Decision aids for people considering taking part in clinical trials.

Science.gov (United States)

Gillies, Katie; Cotton, Seonaidh C; Brehaut, Jamie C; Politi, Mary C; Skea, Zoe

2015-11-27

Several interventions have been developed to promote informed consent for participants in clinical trials. However, many of these interventions focus on the content and structure of information (e.g. enhanced information or changes to the presentation format) rather than the process of decision making. Patient decision aids support a decision making process about medical options. Decision aids support the decision process by providing information about available options and their associated outcomes, alongside information that enables patients to consider what value they place on particular outcomes, and provide structured guidance on steps of decision making. They have been shown to be effective for treatment and screening decisions but evidence on their effectiveness in the context of informed consent for clinical trials has not been synthesised. To assess the effectiveness of decision aids for clinical trial informed consent compared to no intervention, standard information (i.e. usual practice) or an alternative intervention on the decision making process. We searched the following databases and to March 2015: Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library; MEDLINE (OvidSP) (from 1950); EMBASE (OvidSP) (from 1980); PsycINFO (OvidSP) (from 1806); ASSIA (ProQuest) (from 1987); WHO International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch/); ClinicalTrials.gov; ISRCTN Register (http://www.controlled-trials.com/isrctn/). We also searched reference lists of included studies and relevant reviews. We contacted study authors and other experts. There were no language restrictions. We included randomised and quasi-randomised controlled trials comparing decision aids in the informed consent process for clinical trials alone, or in conjunction with standard information (such as written or verbal) or alongside alternative interventions (e.g. paper-based versus web-based decision aids). Included trials involved

Explanation and elaboration of the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) guidelines: examples of reporting SUNDAE items from patient decision aid evaluation literature

Science.gov (United States)

Hoffman, Aubri S; Abhyankar, Purva; Sheridan, Stacey; Bekker, Hilary; LeBlanc, Annie; Levin, Carrie; Ropka, Mary; Shaffer, Victoria; Stacey, Dawn; Stalmeier, Peep; Vo, Ha; Wills, Celia; Thomson, Richard

2018-01-01

This Explanation and Elaboration (E&E) article expands on the 26 items in the Standards for UNiversal reporting of Decision Aid Evaluations guidelines. The E&E provides a rationale for each item and includes examples for how each item has been reported in published papers evaluating patient decision aids. The E&E focuses on items key to reporting studies evaluating patient decision aids and is intended to be illustrative rather than restrictive. Authors and reviewers may wish to use the E&E broadly to inform structuring of patient decision aid evaluation reports, or use it as a reference to obtain details about how to report individual checklist items. PMID:29467235

Community Pharmacists' Perspectives of a Decision Aid for Managing Type 2 Diabetes in Ontario.

Science.gov (United States)

Verweel, Lee; Gionfriddo, Michael R; MacCallum, Lori; Dolovich, Lisa; Rosenberg-Yunger, Zahava R S

2017-12-01

Decision aids are tools designed to help patients make choices about their health care. We explored pharmacists' perceptions of an evidence-based diabetes decision aid developed by the Mayo Clinic, Diabetes Medication Choice (DMC). Using DMC as a reference, we aimed to explore pharmacists' perspectives on decision aids, their place in a community pharmacy setting and the implementing of a decision aid, such as DMC, in Ontario. We used semistructured interviews with a convenience sample of community pharmacists from Ontario. We applied a thematic analysis to the data. We conducted 16 interviews with pharmacists, of whom 9 were certified diabetes educators, and 10 were female. Three themes emerged from the data: pharmacists' knowledge and awareness of decision aids; pharmacists' perceptions of the DMC decision aids, and implementation of the DMC decision aids in Ontario pharmacies. Participants discussed their limited experience with and training in the use of decision aids. Although many participants agreed that the DMC decision aids may contribute to patient-centred care, all agreed that significant changes were needed to be made to implement this tool in practice. Pharmacists felt that the use of decision aids in community pharmacies in Ontario may improve patient-centred care. Modifications, however, are needed to improve the applicability to their context and fit into their workflow. Empirical data concerning the impact of decision aids in community pharmacy is needed. Copyright © 2017 Diabetes Canada. Published by Elsevier Inc. All rights reserved.

Probability of Survival Decision Aid (PSDA)

National Research Council Canada - National Science Library

Xu, Xiaojiang; Amin, Mitesh; Santee, William R

2008-01-01

A Probability of Survival Decision Aid (PSDA) is developed to predict survival time for hypothermia and dehydration during prolonged exposure at sea in both air and water for a wide range of environmental conditions...

Patient decision aids in routine maternity care: Benefits, barriers, and new opportunities.

Science.gov (United States)

Stevens, Gabrielle; Thompson, Rachel; Watson, Bernadette; Miller, Yvette D

2016-02-01

Participation in decision-making, supported by comprehensive and quality information provision, is increasingly emphasised as a priority for women in maternity care. Patient decision aids are tools that can offer women greater access to information and guidance to participate in maternity care decision-making. Relative to their evaluation in controlled settings, the implementation of patient decision aids in routine maternity care has received little attention and our understanding of which approaches may be effective is limited. This paper critically discusses the application of patient decision aids in routine maternity care and explores viable solutions for promoting their successful uptake. A range of patient decision aids have been developed for use within maternity care, and controlled trials have highlighted their positive impact on the decision-making process for women. Nevertheless, evidence of successful patient decision aid implementation in real world health care settings is lacking due to practical and ideological barriers that exist. Patient-directed social marketing campaigns are a relatively novel approach to patient decision aid delivery that may facilitate their adoption in maternity care, at least in the short-term, by overcoming common implementation barriers. Social marketing may also be particularly well suited to maternity care, given the unique characteristics of this health context. The potential of social marketing campaigns to facilitate patient decision aid adoption in maternity care highlights the need for pragmatic trials to evaluate their effectiveness. Identifying which sub-groups of women are more or less likely to respond to these strategies will further direct implementation. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Features of Computer-Based Decision Aids: Systematic Review, Thematic Synthesis, and Meta-Analyses

Science.gov (United States)

Krömker, Dörthe; Meguerditchian, Ari N; Tamblyn, Robyn

2016-01-01

Background Patient information and education, such as decision aids, are gradually moving toward online, computer-based environments. Considerable research has been conducted to guide content and presentation of decision aids. However, given the relatively new shift to computer-based support, little attention has been given to how multimedia and interactivity can improve upon paper-based decision aids. Objective The first objective of this review was to summarize published literature into a proposed classification of features that have been integrated into computer-based decision aids. Building on this classification, the second objective was to assess whether integration of specific features was associated with higher-quality decision making. Methods Relevant studies were located by searching MEDLINE, Embase, CINAHL, and CENTRAL databases. The review identified studies that evaluated computer-based decision aids for adults faced with preference-sensitive medical decisions and reported quality of decision-making outcomes. A thematic synthesis was conducted to develop the classification of features. Subsequently, meta-analyses were conducted based on standardized mean differences (SMD) from randomized controlled trials (RCTs) that reported knowledge or decisional conflict. Further subgroup analyses compared pooled SMDs for decision aids that incorporated a specific feature to other computer-based decision aids that did not incorporate the feature, to assess whether specific features improved quality of decision making. Results Of 3541 unique publications, 58 studies met the target criteria and were included in the thematic synthesis. The synthesis identified six features: content control, tailoring, patient narratives, explicit values clarification, feedback, and social support. A subset of 26 RCTs from the thematic synthesis was used to conduct the meta-analyses. As expected, computer-based decision aids performed better than usual care or alternative aids; however

Features of Computer-Based Decision Aids: Systematic Review, Thematic Synthesis, and Meta-Analyses.

Science.gov (United States)

Syrowatka, Ania; Krömker, Dörthe; Meguerditchian, Ari N; Tamblyn, Robyn

2016-01-26

Patient information and education, such as decision aids, are gradually moving toward online, computer-based environments. Considerable research has been conducted to guide content and presentation of decision aids. However, given the relatively new shift to computer-based support, little attention has been given to how multimedia and interactivity can improve upon paper-based decision aids. The first objective of this review was to summarize published literature into a proposed classification of features that have been integrated into computer-based decision aids. Building on this classification, the second objective was to assess whether integration of specific features was associated with higher-quality decision making. Relevant studies were located by searching MEDLINE, Embase, CINAHL, and CENTRAL databases. The review identified studies that evaluated computer-based decision aids for adults faced with preference-sensitive medical decisions and reported quality of decision-making outcomes. A thematic synthesis was conducted to develop the classification of features. Subsequently, meta-analyses were conducted based on standardized mean differences (SMD) from randomized controlled trials (RCTs) that reported knowledge or decisional conflict. Further subgroup analyses compared pooled SMDs for decision aids that incorporated a specific feature to other computer-based decision aids that did not incorporate the feature, to assess whether specific features improved quality of decision making. Of 3541 unique publications, 58 studies met the target criteria and were included in the thematic synthesis. The synthesis identified six features: content control, tailoring, patient narratives, explicit values clarification, feedback, and social support. A subset of 26 RCTs from the thematic synthesis was used to conduct the meta-analyses. As expected, computer-based decision aids performed better than usual care or alternative aids; however, some features performed better than

46 CFR 199.180 - Training and drills.

Science.gov (United States)

2010-10-01

... problems of hypothermia, first aid treatment for hypothermia, and other appropriate first aid procedures... 46 Shipping 7 2010-10-01 2010-10-01 false Training and drills. 199.180 Section 199.180 Shipping... LIFESAVING SYSTEMS FOR CERTAIN INSPECTED VESSELS Requirements for All Vessels § 199.180 Training and drills...

Empirical Evaluation of a Decision-Analytic Aid.

Science.gov (United States)

1980-05-01

Morris, Smallwood , Lansford, and Gibbons (1980) state: "In the traditional paradigm, the decision-maker must decide to accept or reject the model. If he... Smallwood , R. D., Langford, R. K., & Gibbons, R. S. Analytic Procedures for Evaluating Decision Aids. Applied Decision Analysis, Inc. (Menlo Park, CA...Menlo Park, CA 94025 Department of Psychology University of Oklahoma Dr. Jesse Orlansky 455 West Lindsey Institute for Defense Analyses Norman , OK 73069

Development of a decision aid for children faced with the decision to undergo dental treatment with sedation or general anaesthesia.

Science.gov (United States)

Hulin, Joe; Baker, Sarah R; Marshman, Zoe; Albadri, Sondos; Rodd, Helen D

2017-09-01

Decision aids are tools used to help individuals faced with difficult healthcare decisions. They help patients further understand the treatment options available and encourage the sharing of information between patients and clinicians. To develop a decision aid for young patients faced with the decision to undergo dental treatment with inhalation sedation, intravenous sedation, or general anaesthesia (GA). Qualitative interviews with dental patients (aged 10-16 years), and their parents/guardians were used to inform the content of a draft decision aid. Following further revisions, a pilot evaluation of the decision aid was conducted. Patients referred for dental treatment with sedation or GA were recruited from a UK dental hospital. Patients (n = 15) and parents/guardians (n = 13) assigned to the intervention group received the decision aid and routine clinical counselling, whereas patients (n = 17) and parents/guardians (n = 13) in the control group only received routine clinical counselling. Participants completed measures of knowledge, decisional conflict, and dental anxiety. Knowledge scores were significantly higher for participants who received the decision aid when compared to standard care. There were no other significant differences between groups. A decision aid was successfully developed, and initial findings suggest such tools could be beneficial to dental sedation or GA patients and their parents/guardians. Further research is required on the use of such tools in primary care settings, with particular attention to the impact of the decision aid on attendance and completion rates of treatment. © 2016 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Refining a brief decision aid in stable CAD: cognitive interviews

OpenAIRE

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

2014-01-01

Background We describe the results of cognitive interviews to refine the “Making Choices©” Decision Aid (DA) for shared decision-making (SDM) about stress testing in patients with stable coronary artery disease (CAD). Methods We conducted a systematic development process to design a DA consistent with International Patient Decision Aid Standards (IPDAS) focused on Alpha testing criteria. Cognitive interviews were conducted with ten stable CAD patients using the “think aloud” interview techniq...

Assisting informed decision making for labour analgesia: a randomised controlled trial of a decision aid for labour analgesia versus a pamphlet

Directory of Open Access Journals (Sweden)

Torvaldsen Siranda

2010-04-01

Full Text Available Abstract Background Most women use some method of pain relief during labour. There is extensive research evidence available of pharmacological pain relief during labour; however this evidence is not readily available to pregnant women. Decision aids are tools that present evidence based information and allow preference elicitation. Methods We developed a labour analgesia decision aid. Using a RCT design women either received a decision aid or a pamphlet. Eligible women were primiparous, ≥ 37 weeks, planning a vaginal birth of a single infant and had sufficient English to complete the trial materials. We used a combination of affective (anxiety, satisfaction and participation in decision-making and behavioural outcomes (intention and analgesia use to assess the impact of the decision aid, which were assessed before labour. Results 596 women were randomised (395 decision aid group, 201 pamphlet group. There were significant differences in knowledge scores between the decision aid group and the pamphlet group (mean difference 8.6, 95% CI 3.70, 13.40. There were no differences between decisional conflict scores (mean difference -0.99 (95% CI -3.07, 1.07, or anxiety (mean difference 0.3, 95% CI -2.15, 1.50. The decision aid group were significantly more likely to consider their care providers opinion (RR 1.28 95%CI 0.64, 0.95. There were no differences in analgesia use and poor follow through between antenatal analgesia intentions and use. Conclusions This decision aid improves women's labour analgesia knowledge without increasing anxiety. Significantly, the decision aid group were more informed of labour analgesia options, and considered the opinion of their care providers more often when making their analgesia decisions, thus improving informed decision making. Trial Registration Trial registration no: ISRCTN52287533

Rade-aid a decision support system to evaluate countermeasures after a radiological accident

International Nuclear Information System (INIS)

Wagenaar, G.; Van Den Bosch, C.J.H.; Weger, D. de.

1990-01-01

After Chernobyl the authorities in many countries were overwhelmed by the enormous amount of information that was being generated by measuring and monitoring programs. In making decisions, this information had to be combined with the results of specific countermeasures, in order to determine the optimal strategy with respect to a large number of consequences. The development of RADE-AID, the Radiological Accident Decision AIDing system, is aimed at providing a powerful tool in the decision-making process. RADE-AID is developed by TNO (The Netherlands) in a joint contract with KfK (FRG) and NRPB (UK). In the first phase a demonstration system will be built, called RADE-AID/D. RADE-AID/D will be used as a decision support system in the intermediate and late phase after a radiological accident. RADE-AID/D will consider countermeasures with respect to external exposure and internal exposure by food ingestion. Countermeasures are evaluated considering reduction in doses and in numbers of health effects, costs, and social effects. The paper covers the structure of the program, presentation of data and results, and the decision analysis technique that is being used. This decision analysis part is an important feature of the system; an advanced decision analysis technique is used, that is able to compare data of varying nature. Furthermore the place of RADE-AID in the decision-making process will be treated. RADE-AID/D is an interactive computer program, that offers the user the possibility to enter relevant data and to have data and results displayed in a variety of ways. Furthermore the system contains an advanced decision analysis technique, that is able to compare data of varying nature. Input data for the decision analysis calculations are provided by models from UFOMOD and MARC-codes

A Framework for Evaluating the Cost-Effectiveness of Patient Decision Aids: A Case Study Using Colorectal Cancer Screening

Science.gov (United States)

Cantor, Scott B.; Rajan, Tanya; Linder, Suzanne K.; Volk, Robert J.

2017-01-01

Objective Patient decision aids are important tools for facilitating balanced, evidence-based decision making. However, the potential of decision aids to lower health care utilization and costs is uncertain; few studies have investigated the cost-effectiveness of decision aids that change patient behavior. Using an example of a decision aid for colorectal cancer screening, we provide a framework for analyzing the cost-effectiveness of decision aids. Methods A decision-analytic model with two strategies (decision aid or no decision aid) was used to calculate expected costs in U.S. dollars and benefits measured in life-years saved (LYS). Data from a systematic review of ten studies about decision aid effectiveness was used to calculate the percentage increase in the number of people choosing screening instead of no screening. We then calculated the incremental cost per LYS with the use of the decision aid. Results The no decision aid strategy had an expected cost of $3,023 and yielded 18.19 LYS. The decision aid strategy cost $3,249 and yielded 18.20 LYS. The incremental cost-effectiveness ratio for the decision aid strategy was $36,126 per LYS. Results were sensitive to the cost of the decision aid and the percentage change in behavior caused by the decision aid. Conclusions This study provides proof-of-concept evidence for future studies examining the cost-effectiveness of decision aids. The results suggest that decision aids can be beneficial and cost-effective. PMID:25979678

arriba-lib: evaluation of an electronic library of decision aids in primary care physicians

Directory of Open Access Journals (Sweden)

Hirsch Oliver

2012-06-01

Full Text Available Abstract Background The successful implementation of decision aids in clinical practice initially depends on how clinicians perceive them. Relatively little is known about the acceptance of decision aids by physicians and factors influencing the implementation of decision aids from their point of view. Our electronic library of decision aids (arriba-lib is to be used within the encounter and has a modular structure containing evidence-based decision aids for the following topics: cardiovascular prevention, atrial fibrillation, coronary heart disease, oral antidiabetics, conventional and intensified insulin therapy, and unipolar depression. The aim of our study was to evaluate the acceptance of arriba-lib in primary care physicians. Methods We conducted an evaluation study in which 29 primary care physicians included 192 patients. The physician questionnaire contained information on which module was used, how extensive steps of the shared decision making process were discussed, who made the decision, and a subjective appraisal of consultation length. We used generalised estimation equations to measure associations within patient variables and traditional crosstab analyses. Results Only a minority of consultations (8.9% was considered to be unacceptably extended. In 90.6% of consultations, physicians said that a decision could be made. A shared decision was perceived by physicians in 57.1% of consultations. Physicians said that a decision was more likely to be made when therapeutic options were discussed “detailed”. Prior experience with decision aids was not a critical variable for implementation within our sample of primary care physicians. Conclusions Our study showed that it might be feasible to apply our electronic library of decision aids (arriba-lib in the primary care context. Evidence-based decision aids offer support for physicians in the management of medical information. Future studies should monitor the long-term adoption of

Supporting informed decision making online in 20 minutes: an observational web-log study of a PSA test decision aid.

NARCIS (Netherlands)

Joseph-Williams, N.; Evans, R.; Edwards, A.; Newcombe, R.G.; Wright, P.; Grol, R.P.T.M.; Elwyn, G.

2010-01-01

BACKGROUND: Web-based decision aids are known to have an effect on knowledge, attitude, and behavior; important components of informed decision making. We know what decision aids achieve in randomized controlled trials (RCTs), but we still know very little about how they are used and how this

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

Science.gov (United States)

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

2017-08-02

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

Geo-Spatial Tactical Decision Aid Systems: Fuzzy Logic for Supporting Decision Making

National Research Council Canada - National Science Library

Grasso, Raffaele; Giannecchini, Simone

2006-01-01

.... This paper describes a tactical decision aid system based on fuzzy logic reasoning for data fusion and on current Open Geospatial Consortium specifications for interoperability, data dissemination...

Aiding Lay Decision Making Using a Cognitive Competencies Approach.

Science.gov (United States)

Maule, A J; Maule, Simon

2015-01-01

Two prescriptive approaches have evolved to aid human decision making: just in time interventions that provide support as a decision is being made; and just in case interventions that educate people about future events that they may encounter so that they are better prepared to make an informed decision when these events occur. We review research on these two approaches developed in the context of supporting everyday decisions such as choosing an apartment, a financial product or a medical procedure. We argue that the lack of an underlying prescriptive theory has limited the development and evaluation of these interventions. We draw on recent descriptive research on the cognitive competencies that underpin human decision making to suggest new ways of interpreting how and why existing decision aids may be effective and suggest a different way of evaluating their effectiveness. We also briefly outline how our approach has the potential to develop new interventions to support everyday decision making and highlight the benefits of drawing on descriptive research when developing and evaluating interventions.

New drilling optimization technologies make drilling more efficient

Energy Technology Data Exchange (ETDEWEB)

Chen, D.C.-K. [Halliburton Energy Services, Calgary, AB (Canada). Sperry Division

2004-07-01

Several new technologies have been adopted by the upstream petroleum industry in the past two decades in order to optimize drilling operations and improve drilling efficiency. Since financial returns from an oil and gas investment strongly depend on drilling costs, it is important to reduce non-productive time due to stuck pipes, lost circulation, hole cleaning and well bore stability problems. The most notable new technologies are the use of computer-based instrumentation and data acquisition systems, integrated rig site systems and networks, and Measurement-While-Drilling and Logging-While-Drilling (MWD/LWD) systems. Drilling optimization should include solutions for drillstring integrity, hydraulics management and wellbore integrity. New drilling optimization methods emphasize information management and real-time decision making. A recent study for drilling in shallow water in the Gulf of Mexico demonstrates that trouble time accounts for 25 per cent of rig time. This translates to about $1.5 MM U.S. per well. A reduction in trouble time could result in significant cost savings for the industry. This paper presents a case study on vibration prevention to demonstrate how the drilling industry has benefited from new technologies. 13 refs., 10 figs.

Decision aid prototype development for parents considering adenotonsillectomy for their children with sleep disordered breathing

OpenAIRE

Maguire, Erin; Hong, Paul; Ritchie, Krista; Meier, Jeremy; Archibald, Karen; Chorney, Jill

2016-01-01

Background To describe the process involved in developing a decision aid prototype for parents considering adenotonsillectomy for their children with sleep disordered breathing. Methods A paper-based decision aid prototype was developed using the framework proposed by the International Patient Decision Aids Standards Collaborative. The decision aid focused on two main treatment options: watchful waiting and adenotonsillectomy. Usability was assessed with parents of pediatric patients and prov...

Acceptance of shared decision making with reference to an electronic library of decision aids (arriba-lib) and its association to decision making in patients: an evaluation study.

Science.gov (United States)

Hirsch, Oliver; Keller, Heidemarie; Krones, Tanja; Donner-Banzhoff, Norbert

2011-07-07

Decision aids based on the philosophy of shared decision making are designed to help patients make informed choices among diagnostic or treatment options by delivering evidence-based information on options and outcomes. A patient decision aid can be regarded as a complex intervention because it consists of several presumably relevant components. Decision aids have rarely been field tested to assess patients' and physicians' attitudes towards them. It is also unclear what effect decision aids have on the adherence to chosen options. The electronic library of decision aids (arriba-lib) to be used within the clinical encounter has a modular structure and contains evidence-based decision aids for the following topics: cardiovascular prevention, atrial fibrillation, coronary heart disease, oral antidiabetics, conventional and intensified insulin therapy, and unipolar depression. We conducted an evaluation study in which 29 primary care physicians included 192 patients. After the consultation, patients filled in questionnaires and were interviewed via telephone two months later. We used generalised estimation equations to measure associations within patient variables and traditional crosstab analyses. Patients were highly satisfied with arriba-lib and the process of shared decision making. Two-thirds of patients reached in the telephone interview wanted to be counselled again with arriba-lib. There was a high congruence between preferred and perceived decision making. Of those patients reached in the telephone interview, 80.7% said that they implemented the decision, independent of gender and education. Elderly patients were more likely to say that they implemented the decision. Shared decision making with our multi-modular electronic library of decision aids (arriba-lib) was accepted by a high number of patients. It has positive associations to general aspects of decision making in patients. It can be used for patient groups with a wide range of individual

Assessing Practitioners’ and Patients’ Needs Regarding Shared Decision-Making and Decision Aids

Directory of Open Access Journals (Sweden)

Michiel Hageman

2016-04-01

Full Text Available Background: As part of the process of developing a decision aid for carpal tunnel syndrome (CTS according to the Ottawa Decision Support Framework, we were interested in the level of ‘decisional conflict’ of hand surgeons and patients with CTS. This study addresses the null hypothesis that there is no difference between surgeon and patient decisional conflict with respect to test and treatment options for CTS. Secondary analyses assess the impact of patient and physician demographics and the strength of the patient-physician relationship on decisional conflict.   Methods: One-hundred-twenty-three observers of the Science of Variation Group (SOVG and 84 patients with carpal tunnel syndrome completed a survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ and the Patient Doctor Relationship Questionnaire (PDRQ-9.   Results: On average, patients had significantly greater decision conflict and scored higher on most subscales of the decisional conflict scale than hand surgeons.Factors associated with greater decision conflict were specific hand surgeon, less self-efficacy (confidence that one can achieve one’s goals in spite of pain, and higher PDRQ (relationship between patient and doctor. Surgeons from Europe have--on average--significantly more decision conflict than surgeons in the United States of America.   Conclusions: Patients with CTS have more decision conflict than hand surgeons. Decision aids might help narrow this gap in decisional conflict.

SMART MONITORING AND DECISION MAKING FOR REGULATING ANNULUS BOTTOM HOLE PRESSURE WHILE DRILLING OIL WELLS

Directory of Open Access Journals (Sweden)

M. P. Vega

Full Text Available Abstract Real time measurements and development of sensor technology are research issues associated with robustness and safety during oil well drilling operations, making feasible the diagnosis of problems and the development of a regulatory strategy. The major objective of this paper is to use an experimental plant and also field data, collected from a basin operation, offshore Brazil, for implementing smart monitoring and decision making, in order to assure drilling inside operational window, despite the commonly observed disturbances that produce fluctuations in the well annulus bottom hole pressure. Using real time measurements, the performance of a continuous automated drilling unit is analyzed under a scenario of varying levels of rate of penetration; aiming pressure set point tracking (inside the operational drilling window and also rejecting kick, a phenomenon that occurs when the annulus bottom hole pressure is inferior to the porous pressure, producing the migration of reservoir fluids into the annulus region. Finally, an empirical model was built, using real experimental data from offshore Brazil basins, enabling diagnosing and regulating a real drilling site by employing classic and advanced control strategies.

onlineDeCISion.org: a web-based decision aid for DCIS treatment.

Science.gov (United States)

Ozanne, Elissa M; Schneider, Katharine H; Soeteman, Djøra; Stout, Natasha; Schrag, Deborah; Fordis, Michael; Punglia, Rinaa S

2015-11-01

Women diagnosed with DCIS face complex treatment decisions and often do so with inaccurate and incomplete understanding of the risks and benefits involved. Our objective was to create a tool to guide these decisions for both providers and patients. We developed a web-based decision aid designed to provide clinicians with tailored information about a patient’s recurrence risks and survival outcomes following different treatment strategies for DCIS. A theoretical framework, microsimulation model (Soeteman et al., J Natl Cancer 105:774–781, 2013) and best practices for web-based decision tools guided the development of the decision aid. The development process used semi-structured interviews and usability testing with key stakeholders, including a diverse group of multidisciplinary clinicians and a patient advocate. We developed onlineDeCISion.​org to include the following features that were rated as important by the stakeholders: (1) descriptions of each of the standard treatment options available; (2) visual projections of the likelihood of time-specific (10-year and lifetime) breast-preservation, recurrence, and survival outcomes; and (3) side-by-side comparisons of down-stream effects of each treatment choice. All clinicians reviewing the decision aid in usability testing were interested in using it in their clinical practice. The decision aid is available in a web-based format and is planned to be publicly available. To improve treatment decision making in patients with DCIS, we have developed a web-based decision aid onlineDeCISion.​org that conforms to best practices and that clinicians are interested in using in their clinics with patients to better inform treatment decisions.

Stakeholder acceptance analysis ResonantSonic drilling

International Nuclear Information System (INIS)

Peterson, T.

1995-12-01

This report presents evaluations, recommendations, and requirements concerning ResonantSonic Drilling (Sonic Drilling), derived from a three-year program of stakeholder involvement. Sonic Drilling is an innovative method to reach contamination in soil and groundwater. The resonant sonic drill rig uses counter-rotating weights to generate energy, which causes the drill pipe to vibrate elastically along its entire length. In the resonant condition, forces of up to 200,000 pounds are transmitted to the drill bit face to create a cutting action. The resonant energy causes subsurface materials to move back into the adjacent formation, permitting the drill pipe to advance. This report is for technology developers and those responsible for making decisions about the use of technology to remediate contamination by volatile organic compounds. Stakeholders' perspectives help those responsible for technology deployment to make good decisions concerning the acceptability and applicability of sonic drilling to the remediation problems they face

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

Science.gov (United States)

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

2017-08-01

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

Studies and Analyses of Vulnerabilities in Aided Adversarial Decision Making

National Research Council Canada - National Science Library

Llinas, James

1998-01-01

.... The aid" in the analysis (i.e., an automated decision aid) focuses upon a generic data fusion processor that estimates situation and threat states based on multisensor/multisource-based data assessments...

Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision making.

Science.gov (United States)

Schroy, Paul C; Mylvaganam, Shamini; Davidson, Peter

2014-02-01

Decision aids for colorectal cancer (CRC) screening have been shown to enable patients to identify a preferred screening option, but the extent to which such tools facilitate shared decision making (SDM) from the perspective of the provider is less well established. Our goal was to elicit provider feedback regarding the impact of a CRC screening decision aid on SDM in the primary care setting. Cross-sectional survey. Primary care providers participating in a clinical trial evaluating the impact of a novel CRC screening decision aid on SDM and adherence. Perceptions of the impact of the tool on decision-making and implementation issues. Twenty-nine of 42 (71%) eligible providers responded, including 27 internists and two nurse practitioners. The majority (>60%) felt that use of the tool complimented their usual approach, increased patient knowledge, helped patients identify a preferred screening option, improved the quality of decision making, saved time and increased patients' desire to get screened. Respondents were more neutral is their assessment of whether the tool improved the overall quality of the patient visit or patient satisfaction. Fewer than 50% felt that the tool would be easy to implement into their practices or that it would be widely used by their colleagues. Decision aids for CRC screening can improve the quality and efficiency of SDM from the provider perspective but future use is likely to depend on the extent to which barriers to implementation can be addressed. © 2011 John Wiley & Sons Ltd.

Constructing a relevant decision aid for parents of children with bronchopulmonary dysplasia.

