, Glyn

    2013-09-05

    Implementing shared decision making into routine practice is proving difficult, despite considerable interest from policy-makers, and is far more complex than merely making decision support interventions available to patients. Few have reported successful implementation beyond research studies. MAking Good Decisions In Collaboration (MAGIC) is a multi-faceted implementation program, commissioned by The Health Foundation (UK), to examine how best to put shared decision making into routine practice. In this paper, we investigate healthcare professionals' perspectives on implementing shared decision making during the MAGIC program, to examine the work required to implement shared decision making and to inform future efforts. The MAGIC program approached implementation of shared decision making by initiating a range of interventions including: providing workshops; facilitating development of brief decision support tools (Option Grids); initiating a patient activation campaign ('Ask 3 Questions'); gathering feedback using Decision Quality Measures; providing clinical leads meetings, learning events, and feedback sessions; and obtaining executive board level support. At 9 and 15 months (May and November 2011), two rounds of semi-structured interviews were conducted with healthcare professionals in three secondary care teams to explore views on the impact of these interventions. Interview data were coded by two reviewers using a framework derived from the Normalization Process Theory. A total of 54 interviews were completed with 31 healthcare professionals. Partial implementation of shared decision making could be explained using the four components of the Normalization Process Theory: 'coherence,' 'cognitive participation,' 'collective action,' and 'reflexive monitoring.' Shared decision making was integrated into routine practice when clinical teams shared coherent views of role and purpose ('coherence'). Shared decision making was facilitated when teams engaged in

  1. Individual behavioral and neurochemical markers of unadapted decision-making processes in healthy inbred mice.

    PubMed

    Pittaras, Elsa; Callebert, Jacques; Chennaoui, Mounir; Rabat, Arnaud; Granon, Sylvie

    2016-12-01

    One of the hallmarks of decision-making processes is the inter-individual variability between healthy subjects. These behavioral patterns could constitute risk factors for the development of psychiatric disorders. Therefore, finding predictive markers of safe or risky decision-making is an important challenge for psychiatry research. We set up a mouse gambling task (MGT)-adapted from the human Iowa gambling task with uncertain contingencies between response and outcome that furthermore enables the emergence of inter-individual differences. Mice (n = 54) were further individually characterized for locomotive, emotional and cognitive behavior. Individual basal rates of monoamines and brain activation after the MGT were assessed in brain regions related to reward, emotion or cognition. In a large healthy mice population, 44 % showed a balanced strategy with limited risk-taking and flexible choices, 29 % showed a safe but rigid strategy, while 27 % adopted risky behavior. Risky mice took also more risks in other apparatus behavioral devices and were less sensitive to reward. No difference existed between groups regarding anxiety, working memory, locomotion and impulsivity. Safe/rigid mice exhibited a hypoactivation of prefrontal subareas, a high level of serotonin in the orbitofrontal cortex combined with a low level of dopamine in the putamen that predicted the emergence of rigid behavior. By contrast, high levels of dopamine, serotonin and noradrenalin in the hippocampus predicted the emergence of more exploratory and risky behaviors. The coping of C57bl/6J mice in MGT enables the determination of extreme patterns of choices either safe/rigid or risky/flexible, related to specific neurochemical and behavioral markers.

  2. How Accumulated Real Life Stress Experience and Cognitive Speed Interact on Decision-Making Processes.

    PubMed

    Friedel, Eva; Sebold, Miriam; Kuitunen-Paul, Sören; Nebe, Stephan; Veer, Ilya M; Zimmermann, Ulrich S; Schlagenhauf, Florian; Smolka, Michael N; Rapp, Michael; Walter, Henrik; Heinz, Andreas

    2017-01-01

    Rationale: Advances in neurocomputational modeling suggest that valuation systems for goal-directed (deliberative) on one side, and habitual (automatic) decision-making on the other side may rely on distinct computational strategies for reinforcement learning, namely model-free vs. model-based learning. As a key theoretical difference, the model-based system strongly demands cognitive functions to plan actions prospectively based on an internal cognitive model of the environment, whereas valuation in the model-free system relies on rather simple learning rules from operant conditioning to retrospectively associate actions with their outcomes and is thus cognitively less demanding. Acute stress reactivity is known to impair model-based but not model-free choice behavior, with higher working memory capacity protecting the model-based system from acute stress. However, it is not clear which impact accumulated real life stress has on model-free and model-based decision systems and how this influence interacts with cognitive abilities. Methods: We used a sequential decision-making task distinguishing relative contributions of both learning strategies to choice behavior, the Social Readjustment Rating Scale questionnaire to assess accumulated real life stress, and the Digit Symbol Substitution Test to test cognitive speed in 95 healthy subjects. Results: Individuals reporting high stress exposure who had low cognitive speed showed reduced model-based but increased model-free behavioral control. In contrast, subjects exposed to accumulated real life stress with high cognitive speed displayed increased model-based performance but reduced model-free control. Conclusion: These findings suggest that accumulated real life stress exposure can enhance reliance on cognitive speed for model-based computations, which may ultimately protect the model-based system from the detrimental influences of accumulated real life stress. The combination of accumulated real life stress exposure

  3. Family practitioners' diagnostic decision-making processes regarding patients with respiratory tract infections: an observational study.

    PubMed

    Fischer, Thomas; Fischer, Susanne; Himmel, Wolfgang; Kochen, Michael M; Hummers-Pradier, Eva

    2008-01-01

    The influence of patient characteristics on family practitioners' (FPs') diagnostic decision making has mainly been investigated using indirect methods such as vignettes or questionnaires. Direct observation-borrowed from social and cultural anthropology-may be an alternative method for describing FPs' real-life behavior and may help in gaining insight into how FPs diagnose respiratory tract infections, which are frequent in primary care. To clarify FPs' diagnostic processes when treating patients suffering from symptoms of respiratory tract infection. This direct observation study was performed in 30 family practices using a checklist for patient complaints, history taking, physical examination, and diagnoses. The influence of patients' symptoms and complaints on the FPs' physical examination and diagnosis was calculated by logistic regression analyses. Dummy variables based on combinations of symptoms and complaints were constructed and tested against saturated (full) and backward regression models. In total, 273 patients (median age 37 years, 51% women) were included. The median number of symptoms described was 4 per patient, and most information was provided at the patients' own initiative. Multiple logistic regression analysis showed a strong association between patients' complaints and the physical examination. Frequent diagnoses were upper respiratory tract infection (URTI)/common cold (43%), bronchitis (26%), sinusitis (12%), and tonsillitis (11%). There were no significant statistical differences between "simple heuristic'' models and saturated regression models in the diagnoses of bronchitis, sinusitis, and tonsillitis, indicating that simple heuristics are probably used by the FPs, whereas "URTI/common cold'' was better explained by the full model. FPs tended to make their diagnosis based on a few patient symptoms and a limited physical examination. Simple heuristic models were almost as powerful in explaining most diagnoses as saturated models. Direct

  4. Stochastic transitions between neural states in taste processing and decision-making.

    PubMed

    Miller, Paul; Katz, Donald B

    2010-02-17

    Noise, which is ubiquitous in the nervous system, causes trial-to-trial variability in the neural responses to stimuli. This neural variability is in turn a likely source of behavioral variability. Using Hidden Markov modeling, a method of analysis that can make use of such trial-to-trial response variability, we have uncovered sequences of discrete states of neural activity in gustatory cortex during taste processing. Here, we advance our understanding of these patterns in two ways. First, we reproduce the experimental findings in a formal model, describing a network that evinces sharp transitions between discrete states that are deterministically stable given sufficient noise in the network; as in the empirical data, the transitions occur at variable times across trials, but the stimulus-specific sequence is itself reliable. Second, we demonstrate that such noise-induced transitions between discrete states can be computationally advantageous in a reduced, decision-making network. The reduced network produces binary outputs, which represent classification of ingested substances as palatable or nonpalatable, and the corresponding behavioral responses of "spit" or "swallow". We evaluate the performance of the network by measuring how reliably its outputs follow small biases in the strengths of its inputs. We compare two modes of operation: deterministic integration ("ramping") versus stochastic decision-making ("jumping"), the latter of which relies on state-to-state transitions. We find that the stochastic mode of operation can be optimal under typical levels of internal noise and that, within this mode, addition of random noise to each input can improve optimal performance when decisions must be made in limited time.

  5. Teaching ethics to engineers: ethical decision making parallels the engineering design process.

    PubMed

    Bero, Bridget; Kuhlman, Alana

    2011-09-01

    In order to fulfill ABET requirements, Northern Arizona University's Civil and Environmental engineering programs incorporate professional ethics in several of its engineering courses. This paper discusses an ethics module in a 3rd year engineering design course that focuses on the design process and technical writing. Engineering students early in their student careers generally possess good black/white critical thinking skills on technical issues. Engineering design is the first time students are exposed to "grey" or multiple possible solution technical problems. To identify and solve these problems, the engineering design process is used. Ethical problems are also "grey" problems and present similar challenges to students. Students need a practical tool for solving these ethical problems. The step-wise engineering design process was used as a model to demonstrate a similar process for ethical situations. The ethical decision making process of Martin and Schinzinger was adapted for parallelism to the design process and presented to students as a step-wise technique for identification of the pertinent ethical issues, relevant moral theories, possible outcomes and a final decision. Students had greatest difficulty identifying the broader, global issues presented in an ethical situation, but by the end of the module, were better able to not only identify the broader issues, but also to more comprehensively assess specific issues, generate solutions and a desired response to the issue.

  6. Decision Making Under Objective Risk Conditions-a Review of Cognitive and Emotional Correlates, Strategies, Feedback Processing, and External Influences.

    PubMed

    Schiebener, Johannes; Brand, Matthias

    2015-06-01

    While making decisions under objective risk conditions, the probabilities of the consequences of the available options are either provided or calculable. Brand et al. (Neural Networks 19:1266-1276, 2006) introduced a model describing the neuro-cognitive processes involved in such decisions. In this model, executive functions associated with activity in the fronto-striatal loop are important for developing and applying decision-making strategies, and for verifying, adapting, or revising strategies according to feedback. Emotional rewards and punishments learned from such feedback accompany these processes. In this literature review, we found support for the role of executive functions, but also found evidence for the importance of further cognitive abilities in decision making. Moreover, in addition to reflective processing (driven by cognition), decisions can be guided by impulsive processing (driven by anticipation of emotional reward and punishment). Reflective and impulsive processing may interact during decision making, affecting the evaluation of available options, as both processes are affected by feedback. Decision-making processes are furthermore modulated by individual attributes (e.g., age), and external influences (e.g., stressors). Accordingly, we suggest a revised model of decision making under objective risk conditions.

  7. A software tool to assist business-process decision-making in the biopharmaceutical industry.

    PubMed

    Mustafa, Mustafa A; Washbrook, John; Lim, Ai Chye; Zhou, Yuhong; Titchener-Hooker, Nigel J; Morton, Philip; Berezenko, Steve; Farid, Suzanne S

    2004-01-01

    Conventionally, software tools for the design of bioprocesses have provided only limited business-related information for decision-making. There is an industrial need to investigate manufacturing options and to gauge the impact of various decisions from economic as well as process perspectives. This paper describes the development and use of a tool to provide an assessment of whole flowsheets by capturing both process and business aspects. The tool is demonstrated by considering the issues concerned when making decisions between two potential flowsheets for a common product. A case study approach is used to compare the process and business benefits of a conventional process route employing packed chromatography beds and an alternative that uses expanded bed adsorption (EBA). The tool allows direct evaluation of the benefits of capital cost reduction and increased yield offered by EBA against penalties of using potentially more expensive EBA matrix with lower lifetimes. Furthermore, the tool provides the ability to gauge the process robustness of each flowsheet option.

  8. 14 CFR § 1216.303 - NEPA process in NASA planning and decision making.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... ADMINISTRATION ENVIRONMENTAL QUALITY Subpart 1216.3 Procedures for Implementing the National Environmental Policy... systematic examination of the environmental consequences of implementing a proposed Agency action. Full... that: (1) Planning and decision making support NASA's strategic plan commitment to sustainability...

  9. The application of fuzzy decision-making in geochemical data processing

    NASA Astrophysics Data System (ADS)

    Zhou, Lili; Song, Liangtu; Liu, Lei; Wu, Yue

    2017-03-01

    Fuzzy similarity ratio method is a widely used method of fuzzy decision-making, not only to classification, but also to sort. In this paper, we constructed a geochemical anomaly evaluation model using the Fuzzy similarity ratio method; we also program it with C# language and applied the model to practical work. Practice has proved that the fuzzy decision-making applies to the evaluation of geochemical anomalies can effectively improve the accuracy of the evaluation.

  10. Graphics Processing Unit-Based Bioheat Simulation to Facilitate Rapid Decision Making Associated with Cryosurgery Training.

    PubMed

    Keelan, Robert; Zhang, Hong; Shimada, Kenji; Rabin, Yoed

    2016-04-01

    This study focuses on the implementation of an efficient numerical technique for cryosurgery simulations on a graphics processing unit as an alternative means to accelerate runtime. This study is part of an ongoing effort to develop computerized training tools for cryosurgery, with prostate cryosurgery as a developmental model. The ability to perform rapid simulations of various test cases is critical to facilitate sound decision making associated with medical training. Consistent with clinical practice, the training tool aims at correlating the frozen region contour and the corresponding temperature field with the target region shape. The current study focuses on the feasibility of graphics processing unit-based computation using C++ accelerated massive parallelism, as one possible implementation. Benchmark results on a variety of computation platforms display between 3-fold acceleration (laptop) and 13-fold acceleration (gaming computer) of cryosurgery simulation, in comparison with the more common implementation on a multicore central processing unit. While the general concept of graphics processing unit-based simulations is not new, its application to phase-change problems, combined with the unique requirements for cryosurgery optimization, represents the core contribution of the current study. © The Author(s) 2015.

  11. The decision-making process for breast reconstruction after cancer surgery: Representations of heterosexual couples in long-standing relationships.

    PubMed

    Fasse, Léonor; Flahault, Cécile; Vioulac, Christel; Lamore, Kristopher; Van Wersch, Anna; Quintard, Bruno; Untas, Aurélie

    2017-05-01

    Most people deal with intrusive life events such as cancer and the care trajectory together with their intimate partners. To our knowledge, no research has studied the involvement of the partner in the decision-making process regarding breast reconstruction (BR) after cancer. This study aimed to gain a better understanding of the couples' decision-making process for BR in the cancer context and particularly to investigate the partners' involvement in this process. Eighteen participants (nine women who underwent a mastectomy following a first breast cancer and their intimate partners) took part in this study. We conducted semidirective interviews, and a general inductive approach was chosen to capture the representations of the couples. The women in the sample were aged between 33 and 66 years (M = 54, SD = 7.5) and their partner between 40 and 76 years (M = 59, SD = 11.6). The duration of their intimate relationship was on average 18 years (SD = 10.4; minimum = 4; maximum = 33). The analysis revealed 11 major themes. The two most salient ones were 'external influence' and 'implication of the partner'. The exploration of the subthemes revealed that the decision-making process is often reported as an interrelated experience by the couples and as a dyadic stressor. The partner's role is depicted as consultative and mostly supportive. These results provide new insights on the involvement of the partner in decision-making. Thus, it now seems crucial to develop a prospective study, which will help understand the progression of the decision-making process over time. Statement of contribution What is already known on this subject? Most people deal with intrusive life events such as cancer and the care trajectory together with their intimate partners. Shared decision-making between patients and physicians is now the 'gold standard' in Western Europe and the United States. However, in the context of breast reconstruction (BR) after cancer, factors guiding

  12. [Alterations in the decision making processes linked to the ventromedial prefrontal cortex in drug-abusing patients].

    PubMed

    Verdejo, A; Aguilar de Arcos, F; Pérez García, M

    The somatic marker hypothesis proposes that somatic signals guide the decision making processes in an adaptive sense for the organism. The processing of these somatic signals is linked to the ventromedial prefrontal cortex activity. The influence of somatic markers on decision making processes has been studied by means of the 'gambling task' (GT). Several studies using the GT in substance abusers have showed the existence of decision making impairments in these patients. To examine the performance in the GT of a Spanish sample of substance abusers; and to study the influence of clinically relevant variables: type of substance, years of abuse and abstinence period on GT performance. 106 substance abusers patients during the dishabituation phase participated in the study. We administered a computerized version of the GT in a single individual session. We used descriptive analyses to study the patients' performance in the GT. Next we carried out multiple regression analyses to study the influence of the clinical variables on the GT performance. A 76.4% of the sample patients showed impairments in the decision making processes measured by the GT. None of the clinical variables significantly predicted performance in the task. These results suggest the existence of decision making impairments in substance abusers that may be related to pre morbid alterations, or to a neurotoxic effect of drugs of abuse on the activity of the ventromedial prefrontal cortex.

  13. Physics of the Mind:. Opinion Dynamics and Decision Making Processes Based on a Binary Network Model

    NASA Astrophysics Data System (ADS)

    Kusmartsev, F. V.; Kürten, Karl E.

    2009-12-01

    We propose a new theory of the human mind. The formation of human mind is considered as a collective process of the mutual interaction of people via exchange of opinions and formation of collective decisions. We investigate the associated dynamical processes of the decision making when people are put in different conditions including risk situations in natural catastrophes when the decision must be made very fast or at national elections. We also investigate conditions at which the fast formation of opinion is arising as a result of open discussions or public vote. Under a risk condition the system is very close to chaos and therefore the opinion formation is related to the order disorder transition. We study dramatic changes which may happen with societies which in physical terms may be considered as phase transitions from ordered to chaotic behavior. Our results are applicable to changes which are arising in various social networks as well as in opinion formation arising as a result of open discussions. One focus of this study is the determination of critical parameters, which influence a formation of stable mind, public opinion and where the society is placed "at the edge of chaos". We show that social networks have both, the necessary stability and the potential for evolutionary improvements or self-destruction. We also show that the time needed for a discussion to take a proper decision depends crucially on the nature of the interactions between the entities as well as on the topology of the social networks.

  14. Physics of the Mind:. Opinion Dynamics and Decision Making Processes Based on a Binary Network Model

    NASA Astrophysics Data System (ADS)

    Kusmartsev, F. V.; Kürten, Karl E.

    We propose a new theory of the human mind. The formation of human mind is considered as a collective process of the mutual interaction of people via exchange of opinions and formation of collective decisions. We investigate the associated dynamical processes of the decision making when people are put in different conditions including risk situations in natural catastrophes when the decision must be made very fast or at national elections. We also investigate conditions at which the fast formation of opinion is arising as a result of open discussions or public vote. Under a risk condition the system is very close to chaos and therefore the opinion formation is related to the order disorder transition. We study dramatic changes which may happen with societies which in physical terms may be considered as phase transitions from ordered to chaotic behavior. Our results are applicable to changes which are arising in various social networks as well as in opinion formation arising as a result of open discussions. One focus of this study is the determination of critical parameters, which influence a formation of stable mind, public opinion and where the society is placed “at the edge of chaos”. We show that social networks have both, the necessary stability and the potential for evolutionary improvements or self-destruction. We also show that the time needed for a discussion to take a proper decision depends crucially on the nature of the interactions between the entities as well as on the topology of the social networks.

  15. The cognitive processes underlying affective decision-making predicting adolescent smoking behaviors in a longitudinal study

    PubMed Central

    Xiao, Lin; Koritzky, Gilly; Johnson, C. Anderson; Bechara, Antoine

    2013-01-01

    This study investigates the relationship between three different cognitive processes underlying the Iowa Gambling Task (IGT) and adolescent smoking behaviors in a longitudinal study. We conducted a longitudinal study of 181 Chinese adolescents in Chengdu City, China. The participants were followed from 10th to 11th grade. When they were in the 10th grade (Time 1), we tested these adolescents' decision-making using the IGT and working memory capacity using the Self-ordered Pointing Test (SOPT). Self-report questionnaires were used to assess school academic performance and smoking behaviors. The same questionnaires were completed again at the 1-year follow-up (Time 2). The Expectancy-Valence (EV) Model was applied to distill the IGT performance into three different underlying psychological components: (i) a motivational component which indicates the subjective weight the adolescents assign to gains vs. losses; (ii) a learning-rate component which indicates the sensitivity to recent outcomes vs. past experiences; and (iii) a response component which indicates how consistent the adolescents are between learning and responding. The subjective weight to gains vs. losses at Time 1 significantly predicted current smokers and current smoking levels at Time 2, controlling for demographic variables and baseline smoking behaviors. Therefore, by decomposing the IGT into three different psychological components, we found that the motivational process of weight gain vs. losses may serve as a neuropsychological marker to predict adolescent smoking behaviors in a general youth population. PMID:24101911

  16. The possible impact of the German DRGs reimbursement system on end-of-life decision making in a surgical intensive care unit.

    PubMed

    Stachura, Peter; Oberender, Peter; Bundscherer, Anika C; Wiese, Christoph H R

    2015-02-01

    More than 70 % of critically ill patients die in intensive care units (ICUs) after treatment is reduced. End-of-life decision making in the ICU is a grey area that varies in practice, and there are potential economic consequences of over- and under-treatment. The aim of this study was to describe the end-of-life decisions of critically ill patients in a surgical ICU in Germany and to identify how financial incentives may influence decision making. Data on the admission diagnosis, end-of-life decision making and cause of death were obtained for 69 critically ill patients who died in the ICU (Hospital of Bayreuth, Germany) in 2009. A cost-revenue analysis was conducted on the 46 patients who did not die within 3 days of ICU admission. Because we lacked real data on costs, our analysis was based on the average cost for each diagnosis-related group (DRG) from the Institute for the Hospital Remuneration System (InEK). Hospital revenues based on the DRG were considered. Subsequently, we compared the estimated financial impact of earlier and later decisions to withdraw or withhold futile therapy. In this study, we found that end-of-life decision making was poorly documented. Only 11 % of patients had a valid power of attorney and advanced directives, and therapy with presumed consent was performed in 43 % of all cases. From long-stay patients, therapy was withdrawn for 37 % of patients and withheld from 26 % of patients, and 37 % of the patients died receiving maximal therapy. Almost 72 % of DRG-related reimbursements were dependent on ventilation hours. The average total cost estimate (according to InEK) for the 46 long-stay patients was 1,201,000 . The revenues without additional remuneration were 1,358,000 , and the total estimated profit was approximately 157,000 . Only 10 cases were assumed to be non-profitable. In cases where the decision to withdraw or withhold therapy could have occurred 3 days earlier, the estimated profit shrank

  17. Combined Economic and Hydrologic Modeling to Support Collaborative Decision Making Processes

    NASA Astrophysics Data System (ADS)

    Sheer, D. P.

    2008-12-01

    For more than a decade, the core concept of the author's efforts in support of collaborative decision making has been a combination of hydrologic simulation and multi-objective optimization. The modeling has generally been used to support collaborative decision making processes. The OASIS model developed by HydroLogics Inc. solves a multi-objective optimization at each time step using a mixed integer linear program (MILP). The MILP can be configured to include any user defined objective, including but not limited too economic objectives. For example, an estimated marginal value for water for crops and M&I use were included in the objective function to drive trades in a model of the lower Rio Grande. The formulation of the MILP, constraints and objectives, in any time step is conditional: it changes based on the value of state variables and dynamic external forcing functions, such as rainfall, hydrology, market prices, arrival of migratory fish, water temperature, etc. It therefore acts as a dynamic short term multi-objective economic optimization for each time step. MILP is capable of solving a general problem that includes a very realistic representation of the physical system characteristics in addition to the normal multi-objective optimization objectives and constraints included in economic models. In all of these models, the short term objective function is a surrogate for achieving long term multi-objective results. The long term performance for any alternative (especially including operating strategies) is evaluated by simulation. An operating rule is the combination of conditions, parameters, constraints and objectives used to determine the formulation of the short term optimization in each time step. Heuristic wrappers for the simulation program have been developed improve the parameters of an operating rule, and are initiating research on a wrapper that will allow us to employ a genetic algorithm to improve the form of the rule (conditions, constraints

  18. A synthesis of drug reimbursement decision-making processes in organisation for economic co-operation and development countries.

    PubMed

    Barnieh, Lianne; Manns, Braden; Harris, Anthony; Blom, Marja; Donaldson, Cam; Klarenbach, Scott; Husereau, Don; Lorenzetti, Diane; Clement, Fiona

    2014-01-01

    The use of a restrictive formulary, with placement determined through a drug-reimbursement decision-making process, is one approach to managing drug expenditures. To describe the processes in drug reimbursement decision-making systems currently used in national publicly funded outpatient prescription drug insurance plans. By using the Organisation for Economic Co-operation and Development (OECD) nations as the sampling frame, a search was done in the published literature, followed by the gray literature. Collected data were verified by a system expert within the prescription drug insurance plan in each country to ensure the accuracy of key data elements across countries. All but one country provided at least one publicly funded prescription drug formulary. Many systems have adopted similar processes of drug reimbursement decision making. All but three systems required additional consideration of clinical evidence within the decision-making process. Transparency of recommendations varied between systems, from having no information publicly available (three systems) to all information available and accessible to the public (16 systems). Only four countries did not consider cost within the drug reimbursement decision-making process. There were similarities in the decision-making process for drug reimbursement across the systems; however, only five countries met the highest standard of transparency, requirement of evidence, and ability to appeal. Future work should focus on examining how these processes may affect formulary listing decisions for drugs between countries. © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Published by International Society for Pharmacoeconomics and Outcomes Research (ISPOR) All rights reserved.

  19. The evolving role of the nurse during the cancer treatment decision-making process: a literature review.

    PubMed

    Tariman, Joseph D; Szubski, Katharine L

    2015-10-01

    Many models of patient-physician relationships have been described since a paternalistic model was postulated in the early 1950s. Among them are the informative model, doctor-as-agent model, shared model of care, family-centered model, and Degner and Beaton's Patterns of Decision Making. This article aims to examine the contemporary role of the nurse during the cancer treatment decision-making process. This article reviews the current and evidence-based role of the nurse during cancer treatment decision making, and implications for practice and research are discussed. Because of external forces, such as rising cost of health care, increasing healthcare consumerism, and increased emphasis on patient-centered care, the shared model of care is taking hold, particularly in the cancer setting. The evolution of these models has caused a shift in the dialogue related to cancer treatment decision making between patients and physicians, as well as oncology nurses. These events contribute to the evolving role of the nurse during the cancer treatment decision-making process.

  20. Power to Punish Norm Violations Affects the Neural Processes of Fairness-Related Decision Making

    PubMed Central

    Cheng, Xuemei; Zheng, Li; Li, Lin; Guo, Xiuyan; Wang, Qianfeng; Lord, Anton; Hu, Zengxi; Yang, Guang

    2015-01-01

    Punishing norm violations is considered an important motive during rejection of unfair offers in the ultimatum game (UG). The present study investigates the impact of the power to punish norm violations on people’s responses to unfairness and associated neural correlates. In the UG condition participants had the power to punish norm violations, while an alternate condition, the impunity game (IG), was presented where participants had no power to punish norm violations since rejection only reduced the responder’s income to zero. Results showed that unfair offers were rejected more often in UG compared to IG. At the neural level, anterior insula and dorsal anterior cingulate cortex were more active when participants received and rejected unfair offers in both UG and IG. Moreover, greater dorsolateral prefrontal cortex activity was observed when participants rejected than accepted unfair offers in UG but not in IG. Ventromedial prefrontal cortex activation was higher in UG than IG when unfair offers were accepted as well as when rejecting unfair offers in IG as opposed to UG. Taken together, our results demonstrate that the power to punish norm violations affects not only people’s behavioral responses to unfairness but also the neural correlates of the fairness-related social decision-making process. PMID:26696858

  1. A transdisciplinary approach to the decision-making process in extreme prematurity.

    PubMed

    Simard, Marc; Gagné, Anne-Marie; Lambert, Raymond D; Tremblay, Yves

    2014-07-14

    A wide range of dilemmas encountered in the health domain can be addressed more efficiently by a transdisciplinary approach. The complex context of extreme prematurity, which is raising important challenges for caregivers and parents, warrants such an approach. In the present work, experts from various disciplinary fields, namely biomedical, epidemiology, psychology, ethics, and law, were enrolled to participate in a reflection. Gathering a group of experts could be very demanding, both in terms of time and resources, so we created a web-based discussion forum to facilitate the exchanges. The participants were mandated to solve two questions: "Which parameters should be considered before delivering survival care to a premature baby born at the threshold of viability?" and "Would it be acceptable to give different information to parents according to the sex of the baby considering that outcome differences exist between sexes?" The discussion forum was performed over a period of nine months and went through three phases: unidisciplinary, interdisciplinary and transdisciplinary, which required extensive discussions and the preparation of several written reports. Those steps were successfully achieved and the participants finally developed a consensual point of view regarding the initial questions. This discussion board also led to a concrete knowledge product, the publication of the popularized results as an electronic book. We propose, with our transdisciplinary analysis, a relevant and innovative complement to existing guidelines regarding the decision-making process for premature infants born at the threshold of viability, with an emphasis on the respective responsabilities of the caregivers and the parents.

  2. Social provocation modulates decision making and feedback processing: Examining the trajectory of development in adolescent participants.

    PubMed

    Pincham, Hannah L; Wu, Claire; Killikelly, Clare; Vuillier, Laura; Fearon, R M Pasco

    2015-10-01

    Increasingly, research is turning to the ways in which social context impacts decision making and feedback processing in adolescents. The current study recorded electroencephalography to examine the trajectory of development across adolescence, with a focus on how social context impacts cognition and behaviour. To that end, younger (10-12 years) and older (14-16 years) adolescents played a modified Taylor Aggression Paradigm against two virtual opponents: a low-provoker and a high-provoker. During the task's decision phase (where participants select punishment for their opponent), we examined two event-related potentials: the N2 and the late positive potential (LPP). During the outcome phase (where participants experience win or loss feedback), we measured the feedback related negativity (FRN). Although N2 amplitudes did not vary with provocation, LPP amplitudes were enhanced under high provocation for the younger group, suggesting that emotional reactivity during the decision phase was heightened for early adolescents. During the outcome phase, the FRN was reduced following win outcomes under high provocation for both groups, suggesting that a highly provocative social opponent may influence the reward response. Collectively, the data argue that social context is an important factor modulating neural responses in adolescent behavioural and brain development.

  3. Searching Choices: Quantifying Decision-Making Processes Using Search Engine Data.

    PubMed

    Moat, Helen Susannah; Olivola, Christopher Y; Chater, Nick; Preis, Tobias

    2016-07-01

    When making a decision, humans consider two types of information: information they have acquired through their prior experience of the world, and further information they gather to support the decision in question. Here, we present evidence that data from search engines such as Google can help us model both sources of information. We show that statistics from search engines on the frequency of content on the Internet can help us estimate the statistical structure of prior experience; and, specifically, we outline how such statistics can inform psychological theories concerning the valuation of human lives, or choices involving delayed outcomes. Turning to information gathering, we show that search query data might help measure human information gathering, and it may predict subsequent decisions. Such data enable us to compare information gathered across nations, where analyses suggest, for example, a greater focus on the future in countries with a higher per capita GDP. We conclude that search engine data constitute a valuable new resource for cognitive scientists, offering a fascinating new tool for understanding the human decision-making process. Copyright © 2016 The Authors. Topics in Cognitive Science published by Wiley Periodicals, Inc. on behalf of Cognitive Science Society.

  4. The Experience of Older People in the Shared Decision-Making Process in Advanced Kidney Care

    PubMed Central

    Jenkins, Karen; McManus, Breeda; Gracey, Brian

    2016-01-01

    Introduction. This qualitative descriptive study was designed to understand the experiences of older people (>70 years) when making a decision about renal replacement therapy. This was a coproduced study, whereby patients and carers were involved in all aspects of the research process. Methods. A Patient and Carer Group undertook volunteer and research training. The group developed the interview questions and interviewed 29 people who had commenced dialysis or made a decision not to have dialysis. Interview data were transcribed and analysed, and common themes were identified. Results. 22 men and 7 women (mean age 77.4 yrs) from two hospitals were interviewed. 18 had chosen haemodialysis, 6 peritoneal dialysis, and 5 supportive care. The majority of patients were involved in the dialysis decision. Most were satisfied with the amount of information that they received, although some identified that the quality of the information could be improved, especially how daily living can be affected by dialysis. Conclusion. Our findings show that overall older patients were involved in the dialysis decision along with their families. Our approach is innovative because it is the first time that patients and carers have been involved in a coproduced study about shared decision-making. PMID:27990438

  5. Power to Punish Norm Violations Affects the Neural Processes of Fairness-Related Decision Making.

    PubMed

    Cheng, Xuemei; Zheng, Li; Li, Lin; Guo, Xiuyan; Wang, Qianfeng; Lord, Anton; Hu, Zengxi; Yang, Guang

    2015-01-01

    Punishing norm violations is considered an important motive during rejection of unfair offers in the ultimatum game (UG). The present study investigates the impact of the power to punish norm violations on people's responses to unfairness and associated neural correlates. In the UG condition participants had the power to punish norm violations, while an alternate condition, the impunity game (IG), was presented where participants had no power to punish norm violations since rejection only reduced the responder's income to zero. Results showed that unfair offers were rejected more often in UG compared to IG. At the neural level, anterior insula and dorsal anterior cingulate cortex were more active when participants received and rejected unfair offers in both UG and IG. Moreover, greater dorsolateral prefrontal cortex activity was observed when participants rejected than accepted unfair offers in UG but not in IG. Ventromedial prefrontal cortex activation was higher in UG than IG when unfair offers were accepted as well as when rejecting unfair offers in IG as opposed to UG. Taken together, our results demonstrate that the power to punish norm violations affects not only people's behavioral responses to unfairness but also the neural correlates of the fairness-related social decision-making process.

  6. Nurses' Perception of Shared Decision-Making Processes: Quantifying a Shared Governance Culture.

    PubMed

    Gerard, Sally O; Owens, Deborah L; Oliver, Patricia

    2016-09-01

    The aim of this study is to describe how measuring the perceived and desired decision-making capacity of nurses in a model of shared governance (SG) can be beneficial. Shared governance (SG) increases nurse's control over professional practice. Engagement in SG can be impacted by how much decision-making power nurses desire. This concept related to decision making has been termed decisional involvement (DI). Few studies exist that examine the concept of DI. Using the Decisional Involvement Scale, acute care nurses were sampled concerning desired and perceived decision making on 21 topics related to nursing practice. Analysis of the data identified different governance priorities for several areas. Of particular interest was that those nurses on SG councils for more than 5 years did not report higher satisfaction with decision involvement. A comprehensive evaluation of shared decision making was a valuable tool to establish a baseline of data and seek opportunities for improvement. A well-integrated model of SG requires continuous improvement and analysis to be sustained. Measuring and evaluating staff nurses desire to control varied aspects of DI can allow organizations to make focused efforts to strengthen SG.

  7. Dual Processing Model for Medical Decision-Making: An Extension to Diagnostic Testing.

    PubMed

    Tsalatsanis, Athanasios; Hozo, Iztok; Kumar, Ambuj; Djulbegovic, Benjamin

    2015-01-01

    Dual Processing Theories (DPT) assume that human cognition is governed by two distinct types of processes typically referred to as type 1 (intuitive) and type 2 (deliberative). Based on DPT we have derived a Dual Processing Model (DPM) to describe and explain therapeutic medical decision-making. The DPM model indicates that doctors decide to treat when treatment benefits outweigh its harms, which occurs when the probability of the disease is greater than the so called "threshold probability" at which treatment benefits are equal to treatment harms. Here we extend our work to include a wider class of decision problems that involve diagnostic testing. We illustrate applicability of the proposed model in a typical clinical scenario considering the management of a patient with prostate cancer. To that end, we calculate and compare two types of decision-thresholds: one that adheres to expected utility theory (EUT) and the second according to DPM. Our results showed that the decisions to administer a diagnostic test could be better explained using the DPM threshold. This is because such decisions depend on objective evidence of test/treatment benefits and harms as well as type 1 cognition of benefits and harms, which are not considered under EUT. Given that type 1 processes are unique to each decision-maker, this means that the DPM threshold will vary among different individuals. We also showed that when type 1 processes exclusively dominate decisions, ordering a diagnostic test does not affect a decision; the decision is based on the assessment of benefits and harms of treatment. These findings could explain variations in the treatment and diagnostic patterns documented in today's clinical practice.

  8. Abnormal emotion processing, but intact fairness and intentionality considerations during social decision-making in schizophrenia.

    PubMed

    de la Asuncion, Javier; Docx, Lise; Sabbe, Bernard; Morrens, Manuel; de Bruijn, Ellen R A

    2015-01-01

    Schizophrenia is a severe mental disorder that is highly characterized by social cognitive impairments. Most studies investigating these impairments focus on one specific social domain such as emotion recognition. However, in daily life, processing complex social situations relies on the combination of several social cognitive and affective processes simultaneously rather than one process alone. A modified version of the economically based Ultimatum Game was used to measure the interplay between fairness, intentionality, and emotion considerations during social decision-making. In this task, participants accept or reject fair and unfair monetary offers proposed intentionally or unintentionally by either angry, happy, neutral, or sad proposers. Behavioral data was collected from a group of schizophrenia patients (N = 35) and a group of healthy individuals (N = 30). Like healthy participants, schizophrenia patients differentiated between fair and unfair offers by rejecting unfair offers more compared to fair offers. However, overall patients did reject more fair offers, indicating that their construct of fairness operates within different margins. In both groups, intentional unfair offers were rejected more compared to unintentional ones, indicating a normal integration of intentionality considerations in schizophrenia. Importantly, healthy subjects also differentiated between proposers' emotion when rejecting unfair offers (more rejections from proposers depicting angry faces compared to proposers depicting, happy, neutral, or sad faces). Schizophrenia patients' decision behavior on the other hand, was not affected by the proposers' emotions. The current study thus shows that schizophrenia patients have specific problems with processing and integrating emotional information. Importantly, the finding that patients display normal fairness and intentionality considerations emphasizes preservation of central social cognitive processes in schizophrenia.

  9. Challenges to fair decision-making processes in the context of health care services: a qualitative assessment from Tanzania.

    PubMed

    Shayo, Elizabeth H; Norheim, Ole F; Mboera, Leonard E G; Byskov, Jens; Maluka, Stephen; Kamuzora, Peter; Blystad, Astrid

    2012-06-07

    Fair processes in decision making need the involvement of stakeholders who can discuss issues and reach an agreement based on reasons that are justifiable and appropriate in meeting people's needs. In Tanzania, the policy of decentralization and the health sector reform place an emphasis on community participation in making decisions in health care. However, aspects that can influence an individual's opportunity to be listened to and to contribute to discussion have been researched to a very limited extent in low-income settings. The objective of this study was to explore challenges to fair decision-making processes in health care services with a special focus on the potential influence of gender, wealth, ethnicity and education. We draw on the principle of fairness as outlined in the deliberative democratic theory. The study was carried out in the Mbarali District of Tanzania. A qualitative study design was used. In-depth interviews and focus group discussion were conducted among members of the district health team, local government officials, health care providers and community members. Informal discussion on the topics was also of substantial value. The study findings indicate a substantial influence of gender, wealth, ethnicity and education on health care decision-making processes. Men, wealthy individuals, members of strong ethnic groups and highly educated individuals had greater influence. Opinions varied among the study informants as to whether such differences should be considered fair. The differences in levels of influence emerged most clearly at the community level, and were largely perceived as legitimate. Existing challenges related to individuals' influence of decision making processes in health care need to be addressed if greater participation is desired. There is a need for increased advocacy and a strengthening of responsive practices with an emphasis on the right of all individuals to participate in decision-making processes. This

  10. Using social network analysis to examine the decision-making process on new vaccine introduction in Nigeria.

    PubMed

    Wonodi, C B; Privor-Dumm, L; Aina, M; Pate, A M; Reis, R; Gadhoke, P; Levine, O S

    2012-05-01

    The decision-making process to introduce new vaccines into national immunization programmes is often complex, involving many stakeholders who provide technical information, mobilize finance, implement programmes and garner political support. Stakeholders may have different levels of interest, knowledge and motivations to introduce new vaccines. Lack of consensus on the priority, public health value or feasibility of adding a new vaccine can delay policy decisions. Efforts to support country-level decision-making have largely focused on establishing global policies and equipping policy makers with the information to support decision-making on new vaccine introduction (NVI). Less attention has been given to understanding the interactions of policy actors and how the distribution of influence affects the policy process and decision-making. Social network analysis (SNA) is a social science technique concerned with explaining social phenomena using the structural and relational features of the network of actors involved. This approach can be used to identify how information is exchanged and who is included or excluded from the process. For this SNA of vaccine decision-making in Nigeria, we interviewed federal and state-level government officials, officers of bilateral and multilateral partner organizations, and other stakeholders such as health providers and the media. Using data culled from those interviews, we performed an SNA in order to map formal and informal relationships and the distribution of influence among vaccine decision-makers, as well as to explore linkages and pathways to stakeholders who can influence critical decisions in the policy process. Our findings indicate a relatively robust engagement of key stakeholders in Nigeria. We hypothesized that economic stakeholders and implementers would be important to ensure sustainable financing and strengthen programme implementation, but some economic and implementation stakeholders did not appear centrally on

  11. Roles of the Different Sub-Regions of the Insular Cortex in Various Phases of the Decision-Making Process

    PubMed Central

    Droutman, Vita; Bechara, Antoine; Read, Stephen J.

    2015-01-01

    This paper presents a coherent account of the role of the insular cortex (IC) in decision-making. We follow a conceptualization of decision-making that is very close to one previously proposed by Ernst and Paulus (2005): that the decision process is a progression of four phases: (1) re-focusing attention; (2) evaluation; (3) action; and (4) outcome processing, and we present evidence for the insula’s role in all these phases. We review the existing work on insula’s functional anatomy that subdivides the IC into posterior, dorsal anterior and ventral anterior regions. We re-map the results provided by the existing literature into these subdivisions wherever possible, to identify the components’ role in each decision making phase. In addition, we identify a self-regulating quality of the IC focused on harm avoidance. PMID:26635559

  12. Optimal decision making modeling for copper-matte Peirce-Smith converting process by means of data mining

    NASA Astrophysics Data System (ADS)

    Song, Yanpo; Peng, Xiaoqi; Tang, Ying; Hu, Zhikun

    2013-07-01

    To improve the operation level of copper converter, the approach to optimal decision making modeling for coppermatte converting process based on data mining is studied: in view of the characteristics of the process data, such as containing noise, small sample size and so on, a new robust improved ANN (artificial neural network) modeling method is proposed; taking into account the application purpose of decision making model, three new evaluation indexes named support, confidence and relative confidence are proposed; using real production data and the methods mentioned above, optimal decision making model for blowing time of S1 period (the 1st slag producing period) are developed. Simulation results show that this model can significantly improve the converting quality of S1 period, increase the optimal probability from about 70% to about 85%.

  13. Thermodynamic view on decision-making process: emotions as a potential power vector of realization of the choice.

    PubMed

    Pakhomov, Anton; Sudin, Natalya

    2013-12-01

    This research is devoted to possible mechanisms of decision-making in frames of thermodynamic principles. It is also shown that the decision-making system in reply to emotion includes vector component which seems to be often a necessary condition to transfer system from one state to another. The phases of decision-making system can be described as supposed to be nonequilibrium and irreversible to which thermodynamics laws are applied. The mathematical model of a decision choice, proceeding from principles of the nonlinear dynamics considering instability of movement and bifurcation is offered. The thermodynamic component of decision-making process on the basis of vector transfer of energy induced by emotion at the given time is surveyed. It is proposed a three-modular model of decision making based on principles of thermodynamics. Here it is suggested that at entropy impact due to effect of emotion, on the closed system-the human brain,-initially arises chaos, then after fluctuations of possible alternatives which were going on-reactions of brain zones in reply to external influence, an order is forming and there is choice of alternatives, according to primary entrance conditions and a state of the closed system. Entropy calculation of a choice expectation of negative and positive emotion shows judgment possibility of existence of "the law of emotion conservation" in accordance with several experimental data.

  14. Flaws in the Decision-Making Process: Assessment and Acceptance in the Decision to Launch Flight 51-L.

    ERIC Educational Resources Information Center

    Renz, Mary Ann; Greg, John

    1988-01-01

    Argues that it was the failure of the decision-making process, rather than the mode of risk assessment, which led to the decision to launch the Space Shuttle Challenger. Identifies the phrasing of the decision question and a shift in the burden of proof as specific problems of the process. (MS)

  15. Flaws in the Decision-Making Process: Assessment and Acceptance in the Decision to Launch Flight 51-L.

    ERIC Educational Resources Information Center

    Renz, Mary Ann; Greg, John

    1988-01-01

    Argues that it was the failure of the decision-making process, rather than the mode of risk assessment, which led to the decision to launch the Space Shuttle Challenger. Identifies the phrasing of the decision question and a shift in the burden of proof as specific problems of the process. (MS)

  16. Individual differences in decision making and reward processing predict changes in cannabis use: a prospective functional magnetic resonance imaging study.

    PubMed

    Cousijn, Janna; Wiers, Reinout W; Ridderinkhof, K Richard; van den Brink, Wim; Veltman, Dick J; Porrino, Linda J; Goudriaan, Anna E

    2013-11-01

    Decision-making deficits are thought to play an important role in the development and persistence of substance use disorders. Individual differences in decision-making abilities and their underlying neurocircuitry may, therefore, constitute an important predictor for the course of substance use and the development of substance use disorders. Here, we investigate the predictive value of decision making and neural mechanisms underlying decision making for future cannabis use and problem severity in a sample of heavy cannabis users. Brain activity during a monetary decision-making task (Iowa gambling task) was compared between 32 heavy cannabis users and 41 matched non-using controls using functional magnetic resonance imaging. In addition, within the group of heavy cannabis users, associations were examined between task-related brain activations, cannabis use and cannabis use-related problems at baseline, and change in cannabis use and problem severity after a 6-month follow-up. Despite normal task performance, heavy cannabis users compared with controls showed higher activation during wins in core areas associated with decision making. Moreover, within the group of heavy cannabis users, win-related activity and activity anticipating loss outcomes in areas generally involved in executive functions predicted change in cannabis use after 6 months. These findings are consistent with previous studies and point to abnormal processing of motivational information in heavy cannabis users. A new finding is that individuals who are biased toward immediate rewards have a higher probability of increasing drug use, highlighting the importance of the relative balance between motivational processes and regulatory executive processes in the development of substance use disorders.

  17. Nurses' decision-making process in cases of physical restraint in acute elderly care: a qualitative study.

    PubMed

    Goethals, S; Dierckx de Casterlé, B; Gastmans, C

    2013-05-01

    The increasing vulnerability of patients in acute elderly care requires constant critical reflection in ethically charged situations such as when employing physical restraint. Qualitative evidence concerning nurses' decision making in cases of physical restraint is limited and fragmented. A thorough understanding of nurses' decision-making process could be useful to understand how nurses reason and make decisions in ethically laden situations. The aims of this study were to explore and describe nurses' decision-making process in cases of physical restraint. We used a qualitative interview design inspired by the Grounded Theory approach. Data analysis was guided by the Qualitative Analysis Guide of Leuven. Twelve hospitals geographically spread throughout the five provinces of Flanders, Belgium. Twenty-one acute geriatric nurses interviewed between October 2009 and April 2011 were purposively and theoretically selected, with the aim of including nurses having a variety of characteristics and experiences concerning decisions on using physical restraint. In cases of physical restraint in acute elderly care, nurses' decision making was never experienced as a fixed decision but rather as a series of decisions. Decision making was mostly reasoned upon and based on rational arguments; however, decisions were also made routinely and intuitively. Some nurses felt very certain about their decisions, while others experienced feelings of uncertainty regarding their decisions. Nurses' decision making is an independent process that requires nurses to obtain a good picture of the patient, to be constantly observant, and to assess and reassess the patient's situation. Coming to thoughtful and individualized decisions requires major commitment and constant critical reflection. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Mindless decision making and environmental issues: gestalt/feature-intensive processing and contextual reasoning in environmental decisions.

    PubMed

    Sharps, Matthew J; Hess, Adam B; Ranes, Bethany

    2007-09-01

    In the absence of relevant information in working memory during decision consideration, respondents tend to rely on a style of cognitive processing that may result in premature or inaccurate decision making (M. J. Sharps, 2003). M. J. Sharps and S. S. Martin (2002) demonstrated this effect in executive decision making. In the present study, the authors extended these methods to decisions about environmental issues. Respondents rated decisions about issues such as overpopulation, energy policy, and food production in the presence or absence of simple pertinent information. The presence of such information in the immediate context of environmental decisions, and therefore in working memory, significantly improved respondents' ability to understand negative decision consequences. These results demonstrate the importance of contextual information in environmental decision making.

  19. The family as window onto the world of the patient: involving patients and families in the decision-making process.

    PubMed

    Chambers-Evans, Jane

    2002-10-01

    The need to involve family members as patient advocates and as surrogates when patients are unable to speak for themselves is not an issue. What continues to be debated are the methods for involving family members in the decision-making process. Such decisions can be complex and the environment in which they are made can be chaotic, while clinicians' approach to decision-making is often seen as insensitive. Families struggle with the emotional burden of their role and clinicians struggle to translate complex information into comprehensible, meaningful, and practical language. There is a need to examine clinical practice to determine which approaches to involving family members are preferable from a philosophical as well as a practical point of view. The paper explores the many facets of the surrogate decision-making role and suggests a reorientation of current models of the professional-surrogate relationship.

  20. Distributed multisensor processing, decision making, and control under constrained resources for remote health and environmental monitoring

    NASA Astrophysics Data System (ADS)

    Talukder, Ashit; Sheikh, Tanwir; Chandramouli, Lavanya

    2004-04-01

    Previous field-deployable distributed sensing systems for health/biomedical applications and environmental sensing have been designed for data collection and data transmission at pre-set intervals, rather than for on-board processing These previous sensing systems lack autonomous capabilities, and have limited lifespans. We propose the use of an integrated machine learning architecture, with automated planning-scheduling and resource management capabilities that can be used for a variety of autonomous sensing applications with very limited computing, power, and bandwidth resources. We lay out general solutions for efficient processing in a multi-tiered (three-tier) machine learning framework that is suited for remote, mobile sensing systems. Novel dimensionality reduction techniques that are designed for classification are used to compress each individual sensor data and pass only relevant information to the mobile multisensor fusion module (second-tier). Statistical classifiers that are capable of handling missing/partial sensory data due to sensor failure or power loss are used to detect critical events and pass the information to the third tier (central server) for manual analysis and/or analysis by advanced pattern recognition techniques. Genetic optimisation algorithms are used to control the system in the presence of dynamic events, and also ensure that system requirements (i.e. minimum life of the system) are met. This tight integration of control optimisation and machine learning algorithms results in a highly efficient sensor network with intelligent decision making capabilities. The applicability of our technology in remote health monitoring and environmental monitoring is shown. Other uses of our solution are also discussed.

  1. Government: The Decision-Making Process. A Resource Manual for Teachers and Students. Revised Edition.

    ERIC Educational Resources Information Center

    Khanlian, John F.; Wallin, Katherine L.

    This guide for high school political science teachers focuses on political decision making. The program emphasizes experiential learning through utilizing community and state resources and implementing field study and internships for students. The document is presented in eight sections. The introduction includes a values survey and suggestions…

  2. 14 CFR 1216.303 - NEPA process in NASA planning and decision making.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...) Planning and decision making support NASA's strategic plan commitment to sustainability and environmental... ENVIRONMENTAL QUALITY Subpart 1216.3 Procedures for Implementing the National Environmental Policy Act (NEPA... examination of the environmental consequences of implementing a proposed Agency action. Full integration...

  3. Headed for the Heartland: Decision Making Process of Community College Bound International Students

    ERIC Educational Resources Information Center

    Bohman, Eric

    2010-01-01

    Despite record growth in international student enrollment at U.S. community colleges, little is known regarding how the international students learn about--and ultimately decide to attend--community colleges. This research study identifies the decision making factors and explores the sources of information utilized by international students who…

  4. Donor Motivations and Decision Making: Understanding the Major Gift Development Process from a Donor's Perspective

    ERIC Educational Resources Information Center

    Morrison, Anna Lee

    2015-01-01

    Higher education is faced with a challenge to its traditional funding structure. As a result, academic programs must seek alternative sources of support. Chief among these sources is philanthropy in the form of major gifts. Insight into donor motivations and decision making when approached to consider a major gift may help to maximize the success…

  5. The Decision-Making Process in Conspectus Evaluation of Collections: The Quest for Certainty

    ERIC Educational Resources Information Center

    Munroe, Mary H.; Ver Steeg, Jennie E.