Science.gov (United States)

Skibo, M; Guillen, U; Zhang, H; Munson, D; Mackley, A; Nilan, K; Kirpalani, H

2017-12-01

To develop and test a decision aid for counseling parents of children with bronchopulmonary dysplasia (BPD).Local problem:Parental education about complex conditions is not standardized and communication and understanding may not be adequate. Semi-structured interviews were conducted with 33 neonatal clinicians and 12 parents of children with BPD using a qualitative research design. The interviews were used to identify education topics that were felt to be important in BPD education. These topics were then used to create a visual decision aid to be used in counseling sessions with parents. The decision aid was then used in mock counseling sessions with 15 'experienced' participants and 7 'naïve' participants to assess its efficacy. The participants completed a pre and post test to assess change in knowledge as well as an 11-question Likert style acceptability survey. Implementation of a decision aid while educating parents about BPD. Topics identified during the interviews were used to create eight educational cards which included pictures, pictographs and statistics. Overall, participants thought the decision aid contained an appropriate amount of information, were easy to understand and improved their knowledge about BPD. Testing demonstrated a significant increase in knowledge in both the 'experienced' (Pdecision aid for parents of children with BPD may improve understanding of the condition and help facilitate communication between parents and doctors.

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

Science.gov (United States)

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

2014-02-13

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

Teaching advance care planning to medical students with a computer-based decision aid.

Science.gov (United States)

Green, Michael J; Levi, Benjamin H

2011-03-01

Discussing end-of-life decisions with cancer patients is a crucial skill for physicians. This article reports findings from a pilot study evaluating the effectiveness of a computer-based decision aid for teaching medical students about advance care planning. Second-year medical students at a single medical school were randomized to use a standard advance directive or a computer-based decision aid to help patients with advance care planning. Students' knowledge, skills, and satisfaction were measured by self-report; their performance was rated by patients. 121/133 (91%) of students participated. The Decision-Aid Group (n = 60) outperformed the Standard Group (n = 61) in terms of students' knowledge (p satisfaction with their learning experience (p student performance. Use of a computer-based decision aid may be an effective way to teach medical students how to discuss advance care planning with cancer patients.

Veterans Like Me: Formative evaluation of a patient decision aid design.

Science.gov (United States)

Gibson, Bryan; Butler, Jorie; Doyon, Katherine; Ellington, Lee; Bray, Bruce E; Zeng, Qing

2017-07-01

Patient decision aids are tools intended to facilitate shared decision-making. Currently development of a patient decision aid is resource intensive: it requires a decision-specific review of the scientific literature by experts to ascertain the potential outcomes under different treatments. The goal of this project was to conduct a formative evaluation of a generalizable, scalable decision aid component we call Veterans Like Me (VLme). VLme mines EHR data to present the outcomes of individuals "like you" on different treatments to the user. These outcome are presented through a combination of an icon array and simulated narratives. Twenty-six patients participated in semi-structured interviews intended to elicit feedback on the tool's functional and interface design. The interview focused on the filters users desired with which to make cases similar to them, the kinds of outcomes they wanted presented, and their envisioned use of the tool. The interview also elicited participants information needs and salient factors related to the therapeutic decision. The interview transcripts were analyzed using an iteratively refined coding schema and content analysis. . Participants generally expressed enthusiasm for the tool's design and functionality. Our analysis identified desired filters for users to view patients like themselves, outcome types that should be included in future iterations of the tool (e.g. patient reported outcomes), and information needs that need to be addressed for patients to effectively participate in shared decision making. Implications for the integration of our findings into the design of patient decision aids are discussed. Published by Elsevier Inc.

Tactical and strategic decision-making aids for nuclear power plant emergency response

International Nuclear Information System (INIS)

Cain, D.G.

1987-01-01

This paper examines the prospective role of computer-based decision aids for nuclear power plant emergency response. The role of these systems is subordinate to human activities, but in a complementary manner these systems process decision logic more accurately and foster a more thorough understanding of emergency situations than might other wise be possible. Within this context two decision support systems being developed are discussed. Both of these systems utilize technology derived from artificial intelligence, focussing on two different facets of emergency response. An automated emergency operating procedures (EOP) tracking expert system is described as a tactical aid for control room operator response. A reactor emergency action level monitor (REALM) expert system is proposed as a strategic decision aid for site emergency response. The discrimination between tactical and strategic decision-making is an intrinsic part of this examination

Feasibility of web-based decision aids in neurological patients

NARCIS (Netherlands)

van Til, Janine Astrid; Drossaert, Constance H.C.; Renzenbrink, Gerbert J.; Snoek, Govert J.; Dijkstra, Evelien; Stiggelbout, Anne M.; IJzerman, Maarten Joost

2010-01-01

Decision aids (DAs) may be helpful in improving patients' participation in medical decision-making. We investigated the potential for web-based DAs in a rehabilitation population. Two self-administered DAs focused on the treatment of acquired ankle-foot impairment in stroke and the treatment of

Phytoremediation of abandoned crude oil contaminated drill sites of Assam with the aid of a hydrocarbon-degrading bacterial formulation.

Science.gov (United States)

Yenn, R; Borah, M; Boruah, H P Deka; Roy, A Sarma; Baruah, R; Saikia, N; Sahu, O P; Tamuli, A K

2014-01-01

Environmental deterioration due to crude oil contamination and abandoned drill sites is an ecological concern in Assam. To revive such contaminated sites, afield study was conducted to phytoremediate four crude oil abandoned drill sites of Assam (Gelakey, Amguri, Lakwa, and Borholla) with the aid of two hydrocarbon-degrading Pseudomonas strains designated N3 and N4. All the drill sites were contaminated with 15.1 to 32.8% crude oil, and the soil was alkaline in nature (pH8.0-8.7) with low moisture content, low soil conductivity and low activities of the soil enzymes phosphatase, dehydrogenase and urease. In addition, N, P, K, and C contents were below threshold limits, and the soil contained high levels of heavy metals. Bio-augmentation was achieved by applying Pseudomonas aeruginosa strains N3 and N4 followed by the introduction of screened plant species Tectona grandis, Gmelina arborea, Azadirachta indica, and Michelia champaca. The findings established the feasibility of the phytoremediation of abandoned crude oil-contaminated drill sites in Assam using microbes and native plants.

Effect of patient decision aid was influenced by presurgical evaluation among patients with osteoarthritis of the knee.

Science.gov (United States)

Boland, Laura; Taljaard, Monica; Dervin, Geoffrey; Trenaman, Logan; Tugwell, Peter; Pomey, Marie-Pascale; Stacey, Dawn

2018-02-01

Decision aids help patients make total joint arthroplasty decisions, but presurgical evaluation might influence the effects of a decision aid. We compared the effects of a decision aid among patients considering total knee arthroplasty at 2 surgical screening clinics with different evaluation processes. We performed a subgroup analysis of a randomized controlled trial. Patients were recruited from 2 surgical screening clinics: an academic clinic providing 20-minute physician consultations and a community clinic providing 45-minute physiotherapist/nurse consultations with education. We compared the effects of decision quality, decisional conflict and surgery rate using Cochran-Mantel-Haenszel χ 2 tests and the Breslow-Day test. We evaluated 242 patients: 123 from the academic clinic (61 who used the decision aid and 62 controls) and 119 from the community clinic (59 who used the decision aid and 60 controls). Results suggested a between-site difference in the effect of the decision aid on the patients' decision quality ( p = 0.09): at the academic site, patients who used the decision aid were more likely to make better-quality decisions than controls (54% v. 35%, p = 0.044), but not at the community site (47% v. 51%, p = 0.71). Fewer patients who used decision aids at the academic site than at the community site experienced decisional conflict ( p = 0.007) (33% v. 52%, p = 0.05 at the academic site and 40% v. 24%, p = 0.08 at the community site). The effect of the decision aid on surgery rates did not differ between sites ( p = 0.65). The decision aid had a greater effect at the academic site than at the community site, which provided longer consultations with more verbal education. Hence, decision aids might be of greater value when more extensive total knee arthroplasty presurgical assessment and counselling are either impractical or unavailable.

Development and testing of a decision aid on goals of care for advanced dementia.

Science.gov (United States)

Einterz, Seth F; Gilliam, Robin; Lin, Feng Chang; McBride, J Marvin; Hanson, Laura C

2014-04-01

Decision aids are effective to improve decision-making, yet they are rarely tested in nursing homes (NHs). Study objectives were to (1) examine the feasibility of a goals of care (GOC) decision aid for surrogate decision-makers (SDMs) of persons with dementia; and (2) to test its effect on quality of communication and decision-making. Pre-post intervention to test a GOC decision aid intervention for SDMs for persons with dementia in NHs. Investigators collected data from reviews of resident health records and interviews with SDMs at baseline and 3-month follow-up. Two NHs in North Carolina. Eighteen residents who were over 65 years of age, had moderate to severe dementia on the global deterioration scale (5, 6, or 7), and an English-speaking surrogate decision-maker. (1) GOC decision aid video viewed by the SDM and (2) a structured care plan meeting between the SDM and interdisciplinary NH team. Surrogate knowledge, quality of communication with health care providers, surrogate-provider concordance on goals of care, and palliative care domains addressed in the care plan. Eighty-nine percent of the SDMs thought the decision aid was relevant to their needs. After viewing the video decision aid, SDMs increased the number of correct responses on knowledge-based questions (12.5 vs 14.2; P communication scores (6.1 vs 6.8; P = .01) and improved concordance on primary goal of care with NH team (50% vs 78%; P = .003). The number of palliative care domains addressed in the care plan increased (1.8 vs 4.3; P decision-support intervention piloted in this study was feasible and relevant for surrogate decision-makers of persons with advanced dementia in NHs, and it improved quality of communication between SDM and NH providers. A larger randomized clinical trial is underway to provide further evidence of the effects of this decision aid intervention. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

A theory-based decision aid for patients with cancer: results of feasibility and acceptability testing of DecisionKEYS for cancer.

Science.gov (United States)

Hollen, Patricia J; Gralla, Richard J; Jones, Randy A; Thomas, Christopher Y; Brenin, David R; Weiss, Geoffrey R; Schroen, Anneke T; Petroni, Gina R

2013-03-01

Appropriate utilization of treatment is a goal for all patients undergoing cancer treatment. Proper treatment maximizes benefit and limits exposure to unnecessary measures. This report describes findings of the feasibility and acceptability of implementing a short, clinic-based decision aid and presents an in-depth clinical profile of the participants. This descriptive study used a prospective, quantitative approach to obtain the feasibility and acceptability of a decision aid (DecisionKEYS for Balancing Choices) for use in clinical settings. It combined results of trials of patients with three different common malignancies. All groups used the same decision aid series. Participants included 80 patients with solid tumors (22 with newly diagnosed breast cancer, 19 with advanced prostate cancer, and 39 with advanced lung cancer) and their 80 supporters as well as their physicians and nurses, for a total of 160 participants and 10 health professionals. The decision aid was highly acceptable to patient and supporter participants in all diagnostic groups. It was feasible for use in clinic settings; the overall value was rated highly. Of six physicians, all found the interactive format with the help of the nurse as feasible and acceptable. Nurses also rated the decision aid favorably. This intervention provides the opportunity to enhance decision making about cancer treatment and warrants further study including larger and more diverse groups. Strengths of the study included a theoretical grounding, feasibility testing of a practical clinic-based intervention, and summative evaluation of acceptability of the intervention by patient and supporter pairs. Further research also is needed to test the effectiveness of the decision aid in diverse clinical settings and to determine if this intervention can decrease overall costs.

Decision aids for improved accuracy and standardization of mammographic diagnosis

International Nuclear Information System (INIS)

D'Orsi, C.J.; Getty, D.J.; Swets, J.A.; Pickett, R.M.; Seltzer, S.E.; McNeil, B.J.

1990-01-01

This paper examines the gains in the accuracy of mammographic diagnosis of breast cancer achievable from a pair of decision aids. Twenty-three potentially relevant perceptual features of mammograms were identified through interviews, psychometric tests, and consensus meetings with mammography specialists. Statistical analyses determined the 12 independent features that were most information diagnostically and assigned a weight to each according to its importance. Two decision aids were developed: a checklist that solicits a scale value from the radiologist for each feature and a computer program that merges those values optimally in an advisory estimate of the probability of malignancy. Six radiologists read a set of 150 cases, first in their usual way and later with the aids

Promoting Shared Decision Making in Disorders of Sex Development (DSD): Decision Aids and Support Tools.

Science.gov (United States)

Siminoff, L A; Sandberg, D E

2015-05-01

Specific complaints and grievances from adult patients with disorders of sex development (DSD), and their advocates center around the lack of information or misinformation they were given about their condition and feeling stigmatized and shamed by the secrecy surrounding their condition and its management. Many also attribute poor sexual function to damaging genital surgery and/or repeated, insensitive genital examinations. These reports suggest the need to reconsider the decision-making process for the treatment of children born with DSD. This paper proposes that shared decision making, an important concept in adult health care, be operationalized for the major decisions commonly encountered in DSD care and facilitated through the utilization of decision aids and support tools. This approach may help patients and their families make informed decisions that are better aligned with their personal values and goals. It may also lead to greater confidence in decision making with greater satisfaction and less regret. A brief review of the past and current approach to DSD decision making is provided, along with a review of shared decision making and decision aids and support tools. A case study explores the need and potential utility of this suggested new approach. © Georg Thieme Verlag KG Stuttgart · New York.

Theoretical concepts aiding in decision making and practical aspects

International Nuclear Information System (INIS)

Schenker-Wicki, Andrea; Rauber, Dominique

1997-01-01

Emergency-simulating drillings are current preoccupations of the national organizations in charge with emergency interventions. Generally, the attention is focused on the initial phases of the operations to the detriment of the later stages that concern the agricultural and agro-alimentary problems. In order to test its theoretical concepts and its coordinating role, the National Centre for Emergency Operations launched the drilling BACCHUS, addressed to the personnel of different authorities. For the first time in Switzerland executive bodies in the agricultural and agro-alimentary fields were integrated in the decision-making process involved in final phases. These final phases aim at simulating the means of reducing the ingestion doses after an accidental release of radioactivity. The principal conclusion was that the contamination criteria used by radiation protection and agro-alimentary industry experts could be very different if healthy foodstuffs are available

A decision-aiding system: DACFOOD

International Nuclear Information System (INIS)

Despres, A.; Heymes, P.

1994-01-01

The DACFOOD (Decision Aiding for Contaminated FOODstuffs) system provides decision makers with necessary data for the implementation of optimized protection measures in case of radioactive contamination of foodstuffs. The system evaluates the dose impact due to ingestion of these products, calculates the dose reduction after implementation of specific actions and, by combining these actions, assesses several strategies by using their cost-effectiveness ratios. Such evaluations need the description of contamination as radionuclide activities in each foodstuff, and the description of consumers' groups according to their dietary habits. Then it is possible to define areas in which the doses received are reasonably homogeneous in different age classes. If deposition occurs at a period of the year without harvest, the system applies dynamic transfer models to calculate the concentration in future productions. (authors). 2 refs

Encounter Decision Aid vs. Clinical Decision Support or Usual Care to Support Patient-Centered Treatment Decisions in Osteoporosis: The Osteoporosis Choice Randomized Trial II.

Directory of Open Access Journals (Sweden)

Annie LeBlanc

Full Text Available Osteoporosis Choice, an encounter decision aid, can engage patients and clinicians in shared decision making about osteoporosis treatment. Its effectiveness compared to the routine provision to clinicians of the patient's estimated risk of fracture using the FRAX calculator is unknown.Patient-level, randomized, three-arm trial enrolling women over 50 with osteopenia or osteoporosis eligible for treatment with bisphosphonates, where the use of Osteoporosis Choice was compared to FRAX only and to usual care to determine impact on patient knowledge, decisional conflict, involvement in the decision-making process, decision to start and adherence to bisphosphonates.We enrolled 79 women in the three arms. Because FRAX estimation alone and usual care produced similar results, we grouped them for analysis. Compared to these, use of Osteoporosis Choice increased patient knowledge (median score 6 vs. 4, p = .01, improved understanding of fracture risk and risk reduction with bisphosphonates (p = .01 and p<.0001, respectively, had no effect on decision conflict, and increased patient engagement in the decision making process (OPTION scores 57% vs. 43%, p = .001. Encounters with the decision aid were 0.8 minutes longer (range: 33 minutes shorter to 3.0 minutes longer. There were twice as many patients receiving and filling prescriptions in the decision aid arm (83% vs. 40%, p = .07; medication adherence at 6 months was no different across arms.Supporting both patients and clinicians during the clinical encounter with the Osteoporosis Choice decision aid efficiently improves treatment decision making when compared to usual care with or without clinical decision support with FRAX results.clinical trials.gov NCT00949611.

Online, Interactive Option Grid Patient Decision Aids and their Effect on User Preferences.

Science.gov (United States)

Scalia, Peter; Durand, Marie-Anne; Kremer, Jan; Faber, Marjan; Elwyn, Glyn

2018-01-01

Randomized trials have shown that patient decision aids can modify users' preferred healthcare options, but research has yet to identify the attributes embedded in these tools that cause preferences to shift. The aim of this study was to investigate people's preferences as they used decision aids for 5 health decisions and, for each of the following: 1) determine if using the interactive Option Grid led to a pre-post shift in preferences; 2) determine which frequently asked questions (FAQs) led to preference shifts; 3) determine the FAQs that were rated as the most important as users compared options. Interactive Option Grid decision aids enable users to view attributes of available treatment or screening options, rate their importance, and specify their preferred options before and after decision aid use. The McNemar-Bowker paired test was used to compare stated pre-post preferences. Multinomial logistic regressions were conducted to investigate possible associations between covariates and preference shifts. Overall, 626 users completed the 5 most-used tools: 1) Amniocentesis test: yes or no? ( n = 73); 2) Angina: treatment options ( n = 88); 3) Breast cancer: surgical options ( n = 265); 4) Prostate Specific Antigen (PSA) test: yes or no? ( n = 82); 5) Statins for heart disease risk: yes or no? ( n = 118). The breast cancer, PSA, and statins Option Grid decision aids generated significant preference shifts. Generally, users shifted their preference when presented with the description of the available treatment options, and the risk associated with each option. The use of decision aids for some, but not all health decisions, was accompanied by a shift in user preferences. Users typically valued information associated with risks, and chose more risk averse options after completing the interactive tool.

Aiding Lay Decision Making Using a Cognitive Competencies Approach

OpenAIRE

Maule, A. J.; Maule, Simon

2016-01-01

Two prescriptive approaches have evolved to aid human decision making: just in time interventions that provide support as a decision is being made; and just in case interventions that educate people about future events that they may encounter so that they are better prepared to make an informed decision when these events occur. We review research on these two approaches developed in the context of supporting everyday decisions such as choosing an apartment, a financial product or a medical pr...

Trustworthy patient decision aids: a qualitative analysis addressing the risk of competing interests

NARCIS (Netherlands)

Elwyn, G.; Dannenberg, M.; Blaine, A.; Poddar, U.; Durand, M.A.

2016-01-01

OBJECTIVE: Our aim in this study was to examine the competing interest policies and procedures of organisations who develop and maintain patient decision aids. DESIGN: Descriptive and thematic analysis of data collected from a cross-sectional survey of patient decision aid developer's competing

Selecting a risk-based tool to aid in decision making

Energy Technology Data Exchange (ETDEWEB)

Bendure, A.O.

1995-03-01

Selecting a risk-based tool to aid in decision making is as much of a challenge as properly using the tool once it has been selected. Failure to consider customer and stakeholder requirements and the technical bases and differences in risk-based decision making tools will produce confounding and/or politically unacceptable results when the tool is used. Selecting a risk-based decisionmaking tool must therefore be undertaken with the same, if not greater, rigor than the use of the tool once it is selected. This paper presents a process for selecting a risk-based tool appropriate to a set of prioritization or resource allocation tasks, discusses the results of applying the process to four risk-based decision-making tools, and identifies the ``musts`` for successful selection and implementation of a risk-based tool to aid in decision making.

Rough set and rule-based multicriteria decision aiding

Directory of Open Access Journals (Sweden)

Roman Slowinski

2012-08-01

Full Text Available The aim of multicriteria decision aiding is to give the decision maker a recommendation concerning a set of objects evaluated from multiple points of view called criteria. Since a rational decision maker acts with respect to his/her value system, in order to recommend the most-preferred decision, one must identify decision maker's preferences. In this paper, we focus on preference discovery from data concerning some past decisions of the decision maker. We consider the preference model in the form of a set of "if..., then..." decision rules discovered from the data by inductive learning. To structure the data prior to induction of rules, we use the Dominance-based Rough Set Approach (DRSA. DRSA is a methodology for reasoning about data, which handles ordinal evaluations of objects on considered criteria and monotonic relationships between these evaluations and the decision. We review applications of DRSA to a large variety of multicriteria decision problems.

Development and pilot testing of a decision aid for surrogates of patients with prolonged mechanical ventilation

Science.gov (United States)

Cox, Christopher E.; Lewis, Carmen L.; Hanson, Laura C.; Hough, Catherine L.; Kahn, Jeremy M.; White, Douglas B.; Song, Mi-Kyung; Tulsky, James A.; Carson, Shannon S.

2013-01-01

Objective Shared decision making is inadequate in intensive care units (ICUs). Decision aids can improve decision making quality, though their role in an ICU setting is unclear. We aimed to develop and pilot test a decision aid for shared decision makers of patients undergoing prolonged mechanical ventilation. Setting ICUs at three medical centers. Subjects 53 surrogate decision makers and 58 physicians. Design and interventions We developed the decision aid using defined methodological guidelines. After an iterative revision process, formative cognitive testing was performed among surrogate-physician dyads. Next, we compared the decision aid to usual care control in a prospective, before/after design study. Measurements and main results Primary outcomes were physician-surrogate discordance for expected patient survival, comprehension of relevant medical information, and the quality of communication. Compared to control, the intervention group had lower surrogate-physician discordance (7 [10] vs 43 [21]), greater comprehension (11.4 [0.7] vs 6.1 [3.7]), and improved quality of communication (8.7 [1.3] vs 8.4 [1.3]) (all ppost-intervention. Hospital costs were lower in the intervention group ($110,609 vs $178,618; p=0.044); mortality did not differ by group (38% vs 50%, p=0.95). 94% of surrogates and 100% of physicians reported that the decision aid was useful in decision making. Conclusion We developed a prolonged mechanical ventilation decision aid that is feasible, acceptable, and associated with both improved decision making quality and less resource utilization. Further evaluation using a randomized controlled trial design is needed to evaluate the decision aid's effect on long-term patient and surrogate outcomes. PMID:22635048

Cultural targeting and tailoring of shared decision making technology: a theoretical framework for improving the effectiveness of patient decision aids in culturally diverse groups.

Science.gov (United States)

Alden, Dana L; Friend, John; Schapira, Marilyn; Stiggelbout, Anne

2014-03-01

Patient decision aids are known to positively impact outcomes critical to shared decision making (SDM), such as gist knowledge and decision preparedness. However, research on the potential improvement of these and other important outcomes through cultural targeting and tailoring of decision aids is very limited. This is the case despite extensive evidence supporting use of cultural targeting and tailoring to improve the effectiveness of health communications. Building on prominent psychological theory, we propose a two-stage framework incorporating cultural concepts into the design process for screening and treatment decision aids. The first phase recommends use of cultural constructs, such as collectivism and individualism, to differentially target patients whose cultures are known to vary on these dimensions. Decision aid targeting is operationalized through use of symbols and values that appeal to members of the given culture. Content dimensions within decision aids that appear particularly appropriate for targeting include surface level visual characteristics, language, beliefs, attitudes and values. The second phase of the framework is based on evidence that individuals vary in terms of how strongly cultural norms influence their approach to problem solving and decision making. In particular, the framework hypothesizes that differences in terms of access to cultural mindsets (e.g., access to interdependent versus independent self) can be measured up front and used to tailor decision aids. Thus, the second phase in the framework emphasizes the importance of not only targeting decision aid content, but also tailoring the information to the individual based on measurement of how strongly he/she is connected to dominant cultural mindsets. Overall, the framework provides a theory-based guide for researchers and practitioners who are interested in using cultural targeting and tailoring to develop and test decision aids that move beyond a "one-size fits all" approach

The Pathways fertility preservation decision aid website for women with cancer: development and field testing.

Science.gov (United States)

Woodard, Terri L; Hoffman, Aubri S; Covarrubias, Laura A; Holman, Deborah; Schover, Leslie; Bradford, Andrea; Hoffman, Derek B; Mathur, Aakrati; Thomas, Jerah; Volk, Robert J

2018-02-01

To improve survivors' awareness and knowledge of fertility preservation counseling and treatment options, this study engaged survivors and providers to design, develop, and field-test Pathways: a fertility preservation patient decision aid website for young women with cancer©. Using an adapted user-centered design process, our stakeholder advisory group and research team designed and optimized the Pathways patient decision aid website through four iterative cycles of review and revision with clinicians (n = 21) and survivors (n = 14). Field-testing (n = 20 survivors) assessed post-decision aid scores on the Fertility Preservation Knowledge Scale, feasibility of assessing women's decision-making values while using the website, and website usability/acceptability ratings. Iterative stakeholder engagement optimized the Pathways decision aid website to meet survivors' and providers' needs, including providing patient-friendly information and novel features such as interactive value clarification exercises, testimonials that model shared decision making, financial/referral resources, and a printable personal summary. Survivors scored an average of 8.2 out of 13 (SD 1.6) on the Fertility Preservation Knowledge Scale. They rated genetic screening and having a biological child as strong factors in their decision-making, and 71% indicated a preference for egg freezing. Most women (> 85%) rated Pathways favorably, and all women (100%) said they would recommend it to other women. The Pathways decision aid is a usable and acceptable tool to help women learn about fertility preservation. The Pathways decision aid may help women make well-informed values-based decisions and prevent future infertility-related distress.

A comparison of web-based versus print-based decision AIDS for prostate cancer screening: participants' evaluation and utilization.

Science.gov (United States)

Tomko, Catherine; Davis, Kimberly M; Luta, George; Krist, Alexander H; Woolf, Steven H; Taylor, Kathryn L

2015-01-01

Patient decision aids facilitate informed decision making for medical tests and procedures that have uncertain benefits. To describe participants' evaluation and utilization of print-based and web-based prostate cancer screening decision aids that were found to improve decisional outcomes in a prior randomized controlled trial. Men completed brief telephone interviews at baseline, one month, and 13 months post-randomization. Participants were primary care patients, 45-70 years old, who received the print-based (N = 628) or web-based decision aid (N = 625) and completed the follow-up assessments. We assessed men's baseline preference for web-based or print-based materials, time spent using the decision aids, comprehension of the overall message, and ratings of the content. Decision aid use was self-reported by 64.3 % (web) and 81.8 % (print) of participants. Significant predictors of decision aid use were race (white vs. non-white, OR = 2.43, 95 % CI: 1.77, 3.35), higher education (OR = 1.68, 95 % CI: 1.06, 2.70) and trial arm (print vs. web, OR = 2.78, 95 % CI: 2.03, 3.83). Multivariable analyses indicated that web-arm participants were more likely to use the website when they preferred web-based materials (OR: 1.91, CI: 1.17, 3.12), whereas use of the print materials was not significantly impacted by a preference for print-based materials (OR: 0.69, CI: 0.38, 1.25). Comprehension of the decision aid message (i.e., screening is an individual decision) did not significantly differ between arms in adjusted analyses (print: 61.9 % and web: 68.2 %, p = 0.42). Decision aid use was independently influenced by race, education, and the decision aid medium, findings consistent with the 'digital divide.' These results suggest that when it is not possible to provide this age cohort with their preferred decision aid medium, print materials will be more highly used than web-based materials. Although there are many advantages to web-based decision aids, providing an option for

Offering online recommendations with minimum customer input through conjoint-based decision aids

NARCIS (Netherlands)

De Bruyn, Arnaud; Liechty, John C.; Huizingh, Eelko K. R. E.; Lilien, Gary L.

2008-01-01

In their purchase decisions, online customers seek to improve decision quality while limiting search efforts. In practice, many merchants have understood the importance of helping customers in the decision-making process and provide online decision aids to their visitors. In this paper, we show how

Decision aids for respite service choices by carers of people with dementia: development and pilot RCT

Directory of Open Access Journals (Sweden)

Stirling Christine

2012-03-01

Full Text Available Abstract Background Decision aids are often used to assist individuals confronted with a diagnosis of a serious illness to make decisions about treatment options. However, they are rarely utilised to help those with chronic or age related conditions to make decisions about care services. Decision aids should also be useful for carers of people with decreased decisional capacity. These carers' choices must balance health outcomes for themselves and for salient others with relational and value-based concerns, while relying on information from health professionals. This paper reports on a study that both developed and pilot tested a decision aid aimed at assisting carers to make evaluative judgements of community services, particularly respite care. Methods A mixed method sequential study, involving qualitative development and a pilot randomised controlled trial, was conducted in Tasmania, Australia. We undertook 13 semi-structured interviews and three focus groups to inform the development of the decision aid. For the randomised control trial we randomly assigned 31 carers of people with dementia to either receive the service decision aid at the start or end of the study. The primary outcome was measured by comparing the difference in carer burden between the two groups three months after the intervention group received the decision aid. Pilot data was collected from carers using interviewer-administered questionnaires at the commencement of the project, two weeks and 12 weeks later. Results The qualitative data strongly suggest that the intervention provides carers with needed decision support. Most carers felt that the decision aid was useful. The trial data demonstrated that, using the mean change between baseline and three month follow-up, the intervention group had less increase in burden, a decrease in decisional conflict and increased knowledge compared to control group participants. Conclusions While these results must be interpreted with

Arriba-lib: association of an evidence-based electronic library of decision aids with communication and decision-making in patients and primary care physicians.