    2004-01-01

    Conspectus tools are used to gather collection data for a variety of reasons. Criticisms of the instruments are equally varied. Conspectus users frequently express uncertainty about the accuracy and validity of judgments about collections based on conspectus evaluations. An overview of decision-making research demonstrates that uncertainty is…

  6. Factors Influencing New Entrant Dairy Farmer's Decision-Making Process around Technology Adoption

    ERIC Educational Resources Information Center

    McDonald, Roberta; Heanue, Kevin; Pierce, Karina; Horan, Brendan

    2016-01-01

    Purpose: The aims of this paper are to (1) evaluate the main factors influencing grazing system technology adoption among new entrant (NE) dairy farmers within Europe and the Irish pasture-based dairy industry, and (2) to determine the extent to which economic factors influence decision-making around technology adoption and use among NEs to the…

  7. Career Decision Making: The Limits of Rationality and the Abundance of Non-Conscious Processes

    ERIC Educational Resources Information Center

    Krieshok, Thomas S.; Black, Michael D.; McKay, Robyn A.

    2009-01-01

    The terms of work have changed, with multiple transitions now characterizing the arc of a typical career. This article examines an ongoing shift in the area of vocational decision making, as it moves from a place where "it's all about the match" to one closer to "it's all about adapting to change". We review literatures on judgment and decision…

  8. The Impact of College Student Employment on the Career Decision-Making Process.

    ERIC Educational Resources Information Center

    Luzzo, Darrell Anthony

    Research has found the majority of college students are working in full- or part-time capacities while classes are in session. Research has identified several benefits of college student employment. This study analyzed additional career decision-making benefits associated with college student employment, especially when such employment offers…

  9. The Role of Emotional Intelligence in the Career Commitment and Decision-Making Process.

    ERIC Educational Resources Information Center

    Brown, Chris; George-Curran, Roberta; Smith, Marian L.

    2003-01-01

    Measures of emotional intelligence, vocational exploration, and career decision-making self-efficacy (CDMSE) were completed by 288 college students. Emotional intelligence was positively related to CDMSE. Utilization of feelings and self-control factors were inversely related to vocational exploration and commitment. Gender was not a moderator of…

  10. Choosing a Major in Higher Education: Profiles of Students' Decision-Making Process

    ERIC Educational Resources Information Center

    Germeijs, Veerle; Luyckx, Koen; Notelaers, Guy; Goossens, Luc; Verschueren, Karine

    2012-01-01

    This study identified decision-making profiles of students who make a choice of a major in higher education. These profiles were examined in a sample of Belgian students at the end of Grade 12, when the educational system expects that these adolescents choose a specific major. Using latent class cluster analysis on adolescents' scores for coping…

  11. The Role of Emotional Intelligence in the Career Commitment and Decision-Making Process.

    ERIC Educational Resources Information Center

    Brown, Chris; George-Curran, Roberta; Smith, Marian L.

    2003-01-01

    Measures of emotional intelligence, vocational exploration, and career decision-making self-efficacy (CDMSE) were completed by 288 college students. Emotional intelligence was positively related to CDMSE. Utilization of feelings and self-control factors were inversely related to vocational exploration and commitment. Gender was not a moderator of…

  12. Elementary Principal Decision-Making Process during Crisis Situations in One Northern New Jersey District

    ERIC Educational Resources Information Center

    Torley, Marilyn

    2011-01-01

    The purpose of this qualitative study was to investigate how school administrators respond during a crisis. Relevant research pertaining to crisis decision-making will be presented, focusing on the three steps of crisis decision theory (a) assessing the severity of the negative event (b) determining response options, and (c) evaluating response…

  13. Elementary Principal Decision-Making Process during Crisis Situations in One Northern New Jersey District

    ERIC Educational Resources Information Center

    Torley, Marilyn

    2011-01-01

    The purpose of this qualitative study was to investigate how school administrators respond during a crisis. Relevant research pertaining to crisis decision-making will be presented, focusing on the three steps of crisis decision theory (a) assessing the severity of the negative event (b) determining response options, and (c) evaluating response…

  14. Donor Motivations and Decision Making: Understanding the Major Gift Development Process from a Donor's Perspective

    ERIC Educational Resources Information Center

    Morrison, Anna Lee

    2015-01-01

    Higher education is faced with a challenge to its traditional funding structure. As a result, academic programs must seek alternative sources of support. Chief among these sources is philanthropy in the form of major gifts. Insight into donor motivations and decision making when approached to consider a major gift may help to maximize the success…

  15. Factors Influencing New Entrant Dairy Farmer's Decision-Making Process around Technology Adoption

    ERIC Educational Resources Information Center

    McDonald, Roberta; Heanue, Kevin; Pierce, Karina; Horan, Brendan

    2016-01-01

    Purpose: The aims of this paper are to (1) evaluate the main factors influencing grazing system technology adoption among new entrant (NE) dairy farmers within Europe and the Irish pasture-based dairy industry, and (2) to determine the extent to which economic factors influence decision-making around technology adoption and use among NEs to the…

  16. Community College Presidents' Decision-Making Processes during a Potential Crisis

    ERIC Educational Resources Information Center

    Berry, Judith Kaye

    2013-01-01

    This case study addressed how community college presidents make decisions under conditions that can escalate to full-scale crises. The purpose of this study was to gather data to support the development of alternative models or refinement of existing models for crisis decision making on community college campuses, using an abbreviated…

  17. Headed for the Heartland: Decision Making Process of Community College Bound International Students

    ERIC Educational Resources Information Center

    Bohman, Eric

    2010-01-01

    Despite record growth in international student enrollment at U.S. community colleges, little is known regarding how the international students learn about--and ultimately decide to attend--community colleges. This research study identifies the decision making factors and explores the sources of information utilized by international students who…

  18. Physician Decision Making and Cardiac Risk: Effects of Knowledge, Risk Perception, Risk Tolerance, and Fuzzy Processing

    ERIC Educational Resources Information Center

    Reyna, Valerie F.; Lloyd, Farrell J.

    2006-01-01

    Despite training, professionals sometimes make serious errors in risky decision making. The authors investigated judgments and decisions for 9 hypothetical patients at 3 levels of cardiac risk, comparing student and physician groups varying in domain-specific knowledge. Decisions were examined regarding whether they deviated from guidelines, how…

  19. The Suasory Functions of Communication in the Process of Group Decision-Making: Necessity and Paradox.

    ERIC Educational Resources Information Center

    Gouran, Dennis S.

    Of the many specific situations in which the exercise of suasory influence may be necessary to assure that a decision making group meets its analytical responsibilities, five appear to be particularly important. These are circumstances in which (1) a group is violating accepted procedural norms, (2) an authority figure or high status group member…

  20. Practical Activities that Focus on the Decision-Making Process. TEAL Occasional Papers, Vol. 2, 1978.

    ERIC Educational Resources Information Center

    Yildiz, Nancy

    This paper demonstrates how a diagram of a Safeway supermarket can be the vehicle for a language lesson based on Lawrence's cognitive categories (classification, definition, spatial order, chronological order, generalizations and specifics, and cause and effect). A wide variety of decision-making activities based on this diagram are described.…

  1. Practical Activities that Focus on the Decision-Making Process. TEAL Occasional Papers, Vol. 2, 1978.

    ERIC Educational Resources Information Center

    Yildiz, Nancy

    This paper demonstrates how a diagram of a Safeway supermarket can be the vehicle for a language lesson based on Lawrence's cognitive categories (classification, definition, spatial order, chronological order, generalizations and specifics, and cause and effect). A wide variety of decision-making activities based on this diagram are described.…

  2. Community College Presidents' Decision-Making Processes during a Potential Crisis

    ERIC Educational Resources Information Center

    Berry, Judith Kaye

    2013-01-01

    This case study addressed how community college presidents make decisions under conditions that can escalate to full-scale crises. The purpose of this study was to gather data to support the development of alternative models or refinement of existing models for crisis decision making on community college campuses, using an abbreviated…

  3. The influence of a bystander agent's beliefs on children's and adults' decision-making process.

    PubMed

    Buttelmann, Frances; Buttelmann, David

    2017-01-01

    The ability to attribute and represent others' mental states (e.g., beliefs; so-called "theory of mind") is essential for participation in human social interaction. Despite a considerable body of research using tasks in which protagonists in the participants' attentional focus held false or true beliefs, the question of automatic belief attribution to bystander agents has received little attention. In the current study, we presented adults and 6-year-olds (N=92) with an implicit computer-based avoidance false-belief task in which participants were asked to place an object into one of three boxes. While doing so, we manipulated the beliefs of an irrelevant human-like or non-human-like bystander agent who was visible on the screen. Importantly, the bystander agent's beliefs were irrelevant for solving the task. Still, children's decision making was significantly influenced by the bystander agent's beliefs even if this was a non-human-like self-propelled object. Such an influence did not become obvious in adults' deliberate decisions but occurred only in their reaction times, which suggests that they also processed the bystander agent's beliefs but were able to suppress the influence of such beliefs on their behavior regulation. The results of a control study (N=53) ruled out low-level explanations and confirmed that self-propelledness of agents is a necessary factor for belief attribution to occur. Thus, not only do humans spontaneously ascribe beliefs to self-propelled bystander agents, but those beliefs even influence meaningful decisions in children.

  4. The Role of Psychological Adjustment in the Decision-making Process for Voluntary Termination of Pregnancy

    PubMed Central

    Sereno, Sara; Leal, Isabel; Maroco, João

    2013-01-01

    Background This study's objective was to evaluate the role of psychological adjustment in the decision-making process to have an abortion and explore individual variables that might influence this decision. Methods In this cross-sectional study, we sequentially enrolled 150 women who made the decision to voluntarily terminate a pregnancy in Maternity Dr. Alfredo da Costa, in Lisbon, Portugal, between September 2008 and June 2009. The instruments were the Depression, Anxiety and Stress Scale (DASS), Satisfaction with Social Support Scale (SSSS), Emotional Assessment Scale (EAS), Decision Conflict Scale (DCS), and Beliefs and Values Questionnaire (BVQ). We analyzed the data using Student's T-tests, MANOVA, ANOVA, Tukey's post-hoc tests and CATPCA. Statistically significant effects were accepted for p<0.05. Results The participants found the decision difficult and emotionally demanding, although they also identified it as a low conflict decision. The prevailing emotions were sadness, fear and stress; but despite these feelings, the participants remained psychologically adjusted in the moment they decided to have an abortion. The resolution to terminate the pregnancy was essentially shared with supportive people and it was mostly motivated by socio-economic issues. The different beliefs and values found in this sample, and their possible associations are discussed. Conclusion Despite high levels of stress, the women were psychologically adjusted at the time of making the decision to terminate the pregnancy. However, opposing what has been previously reported, the women presented high levels of sadness and fear, showing that this decision was hard to make, triggering disruptive emotions. PMID:24163799

  5. Quantum-like model of cognitive decision making and information processing.

    PubMed

    Khrennikov, Andrei

    2009-03-01

    In this paper we offer the quantum-like (QL) representation of the Shafir-Tversky statistical effect which is well known in cognitive psychology. We apply the so-called contextual approach. We consider the Shafir-Tversky effect to result from mixing statistical data obtained in incompatible contexts which are involved, e.g. in Prisoner's Dilemma or in more general games in which the disjunction effect can be found. As a consequence, the law of total probability is violated for the experimental data obtained in experiments on cognitive psychology by Shafir and Tversky [Shafir, E., Tversky, A., 1992. Thinking through uncertainty: nonconsequential reasoning and choice. Cogn. Psychol. 24, 449-474] as well as Tversky and Shafir [Tversky, A., Shafir, E., 1992. The disjunction effect in choice under uncertainty. Psychol. Sci. 3, 305-309]. Moreover, we can find a numerical measure of contextual incompatibility (the so-called coefficient of interference) as well as represent contexts which are involved in Prisoner's Dilemma (PD) by probability amplitudes-normalized vectors ("mental wave functions"). We remark that statistical data from Shafir and Tversky [Shafir, E., Tversky, A., 1992. Thinking through uncertainty: nonconsequential reasoning and choice. Cogn. Psychol. 24, 449-474] and Tversky and Shafir [Tversky, A., Shafir, E., 1992. The disjunction effect in choice under uncertainty. Psychol. Sci. 3, 305-309] experiments differ crucially from the point of view of mental interference. The second one exhibits the conventional trigonometric (cos-type) interference while the first one exhibits even the so-called hyperbolic (cosh-type) interference. We discuss the QL processing of information by cognitive systems, especially, the QL decision making and both classical and QL rationality and ethics.

  6. A transdisciplinary approach to the decision-making process in extreme prematurity

    PubMed Central

    2014-01-01

    Background A wide range of dilemmas encountered in the health domain can be addressed more efficiently by a transdisciplinary approach. The complex context of extreme prematurity, which is raising important challenges for caregivers and parents, warrants such an approach. Methods In the present work, experts from various disciplinary fields, namely biomedical, epidemiology, psychology, ethics, and law, were enrolled to participate in a reflection. Gathering a group of experts could be very demanding, both in terms of time and resources, so we created a web-based discussion forum to facilitate the exchanges. The participants were mandated to solve two questions: “Which parameters should be considered before delivering survival care to a premature baby born at the threshold of viability?” and “Would it be acceptable to give different information to parents according to the sex of the baby considering that outcome differences exist between sexes?” Results The discussion forum was performed over a period of nine months and went through three phases: unidisciplinary, interdisciplinary and transdisciplinary, which required extensive discussions and the preparation of several written reports. Those steps were successfully achieved and the participants finally developed a consensual point of view regarding the initial questions. This discussion board also led to a concrete knowledge product, the publication of the popularized results as an electronic book. Conclusions We propose, with our transdisciplinary analysis, a relevant and innovative complement to existing guidelines regarding the decision-making process for premature infants born at the threshold of viability, with an emphasis on the respective responsabilities of the caregivers and the parents. PMID:25023324

  7. Older people's reasoning for resuscitation preferences and their role in the decision-making process.

    PubMed

    Laakkonen, Marja-Liisa; Pitkala, Kaisu H; Strandberg, Timo E; Berglind, Saila; Tilvis, Reijo S

    2005-05-01

    To investigate older patients' reasoning for their cardiopulmonary resuscitation (CPR) preferences and the related decision-making process (DMP). In a descriptive study 220 elderly home-dwelling cardiovascular patients were interviewed and asked to justify their CPR preferences according to the given statements. Questions related to DMP were asked and their physical function, cognition, mood, and quality of life were assessed. Resuscitation preferences were associated with several patient characteristics, such as age, mood and quality of life. Patients preferring CPR (114/220, 52%) estimated their prognosis of CPR to be better than those preferring to forgo CPR. They justified their view: "Life is precious and worth living for me" (92%), "Maintaining life is a value of its own" (92%), "I feel needed by my family and my closest" (81%). Participants preferring to forgo CPR (106/220, 48%) justified: "I have already gained old age and led a full life" (88%), "People cannot decide these things" (72%). Only 9% of patients had discussed, and 38% would like to discuss preferences for life-sustaining treatments (LSTs) with their physician. However, 80% of respondents felt that the patients should take some part in the DMP; either alone (9%), together with a physician (23%), or together with a physician and a close relative (48%). Older people justify their resuscitation preferences highlighting their experiences of meaningful life or fulfillment of their life, interpersonal relationships with their loved ones and presumed outcome of CPR. Less than a half of the patients wished to discuss CPR and LSTs preferences in their current situation with their physician, but nevertheless wanted to participate in the DMP of end-of-life treatment. Physicians should assess patients' own preferences in-depth.

  8. [Decision making process for compulsory admission: study of a group of psychiatrists of Sardinia, Italy].

    PubMed

    Dazzan, P; Bhugra, D; Carta, M G; Carpiniello, B

    2001-01-01

    The aim of the study was to investigate the attitudes in the decision making process for admitting patients compulsorily under the Italian Law 180/78. A group of psychiatrists (n = 81) working in the area of Cagliari (Sardinia, Italy). Three case-vignettes describing different hypothetical clinical situations: 1) a man with depression and psychotic symptoms; 2) a woman with a possible first episode of psychosis; and 3) a man with a history of substance abuse and bipolar disorder. Each vignette was followed by a list of 11 factors reported in the literature as important in the decision to admit compulsorily (current mental state, severity of the disease, dangerousness to self or others, psychiatric history, likely response of the mental state to the medical treatment, age and gender of the patient, owning a home, occupational status, social support available). Psychiatrists were asked: a) whether they would admit the patient compulsorily; and b) to rate 11 factors from the most to the least important in their decision. We obtained responses from 57 psychiatrists (26 males and 31 females). The most important factors for deciding to detain a patient compulsorily were: current mental state, diagnosis, severity of the illness and possible contribution of medical treatment. Perceived dangerousness to self and others was considered the most important factor by 23% of the sample. Our results confirm that, in three different hypothetical situations, there is agreement in the factors perceived as the most important in the decision to admit compulsorily, although their application is highly subjective. The factors correspond to those recommended by the Italian Law 180. The need for protection of the patient or others has an important role in the decision and may take precedence over the current mental state of the patients [corrected].

  9. Effects of stochastic interest rates in decision making under risk: A Markov decision process model for forest management

    Treesearch

    Mo Zhou; Joseph Buongiorno

    2011-01-01

    Most economic studies of forest decision making under risk assume a fixed interest rate. This paper investigated some implications of this stochastic nature of interest rates. Markov decision process (MDP) models, used previously to integrate stochastic stand growth and prices, can be extended to include variable interest rates as well. This method was applied to...

  10. The Decision-Making Processes of Early Childhood Teachers When Working with Children Experiencing Parental Separation and Divorce

    ERIC Educational Resources Information Center

    Mahony, L.; Lunn, J.; Petriwskyj, A.; Walsh, K.

    2015-01-01

    In this study, the pedagogical decision-making processes of 21 Australian early childhood teachers working with children experiencing parental separation and divorce were examined. Transcripts from interviews and a focus group with teachers were analysed using grounded theory methodology. The findings showed that as teachers interacted with young…

  11. Implementing Project SIED: Special Education Teachers' Perceptions of a Simplified Technology Decision-Making Process for App Identification and Evaluation

    ERIC Educational Resources Information Center

    Schmidt, Matthew M.; Lin, Meng-Fen Grace; Paek, Seungoh; MacSuga-Gage, Ashley; Gage, Nicholas A.

    2017-01-01

    The worldwide explosion in popularity of mobile devices has created a dramatic increase in mobile software (apps) that are quick and easy to find and install, cheap, disposable, and usually single purpose. Hence, teachers need an equally streamlined and simplified decision-making process to help them identify educational apps--an approach that…

  12. A Mixed Method Inquiry into the Perceptions of the Faculty Senate Concerning the Budget Decision-Making Process

    ERIC Educational Resources Information Center

    Higgins, Jeremy Keith

    2013-01-01

    Historically universities have been academically focused institutions; however, in recent years they have begun to resemble a corporate business. The purpose of this dissertation was to determine the faculty senate's perceptions of the budget decision-making process at a public institution of higher education in Texas. The institution under study…

  13. Modeling the Occupational/Career Decision-Making Processes of Intellectually Gifted Adolescents: A Competing Models Strategy

    ERIC Educational Resources Information Center

    Jung, Jae Yup

    2014-01-01

    This study developed and empirically tested two related models of the occupational/career decision-making processes of gifted adolescents using a competing models strategy. The two models that guided the study, which acknowledged cultural orientations, social influences from the family, occupational/career values, and characteristics of…

  14. Case Study: An Examination of the Decision Making Process for Selecting Simulations for an Online MBA Program

    ERIC Educational Resources Information Center

    Neely, Pat; Tucker, Jan

    2013-01-01

    Purpose: Simulations are designed as activities which imitate real world scenarios and are often used to teach and enhance skill building. The purpose of this case study is to examine the decision making process and outcomes of a faculty committee tasked with examining simulations in the marketplace to determine if the simulations could be used as…

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

    ERIC Educational Resources Information Center

    Kelting, Scott

    2011-01-01

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

  16. An Assessment of Decision-Making Processes: Evaluation of Where Land Protection Planning Can Incorporate Climate Change Information (Final Report)

    EPA Science Inventory

    This report, prepared by the Global Change Research Program (GCRP) in the National Center for Environmental Assessment (NCEA) of the Office of Research and Development (ORD) at the U.S. Environmental Protection Agency (EPA), is a review of decision-making processes of selected la...

  17. Implementing Project SIED: Special Education Teachers' Perceptions of a Simplified Technology Decision-Making Process for App Identification and Evaluation

    ERIC Educational Resources Information Center

    Schmidt, Matthew M.; Lin, Meng-Fen Grace; Paek, Seungoh; MacSuga-Gage, Ashley; Gage, Nicholas A.

    2017-01-01

    The worldwide explosion in popularity of mobile devices has created a dramatic increase in mobile software (apps) that are quick and easy to find and install, cheap, disposable, and usually single purpose. Hence, teachers need an equally streamlined and simplified decision-making process to help them identify educational apps--an approach that…

  18. 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…

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

    ERIC Educational Resources Information Center

    Kelting, Scott

    2011-01-01

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

  20. Adolescent Decision-Making Processes regarding University Entry: A Model Incorporating Cultural Orientation, Motivation and Occupational Variables

    ERIC Educational Resources Information Center

    Jung, Jae Yup

    2013-01-01

    This study tested a newly developed model of the cognitive decision-making processes of senior high school students related to university entry. The model incorporated variables derived from motivation theory (i.e. expectancy-value theory and the theory of reasoned action), literature on cultural orientation and occupational considerations. A…

  1. 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…

  2. The Decision-Making Processes of Early Childhood Teachers When Working with Children Experiencing Parental Separation and Divorce

    ERIC Educational Resources Information Center

    Mahony, L.; Lunn, J.; Petriwskyj, A.; Walsh, K.

    2015-01-01

    In this study, the pedagogical decision-making processes of 21 Australian early childhood teachers working with children experiencing parental separation and divorce were examined. Transcripts from interviews and a focus group with teachers were analysed using grounded theory methodology. The findings showed that as teachers interacted with young…

  3. High School Students' Career Decision-Making Process: Development and Validation of the Study Choice Task Inventory

    ERIC Educational Resources Information Center

    Germeijs, Veerle; Verschueren, Karine

    2006-01-01

    During adolescence, one important career-related decision is the choice of a study in higher education. In this article, a new set of measures for different tasks (i.e., orientation, exploration, commitment) that can be distinguished during this career decision-making process was constructed: the Study Choice Task Inventory (SCTI). A sample of 946…

  4. The Effects of Cognitive Process and Decision Making Training in Reading Experience on Meaningful Learning with Underachieving College Students

    ERIC Educational Resources Information Center

    Dean, Rebecca J.

    2010-01-01

    The ability of underprepared college students to read and learn from their reading is essential to their academic success and to their ability to persist towards completing their degree. The purposes of this study were to (a) assess the relationship between the cognitive processes of reading-based decision making and meaningful learning and (b)…

  5. ’The Berlin Crisis in 1961’ U.S. Intelligence Analysis and the Presidential Decision Making Process.

    DTIC Science & Technology

    1997-01-01

    Intelligence analysis played a crucial role in the presidential decision making process throughout the Berlin Crisis. This paper focuses on how... intelligence analysis might have aided or misled President Kennedy during the 1961 phase of the crisis, especially during the months of January to July. It

  6. Case Study: An Examination of the Decision Making Process for Selecting Simulations for an Online MBA Program

    ERIC Educational Resources Information Center

    Neely, Pat; Tucker, Jan

    2013-01-01

    Purpose: Simulations are designed as activities which imitate real world scenarios and are often used to teach and enhance skill building. The purpose of this case study is to examine the decision making process and outcomes of a faculty committee tasked with examining simulations in the marketplace to determine if the simulations could be used as…

  7. Modeling the Occupational/Career Decision-Making Processes of Intellectually Gifted Adolescents: A Competing Models Strategy

    ERIC Educational Resources Information Center

    Jung, Jae Yup

    2014-01-01

    This study developed and empirically tested two related models of the occupational/career decision-making processes of gifted adolescents using a competing models strategy. The two models that guided the study, which acknowledged cultural orientations, social influences from the family, occupational/career values, and characteristics of…

  8. Adolescent Decision-Making Processes regarding University Entry: A Model Incorporating Cultural Orientation, Motivation and Occupational Variables

    ERIC Educational Resources Information Center

    Jung, Jae Yup

    2013-01-01

    This study tested a newly developed model of the cognitive decision-making processes of senior high school students related to university entry. The model incorporated variables derived from motivation theory (i.e. expectancy-value theory and the theory of reasoned action), literature on cultural orientation and occupational considerations. A…

  9. A Mixed Method Inquiry into the Perceptions of the Faculty Senate Concerning the Budget Decision-Making Process

    ERIC Educational Resources Information Center

    Higgins, Jeremy Keith

    2013-01-01

    Historically universities have been academically focused institutions; however, in recent years they have begun to resemble a corporate business. The purpose of this dissertation was to determine the faculty senate's perceptions of the budget decision-making process at a public institution of higher education in Texas. The institution under study…

  10. How organizational context affects bioethical decision-making: pharmacists' management of gatekeeping processes in retail and hospital settings.

    PubMed

    Chiarello, Elizabeth

    2013-12-01

    Social science studies of bioethics demonstrate that ethics are highly contextual, functioning differently across local settings as actors make daily decisions "on the ground." Sociological studies that demonstrate the key role organizations play in shaping ethical decision-making have disproportionately focused on physicians and nurses working in hospital settings where they contend with life and death issues. This study broadens our understanding of the contexts of ethical decision-making by empirically examining understudied healthcare professionals - pharmacists - working in two organizational settings, retail and hospital, where they act as gatekeepers to regulated goods and services as they contend with ethical issues ranging from the serious to the mundane. This study asks: How do organizations shape pharmacists' identification, negotiation, and resolution of ethical challenges; in other words, how do organizations shape pharmacists' gatekeeping processes? Based on 95 semi-structured interviews with U.S. pharmacists practicing in retail and hospital pharmacies conducted between September 2009 and May 2011, this research finds that organizations influence ethical decision-making by shaping how pharmacists construct four gatekeeping processes: medical, legal, fiscal, and moral. Each gatekeeping process manifests differently across organizations due to how these settings structure inter-professional power dynamics, proximity to patients, and means of accessing information. Findings suggest new directions for theorizing about ethical decision-making in medical contexts by drawing attention to new ethical actors, new organizational settings, an expanded definition of ethical challenges, and a broader conceptualization of gatekeeping. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. [Decision Making and Electrodermal Activity].

    PubMed

    Kobayakawa, Mutsutaka

    2016-08-01

    Decision making is aided by emotions. Bodily responses, such as sweating, heartbeat, and visceral sensation, are used to monitor the emotional state during decision making. Because decision making in dairy life is complicated and cognitively demanding, these bodily signals are thought to facilitate the decision making process by assigning positive or negative values for each of the behavioral options. The sweat response in a decision making task is measured by skin conductance response (SCR). SCR in decision making is divided into two categories: anticipatory SCR is observed before making decisions, and reward/punishment SCR is observed after the outcome of the decision is perceived. Brain lesion studies in human revealed that the amygdala and ventromedial prefrontal cortex are important in decision making. Patients with lesinon in the amygdala exhibit neither the anticipatory nor reward/punishment SCRs, while patients with the ventromedial prefrontal lesions have deficits only in the anticipatory SCRs. Decision making tasks and SCR analysis have contributed to reveal the implicit aspects of decision making. Further research is necessary for clarifying the role of explicit process of decision making and its relationship with the implicit process.

  12. HTA and decision-making processes in Central, Eastern and South Eastern Europe: Results from a survey.

    PubMed

    García-Mochón, Leticia; Espín Balbino, Jaime; Olry de Labry Lima, Antonio; Caro Martinez, Araceli; Martin Ruiz, Eva; Pérez Velasco, Román

    2017-03-31

    To gain knowledge and insights on health technology assessment (HTA) and decision-making processes in Central, Eastern and South Eastern Europe (CESEE) countries. A cross-sectional study was performed. Based on the literature, a questionnaire was developed in a multi-stage process. The questionnaire was arranged according to 5 broad domains: (i) introduction/country settings; (ii) use of HTA in the country; (iii) decision-making process; (iv) implementation of decisions; and (v) HTA and decision-making: future challenges. Potential survey respondents were identified through literature review-with a total of 118 contacts from the 24 CESEE countries. From March to July 2014, the survey was administered via e-mail. A total of 22 questionnaires were received generating an 18.6% response rate, including 4 responses indicating that their institutions had no involvement in HTA. Most of the CESEE countries have entities under government mandates with advisory functions and different responsibilities for decision-making, but mainly in charge of the reimbursement and pricing of medicines. Other areas where discrepancies across countries were found include criteria for selecting technologies to be assessed, stakeholder involvement, evidence requirements, use of economic evaluation, and timeliness of HTA. A number of CESEE countries have created formal decision-making processes for which HTA is used. However, there is a high level of heterogeneity related to the degree of development of HTA structures, and the methods and processes followed. Further studies focusing on the countries from which information is scarcer and on the HTA of health technologies other than medicines are warranted. Reviews/comparative analyses. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Toward theoretical understanding of the fertility preservation decision-making process: examining information processing among young women with cancer.

    PubMed

    Hershberger, Patricia E; Finnegan, Lorna; Altfeld, Susan; Lake, Sara; Hirshfeld-Cytron, Jennifer

    2013-01-01

    Young women with cancer now face the complex decision about whether to undergo fertility preservation. Yet little is known about how these women process information involved in making this decision. The purpose of this article is to expand theoretical understanding of the decision-making process by examining aspects of information processing among young women diagnosed with cancer. Using a grounded theory approach, 27 women with cancer participated in individual, semistructured interviews. Data were coded and analyzed using constant-comparison techniques that were guided by 5 dimensions within the Contemplate phase of the decision-making process framework. In the first dimension, young women acquired information primarily from clinicians and Internet sources. Experiential information, often obtained from peers, occurred in the second dimension. Preferences and values were constructed in the third dimension as women acquired factual, moral, and ethical information. Women desired tailored, personalized information that was specific to their situation in the fourth dimension; however, women struggled with communicating these needs to clinicians. In the fifth dimension, women offered detailed descriptions of clinician behaviors that enhance or impede decisional debriefing. Better understanding of theoretical underpinnings surrounding women's information processes can facilitate decision support and improve clinical care.

  14. Sensory shelf life estimation of minimally processed lettuce considering two stages of consumers' decision-making process.

    PubMed

    Ares, Gastón; Giménez, Ana; Gámbaro, Adriana

    2008-01-01

    The aim of the present work was to study the influence of context, particularly the stage of the decision-making process (purchase vs consumption stage), on sensory shelf life of minimally processed lettuce. Leaves of butterhead lettuce were placed in common polypropylene bags and stored at 5, 10 and 15 degrees C. Periodically, a panel of six assessors evaluated the appearance of the samples, and a panel of 40 consumers evaluated their appearance and answered "yes" or "no" to the questions: "Imagine you are in a supermarket, you want to buy a minimally processed lettuce, and you find a package of lettuce with leaves like this, would you normally buy it?" and "Imagine you have this leaf of lettuce stored in your refrigerator, would you normally consume it?". Survival analysis was used to calculate the shelf lives of minimally processed lettuce, considering both decision-making stages. Shelf lives estimated considering rejection to purchase were significantly lower than those estimated considering rejection to consume. Therefore, in order to be conservative and assure the products' quality, shelf life should be estimated considering consumers' rejection to purchase instead of rejection to consume, as traditionally has been done. On the other hand, results from logistic regressions of consumers' rejection percentage as a function of the evaluated appearance attributes suggested that consumers considered them differently while deciding whether to purchase or to consume minimally processed lettuce.

  15. Toward theoretical understanding of the fertility preservation decision-making process: Examining information processing among young women with cancer

    PubMed Central

    Hershberger, Patricia E.; Finnegan, Lorna; Altfeld, Susan; Lake, Sara; Hirshfeld-Cytron, Jennifer

    2014-01-01

    Background Young women with cancer now face the complex decision about whether to undergo fertility preservation. Yet little is known about how these women process information involved in making this decision. Objective The purpose of this paper is to expand theoretical understanding of the decision-making process by examining aspects of information processing among young women diagnosed with cancer. Methods Using a grounded theory approach, 27 women with cancer participated in individual, semi-structured interviews. Data were coded and analyzed using constant-comparison techniques that were guided by five dimensions within the Contemplate phase of the decision-making process framework. Results In the first dimension, young women acquired information primarily from clinicians and Internet sources. Experiential information, often obtained from peers, occurred in the second dimension. Preferences and values were constructed in the third dimension as women acquired factual, moral, and ethical information. Women desired tailored, personalized information that was specific to their situation in the fourth dimension; however, women struggled with communicating these needs to clinicians. In the fifth dimension, women offered detailed descriptions of clinician behaviors that enhance or impede decisional debriefing. Conclusion Better understanding of theoretical underpinnings surrounding women’s information processes can facilitate decision support and improve clinical care. PMID:24552086

  16. Evolution of Pediatric Chronic Disease Treatment Decisions: A Qualitative, Longitudinal View of Parents' Decision-Making Process.

    PubMed

    Lipstein, Ellen A; Britto, Maria T

    2015-08-01

    In the context of pediatric chronic conditions, patients and families are called upon repeatedly to make treatment decisions. However, little is known about how their decision making evolves over time. The objective was to understand parents' processes for treatment decision making in pediatric chronic conditions. We conducted a qualitative, prospective longitudinal study using recorded clinic visits and individual interviews. After consent was obtained from health care providers, parents, and patients, clinic visits during which treatment decisions were expected to be discussed were video-recorded. Parents then participated in sequential telephone interviews about their decision-making experience. Data were coded by 2 people and analyzed using framework analysis with sequential, time-ordered matrices. 21 families, including 29 parents, participated in video-recording and interviews. We found 3 dominant patterns of decision evolution. Each consisted of a series of decision events, including conversations, disease flares, and researching of treatment options. Within all 3 patterns there were both constant and evolving elements of decision making, such as role perceptions and treatment expectations, respectively. After parents made a treatment decision, they immediately turned to the next decision related to the chronic condition, creating an iterative cycle. In this study, decision making was an iterative process occurring in 3 distinct patterns. Understanding these patterns and the varying elements of parents' decision processes is an essential step toward developing interventions that are appropriate to the setting and that capitalize on the skills families may develop as they gain experience with a chronic condition. Future research should also consider the role of children and adolescents in this decision process. © The Author(s) 2015.

  17. Decision Making In Orienteering.

    ERIC Educational Resources Information Center

    Almeida, Katia

    1997-01-01

    Eight psychometric instruments were administered to 10 elite male Portuguese orienteers. The cognitive process involved in decision making did not differ between the best orienteers and the others. This group of athletes had a high capacity for work realization and a strong need to be in control of interpersonal situations. (Author/SV)

  18. Imitation versus payoff: Duality of the decision-making process demonstrates criticality and consensus formation

    NASA Astrophysics Data System (ADS)

    Turalska, M.; West, B. J.

    2014-11-01

    We consider a dual model of decision making, in which an individual forms its opinion based on contrasting mechanisms of imitation and rational calculation. The decision-making model (DMM) implements imitating behavior by means of a network of coupled two-state master equations that undergoes a phase transition at a critical value of a control parameter. The evolutionary spatial game, being a generalization of the prisoner's dilemma game, is used to determine in objective fashion the cooperative or anticooperative strategy adopted by individuals. Interactions between two sources of dynamics increases the domain of initial states attracted to phase transition dynamics beyond that of the DMM network in isolation. Additionally, on average the influence of the DMM on the game increases the final observed fraction of cooperators in the system.

  19. [Allocating resources for cancer control--resolving multicriteria decision-making using the analytic hierarchy process].

    PubMed

    Gróf, Agnes

    2007-01-01

    When competing programs ought to be financed simultaneously for the same purpose, an allocation problem occurs due to scarce resources, and different perspectives and preferences. Facing the problem needs determining criteria which the decision might be based on. Those criteria form the objectives (the scope) of the different participants, and are relevant for the achievement of the goal, providing a comprehensive resource allocation that bridges and integrates the different perspectives. In case of cancer control primary prevention, secondary prevention, therapy and tertiary prevention, education, basic sciences, and clinical trials form the alternatives. An analytic hierarchy process (AHP) is used for supporting decision-making in the resource allocation problem. AHP is a method for setting priorities, but can only work out the implications of what was declared through the pairwise-ranking process, namely the relative preferences, weighing the criteria and rating the alternatives two by two. In the first analysis the relative weights to criteria were 0.099 for 'distributive justice'; 0.120 for constitutional and human rights; 0.251 for lay opinion; 0.393 for EBM; 0.137 for cost-effectiveness. Ranking the alternatives using 'judgements' resulted in relative preference of 0.238 for therapy, 0.204 for primary prevention, 0.201 for secondary prevention, 0.135 for clinical trials, 0.111 for tertiary prevention, 0.066 for basic sciences and 0.045 for education. In the second analysis the relative importance of "cost-effectiveness" was doubled, thus resulting in 0.234 for therapy, 0.216 for secondary prevention, 0.183 for primary prevention, 0.145 for clinical trials, 0.113 for tertiary prevention, 0.063 for basic sciences and 0.046 for education. Sensitivity analysis has shown that increasing the relative weight of cost-effectiveness up to approximately 0.4 changes the rank of alternatives, and above 0.4 this criterion gives secondary prevention preferences. According

  20. The Military Decision Making Process: Making Better Decisions Versus Making Decisions Better

    DTIC Science & Technology

    2007-11-02

    Background to Decision Making, 103. (No reference listed). 69 SELECTED BIBLIOGRAPHY BOOKS Bertalanffy , Ludwig von . General Systems Theory...Washington, D.C.: Headquarters, Department of the Army), 1993, 6-3. 30 Carl Von Clausewitz, On War, ed. and trans by Michael Howard and Peter Paret...Field Marshal Helmuth von Moltke’s famous dictum that “no plan survives contact with the enemy.”2 Current keystone doctrine establishes flexibility

  1. Between Discipline and Intuition: The Military Decision Making Process in the Army’s Future Force

    DTIC Science & Technology

    2004-01-01

    not be discarded nor that the RPD need to be adopted as-is. Rather, the integration of course of action development and wargaming earlier into the...planning and decision making framework. Lastly, specific recommendations to formalize adaptive leadership development that increase an officer’s...experiential database in both the institutional and organizational Army is given to develop those leadership traits and abilities that support planning

  2. Decision-making processes shaping the home food environments of young adult women with and without children.

    PubMed

    Raskind, Ilana G; Woodruff, Rebecca C; Ballard, Denise; Cherry, Sabrina T; Daniel, Sandra; Haardörfer, Regine; Kegler, Michelle C

    2017-02-21

    Although young adult women consume the majority of their total daily energy intake from home food sources, the decision-making processes that shape their home food environments have received limited attention. Further, how decision-making may be affected by the transformative experience of motherhood is unknown. In this study, we explore the factors that influence two key decision-making processes-food choices while grocery shopping and the use of non-home food sources-and whether there are differences by motherhood status. In-depth interviews were conducted with 40 women, aged 20-29, living in southwest Georgia. Thematic analysis was used to analyze qualitative data stratified by whether or not children were present in the home. Decision-making was affected by numerous factors, which differed across groups. In regard to grocery shopping, women with children more frequently discussed the influence of nutrition and the preferences of children, while women without children more frequently discussed the influence of taste and the preferences of other household members. Cost, convenience, weight control, and pre-planning meals emerged as salient in both groups. In regard to the use of non-home food sources, convenience and taste were discussed by both groups, while social factors were only discussed by women without children. The cost of eating out was the only reason cited for eating inside the home, and this factor only emerged among women with children. Motherhood may be an important contributor to the decision-making processes that shape young adult women's home food environments. Interventions may find success in framing messaging to emphasize factors identified as motivating healthy decisions, such as protecting the health of children, and practical strategies may be adapted from those already in use, such as pre-planning and budgeting for healthy meals.

  3. Mapping the Decision-Making Process for Adjuvant Endocrine Therapy for Breast Cancer: The Role of Decisional Resolve.

    PubMed

    Beryl, Louise L; Rendle, Katharine A S; Halley, Meghan C; Gillespie, Katherine A; May, Suepattra G; Glover, Jennifer; Yu, Peter; Chattopadhyay, Runi; Frosch, Dominick L

    2017-01-01

    Studies show adjuvant endocrine therapy increases survival and decreases risk of breast cancer recurrence for hormone receptor-positive tumors. Yet studies also suggest that adherence rates among women taking this therapy may be as low as 50% owing largely to adverse side effects. Despite these rates, research on longitudinal patient decision making regarding this therapy is scant. We sought to map the decision-making process for women considering and initiating adjuvant endocrine therapy, paying particular attention to patterns of uncertainty and decisional change over time. A longitudinal series of semistructured interviews conducted at a multispecialty health care organization in Northern California with 35 newly diagnosed patients eligible for adjuvant endocrine therapy were analyzed. Analysis led to the identification and indexing of 3 new decision-making constructs-decisional phase, decisional direction, and decisional resolve-which were then organized using a visual matrix and examined for patterns characterizing the decision-making process. Our data reveal that most patients do not make a single, discrete decision to take or not take hormone therapy but rather traverse multiple decisional states, characterized by 1) phase, 2) direction, and 3) strength of resolve. Our analysis tracks these decisional states longitudinally using a grayscale-coded matrix. Our data show that decisional resolve wavers not just when considering therapy, as the existing concept of decisional conflict suggests, but even after initiating it, which may signal future decisions to forgo therapy. Adjuvant endocrine therapy, like other chronic care decisions, has a longer decision-making process and implementation period. Thus, theoretical, empirical, and clinical approaches should consider further exploring the new concept and measurement of decisional resolve, as it may help to improve subsequent medication adherence. © The Author(s) 2016.

  4. Development of a video-based education and process change intervention to improve advance cardiopulmonary resuscitation decision-making.

    PubMed

    Waldron, Nicholas; Johnson, Claire E; Saul, Peter; Waldron, Heidi; Chong, Jeffrey C; Hill, Anne-Marie; Hayes, Barbara

    2016-10-06

    Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions. Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature. A subsequent iterative consensus process developed two intervention elements: (i) an updated 'Goals of Patient Care' (GOPC) form and process; (ii) an education video and resources for teaching advance CPR decision-making and communication. A multidisciplinary group of health professionals and policy-makers with experience in systems development, education and research provided critical feedback. Three key themes emerged from the focus groups and the literature, which identified a structure for the intervention: (i) knowing what to say; (ii) knowing how to say it; (iii) wanting to say it. The themes informed the development of a video to provide education about advance CPR decision-making framework, improving communication and contextualising relevant clinical issues. Critical feedback assisted in refining the video and further guided development and evolution of a medical GOPC approach to discussing and recording medical treatment and advance care plans. Through an iterative process of consultation and review, video-based education and an expanded GOPC form and approach were developed to address physician and systemic barriers to advance CPR decision-making and documentation. Implementation and evaluation across hospital settings is required to examine utility and determine effect on quality of care.

  5. Integration of robotic surgery into routine practice and impacts on communication, collaboration, and decision making: a realist process evaluation protocol

    PubMed Central

    2014-01-01

    Background Robotic surgery offers many potential benefits for patients. While an increasing number of healthcare providers are purchasing surgical robots, there are reports that the technology is failing to be introduced into routine practice. Additionally, in robotic surgery, the surgeon is physically separated from the patient and the rest of the team, with the potential to negatively impact teamwork in the operating theatre. The aim of this study is to ascertain: how and under what circumstances robotic surgery is effectively introduced into routine practice; and how and under what circumstances robotic surgery impacts teamwork, communication and decision making, and subsequent patient outcomes. Methods and design We will undertake a process evaluation alongside a randomised controlled trial comparing laparoscopic and robotic surgery for the curative treatment of rectal cancer. Realist evaluation provides an overall framework for the study. The study will be in three phases. In Phase I, grey literature will be reviewed to identify stakeholders’ theories concerning how robotic surgery becomes embedded into surgical practice and its impacts. These theories will be refined and added to through interviews conducted across English hospitals that are using robotic surgery for rectal cancer resection with staff at different levels of the organisation, along with a review of documentation associated with the introduction of robotic surgery. In Phase II, a multi-site case study will be conducted across four English hospitals to test and refine the candidate theories. Data will be collected using multiple methods: the structured observation tool OTAS (Observational Teamwork Assessment for Surgery); video recordings of operations; ethnographic observation; and interviews. In Phase III, interviews will be conducted at the four case sites with staff representing a range of surgical disciplines, to assess the extent to which the results of Phase II are generalisable and to

  6. Integration of robotic surgery into routine practice and impacts on communication, collaboration, and decision making: a realist process evaluation protocol.

    PubMed

    Randell, Rebecca; Greenhalgh, Joanne; Hindmarsh, Jon; Dowding, Dawn; Jayne, David; Pearman, Alan; Gardner, Peter; Croft, Julie; Kotze, Alwyn

    2014-05-02

    Robotic surgery offers many potential benefits for patients. While an increasing number of healthcare providers are purchasing surgical robots, there are reports that the technology is failing to be introduced into routine practice. Additionally, in robotic surgery, the surgeon is physically separated from the patient and the rest of the team, with the potential to negatively impact teamwork in the operating theatre. The aim of this study is to ascertain: how and under what circumstances robotic surgery is effectively introduced into routine practice; and how and under what circumstances robotic surgery impacts teamwork, communication and decision making, and subsequent patient outcomes. We will undertake a process evaluation alongside a randomised controlled trial comparing laparoscopic and robotic surgery for the curative treatment of rectal cancer. Realist evaluation provides an overall framework for the study. The study will be in three phases. In Phase I, grey literature will be reviewed to identify stakeholders' theories concerning how robotic surgery becomes embedded into surgical practice and its impacts. These theories will be refined and added to through interviews conducted across English hospitals that are using robotic surgery for rectal cancer resection with staff at different levels of the organisation, along with a review of documentation associated with the introduction of robotic surgery. In Phase II, a multi-site case study will be conducted across four English hospitals to test and refine the candidate theories. Data will be collected using multiple methods: the structured observation tool OTAS (Observational Teamwork Assessment for Surgery); video recordings of operations; ethnographic observation; and interviews. In Phase III, interviews will be conducted at the four case sites with staff representing a range of surgical disciplines, to assess the extent to which the results of Phase II are generalisable and to refine the resulting theories to

  7. Patient involvement in the decision-making process improves satisfaction and quality of life in postmastectomy breast reconstruction.

    PubMed

    Ashraf, Azra A; Colakoglu, Salih; Nguyen, John T; Anastasopulos, Alexandra J; Ibrahim, Ahmed M S; Yueh, Janet H; Lin, Samuel J; Tobias, Adam M; Lee, Bernard T

    2013-09-01

    The patient-physician relationship has evolved from the paternalistic, physician-dominant model to the shared-decision-making and informed-consumerist model. The level of patient involvement in this decision-making process can potentially influence patient satisfaction and quality of life. In this study, patient-physician decision models are evaluated in patients undergoing postmastectomy breast reconstruction. All women who underwent breast reconstruction at an academic hospital from 1999-2007 were identified. Patients meeting inclusion criteria were mailed questionnaires at a minimum of 1 y postoperatively with questions about decision making, satisfaction, and quality of life. There were 707 women eligible for our study and 465 completed surveys (68% response rate). Patients were divided into one of three groups: paternalistic (n = 18), informed-consumerist (n = 307), shared (n = 140). There were differences in overall general satisfaction (P = 0.034), specifically comparing the informed group to the paternalistic group (66.7% versus 38.9%, P = 0.020) and the shared to the paternalistic group (69.3% versus 38.9%, P = 0.016). There were no differences in aesthetic satisfaction. There were differences found in the SF-12 physical component summary score across all groups (P = 0.033), and a difference was found between the informed and paternalistic groups (P < 0.05). There were no differences in the mental component score (P = 0.42). Women undergoing breast reconstruction predominantly used the informed model of decision making. Patients who adopted a more active role, whether using an informed or shared approach, had higher general patient satisfaction and physical component summary scores compared with patients whose decision making was paternalistic. Copyright © 2013 Elsevier Inc. All rights reserved.

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

    PubMed Central

    2013-01-01

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

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

    PubMed

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

    2013-08-08

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

  10. Challenges to fair decision-making processes in the context of health care services: a qualitative assessment from Tanzania

    PubMed Central

    2012-01-01

    Background Fair processes in decision making need the involvement of stakeholders who can discuss issues and reach an agreement based on reasons that are justifiable and appropriate in meeting people’s needs. In Tanzania, the policy of decentralization and the health sector reform place an emphasis on community participation in making decisions in health care. However, aspects that can influence an individual’s opportunity to be listened to and to contribute to discussion have been researched to a very limited extent in low-income settings. The objective of this study was to explore challenges to fair decision-making processes in health care services with a special focus on the potential influence of gender, wealth, ethnicity and education. We draw on the principle of fairness as outlined in the deliberative democratic theory. Methods The study was carried out in the Mbarali District of Tanzania. A qualitative study design was used. In-depth interviews and focus group discussion were conducted among members of the district health team, local government officials, health care providers and community members. Informal discussion on the topics was also of substantial value. Results The study findings indicate a substantial influence of gender, wealth, ethnicity and education on health care decision-making processes. Men, wealthy individuals, members of strong ethnic groups and highly educated individuals had greater influence. Opinions varied among the study informants as to whether such differences should be considered fair. The differences in levels of influence emerged most clearly at the community level, and were largely perceived as legitimate. Conclusions Existing challenges related to individuals’ influence of decision making processes in health care need to be addressed if greater participation is desired. There is a need for increased advocacy and a strengthening of responsive practices with an emphasis on the right of all individuals to participate in

  11. Towards a conceptual multi-agent-based framework to simulate the spatial group decision-making process

    NASA Astrophysics Data System (ADS)

    Ghavami, Seyed Morsal; Taleai, Mohammad

    2017-04-01

    Most spatial problems are multi-actor, multi-issue and multi-phase in nature. In addition to their intrinsic complexity, spatial problems usually involve groups of actors from different organizational and cognitive backgrounds, all of whom participate in a social structure to resolve or reduce the complexity of a given problem. Hence, it is important to study and evaluate what different aspects influence the spatial problem resolution process. Recently, multi-agent systems consisting of groups of separate agent entities all interacting with each other have been put forward as appropriate tools to use to study and resolve such problems. In this study, then in order to generate a better level of understanding regarding the spatial problem group decision-making process, a conceptual multi-agent-based framework is used that represents and specifies all the necessary concepts and entities needed to aid group decision making, based on a simulation of the group decision-making process as well as the relationships that exist among the different concepts involved. The study uses five main influencing entities as concepts in the simulation process: spatial influence, individual-level influence, group-level influence, negotiation influence and group performance measures. Further, it explains the relationship among different concepts in a descriptive rather than explanatory manner. To illustrate the proposed framework, the approval process for an urban land use master plan in Zanjan—a provincial capital in Iran—is simulated using MAS, the results highlighting the effectiveness of applying an MAS-based framework when wishing to study the group decision-making process used to resolve spatial problems.

  12. Towards a conceptual multi-agent-based framework to simulate the spatial group decision-making process

    NASA Astrophysics Data System (ADS)

    Ghavami, Seyed Morsal; Taleai, Mohammad

    2016-11-01

    Most spatial problems are multi-actor, multi-issue and multi-phase in nature. In addition to their intrinsic complexity, spatial problems usually involve groups of actors from different organizational and cognitive backgrounds, all of whom participate in a social structure to resolve or reduce the complexity of a given problem. Hence, it is important to study and evaluate what different aspects influence the spatial problem resolution process. Recently, multi-agent systems consisting of groups of separate agent entities all interacting with each other have been put forward as appropriate tools to use to study and resolve such problems. In this study, then in order to generate a better level of understanding regarding the spatial problem group decision-making process, a conceptual multi-agent-based framework is used that represents and specifies all the necessary concepts and entities needed to aid group decision making, based on a simulation of the group decision-making process as well as the relationships that exist among the different concepts involved. The study uses five main influencing entities as concepts in the simulation process: spatial influence, individual-level influence, group-level influence, negotiation influence and group performance measures. Further, it explains the relationship among different concepts in a descriptive rather than explanatory manner. To illustrate the proposed framework, the approval process for an urban land use master plan in Zanjan—a provincial capital in Iran—is simulated using MAS, the results highlighting the effectiveness of applying an MAS-based framework when wishing to study the group decision-making process used to resolve spatial problems.

  13. Blunted feedback processing during risky decision making in adolescents with a parental history of substance use disorders.