Science.gov (United States)

Hirsch, Oliver; Keller, Heidemarie; Krones, Tanja; Donner-Banzhoff, Norbert

2012-03-01

In shared decision-making, patients are empowered to actively ask questions and participate in decisions about their healthcare based on their preferences and values. Decision aids should help patients make informed choices among diagnostic or treatment options by delivering evidence-based information on options and outcomes; however, they have rarely been field tested, especially in the primary care context. We therefore evaluated associations between the use of an interactive, transactional and evidence-based library of decision aids (arriba-lib) and communication and decision-making in patients and physicians in the primary care context. Our electronic library of decision aids ('arriba-lib') includes evidence-based modules for cardiovascular prevention, diabetes, coronary heart disease, atrial fibrillation and depression. Twenty-nine primary care physicians recruited 192 patients. We used questionnaires to ask patients and physicians about their experiences with and attitudes towards the programme. Patients were interviewed via telephone 2 months after the consultation. Data were analysed by general estimation equations, cross tab analyses and by using effect sizes. Only a minority (8.9%) of the consultations were felt to be too long because physicians said consultations were unacceptably extended by arriba-lib. We found a negative association between the detailedness of the discussion of the clinical problem's definition and the age of the patients. Physicians discuss therapeutic options in less detail with patients who have a formal education of less than 8 years. Patients who were counselled by a physician with no experience in using a decision aid more often reported that they do not remember being counselled with the help of a decision aid or do not wish to be counselled again with a decision aid. Arriba-lib has positive associations to the decision-making process in patients and physicians. It can also be used with older age groups and patients with less

Shared decision making and patient decision aids: knowledge, attitudes, and practices among Hawai'i physicians.

Science.gov (United States)

Alden, Dana L; Friend, John; Chun, Maria B J

2013-11-01

As the health care field moves toward patient-centered care (PCC), increasing emphasis has been placed on the benefits of patient decision aids for promoting shared decision making (SDM). This study provides a baseline measure of knowledge, attitudes, and practices (KAP) among Hawai'i's physicians with respect to patient decision aids (DAs). Physicians throughout the State of Hawai'i were invited to complete a survey assessing their knowledge, attitudes, and practices with respect to the clinical use of DAs. One hundred and seventy four valid surveys were analyzed. Reported awareness and use of DAs were low, but recognition of the benefits of SDM and openness to the use of DAs were very high. The leading perceived barriers to the implementation of DAs were lack of awareness, lack of resources, and limited physician time to learn about DA technology. However, a significant majority of the respondents reported that DAs could empower patients by improving knowledge (88%), increasing satisfaction with the consultation process (81%), and increasing compliance (74%). Among physicians currently employing DAs, use of brochures or options matrix sheets was the most common aid tool. However, leading recommended DA formats were paper-based brochures for clinic use (75%) and interactive online website programs for outside clinic use (73.5%). Given growing emphasis on the PCC model and the recognized desire of many patients to participate in the medical decision making process, positive responses toward SDM and the use of DAs by Hawai'i physicians are promising.

Coaching patients in the use of decision and communication aids: RE-AIM evaluation of a patient support program

OpenAIRE

Belkora, Jeff; Volz, Shelley; Loth, Meredith; Teng, Alexandra; Zarin-Pass, Margot; Moore, Dan; Esserman, Laura

2015-01-01

Background Decision aids educate patients about treatment options and outcomes. Communication aids include question lists, consultation summaries, and audio-recordings. In efficacy studies, decision aids increased patient knowledge, while communication aids increased patient question-asking and information recall. Starting in 2004, we trained successive cohorts of post-baccalaureate, pre-medical interns to coach patients in the use of decision and communication aids at our university-based br...

Reduction in uptake of PSA tests following decision aids: systematic review of current aids and their evaluations.

NARCIS (Netherlands)

Evans, R.; Edwards, A.; Brett, J.; Bradburn, M.; Watson, E.; Austoker, J.; Elwyn, G.

2005-01-01

A man's decision to have a prostate-specific antigen (PSA) test should be an informed one. We undertook a systematic review to identify and appraise PSA decision aids and evaluations. We searched 15 electronic databases and hand-searched key journals. We also contacted key authors and organisations.

Modelling elderly cardiac patients decision making using Cognitive Work Analysis: identifying requirements for patient decision aids.

Science.gov (United States)

Dhukaram, Anandhi Vivekanandan; Baber, Chris

2015-06-01

Patients make various healthcare decisions on a daily basis. Such day-to-day decision making can have significant consequences on their own health, treatment, care, and costs. While decision aids (DAs) provide effective support in enhancing patient's decision making, to date there have been few studies examining patient's decision making process or exploring how the understanding of such decision processes can aid in extracting requirements for the design of DAs. This paper applies Cognitive Work Analysis (CWA) to analyse patient's decision making in order to inform requirements for supporting self-care decision making. This study uses focus groups to elicit information from elderly cardiovascular disease (CVD) patients concerning a range of decision situations they face on a daily basis. Specifically, the focus groups addressed issues related to the decision making of CVD in terms of medication compliance, pain, diet and exercise. The results of these focus groups are used to develop high level views using CWA. CWA framework decomposes the complex decision making problem to inform three approaches to DA design: one design based on high level requirements; one based on a normative model of decision-making for patients; and the third based on a range of heuristics that patients seem to use. CWA helps in extracting and synthesising decision making from different perspectives: decision processes, work organisation, patient competencies and strategies used in decision making. As decision making can be influenced by human behaviour like skills, rules and knowledge, it is argued that patients require support to different types of decision making. This paper also provides insights for designers in using CWA framework for the design of effective DAs to support patients in self-management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Do personal stories make patient decision aids more effective? A critical review of theory and evidence

Science.gov (United States)

2013-01-01

Background Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others’ experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions. Methods A survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people’s healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings. Results Of 734 citations identified, 11 were included describing 13 studies. All studies found participants’ judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both “system 1” (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and “system 2” (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real

Helicopter-supported drilling operation in Papua New Guinea

International Nuclear Information System (INIS)

Wagner, E.R.; Juneau, M.S.

1991-01-01

This paper reports on drilling cost per foot of Chevron's helilift drilling operation in the remote Southern Highlands of Papua New Guinea, reduced from 1360 to 267 S/ft (4462 to 876$/m) during the period from 1985 to 1989. The operation provides many challenges, as it is thousands of miles from major oil-field supply centers. This requires advanced will-planning and logistical management of drilling materials so that they arrive at the drilling rig in a timely manner. The wells are also drilled into structurally complex geology without the aid of seismic data which can lead to unexpected results

Coaching patients in the use of decision and communication aids: RE-AIM evaluation of a patient support program.

Science.gov (United States)

Belkora, Jeff; Volz, Shelley; Loth, Meredith; Teng, Alexandra; Zarin-Pass, Margot; Moore, Dan; Esserman, Laura

2015-05-28

Decision aids educate patients about treatment options and outcomes. Communication aids include question lists, consultation summaries, and audio-recordings. In efficacy studies, decision aids increased patient knowledge, while communication aids increased patient question-asking and information recall. Starting in 2004, we trained successive cohorts of post-baccalaureate, pre-medical interns to coach patients in the use of decision and communication aids at our university-based breast cancer clinic. From July 2005 through June 2012, we used the RE-AIM framework to measure Reach, Effectiveness, Adoption, Implementation and Maintenance of our interventions. 1. Reach: Over the study period, our program sent a total of 5,153 decision aids and directly administered 2,004 communication aids. In the most recent program year (2012), out of 1,524 eligible patient appointments, we successfully contacted 1,212 (80%); coached 1,110 (73%) in the self-administered use of decision and communication aids; sent 958 (63%) decision aids; and directly administered communication aids for 419 (27%) patients. In a 2010 survey, coached patients reported self-administering one or more communication aids in 81% of visits 2. Effectiveness: In our pre-post comparisons, decision aids were associated with increased patient knowledge and decreased decisional conflict. Communication aids were associated with increased self-efficacy and number of questions; and with high ratings of patient preparedness and satisfaction 3. Adoption: Among visitors sent decision aids, 82% of survey respondents reviewed some or all; among those administered communication aids, 86% reviewed one or more after the visit 4. Through continuous quality adaptations, we increased the proportion of available staff time used for patient support (i.e. exploitation of workforce capacity) from 29% in 2005 to 84% in 2012 5. Maintenance: The main barrier to sustainability was the cost of paid intern labor. We addressed this by

Use of a patient decision aid for prenatal screening for Down syndrome: what do pregnant women say?

NARCIS (Netherlands)

Portocarrero, M.E.; Giguere, A.M.; Lepine, J.; Garvelink, M.M.; Robitaille, H.; Delanoe, A.; Levesque, I.; Wilson, B.J.; Rousseau, F.; Legare, F.

2017-01-01

BACKGROUND: Patient decision aids (PtDAs) help people make difficult, values-sensitive decisions. Prenatal screening for assessing the risk of genetic conditions in the fetus is one such decision and patient decision aids are rarely used in this clinical context. We sought to identify factors

A study on spatial decision support systems for HIV/AIDS prevention based on COM GIS technology

Science.gov (United States)

Yang, Kun; Luo, Huasong; Peng, Shungyun; Xu, Quanli

2007-06-01

Based on the deeply analysis of the current status and the existing problems of GIS technology applications in Epidemiology, this paper has proposed the method and process for establishing the spatial decision support systems of AIDS epidemic prevention by integrating the COM GIS, Spatial Database, GPS, Remote Sensing, and Communication technologies, as well as ASP and ActiveX software development technologies. One of the most important issues for constructing the spatial decision support systems of AIDS epidemic prevention is how to integrate the AIDS spreading models with GIS. The capabilities of GIS applications in the AIDS epidemic prevention have been described here in this paper firstly. Then some mature epidemic spreading models have also been discussed for extracting the computation parameters. Furthermore, a technical schema has been proposed for integrating the AIDS spreading models with GIS and relevant geospatial technologies, in which the GIS and model running platforms share a common spatial database and the computing results can be spatially visualized on Desktop or Web GIS clients. Finally, a complete solution for establishing the decision support systems of AIDS epidemic prevention has been offered in this paper based on the model integrating methods and ESRI COM GIS software packages. The general decision support systems are composed of data acquisition sub-systems, network communication sub-systems, model integrating sub-systems, AIDS epidemic information spatial database sub-systems, AIDS epidemic information querying and statistical analysis sub-systems, AIDS epidemic dynamic surveillance sub-systems, AIDS epidemic information spatial analysis and decision support sub-systems, as well as AIDS epidemic information publishing sub-systems based on Web GIS.

Core drilling of short drillholes at Olkiluoto in Eurajoki 2006

International Nuclear Information System (INIS)

Rautio, T.

2007-05-01

Posiva Oy submitted an application to the Finnish Government in May 1999 for the Decision in Principle to choose Olkiluoto in the municipality of Eurajoki as the site of the final disposal facility for spent nuclear fuel. A positive decision was made at the end of 2000 by the Government. The Finnish Parliament ratified the decision in May 2001. The decision makes it possible for Posiva to focus the confirming bedrock investigations at Olkiluoto, where in the next few years an underground rock characterisation facility, ONKALO, will be constructed. As a part of the investigations Suomen Malmi Oy (Smoy) core drilled six short drillholes with a diameter of 75.7 mm at Olkiluoto in July - August 2006. The identification numbers of the drillholes are OL-PP51 - OL-PP56. The deviation of the drillholes was measured with the deviation measuring instruments Reflex EMS. A set of monitoring measurements and samplings from the drilling and returning water was carried out during the drilling. The volume of the drilling water was recorded. Sodium fluorescein was used as a label agent in the drilling water. The total volume of the used drilling and flushing water were 37 m 3 . (orig.)

A global, incremental development method for a web-based prostate cancer treatment decision aid and usability testing in a Dutch clinical setting.

Science.gov (United States)

Cuypers, Maarten; Lamers, Romy Ed; Kil, Paul Jm; The, Regina; Karssen, Klemens; van de Poll-Franse, Lonneke V; de Vries, Marieke

2017-07-01

Many new decision aids are developed while aspects of existing decision aids could also be useful, leading to a sub-optimal use of resources. To support treatment decision-making in prostate cancer patients, a pre-existing evidence-based Canadian decision aid was adjusted to Dutch clinical setting. After analyses of the original decision aid and routines in Dutch prostate cancer care, adjustments to the decision aid structure and content were made. Subsequent usability testing (N = 11) resulted in 212 comments. Care providers mainly provided feedback on medical content, and patients commented most on usability and summary layout. All participants reported that the decision aid was comprehensible and well-structured and would recommend decision aid use. After usability testing, final adjustments to the decision aid were made. The presented methods could be useful for cultural adaptation of pre-existing tools into other languages and settings, ensuring optimal usage of previous scientific and practical efforts and allowing for a global, incremental decision aid development process.

Comparison of safety measures with a multicriteria decision aiding technique

International Nuclear Information System (INIS)

Lombard, J.

1985-01-01

Attributes such as political, social and psychological factors have to be taken into account for the decision-making process. Multiattribute decision-aiding techniques are used to cope with this multidimensionality of the risk management process. A simple example will be given to illustrate how such method can be helpful for the selection of proper safety measures in a rational way. (orig./HP) [de

The development of an online decision aid to support persons having a genetic predisposition to cancer and their partners during reproductive decision-making: a usability and pilot study.

Science.gov (United States)

Reumkens, Kelly; Tummers, Marly H E; Gietel-Habets, Joyce J G; van Kuijk, Sander M J; Aalfs, Cora M; van Asperen, Christi J; Ausems, Margreet G E M; Collée, Margriet; Dommering, Charlotte J; Kets, C Marleen; van der Kolk, Lizet E; Oosterwijk, Jan C; Tjan-Heijnen, Vivianne C G; van der Weijden, Trudy; de Die-Smulders, Christine E M; van Osch, Liesbeth A D M

2018-05-30

An online decision aid to support persons having a genetic predisposition to cancer and their partners during reproductive decision-making was developed. A two-phase usability test was conducted among 12 couples (N = 22; 2 persons participated without their partner) at risk for hereditary cancer and 15 health care providers. Couples and health care providers expressed similar suggestions for improvements, and evaluated the modified decision aid as acceptable, easy to use, and comprehensible. The final decision aid was pilot tested (N = 16) with paired sample t tests comparing main outcomes (decisional conflict, knowledge, realistic expectations regarding the reproductive options and decision self-efficacy) before (T0), immediately (T1) and 2 weeks after (T2) use of the decision aid. Pilot testing indicated decreased decisional conflict scores, increased knowledge, and improved realistic expectations regarding the reproductive options, at T1 and T2. No effect was found for couples' decision self-efficacy. The positive findings during usability testing were thus reflected in the pilot study. The decision aid will be further evaluated in a nationwide pretest-posttest study to facilitate implementation in the onco-genetic counselling setting. Ultimately, it is expected that the decision aid will enable end-users to make an informed decision.

Clinical use of patient decision-making aids for stone patients.

Science.gov (United States)

Lim, Amy H; Streeper, Necole M; Best, Sara L; Penniston, Kristina L; Nakada, Stephen Y

2017-08-01

Patient decision-making aids (PDMAs) help patients make informed healthcare decisions and improve patient satisfaction. The utility of PDMAs for patients considering treatments for urolithiasis has not yet been published. We report our experience using PDMAs developed at our institution in the outpatient clinical setting in patients considering a variety of treatment options for stones. Patients with radiographically confirmed urolithiasis were given PDMAs regarding treatment options for their stone(s) based on their clinical profile. We assessed patients' satisfaction, involvedness, and feeling of making a more informed decision with utilization of the PDMAs using a Likert Scale Questionnaire. Information was also collected regarding previous stone passage, history and type of surgical intervention for urolithiasis, and level of education. Patients (n = 43; 18 males, 23 females and two unknown) 53 +/- 14years old were included. Patients reported that they understood the advantages and disadvantages outlined in the PDMAs (97%), that the PDMAs helped them make a more informed decision (83%) and felt more involved in the decision making process (88%). Patients reported that the aids were presented in a balanced manner and used up-to-date scientific information (100%, 84% respectively). Finally, a majority of the patients prefer an expert's opinion when making a treatment decision (98%) with 73% of patients preferring to form their own opinion based on available information. Previous stone surgery was associated with patients feeling more involved with the decision making process (p = 0.0465). PDMAs have a promising role in shared decision-making in the setting of treatment options for nephrolithiasis.

Decision aids for familial breast cancer: exploring women's views using focus groups.

NARCIS (Netherlands)

Rapport, F.; Iredale, R.; Jones, W.; Sivell, S.; Edwards, A.; Gray, J.; Elwyn, G.

2006-01-01

BACKGROUND: There is increasing need for accessible information about familial breast cancer for those facing complex decisions around genetic testing, screening and treatment. Information currently includes leaflets and computerized decision aids, offering interactive interfaces to clarify complex

Protocol for the evaluation of a decision aid for women with a breech-presenting baby [ISRCTN14570598

Directory of Open Access Journals (Sweden)

Peat Brian

2004-12-01

Full Text Available Abstract Background There is now good evidence about the management options for pregnant women with a breech presentation (buttocks or feet rather than head-first at term; external cephalic version (ECV – the turning of a breech baby to a head-down position and/or planned caesarean section (CS. Each of these options has benefits and risks and the relative importance of these vary for each woman, subject to her personal values and preferences, a situation where a decision aid may be helpful. Decision aids are designed to assist patients and their doctors in making informed decisions using information that is unbiased and based on high quality research evidence. Decision aids are non-directive in the sense that they do not aim to steer the user towards any one option, but rather to support decision making which is informed and consistent with personal values. The ECV decision aid was developed using the Ottawa Decision Support Framework, including a systematic review of the evidence about the benefits and risks of the options for breech pregnancy. It comprises an audiotape with a supplementary booklet and worksheet, a format that can be taken home and discussed with a partner. This project aims to evaluate the ECV decision aid for women with a breech presenting baby in late pregnancy. Study design We aim to evaluate the effectiveness of the decision aid compared with usual care in a randomised controlled trial in maternity hospitals that offer ECV. The study group will receive the decision aid in addition to usual care and the control group will receive standard information on management options for breech presentation from their usual pregnancy care provider. Approximately 184 women with a single breech-presenting baby at greater than 34 weeks gestation and who are clinically eligible for ECV will be recruited for the trial. The primary outcomes of the study are knowledge, decisional conflict, anxiety and satisfaction with decision-making that

Protocol for the evaluation of a decision aid for women with a breech-presenting baby [ISRCTN14570598

Science.gov (United States)

Roberts, Christine L; Nassar, Natasha; Barratt, Alexandra; Raynes-Greenow, Camille H; Peat, Brian; Henderson-Smart, David

2004-01-01

Background There is now good evidence about the management options for pregnant women with a breech presentation (buttocks or feet rather than head-first) at term; external cephalic version (ECV) – the turning of a breech baby to a head-down position and/or planned caesarean section (CS). Each of these options has benefits and risks and the relative importance of these vary for each woman, subject to her personal values and preferences, a situation where a decision aid may be helpful. Decision aids are designed to assist patients and their doctors in making informed decisions using information that is unbiased and based on high quality research evidence. Decision aids are non-directive in the sense that they do not aim to steer the user towards any one option, but rather to support decision making which is informed and consistent with personal values. The ECV decision aid was developed using the Ottawa Decision Support Framework, including a systematic review of the evidence about the benefits and risks of the options for breech pregnancy. It comprises an audiotape with a supplementary booklet and worksheet, a format that can be taken home and discussed with a partner. This project aims to evaluate the ECV decision aid for women with a breech presenting baby in late pregnancy. Study design We aim to evaluate the effectiveness of the decision aid compared with usual care in a randomised controlled trial in maternity hospitals that offer ECV. The study group will receive the decision aid in addition to usual care and the control group will receive standard information on management options for breech presentation from their usual pregnancy care provider. Approximately 184 women with a single breech-presenting baby at greater than 34 weeks gestation and who are clinically eligible for ECV will be recruited for the trial. The primary outcomes of the study are knowledge, decisional conflict, anxiety and satisfaction with decision-making that will be assessed using

Value assessment aid to complex decision making. Final report

International Nuclear Information System (INIS)

Humphress, G.; Lewis, E.

1982-07-01

Value assessment (VA) is a new decision aid that can improve the performance of decisionmakers confronted with multiple attributes and conflicting objectives. Managers who are not supported by formal decision aids turn to various ''satisficing'' or effort-reducing biases that can lead to serious errors in the decisionmaking process. Value assessment, on the other hand, is an optimizing approach to problem-solving behavior. VA helps decisionmakers overcome the tendency to turn to effort-reducing biases by reducing the complexity of making tradeoffs and weighing all available information. Many of the issues which confront modern electric utility managements are complex, multiple attribute problems which must be viewed from engineering, financial and socio-political perspectives simultaneously. Added to this are the complications contributed by factors like uncertainty, risk, incomplete information and conflicting objectives among the public it serves. This is the complex decisionmaking arena which VA is intended to support

Decision aids: when 'nudging' patients to make a particular choice is more ethical than balanced, nondirective content.

Science.gov (United States)

Blumenthal-Barby, J S; Cantor, Scott B; Russell, Heidi Voelker; Naik, Aanand D; Volk, Robert J

2013-02-01

Patient decision aids, such as instructional leaflets describing treatment options for prostate cancer, are designed to help educate patients so that they can share in decisions about their care. Developers of these decision aids strive for balance, aiming to be as neutral, unbiased, and nondirective as possible. We argue that balance should not always be a goal, and we identify three situations where it should not be. For example, men diagnosed with early-stage prostate cancer frequently are not advised by their physicians that active surveillance is a reasonable alternative to immediate surgery or radiation. It may be desirable to design decision aids that promote active surveillance as an option. We recognize that the arguments put forth in this article are controversial. But they are also justified. We challenge medical decision makers and decision aid developers to determine if and when patients should be "nudged" toward one option or another.

User-centered design and the development of patient decision aids: protocol for a systematic review.

Science.gov (United States)

Witteman, Holly O; Dansokho, Selma Chipenda; Colquhoun, Heather; Coulter, Angela; Dugas, Michèle; Fagerlin, Angela; Giguere, Anik Mc; Glouberman, Sholom; Haslett, Lynne; Hoffman, Aubri; Ivers, Noah; Légaré, France; Légaré, Jean; Levin, Carrie; Lopez, Karli; Montori, Victor M; Provencher, Thierry; Renaud, Jean-Sébastien; Sparling, Kerri; Stacey, Dawn; Vaisson, Gratianne; Volk, Robert J; Witteman, William

2015-01-26

Providing patient-centered care requires that patients partner in their personal health-care decisions to the full extent desired. Patient decision aids facilitate processes of shared decision-making between patients and their clinicians by presenting relevant scientific information in balanced, understandable ways, helping clarify patients' goals, and guiding decision-making processes. Although international standards stipulate that patients and clinicians should be involved in decision aid development, little is known about how such involvement currently occurs, let alone best practices. This systematic review consisting of three interlinked subreviews seeks to describe current practices of user involvement in the development of patient decision aids, compare these to practices of user-centered design, and identify promising strategies. A research team that includes patient and clinician representatives, decision aid developers, and systematic review method experts will guide this review according to the Cochrane Handbook and PRISMA reporting guidelines. A medical librarian will hand search key references and use a peer-reviewed search strategy to search MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, the ACM library, IEEE Xplore, and Google Scholar. We will identify articles across all languages and years describing the development or evaluation of a patient decision aid, or the application of user-centered design or human-centered design to tools intended for patient use. Two independent reviewers will assess article eligibility and extract data into a matrix using a structured pilot-tested form based on a conceptual framework of user-centered design. We will synthesize evidence to describe how research teams have included users in their development process and compare these practices to user-centered design methods. If data permit, we will develop a measure of the user-centeredness of development processes and identify practices that are likely

Intra-annual wave resource characterization for energy exploitation: A new decision-aid tool

International Nuclear Information System (INIS)

Carballo, R.; Sánchez, M.; Ramos, V.; Fraguela, J.A.; Iglesias, G.

2015-01-01

Highlights: • A decision-aid tool is developed for computing the monthly performance of WECs. • It allows the generation of high-resolution monthly characterization matrices. • The decision-aid tool is implemented to the Death Coast (N Spain). • The monthly matrices can be obtained at any coastal location within the Death Coast. • The tool is applied to a coastal location of a proposed wave farm. - Abstract: The wave energy resource is usually characterized by a significant variability throughout the year. In estimating the power performance of a Wave Energy Converter (WEC) it is fundamental to take into account this variability; indeed, an estimate based on mean annual values may well result in a wrong decision making. In this work, a novel decision-aid tool, iWEDGE (intra-annual Wave Energy Diagram GEnerator) is developed and implemented to a coastal region of interest, the Death Coast (Spain), one of the regions in Europe with the largest wave resource. Following a comprehensive procedure, and based on deep water wave data and high-resolution numerical modelling, this tool provides the monthly high-resolution characterization matrices (or energy diagrams) for any location of interest. In other words, the information required for the accurate computation of the intra-annual performance of any WEC at any location within the region covered is made available. Finally, an application of iWEDGE to the site of a proposed wave farm is presented. The results obtained highlight the importance of the decision-aid tool herein provided for wave energy exploitation

Promoting the dissemination of decision aids: an odyssey in a dysfunctional health care financing system.

Science.gov (United States)

Billings, John

2004-01-01

The usefulness of patient decision aids (PtDAs) is well documented, yet they are not in widespread use. Barriers include assuring balance and fairness (auspices matter), the cost of producing and maintaining them, and getting them into the hands of patients at the right time. The Foundation for Informed Medical Decision Making and its for-profit partner, Health Dialog, have developed a creative business model that helps overcome these barriers and has greatly expanded the reach of decision aids.

Use of a decision aid for prenatal testing of fetal abnormalities to improve women's informed decision making: a cluster randomised controlled trial [ISRCTN22532458].

Science.gov (United States)

Nagle, C; Gunn, J; Bell, R; Lewis, S; Meiser, B; Metcalfe, S; Ukoumunne, O C; Halliday, J

2008-02-01

To evaluate the effectiveness of a decision aid for prenatal testing of fetal abnormalities compared with a pamphlet in supporting women's decision making. A cluster randomised controlled trial. Primary health care. Women in early pregnancy consulting a GP. GPs were randomised to provide women with either a decision aid or a pamphlet. The decision aid was a 24-page booklet designed using the Ottowa Decision Framework. The pamphlet was an existing resource available in the trial setting. Validated scales were used to measure the primary outcomes, informed choice and decisional conflict, and the secondary outcomes, anxiety, depression, attitudes to the pregnancy/fetus and acceptability of the resource. Outcomes were measured at 14 weeks of gestation from questionnaires that women completed and returned by post. Women in the intervention group were more likely to make an informed decision 76% (126/165) than those in the control group 65% (107/165) (adjusted OR 2.08; 95% CI 1.14-3.81). A greater proportion of women in the intervention group 88% (147/167) had a 'good' level of knowledge than those in the control group 72% (123/171) (adjusted OR 3.43; 95% CI 1.79-6.58). Mean (SD) decisional conflict scores were low in both groups, decision aid 1.71 (0.49), pamphlet 1.65 (0.55) (adjusted mean difference 0.10; 95% CI -0.02 to 0.22). There was no strong evidence of differences between the trial arms in the measures of psychological or acceptability outcomes. A tailored prenatal testing decision aid plays an important role in improving women's knowledge of first and second trimester screening tests and assisting them to make decisions about screening and diagnostic tests that are consistent with their values.

Stinger Enhanced Drill Bits For EGS

Energy Technology Data Exchange (ETDEWEB)

Durrand, Christopher J. [Novatek International, Inc., Provo, UT (United States); Skeem, Marcus R. [Novatek International, Inc., Provo, UT (United States); Crockett, Ron B. [Novatek International, Inc., Provo, UT (United States); Hall, David R. [Novatek International, Inc., Provo, UT (United States)

2013-04-29

The project objectives were to design, engineer, test, and commercialize a drill bit suitable for drilling in hard rock and high temperature environments (10,000 meters) likely to be encountered in drilling enhanced geothermal wells. The goal is provide a drill bit that can aid in the increased penetration rate of three times over conventional drilling. Novatek has sought to leverage its polycrystalline diamond technology and a new conical cutter shape, known as the Stinger®, for this purpose. Novatek has developed a fixed bladed bit, known as the JackBit®, populated with both shear cutter and Stingers that is currently being tested by major drilling companies for geothermal and oil and gas applications. The JackBit concept comprises a fixed bladed bit with a center indenter, referred to as the Jack. The JackBit has been extensively tested in the lab and in the field. The JackBit has been transferred to a major bit manufacturer and oil service company. Except for the attached published reports all other information is confidential.

Balancing the presentation of information and options in patient decision aids: an updated review.

Science.gov (United States)

Abhyankar, Purva; Volk, Robert J; Blumenthal-Barby, Jennifer; Bravo, Paulina; Buchholz, Angela; Ozanne, Elissa; Vidal, Dale Colins; Col, Nananda; Stalmeier, Peep

2013-01-01

Standards for patient decision aids require that information and options be presented in a balanced manner; this requirement is based on the argument that balanced presentation is essential to foster informed decision making. If information is presented in an incomplete/non-neutral manner, it can stimulate cognitive biases that can unduly affect individuals' knowledge, perceptions of risks and benefits, and, ultimately, preferences. However, there is little clarity about what constitutes balance, and how it can be determined and enhanced. We conducted a literature review to examine the theoretical and empirical evidence related to balancing the presentation of information and options. A literature search related to patient decision aids and balance was conducted on Medline, using MeSH terms and PubMed; this search supplemented the 2011 Cochrane Collaboration's review of patient decision aids trials. Only English language articles relevant to patient decision making and addressing the balance of information and options were included. All members of the team independently screened clusters of articles; uncertainties were resolved by seeking review by another member. The team then worked in sub-groups to extract and synthesise data on theory, definitions, and evidence reported in these studies. A total of 40 articles met the inclusion criteria. Of these, six explained the rationale for balancing the presentation of information and options. Twelve defined "balance"; the definition of "balance" that emerged is as follows: "The complete and unbiased presentation of the relevant options and the information about those options-in content and in format-in a way that enables individuals to process this information without bias". Ten of the 40 articles reported assessing the balance of the relevant decision aid. All 10 did so exclusively from the users' or patients' perspective, using a five-point Likert-type scale. Presenting information in a side-by-side display form was

[Evaluation of the decision aid "Entscheidungshilfe Prostatakrebs" from the patients' view : Results from the first three months].

Science.gov (United States)

Groeben, C; Ihrig, A; Hölscher, T; Krones, T; Kessler, E; Kliesch, S; Wülfing, C; Koch, R; Wirth, M P; Huber, J

2016-12-01

The decision aid "Entscheidungshilfe Prostatakrebs" is available online free of charge since June 2016. It is designed to support patients with their treatment decision-making and to lighten the burden on their treating urologists. This study evaluates usage data from the first 3 months. The ICHOM standard set was applied to allow a personalised presentation and to collect relevant data for subsequent counselling. Additionally, personal preferences and psychological burden were assessed amongst others. We collected anonymous data. A multivariate model evaluated predictors for high user satisfaction. From June through August 2016 a total of 319 patients used the decision aid, showing a continuous monthly increase in the number of users. There were n = 219 (68.7%) complete questionnaires. Median age was 66.1 ± 8.0 years. The oncological risk was low in 30.3%, intermediate in 43.6% and high in 26.1%. A majority of 57.5% used the decision aid together with their partner, 35.1% alone and 5.5% with their children. In all, 54.8% were "very satisfied" and 32.0% were "satisfied" with the decision aid for a total satisfaction rate of about 87%. The only predictors of total satisfaction were the usage mode and reported distress level. As shown by the continuously increasing number of users this decision aid is becoming well established in German urology. Patients' overall ratings are very positive. The majority of patients use the decision aid with their partner. This represents a significant advantage of a multimedia approach compared to print media.

Evaluation of a decision aid for women with breech presentation at term: a randomised controlled trial [ISRCTN14570598

Science.gov (United States)

Nassar, N; Roberts, CL; Raynes-Greenow, CH; Barratt, A; Peat, B

2007-01-01

Objectives To evaluate the effectiveness of a decision aid for women with a breech presentation compared with usual care. Design Randomised controlled trial. Setting Tertiary obstetric hospitals offering external cephalic version (ECV). Population Women with a singleton pregnancy were diagnosed antenatally with a breech presentation at term, and were clinically eligible for ECV. Methods Women were randomised to either receive a decision aid about the management options for breech presentation in addition to usual care or to receive usual care only with standard counselling from their usual pregnancy care provider. The decision aid comprised a 24-page booklet supplemented by a 30-minute audio-CD and worksheet that was designed for women to take home and review with a partner. Main outcome measures Decisional conflict (uncertainty), knowledge, anxiety and satisfaction with decision making, and were assessed using self-administered questionnaires. Results Compared with usual care, women reviewing the decision aid experienced significantly lower decisional conflict (mean difference −8.92; 95% CI −13.18, −4.66) and increased knowledge (mean difference 8.40; 95% CI 3.10, 13.71), were more likely to feel that they had enough information to make a decision (RR 1.30; 95% CI 1.14, 1.47), had no increase in anxiety and reported greater satisfaction with decision making and overall experience of pregnancy and childbirth. In contrast, 19% of women in the usual care group reported they would have made a different decision about their care. Conclusions A decision aid is an effective and acceptable tool for pregnant women that provides an important adjunct to standard counselling for the management of breech presentation. Please cite this paper as: Nassar N, Roberts C, Raynes-Greenow C, Barratt A, Peat B, on behalf of the Decision Aid for Breech Presentation Trial Collaborators. Evaluation of a decision aid for women with breech presentation at term: a randomised controlled

The effect of patient narratives on information search in a web-based breast cancer decision aid: an eye-tracking study.

Science.gov (United States)

Shaffer, Victoria A; Owens, Justin; Zikmund-Fisher, Brian J

2013-12-17

Previous research has examined the impact of patient narratives on treatment choices, but to our knowledge, no study has examined the effect of narratives on information search. Further, no research has considered the relative impact of their format (text vs video) on health care decisions in a single study. Our goal was to examine the impact of video and text-based narratives on information search in a Web-based patient decision aid for early stage breast cancer. Fifty-six women were asked to imagine that they had been diagnosed with early stage breast cancer and needed to choose between two surgical treatments (lumpectomy with radiation or mastectomy). Participants were randomly assigned to view one of four versions of a Web decision aid. Two versions of the decision aid included videos of interviews with patients and physicians or videos of interviews with physicians only. To distinguish between the effect of narratives and the effect of videos, we created two text versions of the Web decision aid by replacing the patient and physician interviews with text transcripts of the videos. Participants could freely browse the Web decision aid until they developed a treatment preference. We recorded participants' eye movements using the Tobii 1750 eye-tracking system equipped with Tobii Studio software. A priori, we defined 24 areas of interest (AOIs) in the Web decision aid. These AOIs were either separate pages of the Web decision aid or sections within a single page covering different content. We used multilevel modeling to examine the effect of narrative presence, narrative format, and their interaction on information search. There was a significant main effect of condition, P=.02; participants viewing decision aids with patient narratives spent more time searching for information than participants viewing the decision aids without narratives. The main effect of format was not significant, P=.10. However, there was a significant condition by format interaction on

Decision aids for second-line palliative chemotherapy: a randomised phase II multicentre trial

NARCIS (Netherlands)

Oostendorp, L.J.M.; Ottevanger, P.B.; Donders, A.R.T.; Wouw, A.J. van de; Schoenaker, I.J.; Smilde, T.J.; Graaf, W.T.A. van der; Stalmeier, P.F.M.

2017-01-01

BACKGROUND: There is increasing recognition of the delicate balance between the modest benefits of palliative chemotherapy and the burden of treatment. Decision aids (DAs) can potentially help patients with advanced cancer with these difficult treatment decisions, but providing detailed information

Aid to Families with Dependent Children Quality Control Review Panel Decisions

Data.gov (United States)

U.S. Department of Health & Human Services — Decisions issued by the Aid to Families with Dependent Children (AFDC) Quality Control Review Panel of the Departmental Appeals Board concerning the AFDC program...

A global, incremental development method for a web-based prostate cancer treatment decision aid and usability testing in a Dutch clinical setting

NARCIS (Netherlands)

Cuypers, M.; Lamers, R.E.D.; Kil, P.J.M.; The, R.; Karssen, K.; van de Poll-Franse, L.V.; de Vries, M.

2018-01-01

Many new decision aids are developed while aspects of existing decision aids could also be useful, leading to a sub-optimal use of resources. To support treatment decision-making in prostate cancer patients, a pre-existing evidence-based Canadian decision aid was adjusted to Dutch clinical setting.

Decision aids for multiple-decision disease management as affected by weather input errors.

Science.gov (United States)

Pfender, W F; Gent, D H; Mahaffee, W F; Coop, L B; Fox, A D

2011-06-01

Many disease management decision support systems (DSSs) rely, exclusively or in part, on weather inputs to calculate an indicator for disease hazard. Error in the weather inputs, typically due to forecasting, interpolation, or estimation from off-site sources, may affect model calculations and management decision recommendations. The extent to which errors in weather inputs affect the quality of the final management outcome depends on a number of aspects of the disease management context, including whether management consists of a single dichotomous decision, or of a multi-decision process extending over the cropping season(s). Decision aids for multi-decision disease management typically are based on simple or complex algorithms of weather data which may be accumulated over several days or weeks. It is difficult to quantify accuracy of multi-decision DSSs due to temporally overlapping disease events, existence of more than one solution to optimizing the outcome, opportunities to take later recourse to modify earlier decisions, and the ongoing, complex decision process in which the DSS is only one component. One approach to assessing importance of weather input errors is to conduct an error analysis in which the DSS outcome from high-quality weather data is compared with that from weather data with various levels of bias and/or variance from the original data. We illustrate this analytical approach for two types of DSS, an infection risk index for hop powdery mildew and a simulation model for grass stem rust. Further exploration of analysis methods is needed to address problems associated with assessing uncertainty in multi-decision DSSs.

Intelligent decision aids for abnormal events in nuclear power plants

International Nuclear Information System (INIS)

Kafka, P.; Polke, H.

1988-01-01

German nuclear power plants are characterized by a high degree of automation, not only for normal operation but also for abnormal events. Therefore the role of the operating personnel is mainly a supervisory function. Nevertheless, for a spectrum of unexpected events the operating personnel have to react with manual recovery actions. In order to minimize human error in such recovery actions, different kinds of intelligent decision aid support the operators today. In this paper such aids are discussed and one of them is described in more detail. (author)

A risk-based decision-aiding tool for waste disposal

International Nuclear Information System (INIS)

Weiner, R.F.; Reiser, A.S.; Elcock, C.G.; Nevins, S.

1997-01-01

N-CART (the National Spent Nuclear Fuel Program Cost Analysis and Risk Tool) is being developed to aid in low-risk, cost-effective, timely management of radioactive waste and spent nuclear fuel, and can therefore be used in management of mixed waste. N-CART provides evaluation of multiple alternatives and presents the consequences of proposed waste management activities in a clear and concise format. N-CART's decision-aiding analyses include comparisons and sensitivity analyses of multiple alternatives and allows the user to perform quick turn-around open-quotes what ifclose quotes studies to investigate various scenarios. Uncertainties in data (such as cost and schedule of various activities) are represented as distributions. N-CART centralizes documentation of the bases of program alternatives and program decisions, thereby supporting responses to stakeholders concerns. The initial N-CART design considers regulatory requirements, costs, and schedules for alternative courses of action. The final design will include risks (public health, occupational, economic, scheduling), economic benefits, and the impacts of secondary waste generation. An optimization tool is being incorporated that allows the user to specify the relative importance of cost, time risks, and other bases for decisions. The N-CART prototype can be used to compare the costs and schedules of disposal alternatives for mixed low-level radioactive waste (MLLW) and greater-than-Class-C (GTCC) waste, as well as spent nuclear fuel (SNF) and related scrap material

Use of Video Decision Aids to Promote Advance Care Planning in Hilo, Hawai'i.

Science.gov (United States)

Volandes, Angelo E; Paasche-Orlow, Michael K; Davis, Aretha Delight; Eubanks, Robert; El-Jawahri, Areej; Seitz, Rae

2016-09-01

Advance care planning (ACP) seeks to promote care delivery that is concordant with patients' informed wishes. Scalability and cost may be barriers to widespread ACP, and video decision aids may help address such barriers. Our primary hypothesis was that ACP documentation would increase in Hilo after ACP video implementation. Secondary hypotheses included increased use of hospice, fewer deaths in the hospital, and decreased costs in the last month of life. The city of Hilo in Hawai'i (population 43,263), which is served by one 276-bed hospital (Hilo Medical Center), one hospice (the Hospice of Hilo), and 30 primary care physicians. The intervention consisted of a single, 1- to 4-h training and access to a suite of ACP video decision aids. Prior to implementation, the rate of ACP documentation for hospitalized patients with late-stage disease was 3.2 % (11/346). After the intervention, ACP documentation was 39.9 % (1,107/2,773) (P Hilo patients was $3,458 (95 % CI $3,051 to 3,865) lower per patient after the intervention when compared to the control region. Implementing ACP video decision aids was associated with improved ACP documentation, greater use of hospice, and decreased costs. Decision aids that promote ACP offer a scalable and cost-efficient medium to place patients at the center of their care.

Development and initial testing of a computer-based patient decision aid to promote colorectal cancer screening for primary care practice

Directory of Open Access Journals (Sweden)

Fowler Beth

2005-11-01

Full Text Available Abstract Background Although colorectal cancer screening is recommended by major policy-making organizations, rates of screening remain low. Our aim was to develop a patient-directed, computer-based decision aid about colorectal cancer screening and investigate whether it could increase patient interest in screening. Methods We used content from evidence-based literature reviews and our previous decision aid research to develop a prototype. We performed two rounds of usability testing with representative patients to revise the content and format. The final decision aid consisted of an introductory segment, four test-specific segments, and information to allow comparison of the tests across several key parameters. We then conducted a before-after uncontrolled trial of 80 patients 50–75 years old recruited from an academic internal medicine practice. Results Mean viewing time was 19 minutes. The decision aid improved patients' intent to ask providers for screening from a mean score of 2.8 (1 = not at all likely to ask, 4 = very likely to ask before viewing the decision aid to 3.2 afterwards (difference, 0.4; p Conclusion We conclude that a computer-based decision aid can increase patient intent to be screened and increase interest in screening. Practice Implications: This decision aid can be viewed by patients prior to provider appointments to increase motivation to be screened and to help them decide about which modality to use for screening. Further work is required to integrate the decision aid with other practice change strategies to raise screening rates to target levels.

Decision support aids with anthropomorphic characteristics influence trust and performance in younger and older adults.

Science.gov (United States)

Pak, Richard; Fink, Nicole; Price, Margaux; Bass, Brock; Sturre, Lindsay

2012-01-01

This study examined the use of deliberately anthropomorphic automation on younger and older adults' trust, dependence and performance on a diabetes decision-making task. Research with anthropomorphic interface agents has shown mixed effects in judgments of preferences but has rarely examined effects on performance. Meanwhile, research in automation has shown some forms of anthropomorphism (e.g. etiquette) have effects on trust and dependence on automation. Participants answered diabetes questions with no-aid, a non-anthropomorphic aid or an anthropomorphised aid. Trust and dependence in the aid was measured. A minimally anthropomorphic aide primarily affected younger adults' trust in the aid. Dependence, however, for both age groups was influenced by the anthropomorphic aid. Automation that deliberately embodies person-like characteristics can influence trust and dependence on reasonably reliable automation. However, further research is necessary to better understand the specific aspects of the aid that affect different age groups. Automation that embodies human-like characteristics may be useful in situations where there is under-utilisation of reasonably reliable aids by enhancing trust and dependence in that aid. Practitioner Summary: The design of decision-support aids on consumer devices (e.g. smartphones) may influence the level of trust that users place in that system and their amount of use. This study is the first step in articulating how the design of aids may influence user's trust and use of such systems.

A novel classification method for aid decision of traditional Chinese patent medicines for stroke treatment.

Science.gov (United States)

Zhao, Yufeng; Liu, Bo; He, Liyun; Bai, Wenjing; Yu, Xueyun; Cao, Xinyu; Luo, Lin; Rong, Peijing; Zhao, Yuxue; Li, Guozheng; Liu, Baoyan

2017-09-01

Traditional Chinese patent medicines are widely used to treat stroke because it has good efficacy in the clinical environment. However, because of the lack of knowledge on traditional Chinese patent medicines, many Western physicians, who are accountable for the majority of clinical prescriptions for such medicine, are confused with the use of traditional Chinese patent medicines. Therefore, the aid-decision method is critical and necessary to help Western physicians rationally use traditional Chinese patent medicines. In this paper, Manifold Ranking is employed to develop the aid-decision model of traditional Chinese patent medicines for stroke treatment. First, 115 stroke patients from three hospitals are recruited in the cross-sectional survey. Simultaneously, traditional Chinese physicians determine the traditional Chinese patent medicines appropriate for each patient. Second, particular indicators are explored to characterize the population feature of traditional Chinese patent medicines for stroke treatment. Moreover, these particular indicators can be easily obtained byWestern physicians and are feasible for widespread clinical application in the future. Third, the aid-decision model of traditional Chinese patent medicines for stroke treatment is constructed based on Manifold Ranking. Experimental results reveal that traditional Chinese patent medicines can be differentiated. Moreover, the proposed model can obtain high accuracy of aid decision.

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

Science.gov (United States)

Necefer, Len Edward

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

Using linguistic descriptions with multi-criteria decision aid approaches in urban energy systems

OpenAIRE

Afsordegan, Arayeh; Sánchez Soler, Monica; Agell Jané, Núria; Gamboa Jimenez, Gonzalo; Cremades Oliver, Lázaro Vicente

2015-01-01

Multi-Criteria Decision Aid (MCDA) methods include various collections of mathematical techniques related to decision support systems in non-deterministic environments to support such applications as facility management, disaster management and urban planning. This paper applies MCDA approaches based on qualitative reasoning techniques with linguistic labels assessment. The aim of this method is ranking multi-attribute alternatives in group decision-making with qualitative labels. Finally ...

Measuring the Extent of European State Aid Control : An Econometric Analysis of the European Commission Decisions

NARCIS (Netherlands)

Brouwer, E.; Ozbugday, F.C.

2011-01-01

This paper provides an analysis of the European Commission (EC) decisions on state aid control using data on 550 state aid cases approved by the EC between 1998 and 2009. More specifically, we measure the determinants of the duration of state aid, total budget of state aid and daily budget of state

Measuring the Extent of European State Aid Control : An Econometric Analysis of the European Commission Decisions

NARCIS (Netherlands)

Brouwer, E.; Ozbugday, F.C.

2010-01-01

This paper provides an analysis of the European Commission (EC) decisions on state aid control using data on 550 state aid cases approved by the EC between 1998 and 2009. More specifically, we measure the determinants of the duration of state aid, total budget of state aid and daily budget of state

Decision aiding in public policy generation and implementation: a multicriteria approach to evaluate territorial resilience

Directory of Open Access Journals (Sweden)

Maria Franca Norese

2016-12-01

Full Text Available A decision aid process should be the result of an interaction between analysts, decision makers and stakeholders. Decision aiding is sometimes required when the problem situation is new and a formal decision system does not exist. Its role becomes that of facilitating the Intelligence phase of a decision process. In other situations, a criticism of certain policy making processes and their use of data, which may be available in institutional databases or are required as indicators for the decision process, motivates an intervention oriented towards structure knowledge and improvements of these processes. A preliminary study, which includes modelling and application of multi-criteria methods, can clarify a complex and new situation, propose a consistent approach for the later phases of a decision process or propose a different and more effective use of the data. A case study is proposed here to describe this methodological approach in relation to the disaster resilience of municipalities near the mbrone River, in Tuscany (Italy.

Development of a patient decision aid for prevention of myocardial infarction in type 2 diabetes - rationale, design and pilot testing.

Science.gov (United States)

Lenz, Matthias; Kasper, Jürgen; Mühlhauser, Ingrid

2009-10-19

Development and testing of a decision aid about prevention of myocardial infarction for persons with type 2 diabetes. Development and testing were guided by the UK Medical Research Council's guidance for the development and evaluation of complex interventions. This comprised a systematic literature review, a focus group of 9 potential providers, modelling a prototype, interviews to qualitatively explore understanding and additional information needs, and revision of the decision aid. The decision aid includes evidence-based information, a tool for individual risk-assessment, worksheets, and an action plan. Five diabetes educators and 15 patients underwent two 60-minutes face-to-face interviews, firstly browsing the decision aid for the first time and then after using it. Both groups differed in their ratings. Overall, the decision aid was rated to present essential information in a complex but understandable and unbiased manner. Difficulties involved understanding of terminology and risk interpretation. "Social status as a risk factor" was the most challenged content by educators but considered as highly important by patients. The risk assessment tool was used inadequately. 5 patients allocated themselves into false risk categories. After revision of the tool, all 12 patients who were recruited for reassessment used the tool correctly. The decision aid was evaluated with diabetes educators and patients. Qualitative data analysis revealed aspects for revision. The decision aid is planned to be part of a shared decision making programme, comprising a strategy for patient counselling and educational modules addressed to providers. Quantitative evaluation is required to assess its effectiveness.

Protocol for the Osteoporosis Choice trial. A pilot randomized trial of a decision aid in primary care practice

Directory of Open Access Journals (Sweden)

Tulledge-Scheitel Sidna M

2009-12-01

Full Text Available Abstract Background Bisphosphonates can reduce fracture risk in patients with osteoporosis, but many at-risk patients do not start or adhere to these medications. The aims of this study are to: (1 preliminarily evaluate the effect of an individualized 10-year osteoporotic fracture risk calculator and decision aid (OSTEOPOROSIS CHOICE for postmenopausal women at risk for osteoporotic fractures; and (2 assess the feasibility and validity (i.e., absence of contamination of patient-level randomization (vs. cluster randomization in pilot trials of decision aid efficacy. Methods/Design This is a protocol for a parallel, 2-arm, randomized trial to compare an intervention group receiving OSTEOPOROSIS CHOICE to a control group receiving usual primary care. Postmenopausal women with bone mineral density T-scores of STEOPOROSIS CHOICE on five outcomes: (a patient knowledge regarding osteoporosis risk factors and treatment; (b quality of the decision-making process for both the patient and clinician; (c patient and clinician acceptability and satisfaction with the decision aid; (d rate of bisphosphonate use and adherence, and (e trial processes (e.g., ability to recruit participants, collect patient outcomes. To capture these outcomes, we will use patient and clinician surveys following each visit and video recordings of the clinical encounters. These video recordings will also allow us to determine the extent to which clinicians previously exposed to the decision aid were able to recreate elements of the decision aid with control patients (i.e., contamination. Pharmacy prescription profiles and follow-up phone interviews will assess medication start and adherence at 6 months. Discussion This pilot trial will provide evidence of feasibility, validity of patient randomization, and preliminary efficacy of a novel approach -- decision aids -- to improving medication adherence for postmenopausal women at risk of osteoporotic fractures. The results will inform

Regional Climate Change and Development of Public Health Decision Aids

Science.gov (United States)

Hegedus, A. M.; Darmenova, K.; Grant, F.; Kiley, H.; Higgins, G. J.; Apling, D.

2011-12-01

According to the World Heath Organization (WHO) climate change is a significant and emerging threat to public health, and changes the way we must look at protecting vulnerable populations. Worldwide, the occurrence of some diseases and other threats to human health depend predominantly on local climate patterns. Rising average temperatures, in combination with changing rainfall patterns and humidity levels, alter the lifecycle and regional distribution of certain disease-carrying vectors, such as mosquitoes, ticks and rodents. In addition, higher surface temperatures will bring heat waves and heat stress to urban regions worldwide and will likely increase heat-related health risks. A growing body of scientific evidence also suggests an increase in extreme weather events such as floods, droughts and hurricanes that can be destructive to human health and well-being. Therefore, climate adaptation and health decision aids are urgently needed by city planners and health officials to determine high risk areas, evaluate vulnerable populations and develop public health infrastructure and surveillance systems. To address current deficiencies in local planning and decision making with respect to regional climate change and its effect on human health, our research is focused on performing a dynamical downscaling with the Weather Research and Forecasting (WRF) model to develop decision aids that translate the regional climate data into actionable information for users. WRF model is initialized with the Max Planck Institute European Center/Hamburg Model version 5 (ECHAM5) General Circulation Model simulations forced with the Special Report on Emissions (SRES) A1B emissions scenario. Our methodology involves development of climatological indices of extreme weather, quantifying the risk of occurrence of water/rodent/vector-borne diseases as well as developing various heat stress related decision aids. Our results indicate that the downscale simulations provide the necessary

Exploring the use of Option Grid™ patient decision aids in a sample of clinics in Poland.

Science.gov (United States)

Scalia, Peter; Elwyn, Glyn; Barr, Paul; Song, Julia; Zisman-Ilani, Yaara; Lesniak, Monika; Mullin, Sarah; Kurek, Krzysztof; Bushell, Matt; Durand, Marie-Anne

2018-05-29

Research on the implementation of patient decision aids to facilitate shared decision making in clinical settings has steadily increased across Western countries. A study which implements decision aids and measures their impact on shared decision making has yet to be conducted in the Eastern part of Europe. To study the use of Option Grid TM patient decision aids in a sample of Grupa LUX MED clinics in Warsaw, Poland, and measure their impact on shared decision making. We conducted a pre-post interventional study. Following a three-month period of usual care, clinicians from three Grupa LUX MED clinics received a one-hour training session on how to use three Option Grid TM decision aids and were provided with copies for use for four months. Throughout the study, all eligible patients were asked to complete the three-item CollaboRATE patient-reported measure of shared decision making after their clinical encounter. CollaboRATE enables patients to assess the efforts clinicians make to: (i) inform them about their health issues; (ii) listen to 'what matters most'; (iii) integrate their treatment preference in future plans. A Hierarchical Logistic Regression model was performed to understand which variables had an effect on CollaboRATE. 2,048 patients participated in the baseline phase; 1,889 patients participated in the intervention phase. Five of the thirteen study clinicians had a statistically significant increase in their CollaboRATE scores (pOption Grid TM helped some clinicians practice shared decision making as reflected in CollaboRATE scores, but most clinicians did not have a significant increase in their scores. Our study indicates that the effect of these interventions may be dependent on clinic contexts and clinician engagement. Copyright © 2018. Published by Elsevier GmbH.

Breast cancer anxiety's associations with responses to a chemoprevention decision aid.

Science.gov (United States)

Dillard, Amanda J; Scherer, Laura; Ubel, Peter A; Smith, Dylan M; Zikmund-Fisher, Brian J; McClure, Jennifer B; Greene, Sarah; Stark, Azadeh; Fagerlin, Angela

2013-01-01

Few studies have examined how specific emotions may affect decision-making processes. Anxiety may be especially relevant in health decisions such as those related to cancer in which thoughts of illness or death may be abundant. We examined associations between women's anxiety about developing breast cancer and variables related to their decision to take a medication that could reduce their chances of the disease. Six-hundred and thirty-two American women, who had an increased risk of breast cancer, reviewed a web-based decision aid about tamoxifen. We examined associations between their baseline, self-reported anxiety about developing the disease and post decision aid measures including knowledge about tamoxifen, attitude toward the medication, and behavioral intentions to look for more information and take the medication. Results showed that anxiety was not associated with knowledge about tamoxifen, but it was associated with attitude toward the medication such that women who were more anxious about developing breast cancer were more likely to think the benefits were worth the risks. Greater anxiety was also associated with greater behavioral intentions to look for additional information and take the medication in the next few months. Secondary analyses showed that behavioral intentions were related to knowledge of tamoxifen and attitude toward the medication only for women who were reporting low levels of anxiety. Overall, the findings suggest that anxiety about breast cancer may motivate interest in tamoxifen and not necessarily through affecting knowledge or attitudes. Copyright © 2012 Elsevier Ltd. All rights reserved.

Long-term health outcomes of a decision aid: data from a randomized trial of adjuvant! In women with localized breast cancer.

Science.gov (United States)

Vickers, Andrew J; Elkin, Elena B; Peele, Pamela B; Dickler, Maura; Siminoff, Laura A

2009-01-01

Women with localized breast cancer face difficult decisions about adjuvant therapy. Several decision aids are available to help women choose between treatment options. Decision aids are known to affect treatment choices and may therefore affect patient survival. The authors aimed to model the effects of the Adjuvant! decision aid on expected survival in women with early stage breast cancer. Data were obtained from a randomized trial of Adjuvant! (n = 395). To calculate the effects of the decision aid on survival, the authors used the Adjuvant! survival predictions as a surrogate endpoint. Data from each arm were entered separately into statistical models to estimate change in survival associated with receiving the Adjuvant! decision aid. Most women (approximately 85%) chose a treatment option that maximized predicted survival. The effects of the decision aid on outcome could not be modeled because a small number of women (n = 12, 3%) chose treatment options associated with a large (5%-14%) loss in survival. These women-most typically estrogen receptor positive but refusing hormonal therapy-were equally divided between Adjuvant! and control groups and were not distinguished by medical or demographic factors. Expected benefit from treatment is a key variable in understanding patient behavior. A small number of women refuse adjuvant treatment associated with large increases in predicted survival, even when they are explicitly informed about the degree of benefit they would forgo. Investigation of the effects of decision aids on cancer survival is unlikely to be fruitful due to power considerations.

Which Cooperative Ownership Model Performs Better? A Financial-Decision Aid Approach

NARCIS (Netherlands)

Kalogeras, N.; Pennings, J.M.E.; Benos, T.; Doumpos, M.

2013-01-01

In this article the financial/ownership structures of agribusiness cooperatives are analyzed to examine whether new cooperative models perform better than the more traditional ones. The assessment procedure introduces a new financial decision-aid approach, which is based on data-analysis techniques

Coiled tubing drilling with supercritical carbon dioxide

Science.gov (United States)

Kolle , Jack J.

2002-01-01

A method for increasing the efficiency of drilling operations by using a drilling fluid material that exists as supercritical fluid or a dense gas at temperature and pressure conditions existing at a drill site. The material can be used to reduce mechanical drilling forces, to remove cuttings, or to jet erode a substrate. In one embodiment, carbon dioxide (CO.sub.2) is used as the material for drilling within wells in the earth, where the normal temperature and pressure conditions cause CO.sub.2 to exist as a supercritical fluid. Supercritical carbon dioxide (SC--CO.sub.2) is preferably used with coiled tube (CT) drilling equipment. The very low viscosity SC--CO.sub.2 provides efficient cooling of the drill head, and efficient cuttings removal. Further, the diffusivity of SC--CO.sub.2 within the pores of petroleum formations is significantly higher than that of water, making jet erosion using SC--CO.sub.2 much more effective than water jet erosion. SC--CO.sub.2 jets can be used to assist mechanical drilling, for erosion drilling, or for scale removal. A choke manifold at the well head or mud cap drilling equipment can be used to control the pressure within the borehole, to ensure that the temperature and pressure conditions necessary for CO.sub.2 to exist as either a supercritical fluid or a dense gas occur at the drill site. Spent CO.sub.2 can be vented to the atmosphere, collected for reuse, or directed into the formation to aid in the recovery of petroleum.

Assessing the quality of decision support technologies using the International Patient Decision Aid Standards instrument (IPDASi.