    PubMed

    Euser, Anja S; Greaves-Lord, Kirstin; Crowley, Michael J; Evans, Brittany E; Huizink, Anja C; Franken, Ingmar H A

    2013-11-01

    Risky decision making, a hallmark phenotype of substance use disorders (SUD), is thought to be associated with deficient feedback processing. Whether these aberrations are present prior to SUD onset or reflect merely a consequence of chronic substance use on the brain remains unclear. The present study investigated whether blunted feedback processing during risky decision making reflects a biological predisposition to SUD. We assessed event-related potentials elicited by positive and negative feedback during performance of a modified version of the Balloon Analogue Risk Task (BART) among high-risk adolescents with a parental history of SUD (HR; n = 61) and normal-risk controls (NR; n = 91). HR males made significantly more risky and faster decisions during the BART than did NR controls. Moreover, HR adolescents showed significantly reduced P300 amplitudes in response to both positive and negative feedback as compared to NR controls. These differences were not secondary to prolonged substance use exposure. Results are discussed in terms of feedback-specific processes. Reduced P300 amplitudes in the BART may reflect poor processing of feedback at the level of overall salience, which may keep people from effectively predicting the probability of future gains and losses. Though conclusions are tentative, blunted feedback processing during risky decision making may represent a promising endophenotypic vulnerability marker for SUD.

  14. A novel decision-making process for tooth retention or extraction.

    PubMed

    Avila, Gustavo; Galindo-Moreno, Pablo; Soehren, Stephen; Misch, Carl E; Morelli, Thiago; Wang, Hom-Lay

    2009-03-01

    Implant-supported restorations have become the most popular therapeutic option for professionals and patients for the treatment of total and partial edentulism. When implants are placed in an ideal position, with adequate prosthetic loading and proper maintenance, they can have success rates >90% over 15 years of function. Implants may be considered a better therapeutic alternative than performing more extensive conservative procedures in an attempt to save or maintain a compromised tooth. Inadequate indication for tooth extraction has resulted in the sacrifice of many sound savable teeth. This article presents a chart that can assist clinicians in making the right decision when they are deciding which route to take. Articles published in peer-reviewed English journals were selected using several scientific databases and subsequently reviewed. Book sources were also searched. Individual tooth- and patient-related features were thoroughly analyzed, particularly when determining if a tooth should be indicated for extraction. A color-based decision-making chart with six different levels, including several factors, was developed based upon available scientific literature. The rationale for including these factors is provided, and its interpretation is justified with literature support. The decision-making chart provided may serve as a reference guide for dentists when making the decision to save or extract a compromised tooth.

  15. The Military Decision-Making Process and Special Forces Mission Planning: "A Square Peg for a Round Hole?"

    DTIC Science & Technology

    2007-11-02

    second step of the Military Decision-Making Process is a staff that has a shared visualization of an operation in time and space consistent with their...organizational functions in a more efficent and timely manner. 19980731 054 14.SUBJECT TERMS MDMP, Special Forces, FOB,SFOB, AOB,SFOD-A,SOCCE,SOLE,JSOTF...multiple and simultaneous operations to perform their organizational functions in a more efficient and timely manner. in ACKNOWLEDGMENTS During the

  16. Health-care decision-making processes in Latin America: problems and prospects for the use of economic evaluation.

    PubMed

    Iglesias, Cynthia P; Drummond, Michael F; Rovira, Joan

    2005-01-01

    The use of economic evaluation studies (EE) in the decision-making process within the health-care system of nine Latin American (LA) and three European countries was investigated. The aim was to identify the opportunities, obstacles, and changes needed to facilitate the introduction of EE as a formal tool in health-care decision-making processes in LA. A comparative study was conducted based on existing literature and information provided through a questionnaire applied to decision makers in Argentina, Brazil, Colombia, Cuba, Mexico, Nicaragua, Peru, Portugal Spain, United Kingdom, Uruguay, and Venezuela. Systematic electronic searches of HEED, NHS EED, and LILACS were conducted to identify published economic evaluation studies in LA from 1982 onward. There is relatively little evidence of the conduct and use of EE within the health care systems in LA. Electronic searches retrieved 554 records; however, only 93 were EE. In the nine LA participating countries, broad allocation of health-care resources is primarily based on political criteria, historical records, geographical areas, and specific groups of patients and diseases. Public-health provision and inclusion of services in health-insurance package are responsibilities of the Ministry of Health. Decisions regarding the purchase of medicines are primarily made through public tenders, and mainly based on differences in clinical efficacy and the price of health technologies of interest. To expedite the process of incorporating EE as a formal tool to inform decision-making processes within the health-care systems in LA countries, two main conditions need to be fulfilled. First, adequate resources and skills need to be available to conduct EE of good quality. Second, decision-making procedures need to be modified to accommodate "evidence-based" approaches such as EE.

  17. Quantitative imaging biomarkers: the application of advanced image processing and analysis to clinical and preclinical decision making.

    PubMed

    Prescott, Jeffrey William

    2013-02-01

    The importance of medical imaging for clinical decision making has been steadily increasing over the last four decades. Recently, there has also been an emphasis on medical imaging for preclinical decision making, i.e., for use in pharamaceutical and medical device development. There is also a drive towards quantification of imaging findings by using quantitative imaging biomarkers, which can improve sensitivity, specificity, accuracy and reproducibility of imaged characteristics used for diagnostic and therapeutic decisions. An important component of the discovery, characterization, validation and application of quantitative imaging biomarkers is the extraction of information and meaning from images through image processing and subsequent analysis. However, many advanced image processing and analysis methods are not applied directly to questions of clinical interest, i.e., for diagnostic and therapeutic decision making, which is a consideration that should be closely linked to the development of such algorithms. This article is meant to address these concerns. First, quantitative imaging biomarkers are introduced by providing definitions and concepts. Then, potential applications of advanced image processing and analysis to areas of quantitative imaging biomarker research are described; specifically, research into osteoarthritis (OA), Alzheimer's disease (AD) and cancer is presented. Then, challenges in quantitative imaging biomarker research are discussed. Finally, a conceptual framework for integrating clinical and preclinical considerations into the development of quantitative imaging biomarkers and their computer-assisted methods of extraction is presented.

  18. Influence of the Preoperative Decision-Making Process on the Postoperative Outcome after Hysterectomy for Benign Uterine Pathologies.

    PubMed

    Radosa, J C; Radosa, C G; Kastl, C; Mavrova, R; Gabriel, L; Gräber, S; Wagenpfeil, G; Baum, S; Hamza, A; Joukhadar, R; Juhasz-Böss, I; Heimes, A-S; Meyberg-Solomayer, G; Solomayer, E-F; Radosa, M P

    2016-04-01

    Introduction: The aim of this study was to assess whether the preoperative decision-making process might influence treatment success in premenopausal women undergoing hysterectomy for benign uterine pathologies Materials and Methods: All premenopausal women treated with hysterectomy for benign uterine pathologies between April 2011 and June 2013 at a tertiary university center were enrolled in this prospective observational cohort study. Five parameters of the preoperative decision-making process were assessed upon their correlation with postoperative quality of life, sexual function and patients' satisfaction. These outcome measures were assessed for the pre- and postoperative (six months after surgery) status using two validated questionnaires (EQ-5D and "female sexual function index" (FSFI). Patients' satisfaction with the postoperative outcome was assessed with a self-developed questionnaire. Results: 255 of 402 (63 %) patients completed the study. A correlation between the co-variables "interval between first counseling and decision to surgery", "subjectively perceived quality of the preoperative counseling" and "certainty in the decision for the intervention" and postoperative outcomes were found. The co-variables "person mainly responsible for election of hysterectomy mode" and "discussion of decision for surgery with others" showed no influence on postoperative patients-reported outcomes. Conclusion: We found a correlation between certain parameters of the preoperative decision-making process and postoperative patient-reported sexual function, quality of life and patients' satisfaction in premenopausal women undergoing hysterectomy for benign uterine pathologies. An optimization of these factors could contribute to an improvement in treatment outcomes.

  19. Preserving the Self: The Process of Decision Making About Hereditary Breast Cancer and Ovarian Cancer Risk Reduction

    PubMed Central

    Howard, A. Fuchsia; Balneaves, Lynda G.; Bottorff, Joan L.; Rodney, Patricia

    2016-01-01

    Women who carry BRCA1 or BRCA2 (BRCA1/2) gene mutations have up to an 88% lifetime risk of breast cancer and up to a 65% lifetime risk of ovarian cancer. Strategies to address these risks include cancer screening and risk-reducing surgery (i.e., mastectomy and salpingo-oophorectomy). We conducted a grounded theory study with 22 BRCA1/2 mutation-carrier women to understand how women make decisions about these risk-reducing strategies. Preserving the self was the overarching decision-making process evident in the participants’ descriptions. This process was shaped by contextual conditions including the characteristics of health services, the nature of hereditary breast and ovarian cancer risk-reduction decisions, gendered roles, and the women’s perceived proximity to cancer. The women engaged in five decision-making styles, and these were characterized by the use of specific decision-making approaches. These findings provide theoretical insights that could inform the provision of decisional support to BRCA1/2 carriers. PMID:20980697

  20. Shared decision making in transplantation: how patients see their role in the decision process of accepting a donor liver.

    PubMed

    Op den Dries, Sanna; Annema, Coby; Berg, Aad P van den; Ranchor, Adelita V; Porte, Robert J

    2014-09-01

    At the time of the organ offer for transplantation, donor-related risks such as disease transmission and graft failure are weighed against the patient's risk of remaining on the waiting list. The patient's commonly inactive role in decision making and the timing and extent of donor-specific risk information have been discussed in the medical literature. This is the first study revealing the opinions of liver patients on these issues. Forty patients listed for liver transplantation and 179 liver transplant patients participated in an anonymous questionnaire-based survey. The majority of the patients wanted to be informed about donor-related risks (59.8%-74.8%). The preferred timing for being informed about donor-related risks was the time of the organ offer for 53.3% of the patients. Among these patients, 79.8% wished to be involved in making the decision to accept or not accept a liver for transplantation, 10.6% wished to make the final decision alone, and only 9.6% did not want to be involved in the decision-making process. Implementing this knowledge through the standardization of the content, the manner of transfer, and the amount of information that we provide to our patients will improve opportunities for shared decision making at different time points during the transplant allocation process. This will enable us to provide the same opportunities and care to every patient on the waiting list.

  1. Social Networks Influence Hispanic College Women's HPV Vaccine Uptake Decision-making Processes.

    PubMed

    Stephens, Dionne P; Thomas, Tami L

    2014-07-01

    This qualitative study was designed to assess current and preferred social networks that influence human papillomavirus (HPV) vaccine decision making in a sample of Hispanic college women. Individual, semi-structured interviews were conducted with 41 Hispanic college women attending a large southeastern Hispanic-serving institution. Television commercials and discussions with mothers were found to be the most influential social networks for current HPV vaccination beliefs. Internet sites, close family members, and healthcare providers' communications were preferred social networks for HPV vaccine information. Perceived accessibility and sense of comfort influenced the order in which these social networks' communications would be accepted. Findings suggest that Hispanic college women utilize specific social networks to gather information and make decisions about HPV vaccination. Continued efforts are needed to promote further understanding of the purpose of the HPV vaccine via these preferred sources of information.

  2. Social Networks Influence Hispanic College Women’s HPV Vaccine Uptake Decision-making Processes

    PubMed Central

    Stephens, Dionne P.; Thomas, Tami L.

    2014-01-01

    This qualitative study was designed to assess current and preferred social networks that influence human papillomavirus (HPV) vaccine decision making in a sample of Hispanic college women. Individual, semi-structured interviews were conducted with 41 Hispanic college women attending a large southeastern Hispanic-serving institution. Television commercials and discussions with mothers were found to be the most influential social networks for current HPV vaccination beliefs. Internet sites, close family members, and healthcare providers’ communications were preferred social networks for HPV vaccine information. Perceived accessibility and sense of comfort influenced the order in which these social networks’ communications would be accepted. Findings suggest that Hispanic college women utilize specific social networks to gather information and make decisions about HPV vaccination. Continued efforts are needed to promote further understanding of the purpose of the HPV vaccine via these preferred sources of information. PMID:25599082

  3. Instruments to assess the perception of physicians in the decision-making process of specific clinical encounters: a systematic review.

    PubMed

    Légaré, France; Moher, David; Elwyn, Glyn; LeBlanc, Annie; Gravel, Karine

    2007-10-15

    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. 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. 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

  4. 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

  5. Medical Decision-Making Processes and Online Behaviors Among Cannabis Dispensary Staff.

    PubMed

    Peiper, Nicholas C; Gourdet, Camille; Meinhofer, Angélica; Reiman, Amanda; Reggente, Nicco

    2017-01-01

    Most cannabis patients engage with dispensary staff, like budtenders, for medical advice on cannabis. Yet, little is known about these interactions and how the characteristics of budtenders affect these interactions. This study investigated demographics, workplace characteristics, medical decision-making, and online behaviors among a sample of budtenders. Between June and September 2016, a cross-sectional Internet survey was administered to budtenders in the San Francisco Bay Area and Greater Los Angeles. A total of 158 budtenders fully responded to the survey. A series of comparisons were conducted to determine differences between trained and untrained budtenders. Among the 158 budtenders, 56% had received formal training to become a budtender. Several demographic differences were found between trained and untrained budtenders. For workplace characteristics, trained budtenders were more likely to report budtender as their primary job (74% vs 53%), practice more than 5 years (34% vs 11%), and receive sales commission (57% vs 16%). Trained budtenders were significantly less likely to perceive medical decision-making as very important (47% vs 68%) and have a patient-centered philosophy (77% vs 89%). Although trained budtenders had significantly lower Internet usage, they were significantly more likely to exchange information with patients through e-mail (58% vs 39%), text message (46% vs 30%), mobile app (33% vs 11%), video call (26% vs 3%), and social media (51% vs 23%). Budtenders who are formally trained exhibit significantly different patterns of interaction with medical cannabis patients. Future studies will use multivariate methods to better determine which factors independently influence interactions and how budtenders operate after the introduction of regulations under the newly passed Proposition 64 that permits recreational cannabis use in California.

  6. Effluent trading in river systems through stochastic decision-making process: a case study.

    PubMed

    Zolfagharipoor, Mohammad Amin; Ahmadi, Azadeh

    2017-07-15

    The objective of this paper is to provide an efficient framework for effluent trading in river systems. The proposed framework consists of two pessimistic and optimistic decision-making models to increase the executability of river water quality trading programs. The models used for this purpose are (1) stochastic fallback bargaining (SFB) to reach an agreement among wastewater dischargers and (2) stochastic multi-criteria decision-making (SMCDM) to determine the optimal treatment strategy. The Monte-Carlo simulation method is used to incorporate the uncertainty into analysis. This uncertainty arises from stochastic nature and the errors in the calculation of wastewater treatment costs. The results of river water quality simulation model are used as the inputs of models. The proposed models are used in a case study on the Zarjoub River in northern Iran to determine the best solution for the pollution load allocation. The best treatment alternatives selected by each model are imported, as the initial pollution discharge permits, into an optimization model developed for trading of pollution discharge permits among pollutant sources. The results show that the SFB-based water pollution trading approach reduces the costs by US$ 14,834 while providing a relative consensus among pollutant sources. Meanwhile, the SMCDM-based water pollution trading approach reduces the costs by US$ 218,852, but it is less acceptable by pollutant sources. Therefore, it appears that giving due attention to stability, or in other words acceptability of pollution trading programs for all pollutant sources, is an essential element of their success.

  7. Citizen Participation in Decision Making.

    ERIC Educational Resources Information Center

    Paddock, Susan C.; Sferra, Bobbie A.

    This handbook for parents defines and describes the process of citizen participation in educational decision making. After describing the history of citizen involvement, the booklet answers questions regarding why and how community members can become involved in policy formation. Problems in participatory decision making and strategies for…

  8. Decision making in psychiatric emergencies.

    PubMed

    Murdach, A D

    1987-01-01

    Social workers increasingly are being required to assist clients in emergency situations. Such conditions typically require rapid decision making and quick action. In this article, the processes practitioners use in their interventions in psychiatric emergencies are examined. This examination is based on concepts derived from cognitive psychology and decision-making theory. Implications for practice and training also are discussed.

  9. Citizen Participation in Decision Making.

    ERIC Educational Resources Information Center

    Paddock, Susan C.; Sferra, Bobbie A.

    This handbook for parents defines and describes the process of citizen participation in educational decision making. After describing the history of citizen involvement, the booklet answers questions regarding why and how community members can become involved in policy formation. Problems in participatory decision making and strategies for…

  10. 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

  11. 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

  12. [An aid to decision making in the treatment of furcation diseases. Part 1: Results of surgical treatment of furcation diseases].

    PubMed

    De Beule, F; Defleur, P; Bercy, P

    1998-01-01

    Periodontal diseases combined with furcation defects are more difficult to treat; it's evidence. Furcation defects occur still very frequently. GTR treatments have shown some efficacy in those lesions, but, the success of those treatments is still uncertain and, therefore, indications are limited. Root amputations are, at this time, frequently chosen to treat furcation defects. The goal of this work was to evaluate the success rate of root amputations, to discuss the origin of the failures and to propose a new design for a better decision making.

  13. A meta-synthesis of pregnant women's decision-making processes with regard to antenatal screening for Down syndrome.

    PubMed

    Reid, Bernie; Sinclair, Marlene; Barr, Owen; Dobbs, Frank; Crealey, Grainne

    2009-12-01

    The diffusion of antenatal screening programmes for Down syndrome has triggered much discussion about their powerful potential to enhance pregnant women's autonomy and reproductive choices. Simultaneously, considerable debate has been engendered by concerns that such programmes may directly contribute to the emergence of new and complex ethical, legal and social dilemmas for women. Given such discussion and debate, an examination of women's decision-making within the context of antenatal screening for Down syndrome is timely. This paper aims to undertake a meta-synthesis of qualitative studies examining the factors influencing pregnant women's decisions to accept or decline antenatal screening for Down syndrome. The meta-synthesis aims to create more comprehensive understandings and to develop theory which might enable midwives and other healthcare professionals to better meet the needs of pregnant women as they make their screening decisions. Ten electronic health and social science databases were searched together with a hand-search of eleven journals for papers published in English between 1999 and 2008, using predefined search terms, inclusion and exclusion criteria, and a quality appraisal framework. Nine papers met the criteria for this meta-synthesis, providing an international perspective on pregnant women's decision-making. Twelve themes were identified by consensus and combined into five core concepts. These core concepts were: destination unknown; to choose or not to choose; risk is rarely pure and never simple; treading on dreams, and betwixt and between. A conceptual framework is proposed which incorporates these themes and core concepts, and provides a new insight into pregnant women's complex decision-making processes with regard to antenatal screening for Down syndrome. However, further research is necessary to determine whether or not the development of a model of decision-making may empower pregnant women in making choices about screening.

  14. 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

  15. Interaction between assessment and instruction in science: A teacher's decision-making process

    NASA Astrophysics Data System (ADS)

    Brownstein, Erica Marie

    This study describes the interaction between assessment and instruction in a secondary science classroom. This research examines a chemistry teacher in an AP class in a midwestern urban setting interactively assessing his students and how knowledge gained during that assessment affected his instructional decision-making. The theoretical framework includes reflection-in-action, the zone of proximal development, and social constructivism. The primary question that guided the study was: What is the interaction between assessment and instruction in a science classroom? The three sub questions were: How does a teacher gain knowledge of students' thinking? How does a teacher use knowledge of his students' thinking in interactive instructional decisions? What are the components of his interactive instructional decisions? Participant observation of the classroom occurred over a four month period. The elicit interview technique was used immediately following class to discuss interactive instructional decisions with the teacher. Data sources included videotapes, interviews, field notes, classroom documents, intern journal, and member checking from which triangulation was possible. The goal was to examine and understand interactive decisions that had an impact on instruction. The results indicated that the students were in a safe, accepting environment and that student levels of understanding chemistry were indeterminate, low, medium, and high. Impacts on teacher decision making were pedagogical content knowledge, assessing context, and knowledge of the student. It was found that to gain knowledge of student thinking, the teacher listened, examined student work, asked questions, and made statements. Questions the teacher asked were to probe, lead, or clarify student knowledge. Statements the teacher made would clarify or restate student words. The teacher used his understanding of student knowledge to make instructional decisions by recognizing student knowledge, connecting

  16. A Study of Secondary Students' Decision-Making Processes with Respect to Information Use, Particularly Students' Judgements of Relevance and Reliability

    ERIC Educational Resources Information Center

    Watson, Curtis L.

    2010-01-01

    This report details an ongoing investigation of the decision-making processes of a group of secondary school students in south-eastern Australia undertaking information search tasks. The study is situated in the field of information seeking and use, and, more broadly, in decision making. Research questions focus on students' decisions about the…

  17. Argument structure hierarchy system and method for facilitating analysis and decision-making processes

    DOEpatents

    Janssen, Terry

    2000-01-01

    A system and method for facilitating decision-making comprising a computer program causing linkage of data representing a plurality of argument structure units into a hierarchical argument structure. Each argument structure unit comprises data corresponding to a hypothesis and its corresponding counter-hypothesis, data corresponding to grounds that provide a basis for inference of the hypothesis or its corresponding counter-hypothesis, data corresponding to a warrant linking the grounds to the hypothesis or its corresponding counter-hypothesis, and data corresponding to backing that certifies the warrant. The hierarchical argument structure comprises a top level argument structure unit and a plurality of subordinate level argument structure units. Each of the plurality of subordinate argument structure units comprises at least a portion of the grounds of the argument structure unit to which it is subordinate. Program code located on each of a plurality of remote computers accepts input from one of a plurality of contributors. Each input comprises data corresponding to an argument structure unit in the hierarchical argument structure and supports the hypothesis or its corresponding counter-hypothesis. A second programming code is adapted to combine the inputs into a single hierarchical argument structure. A third computer program code is responsive to the second computer program code and is adapted to represent a degree of support for the hypothesis and its corresponding counter-hypothesis in the single hierarchical argument structure.

  18. Study types and reliability of Real World Evidence compared with experimental evidence used in Polish reimbursement decision-making processes.

    PubMed

    Wilk, N; Wierzbicka, N; Skrzekowska-Baran, I; Moćko, P; Tomassy, J; Kloc, K

    2017-04-01

    The aim of this study was to identify the relationship and impact between Real World Evidence (RWE) and experimental evidence (EE) in Polish decision-making processes for the drugs from selected Anatomical Therapeutic Chemical (ATC) groups. Descriptive study. A detailed analysis was performed for 58 processes from five ATC code groups in which RWE for effectiveness, or effectiveness and safety were cited in Agency for Health Technology Assessment and Tariff System's (AOTMiT) documents published between January 2012 and September 2015: Verification Analysis of AOTMiT, Statement of the Transparency Council of AOTMiT, and Recommendation of the President of AOTMiT. In 62% of the cases, RWE supported the EE and confirmed its main conclusions. The majority of studies in the EE group showed to be RCTs (97%), and the RWE group included mainly cohort studies (89%). There were more studies without a control group within RWE compared with the EE group (10% vs 1%). Our results showed that EE are more often assessed using Jadad, NICE or NOS scale by AOTMiT compared with RWE (93% vs 48%). When the best evidence within a given decision-making process is analysed, half of RWE and two-thirds of EE are considered high quality evidence. RWE plays an important role in the decision-making processes on public funding of drugs in Poland, contributing to nearly half (45%) of all the evidence considered. There exist such processes in which the proportion of RWE is dominant, with one process showing RWE as the only evidence presented. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  19. Multi criteria decision making to select the suitable method for the preparation of nanoparticles using an analytical hierarchy process.

    PubMed

    Velmurugan, R; Selvamuthukumar, S; Manavalan, R

    2011-11-01

    Selecting the right method for the preparation of nanoparticles is a crucial decision. A wrong decision can result in the product having to be formulated and developed again. One tool that can be useful in determining the most appropriate method is the Analytical Hierarchy Process (AHP). AHP has been employed in almost all areas related to decision-making problems. In this paper, the results of a case study illustrate that the AHP concept can assist designers in the effective evaluation of various methods available for the preparation of nanoparticles. This paper presents the methodology of selecting the most suitable method for preparing nanoparticles using the analytical hierarchy process.

  20. Incorporating risk attitude into Markov-process decision models: importance for individual decision making.

    PubMed

    Cher, D J; Miyamoto, J; Lenert, L A

    1997-01-01

    Most decision models published in the medical literature take a risk-neutral perspective. Under risk neutrality, the utility of a gamble is equivalent to its expected value and the marginal utility of living a given unit of time is the same regardless of when it occurs. Most patients, however, are not risk-neutral. Not only does risk aversion affect decision analyses when tradeoffs between short- and long-term survival are involved, it also affects the interpretation of time-tradeoff measures of health-state utility. The proportional time tradeoff under- or overestimates the disutility of an inferior health state, depending on whether the patient is risk-seeking or risk-averse (it is unbiased if the patient is risk-neutral). The authors review how risk attitude with respect to gambles for survival duration can be incorporated into decision models using the framework of risk-adjusted quality-adjusted life years (RA-QALYs). They present a simple extension of this framework that allows RA-QALYs to be calculated for Markov-process decision models. Using a previously published Markov-process model of surgical vs expectant treatment for benign prostatic hypertrophy (BPH), they show how attitude towards risk affects the expected number of QALYs calculated by the model. In this model, under risk neutrality, surgery was the preferred option. Under mild risk aversion, expectant treatment was the preferred option. Risk attitude is an important aspect of preferences that should be incorporated into decision models where one treatment option has upfront risks of morbidity or mortality.

  1. Decision making at the end of life: a model using an ethical grid and principles of group process.

    PubMed

    Kuhl, D R; Wilensky, P

    1999-01-01

    Those who provide care for the dying seek to address issues of pain and suffering in the context of the psychological, spiritual, mental, and physical complexities of the individual experiencing a terminal illness. People who are dying are still living. They have the right to be in control of their lives. The staff (caregivers) also have an integrity which must be preserved. They too must be connected to the decision-making process. The reality of palliative care brings up unresolved psychological issues, often turbulent personal issues, for all involved in the process. This can cause extra unnecessary pain and suffering for all concerned. It is essential that a real (unflinching) and an ethical relationship between the patient and the staff be maintained and valued as these issues are confronted and resolved. This relationship will be subject to group process influences, which must be recognized and embraced. Avoidance of these issues can lead to unfairness, misunderstanding, shame, and lasting resentment among the caregivers, as well as to tragic consequences for the patient and the family. The purpose of this article is to describe a decision-making process in palliative care that includes the use of ethical principles as well as features of group process. The ethical grid was adapted and developed from the work of Jonsen, Siegler, and Winslade. The features of group process are based on theories of group work as defined by Trotzer; Johnson and Johnson; Gladding; Bion; Yalom; and Amundson, Borgen, Westwood and Pallard.

  2. A structured process to develop scenarios for use in evaluation of an evidence-based approach in clinical decision making.

    PubMed

    Manns, Patricia J; Darrah, Johanna

    2012-01-01

    Scenarios are used as the basis from which to evaluate the use of the components of evidence-based practice in decision making, yet there are few examples of a standardized process of scenario writing. The aim of this paper is to describe a step-by-step scenario writing method used in the context of the authors' curriculum research study. Scenario writing teams included one physical therapy clinician and one academic staff member. There were four steps in the scenario development process: (1) identify prevalent condition and brainstorm interventions; (2) literature search; (3) develop scenario framework; and (4) write scenario. Scenarios focused only on interventions, not diagnostic or prognostic problems. The process led to two types of scenarios - ones that provided an intervention with strong research evidence and others where the intervention had weak evidence to support its use. The end product of the process was a scenario that incorporates aspects of evidence-based decision making and can be used as the basis for evaluation. The use of scenarios has been very helpful to capture therapists' reasoning processes. The scenario development process was applied in an education context as part of a final evaluation of graduating clinical physical therapy students.

  3. A design process for using normative models in shared decision making: a case study in the context of prenatal testing.

    PubMed

    Rapaport, Sivan; Leshno, Moshe; Fink, Lior

    2014-12-01

    Shared decision making (SDM) encourages the patient to play a more active role in the process of medical consultation and its primary objective is to find the best treatment for a specific patient. Recent findings, however, show that patient preferences cannot be easily or accurately judged on the basis of communicative exchange during routine office visits, even for patients who seek to expand their role in medical decision making (MDM). The objective of this study is to improve the quality of patient-physician communication by developing a novel design process for SDM and then demonstrating, through a case study, the applicability of this process in enabling the use of a normative model for a specific medical situation. Our design process goes through the following stages: definition of medical situation and decision problem, development/identification of normative model, adaptation of normative model, empirical analysis and development of decision support systems (DSS) tools that facilitate the SDM process in the specific medical situation. This study demonstrates the applicability of the process through the implementation of the general normative theory of MDM under uncertainty for the medical-financial dilemma of choosing a physician to perform amniocentesis. The use of normative models in SDM raises several issues, such as the goal of the normative model, the relation between the goals of prediction and recommendation, and the general question of whether it is valid to use a normative model for people who do not behave according to the model's assumptions. © 2012 John Wiley & Sons Ltd.

  4. A structured process to develop scenarios for use in evaluation of an evidence-based approach in clinical decision making

    PubMed Central

    Manns, Patricia J; Darrah, Johanna

    2012-01-01

    Background and purpose Scenarios are used as the basis from which to evaluate the use of the components of evidence-based practice in decision making, yet there are few examples of a standardized process of scenario writing. The aim of this paper is to describe a step-by-step scenario writing method used in the context of the authors’ curriculum research study. Methods Scenario writing teams included one physical therapy clinician and one academic staff member. There were four steps in the scenario development process: (1) identify prevalent condition and brainstorm interventions; (2) literature search; (3) develop scenario framework; and (4) write scenario. Results Scenarios focused only on interventions, not diagnostic or prognostic problems. The process led to two types of scenarios – ones that provided an intervention with strong research evidence and others where the intervention had weak evidence to support its use. The end product of the process was a scenario that incorporates aspects of evidence-based decision making and can be used as the basis for evaluation. Conclusion The use of scenarios has been very helpful to capture therapists’ reasoning processes. The scenario development process was applied in an education context as part of a final evaluation of graduating clinical physical therapy students. PMID:23762009

  5. Decision-Making Processes among Prostate Cancer Survivors with Rising PSA Levels: Results from a Qualitative Analysis1

    PubMed Central

    Shen, Megan Johnson; Nelson, Christian J.; Peters, Ellen; Slovin, Susan F.; Hall, Simon J.; Hall, Matt; Herrera, Phapichaya Chaoprang; Leventhal, Elaine A.; Leventhal, Howard; Diefenbach, Michael A.

    2014-01-01

    Background Prostate cancer survivors with a rising prostate specific antigen (PSA) level have few treatment options, experience a heightened state of uncertainty about their disease trajectory that might include the possibility of cancer metastasis and death, and often experience elevated levels of distress as they have to deal with a disease they thought they had conquered. Guided by self-regulation theory, the present study examined the cognitive and affective processes involved in shared decision making between physician and patients who experience a rising PSA after definitive treatment for prostate cancer. Methods In-depth interviews were conducted with 34 prostate cancer survivors who had been diagnosed with a rising PSA (i.e., biochemical failure) within the past 12 months. Survivors were asked about their experiences and affective responses after being diagnosed with a rising PSA and while weighing potential treatment options. In addition, patients were asked about their decision-making process for the initial prostate cancer treatment. Results Compared to the initial diagnosis, survivors with a rising PSA reported increased negative affect following their diagnosis, concern about the treatability of their disease, increased planning and health behavior change, heightened levels of worry preceding doctor’s appointments (especially prior to the discussion of PSA testing results), and a strong reliance on physicians’ treatment recommendations. Conclusions Prostate cancer survivors’ decision-making processes for the treatment of a rising PSA are markedly different from those of the initial diagnosis of prostate cancer. Because patients experience heightened distress and rely more heavily on their physicians’ recommendations with a rising PSA, interactions with the health care provider provide an excellent opportunity to address and assist patients with managing the uncertainty and distress inherent with rising PSA levels. PMID:25385751

  6. Decision-making Processes among Prostate Cancer Survivors with Rising PSA Levels: Results from a Qualitative Analysis.

    PubMed

    Shen, Megan Johnson; Nelson, Christian J; Peters, Ellen; Slovin, Susan F; Hall, Simon J; Hall, Matt; Herrera, Phapichaya Chaoprang; Leventhal, Elaine A; Leventhal, Howard; Diefenbach, Michael A

    2015-05-01

    Prostate cancer survivors with a rising prostate-specific antigen (PSA) level have few treatment options, experience a heightened state of uncertainty about their disease trajectory that might include the possibility of cancer metastasis and death, and often experience elevated levels of distress as they have to deal with a disease they thought they had conquered. Guided by self-regulation theory, the present study examined the cognitive and affective processes involved in shared decision making between physicians and patients who experience a rising PSA after definitive treatment for prostate cancer. In-depth interviews were conducted with 34 prostate cancer survivors who had been diagnosed with a rising PSA (i.e., biochemical failure) within the past 12 months. Survivors were asked about their experiences and affective responses after being diagnosed with a rising PSA and while weighing potential treatment options. In addition, patients were asked about their decision-making process for the initial prostate cancer treatment. Compared with the initial diagnosis, survivors with a rising PSA reported increased negative affect following their diagnosis, concern about the treatability of their disease, increased planning and health behavior change, heightened levels of worry preceding doctor appointments (especially prior to the discussion of PSA testing results), and a strong reliance on physicians' treatment recommendations. Prostate cancer survivors' decision-making processes for the treatment of a rising PSA are markedly different from those of the initial diagnosis of prostate cancer. Because patients experience heightened distress and rely more heavily on their physicians' recommendations with a rising PSA, interactions with the health care provider provide an excellent opportunity to address and assist patients with managing the uncertainty and distress inherent with rising PSA levels. © The Author(s) 2014.

  7. Uncertainties in hydrological extremes projections and its effects on decision-making processes in an Amazonian sub-basin.

    NASA Astrophysics Data System (ADS)

    Andres Rodriguez, Daniel; Garofolo, Lucas; Lazaro Siqueira Junior, Jose

    2013-04-01

    Uncertainties in Climate Change projections are affected by irreducible uncertainties due to knowledge's limitations, chaotic nature of climate system and human decision-making process. Such uncertainties affect the impact studies, complicating the decision-making process aimed at mitigation and adaptation. However, these uncertainties allow the possibility to develop exploratory analyses on system's vulnerability to different sceneries. Through these kinds of analyses it is possible to identify critical issues, which must be deeper studied. For this study we used several future's projections from General Circulation Models to feed a Hydrological Model, applied to the Amazonian sub-basin of Ji-Paraná. Hydrological Model integrations are performed for present historical time (1970-1990) and for future period (2010-2100). Extreme values analyses are performed to each simulated time series and results are compared with extremes events in present time. A simple approach to identify potential vulnerabilities consists of evaluating the hydrologic system response to climate variability and extreme events observed in the past, comparing them with the conditions projected for the future. Thus it is possible to identify critical issues that need attention and more detailed studies. For the goal of this work, we used socio-economic data from Brazilian Institute of Geography and Statistics, the Operator of the National Electric System, the Brazilian National Water Agency and scientific and press published information. This information is used to characterize impacts associated to extremes hydrological events in the basin during the present historical time and to evaluate potential impacts in the future face to the different hydrological projections. Results show inter-model variability results in a broad dispersion on projected extreme's values. The impact of such dispersion is differentiated for different aspects of socio-economic and natural systems and must be carefully

  8. The decision-making process for the fate of frozen embryos by Japanese infertile women: a qualitative study

    PubMed Central

    2012-01-01

    Background Previous studies have found that the decision-making process for stored unused frozen embryos involves much emotional burden influenced by socio-cultural factors. This study aims to ascertain how Japanese patients make a decision on the fate of their frozen embryos: whether to continue storage discard or donate to research. Methods Ten Japanese women who continued storage, 5 who discarded and 16 who donated to research were recruited from our infertility clinic. Tape-recorded interviews were transcribed and analyzed for emergent themes. Results A model of patients’ decision-making processes for the fate of frozen embryos was developed, with a common emergent theme, “coming to terms with infertility” resulting in either acceptance or postponing acceptance of their infertility. The model consisted of 5 steps: 1) the embryo-transfer moratorium was sustained, 2) the “Mottainai”- embryo and having another child were considered; 3) cost reasonability was taken into account; 4) partner’s opinion was confirmed to finally decide whether to continue or discontinue storage. Those discontinuing, then contemplated 5): the effect of donation. Great emotional conflict was expressed in the theme, steps 2, 4, and 5. Conclusions Patients’ 5 step decision-making process for the fate of frozen embryos was profoundly affected by various Japanese cultural values and moral standards. At the end of their decision, patients used culturally inherent values and standards to come to terms with their infertility. While there is much philosophical discussion on the moral status of the embryo worldwide, this study, with actual views of patients who own them, will make a significant contribution to empirical ethics from the practical viewpoint. PMID:22607034

  9. Decision Making and Communications Process Assessment of NASA Using Three Change Requests from the Space Launch System Program

    NASA Technical Reports Server (NTRS)

    Hicks, Karen Campbell

    2015-01-01

    This thesis investigated the communication and decision making process as part of the Systems Engineering practices at the NASA/Marshall Center to determine its level of effectiveness. Data was collected across three change requests to assess how decisions were made, how the decisions were communicated, and whether a process mattered in the formulation and dissemination of those decisions. Data results revealed the comprehensive decision making process for the technical change requests to be effective. Evidence revealed that the process was sufficiently tailored to accommodate the need of each individual technical change which promoted effective communication amongst the stakeholders in the formulation of the strategic decision recommendations elevated to upper management. However, data results also revealed the dissemination of the final decision and approval of the change requests from the higher organizational level down to all stakeholders was less effective. An establishment of a culmination meeting at the end of the change request decision process in which to close the communication loop with all entities would be beneficial.

  10. A new intuitionistic fuzzy rule-based decision-making system for an operating system process scheduler.

    PubMed

    Butt, Muhammad Arif; Akram, Muhammad

    2016-01-01

    We present a new intuitionistic fuzzy rule-based decision-making system based on intuitionistic fuzzy sets for a process scheduler of a batch operating system. Our proposed intuitionistic fuzzy scheduling algorithm, inputs the nice value and burst time of all available processes in the ready queue, intuitionistically fuzzify the input values, triggers appropriate rules of our intuitionistic fuzzy inference engine and finally calculates the dynamic priority (dp) of all the processes in the ready queue. Once the dp of every process is calculated the ready queue is sorted in decreasing order of dp of every process. The process with maximum dp value is sent to the central processing unit for execution. Finally, we show complete working of our algorithm on two different data sets and give comparisons with some standard non-preemptive process schedulers.

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

    PubMed Central

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

    2017-01-01

    Introduction: Three-dimensional. (3D) printing is an innovative manufacturing process that allows computer-assisted conversion of 3D imaging data into physical “printouts” Healthcare applications are currently in evolution. Objective: The objective of this study was to explore the feasibility and impact of using patient-specific 3D-printed cardiac prototypes derived from high-resolution medical imaging data (cardiac magnetic resonance imaging/computed tomography [MRI/CT]) on surgical decision-making and preoperative planning in selected cases of complex congenital heart diseases (CHDs). Materials and Methods: Five patients with complex CHD with previously unresolved management decisions were chosen. These included two patients with complex double-outlet right ventricle, two patients with criss-cross atrioventricular connections, and one patient with congenitally corrected transposition of great arteries with pulmonary atresia. Cardiac MRI was done for all patients, cardiac CT for one; specific surgical challenges were identified. Volumetric data were used to generate patient-specific 3D models. All cases were reviewed along with their 3D models, and the impact on surgical decision-making and preoperative planning was assessed. Results: Accurate life-sized 3D cardiac prototypes were successfully created for all patients. The models enabled radically improved 3D understanding of anatomy, identification of specific technical challenges, and precise surgical planning. Augmentation of existing clinical and imaging data by 3D prototypes allowed successful execution of complex surgeries for all five patients, in accordance with the preoperative planning. Conclusions: 3D-printed cardiac prototypes can radically assist decision-making, planning, and safe execution of complex congenital heart surgery by improving understanding of 3D anatomy and allowing anticipation of technical challenges. PMID:28566818

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

    PubMed

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

    2017-01-01

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

  13. Teachers' Grading Decision Making

    ERIC Educational Resources Information Center

    Isnawati, Ida; Saukah, Ali

    2017-01-01

    This study investigated teachers' grading decision making, focusing on their beliefs underlying their grading decision making, their grading practices and assessment types, and factors they considered in grading decision making. Two teachers from two junior high schools applying different curriculum policies in grade reporting in Indonesian…

  14. Enrolling adolescents in asthma research: Adolescent, parent, and physician influence in the decision-making process

    PubMed Central

    Brody, Janet L.; Annett, Robert D.; Scherer, David G.; Turner, Charles; Dalen, Jeanne

    2009-01-01

    to concur with the final research participation decision, felt less comfortable, and were less likely to feel they influenced the decision. Conclusions Parents’ views on research decisions take precedence over adolescents’ views in most circumstances. Physician-investigator relationships may reduce parental resistance to participation and enhance adolescent decision-making autonomy when research participation is desired by the adolescent. PMID:19544171

  15. The Needs of Hybrid Systems Configuration for Real - Time Decision - Making Process in Surgery

    DTIC Science & Technology

    2001-10-25

    introduction of medical imaging technologies permitted to establish general guidelines for diagnosis and staging to select a range of techniques or...surgical strategies that could fit the spectrum of pathological possibilities. Dynamic medical imaging technologies in pre- operative staging permit

  16. Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus

    PubMed Central

    Patel, N. K.; Griffiths, D.; Athanasiou, T.; Gupte, C. M.; Reilly, P.

    2016-01-01

    Objectives The objective of this study was to perform a meta-analysis of all randomised controlled trials (RCTs) comparing surgical and non-surgical management of fractures of the proximal humerus, and to determine whether further analyses based on complexity of fracture, or the type of surgical intervention, produced disparate findings on patient outcomes. Methods A systematic review of the literature was performed identifying all RCTs that compared surgical and non-surgical management of fractures of the proximal humerus. Meta-analysis of clinical outcomes was performed where possible. Subgroup analysis based on the type of fracture, and a sensitivity analysis based on the type of surgical intervention, were also performed. Results Seven studies including 528 patients were included. The overall meta-analysis found that there was no difference in clinical outcomes. However, subgroup and sensitivity analyses found improved patient outcomes for more complex fractures managed surgically. Four-part fractures that underwent surgery had improved long-term health utility scores (mean difference, MD 95% CI 0.04 to 0.28; p = 0.007). They were also less likely to result in osteoarthritis, osteonecrosis and non/malunion (OR 7.38, 95% CI 1.97 to 27.60; p = 0.003). Another significant subgroup finding was that secondary surgery was more common for patients that underwent internal fixation compared with conservative management within the studies with predominantly three-part fractures (OR 0.15, 95% CI 0.04 to 0.63; p = 0.009). Conclusion This meta-analysis has demonstrated that differences in the type of fracture and surgical treatment result in outcomes that are distinct from those generated from analysis of all types of fracture and surgical treatments grouped together. This has important implications for clinical decision making and should highlight the need for future trials to adopt more specific inclusion criteria. Cite this article: S. Sabharwal, N. K. Patel, D

  17. Combined distributed source and single-trial EEG-fMRI modeling: application to effortful decision making processes.

    PubMed

    Esposito, Fabrizio; Mulert, Christoph; Goebel, Rainer

    2009-08-01

    Single-trial coupling of simultaneously recorded EEG and fMRI time-series can be used to generate fMRI patterns of brain activity with high spatial resolution from EEG responses with high temporal resolution. A forced choice reaction task under different effort conditions has been previously used to demonstrate single-trial EEG-fMRI coupling effects for an early ERP component (N1: 70-150 ms) measured on a single scalp channel (Cz), thereby providing the first multi-modal evidence of early anterior cingulate cortex (ACC) activation in effortful decision making (Mulert, C., Seifert, C., Leicht, G., Kirsch, V., Ertl, M., Karch, S., Moosmann, M., Lutz, J., Möller, H.J., Hegerl, U., Pogarell, O., Jäger, L., 2008. Single-trial coupling of EEG and fMRI reveals the involvement of early anterior cingulate cortex activation in effortful decision making. Neuroimage 42, 158-168.). In this work, we searched for "effort-specific" ERP-N1 sources and explored their single-trial EEG-fMRI correlations for discovering "source-specific" inter-modality coupling effects. To this end, we performed a whole-cortex distributed ERP analysis and used the local source power trial-by-trial variation as an input for single-trial EEG-fMRI coupling analysis. We found a high-effort-specific ERP-N1 source in the ACC and statistically significant differential EEG-fMRI coupling spots in five cortical regions, including the ACC. Our results provide new insights about the neural origins of effort-specific EEG and fMRI response modulations in a choice reaction task and confirm the central role of early ACC activation in motivation-related decision making processes; we discuss the importance of combining distributed source modeling with single-trial coupling for enriching the interpretation of EEG-fMRI patterns.

  18. DIFFERENTIAL DIAGNOSTIC PROCESS AND CLINICAL DECISION MAKING IN A YOUNG ADULT FEMALE WITH LATERAL HIP PAIN: A CASE REPORT.

    PubMed

    Livingston, Jennifer I; Deprey, Sara M; Hensley, Craig P

    2015-10-01

    differential diagnosis and clinical decision making. Young adults with lateral hip pain are often referred to physical therapy (PT). A thorough examination is required to obtain a diagnosis and guide management. The purpose of this case report is to describe the physical therapist's differential diagnostic process and clinical decision making for a subject with the referring diagnosis of trochanteric bursitis. A 29-year-old female presented to PT with limited sitting and running tolerance secondary to right lateral hip pain. Her symptoms began three months prior when she abruptly changed her running intensity and frequency of weight bearing activities, including running and low impact plyometrics for the lower extremity. Physical examination revealed a positive Trendelenburg sign, manual muscle test that was weak and painless of the right hip abductors, and pain elicited when performing a vertical hop on a concrete surface (+single leg hop test), but pain-free when performing the same single leg hop on a foam surface. Examination findings warranted discussion with the referring physician for further diagnostic imaging. Magnetic resonance imaging revealed a focus of edema in the posterior acetabulum, suspicious for an acetabular stress fracture. The subject was subsequently diagnosed with an acetabular stress fracture and restricted from running and plyometrics for four weeks. Thorough examination and appropriate clinical decision making by the physical therapist at the initial examination led to the diagnosis of an acetabular stress fracture in this subject. Clinicians must be aware of symptoms and signs which place the subject at risk for stress fracture for timely referral and management. 4.

  19. The role of citizen public-interest groups in the decision-making process of a science-intensive culture

    SciTech Connect

    Sinclair, M.P.

    1991-01-01

    This study explores how concerns about the environment have escalated in the past three decades from being peripheral to that of a mainstream social movement. Most environmental concerns stem from the deployment of technologies where technical expertise is essential to effective participation in the decision-making process. The manner in which the current policy for the disposal of low-level radioactive waste was devised and passed by Congress provides the information base through which the role of citizen groups in the decision-making process in a science-intensive culture is explored, as they seek to overcome the adverse environmental impacts and economic inequities of this Act. The actual process by which citizens have confronted this current flawed policy is described, which includes how technical expertise from various sources made the citizens' case credible and effective. Several existing and theoretical models of citizen participation are described. Recommendations and conclusions are presented briefly, and a recommended model based on the concept of sustainable development is proposed.

  20. Public Reporting of Hospital-Level Cancer Surgical Volumes in California: An Opportunity to Inform Decision Making and Improve Quality.

    PubMed

    Clarke, Christina A; Asch, Steven M; Baker, Laurence; Bilimoria, Karl; Dudley, R Adams; Fong, Niya; Holliday-Hanson, Merry L; Hopkins, David S P; Imholz, Elizabeth M; Malin, Jennifer; Moy, Lisa; O'Sullivan, Maryann; Parker, Joseph P; Saigal, Christopher S; Spurlock, Bruce; Teleki, Stephanie; Zingmond, David; Lang, Lance

    2016-10-01

    Most patients, providers, and payers make decisions about cancer hospitals without any objective data regarding quality or outcomes. We developed two online resources allowing users to search and compare timely data regarding hospital cancer surgery volumes. Hospital cancer surgery volumes for all California hospitals were calculated using ICD-9 coded hospital discharge summary data. Cancer surgeries included (bladder, brain, breast, colon, esophagus, liver, lung, pancreas, prostate, rectum, and stomach) were selected on the basis of a rigorous literature review to confirm sufficient evidence of a positive association between volume and mortality. The literature could not identify threshold numbers of surgeries associated with better or worse outcomes. A multidisciplinary working group oversaw the project and ensured sound methodology. In California in 2014, about 60% of surgeries were performed at top-quintile-volume hospitals, but the per-hospital median numbers of surgeries for esophageal, pancreatic, stomach, liver, or bladder cancer surgeries were four or fewer. At least 670 patients received cancer surgery at hospitals that performed only one or two surgeries for a particular cancer type; 72% of those patients lived within 50 miles of a top-quintile-volume hospital. There is clear potential for more readily available information about hospital volumes to help patient, providers, and payers choose cancer surgery hospitals. Our successful public reporting of hospital volumes in California represents an important first step toward making publicly available even more provider-specific data regarding cancer care quality, costs, and outcomes, so those data can inform decision-making and encourage quality improvement.

  1. The Lisbon new international airport: The story of a decision-making process and the role of Strategic Environmental Assessment

    SciTech Connect

    Partidario, Maria R.; Coutinho, Miguel

    2011-04-15

    This is the brief story of a decision process and the role of Strategic Environmental Assessment in government political decision-making. Following a prolonged, and agitated, decision process, initiated in the 1960s, the Government of Portugal in 2005 took the final decision to build the new international airport of Lisbon at the controversial location of Ota, 40 km north of Lisbon. The detailed project design and EIA were started. However this decision would change in 2007 due to the challenge raised by a private sponsored study that identified an alternative location for the airport at Campo de Tiro de Alcochete (CTA). This new site, which had never been considered as an option before, appeared to avoid many of the problems that caused public controversy at the Ota site. The Government, pressured by this challenge, promoted a strategic comparative assessment between the two sites. The result of this study was the choice of CTA as the preferred location. This paper discusses this radical change in the decision from a socio-political perspective. It will highlight the relevance of Strategic Environmental Assessment (SEA), and the strategic and constructive approach it enables in mega-project decision-making.

  2. [Shared decision making from the perspective of the cancer patient: participatory roles and evaluation of the process].

    PubMed

    Padilla Garrido, N; Aguado Correa, F; Ortega Moreno, M; Bayo Calero, J; Bayo Lozano, E

    2017-04-30

    In Spain there is no clear knowledge about the degree to which Shared Decision Making (SDM) is carried out in the normal practice of oncology. Our article analyses the preferred role and the perceived role of oncological patients and measures the SDM process from their perspective. Descriptive transversal study using a self-conducted questionnaire with patients with different types of cancer. To evaluate the role preferred and perceived by the patient we used The Control Preference Scales (CPS) and to measure SDM we used The nine-item Shared Decision Making Questionnaire (SDM-Q-9). Out of the 132 patients surveyed, only 118 provided analysable data. No evidence was found that sex, age, educational level or type of tumour affected the preferred role or the perceived role. Only 59.3% was in agreement with the role exercised. All of those who preferred a passive role achieved this (21.2%), while out of those who wanted a shared role (78.8%), this was achieved by only 48.39% while the remaining 51.61% played a passive role. None preferred or played an active role. The set of patients evaluated the SDM process with a score of 41.07±5.94, on a scale of 0 to 100, with the highest score of 61.39 ± 13.24 reached by urological patients. Our study found no evidence that, from the point of view of the oncological patient, the SDM model is being implemented in practice.

  3. The decision-making process in Brazil's ratification of the World Health Organization Framework Convention on Tobacco Control.

    PubMed

    Rangel, Erica Cavalcanti; Pereira, Andre; Cavalcante, Tania Maria; Oliveira, Egléubia Andrade; Silva, Vera Luiza da Costa E

    2017-09-21

    Tobacco consumption is a leading cause of various types of cancer and other tobacco-related diseases. In 2003, the World Health Assembly adopted the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC), which aims to protect citizens from the health, social, environmental, and economic consequences of tobacco consumption and exposure to tobacco smoke. The Convention was to be ratified by the Member States of the WHO; in Brazil's case, ratification involved the National Congress, which held public hearings in the country's leading tobacco growing communities (municipalities). The current study analyzes this decision-making process according to the different interests, positions, and stakeholders. In methodological terms, this is a qualitative study based on document research, drawing primarily on the shorthand notes from the public hearings. We analyze the interests and arguments for and against ratification. The article shows that although preceded by intense debates, the final decision in favor of ratification was made by a limited group of government stakeholders, characterizing a decision-making process similar to a funnel.