Directory of Open Access Journals (Sweden)

Glyn Elwyn

Full Text Available To describe the development, validation and inter-rater reliability of an instrument to measure the quality of patient decision support technologies (decision aids.Scale development study, involving construct, item and scale development, validation and reliability testing.There has been increasing use of decision support technologies--adjuncts to the discussions clinicians have with patients about difficult decisions. A global interest in developing these interventions exists among both for-profit and not-for-profit organisations. It is therefore essential to have internationally accepted standards to assess the quality of their development, process, content, potential bias and method of field testing and evaluation.Scale development study, involving construct, item and scale development, validation and reliability testing.Twenty-five researcher-members of the International Patient Decision Aid Standards Collaboration worked together to develop the instrument (IPDASi. In the fourth Stage (reliability study, eight raters assessed thirty randomly selected decision support technologies.IPDASi measures quality in 10 dimensions, using 47 items, and provides an overall quality score (scaled from 0 to 100 for each intervention. Overall IPDASi scores ranged from 33 to 82 across the decision support technologies sampled (n = 30, enabling discrimination. The inter-rater intraclass correlation for the overall quality score was 0.80. Correlations of dimension scores with the overall score were all positive (0.31 to 0.68. Cronbach's alpha values for the 8 raters ranged from 0.72 to 0.93. Cronbach's alphas based on the dimension means ranged from 0.50 to 0.81, indicating that the dimensions, although well correlated, measure different aspects of decision support technology quality. A short version (19 items was also developed that had very similar mean scores to IPDASi and high correlation between short score and overall score 0.87 (CI 0.79 to 0.92.This work

Studies and Analyses of Aided Adversarial Decision Making. Phase 2: Research on Human Trust in Automation

National Research Council Canada - National Science Library

Llinas, James

1998-01-01

.... Given that offensive IW operations may interfere with automated, data-fusion based decision aids, it is necessary to understand how personnel may rely on or trust these aids when appropriate (e.g...

How do patients between the age of 65 and 75 use a web-based decision aid for treatment choice in localized prostate cancer?

Science.gov (United States)

Schrijvers, Jessie; Vanderhaegen, Joke; Van Poppel, Hendrik; Haustermans, Karin; Van Audenhove, Chantal

2013-08-01

This study was designed to evaluate the use of a web-based decision aid by a 65plus patient group in their decision-making process for treatment of localized prostate cancer. Of particular interest was the use of technology features such as patients' statements, comparative tables, and a values clarification tool. One hundred men from the University Hospital of Leuven campus, Gasthuisberg, were invited to use the web-based decision aid in their decision-making process. Twenty-six men were excluded based on non- or limited use of the decision aid. Of the remaining 74 men, user specifications, decision aid surfing characteristics by means of web-log data, and especially the use of technology features were analyzed. Men spent on average 30 minutes on the web-based decision aid. Most time was spent on the pages with information on treatment options. These pages were also most frequently accessed. The use of the feature 'comparative tables' was the highest, followed by the 'values clarification tool'. According to age (70 years) differences were observed for the time spent on the decision aid, the pages accessed, and the use of the technology features. Despite concerns about the usability of a web-based decision aid for elderly patients, these results indicated that the majority of 65plus persons with good internet skills use a web-based decision aid as well as its incorporated technology features. © 2013 Wiley Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

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

Science.gov (United States)

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

2018-04-25

Decisions about prenatal screening for Down syndrome are difficult for women, as they entail risk, potential loss, and regret. Shared decision making increases women's knowledge of their choices and better aligns decisions with their values. Patient decision aids foster shared decision making but are rarely used in this context. One of the most promising strategies for implementing shared decision making is distribution of decision aids by health professionals. We aimed to identify factors influencing their intention to use a DA during prenatal visit for decisions about Down syndrome screening. We conducted a cross-sectional quantitative study. Using a Web panel, we conducted a theory-based survey of health professionals in Quebec province (Canada). Eligibility criteria were as follows: (1) family physicians, midwives, obstetrician-gynecologists, or trainees in these professions; (2) involved in prenatal care; and (3) working in Quebec province. Participants watched a video depicting a health professional using a decision aid during a prenatal consultation with a woman and her partner, and then answered a questionnaire based on an extended version of the theory of planned behavior, including some of the constructs of the theoretical domains framework. The questionnaire assessed 8 psychosocial constructs (attitude, anticipated regret, subjective norm, self-identity, moral norm, descriptive norm, self-efficacy, and perceived control), 7 related sets of behavioral beliefs (advantages, disadvantages, emotions, sources of encouragement or discouragement, incentives, facilitators, and barriers), and sociodemographic data. We performed descriptive, bivariate, and multiple linear regression analyses to identify factors influencing health professionals' intention to use a decision aid. Among 330 health professionals who completed the survey, 310 met the inclusion criteria: family physicians, 55.2% (171/310); obstetrician-gynecologists, 33.8% (105/310); and midwives, 11

Development and Pilot Testing of a Decision Aid for Genomic Research Participants Notified of Clinically Actionable Research Findings for Cancer Risk.

Science.gov (United States)

Willis, Amanda M; Smith, Sian K; Meiser, Bettina; Ballinger, Mandy L; Thomas, David M; Tattersall, Martin; Young, Mary-Anne

2018-02-17

Germline genomic testing is increasingly used in research to identify genetic causes of disease, including cancer. However, there is evidence that individuals who are notified of clinically actionable research findings have difficulty making informed decisions regarding uptake of genetic counseling for these findings. This study aimed to produce and pilot test a decision aid to assist participants in genomic research studies who are notified of clinically actionable research findings to make informed choices regarding uptake of genetic counseling. Development was guided by published literature, the International Patient Decision Aid Standards, and the expertise of a steering committee of clinicians, researchers, and consumers. Decision aid acceptability was assessed by self-report questionnaire. All 19 participants stated that the decision aid was easy to read, clearly presented, increased their understanding of the implications of taking up research findings, and would be helpful in decision-making. While low to moderate levels of distress/worry were reported after reading the booklet, a majority of participants also reported feeling reassured. All participants would recommend the booklet to others considering uptake of clinically actionable research findings. Results indicate the decision aid is acceptable to the target audience, with potential as a useful decision support tool for genomic research participants.

A method for automated processing of measurement information during mechanical drilling

Energy Technology Data Exchange (ETDEWEB)

Samonenko, V.I.; Belinkov, V.G.; Romanova, L.A.

1984-01-01

An algorithm is cited for a developed method for automated processing of measurement information during mechanical drilling. Its use in conditions of operation of an automated control system (ASU) from drilling will make it possible to precisely identify a change in the lithology, the physical and mechanical and the abrasive properties, in the stratum (pore) pressure in the rock being drilled out during mechanical drilling, which along with other methods for testing the drilling process will increase the reliability of the decisions made.

Review of Multi-Criteria Decision Aid for Integrated Sustainability Assessment of Urban Water Systems - MCEARD

Science.gov (United States)

Integrated sustainability assessment is part of a new paradigm for urban water decision making. Multi-criteria decision aid (MCDA) is an integrative framework used in urban water sustainability assessment, which has a particular focus on utilising stakeholder participation. Here ...

Perceptions of shared decision making and decision aids among rural primary care clinicians.

Science.gov (United States)

King, Valerie J; Davis, Melinda M; Gorman, Paul N; Rugge, J Bruin; Fagnan, L J

2012-01-01

Shared decision making (SDM) and decision aids (DAs) increase patients' involvement in health care decisions and enhance satisfaction with their choices. Studies of SDM and DAs have primarily occurred in academic centers and large health systems, but most primary care is delivered in smaller practices, and over 20% of Americans live in rural areas, where poverty, disease prevalence, and limited access to care may increase the need for SDM and DAs. To explore perceptions and practices of rural primary care clinicians regarding SDM and DAs. Cross-sectional survey. Setting and Participants Primary care clinicians affiliated with the Oregon Rural Practice-based Research Network. Surveys were returned by 181 of 231 eligible participants (78%); 174 could be analyzed. Two-thirds of participants were physicians, 84% practiced family medicine, and 55% were male. Sixty-five percent of respondents were unfamiliar with the term shared decision making, but following definition, 97% reported that they found the approach useful for conditions with multiple treatment options. Over 90% of clinicians perceived helping patients make decisions regarding chronic pain and health behavior change as moderate/hard in difficulty. Although 69% of respondents preferred that patients play an equal role in making decisions, they estimate that this happens only 35% of the time. Time was reported as the largest barrier to engaging in SDM (63%). Respondents were receptive to using DAs to facilitate SDM in print- (95%) or web-based formats (72%), and topic preference varied by clinician specialty and decision difficulty. Rural clinicians recognized the value of SDM and were receptive to using DAs in multiple formats. Integration of DAs to facilitate SDM in routine patient care may require addressing practice operation and reimbursement.

A decision aid for men with early stage prostate cancer: theoretical basis and a test by surrogate patients

Science.gov (United States)

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

2008-01-01

Background We developed a decision aid for patients with curable prostate cancer based on Svenson’s DiffCon Theory of Decision Making. This study was designed to determine if surrogate patients using the aid could understand the information presented, complete all tasks, show evidence of differentiation, and arrive at a preferred treatment choice. Methods Men, at least 50 years old and never diagnosed with prostate cancer, were recruited through local advertisements. Participants were asked to imagine that they were a case‐scenario patient. Then they completed the decision aid interview, which included three components: (i) information presentation, with comprehension questions, (ii) exercises to help identify attributes important to the decision, and (iii) value‐clarification exercises. Results Sixty‐nine men volunteered. They had a mean age of 61.2 (range 50–83) years, 37% had no formal education beyond high school, and 87% were living with a partner. All participants completed all aspects of the interview. They answered an average of 10 comprehension questions each, with a mean of 94.7% correct without a prompt. Each attribute in the information presented was identified by at least one participant as important to his decision. Participants identified a median of five attributes as important (ranges 1–14) at each of three points during the interview; 75% changed at least one important attribute during the interview. Forty‐nine per cent of participants also identified attributes as important that were not included in the presented information. Participants showed a wide range of values in each of seven trade‐off exercises. Eighty‐eight per cent of participants showed evidence of differentiation; 75% had a clear treatment preference by the end of the interview. Conclusions Our decision aid appears to meet its goals for surrogate patients and illustrates the strengths of the DiffCon theory. The ability of the aid to accommodate wide

Development and evaluation of a patient decision aid for young people and parents considering fixed orthodontic appliances.

Science.gov (United States)

Marshman, Zoe; Eddaiki, Abdussalam; Bekker, Hilary L; Benson, Philip E

2016-12-01

To develop and evaluate a child-centred patient decision aid for young people, and their parents, supporting shared decision making about fixed orthodontic appliance treatment with dental health professionals, namely the Fixed Appliance Decision Aid (FADA). The studies were undertaken in a UK teaching dental hospital orthodontic department in 2013-2014. The development phase involved an interview study with: (a) 10 patients (12-16 years old), and their parents, receiving orthodontic care to investigate treatment decision making and inform the content of the FADA and (b) 23 stakeholders critiquing the draft decision aid's content, structure and utility. The evaluation phase employed a pre-/post-test study design, with 30 patients (12-16 years old) and 30 parents. Outcomes included the Decisional Conflict Scale; measures of orthodontic treatment expectations and knowledge. Qualitative analysis identified two informational needs: effectiveness of treatment on orthodontic outcomes and treatment consequences for patients' lives. Quantitative analysis found decisional conflict reduced in both patients (mean difference -12.3, SD 15.3, 95% CI 6.6-17.9; p orthodontic treatment increased; expectations about care were unchanged. Using the FADA may enable dental professionals to support patients and their parents, decisions about fixed appliance treatments more effectively, ensuring young people's preferences are integrated into care planning.

Weather Avoidance Using Route Optimization as a Decision Aid: An AWIN Topical Study. Phase 1

Science.gov (United States)

1998-01-01

The aviation community is faced with reducing the fatal aircraft accident rate by 80 percent within 10 years. This must be achieved even with ever increasing, traffic and a changing National Airspace System. This is not just an altruistic goal, but a real necessity, if our growing level of commerce is to continue. Honeywell Technology Center's topical study, "Weather Avoidance Using Route Optimization as a Decision Aid", addresses these pressing needs. The goal of this program is to use route optimization and user interface technologies to develop a prototype decision aid for dispatchers and pilots. This decision aid will suggest possible diversions through single or multiple weather hazards and present weather information with a human-centered design. At the conclusion of the program, we will have a laptop prototype decision aid that will be used to demonstrate concepts to industry for integration into commercialized products for dispatchers and/or pilots. With weather a factor in 30% of aircraft accidents, our program will prevent accidents by strategically avoiding weather hazards in flight. By supplying more relevant weather information in a human-centered format along with the tools to generate flight plans around weather, aircraft exposure to weather hazards can be reduced. Our program directly addresses the NASA's five year investment areas of Strategic Weather Information and Weather Operations (simulation/hazard characterization and crew/dispatch/ATChazard monitoring, display, and decision support) (NASA Aeronautics Safety Investment Strategy: Weather Investment Recommendations, April 15, 1997). This program is comprised of two phases, Phase I concluded December 31, 1998. This first phase defined weather data requirements, lateral routing algorithms, an conceptual displays for a user-centered design. Phase II runs from January 1999 through September 1999. The second phase integrates vertical routing into the lateral optimizer and combines the user

Ecological rationality: a framework for understanding and aiding the aging decision maker.

Science.gov (United States)

Mata, Rui; Pachur, Thorsten; von Helversen, Bettina; Hertwig, Ralph; Rieskamp, Jörg; Schooler, Lael

2012-01-01

The notion of ecological rationality sees human rationality as the result of the adaptive fit between the human mind and the environment. Ecological rationality focuses the study of decision making on two key questions: First, what are the environmental regularities to which people's decision strategies are matched, and how frequently do these regularities occur in natural environments? Second, how well can people adapt their use of specific strategies to particular environmental regularities? Research on aging suggests a number of changes in cognitive function, for instance, deficits in learning and memory that may impact decision-making skills. However, it has been shown that simple strategies can work well in many natural environments, which suggests that age-related deficits in strategy use may not necessarily translate into reduced decision quality. Consequently, we argue that predictions about the impact of aging on decision performance depend not only on how aging affects decision-relevant capacities but also on the decision environment in which decisions are made. In sum, we propose that the concept of the ecological rationality is crucial to understanding and aiding the aging decision maker.

Managing Geothermal Exploratory Drilling Risks Drilling Geothermal Exploration and Delineation Wells with Small-Footprint Highly Portable Diamond Core Drills

Science.gov (United States)

Tuttle, J.; Listi, R.; Combs, J.; Welch, V.; Reilly, S.

2012-12-01

Small hydraulic core rigs are highly portable (truck or scow-mounted), and have recently been used for geothermal exploration in areas such as Nevada, California, the Caribbean Islands, Central and South America and elsewhere. Drilling with slim diameter core rod below 7,000' is common, with continuous core recovery providing native-state geological information to aid in identifying the resource characteristics and boundaries; this is a highly cost-effective process. Benefits associated with this innovative exploration and delineation technology includes the following: Low initial Capital Equipment Cost and consumables costs Small Footprint, reducing location and road construction, and cleanup costs Supporting drill rod (10'/3meter) and tools are relatively low weight and easily shipped Speed of Mobilization and rig up Reduced requirements for support equipment (cranes, backhoes, personnel, etc) Small mud systems and cementing requirements Continuous, simplified coring capability Depth ratings comparable to that of large rotary rigs (up to ~10,000'+) Remote/small-location accessible (flown into remote areas or shipped in overseas containers) Can be scow or truck-mounted This technical presentation's primary goal is to share the technology of utilizing small, highly portable hydraulic coring rigs to provide exploratory drilling (and in some cases, production drilling) for geothermal projects. Significant cost and operational benefits are possible for the Geothermal Operator, especially for those who are pursuing projects in remote locations or countries, or in areas that are either inaccessible or in which a small footprint is required. John D. Tuttle Sinclair Well Products jtuttle@sinclairwp.com

Drillings at Kivetty in Konginkangas

International Nuclear Information System (INIS)

Hinkkanen, H.; Oehberg, A.

1990-05-01

According to Government's decision in principle Teollisuuden Voima Oy is obliged to make bedrock investigations for the final disposal of the spent fuel produced by its power plant in Olkiluoto. Areas in Kuhmo, Hyrynsalmi, Sievi, Konginkangas and Olkiluoto were selected for the preliminary site investigations to be carried out during years 1987-1992. In Kivetty, Konginkangas the investigation program was started in spring 1988. During years 1988-1989 a deep borehole (1019 m) and 4 about 500 m deep additional boreholes were core drilled in the area. The structure of the holes makes it possible to carry out many investigations in the holes. Various parameters were measured from the flushing water during the drilling. Corelogging included collecting detailed data of fractures and determining the weathering degree and petrographical properties. Rock mechanical properties, uniaxial compressive strength, Young's modulus and Poisson's ratio were measured from core samples. The flushing water needed in the drillings was pumped from 100 m deep borehole wells drilled with down-the-hole method in the vicinity of the borehole. The water was labeled with 2 tracers before use. 30 vertical holes were core drilled down to the depth of 10 m in bedrock with a light drilling unit. Drilling was carried out in order to determine the thickness of the overburden to investigate the geophysical anomaly sources and to support geological mapping in areas covered with overburden. Groundwater hydraulics is one of the main subjects during the preliminary site investigation phase. For that reason 7 multilevel piezometers were installed on the site to monitore hydraulic head in 3 levels in the uppermost part of bedrock. The work consisted of borehole drillings to the depth of 100 m, geophysical borehole loggings and installation of piezometers. In addition about 65 shotholes were drilled for VSP-, tubewave and seismic measurements

Drillings at Syyry in Sievi

International Nuclear Information System (INIS)

Hinkkanen, H.; Oehberg, A.

1990-10-01

According to Government's decision in principle Teollisuuden Voima Oy is obliged to make bedrock investigations for the final disposal of the spent fuel produced by its power plant in Olkiluoto. Areas in Kuhmo, Hyrynsalmi, Sievi, Konginkangas and Olkiluoto were selected for the preliminary site investigations to be carried out during years 1987-1992. In Syyry, Sievi the investigation program was started in spring 1988. During years 1988-1989 a deep borehole (1022 m) and 4 about 500-700 m deep additional boreholes were core drilled in the area. The structure of the holes makes it possible to carry out many investigations in the holes. Various parameters were measured from the flushing water during the drilling. Corelogging included collecting detailed data of fractures and determining the weathering degree and petrographical properties. Rock mechanical properties, uniaxial compressive strength, Young's modulus and Poisson's ratio were measured from core samples. The flushing water needed in the drillings was pumped from 100 m deep borehole wells drilled with down-the-hole method in the vicinity of the borehole. The water was labeled with 2 tracers before use. 35 vertical holes were core drilled down to the depth of 10-20 m in bedrock with a light drilling unit. Drilling was carried out in order to determine the thickness of the overburden, to investigate the geophysical anomaly sources and to support geological mapping in areas covered with overburden. Groundwater hydraulics is one of the main subjects during the preliminary site investigation phase. For that reason 7 multilevel piezometers were installed on the site to monitore hydraulic head in 3 levels in the uppermost part of bedrock. The work consisted of borehole drillings to the depth of 100 m, geophysical borehole loggings and installation of piezometers. In addition about 85 shotholes were drilled for VSP-, tubewave and seismic measurements

Framework for a comparative environmental assessment of drilling fluids

Energy Technology Data Exchange (ETDEWEB)

Meinhold, A.F.

1998-11-01

During the drilling of an oil or gas well, drilling fluid (or mud) is used to maintain well control and to remove drill cuttings from the hole. In response to effluent limitation guidelines promulgated by the US Environmental Protection Agency (EPA) for discharge of drilling wastes offshore, alternatives to water and oil-based muds have been developed. These synthetic-based muds (SBMs) are more efficient than water-based muds (WBMs) for drilling difficult and complex formation intervals and have lower toxicity and smaller environmental impacts than diesel or conventional mineral oil-based muds (OBMs). A third category of drilling fluids, derived from petroleum and called enhanced mineral oils (EMOs), also have these advantages over the traditionally used OBMs and WBMs. EPA recognizes that SBMs and EMOs are new classes of drilling fluids, but their regulatory status is unclear. To address this uncertainty, EPA is following an innovative presumptive rulemaking process that will develop final regulations for SBM discharges offshore in less than three years. This report develops a framework for a comparative risk assessment for the discharge of SBMs and EMOs, to help support a risk-based, integrated approach to regulatory decision making. The framework will help identify potential impacts and benefits associated with the use of SBMs, EMOs, WBMs, and OBMs; identify areas where additional data are needed; and support early decision-making in the absence of complete data. As additional data becomes available, the framework can support a full quantitative comparative assessment. Detailed data are provided to support a comparative assessment in the areas of occupational and public health impacts.

46 CFR 108.707 - First aid kit.

Science.gov (United States)

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false First aid kit. 108.707 Section 108.707 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS DESIGN AND EQUIPMENT Miscellaneous Equipment § 108.707 First aid kit. Each unit must have a first-aid kit approved by the Mine Safety...

Development and testing of a decision aid for women considering delayed breast reconstruction.

Science.gov (United States)

Metcalfe, Kelly; Zhong, Toni; O'Neill, Anne C; McCready, David; Chan, Linda; Butler, Kate; Brennenstuhl, Sarah; Hofer, Stefan O P

2018-03-01

The decision to have post-mastectomy breast reconstruction (PMBR) is highly complex and many women feel ill equipped to make this decision. Decision aids have been advocated to promote patient involvement in decision-making by streamlining and standardizing communication between the patient and the health care professional. In this study, we report on the development and testing of a decision aid (DA) for breast cancer survivors considering delayed PMBR. The DA was developed and evaluated in three phases. The first phase included the development of the DA with input and review by practitioners and key stakeholders. The second phase involved pilot testing of the feasibility and acceptability of the DA with a convenience sample of women with delayed PMBR. The third phase involved a pretest/post-test evaluation of the DA for women who were making decisions about their PMBR options. The DA was developed using the Ottawa Decision Support Framework. In the second phase of the study, 21 women completed the acceptability survey, of whom 100% reported that they would recommend the DA to other women. In the third phase, decisional conflict decreased significantly (p < 0.001) and knowledge increased significantly (p < 0.001) from prior to using the DA to 1-2 weeks after using the DA. The DA is feasible and acceptable to women considering delayed PMBR. Furthermore, the DA is effective at reducing decisional conflict and increasing knowledge about delayed PMBR. The DA is an appropriate tool to be used in addition with standard care in women considering PMBR. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Decision optimization of case-based computer-aided decision systems using genetic algorithms with application to mammography

International Nuclear Information System (INIS)

Mazurowski, Maciej A; Habas, Piotr A; Zurada, Jacek M; Tourassi, Georgia D

2008-01-01

This paper presents an optimization framework for improving case-based computer-aided decision (CB-CAD) systems. The underlying hypothesis of the study is that each example in the knowledge database of a medical decision support system has different importance in the decision making process. A new decision algorithm incorporating an importance weight for each example is proposed to account for these differences. The search for the best set of importance weights is defined as an optimization problem and a genetic algorithm is employed to solve it. The optimization process is tailored to maximize the system's performance according to clinically relevant evaluation criteria. The study was performed using a CAD system developed for the classification of regions of interests (ROIs) in mammograms as depicting masses or normal tissue. The system was constructed and evaluated using a dataset of ROIs extracted from the Digital Database for Screening Mammography (DDSM). Experimental results show that, according to receiver operator characteristic (ROC) analysis, the proposed method significantly improves the overall performance of the CAD system as well as its average specificity for high breast mass detection rates

46 CFR 108.241 - Visual aids.

Science.gov (United States)

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Visual aids. 108.241 Section 108.241 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS DESIGN AND EQUIPMENT Construction and Arrangement Helicopter Facilities § 108.241 Visual aids. (a) Each helicopter deck must— (1...

Drillings at Veitsivaara in Hyrynsalmi

International Nuclear Information System (INIS)

Hinkkanen, H.; Oehberg, A.

1990-04-01

According to Governmen's decision in principle Teollisuuden Voima Oy is obliged to make bedrock investigations for the final disposal of the spent fuel produced by its power plant in Olkiluoto. Areas in Kuhmo, Hyrynsalmi, Sievi, Konginkangas and Olkiluoto were selected for the preliminary site investigations to be carried out during years 1987-1992. In Veitsivaara, Hyrynsalmi the investigation program was started in April 1987. During years 1987-1988 a deep borehole (1002 m) and 4 and 500 m deep additional boreholes were core drilled in the area. Various parameters were measured from the flushing water during the drilling. Corelogging included collecting detailed data of fractures and determining the weathering degree and petrographical properties. Rock mechanical properties, uniaxial compressive strength, Young's modulus and Poisso's ratio were measured from core samples. The flushing water needed in the drillings was pumped from 100 m deep borehole wells drilled with down-the-hole method in the vicinity of the borehole. The water was labeled with 2 tracers before use. About 75 m deep hole was percussion drilled near the borehole KR1. The spreading of the flushing water in the upper part of bedrock and the quality off the ground of the groundwater were studied by taking watersamples from the hole. 30 vertical holes were core drilled down to the depth of 10 m in bedrock with a light drilling unit. Drilling was carried out in order to determine the thickness of the overburden, to investigate the geophysical anomaly sources and to support geological mapping in areas covered with overburden. Groundwater hydraulics is one of the main subjects during the preliminary site investigation phase. For that reason 7 multilevel piezometers were installed on the site to monitore hydraulic head in 3 levels in the uppermost part of bedrock. The work consisted of borehole drillings to the depth of 100 m, geophysical borehole loggings and installation of piezometers. In addition

Innovative analysis of HS 6-5-2 drills edges quality

Directory of Open Access Journals (Sweden)

Daicu Raluca

2017-01-01

Full Text Available The paper is analyzing the quality of Ø8 drills edges from HS 6-5-2 steel, using an innovative technique, the measurement of electrical current at cutting. The method is useful to take the right decision about drills acquisition from different suppliers based on the quality/price ratio. Also, it can be made a fast quality comparison of drills that leads to a selection of the acquisition places. The analysis of a drill batch is done using the microscope and the measurement of the electrical current at cutting, showing the better accuracy of the last method.

Advanced Drilling through Diagnostics-White-Drilling

International Nuclear Information System (INIS)

FINGER, JOHN T.; GLOWKA, DAVID ANTHONY; LIVESAY, BILLY JOE; MANSURE, ARTHUR J.; PRAIRIE, MICHAEL R.

1999-01-01

A high-speed data link that would provide dramatically faster communication from downhole instruments to the surface and back again has the potential to revolutionize deep drilling for geothermal resources through Diagnostics-While-Drilling (DWD). Many aspects of the drilling process would significantly improve if downhole and surface data were acquired and processed in real-time at the surface, and used to guide the drilling operation. Such a closed-loop, driller-in-the-loop DWD system, would complete the loop between information and control, and greatly improve the performance of drilling systems. The main focus of this program is to demonstrate the value of real-time data for improving drilling. While high-rate transfer of down-hole data to the surface has been accomplished before, insufficient emphasis has been placed on utilization of the data to tune the drilling process to demonstrate the true merit of the concept. Consequently, there has been a lack of incentive on the part of industry to develop a simple, low-cost, effective high-speed data link. Demonstration of the benefits of DWD based on a high-speed data link will convince the drilling industry and stimulate the flow of private resources into the development of an economical high-speed data link for geothermal drilling applications. Such a downhole communication system would then make possible the development of surface data acquisition and expert systems that would greatly enhance drilling operations. Further, it would foster the development of downhole equipment that could be controlled from the surface to improve hole trajectory and drilling performance. Real-time data that would benefit drilling performance include: bit accelerations for use in controlling bit bounce and improving rock penetration rates and bit life; downhole fluid pressures for use in the management of drilling hydraulics and improved diagnosis of lost circulation and gas kicks; hole trajectory for use in reducing directional

Identifying design considerations for a shared decision aid for use at the point of outpatient clinical care: An ethnographic study at an inner city clinic.

Science.gov (United States)

Hajizadeh, Negin; Perez Figueroa, Rafael E; Uhler, Lauren M; Chiou, Erin; Perchonok, Jennifer E; Montague, Enid

2013-03-06

Computerized decision aids could facilitate shared decision-making at the point of outpatient clinical care. The objective of this study was to investigate whether a computerized shared decision aid would be feasible to implement in an inner-city clinic by evaluating the current practices in shared decision-making, clinicians' use of computers, patient and clinicians' attitudes and beliefs toward computerized decision aids, and the influence of time on shared decision-making. Qualitative data analysis of observations and semi-structured interviews with patients and clinicians at an inner-city outpatient clinic. The findings provided an exploratory look at the prevalence of shared decision-making and attitudes about health information technology and decision aids. A prominent barrier to clinicians engaging in shared decision-making was a lack of perceived patient understanding of medical information. Some patients preferred their clinicians make recommendations for them rather than engage in formal shared decision-making. Health information technology was an integral part of the clinic visit and welcomed by most clinicians and patients. Some patients expressed the desire to engage with health information technology such as viewing their medical information on the computer screen with their clinicians. All participants were receptive to the idea of a decision aid integrated within the clinic visit although some clinicians were concerned about the accuracy of prognostic estimates for complex medical problems. We identified several important considerations for the design and implementation of a computerized decision aid including opportunities to: bridge clinician-patient communication about medical information while taking into account individual patients' decision-making preferences, complement expert clinician judgment with prognostic estimates, take advantage of patient waiting times, and make tasks involved during the clinic visit more efficient. These findings

Decision aid on breast cancer screening reduces attendance rate: results of a large-scale, randomized, controlled study by the DECIDEO group

Science.gov (United States)

Bourmaud, Aurelie; Soler-Michel, Patricia; Oriol, Mathieu; Regnier, Véronique; Tinquaut, Fabien; Nourissat, Alice; Bremond, Alain; Moumjid, Nora; Chauvin, Franck

2016-01-01

Controversies regarding the benefits of breast cancer screening programs have led to the promotion of new strategies taking into account individual preferences, such as decision aid. The aim of this study was to assess the impact of a decision aid leaflet on the participation of women invited to participate in a national breast cancer screening program. This Randomized, multicentre, controlled trial. Women aged 50 to 74 years, were randomly assigned to receive either a decision aid or the usual invitation letter. Primary outcome was the participation rate 12 months after the invitation. 16 000 women were randomized and 15 844 included in the modified intention-to-treat analysis. The participation rate in the intervention group was 40.25% (3174/7885 women) compared with 42.13% (3353/7959) in the control group (p = 0.02). Previous attendance for screening (RR = 6.24; [95%IC: 5.75-6.77]; p < 0.0001) and medium household income (RR = 1.05; [95%IC: 1.01-1.09]; p = 0.0074) were independently associated with attendance for screening. This large-scale study demonstrates that the decision aid reduced the participation rate. The decision aid activate the decision making process of women toward non-attendance to screening. These results show the importance of promoting informed patient choices, especially when those choices cannot be anticipated. PMID:26883201

Drill bit seismic, vertical seismic profiling, and seismic depth imaging to aid drilling decisions in the Tho Tinh structure, Nam Con Son basin, Vietnam

Energy Technology Data Exchange (ETDEWEB)

Borland, W; Hayashida, N; Kusaka, H; Leaney, W; Nakanishi, S

1996-10-01

This paper reviews the problem of overpressure, a common reason for acquiring look-ahead VSPs, and the seismic trace inversion problem, a fundamental issue in look-ahead prediction. The essential components of intermediate VSPs were examined from acquisition through processing to inversion, and recently acquired real data were provided, which were indicative of the advances being made toward developing an exclusive high resolution VSP service. A simple interpretation method and an end product of predicted mud weight versus depth were also presented, which were obtained from the inverted acoustic impedance and empirical relations. Of paramount importance in predicting the depth to a target was the velocity function used below the intermediate TD. The use of empirical or assumed density functions was an obvious weak link in the procedure. The advent of real-time time-depth measurements from drill bit seismic allowed a continuously updated predicted target depth below the present bit depth. 8 refs., 7 figs.