  4. Single-process versus multiple-strategy models of decision making: evidence from an information intrusion paradigm.

    PubMed

    Söllner, Anke; Bröder, Arndt; Glöckner, Andreas; Betsch, Tilmann

    2014-02-01

    When decision makers are confronted with different problems and situations, do they use a uniform mechanism as assumed by single-process models (SPMs) or do they choose adaptively from a set of available decision strategies as multiple-strategy models (MSMs) imply? Both frameworks of decision making have gathered a lot of support, but only rarely have they been contrasted with each other. Employing an information intrusion paradigm for multi-attribute decisions from givens, SPM and MSM predictions on information search, decision outcomes, attention, and confidence judgments were derived and tested against each other in two experiments. The results consistently support the SPM view: Participants seemingly using a "take-the-best" (TTB) strategy do not ignore TTB-irrelevant information as MSMs would predict, but adapt the amount of information searched, choose alternative choice options, and show varying confidence judgments contingent on the quality of the "irrelevant" information. The uniformity of these findings underlines the adequacy of the novel information intrusion paradigm and comprehensively promotes the notion of a uniform decision making mechanism as assumed by single-process models. Copyright © 2013 The Authors. Published by Elsevier B.V. All rights reserved.

  5. Measuring critical deficits in shared decision making before elective surgery.

    PubMed

    Ankuda, Claire K; Block, Susan D; Cooper, Zara; Correll, Darin J; Hepner, David L; Lasic, Morana; Gawande, Atul A; Bader, Angela M

    2014-03-01

    Identifying patient factors correlated with specific needs in preoperative decision making is of clinical and ethical importance. We examined patterns and predictors of deficiencies in informed surgical consent and shared decision-making in preoperative patients. Validated measures were used to survey 1034 preoperative patients in the preoperative clinic after signed informed consent. Principal component analysis defined correlated groupings of factors. Multivariable analysis assessed patient factors associated with resultant groupings. 13% of patients exhibited deficits in their informed consent process; 33% exhibited other types of deficits. Informed consent deficits included not knowing the procedure being performed or risks and benefits. Other deficits included not having addressed patient values, preferences and goals. Non-English language and lower educational level were factors correlated with higher risk for deficits. Deficits exist in over a third of patients undergoing preoperative decision-making. Sociodemographic factors such as language and educational level identified particularly vulnerable groups at risk for having an incomplete, and possibly ineffective, decision-making process. Interventions to identify vulnerable groups and address patient centered surgical decision making in the pre-operative setting are needed. Focused interventions to address the needs of at-risk patients have potential to improve the surgical decision-making process and reduce disparities. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  6. Intraoperative frozen sections of the regional lymph nodes contribute to surgical decision-making in non-small cell lung cancer patients

    PubMed Central

    Li, Wei; Yang, Xue-Ning; Liao, Ri-Qiang; Nie, Qiang; Dong, Song; Zhai, Hao-Ran

    2016-01-01

    Background Individualization of pulmonary parenchymal resection and lymphadenectomy in lung cancer patients will likely become more important as surgical innovation. This study explored the utility of intraoperative pathological frozen sections of regional lymph nodes in non-small cell lung cancer (NSCLC) patients. Methods Patients with NSCLC underwent intraoperative sampling of N1 station lymph nodes depending on the location of the tumor, any other suspicious lymph nodes were also biopsied. The contribution of frozen-section analysis to surgical decision-making was evaluated. Results Of 74 lung cancer patients who underwent intraoperative frozen section analysis of lymph nodes, the positive rate was 18/74 (24.3%). The extents of agreement between preoperative N staging (cN) and intraoperative N staging (sN), cN staging and postoperative N staging (pN), and sN staging and pN staging were 62.2% (46/74), 63.5% (47/74), and 71.6% (53/74), respectively. When frozen section was combined with evaluation of pulmonary function and intrathoracic adhesions, surgical strategies were modified during operations in 18 cases (5 sN-positive, 13 sN-negative). Of these patients, five underwent extensive pulmonary parenchymal resection, and four had conservative lung parenchymal resection. In nine patients, the extent of lymph node dissection (LND) was changed. Conclusions Intraoperative frozen section of regional lymph nodes led to 24.3% operative strategies modification in lung cancer. Frozen section analysis may make an important contribution to surgical decision-making in terms of pulmonary parenchymal resection and LND. PMID:27621849

  7. Evaluating Quality of Decision-Making Processes in Medicines' Development, Regulatory Review, and Health Technology Assessment: A Systematic Review of the Literature

    PubMed Central

    Bujar, Magdalena; McAuslane, Neil; Walker, Stuart R.; Salek, Sam

    2017-01-01

    Introduction: Although pharmaceutical companies, regulatory authorities, and health technology assessment (HTA) agencies have been increasingly using decision-making frameworks, it is not certain whether these enable better quality decision making. This could be addressed by formally evaluating the quality of decision-making process within those organizations. The aim of this literature review was to identify current techniques (tools, questionnaires, surveys, and studies) for measuring the quality of the decision-making process across the three stakeholders. Methods: Using MEDLINE, Web of Knowledge, and other Internet-based search engines, a literature review was performed to systematically identify techniques for assessing quality of decision making in medicines development, regulatory review, and HTA. A structured search was applied using key words and a secondary review was carried out. In addition, the measurement properties of each technique were assessed and compared. Ten Quality Decision-Making Practices (QDMPs) developed previously were then used as a framework for the evaluation of techniques identified in the review. Due to the variation in studies identified, meta-analysis was inappropriate. Results: This review identified 13 techniques, where 7 were developed specifically to assess decision making in medicines' development, regulatory review, or HTA; 2 examined corporate decision making, and 4 general decision making. Regarding how closely each technique conformed to the 10 QDMPs, the 13 techniques assessed a median of 6 QDMPs, with a mode of 3 QDMPs. Only 2 techniques evaluated all 10 QDMPs, namely the Organizational IQ and the Quality of Decision Making Orientation Scheme (QoDoS), of which only one technique, QoDoS could be applied to assess decision making of both individuals and organizations, and it possessed generalizability to capture issues relevant to companies as well as regulatory authorities. Conclusion: This review confirmed a general

  8. Evaluating Quality of Decision-Making Processes in Medicines' Development, Regulatory Review, and Health Technology Assessment: A Systematic Review of the Literature.

    PubMed

    Bujar, Magdalena; McAuslane, Neil; Walker, Stuart R; Salek, Sam

    2017-01-01

    Introduction: Although pharmaceutical companies, regulatory authorities, and health technology assessment (HTA) agencies have been increasingly using decision-making frameworks, it is not certain whether these enable better quality decision making. This could be addressed by formally evaluating the quality of decision-making process within those organizations. The aim of this literature review was to identify current techniques (tools, questionnaires, surveys, and studies) for measuring the quality of the decision-making process across the three stakeholders. Methods: Using MEDLINE, Web of Knowledge, and other Internet-based search engines, a literature review was performed to systematically identify techniques for assessing quality of decision making in medicines development, regulatory review, and HTA. A structured search was applied using key words and a secondary review was carried out. In addition, the measurement properties of each technique were assessed and compared. Ten Quality Decision-Making Practices (QDMPs) developed previously were then used as a framework for the evaluation of techniques identified in the review. Due to the variation in studies identified, meta-analysis was inappropriate. Results: This review identified 13 techniques, where 7 were developed specifically to assess decision making in medicines' development, regulatory review, or HTA; 2 examined corporate decision making, and 4 general decision making. Regarding how closely each technique conformed to the 10 QDMPs, the 13 techniques assessed a median of 6 QDMPs, with a mode of 3 QDMPs. Only 2 techniques evaluated all 10 QDMPs, namely the Organizational IQ and the Quality of Decision Making Orientation Scheme (QoDoS), of which only one technique, QoDoS could be applied to assess decision making of both individuals and organizations, and it possessed generalizability to capture issues relevant to companies as well as regulatory authorities. Conclusion: This review confirmed a general

  9. The amygdala and decision making

    PubMed Central

    Gupta, Rupa; Koscik, Timothy R.; Bechara, Antoine; Tranel, Daniel

    2010-01-01

    Decision-making is a complex process that requires the orchestration of multiple neural systems. For example, decision-making is believed to involve areas of the brain involved in emotion (e.g., amygdala, ventromedial prefrontal cortex) and memory (e.g., hippocampus, dorsolateral prefrontal cortex). In this article, we will present findings related to the amygdala’s role in decision-making, and differentiate the contributions of the amygdala from those of other structurally and functionally connected neural regions. Decades of research have shown that the amygdala is involved in associating a stimulus with its emotional value. This tradition has been extended in newer work, which has shown that the amygdala is especially important for decision-making, by triggering autonomic responses to emotional stimuli, including monetary reward and punishment. Patients with amygdala damage lack these autonomic responses to reward and punishment, and consequently, cannot utilize “somatic marker” type cues to guide future decision-making. Studies using laboratory decision-making tests have found deficient decision-making in patients with bilateral amygdala damage, which resembles their real-world difficulties with decision-making. Additionally, we have found evidence for an interaction between sex and laterality of amygdala functioning, such that unilateral damage to the right amygdala results in greater deficits in decision-making and social behavior in men, while left amygdala damage seems to be more detrimental for women. We have posited that the amygdala is part of an “impulsive,” habit type system that triggers emotional responses to immediate outcomes. PMID:20920513

  10. Propulsion Airframe Aeroacoustics Technology Evaluation and Selection Using a Multi-Attribute Decision Making Process and Non-Deterministic Design

    NASA Technical Reports Server (NTRS)

    Burg, Cecile M.; Hill, Geoffrey A.; Brown, Sherilyn A.; Geiselhart, Karl A.

    2004-01-01

    The Systems Analysis Branch at NASA Langley Research Center has investigated revolutionary Propulsion Airframe Aeroacoustics (PAA) technologies and configurations for a Blended-Wing-Body (BWB) type aircraft as part of its research for NASA s Quiet Aircraft Technology (QAT) Project. Within the context of the long-term NASA goal of reducing the perceived aircraft noise level by a factor of 4 relative to 1997 state of the art, major configuration changes in the propulsion airframe integration system were explored with noise as a primary design consideration. An initial down-select and assessment of candidate PAA technologies for the BWB was performed using a Multi-Attribute Decision Making (MADM) process consisting of organized brainstorming and decision-making tools. The assessments focused on what effect the PAA technologies had on both the overall noise level of the BWB and what effect they had on other major design considerations such as weight, performance and cost. A probabilistic systems analysis of the PAA configurations that presented the best noise reductions with the least negative impact on the system was then performed. Detailed results from the MADM study and the probabilistic systems analysis will be published in the near future.

  11. Processing of decision-making and social threat in patients with history of suicidal attempt: A neuroimaging replication study.

    PubMed

    Olié, Emilie; Ding, Yang; Le Bars, Emmanuelle; de Champfleur, Nicolas Menjot; Mura, Thibault; Bonafé, Alain; Courtet, Philippe; Jollant, Fabrice

    2015-12-30

    Suicidal vulnerability has been related to impaired value-based decision-making and increased sensitivity to social threat, mediated by the prefrontal cortex. Using functional magnetic resonance imaging, we aimed at replicating these previous findings by measuring brain activation during the Iowa Gambling Task and an emotional faces viewing task. Participants comprised 15 euthymic suicide attempters (history of depression and suicidal behavior) who were compared with 23 euthymic patient controls (history of depression without suicidal history) and 35 healthy controls. The following five model-based regions of interest were investigated: the orbitofrontal cortex (OFC), ventrolateral prefrontal cortex (VLPFC), anterior cingulate cortex (ACC), medial (MPFC) and dorsal prefrontal cortex (DPFC). Suicide attempters relative to patient controls showed (1) increased response to angry vs. neutral faces in the left OFC and the VLPFC, as previously reported; (2) increased response to wins vs. losses in the right OFC, DPFC and ACC; (3) decreased response to risky vs. safe choices in the left DPFC; and (4) decreased response to sad vs. neutral faces in the right ACC. This study links impaired valuation processing (here for signals of social threat, sadness and reward) to prefrontal cortex dysfunction in suicide attempters. These long-term deficits may underlie the impaired decision-making and social difficulties found in suicide attempters.

  12. Plastic neo-vaginal construction in Mayer-Rokitansky-Küster-Hauser syndrome: an expert opinion paper on the decision-making treatment process.

    PubMed

    Torres-de la Roche, Luz Angela; Devassy, Rajesh; Gopalakrishnan, Sreelatha; de Wilde, Maya Sophie; Herrmann, Anja; Larbig, Angelika; De Wilde, Rudy Leon

    2016-01-01

    Vaginal agenesis is a congenital anomaly that affects the life of one of each four thousand women around the world. There is a trend that patients request immediate surgical correction, instead of passive vaginal dilatation. Therefore a differentiated counselling should be provided. We present a comparative chart, based on published evidence, with aspect to the available techniques, which will facilitate the decision-making process in the clinical practice. From our point of view, the best results are achieved with techniques that combine the advantages of the minimal-invasive surgery with those derived of the use of peritoneum as covering tissue of the neovagina. Nevertheless there is a lack on interdisciplinary consensus about the best option to restore the physical and sexual quality of life.

  13. Plastic neo-vaginal construction in Mayer-Rokitansky-Küster-Hauser syndrome: an expert opinion paper on the decision-making treatment process

    PubMed Central

    Torres-de la Roche, Luz Angela; Devassy, Rajesh; Gopalakrishnan, Sreelatha; de Wilde, Maya Sophie; Herrmann, Anja; Larbig, Angelika; De Wilde, Rudy Leon

    2016-01-01

    Vaginal agenesis is a congenital anomaly that affects the life of one of each four thousand women around the world. There is a trend that patients request immediate surgical correction, instead of passive vaginal dilatation. Therefore a differentiated counselling should be provided. We present a comparative chart, based on published evidence, with aspect to the available techniques, which will facilitate the decision-making process in the clinical practice. From our point of view, the best results are achieved with techniques that combine the advantages of the minimal-invasive surgery with those derived of the use of peritoneum as covering tissue of the neovagina. Nevertheless there is a lack on interdisciplinary consensus about the best option to restore the physical and sexual quality of life. PMID:26904393

  14. Executive Control- and Reward-Related Neural Processes Associated with the Opportunity to Engage in Voluntary Dishonest Moral Decision Making

    PubMed Central

    Hu, Xiaoqing; Pornpattananangkul, Narun; Nusslock, Robin

    2016-01-01

    Research has begun to examine the neurocognitive processes underlying voluntary moral decision making, which involves engaging in honest or dishonest behavior in a setting where the individual is free to make his or her own moral decisions. Employing event-related potentials (ERPs), we measured executive control and reward-related neural processes during an incentivized coin-guessing task where participants had the opportunity to voluntarily engage in dishonest behavior by over-reporting their wins to maximize earnings. We report four primary findings: First, the opportunity to deceive recruited executive control processes involving conflict monitoring and conflict resolution, as evidenced by a higher N2 and a smaller P3; Second, processing the outcome of the coin-flips engaged reward-related processes, as evidenced by a larger medial feedback-negativity (MFN) for incorrect (loss) than correct (win) guesses, reflecting a reward prediction error signal. Third, elevated executive control-related neural activity reflecting conflict resolution (i.e., attenuated executive control-P3) predicted a greater likelihood of engaging in overall deceptive behavior. Finally, whereas elevated reward-related neural activity (reward-P3) was as associated with a greater likelihood of engaging in overall deceptive behavior, an elevated reward prediction error signal (MFN difference score) predicted increased trial-by-trial moral behavioral adjustment (i.e., a greater likelihood to over-report wins following a previous honest loss than a previous honest win trial). Collectively, these findings suggest that both executive control- and reward-related neural processes are implicated in moral decision making. PMID:25645507

  15. Decision making: the neuroethological turn

    PubMed Central

    Pearson, John M.; Watson, Karli K.; Platt, Michael L.

    2014-01-01

    Neuroeconomics applies models from economics and psychology to inform neurobiological studies of choice. This approach has revealed neural signatures of concepts like value, risk, and ambiguity, which are known to influence decision-making. Such observations have led theorists to hypothesize a single, unified decision process that mediates choice behavior via a common neural currency for outcomes like food, money, or social praise. In parallel, recent neuroethological studies of decision-making have focused on natural behaviors like foraging, mate choice, and social interactions. These decisions strongly impact evolutionary fitness and thus are likely to have played a key role in shaping the neural circuits that mediate decision-making. This approach has revealed a suite of computational motifs that appear to be shared across a wide variety of organisms. We argue that the existence of deep homologies in the neural circuits mediating choice may have profound implications for understanding human decision-making in health and disease. PMID:24908481

  16. Decision making: the neuroethological turn.

    PubMed

    Pearson, John M; Watson, Karli K; Platt, Michael L

    2014-06-04

    Neuroeconomics applies models from economics and psychology to inform neurobiological studies of choice. This approach has revealed neural signatures of concepts like value, risk, and ambiguity, which are known to influence decision making. Such observations have led theorists to hypothesize a single, unified decision process that mediates choice behavior via a common neural currency for outcomes like food, money, or social praise. In parallel, recent neuroethological studies of decision making have focused on natural behaviors like foraging, mate choice, and social interactions. These decisions strongly impact evolutionary fitness and thus are likely to have played a key role in shaping the neural circuits that mediate decision making. This approach has revealed a suite of computational motifs that appear to be shared across a wide variety of organisms. We argue that the existence of deep homologies in the neural circuits mediating choice may have profound implications for understanding human decision making in health and disease.

  17. Perioperative goal-setting consultations by surgical colleagues: a new model for supporting patients, families, and surgeons in shared decision making.

    PubMed

    Berlin, Ana; Kunac, Anastasia; Mosenthal, Anne C

    2016-11-29

    Patients with postoperative complications are often subjected to prolonged life-sustaining treatment based on erroneous assumptions about their goals of care. Shared decision making (SDM) is an evidence-based approach that helps ensure patients' wishes and values are honored in their course of treatment. Perioperative palliative care can help create goal-concordant trajectories of care for high risk, seriously ill, or complicated patients, through sophisticated prognostication, higher-level communication, and recommendations based on the best available evidence and patients' stated goals and priorities. Here, we present a surgeon-to-surgeon consultative model that surmounts many barriers to perioperative palliative care consultation and, as illustrated in the cases presented herein, offers profound and unique benefits for patients, families, and surgeons alike. While the support of a surgical colleague with palliative care skills can be helpful postoperatively in the setting of unanticipated outcomes or prolonged recovery, it is particularly beneficial when accessed preoperatively for the purposes of goal-concordant decision making and advance care planning. We encourage both individuals and professional societies to develop and expand the niche for surgeons interested in assisting with goal setting and SDM for patients on a consultative basis, particularly in the preoperative period.

  18. Decision-making process of Kala Azar care: results from a qualitative study carried out in disease endemic areas of Nepal

    PubMed Central

    2013-01-01

    Background Analysis of consumer decision making in the health sector is a complex process of comparing feasible alternatives and evaluating the levels of satisfaction associated with the relevant options. This paper makes an attempt to understand how and why consumers make specific decisions, what motivates them to adopt a specific health intervention, and what features they find attractive in each of the options. Method The study used a descriptive-explanatory design to analyze the factors determining the choices of healthcare providers. Information was collected through focus group discussions and in-depth interviews. Results The results suggest that the decision making related to seeking healthcare for Kala Azar (KA) treatment is a complex, interactive process. Patients and family members follow a well-defined road map for decision making. The process of decision making starts from the recognition of healthcare needs and is then modified by a number of other factors, such as indigenous knowledge, healthcare alternatives, and available resources. Household and individual characteristics also play important roles in facilitating the process of decision making. The results from the group discussions and in-depth interviews are consistent with the idea that KA patients and family members follow the rational approach of weighing the costs against the benefits of using specific types of medical care. Conclusion The process of decision making related to seeking healthcare follows a complex set of steps and many of the potential factors affect the decision making in a non-linear fashion. Our analysis suggests that it is possible to derive a generalized road map of the decision-making process starting from the recognition of healthcare needs, and then modifying it to show the influences of indigenous knowledge, healthcare alternatives, and available resources. PMID:23849617

  19. Decision-making process of Kala Azar care: results from a qualitative study carried out in disease endemic areas of Nepal.

    PubMed

    Adhikari, Shiva Raj; Supakankunti, Siripen; Khan, M Mahmud

    2013-07-12

    Analysis of consumer decision making in the health sector is a complex process of comparing feasible alternatives and evaluating the levels of satisfaction associated with the relevant options. This paper makes an attempt to understand how and why consumers make specific decisions, what motivates them to adopt a specific health intervention, and what features they find attractive in each of the options. The study used a descriptive-explanatory design to analyze the factors determining the choices of healthcare providers. Information was collected through focus group discussions and in-depth interviews. The results suggest that the decision making related to seeking healthcare for Kala Azar (KA) treatment is a complex, interactive process. Patients and family members follow a well-defined road map for decision making. The process of decision making starts from the recognition of healthcare needs and is then modified by a number of other factors, such as indigenous knowledge, healthcare alternatives, and available resources. Household and individual characteristics also play important roles in facilitating the process of decision making. The results from the group discussions and in-depth interviews are consistent with the idea that KA patients and family members follow the rational approach of weighing the costs against the benefits of using specific types of medical care. The process of decision making related to seeking healthcare follows a complex set of steps and many of the potential factors affect the decision making in a non-linear fashion. Our analysis suggests that it is possible to derive a generalized road map of the decision-making process starting from the recognition of healthcare needs, and then modifying it to show the influences of indigenous knowledge, healthcare alternatives, and available resources.

  20. Decision making in neonatologia.

    PubMed

    Paterlini, G; Tagliabue, P

    2010-06-01

    The field of neonatology presents a fascinating context in which hugely important decisions have to be made on the basis of physicians' assessments of the long term consequences of various possible choices. In many cases such assessments cannot be derived from a consensual professional opinion; the situation is characterized by a high level of uncertainty. A sample of neonatologists in different countries received a questionnaire including vignette cases for which no clear consensus exists regarding the (probabilistic) prognosis. They were asked to (I) assess the probability of various outcomes (death, severe impairment) and (II) choose a treatment to be offered to the parents. Information on the physicians' professional and socio-demographic characteristics and their ethical "values" was also collected. The goal of this international survey is to understand the prognosis and to analyze decision making by professionals in the context of life and death in medicine. The availability of an identical technology in different social and institutional contexts should help identifying the convergences and differences under consideration. Seventy percent of those invited responded to the questionnaire (International 60-80%). Italian neonatologists seem to be quite pessimistic about the prognosis of infants at high risk of death or long term disabilities, they show a pro-life attitude, but in a certain proportion are willing to change their minds if requested by parents. Furthermore personal opinions predominate in the decision-making process and the contribution of team meeting and/or ethic consultation seem not significantly modify the decisions.

  1. Rapid review programs to support health care and policy decision making: a descriptive analysis of processes and methods.

    PubMed

    Polisena, Julie; Garritty, Chantelle; Kamel, Chris; Stevens, Adrienne; Abou-Setta, Ahmed M

    2015-03-14

    Health care decision makers often need to make decisions in limited timeframes and cannot await the completion of a full evidence review. Rapid reviews (RRs), utilizing streamlined systematic review methods, are increasingly being used to synthesize the evidence with a shorter turnaround time. Our primary objective was to describe the processes and methods used internationally to produce RRs. In addition, we sought to understand the underlying themes associated with these programs. We contacted representatives of international RR programs from a broad realm in health care to gather information about the methods and processes used to produce RRs. The responses were summarized narratively to understand the characteristics associated with their processes and methods. The summaries were compared and contrasted to highlight potential themes and trends related to the different RR programs. Twenty-nine international RR programs were included in our sample with a broad organizational representation from academia, government, research institutions, and non-for-profit organizations. Responses revealed that the main objectives for RRs were to inform decision making with regards to funding health care technologies, services and policy, and program development. Central themes that influenced the methods used by RR programs, and report type and dissemination were the imposed turnaround time to complete a report, resources available, the complexity and sensitivity of the research topics, and permission from the requestor. Our study confirmed that there is no standard approach to conduct RRs. Differences in processes and methods across programs may be the result of the novelty of RR methods versus other types of evidence syntheses, customization of RRs for various decision makers, and definition of 'rapid' by organizations, since it impacts both the timelines and the evidence synthesis methods. Future research should investigate the impact of current RR methods and reporting to

  2. Processing ambiguity in a linguistic context: decision-making difficulties in non-aphasic patients with behavioral variant frontotemporal degeneration.

    PubMed

    Spotorno, Nicola; Healey, Meghan; McMillan, Corey T; Rascovsky, Katya; Irwin, David J; Clark, Robin; Grossman, Murray

    2015-01-01

    Some extent of ambiguity is ubiquitous in everyday conversations. For example, words have multiple meaning and very common pronouns, like "he" and "she" (anaphoric pronouns), have little meaning on their own and refer to a noun that has been previously introduced in the discourse. Ambiguity triggers a decision process that is not a subroutine of language processing but rather a more general domain resource. Therefore non-aphasic patients with limited decision-making capability can encounter severe limitation in language processing due to extra linguistic limitations. In the present study, we test patients with behavioral variant frontotemporal degeneration (bvFTD), focusing on anaphora as a paradigmatic example of ambiguity resolution in the linguistic domain. bvFTD is characterized by gray matter (GM) atrophy in prefrontal cortex, but relative sparing of peri-Sylvian cortex. A group of patients with parietal disease due to corticobasal syndrome (CBS) was also tested here in order to investigate the specific role of prefrontal cortex in the task employed in the current study. Participants were presented with a pair of sentences in which the first sentence contained two nouns while the second contained a pronoun. In the experimental (ambiguous) condition, both nouns are plausible referents of the pronoun, thus requiring decision-making resources. The results revealed that bvFTD patients are significantly less accurate than healthy seniors in identifying the correct referent of a pronoun in the ambiguous condition, although CBS patients were as accurate as healthy seniors. Imaging analyses related bvFTD patients' performance to GM atrophy in ventromedial prefrontal cortex (vmPFC). These results suggest that bvFTD patients have difficulties in decision processes that involve the resolution of an ambiguity.

  3. Processing ambiguity in a linguistic context: decision-making difficulties in non-aphasic patients with behavioral variant frontotemporal degeneration

    PubMed Central

    Spotorno, Nicola; Healey, Meghan; McMillan, Corey T.; Rascovsky, Katya; Irwin, David J.; Clark, Robin; Grossman, Murray

    2015-01-01

    Some extent of ambiguity is ubiquitous in everyday conversations. For example, words have multiple meaning and very common pronouns, like “he” and “she” (anaphoric pronouns), have little meaning on their own and refer to a noun that has been previously introduced in the discourse. Ambiguity triggers a decision process that is not a subroutine of language processing but rather a more general domain resource. Therefore non-aphasic patients with limited decision-making capability can encounter severe limitation in language processing due to extra linguistic limitations. In the present study, we test patients with behavioral variant frontotemporal degeneration (bvFTD), focusing on anaphora as a paradigmatic example of ambiguity resolution in the linguistic domain. bvFTD is characterized by gray matter (GM) atrophy in prefrontal cortex, but relative sparing of peri-Sylvian cortex. A group of patients with parietal disease due to corticobasal syndrome (CBS) was also tested here in order to investigate the specific role of prefrontal cortex in the task employed in the current study. Participants were presented with a pair of sentences in which the first sentence contained two nouns while the second contained a pronoun. In the experimental (ambiguous) condition, both nouns are plausible referents of the pronoun, thus requiring decision-making resources. The results revealed that bvFTD patients are significantly less accurate than healthy seniors in identifying the correct referent of a pronoun in the ambiguous condition, although CBS patients were as accurate as healthy seniors. Imaging analyses related bvFTD patients’ performance to GM atrophy in ventromedial prefrontal cortex (vmPFC). These results suggest that bvFTD patients have difficulties in decision processes that involve the resolution of an ambiguity. PMID:26578928

  4. Interorganizational decision making.

    NASA Technical Reports Server (NTRS)

    Tuite, M. (Editor); Chisholm, R.; Radnor, M.

    1972-01-01

    The papers are both theoretical and applied. They include contributions from a spectrum of academic specializations and from practitioners representing several organizations. The papers are divided into theoretical and applied groupings reflecting a variety of systems levels and institutional examples, and into those papers which emphasized the organization structure requirements of interorganizational decision making, those that emphasized the behavioral requirements of interorganizational decision making, and those that developed decision technologies for interorganizational decision making.

  5. State Government: The Decision-making Process. A Resource Manual for Teachers and Students.

    ERIC Educational Resources Information Center

    Khanlian, John F.; Wallin, Katherine L.

    This material provides a program to instruct secondary level students in the political, governmental, and legal process and to encourage active student participation in these processes. Part of a year-long curriculum program, this unit examines the structure and function of the state, county, and local levels. Included are policy formation,…

  6. Drug induced sleep endoscopy in the decision-making process of children with obstructive sleep apnea.

    PubMed

    Galluzzi, Francesca; Pignataro, Lorenzo; Gaini, Renato Maria; Garavello, Werner

    2015-03-01

    Tonsillectomy and adenoidectomy (T&A) is currently recommended in children with Obstructive Sleep Apnea (OSA). However, the condition persists after surgery in about one third of cases. It has been suggested that Drug Induced Sleep Endoscopy (DISE) may be of help for planning a more targeted and effective surgical treatment but evidence is yet weak. The aim of this review is to draw recommendation on the use of DISE in children with OSA. More specifically, we aimed at determine the proportion of cases whose treatment may be influenced by DISE findings. A comprehensive search of articles published from February 1983 to January 2014 listed in the PubMed/MEDLINE databases was performed. The search terms used were: "endoscopy" or "nasoendoscopy" or "DISE" and "obstructive sleep apnea" and "children" or "child" or "pediatric." The main outcome was the rate of naive children with hypertrophic tonsils and/or adenoids. The assumptions are that clinical diagnosis of hypertrophic tonsils and/or adenoids is reliable and does not require DISE, and that exclusive T&A may solve OSA in the vast majority of cases even in the presence of other concomitant sites of obstruction. Five studies were ultimately selected and all were case series. The median (range) number of studied children was 39 (15-82). Mean age varied from 3.2 to 7.8 years. The combined estimate rate of OSA consequent to hypertrophic tonsils and/or adenoids was 71% (95%CI: 64-77%). In children with Down Syndrome, the combined estimated rate of hypertrophic tonsils and/or adenoids was 62% (95%CI: 44-79%). Our findings show that DISE may be of benefit in a minority of children with OSA since up to two thirds of naive cases presents with hypertrophic tonsils and/or adenoids. Its use should be limited to those whose clinical evaluation is unremarkable or when OSA persists after T&A.

  7. Pig farmers' perceptions, attitudes, influences and management of information in the decision-making process for disease control.

    PubMed

    Alarcon, Pablo; Wieland, Barbara; Mateus, Ana L P; Dewberry, Chris

    2014-10-01

    The objectives of this study were (1) to explore the factors involved in the decision-making process used by pig farmers for disease control and (2) to investigate pig farmers' attitudes and perceptions about different information sources relating to disease control. In 2011 a qualitative study involving 20 face-to-face interviews with English pig farmers was conducted. The questionnaire was composed of three parts. The first part required farmers to identify two diseases they had experienced and which were difficult to recognize and/or control. They were asked to report how the disease problem was recognized, how the need for control was decided, and what affected the choice of control approach. For the latter, a structure related to the Theory of Planned Behaviour was used. Their verbal responses were classified as associated with: (1) attitude and beliefs, (2) subjective norms, or (3) perceived behavioural control (PBC). In the second part, five key sources of information for disease control (Defra, BPEX, research from academia, internet and veterinarians) and the factors related to barriers to knowledge were investigated. Interviews were recorded and transcribed. A qualitative analysis of the text of the interview transcripts was carried out using templates. Drivers for disease control were 'pig mortality', 'feeling of entering in an economically critical situation', 'animal welfare' and 'feeling of despair'. Veterinarians were perceived by several participating farmers as the most trusted information source on disease control. However, in particular non-sustainable situations, other producers, and especially experiences from abroad, seemed to considerably influence the farmers' decision-making. 'Lack of knowledge', 'farm structure and management barriers' and 'economic constrains' were identified in relation to PBC. Several negative themes, such as 'lack of communication', 'not knowing where to look', and 'information bias' were associated with research from

  8. Decision making in surgical treatment of chronic low back pain: the performance of prognostic tests to select patients for lumbar spinal fusion.

    PubMed

    Willems, Paul

    2013-02-01

    outcome fusion; 5) to determine the incidence of postdiscography discitis, and whether there is a need for routine antibiotic prophylaxis; 6) to assess whether temporary external transpedicular fixation (TETF) can help to predict the outcome of spinal fusion; 7) to determine the prognostic accuracy of the most commonly used tests in clinical practice to predict the outcome of fusion for CLBP. The results of a national survey among spine surgeons in the Netherlands were presented in Study I. The surgeons were questioned about their opinion on prognostic factors and about the use of predictive tests for lumbar fusion in CLBP patients. The comments were compared with findings from the prevailing literature. The survey revealed a considerable lack of uniformity in the use and appreciation of predictive tests. Prognostic factors known from the literature were not consistently incorporated in the surgeons' decision making process either. This heterogeneity in strategy is most probably caused by the lack of sound scientific evidence for current predictive tests and it was concluded that currently there is not enough consensus among spine surgeons in the Netherlands to create national guidelines for surgical decision making in CLBP. In Study II, the hypothesized working mechanism of a pantaloon cast (i.e., minimisation of lumbosacral joint mobility) was studied. In patients who were admitted for a temporary external transpedicular fixation test (TETF), infrared light markers were rigidly attached to the protruding ends of Steinman pins that were fixed in two spinal levels. In this way three-dimensional motion between these levels could be analysed opto-electronically. During dynamic test conditions such as walking, a plaster cast, either with or without unilateral hip fixation, did not significantly decrease lumbosacral joint motion. Although not substantiated by sound scientific support, lumbosacral orthoses or pantaloon casts are often used in everyday practice as a predictor

  9. Impaired Decision Making in Adolescent Suicide Attempters

    ERIC Educational Resources Information Center

    Bridge, Jeffrey A.; McBee-Strayer, Sandra M.; Cannon, Elizabeth A.; Sheftall, Arielle H.; Reynolds, Brady; Campo, John V.; Pajer, Kathleen A.; Barbe, Remy P.; Brent, David A.

    2012-01-01

    Objective: Decision-making deficits have been linked to suicidal behavior in adults. However, it remains unclear whether impaired decision making plays a role in the etiopathogenesis of youth suicidal behavior. The purpose of this study was to examine decision-making processes in adolescent suicide attempters and never-suicidal comparison…

  10. Impaired Decision Making in Adolescent Suicide Attempters

    ERIC Educational Resources Information Center

    Bridge, Jeffrey A.; McBee-Strayer, Sandra M.; Cannon, Elizabeth A.; Sheftall, Arielle H.; Reynolds, Brady; Campo, John V.; Pajer, Kathleen A.; Barbe, Remy P.; Brent, David A.

    2012-01-01

    Objective: Decision-making deficits have been linked to suicidal behavior in adults. However, it remains unclear whether impaired decision making plays a role in the etiopathogenesis of youth suicidal behavior. The purpose of this study was to examine decision-making processes in adolescent suicide attempters and never-suicidal comparison…

  11. Decision Making in Adults with ADHD

    ERIC Educational Resources Information Center

    Montyla, Timo; Still, Johanna; Gullberg, Stina; Del Missier, Fabio

    2012-01-01

    Objectives: This study examined decision-making competence in ADHD by using multiple decision tasks with varying demands on analytic versus affective processes. Methods: Adults with ADHD and healthy controls completed two tasks of analytic decision making, as measured by the Adult Decision-Making Competence (A-DMC) battery, and two affective…

  12. Decision Making in Adults with ADHD

    ERIC Educational Resources Information Center

    Montyla, Timo; Still, Johanna; Gullberg, Stina; Del Missier, Fabio

    2012-01-01

    Objectives: This study examined decision-making competence in ADHD by using multiple decision tasks with varying demands on analytic versus affective processes. Methods: Adults with ADHD and healthy controls completed two tasks of analytic decision making, as measured by the Adult Decision-Making Competence (A-DMC) battery, and two affective…

  13. The role of meteorological processes in the description of uncertainty for climate change decision-making

    NASA Astrophysics Data System (ADS)

    Briley, Laura J.; Ashley, Walker S.; Rood, Richard B.; Krmenec, Andrew

    2017-02-01

    Downscaled climate data are available at fine spatial scales making them desirable to local climate change practitioners. However, without a description of their uncertainty, practitioners cannot know if they provide quality information. We pose that part of the foundation for the description of uncertainty is an assessment of the ability of the underlying climate model to represent the meteorological or weather-scale processes. Here, we demonstrate an assessment of precipitation processes for the Great Lakes region using the Bias Corrected and Spatially Downscaled (BCSD) Coupled Model Intercomparison Project phase 3 (CMIP3) projections. A major weakness of the underlying models is their inability to simulate the effects of the Great Lakes, which is an important issue for most global climate models. There is also uncertainty among the models in the timing of transition between dominant precipitation processes going from the warm to cool season and vice versa. In addition, warm-season convective precipitation processes very greatly among the models. From the assessment, we discuss how process-based uncertainties in the models are inherited by the downscaled projections and how bias correction increases uncertainty in cases where precipitation processes are not well represented. Implications of these findings are presented for three regional examples: lake-effect snow, the spring seasonal transition, and summertime lake-effect precipitation.

  14. Influences in the Decision-Making Process for Careers as a Speech-Language Pathologist or an Audiologist.

    ERIC Educational Resources Information Center

    Brodsky, Martin B.; Cooke, Paul A.

    2000-01-01

    Students and professionals (N=297) in speech-language pathology and audiology were surveyed about career decision making. Decision-making factors were similar across both professions, with personal factors being the most influential. Employment and education factors were also critical. Early course work also played a significant role. (Author/MKA)

  15. Cellular Decision Making by Non-Integrative Processing of TLR Inputs.

    PubMed

    Kellogg, Ryan A; Tian, Chengzhe; Etzrodt, Martin; Tay, Savaş

    2017-04-04

    Cells receive a multitude of signals from the environment, but how they process simultaneous signaling inputs is not well understood. Response to infection, for example, involves parallel activation of multiple Toll-like receptors (TLRs) that converge on the nuclear factor κB (NF-κB) pathway. Although we increasingly understand inflammatory responses for isolated signals, it is not clear how cells process multiple signals that co-occur in physiological settings. We therefore examined a bacterial infection scenario involving co-stimulation of TLR4 and TLR2. Independent stimulation of these receptors induced distinct NF-κB dynamic profiles, although surprisingly, under co-stimulation, single cells continued to show ligand-specific dynamic responses characteristic of TLR2 or TLR4 signaling rather than a mixed response, comprising a cellular decision that we term "non-integrative" processing. Iterating modeling and microfluidic experiments revealed that non-integrative processing occurred through interaction of switch-like NF-κB activation, receptor-specific processing timescales, cell-to-cell variability, and TLR cross-tolerance mediated by multilayer negative feedback. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  16. Quantum-Like Model for Decision Making Process in Two Players Game. A Non-Kolmogorovian Model

    NASA Astrophysics Data System (ADS)

    Asano, Masanari; Ohya, Masanori; Khrennikov, Andrei

    2011-03-01

    In experiments of games, players frequently make choices which are regarded as irrational in game theory. In papers of Khrennikov (Information Dynamics in Cognitive, Psychological and Anomalous Phenomena. Fundamental Theories of Physics, Kluwer Academic, Norwell, 2004; Fuzzy Sets Syst. 155:4-17, 2005; Biosystems 84:225-241, 2006; Found. Phys. 35(10):1655-1693, 2005; in QP-PQ Quantum Probability and White Noise Analysis, vol. XXIV, pp. 105-117, 2009), it was pointed out that statistics collected in such the experiments have "quantum-like" properties, which can not be explained in classical probability theory. In this paper, we design a simple quantum-like model describing a decision-making process in a two-players game and try to explain a mechanism of the irrational behavior of players. Finally we discuss a mathematical frame of non-Kolmogorovian system in terms of liftings (Accardi and Ohya, in Appl. Math. Optim. 39:33-59, 1999).

  17. Factors influencing nurses' decision-making process on leaving in the peripheral intravascular catheter after 96 hours: a longitudinal study.

    PubMed

    Palese, Alvisa; Cassone, Andrea; Kulla, Annamaria; Dorigo, Sabrina; Magee, Jesse; Artico, Marco; Camero, Francesco; Cassin, Catia; Cialdella, Sandra; Floridia, Giuseppe; Nadlišek, Boris; Palcic, Annamaria; Valle, Giulia; Sclauzero, Paola

    2011-01-01

    The clinical and research debate on the peripheral intravascular (PIV) catheter length of stay in situ is ongoing. The principal aim of this study was to explore the factors behind a nurse's decision to leave a PIV in place for more than 96 hours. The study focused on 7 northern Italian hospitals in 2009. A consequent sample of 269 PIV catheters was included. Direct observation and interviews were adopted. The time of the expected PIV replacement was fixed at 96 hours after its positioning, in accordance with the international guideline. Several factors were taken into account in regard to replacement of the PIV catheters by nurses, ranging from analysis based on their own clinical experience with PIV complications and analysis of the patient's clinical situation to the critical analysis of their own work situation. This clinical decision-making process is valuable: leaving the PIV in place for more than 96 hours is a complex decision and not simply a guideline violation.

  18. Some implications of the technology assessment function for the effective public decision-making process

    NASA Technical Reports Server (NTRS)

    Mayo, L. H.

    1971-01-01

    A preliminary provisional assessment of the prospects for the establishment of an adequate technology assessment function and the implications of the assessment function for the public decision process are presented. Effects of the technology assessment function on each phase of the public decision process and briefly explored. Significant implications during the next decade are projected with respect to the following phases: invention and development of alternative means (technological configurations); evaluation, selection and promotion of preferred courses of action; and modification of statutory scheme or social action program as an outcome of continuing monitoring and appraisal.

  19. Remote Sensing: A valuable tool in the Forest Service decision making process. [in Utah

    NASA Technical Reports Server (NTRS)

    Stanton, F. L.

    1975-01-01

    Forest Service studies for integrating remotely sensed data into existing information systems highlight a need to: (1) re-examine present methods of collecting and organizing data, (2) develop an integrated information system for rapidly processing and interpreting data, (3) apply existing technological tools in new ways, and (4) provide accurate and timely information for making right management decisions. The Forest Service developed an integrated information system using remote sensors, microdensitometers, computer hardware and software, and interactive accessories. Their efforts substantially reduce the time it takes for collecting and processing data.

  20. Remote Sensing: A valuable tool in the Forest Service decision making process. [in Utah

    NASA Technical Reports Server (NTRS)

    Stanton, F. L.

    1975-01-01

    Forest Service studies for integrating remotely sensed data into existing information systems highlight a need to: (1) re-examine present methods of collecting and organizing data, (2) develop an integrated information system for rapidly processing and interpreting data, (3) apply existing technological tools in new ways, and (4) provide accurate and timely information for making right management decisions. The Forest Service developed an integrated information system using remote sensors, microdensitometers, computer hardware and software, and interactive accessories. Their efforts substantially reduce the time it takes for collecting and processing data.

  1. Coronal imbalance in degenerative lumbar scoliosis: Prevalence and influence on surgical decision-making for spinal osteotomy.

    PubMed

    Bao, H; Yan, P; Qiu, Y; Liu, Z; Zhu, F

    2016-09-01

    There is a paucity of information on the pre-operative coronal imbalance in patients with degenerative lumbar scoliosis (DLS) and its influence on surgical outcomes. A total of 284 DLS patients were recruited into this study, among whom 69 patients were treated surgically and the remaining 215 patients conservatively Patients were classified based on the coronal balance distance (CBD): Type A, CBD < 3 cm; Type B, CBD > 3 cm and C7 Plumb Line (C7PL) shifted to the concave side of the curve; Type C, CBD > 3 cm and C7PL shifted to the convex side. A total of 99 of the 284 (34.8%) patient presented with a pre-operative coronal imbalance (mean CBD: 48.5, standard deviation 18.7 mm). More patients with a Type B malalignment were observed than with a Type C malalignment (62 versus 37). A total of 21 pf the 69 (30.4%) surgically treated patients had a post-operative coronal imbalance, which was found to be more prevalent in Type C patients (p < 0.001). At follow-up, less improvement was observed in terms of Short Form-36 Physical Component Score and visual analogue score for back pain (p = 0.034 and 0.025, respectively) in Type C patients. This study shows that patients with Type C coronal malalignment may be at greater risk of post-operative coronal imbalance following posterior osteotomy. Cite this article: Bone Joint J 2016;98-B:1227-33. ©2016 The British Editorial Society of Bone & Joint Surgery.

  2. LIFE CYCLE ASSESSMENT IN MANAGEMENT, PRODUCT AND PROCESS DESIGN, AND POLICY DECISION MAKING: A CONFERENCE REPORT

    EPA Science Inventory

    On 24 September 2003, life cycle assessment (LCA) practitioners and decision makers gathered at the InLCA/LCM Conference in Seattle, Washington, USA (see http://www.lcacenter.org/InLCA-LCM03/index.html) to discuss the role of LCA in management, product design, process development...

  3. Developing a Theory-Based Measure of Career Decision-Making: The Decisional Process Inventory.

    ERIC Educational Resources Information Center

    Hartung, Paul J.

    1995-01-01

    College students completed the Decisional Process Inventory, or DPI (n=248), Career Decision Scale (n=242), Occupational Alternatives Question (n=244), and Gestalt Contact Styles Questionnaire Revised (n=243). Results supported the DPI's content and criterion-related validity as a tool for assessing career decidedness. (SK)

  4. An Examination of the Decision-Making Process Used by Designers in Multiple Disciplines

    ERIC Educational Resources Information Center

    Stefaniak, Jill E.; Tracey, Monica W.

    2014-01-01

    Design-thinking is an inductive and participatory process in which designers are required to manage constraints, generate solutions, and follow project timelines in order to complete project goals. The researchers used this exploration study to look at how designers in various disciplinary fields approach design projects. Designers were asked to…

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

    ERIC Educational Resources Information Center

    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…

  6. Micromanaging Death: Process Preferences, Values, and Goals in End-of-Life Medical Decision Making

    ERIC Educational Resources Information Center

    Hawkins, Nikki Ayers; Ditto, Peter H.; Danks, Joseph H.; Smucker, William D.

    2005-01-01

    Purpose: This study examined patients' and surrogates' attitudes about using advance directives to manage end-of-life medical care. It also explored process preferences, or how patients want decisions to be made. Design and Methods: Data come from the third wave of the Advance Directives, Values Assessment, and Communication Enhancement project, a…

  7. Towards Understanding the Negotiation and Decision-Making Process of Withdrawal from College: A Qualitative Approach

    ERIC Educational Resources Information Center

    Irwin, Mary Ann

    2010-01-01

    This qualitative research project focused on the interviews of 27 low socio-economic students at a research university in the southwestern United States. The students had already withdrawn from the university or were in the process of withdrawing. The study seeks to provide increased understanding of how students negotiate the decision-making…

  8. Due Process and Higher Education: A Systemic Approach to Fair Decision Making. ERIC Digest.

    ERIC Educational Resources Information Center

    Stevens, Ed

    University officials and faculty are frequently required to make decisions based on interpretations of disputed facts. By applying the concept of due process within the context of higher education, they can meet legal challenges of contract and constitutional law and the pedagogical demand for justice. To guide their efforts, decision makers can…

  9. The Teacher Screening and Selection Process: A Decision Making Model for School Administrators.

    ERIC Educational Resources Information Center

    Bredeson, Paul V.

    This paper presents and discusses a conceptual model for understanding, describing, and explaining personnel selection processes and activities. Four theoretical strands--decision theory, impression formation, inference theory, and rating theory--are briefly discussed and woven together as the basis for the proposed model. The model is then used…

  10. The Teacher Screening and Selection Process: A Decision Making Model for School Administrators.

    ERIC Educational Resources Information Center

    Bredeson, Paul V.

    1985-01-01

    This article discusses a conceptual model for understanding, describing, and explaining personnel selection processes and activities. Four theoretical strands--decision theory, impression formation, inference theory, and rating theory--are woven together as the basis for a proposed model to be used by administrators who are selecting teachers. (CB)

  11. Using the Analytic Hierarchy Process for Decision-Making in Ecosystem Management

    Treesearch

    Daniel L. Schmoldt; David L. Peterson

    1997-01-01

    Land management activities on public lands combine multiple objectives in order to create a plan of action over a finite time horizon. Because management activities are constrained by time and money, it is critical to make the best use of available agency resources. The Analytic Hierarchy Process (AHP) offers a structure for multi-objective decisionmaking so that...

  12. Adolescents' Career Decision-Making Process: Related to Quality of Attachment to Parents?

    ERIC Educational Resources Information Center

    Germeijs, Veerle; Verschueren, Karine

    2009-01-01

    This longitudinal study examined how adolescents' perceptions of attachment security with parents relate to their process of choosing a major in higher education. The participants were 281 students who were investigated at the beginning, middle, and end of Grade 12. Findings showed that higher perceived security with mother, but not with father,…

  13. Parallel Process and Isomorphism: A Model for Decision Making in the Supervisory Triad

    ERIC Educational Resources Information Center

    Koltz, Rebecca L.; Odegard, Melissa A.; Feit, Stephen S.; Provost, Kent; Smith, Travis

    2012-01-01

    Parallel process and isomorphism are two supervisory concepts that are often discussed independently but rarely discussed in connection with each other. These two concepts, philosophically, have different historical roots, as well as different implications for interventions with regard to the supervisory triad. The authors examine the difference…

  14. An Examination of the Decision-Making Process Used by Designers in Multiple Disciplines

    ERIC Educational Resources Information Center

    Stefaniak, Jill E.; Tracey, Monica W.

    2014-01-01

    Design-thinking is an inductive and participatory process in which designers are required to manage constraints, generate solutions, and follow project timelines in order to complete project goals. The researchers used this exploration study to look at how designers in various disciplinary fields approach design projects. Designers were asked to…

  15. Parallel Process and Isomorphism: A Model for Decision Making in the Supervisory Triad

    ERIC Educational Resources Information Center

    Koltz, Rebecca L.; Odegard, Melissa A.; Feit, Stephen S.; Provost, Kent; Smith, Travis

    2012-01-01

    Parallel process and isomorphism are two supervisory concepts that are often discussed independently but rarely discussed in connection with each other. These two concepts, philosophically, have different historical roots, as well as different implications for interventions with regard to the supervisory triad. The authors examine the difference…

  16. Some implications of the technology assessment function for the effective public decision making process

    NASA Technical Reports Server (NTRS)

    Mayo, L. H.

    1975-01-01

    A study was undertaken to analyze ways in which the institutionalization of the assessment function can affect the following phases of the public decision process: problem perception, problem definition, data assembly, invention of alternatives, evaluation of options, authorization, implementation, operation, appraisal, and modification.

  17. Some implications of the technology assessment function for the effective public decision making process

    NASA Technical Reports Server (NTRS)

    Mayo, L. H.

    1975-01-01

    A study was undertaken to analyze ways in which the institutionalization of the assessment function can affect the following phases of the public decision process: problem perception, problem definition, data assembly, invention of alternatives, evaluation of options, authorization, implementation, operation, appraisal, and modification.

  18. Towards Understanding the Negotiation and Decision-Making Process of Withdrawal from College: A Qualitative Approach

    ERIC Educational Resources Information Center

    Irwin, Mary Ann

    2010-01-01

    This qualitative research project focused on the interviews of 27 low socio-economic students at a research university in the southwestern United States. The students had already withdrawn from the university or were in the process of withdrawing. The study seeks to provide increased understanding of how students negotiate the decision-making…

  19. Use of magnetic resonance imaging in the decision-making process for lumbar intervertebral disc syndrome.

    PubMed

    Robinson, G K

    1992-02-01

    Magnetic resonance imaging was used to determine the presence or absence of a lumbar herniated nucleus pulposus in a patient suffering from acute sciatica. Treatment decisions were made as a result of this diagnostic process and comparative history and physical exam findings revealed marked improvement in less than 1 wk.

  20. Different roads to the same destination - The impact of impulsivity on decision-making processes under risk within a rewarding context in a healthy male sample.

    PubMed

    Dinu-Biringer, Ramona; Nees, Frauke; Falquez, Rosalux; Berger, Moritz; Barnow, Sven

    2016-02-28

    The results of research about the influences of impulsivity on decision-making in situations of risk have been inconsistent. In this study, we used functional magnetic resonance imaging to examine the neural correlates of decision-making under risk in 12 impulsive, as defined by the Barratt Impulsiveness Scale-11, and 13 normal men. Although both groups showed similar decision-making behavior, neural activation regarding decision-making processes differed significantly. Impulsive persons revealed stronger activation in the (ventro-) medial prefrontal cortex and less deactivation of the orbitofrontal cortex while playing for potential gains. These brain regions might be associated with the emotional components of decision-making processes. Significant differences in brain areas linked to cognitive decision-making components were not found. This activation pattern might be seen as an indication for a hypersensitivity to rewarding cues in impulsive persons and might be linked to the propensity for inappropriate risk-taking behavior in persons with more extreme impulsivity levels, especially in situations in which they have a strong emotional involvement in the decision process.