A Framework of a Computerized Decision Aid to Improve Group Judgments

Directory of Open Access Journals (Sweden)

Utpal Bose

2009-09-01

Full Text Available In organizations, groups of decision makers often meet to make judgments as a group on issues and tasks such as, hiring a person who best fits an open position. In such tasks called cognitive conflict tasks, where there is no conflict of interest, group members attempting to reach a common solution often differ on their perspectives to the problem. Cognitive conflicts have been studied in the context of Social Judgment Theory, which posits that persons or judges make a set of judgments about a set of events based on observation of a set of cues related to the events. Disagreement arises because the judges fail to understand each other’s judgment making policies. In order to reduce disagreement and move the group towards a group judgment policy that has the consensus of the group members and is applied consistently, a computerized decision aid is proposed that can be built around a Group Support System using cognitive mapping as a method of providing cognitive feedback and the Analytic Hierarchy Process to process the conflicting criteria and help an individual formulate a judgment policy, as well as aggregate the individual policies into a group judgment policy. It is argued that such as decision aid by supporting every decision maker in the group to effectively use information about the task so that they have a good understanding of the judgment policy they form, to communicate their evaluation policies accurately to other members, and by providing an iterative mechanism through which members can arrive at a compromise solution to the task, is expected to improve the quality of group judgments.

Optimizing drilling performance using a selected drilling fluid

Science.gov (United States)

Judzis, Arnis [Salt Lake City, UT; Black, Alan D [Coral Springs, FL; Green, Sidney J [Salt Lake City, UT; Robertson, Homer A [West Jordan, UT; Bland, Ronald G [Houston, TX; Curry, David Alexander [The Woodlands, TX; Ledgerwood, III, Leroy W.

2011-04-19

To improve drilling performance, a drilling fluid is selected based on one or more criteria and to have at least one target characteristic. Drilling equipment is used to drill a wellbore, and the selected drilling fluid is provided into the wellbore during drilling with the drilling equipment. The at least one target characteristic of the drilling fluid includes an ability of the drilling fluid to penetrate into formation cuttings during drilling to weaken the formation cuttings.

The Interaction of Decision Aid Usage, Training Methodology, and Personality Construct on Decision Making Among Dyadic Air Crews in a Military Environment

National Research Council Canada - National Science Library

Schipani, Salvatore

2003-01-01

..., processing, and acting upon information is often inadequate. The current research examined two levels of training, decision aiding, and homogeneity on group performance, using a personality concept classified "action orientation...

Comparisons of client and clinician views of the importance of factors in client-clinician interaction in hearing aid purchase decisions.

Science.gov (United States)

Poost-Foroosh, Laya; Jennings, Mary Beth; Cheesman, Margaret F

2015-03-01

Despite clinical recognition of the adverse effects of acquired hearing loss, only a small proportion of adults who could benefit use hearing aids. Hearing aid adoption has been studied in relationship to client-related and hearing aid technology-related factors. The influence of the client-clinician interaction in the decision to purchase hearing aids has not been explored in any depth. Importance ratings of a sample of adults having a recent hearing aid recommendation (clients) and hearing healthcare professionals (clinicians) from across Canada were compared on factors in client-clinician interactions that influence hearing aid purchase decisions. A cross-sectional approach was used to obtain online and paper-based concept ratings. Participants were 43 adults (age range, 45-85 yr) who had received a first hearing aid recommendation in the 3 mo before participation. A total of 54 audiologists and 20 hearing instrument practitioners from a variety of clinical settings who prescribed or dispensed hearing aids completed the concept-rating task. The task consisted of 122 items that had been generated via concept mapping in a previous study and which resulted in the identification of eight concepts that may influence hearing aid purchase decisions. Participants rated "the importance of each of the statements in a person's decision to purchase a hearing aid" on a 5-point Likert scale, from 1 = minimally important to 5 = extremely important. For the initial data analysis, the ratings for each of the items included in each concept were averaged for each participant to provide an estimate of the overall importance rating of each concept. Multivariate analysis of variance was used to compare the mean importance ratings of the clients to the clinicians. Ratings of individual statements were also compared in order to investigate the directionality of the importance ratings within concepts. There was a significant difference in the mean ratings for clients and clinicians for

Ecological Rationality: A Framework for Understanding and Aiding the Aging Decision Maker

Directory of Open Access Journals (Sweden)

Rui eMata

2012-02-01

Full Text Available Ecological rationality sees human rationality as the result of the adaptive fit between the human mind and the environment. The concept of ecological rationality focuses the study of cognition on two key questions: First, what are the environmental regularities to which people’s decision strategies are matched, and how frequently do these regularities occur in natural environments? Second, how well can people adapt their use of specific strategies to particular environments? Research on aging suggests a number of changes in cognitive function, for instance, deficits in learning and memory that may impact decision-making skills. However, it has been shown that simple strategies can work well in many natural environments, which suggests that age-related deficits in strategy use may not necessarily translate into diminished decision performance. Consequently, we argue that predictions about the impact of aging on decision performance depend not only on how aging affects decision-relevant capacities but also on the decision ecology in which decisions are made. In sum, we propose that the concept of the ecological rationality is crucial to understanding and aiding the aging decision maker.

Adaptive Peircean decision aid project summary assessments.

Energy Technology Data Exchange (ETDEWEB)

Senglaub, Michael E.

2007-01-01

This efforts objective was to identify and hybridize a suite of technologies enabling the development of predictive decision aids for use principally in combat environments but also in any complex information terrain. The technologies required included formal concept analysis for knowledge representation and information operations, Peircean reasoning to support hypothesis generation, Mill's's canons to begin defining information operators that support the first two technologies and co-evolutionary game theory to provide the environment/domain to assess predictions from the reasoning engines. The intended application domain is the IED problem because of its inherent evolutionary nature. While a fully functioning integrated algorithm was not achieved the hybridization and demonstration of the technologies was accomplished and demonstration of utility provided for a number of ancillary queries.

Well drilling by rotary percussive drill above ground

International Nuclear Information System (INIS)

Sabatier, G.

1987-01-01

Originally, the Well Drilling Section of Cogema used only the diamond core drilling technique. The appearance of independent rotation for compressed air rock drills has led to the use and to the development of this drilling system, as a drill core is not indispensable, when the material of the search is radioactive. During the last few years, hydraulic drills have replaced the compressed air drills and have resulted in a very marked improvement: - of the penetration rates; - of the depth achieved. The Well Drilling Section of Cogema has to drill about 400 km per year with rock drills above ground and holds also the record for depth achieved with this technique, i.e. 400 m in granite. In France, the costs of these types of drilling are for the same depth of the order of one-quarter of the core drilling and half of the drilling with a down-the-hole drill. Cogema has greatly developed the types of well logging which now permits the extension of this type of drilling to the search for other materials than uranium [fr

Prime costs and economic efficiency of deep drilling in Chechen-Ingush ASSR

Energy Technology Data Exchange (ETDEWEB)

Umanskii, L.M.

1982-04-01

The possibilities of reducing the prime costs of deep well drilling and improving the efficiency of drilling are considered. The dynamics of performance over the last two five-year plan (FYP) periods is analyzed and it is shown that the performance in the 10th FYP did not improve as compared to the 9th FYP. This is due to geological conditions and shortcomings in the technology and organization of drilling. It is shown that the speed and depth of drilling are decisive factors influencing costs.

Consideration of Insulin Pumps or Continuous Glucose Monitors by Adolescents With Type 1 Diabetes and Their Parents: Stakeholder Engagement in the Design of Web-Based Decision Aids.

Science.gov (United States)

Wysocki, Tim; Hirschfeld, Fiona; Miller, Louis; Izenberg, Neil; Dowshen, Steven A; Taylor, Alex; Milkes, Amy; Shinseki, Michelle T; Bejarano, Carolina; Kozikowski, Chelsea; Kowal, Karen; Starr-Ashton, Penny; Ross, Judith L; Kummer, Mark; Carakushansky, Mauri; Lyness, D'Arcy; Brinkman, William; Pierce, Jessica; Fiks, Alexander; Christofferson, Jennifer; Rafalko, Jessica; Lawson, Margaret L

2016-08-01

This article describes the stakeholder-driven design, development, and testing of web-based, multimedia decision aids for youth with type 1 diabetes who are considering the insulin pump or continuous glucose monitoring and their parents. This is the initial phase of work designed to develop and evaluate the efficacy of these decision aids in promoting improved decision-making engagement with use of a selected device. Qualitative interviews of 36 parents and adolescents who had previously faced these decisions and 12 health care providers defined the content, format and structure of the decision aids. Experts in children's health media helped the research team to plan, create, and refine multimedia content and its presentation. A web development firm helped organize the content into a user-friendly interface and enabled tracking of decision aid utilization. Throughout, members of the research team, adolescents, parents, and 3 expert consultants offered perspectives about the website content, structure, and function until the design was complete. With the decision aid websites completed, the next phase of the project is a randomized controlled trial of usual clinical practice alone or augmented by use of the decision aid websites. Stakeholder-driven development of multimedia, web-based decision aids requires meticulous attention to detail but can yield exceptional resources for adolescents and parents contemplating major changes to their diabetes regimens. © 2016 The Author(s).

Core drilling of deep borehole OL-KR39 at Olkiluoto in Eurajoki 2005

Energy Technology Data Exchange (ETDEWEB)

Niinimaeki, R. [Suomen Malmi Oy, Espoo (Finland)

2005-11-15

Posiva Oy submitted an application to the Finnish Government in May 1999 for the Decision in Principle to choose Olkiluoto in the municipality of Eurajoki as the site of the final disposal facility for spent nuclear fuel. A positive decision was made at the end of 2000 by the Government. The Finnish Parliament ratified the decision in May 2001. The decision makes it possible for Posiva to focus the confirming bedrock investigations at Olkiluoto, where in the next few years an underground rock characterisation facility, ONKALO, will be constructed. As a part of the investigations Suomen Malmi Oy (Smoy) core drilled 502.97 m and 45.11 m deep boreholes with a diameter of 75.7 mm at Olkiluoto in August- October 2005. The identification numbers of the boreholes are OL-KR39 and OL-KR39B, respectively. A set of monitoring measurements and samplings from the drilling and returning water was carried out during the drilling. Both the volume and the electric conductivity of the drilling water and the returning water were recorded. The drill rig was computer controlled and during drilling the computer recorded drilling parameters. The objective of all these measurements was to obtain more information about bedrock and groundwater properties. Sodium fluorescein was used as a label agent in the drilling water. The total volumes of the used drilling and flushing water were 415m{sup 3} and 25 m{sup 3} and the measured volumes of the returning water were 175 m{sup 3} and 7 m{sup 3} in boreholes OLKR39 and OL-KR39B, respectively. The deviation of the borehole was measured with the deviation measuring instruments EMS and Maxibor. Uniaxial compressive strength, Young's Modulus and Poisson' s ratio were measured from the core samples. The average uniaxial compressive strength is about 110 MPa, the average Young's Modulus is 49 GP a and the average Poisson' s ratio is 0.25. The main rock types are migmatitic mica gneiss and granite. Filled fracture is the most common

Core drilling of deep borehole OL-KR37 at Olkiluoto in Eurajoki 2005

Energy Technology Data Exchange (ETDEWEB)

Niinimaeki, R. [Suomen Malmi Oy, Espoo (Finland)

2005-11-15

Posiva Oy submitted an application to the Finnish Government in May 1999 for the Decision in Principle to choose Olkiluoto in the municipality of Eurajoki as the site of the final disposal facility for spent nuclear fuel. A positive decision was made at the end of 2000 by the Government. The Finnish Parliament ratified the decision in May 2001. The decision makes it possible for Posiva to focus the confirming bedrock investigations at Olkiluoto, where in the next few years an underground rock characterisation facility, ONKALO, will be constructed. As a part of the investigations Suomen Malmi Oy (Smoy) core drilled 350.00 m and 45.10 m deep boreholes with a diameter of 75.7 mm at Olkiluoto in June- August 2005. The identification numbers of the boreholes are OL-KR37 and OL-KR37B, respectively. A set of monitoring measurements and samplings from the drilling and returning water was carried out during the drilling. Both the volume and the electric conductivity of the drilling water and the returning water were recorded. The drill rig was computer controlled and during drilling the computer recorded information about drilling parameters. The objective of all these measurements was to obtain more information about bedrock and groundwater properties. Sodium fluorescein was used as a label agent in the drilling water. The total volumes of the used drilling and flushing water were 273 m{sup 3} and 21m{sup 3} and the measured volumes of the returning water were 221m{sup 3} and 16m{sup 3} in boreholes OL-KR37 and OL-KR37B, respectively. The deviation of the borehole was measured with the deviation measuring instruments EMS and Maxibor. Uniaxial compressive strength, Young's Modulus and Poisson' s ratio were measured from the core samples. The average uniaxial compressive strength is about 106 MPa, the average Young's modulus is 40 GPa and the average Poisson's ratio is 0.20. The main rock types are migmatitic mica gneiss, granite and tonalite. Filled

Core drilling of deep borehole OL-KR39 at Olkiluoto in Eurajoki 2005

International Nuclear Information System (INIS)

Niinimaeki, R.

2005-11-01

Posiva Oy submitted an application to the Finnish Government in May 1999 for the Decision in Principle to choose Olkiluoto in the municipality of Eurajoki as the site of the final disposal facility for spent nuclear fuel. A positive decision was made at the end of 2000 by the Government. The Finnish Parliament ratified the decision in May 2001. The decision makes it possible for Posiva to focus the confirming bedrock investigations at Olkiluoto, where in the next few years an underground rock characterisation facility, ONKALO, will be constructed. As a part of the investigations Suomen Malmi Oy (Smoy) core drilled 502.97 m and 45.11 m deep boreholes with a diameter of 75.7 mm at Olkiluoto in August- October 2005. The identification numbers of the boreholes are OL-KR39 and OL-KR39B, respectively. A set of monitoring measurements and samplings from the drilling and returning water was carried out during the drilling. Both the volume and the electric conductivity of the drilling water and the returning water were recorded. The drill rig was computer controlled and during drilling the computer recorded drilling parameters. The objective of all these measurements was to obtain more information about bedrock and groundwater properties. Sodium fluorescein was used as a label agent in the drilling water. The total volumes of the used drilling and flushing water were 415m 3 and 25 m 3 and the measured volumes of the returning water were 175 m 3 and 7 m 3 in boreholes OLKR39 and OL-KR39B, respectively. The deviation of the borehole was measured with the deviation measuring instruments EMS and Maxibor. Uniaxial compressive strength, Young's Modulus and Poisson' s ratio were measured from the core samples. The average uniaxial compressive strength is about 110 MPa, the average Young's Modulus is 49 GP a and the average Poisson' s ratio is 0.25. The main rock types are migmatitic mica gneiss and granite. Filled fracture is the most common fracture type. The average fracture

Core drilling of deep borehole OL-KR46 at Olkiluoto in Eurajoki 2007

International Nuclear Information System (INIS)

Toropainen, V.

2007-09-01

Posiva Oy submitted an application to the Finnish Government in May 1999 for the Decision in Principle to choose Olkiluoto in the municipality of Eurajoki as the site of the final disposal facility for spent nuclear fuel. A positive decision was made at the end of 2000 by the Government. The Finnish Parliament ratified the decision in May 2001. The decision makes it possible for Posiva to focus the confirming bedrock investigations at Olkiluoto, where in the next few years an underground rock characterisation facility, ONKALO, will be constructed. As a part of the investigations Suomen Malmi Oy (Smoy) core drilled 600.10 m and 45.16 m deep boreholes with a diameter of 75.7 mm at Olkiluoto in May - June 2007. The identification numbers of the boreholes are OL-KR46 and OL-KR46B, respectively. A set of monitoring measurements and samplings from the drilling and returning water was carried out during the drilling. Both the volume and the electric conductivity of the returning water, and the volume of drilling water were recorded. The drill rig was computer controlled and during drilling the computer recorded drilling parameters. The objective of all these measurements was to obtain more information about bedrock and groundwater properties. Sodium fluorescein was used as a label agent in the drilling water. The total volumes of the used drilling and flushing water were 466 m 3 and 20 m 3 in boreholes OL-KR46 and OL-KR46B, respectively. Measured volumes of the returning water were 407 m 3 in borehole OL-KR46 and 12 m 3 in borehole OL-KR46B. The deviation of the boreholes was measured with the deviation measuring instruments EMS and Maxibor. Uniaxial compressive strength, Young's Modulus and Poisson's ratio were measured from the core samples. The average uniaxial compressive strength is 116.5 MPa, the average Young's Modulus is 31.5 GPa and the average Poisson's ratio is 0.20. The main rock types are veined gneiss, tonalitic-granodioritic-granitic gneiss and pegmatite

Core drilling of deep drillhole OL-KR45 at Olkiluoto in Eurajoki 2007

International Nuclear Information System (INIS)

Toropainen, V.

2007-11-01

Posiva Oy submitted an application to the Finnish Government in May 1999 for the Decision in Principle to choose Olkiluoto in the municipality of Eurajoki as the site of the final disposal facility for spent nuclear fuel. A positive decision was made at the end of 2000 by the Government. The Finnish Parliament ratified the decision in May 2001. The decision makes it possible for Posiva to focus the confirming bedrock investigations at Olkiluoto, where in the next few years an underground rock characterisation facility, ONKALO, will be constructed. As a part of the investigations Suomen Malmi Oy (Smoy) core drilled 1023.30 m and 44.75 m deep drillholes with a diameter of 75.7 mm at Olkiluoto in June - September 2007. The identification numbers of the drillholes are OL-KR45 and OL-KR45B, respectively. A set of monitoring measurements and samplings from the drilling and returning water was carried out during the drilling. Both the volume and the electric conductivity of the returning and drilling waters were recorded. The drill rig was computer controlled and during drilling the computer recorded drilling parameters. The objective of all these measurements was to obtain more information about bedrock and groundwater properties. Sodium fluorescein was used as a label agent in the drilling water. The total volumes of the used drilling and washing water were 1186 m 3 and 19 m 3 in drillholes OL-KR45 and OL-KR45B, respectively. Measured volumes of the returning water were 962 m 3 in drillhole OL-KR45 and 15 m 3 in drillhole OL-KR45B. The deviation of the drillholes was measured with the deviation measuring instruments EMS and Maxibor II. Uniaxial compressive strength, Young's Modulus and Poisson's ratio were measured from the core samples. The average uniaxial compressive strength is 126.2 MPa, the average Young's Modulus is 42.5 GPa and the average Poisson's ratio is 0.21. The main rock types are veined and diatexitic gneisses, pegmatitic granite and tonalitic

Medical communication and technology: a video-based process study of the use of decision aids in primary care consultations

Directory of Open Access Journals (Sweden)

Graham Ruth

2007-01-01

Full Text Available Abstract Background Much of the research on decision-making in health care has focused on consultation outcomes. Less is known about the process by which clinicians and patients come to a treatment decision. This study aimed to quantitatively describe the behaviour shown by doctors and patients during primary care consultations when three types of decision aids were used to promote treatment decision-making in a randomised controlled trial. Methods A video-based study set in an efficacy trial which compared the use of paper-based guidelines (control with two forms of computer-based decision aids (implicit and explicit versions of DARTS II. Treatment decision concerned warfarin anti-coagulation to reduce the risk of stroke in older patients with atrial fibrillation. Twenty nine consultations were video-recorded. A ten-minute 'slice' of the consultation was sampled for detailed content analysis using existing interaction analysis protocols for verbal behaviour and ethological techniques for non-verbal behaviour. Results Median consultation times (quartiles differed significantly depending on the technology used. Paper-based guidelines took 21 (19–26 minutes to work through compared to 31 (16–41 minutes for the implicit tool; and 44 (39–55 minutes for the explicit tool. In the ten minutes immediately preceding the decision point, GPs dominated the conversation, accounting for 64% (58–66% of all utterances and this trend was similar across all three arms of the trial. Information-giving was the most frequent activity for both GPs and patients, although GPs did this at twice the rate compared to patients and at higher rates in consultations involving computerised decision aids. GPs' language was highly technically focused and just 7% of their conversation was socio-emotional in content; this was half the socio-emotional content shown by patients (15%. However, frequent head nodding and a close mirroring in the direction of eye-gaze suggested

Study for increasing micro-drill reliability by vibrating drilling

International Nuclear Information System (INIS)

Yang Zhaojun; Li Wei; Chen Yanhong; Wang Lijiang

1998-01-01

A study for increasing micro-drill reliability by vibrating drilling is described. Under the experimental conditions of this study it is observed, from reliability testing and the fitting of a life-distribution function, that the lives of micro-drills under ordinary drilling follow the log-normal distribution and the lives of micro-drills under vibrating drilling follow the Weibull distribution. Calculations for reliability analysis show that vibrating drilling can increase the lives of micro-drills and correspondingly reduce the scatter of drill lives. Therefore, vibrating drilling increases the reliability of micro-drills

Decision aid use during post-biopsy consultations for localized prostate cancer.

Science.gov (United States)

Holmes-Rovner, Margaret; Srikanth, Akshay; Henry, Stephen G; Langford, Aisha; Rovner, David R; Fagerlin, Angela

2018-02-01

Decision Aids (DAs) effectively translate medical evidence for patients but are not routinely used in clinical practice. Little is known about how DAs are used during patient-clinician encounters. To characterize the content and communicative function of high-quality DAs during diagnostic clinic visits for prostate cancer. 252 men newly diagnosed with localized prostate cancer who had received a DA, 45 treating physicians at 4 US Veterans Administration urology clinics. Qualitative analysis of transcribed audio recordings was used to inductively develop categories capturing content and function of all direct references to DAs (booklet talk). The presence or absence of any booklet talk per transcript was also calculated. Booklet talk occurred in 55% of transcripts. Content focused on surgical procedures (36%); treatment choice (22%); and clarifying risk classification (17%). The most common function of booklet talk was patient corroboration of physicians' explanations (42%), followed by either physician or patient acknowledgement that the patient had the booklet. Codes reflected the absence of DA use for shared decision-making. In regression analysis, predictors of booklet talk were fewer years of patient education (P = .027) and more time in the encounter (P = .027). Patient race, DA type, time reading the DA, physician informing quality and physician age did not predict booklet talk. Results show that good decision aids, systematically provided to patients, appeared to function not to open up deliberations about how to balance benefits and harms of competing treatments, but rather to allow patients to ask narrow technical questions about recommended treatments. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Balancing emotion and cognition: a case for decision aiding in conservation efforts.

Science.gov (United States)

Wilson, Robyn S

2008-12-01

Despite advances in the quality of participatory decision making for conservation, many current efforts still suffer from an inability to bridge the gap between science and policy. Judgment and decision-making research suggests this gap may result from a person's reliance on affect-based shortcuts in complex decision contexts. I examined the results from 3 experiments that demonstrate how affect (i.e., the instantaneous reaction one has to a stimulus) influences individual judgments in these contexts and identified techniques from the decision-aiding literature that help encourage a balance between affect-based emotion and cognition in complex decision processes. In the first study, subjects displayed a lack of focus on their stated conservation objectives and made decisions that reflected their initial affective impressions. Value-focused approaches may help individuals incorporate all the decision-relevant objectives by making the technical and value-based objectives more salient. In the second study, subjects displayed a lack of focus on statistical risk and again made affect-based decisions. Trade-off techniques may help individuals incorporate relevant technical data, even when it conflicts with their initial affective impressions or other value-based objectives. In the third study, subjects displayed a lack of trust in decision-making authorities when the decision involved a negatively affect-rich outcome (i.e., a loss). Identifying shared salient values and increasing procedural fairness may help build social trust in both decision-making authorities and the decision process.

46 CFR 109.213 - Emergency training and drills.

Science.gov (United States)

2010-10-01

... to each person on board the unit. If audiovisual training aids are used, they must be incorporated... month. (3) Drills must be held before the unit enters service for the first time after modification of a... communication system, and ensuring that all on board are made aware of the order to abandon ship. (ii) Each...

The computer-aided design of a servo system as a multiple-criteria decision problem

NARCIS (Netherlands)

Udink ten Cate, A.J.

1986-01-01

This paper treats the selection of controller gains of a servo system as a multiple-criteria decision problem. In contrast to the usual optimization-based approaches to computer-aided design, inequality constraints are included in the problem as unconstrained objectives. This considerably simplifies

The GIN legal problems of multi-parties at the drill site

International Nuclear Information System (INIS)

Case, C.W.

1991-01-01

The presence of multiple parties working at a drilling site complicates the application of the environmental laws, rules and regulations. A critical decision prior to any physical activities needs to be made as to which person (i.e., company, partnership) will be charged with the obligation of being the designated Generator of hazardous waste for that site. This critical decision is dictated by the refusal of the EPA to assign more than one EPA Generator Identification Number (GIN) to a single drilling site. The decision as to which member of the multiple parties presence at the drill site will obtain the GIN has liability ramifications when a mistake is made in the cleanup of spilled hazardous waste or hazardous substances; an improper situation arises as to the transportation, storage, treatment and disposal of hazardous waste; the waste is improperly classified, or the biennial reporting of hazardous waste activities does not occur. Liability issues arise that go far beyond the ordinary contractual disputes seen in the past arising from drilling activities, with liability in some situations well in excess of any damage claims normally allowed under common law or statutory law in the State of Texas for non-environmental disputes. This paper reviews the liabilities and responsibilities of oil and gas drillers under the Resource Conservation and Recovery Act and the Comprehensive Environmental Response, Compensation and Liability Act

Core drilling of deep borehole OL-KR34 at Olkiluoto in Eurajoki 2005

Energy Technology Data Exchange (ETDEWEB)

Rautio, T. [Suomen Malmi Oy, Espoo (Finland)

2005-07-15

Posiva Oy submitted an application for the Decision in Principle to the Finnish Government in May 1999. A positive decision was made at the end of 2000 by the Government. The Finnish Parliament ratified the Decision in Principle on the final disposal facility for spent nuclear fuel at Olkiluoto, Eurajoki in May 2001. The decision makes it possible for Posiva to focus the confirming bedrock investigations at Olkiluoto, where in the next few years an underground rock characterisation facility, ONKALO, will be constructed. As a part of the investigations Suomen Malmi Oy (Smoy) core drilled 100.07 m deep borehole with a diameter of 75.7 mm at Olkiluoto in April 2005. This borehole was aimed to get additional information of the quality of bedrock and the anomalous part of the bedrock and quality and the location of the fractured zones R19A and R19B. The identification number of the borehole is OL-KR34. A set of monitoring measurements and samplings from the drilling and returning water was carried out during the drilling. Both the volume and the electric conductivity of the drilling water and the returning water were recorded. The drill rig was computer controlled and during drilling the computer recorded information about drilling parameters. The objective of all measurements was to obtain more information about bedrock and groundwater properties. Sodium fluorescein was used as a label agent in the drilling water. The volume of the used drilling water was about 37m{sup 3} and the measured volume of the returning water was about 18m{sup 3} in borehole OL-KR34. The deviation of the borehole was measured with the deviation measuring instruments EMS and Maxibor. The results of the Maxibor measurements indicate that borehole OLKR34 deviates 0.84 m right and 0.15 m up at the borehole depth of 99 m. Uniaxial compressive strength, Young's Modulus and Poisson' s ratio were measured from the core samples. The average uniaxial compressive strength is about 142 MPa, the

Core drilling of deep borehole OL-KR36 at Olkiluoto in Eurajoki 2005

Energy Technology Data Exchange (ETDEWEB)

Niinimaeki, R.; Rautio, T. [Suomen Malmi Oy, Espoo (Finland)

2005-07-15

Posiva Oy submitted an application for the Decision in Principle to the Finnish Government in May 1999. A positive decision was made at the end of 2000 by the Government. The Finnish Parliament ratified the Decision in Principle on the final disposal facility for spent nuclear fuel at Olkiluoto, Eurajoki in May 2001. The decision makes it possible for Posiva to focus the confirming bedrock investigations at Olkiluoto, where in the next few years an underground rock characterisation facility, ONKALO, will be constructed. As a part of the investigations Suomen Malmi Oy (Smoy) core drilled 205.17 m deep borehole with a diameter of 75.7 mm at Olkiluoto in May 2005. This borehole was aimed to get additional information of the quality of bedrock and the anomalous part of the bedrock and quality and the location of the fractured zones R19A and R19B. The identification number of the borehole is OL-KR36. A set of monitoring measurements and samplings from the drilling and returning water was carried out during the drilling. Both the volume and the electric conductivity of the drilling water and the returning water were recorded. The drill rig was computer controlled and during drilling the computer recorded information about drilling measurements. The objective of all these measurements was to obtain more information about bedrock and groundwater properties. Sodium fluorescein was used as a label agent in the drilling water. The volume of the used drilling water was about 117 m{sup 3} and the measured volume of the returning water was about 51m{sup 3} in borehole OL-KR36. The deviation of the borehole was measured with the deviation measuring instruments EMS and Maxibor. The results of the Maxibor measurements indicate that borehole OL-KR36 deviates 10.34 m left and 7.11 m up at the borehole depth of 204 m. Uniaxial compressive strength, Young's Modulus and Poisson' s ratio were measured from the core samples. The average uniaxial compressive strength is about 126

Core drilling of deep borehole OL-KR35 at Olkiluoto in Eurajoki 2005

Energy Technology Data Exchange (ETDEWEB)

Rautio, T. [Suomen Malmi Oy, Espoo (Finland)

2005-07-15

Posiva Oy submitted an application for the Decision in Principle to the Finnish Government in May 1999. A positive decision was made at the end of 2000 by the Government. The Finnish Parliament ratified the Decision in Principle on the final disposal facility for spent nuclear fuel at Olkiluoto, Eurajoki in May 2001. The decision makes it possible for Posiva to focus the confirming bedrock investigations at Olkiluoto, where in the next few years an underground rock characterisation facility, ONKALO, will be constructed. As a part of the investigations Suomen Malmi Oy (Smoy) core drilled 100.87 m deep borehole with a diameter of 75.7 mm at Olkiluoto in May 2005. This borehole was aimed to get additional information of the quality of bedrock and the anomalous part of the bedrock and quality and the location of the fractured zones R19A and R19B. The identification number of the borehole is OL-KR35. A set of monitoring measurements and samplings from the drilling and returning water was carried out during the drilling. Both the volume and the electric conductivity of the drilling water and the returning water were recorded. The drill rig was computer controlled and during drilling the computer recorded information about drilling parameters. The objective of all measurements was to obtain more information about bedrock and groundwater properties. Sodium fluorescein was used as a label agent in the drilling water. The volume of the used drilling water was about 53 m{sup 3} and the measured volume of the returning water was about 25 m{sup 3} in borehole OL-KR35. The deviation of the borehole was measured with the deviation measuring instruments EMS and Maxibor. The results of the Maxibor measurements indicate that borehole OL-KR35 deviates 0.49 m right and 0.30 m up at the borehole depth of 99 m. Uniaxial compressive strength, Young's Modulus and Poisson' s ratio were measured from the core samples. The average uniaxial compressive strength is about 90 MPa, the

Core drilling of deep drillhole OL-KR48 at Olkiluoto in Eurajoki 2007

International Nuclear Information System (INIS)

Toropainen, V.

2008-01-01

Posiva Oy submitted an application for the Decision in Principle to the Finnish Government in May 1999. A positive decision was made at the end of 2000 by the Government. The Finnish Parliament ratified the Decision in Principle on the final disposal facility for spent nuclear fuel at Olkiluoto, Eurajoki in May 2001. The decision makes it possible for Posiva to focus the confirming bedrock investigations at Olkiluoto, where in the next few years an underground rock characterisation facility, ONKALO, will be constructed. As a part of the investigations Suomen Malmi Oy (Smoy) core drilled 530.11 m deep drillhole (identification number OL-KR48) with a diameter of 75.7 mm at Olkiluoto in summer 2007. This drillhole was aimed to get additional information of the quality of bedrock in the area, where a new shaft with a diameter of 3.5 m is planned. The drillhole is nearly vertical, and its deviation was minimized with directional drilling. The drillhole requires cleaning and stabilization for down the hole measurements. To obtain more information about bedrock and groundwater properties, a set of monitoring measurements and samplings from the drilling and returning water was carried out during. Both the volume and the electric conductivity of the returning and drilling waters were recorded. The drill rig was computer controlled and recorded drilling parameters. Sodium fluorescein was used as a label agent in the drilling water. The total volume of the used drilling and washing water was 438 m 3 . Measured volume of the returning water was 123 m 3 . The deviation of the drillhole was measured with the deviation measuring instruments DeviTool and EMS. The results of the EMS measurements indicate that the drillhole deviates 2.51 m north and 0.51 m west from the target point at the drillhole depth of 528 m. Results of DeviTool indicate deviation of 1.44 m north and 0.40 m west at depth of 530 m. Uniaxial compressive strength (113.0 Mpa), Young's Modulus (36.2 GPa) and

Operation and validation of the decision aid system 'CAIRE' in complex terrain

International Nuclear Information System (INIS)

De Witt, H.; Nuesser, A.; Brenk, H.D.

1998-01-01

In cases of nuclear emergencies it is the primary task of emergency response forces and decision making authorities to act properly. Based on telemetric surveillance networks, an advanced automatic on-line decision support system named CAIRE (Computer Aided Response to Emergencies) has been developed and is in operation now at 4 sites as a real time emergency response tool. This tool is designed to provide decision makers with precise radiation exposure data for the population at risk. Depending on the individual layout of the connected telemetric networks, CAIRE is able to satisfy the following main requirements: automatic identification of the source location and of the source term, automatic diagnosis of the actual radiological situation and identification of the endangered area, projection of the radiological situation, delivery of all this information in the form computer graphics. (R.P.)

Core drilling of deep borehole OL-KR43 at Olkiluoto in Eurajoki 2006

Energy Technology Data Exchange (ETDEWEB)

Niinimaeki, R. [Suomen Malmi Oy, Espoo (Finland)

2006-12-15

Posiva Oy submitted an application to the Finnish Government in May 1999 for the Decision in Principle to choose Olkiluoto in the municipality of Eurajoki as the site of the final disposal facility for spent nuclear fuel. A positive decision was made at the end of 2000 by the Government. The Finnish Parliament ratified the decision in May 2001. The decision makes it possible for Posiva to focus the confirming bedrock investigations at Olkiluoto, where in the next few years an underground rock characterisation facility, ONKALO, will be constructed. As a part of the investigations Suomen Malmi Oy (Smoy) core drilled 1000.26 m and 45.01 m deep boreholes with a diameter of 75.7 mm at Olkiluoto in July - October 2006. The identification numbers of the boreholes are OL-KR43 and OL-KR43B, respectively. A set of monitoring measurements and samplings from the drilling and returning water was carried out during the drilling. Both the volume and the electric conductivity of the drilling water and the returning water were recorded. The drill rig was computer controlled and during drilling the computer recorded drilling parameters. The objective of all these measurements was to obtain more information about bedrock and groundwater properties. Sodium fluorescein was used as a label agent in the drilling water. The total volumes of the used drilling and flushing water were 1103 m{sup 3} and 16 m{sup 3} in boreholes OL-KR43 and OL-KR43B, respectively. Measured volumes of the returning water were 916m{sup 3} in borehole OL-KR43 and 13m{sup 3} in borehole OL-KR43B. The deviation of the boreholes was measured with the deviation measuring instruments EMS and Maxibor. Uniaxial compressive strength, Young's Modulus and Poisson's ratio were measured from the core samples. The average uniaxial compressive strength is about 131 MPa, the average Young's Modulus is 37 GPa and the average Poisson's ratio is 0.19. The main rock types are veined gneiss, diatexitic gneiss

The Level of Automation in Emergency Quick Disconnect Decision Making

Directory of Open Access Journals (Sweden)

Imset Marius

2018-02-01

Full Text Available As a key measure for safety and environmental protection during offshore well operations, drill rigs are equipped with Emergency Quick Disconnect (EQD systems. However, an EQD operation is in itself considered a risky operation with a major economic impact. For this reason, it is of great importance to aid the operators in their assessment of the situation at all times, and help them make the best decisions. However, despite the availability of such systems, accidents do happen. This demonstrates the vulnerability of our human decision-making capabilities in extremely stressful situations. One way of improving the overall human-system performance with respect to EQD is to increase the level and quality of the automation and decision support systems. Although there is plenty of evidence that automated systems have weaknesses, there is also evidence that advanced software systems outperform humans in complex decision-making. The major challenge is to make sure that EQD is performed when necessary, but there is also a need to decrease the number of false EQDs. This paper applies an existing framework for levels of automation in order to explore the critical decision process leading to an EQD. We provide an overview of the benefits and drawbacks of existing automation and decision support systems vs. manual human decision-making. Data are collected from interviews of offshore users, suppliers, and oil companies, as well as from formal operational procedures. Findings are discussed using an established framework for the level of automation. Our conclusion is that there is an appropriate level of automation in critical situations related to the loss of the position of the drill rig, and that there is the promising potential to increase the autonomy level in a mid- and long-term situation assessment.

Development of a decision aid for cardiopulmonary resuscitation and invasive mechanical ventilation in the intensive care unit employing user-centered design and a wiki platform for rapid prototyping.

Science.gov (United States)

Plaisance, Ariane; Witteman, Holly O; LeBlanc, Annie; Kryworuchko, Jennifer; Heyland, Daren Keith; Ebell, Mark H; Blair, Louisa; Tapp, Diane; Dupuis, Audrey; Lavoie-Bérard, Carole-Anne; McGinn, Carrie Anna; Légaré, France; Archambault, Patrick Michel

2018-01-01

Upon admission to an intensive care unit (ICU), all patients should discuss their goals of care and express their wishes concerning life-sustaining interventions (e.g., cardiopulmonary resuscitation (CPR)). Without such discussions, interventions that prolong life at the cost of decreasing its quality may be used without appropriate guidance from patients. To adapt an existing decision aid about CPR to create a wiki-based decision aid individually adapted to each patient's risk factors; and to document the use of a wiki platform for this purpose. We conducted three weeks of ethnographic observation in our ICU to observe intensivists and patients discussing goals of care and to identify their needs regarding decision making. We interviewed intensivists individually. Then we conducted three rounds of rapid prototyping involving 15 patients and 11 health professionals. We recorded and analyzed all discussions, interviews and comments, and collected sociodemographic data. Using a wiki, a website that allows multiple users to contribute or edit content, we adapted the decision aid accordingly and added the Good Outcome Following Attempted Resuscitation (GO-FAR) prediction rule calculator. We added discussion of invasive mechanical ventilation. The final decision aid comprises values clarification, risks and benefits of CPR and invasive mechanical ventilation, statistics about CPR, and a synthesis section. We added the GO-FAR prediction calculator as an online adjunct to the decision aid. Although three rounds of rapid prototyping simplified the information in the decision aid, 60% (n = 3/5) of the patients involved in the last cycle still did not understand its purpose. Wikis and user-centered design can be used to adapt decision aids to users' needs and local contexts. Our wiki platform allows other centers to adapt our tools, reducing duplication and accelerating scale-up. Physicians need training in shared decision making skills about goals of care and in using the

Development of a decision aid for cardiopulmonary resuscitation and invasive mechanical ventilation in the intensive care unit employing user-centered design and a wiki platform for rapid prototyping.

Directory of Open Access Journals (Sweden)

Ariane Plaisance

Full Text Available Upon admission to an intensive care unit (ICU, all patients should discuss their goals of care and express their wishes concerning life-sustaining interventions (e.g., cardiopulmonary resuscitation (CPR. Without such discussions, interventions that prolong life at the cost of decreasing its quality may be used without appropriate guidance from patients.To adapt an existing decision aid about CPR to create a wiki-based decision aid individually adapted to each patient's risk factors; and to document the use of a wiki platform for this purpose.We conducted three weeks of ethnographic observation in our ICU to observe intensivists and patients discussing goals of care and to identify their needs regarding decision making. We interviewed intensivists individually. Then we conducted three rounds of rapid prototyping involving 15 patients and 11 health professionals. We recorded and analyzed all discussions, interviews and comments, and collected sociodemographic data. Using a wiki, a website that allows multiple users to contribute or edit content, we adapted the decision aid accordingly and added the Good Outcome Following Attempted Resuscitation (GO-FAR prediction rule calculator.We added discussion of invasive mechanical ventilation. The final decision aid comprises values clarification, risks and benefits of CPR and invasive mechanical ventilation, statistics about CPR, and a synthesis section. We added the GO-FAR prediction calculator as an online adjunct to the decision aid. Although three rounds of rapid prototyping simplified the information in the decision aid, 60% (n = 3/5 of the patients involved in the last cycle still did not understand its purpose.Wikis and user-centered design can be used to adapt decision aids to users' needs and local contexts. Our wiki platform allows other centers to adapt our tools, reducing duplication and accelerating scale-up. Physicians need training in shared decision making skills about goals of care and in

Growth in the measurement-while-drilling sector continues

International Nuclear Information System (INIS)

Hall, G.T.

1991-01-01

This book reports that the measurement while drilling (MWD) market is showing some of the most impressive growth in the oil field. Tremendous improvements in the reliability and capability of MWD tools have spurred the expansion of this market. During 1990, the worldwide MWD market expanded by 48%, rising from $250 million in 1989 to $370 million in 1990. The MWD market should expand 15-20% to exceed $430 million in 1991. Although an expansion of 15-20% is considered good, further growth will be impeded by the slowdown of drilling in the Gulf of Mexico. Total market growth should return to greater than 20% per year in 1992 and 1993. MWD technology is in the midst of a rapid adaptation phase, led by expansion of formation evaluation and other logs and by international expansion in long-reach directional and horizontal drilling. The formation evaluation-while- drilling market will have minimal impact on the size and growth of the wire line market. Customers will increasingly employ teams which include drilling and petrophysics personnel to make MWD purchase decisions. Integration of performance drilling systems including all bottom hole components will accelerate because of increases in automation and the need for cost reduction

A study of a Dutch online decision aid for parents of children with ADHD

NARCIS (Netherlands)

Ossebaard, Hans Cornelis; van Gemert-Pijnen, Julia E.W.C.; Sorbi, Marjolijn J.; Seydel, E.R.

2010-01-01

During a three-month study period, visitors to an online decision aid (DA) for attention deficit hyperactivity disorder (ADHD) were invited to complete an online questionnaire before and after working through the DA. Some 75,000 unique visitors found their way to the page on DAs, although fewer than

Core drilling of deep borehole OL-KR3B at Olkiluoto in Eurajoki 2005

Energy Technology Data Exchange (ETDEWEB)

Rautio, T. [Suomen Malmi Oy, Espoo (Finland)

2005-10-15

Posiva Oy submitted an application for the Decision in Principle to the Finnish Government in May 1999. A positive decision was made at the end of 2000 by the Government. The Finnish Parliament ratified the Decision in Principle on the final disposal facility for spent nuclear fuel at Olkiluoto, Eurajoki in May 2001. The decision makes it possible for Posiva to focus the confirming bedrock investigations at Olkiluoto, where in the next few years an underground rock characterisation facility, ONKALO, will be constructed. As a part of the investigations Suomen Malmi Oy (Smoy) core drilled 530.60 m deep borehole with a diameter of 75.7 mm at Olkiluoto in summer 2005. This borehole was aimed to get additional information of the quality of bedrock in the area, where a new shaft with a diameter of 3 m is planned to be located. The identification number of the borehole is OL-KR38. A set of monitoring measurements and samplings from the drilling and returning water was carried out during the drilling. Both the volume and the electric conductivity of the drilling water and the returning water were recorded. The drill rig was computer controlled and during drilling the computer recorded information about drilling parameters. The objective of these measurements was to obtain more information about bedrock and groundwater properties. Sodium fluorescein was used as a label agent in the drilling water. The volume of the used drilling water was about 473m{sup 3} and the measured volume of the returning water was about 38m{sup 3} in borehole OL-KR38. The deviation of the borehole was measured with the deviation measuring instruments EMS and Devitool Peewee. The results of the EMS measurements indicate that borehole OL-KR38 deviates 1.02 m south and 0.58 m west from the target point at the borehole depth of 525 m. Uniaxial compressive strength, Young's Modulus and Poisson's ratio were measured from the core samples. The average uniaxial compressive strength is about 106

The effect of offering different numbers of colorectal cancer screening test options in a decision aid: a pilot randomized trial

Directory of Open Access Journals (Sweden)

Brenner Alison RT

2008-01-01

Full Text Available Abstract Background Decision aids can improve decision making processes, but the amount and type of information that they should attempt to communicate is controversial. We sought to compare, in a pilot randomized trial, two colorectal cancer (CRC screening decision aids that differed in the number of screening options presented. Methods Adults ages 48–75 not currently up to date with screening were recruited from the community and randomized to view one of two versions of our previously tested CRC screening decision aid. The first version included five screening options: fecal occult blood test (FOBT, sigmoidoscopy, a combination of FOBT and sigmoidoscopy, colonoscopy, and barium enema. The second discussed only the two most frequently selected screening options, FOBT and colonoscopy. Main outcomes were differences in screening interest and test preferences between groups after decision aid viewing. Patient test preference was elicited first without any associated out-of-pocket costs (OPC, and then with the following costs: FOBT-$10, sigmoidoscopy-$50, barium enema-$50, and colonoscopy-$200. Results 62 adults participated: 25 viewed the 5-option decision aid, and 37 viewed the 2-option version. Mean age was 54 (range 48–72, 58% were women, 71% were White, 24% African-American; 58% had completed at least a 4-year college degree. Comparing participants that viewed the 5-option version with participants who viewed the 2-option version, there were no differences in screening interest after viewing (1.8 vs. 1.9, t-test p = 0.76. Those viewing the 2-option version were somewhat more likely to choose colonoscopy than those viewing the 5-option version when no out of pocket costs were assumed (68% vs. 46%, p = 0.11, but not when such costs were imposed (41% vs. 42%, p = 1.00. Conclusion The number of screening options available does not appear to have a large effect on interest in colorectal cancer screening. The effect of offering differing

Application of the Consumer Decision-Making Model to Hearing Aid Adoption in First-Time Users.

Science.gov (United States)

Amlani, Amyn M

2016-05-01

Since 1980, hearing aid adoption rates have remained essentially the same, increasing at a rate equal to the organic growth of the population. Researchers have used theoretical models from psychology and sociology to determine those factors or constructs that lead to the adoption of hearing aids by first-time impaired listeners entering the market. In this article, a theoretical model, the Consumer Decision-Making Model (CDM), premised on the neobehavioral approach that considers an individual's psychological and cognitive emphasis toward a product or service, is described. Three theoretical models (i.e., transtheoretical, social model of disability, Health Belief Model), and their relevant findings to the hearing aid market, are initially described. The CDM is then presented, along with supporting evidence of the model's various factors from the hearing aid literature. Future applications of the CDM to hearing health care also are discussed.

Usability evaluation and adaptation of the e-health Personal Patient Profile-Prostate decision aid for Spanish-speaking Latino men.

Science.gov (United States)

Berry, Donna L; Halpenny, Barbara; Bosco, Jaclyn L F; Bruyere, John; Sanda, Martin G

2015-07-24

The Personal Patient Profile-Prostate (P3P), a web-based decision aid, was demonstrated to reduce decisional conflict in English-speaking men with localized prostate cancer early after initial diagnosis. The purpose of this study was to explore and enhance usability and cultural appropriateness of a Spanish P3P by Latino men with a diagnosis of prostate cancer. P3P was translated to Spanish and back-translated by three native Spanish-speaking translators working independently. Spanish-speaking Latino men with a diagnosis of localized prostate cancer, who had made treatment decisions in the past 24 months, were recruited from two urban clinical care sites. Individual cognitive interviews were conducted by two bilingual research assistants as each participant used the Spanish P3P. Notes of user behavior, feedback, and answers to direct questions about comprehension, usability and perceived usefulness were analyzed and categorized. Seven participants with a range of education levels identified 25 unique usability issues in navigation, content comprehension and completeness, sociocultural appropriateness, and methodology. Revisions were prioritized to refine the usability and cultural and linguistic appropriateness of the decision aid. Usability issues were discovered that are potential barriers to effective decision support. Successful use of decision aids requires adaptation and testing beyond translation. Our findings led to revisions further refining the usability and linguistic and cultural appropriateness of Spanish P3P.

Automatic real time drilling support on Ekofisk utilizing eDrilling

Energy Technology Data Exchange (ETDEWEB)

Rommetveit, Rolv; Bjorkevoll, Knut S.; Halsey, George W.; Kluge, Roald; Molde, Dag Ove; Odegard, Sven Inge [SINTEF Petroleum Research, Trondheim (Norway); Herbert, Mike [HITEC Products Drilling, Stavanger (Norway); ConocoPhillips Norge, Stavanger (Norway)

2008-07-01

eDrilling is a new and innovative system for real time drilling simulation, 3D visualization and control from a remote drilling expert centre. The concept uses all available real time drilling data (surface and downhole) in combination with real time modelling to monitor and optimize the drilling process. This information is used to visualize the wellbore in 3D in real time. eDrilling has been implemented in an Onshore Drilling Center in Norway. The system is composed of the following elements, some of which are unique and ground-breaking: an advanced and fast Integrated Drilling Simulator which is capable to model the different drilling sub-processes dynamically, and also the interaction between these sub-processes in real time; automatic quality check and corrections of drilling data; making them suitable for processing by computer models; real time supervision methodology for the drilling process using time based drilling data as well as drilling models / the integrated drilling simulator; methodology for diagnosis of the drilling state and conditions. This is obtained from comparing model predictions with measured data. Advisory technology for more optimal drilling. A Virtual Wellbore, with advanced visualization of the downhole process. Dat low and computer infrastructure. e-Drilling has been implemented in an Onshore Drilling Center on Ekofisk in Norway. The system is being used on drilling operations, and experiences from its use are presented. The supervision and diagnosis functionalities have been useful in particular, as the system has given early warnings on ECD and friction related problems. This paper will present the eDrilling system as well as experiences from its use. (author)

Core drilling of deep borehole OL-KR32 at Olkiluoto in Eurajoki 2004

International Nuclear Information System (INIS)

Rautio, T.

2005-01-01

Posiva Oy submitted an application for the Decision in Principle to the Finnish Government in May 1999. A positive decision was made at the end of 2000 by the Government. The Finnish Parliament ratified the Decision in Principle on the final disposal facility for spent nuclear fuel at Olkiluoto, Eurajoki in May 2001. The decision makes it possible for Posiva to focus the confirming bedrock investigations at Olkiluoto, where in the next few years an underground rock characterisation facility, the ONKALO, will be constructed. As a part of the investigations Suomen Malmi Oy (Smoy) core drilled a 191.81 m deep borehole with a diameter of 75.7 mm at Olkiluoto in November 2004. This borehole was aimed to get additional information of the quality and the location of the fractured zones R20A and R20B and the fractured zones near rock surface noticed in investigation trench TK8. The identification number of the borehole is OL-KR32. A set of monitoring measurements and samplings from the drilling and returning water was carried out during the drilling. Both the volume and the electric conductivity of the drilling water and the returning water were recorded as well as the pressure of the drilling water. The objective of these measurements was to obtain more information about bedrock and groundwater properties. Sodium fluorescein was used as a label agent in the drilling water. The volume of the used drilling water was about 93 m 3 and the measured volume of the returning water was about 6 m 3 in borehole OL-KR32. The deviation of the borehole was measured with the deviation measuring instruments EMS and Maxibor. The results of the Maxibor measurements indicate that borehole OL-KR32 deviates 4.42 m right and 4.66 m up at the borehole depth of 189 m. Uniaxial compressive strength, Young's Modulus and Poisson's ratio were measured from the core samples. The average uniaxial compressive strength is about 130 MPa, the average Young's modulus is 47 GPa and the average Poisson

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

Science.gov (United States)

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

2004-01-01

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

Casing drilling

Energy Technology Data Exchange (ETDEWEB)

Heenan, D. [Tesco Corp., Calgary, AB (Canada)

2003-07-01

This paper reviewed the experience that Tesco has gained by drilling several wells using only casings as the drill stem. Tesco has manufactured a mobile and compact hydraulic drilling rig called the Casing Drilling {sup TM} system. The system could be very effective and efficient for exploration and development of coalbed methane (CBM) reserves which typically require extensive coring. Continuous coring while drilling ahead, along wire line retrieval, can offer time savings and quick core recovery of large diameter core which is typically required for exploration core desorption tests. The proposed system may also have the potential to core or drill typically tight gas sands or underbalanced wells with air or foam. This would reduce drilling fluid damage while simultaneously finding gas. Compared to conventional drill pipes, Casing Drilling {sup TM} could also be effective with water production from shallow sands because of the smaller annual clearance which requires less air volumes to lift any produced water. 9 figs.

Three-dimensional plotting and printing of an implant drilling guide: simplifying guided implant surgery.

Science.gov (United States)

Flügge, Tabea Viktoria; Nelson, Katja; Schmelzeisen, Rainer; Metzger, Marc Christian

2013-08-01

To present an efficient workflow for the production of implant drilling guides using virtual planning tools. For this purpose, laser surface scanning, cone beam computed tomography, computer-aided design and manufacturing, and 3-dimensional (3D) printing were combined. Intraoral optical impressions (iTero, Align Technologies, Santa Clara, CA) and digital 3D radiographs (cone beam computed tomography) were performed at the first consultation of 1 exemplary patient. With image processing techniques, the intraoral surface data, acquired using an intraoral scanner, and radiologic 3D data were fused. The virtual implant planning process (using virtual library teeth) and the in-office production of the implant drilling guide was performed after only 1 clinical consultation of the patient. Implant surgery with a computer-aided design and manufacturing produced implant drilling guide was performed during the second consultation. The production of a scan prosthesis and multiple preoperative consultations of the patient were unnecessary. The presented procedure offers another step in facilitating the production of drilling guides in dental implantology. Four main advantages are realized with this procedure. First, no additional scan prosthesis is needed. Second, data acquisition can be performed during the first consultation. Third, the virtual planning is directly transferred to the drilling guide without a loss of accuracy. Finally, the treatment cost and time required are reduced with this facilitated production process. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

The need for decision and communication aids: a survey of breast cancer survivors.

Science.gov (United States)

Belkora, Jeffrey K; Miller, Melissa F; Dougherty, Kasey; Gayer, Christopher; Golant, Mitch; Buzaglo, Joanne S

2015-03-01

Qualitative studies have identified barriers to communication and informed decision making among breast cancer survivors making treatment decisions. The prevalence of these barriers is unknown. To quantify the need for decision support among breast cancer survivors. We surveyed 2,521 breast cancer survivors participating in an online registry hosted by the Cancer Support Community to find out what proportion of breast cancer patients: made decisions during their first visit with a specialist; received satisfactory information before that visit; asked questions and received responses; and endorsed expanded use of decision support. We received 1,017 (41%) responses and analyzed 917 surveys from women who lived in the United States. Most of the respondents recalled making treatment decisions during their first visit (52%). A minority (14%) received information before the first specialist visit. At least 25% of respondents rated their satisfaction below 7 on a scale of 10 for decision-making, information, and questions asked and answered. Respondents endorsed the need for assistance with obtaining information, listing questions, taking notes, and making audio-recordings of visits. The respondent sample skewed younger and had higher-stage cancer compared with all breast cancer survivors. Responses were subject to recall bias. Cancer survivors expressed gaps in their care with respect to reviewing information, asking questions, obtaining answers, and making decisions. Implementing decision and communication aids immediately upon diagnosis, when treatment decisions are being made, would address these gaps. ©2015 Frontline Medical Communications.

Use of a patient decision aid for prenatal screening for Down syndrome: what do pregnant women say?

Science.gov (United States)

Portocarrero, Maria Esther Leiva; Giguère, Anik M C; Lépine, Johanie; Garvelink, Mirjam M; Robitaille, Hubert; Delanoë, Agathe; Lévesque, Isabelle; Wilson, Brenda J; Rousseau, François; Légaré, France

2017-03-20

Patient decision aids (PtDAs) help people make difficult, values-sensitive decisions. Prenatal screening for assessing the risk of genetic conditions in the fetus is one such decision and patient decision aids are rarely used in this clinical context. We sought to identify factors influencing pregnant women's use of a patient decision aid for deciding about prenatal screening for Down syndrome (DS). This qualitative study was embedded in a sequential mixed-methods research program whose main aim is to implement shared decision-making (SDM) in the context of prenatal screening for DS in the province of Quebec, Canada. We planned to recruit a purposive sample of 45 pregnant women with low-risk pregnancy consulting for prenatal care at three clinical sites. Participating women watched a video depicting a prenatal care follow-up during which a pregnant woman, her partner and a health professional used a PtDA to decide about prenatal screening for DS. The women were then interviewed about factors that would influence the use of this PtDA using questions based on the Theoretical Domains Framework (TDF). We performed content analysis of transcribed verbatim interviews. Out of 216 eligible women, 100 agreed to participate (46% response rate) and 46 were interviewed. Regarding the type of health professional responsible for their prenatal care, 19 participants (41%) reported having made a decision about prenatal screening for DS with an obstetrician-gynecologist, 13 (28%) with a midwife, 12 (26%) with a family physician, and two (4%) decided on their own. We identified 54 factors that were mapped onto nine of the 12 TDF domains. The three most frequently-mentioned were: opinion of the pregnant woman's partner (n = 33, 72%), presentation of the PtDA by health professional and a discussion (n = 27, 72%), and not having encountered a PtDA (n = 26, 57%). This study allowed us to identify factors influencing pregnant women's use of a PtDA for prenatal screening for

On the suitability of fast and frugal heuristics for designing values clarification methods in patient decision aids : A critical analysis

NARCIS (Netherlands)

Pieterse, A.H.; de Vries, M.

2013-01-01

Background  Increasingly, patient decision aids and values clarification methods (VCMs) are being developed to support patients in making preference-sensitive health-care decisions. Many VCMs encourage extensive deliberation about options, without solid theoretical or empirical evidence showing that

Importance of drill string assembly swivel in horizontal drilling

Directory of Open Access Journals (Sweden)

Edmund Tasak

2006-10-01

Full Text Available A part of the drill string – the swivel (rotational connector – accomplishes an important task in the horizontal drilling. Its malfunctioning makes it impossible to draw in ( install large diameter and length pipelines. The causes of the connector break-down during the horizontal drilling are investigated in the paper. The drilling has been made for twenty inches gas pipeline installation during reaming operations. A trouble was encountered making good work conditions of a system consisting of the drilling machine drill string reamer swivel tube shield of Cardan joint and the gas pipeline 500 m long. In this case, the swivel brokes down and the planned operation was not finished. The assessment of improper drilling conditions, selection of operation system components, and drilling parameters and the insufficient technological supervising have created an excessive risk of failure. A proper application of technical analysis would considerably decrease the hazard of failure which cause large costs, delays and decrease of confidence to the drilling contractor and pipeline installation.

Semiorders, Intervals Orders and Pseudo Orders Preference Structures in Multiple Criteria Decision Aid Methods

Directory of Open Access Journals (Sweden)

Fernández Barberis, Gabriela

2013-06-01

Full Text Available During the last decades, an important number of Multicriteria Decision Aid Methods (MCDA has been proposed to help the decision maker to select the best compromise alternative. Meanwhile, the PROMETHEE (Preference Ranking Organization Method for Enrichment Evaluations family of outranking method and their applications has attracted much attention from academics and practitioners. In this paper, an extension of these methods is presented, consisting of analyze its functioning under New Preference Structures (NPS. The preference structures taken into account are, namely: semiorders, intervals orders and pseudo orders. These structures outstandingly improve the modelization as they give more flexibility, amplitude and certainty at the preferences formulation, since they tend to abandon the Complete Transitive Comparability Axiom of Preferences in order to substitute it by the Partial Comparability Axiom of Preferences. It must be remarked the introduction of Incomparability relations to the analysis and the consideration of preference structures that accept the Indifference intransitivity. The NPS incorporation is carried out in three phases that the PROMETHEE Methodology takes in: preference structure enrichment, dominance relation enrichment and outranking relation exploitation for decision aid, in order to finally arrive at solving the alternatives ranking problem through the PROMETHEE I or the PROMETHEE II utilization, according to whether a partial ranking or a complete one, is respectively required under the NPS

Drilling comparison in "warm ice" and drill design comparison

DEFF Research Database (Denmark)

Augustin, L.; Motoyama, H.; Wilhelms, F.

2007-01-01

For the deep ice-core drilling community, the 2005/06 Antarctic season was an exciting and fruitful one. In three different Antarctic locations, Dome Fuji, EPICA DML and Vostok, deep drillings approached bedrock (the ice-water interface in the case of Vostok), emulating what had previously been...... achieved at NorthGRIP, Greenland, (summer 2003 and 2004) and at EPICA Dome C2, Antarctica (season 2004/05). For the first time in ice-core drilling history, three different types of drill (KEMS, JARE and EPICA) simultaneously reached the depth of 'warm ice' under high pressure. After excellent progress...... at each site, the drilling rate dropped and the drilling teams had to deal with refrozen ice on cutters and drill heads. Drills have different limits and perform differently. In this comparative study, we examine depth, pressure, temperature, pump flow and cutting speed. Finally, we compare a few...

Development of vertical drilling apparatus (Terra-Drill); Entwicklung eines Vertikal-Bohrgeraets (Terra-Drill) - Schlussbericht

Energy Technology Data Exchange (ETDEWEB)

Jenne, D.

2009-05-15

This well-illustrated final report for the Swiss Federal Office of Energy (SFOE) reports on the development of a vertical drilling apparatus named Terra-Drill. The various stages of the development of the apparatus, which is based on earlier designs, is discussed. New norms issued in Germany for the size of boreholes for buried vertical heat-exchangers and the appropriate linings to be used are discussed. The new Terra Drill 4407 V drilling apparatus and its testing are discussed. The drill is quoted as being particularly suitable for cramped locations. Technical details are presented and a comprehensive collection of photographs is included. Various preliminary reports and development documentation are included.

Justification, optimization and decision-aiding in existing exposure situations

International Nuclear Information System (INIS)

Hedemann-Jensen, Per

2004-01-01

The existing ICRP system of radiological protection from 1990 (ICRP Publication 60) can be seen as a binary or dual-line system dealing with protection in exposure situations categorized as either practices or interventions. The distinction between practices and interventions is summarized in the paper with focus on some of the problems experienced in making such a distinction. The protection principles within the existing system of protection are presented with emphasis on the application to de facto or existing exposure situations. Decision on countermeasures to mitigate the consequences of existing exposure situations such as nuclear or radiological accidents and naturally occurring exposure situations include factors or attributes describing benefits from the countermeasure and those describing harm. Some of these attributes are discussed and the general process of justification of intervention and optimization of protection arriving at generic reference levels for implementing protective measures is presented. In addition, the role of radiological protection professionals and other stakeholders in the decision-making process is discussed. Special attention is given to the question whether radiological protection should form only one of many decision-aiding inputs to a broader societal decision-making process or whether societal aspects should be fully integrated into the radiological protection framework. The concepts of practices and interventions, however logical they are, have created some confusion when applied to protection of the public following a nuclear or radiological accident. These problems may be solved in a new set of general ICRP recommendations on radiological protection, which are anticipated to supersede Publication 60 in 2005. The evolution of the basic ICRP principles for radiological protection in existing exposure situations into a new set of ICRP recommendations is briefly discussed based upon the various material that has been presented

Impact of a decision aid about stratified ovarian cancer risk-management on women’s knowledge and intentions: a randomised online experimental survey study

Directory of Open Access Journals (Sweden)

Susanne F. Meisel

2017-11-01

Full Text Available Abstract Background Risk stratification using genetic and other types of personal information could improve current best available approaches to ovarian cancer risk reduction, improving identification of women at increased risk of ovarian cancer and reducing unnecessary interventions for women at lower risk. Amounts of information given to women may influence key informed decision-related outcomes, e.g. knowledge. The primary aim of this study was to compare informed decision-related outcomes between women given one of two versions (gist vs. extended of a decision aid about stratified ovarian cancer risk-management. Methods This was an experimental survey study comparing the effects of brief (gist information with lengthier, more detailed (extended information on cognitions relevant to informed decision-making about participating in risk-stratified ovarian cancer screening. Women with no personal history of ovarian cancer were recruited through an online survey company and randomised to view the gist (n = 512 or extended (n = 519 version of a website-based decision aid and completed an online survey. Primary outcomes were knowledge and intentions. Secondary outcomes included attitudes (values and decisional conflict. Results There were no significant differences between the gist and extended conditions in knowledge about ovarian cancer (time*group interaction: F = 0.20, p = 0.66 or intention to participate in ovarian cancer screening based on genetic risk assessment (t(1029 = 0.43, p = 0.67. There were also no between-groups differences in secondary outcomes. In the sample overall (n = 1031, knowledge about ovarian cancer increased from before to after exposure to the decision aid (from 5.71 to 6.77 out of a possible 10: t = 19.04, p < 0.001, and 74% of participants said that they would participate in ovarian cancer screening based on genetic risk assessment. Conclusions No differences in knowledge or

Addressing health literacy in patient decision aids

Science.gov (United States)

2013-01-01

Background Effective use of a patient decision aid (PtDA) can be affected by the user’s health literacy and the PtDA’s characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess: 1. a) the effects of health literacy / numeracy on selected decision-making outcomes, and b) the effects of interventions designed to mitigate the influence of lower health literacy on decision-making outcomes, and 2. the extent to which existing PtDAs a) account for health literacy, and b) are tested in lower health literacy populations. Methods We reviewed literature for evidence relevant to these two aims. When high-quality systematic reviews existed, we summarized their evidence. When reviews were unavailable, we conducted our own systematic reviews. Results Aim 1: In an existing systematic review of PtDA trials, lower health literacy was associated with lower patient health knowledge (14 of 16 eligible studies). Fourteen studies reported practical design strategies to improve knowledge for lower health literacy patients. In our own systematic review, no studies reported on values clarity per se, but in 2 lower health literacy was related to higher decisional uncertainty and regret. Lower health literacy was associated with less desire for involvement in 3 studies, less question-asking in 2, and less patient-centered communication in 4 studies; its effects on other measures of patient involvement were mixed. Only one study assessed the effects of a health literacy intervention on outcomes; it showed that using video to improve the salience of health states reduced decisional uncertainty. Aim 2: In our review of 97 trials, only 3 PtDAs overtly addressed the needs of lower health literacy users. In 90% of trials, user health literacy and readability of the PtDA were not reported. However, increases in knowledge and informed choice were reported in those studies

Deep learning aided decision support for pulmonary nodules diagnosing: a review.

Science.gov (United States)

Yang, Yixin; Feng, Xiaoyi; Chi, Wenhao; Li, Zhengyang; Duan, Wenzhe; Liu, Haiping; Liang, Wenhua; Wang, Wei; Chen, Ping; He, Jianxing; Liu, Bo

2018-04-01

Deep learning techniques have recently emerged as promising decision supporting approaches to automatically analyze medical images for different clinical diagnosing purposes. Diagnosing of pulmonary nodules by using computer-assisted diagnosing has received considerable theoretical, computational, and empirical research work, and considerable methods have been developed for detection and classification of pulmonary nodules on different formats of images including chest radiographs, computed tomography (CT), and positron emission tomography in the past five decades. The recent remarkable and significant progress in deep learning for pulmonary nodules achieved in both academia and the industry has demonstrated that deep learning techniques seem to be promising alternative decision support schemes to effectively tackle the central issues in pulmonary nodules diagnosing, including feature extraction, nodule detection, false-positive reduction, and benign-malignant classification for the huge volume of chest scan data. The main goal of this investigation is to provide a comprehensive state-of-the-art review of the deep learning aided decision support for pulmonary nodules diagnosing. As far as the authors know, this is the first time that a review is devoted exclusively to deep learning techniques for pulmonary nodules diagnosing.

A multi-criteria decision aid methodology to design electric vehicles public charging networks

Directory of Open Access Journals (Sweden)

João Raposo

2015-05-01

Full Text Available This article presents a new multi-criteria decision aid methodology, dynamic-PROMETHEE, here used to design electric vehicle charging networks. In applying this methodology to a Portuguese city, results suggest that it is effective in designing electric vehicle charging networks, generating time and policy based scenarios, considering offer and demand and the city’s urban structure. Dynamic-PROMETHE adds to the already known PROMETHEE’s characteristics other useful features, such as decision memory over time, versatility and adaptability. The case study, used here to present the dynamic-PROMETHEE, served as inspiration and base to create this new methodology. It can be used to model different problems and scenarios that may present similar requirement characteristics.

A multi-criteria decision aid methodology to design electric vehicles public charging networks

Science.gov (United States)

Raposo, João; Rodrigues, Ana; Silva, Carlos; Dentinho, Tomaz

2015-05-01

This article presents a new multi-criteria decision aid methodology, dynamic-PROMETHEE, here used to design electric vehicle charging networks. In applying this methodology to a Portuguese city, results suggest that it is effective in designing electric vehicle charging networks, generating time and policy based scenarios, considering offer and demand and the city's urban structure. Dynamic-PROMETHE adds to the already known PROMETHEE's characteristics other useful features, such as decision memory over time, versatility and adaptability. The case study, used here to present the dynamic-PROMETHEE, served as inspiration and base to create this new methodology. It can be used to model different problems and scenarios that may present similar requirement characteristics.

Core drilling of deep borehole OL-KR32 at Olkiluoto in Eurajoki 2004

Energy Technology Data Exchange (ETDEWEB)

Rautio, T. [Suomen Malmi Oy, Espoo (Finland)

2005-01-15

Posiva Oy submitted an application for the Decision in Principle to the Finnish Government in May 1999. A positive decision was made at the end of 2000 by the Government. The Finnish Parliament ratified the Decision in Principle on the final disposal facility for spent nuclear fuel at Olkiluoto, Eurajoki in May 2001. The decision makes it possible for Posiva to focus the confirming bedrock investigations at Olkiluoto, where in the next few years an underground rock characterisation facility, the ONKALO, will be constructed. As a part of the investigations Suomen Malmi Oy (Smoy) core drilled a 191.81 m deep borehole with a diameter of 75.7 mm at Olkiluoto in November 2004. This borehole was aimed to get additional information of the quality and the location of the fractured zones R20A and R20B and the fractured zones near rock surface noticed in investigation trench TK8. The identification number of the borehole is OL-KR32. A set of monitoring measurements and samplings from the drilling and returning water was carried out during the drilling. Both the volume and the electric conductivity of the drilling water and the returning water were recorded as well as the pressure of the drilling water. The objective of these measurements was to obtain more information about bedrock and groundwater properties. Sodium fluorescein was used as a label agent in the drilling water. The volume of the used drilling water was about 93 m{sup 3} and the measured volume of the returning water was about 6 m{sup 3} in borehole OL-KR32. The deviation of the borehole was measured with the deviation measuring instruments EMS and Maxibor. The results of the Maxibor measurements indicate that borehole OL-KR32 deviates 4.42 m right and 4.66 m up at the borehole depth of 189 m. Uniaxial compressive strength, Young's Modulus and Poisson's ratio were measured from the core samples. The average uniaxial compressive strength is about 130 MPa, the average Young's modulus is 47 GPa and

Drilling bits for deep drilling and process for their manufacture

Energy Technology Data Exchange (ETDEWEB)

Rhode, H.; Juergens, R.; Feenstra, R.; Busking, B.E.

1978-11-30

The invention concerns a drilling head or a drilling bit for use in deep drilling in underground formations and particularly concerns a drilling bit with a drilling bit body, which has a shank and a hollow space, which is connected with a duct extending through the shank. The drilling bit body has several separate cutting elements for removing material from the floor of a borehole and hydraulic devices for cooling and/or cleaning the cutting elements are provided.

A single-blind randomised controlled trial of the effects of a web-based decision aid on self-testing for cholesterol and diabetes. study protocol

Directory of Open Access Journals (Sweden)

Ickenroth Martine HP

2012-01-01

Full Text Available Abstract Background Self-tests, tests on body materials to detect medical conditions, are widely available to the general public. Self-testing does have advantages as well as disadvantages, and the debate on whether self-testing should be encouraged or rather discouraged is still ongoing. One of the concerns is whether consumers have sufficient knowledge to perform the test and interpret the results. An online decision aid (DA with information on self-testing in general, and test specific information on cholesterol and diabetes self-testing was developed. The DA aims to provide objective information on these self-tests as well as a decision support tool to weigh the pros and cons of self-testing. The aim of this study is to evaluate the effect of the online decision aid on knowledge on self-testing, informed choice, ambivalence and psychosocial determinants. Methods/Design A single blind randomised controlled trial in which the online decision aid 'zelftestwijzer' is compared to short, non-interactive information on self-testing in general. The entire trial will be conducted online. Participants will be selected from an existing Internet panel. Consumers who are considering doing a cholesterol or diabetes self-test in the future will be included. Outcome measures will be assessed directly after participants have viewed either the DA or the control condition. Weblog files will be used to record participants' use of the decision aid. Discussion Self-testing does have important pros and cons, and it is important that consumers base their decision whether they want to do a self-test or not on knowledge and personal values. This study is the first to evaluate the effect of an online decision aid for self-testing. Trial registration Dutch Trial Register: NTR3149

Impact of a decision aid about stratified ovarian cancer risk-management on women's knowledge and intentions: a randomised online experimental survey study.

Science.gov (United States)

Meisel, Susanne F; Freeman, Maddie; Waller, Jo; Fraser, Lindsay; Gessler, Sue; Jacobs, Ian; Kalsi, Jatinderpal; Manchanda, Ranjit; Rahman, Belinda; Side, Lucy; Wardle, Jane; Lanceley, Anne; Sanderson, Saskia C

2017-11-16

Risk stratification using genetic and other types of personal information could improve current best available approaches to ovarian cancer risk reduction, improving identification of women at increased risk of ovarian cancer and reducing unnecessary interventions for women at lower risk. Amounts of information given to women may influence key informed decision-related outcomes, e.g. knowledge. The primary aim of this study was to compare informed decision-related outcomes between women given one of two versions (gist vs. extended) of a decision aid about stratified ovarian cancer risk-management. This was an experimental survey study comparing the effects of brief (gist) information with lengthier, more detailed (extended) information on cognitions relevant to informed decision-making about participating in risk-stratified ovarian cancer screening. Women with no personal history of ovarian cancer were recruited through an online survey company and randomised to view the gist (n = 512) or extended (n = 519) version of a website-based decision aid and completed an online survey. Primary outcomes were knowledge and intentions. Secondary outcomes included attitudes (values) and decisional conflict. There were no significant differences between the gist and extended conditions in knowledge about ovarian cancer (time*group interaction: F = 0.20, p = 0.66) or intention to participate in ovarian cancer screening based on genetic risk assessment (t(1029) = 0.43, p = 0.67). There were also no between-groups differences in secondary outcomes. In the sample overall (n = 1031), knowledge about ovarian cancer increased from before to after exposure to the decision aid (from 5.71 to 6.77 out of a possible 10: t = 19.04, p type of content for decision aids about stratified ovarian cancer risk-management. This study was registered with the ISRCTN registry; registration number: ISRCTN48627877 .

The AFFORD clinical decision aid to identify emergency department patients with atrial fibrillation at low risk for 30-day adverse events.

Science.gov (United States)

Barrett, Tyler W; Storrow, Alan B; Jenkins, Cathy A; Abraham, Robert L; Liu, Dandan; Miller, Karen F; Moser, Kelly M; Russ, Stephan; Roden, Dan M; Harrell, Frank E; Darbar, Dawood

2015-03-15

There is wide variation in the management of patients with atrial fibrillation (AF) in the emergency department (ED). We aimed to derive and internally validate the first prospective, ED-based clinical decision aid to identify patients with AF at low risk for 30-day adverse events. We performed a prospective cohort study at a university-affiliated tertiary-care ED. Patients were enrolled from June 9, 2010, to February 28, 2013, and followed for 30 days. We enrolled a convenience sample of patients in ED presenting with symptomatic AF. Candidate predictors were based on ED data available in the first 2 hours. The decision aid was derived using model approximation (preconditioning) followed by strong bootstrap internal validation. We used an ordinal outcome hierarchy defined as the incidence of the most severe adverse event within 30 days of the ED evaluation. Of 497 patients enrolled, stroke and AF-related death occurred in 13 (3%) and 4 (aid included the following: age, triage vitals (systolic blood pressure, temperature, respiratory rate, oxygen saturation, supplemental oxygen requirement), medical history (heart failure, home sotalol use, previous percutaneous coronary intervention, electrical cardioversion, cardiac ablation, frequency of AF symptoms), and ED data (2 hours heart rate, chest radiograph results, hemoglobin, creatinine, and brain natriuretic peptide). The decision aid's c-statistic in predicting any 30-day adverse event was 0.7 (95% confidence interval 0.65, 0.76). In conclusion, in patients with AF in the ED, Atrial Fibrillation and Flutter Outcome Risk Determination provides the first evidence-based decision aid for identifying patients who are at low risk for 30-day adverse events and candidates for safe discharge. Copyright © 2015 Elsevier Inc. All rights reserved.

A hierarchical decision aid in a debate on national energy policy

International Nuclear Information System (INIS)

Haemaelaeinen, R.P.; Seppaelaeinen, T.; Oehladt, K.; Ruusunen, J.

1985-12-01

A wide public depate on the future energy policy of Finland has been going on for the past few years, and at the moment the discussion is centered around the question whether a new nuclear power plant should be built or not. To clarify the differences between anti-nuclear and pro-nuclear opinions, a decision analysis of the issue was conducted with a microcomputer-based decision aid which utilizes the Analytic Hierarchy Process. The participants representing the opposite opinions were the Minister of Finance and a chief industrial executive. This paper presents the preference profiles of the participants and sensitivity analyses of the results, and discusses the implications of the results for the depate. Essential sources of opinion differences are pointed out and a deeper understanding of the issue is gained. This enables focusing the depate on the critical questions and elimination of less important criteria, which otherwise might receive disproportonate attention

Wellsite computers--their increasing role in drilling operations

International Nuclear Information System (INIS)

Keenan, P.G.; Dyson, P.M.

1981-01-01

The increasing expense and complexity of exploration drilling, coupled with rapid advances in computer and microprocessor technology, have led to the development of computer-assisted wellsite logging units from their humble beginnings as simple hot wire gas detectors. The main applications of this technology can be recognized in the following areas: (a) Safety of wellsite personnel, rig and downhole equipment. (b) Increased drilling efficiency with the resultant time and cost savings. (c) Simulation of possible events allowing comparisons between actual and expected data to assist decision making at the wellsite. (d) Storage of data on tape/disk to allow rapid retrieval of data for postwell analysis and report production. 6 refs

Probabilistic risk analysis of casing drilling operation for an onshore Brazilian well; Analise probabilistica de risco de uma operacao de casing drilling para um poco terrestre no Brasil

Energy Technology Data Exchange (ETDEWEB)

Jacinto, Carlos M.C.; Petersen, Flavia C.; Placido, Joao C.R. [PETROBRAS, Rio de Janeiro, RJ (Brazil); Garcia, Pauli A.A. [Universidade Federal Fluminense (UFF), Niteroi, RJ (Brazil)

2008-07-01

In the present paper, one presents an approach to hazard identification and risks quantification concerning the use of retrievable BHA, of a casing drilling system, in 12 1/4 phase of an onshore well. The adopted approach can be subdivided as: execution of a hazard and operability study; prioritization of critical deviance; modeling of critical deviance by mean of event sequence diagram, fault tree and Bayesian network; modeling and simulation of a dynamic decision tree and experts' opinion analysis. As results, one has obtained: the time distribution to achieve the different ends modeled in the decision tree, i.e., sidetrack, or operation canceling, or success; the probabilities to achieve each modeled end and all recommendation to improve the success probability. The approach proved to be efficient in order that it presents significant results to support the decisions involving the casing drilling operations. (author)

The pros and cons of funnel plots as an aid to risk communication and patient decision making.

Science.gov (United States)

Rakow, Tim; Wright, Rebecca J; Spiegelhalter, David J; Bull, Catherine

2015-05-01

Funnel plots, which simultaneously display a sample statistic and the corresponding sample size for multiple cases, have a range of applications. In medicine, they are used to display treatment outcome rates and caseload volume by institution, which can inform strategic decisions about health care delivery. We investigated lay people's understanding of such plots and explored their suitability as an aid to individual treatment decisions. In two studies, 172 participants answered objective questions about funnel plots representing the surgical outcomes (survival or mortality rates) of institutions varying in caseload, and indicated their preferred institutions. Accuracy for extracting objective information was high, unless question phrasing was inconsistent with the plot's survival/mortality framing, or participants had low numeracy levels. Participants integrated caseload-volume and outcome-rate data when forming preferences, but were influenced by reference lines on the plot to make inappropriate discriminations between institutions with similar outcome rates. With careful choice of accompanying language, funnel plots can be readily understood and are therefore a useful tool for communicating risk. However, they are less effective as a decision aid for individual patient's treatment decisions, and we recommend refinements to the standard presentation of the plots if they are to be used for that purpose. © 2014 The British Psychological Society.

Development of an integrated decision support system to aid cognitive activities of operators

International Nuclear Information System (INIS)

Lee, Seung Jun; Seong, Poong Hyun

2007-01-01

As digital and computer technologies have grown, Human-Machine Interfaces (HMIs) have evolved. In safety-critical systems, especially in Nuclear Power Plants (NPPs), HMIs are important for reducing operational costs, the number of necessary operators, and the probability of accident occurrence. Efforts have been made to improve Main Control Room (MCR) interface design and to develop automated or decision support systems to ensure convenient operation and maintenance. In this paper, an integrated decision support system to aid operator cognitive processes is proposed for advanced MCRs of future NPPs. This work suggests the design concept of a decision support system which accounts for an operator's cognitive processes. The proposed system supports not only a particular task, but also the entire operation process based on a human cognitive process model. In this paper, the operator's operation processes are analyzed according to a human cognitive process model and appropriate support systems that support each cognitive process activity are suggested

Evaluation of a Patient Decision Aid for Unicompartmental or Total Knee Arthroplasty for Medial Knee Osteoarthritis.

Science.gov (United States)

de Jesus, Christopher; Stacey, Dawn; Dervin, Geoffrey F

2017-11-01

Many patients with isolated medial compartment osteoarthritis are candidates for either unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). A novel patient decision aid (PDA) was developed to educate patients on both interventions and prepare them for making the decision with their surgeon. The study objective was to evaluate the acceptability and usefulness of a PDA for informing and helping patients reach a surgical preference without increasing decisional conflict. A PDA was developed in accordance with the criteria listed by Ottawa Decision Support Framework and prospectively tested in UKA and TKA patients, who were mailed the PDAs to complete at home along with outcome measures before surgeon consultation. Of 50 patients who consented to participate, 45 patients (26 men, 19 women) used the PDA. Quantitative analysis of acceptability, decisional conflict, knowledge, and preferred surgical option was then performed. Mean patient age was 64.6 years (range, 50-80 years). Patients rated the PDA as acceptable: 84.4% indicated balanced presentation of information and 77.8% asserted that PDA helped them to make decisions between UKA and TKA. Mean knowledge score was 86.6% and total decisional conflict was 19.7 out of 100. Of 45, 33 stated a preferred option (24 UKA; 9 TKA; 12 unsure). Patients understood the majority of the benefits and risks for each surgical option without increasing decisional conflict. The decision aid for advanced medial compartment osteoarthritis is shown to be acceptable and useful for choosing between UKA and TKA. Copyright © 2017 Elsevier Inc. All rights reserved.

Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers

Science.gov (United States)

2013-01-01

Background Making evidence-based decisions often requires comparison of two or more options. Research-based evidence may exist which quantifies how likely the outcomes are for each option. Understanding these numeric estimates improves patients’ risk perception and leads to better informed decision making. This paper summarises current “best practices” in communication of evidence-based numeric outcomes for developers of patient decision aids (PtDAs) and other health communication tools. Method An expert consensus group of fourteen researchers from North America, Europe, and Australasia identified eleven main issues in risk communication. Two experts for each issue wrote a “state of the art” summary of best evidence, drawing on the PtDA, health, psychological, and broader scientific literature. In addition, commonly used terms were defined and a set of guiding principles and key messages derived from the results. Results The eleven key components of risk communication were: 1) Presenting the chance an event will occur; 2) Presenting changes in numeric outcomes; 3) Outcome estimates for test and screening decisions; 4) Numeric estimates in context and with evaluative labels; 5) Conveying uncertainty; 6) Visual formats; 7) Tailoring estimates; 8) Formats for understanding outcomes over time; 9) Narrative methods for conveying the chance of an event; 10) Important skills for understanding numerical estimates; and 11) Interactive web-based formats. Guiding principles from the evidence summaries advise that risk communication formats should reflect the task required of the user, should always define a relevant reference class (i.e., denominator) over time, should aim to use a consistent format throughout documents, should avoid “1 in x” formats and variable denominators, consider the magnitude of numbers used and the possibility of format bias, and should take into account the numeracy and graph literacy of the audience. Conclusion A substantial and

To reiterate the concept of self-aid and buddy-aid for combat wounded

Directory of Open Access Journals (Sweden)

Zhong-jie HE

2015-11-01

Full Text Available Explore new concept of self-aid and buddy-aid for combat wounded based on the emergency timeliness and the challenges we are going to face in the future combats, the importance of self-aid, buddy-aid and rescue are discussed. The concept and characteristics of self-aid and buddy-aid in our army are reviewed, and the care of the wounded in foreign armies were reviewed. Based on the experiences gained from previous combats, and the results of "Medical Service Mission-2014 Drill", it was believed that the emergency rescue of battle wounded should follow the timeliness rule and the principle of self-aid and buddy-aid technology. It might be beneficial to use cell protective agent, urgent relief of life-threatening conditions such as profuse bleeding from extremities, suffocation, pneumothorax, and traumatic shock etc., in order to stabilize the general condition of the wounded, according to the regime of "Platinum 10 minutes" and "golden 1 hour", self-aid and buddy-aid might play an important role in preventing early death and late morbidity of the wounded, thus helps reduce the mortality rate or the victims of combat wounds. DOI: 10.11855/j.issn.0577-7402.2015.11.01

Assessing the information desire of patients with advanced cancer by providing information with a decision aid, which is evaluated in a randomized trial: a study protocol.

Science.gov (United States)

Oostendorp, Linda J M; Ottevanger, Petronella B; van der Graaf, Winette T A; Stalmeier, Peep F M

2011-02-14

There is a continuing debate on the desirability of informing patients with cancer and thereby involving them in treatment decisions. On the one hand, information uptake may be hampered, and additional stress could be inflicted by involving these patients. On the other hand, even patients with advanced cancer desire information on risks and prognosis. To settle the debate, a decision aid will be developed and presented to patients with advanced disease at the point of decision making. The aid is used to assess the amount of information desired. Factors related to information desire are explored, as well as the ability of the medical oncologist to judge the patient's information desire. The effects of the information on patient well-being are assessed by comparing the decision aid group with a usual care group. This study is a randomized controlled trial of patients with advanced colorectal, breast, or ovarian cancer who have started treatment with first-line palliative chemotherapy. The trial will consist of 100 patients in the decision aid group and 70 patients in the usual care group. To collect complete data of 170 patients, 246 patients will be approached for the study. Patients will complete a baseline questionnaire on sociodemographic data, well-being measures, and psychological measures, believed to predict information desire. The medical oncologist will judge the patient's information desire. After disease progression is diagnosed, the medical oncologist offers the choice between second-line palliative chemotherapy plus best supportive care (BSC) and BSC alone. Randomization will take place to determine whether patients will receive usual care (n = 70) or usual care and the decision aid (n = 100). The aid offers information about the potential risks and benefits of both treatment options, in terms of adverse events, tumour response, and survival. Patients decide for each item whether they desire the information or not. Two follow-up questionnaires will

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

Science.gov (United States)

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

2014-12-12

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

A Graphical Adversarial Risk Analysis Model for Oil and Gas Drilling Cybersecurity

OpenAIRE

Vieira, Aitor Couce; Houmb, Siv Hilde; Insua, David Rios

2014-01-01

Oil and gas drilling is based, increasingly, on operational technology, whose cybersecurity is complicated by several challenges. We propose a graphical model for cybersecurity risk assessment based on Adversarial Risk Analysis to face those challenges. We also provide an example of the model in the context of an offshore drilling rig. The proposed model provides a more formal and comprehensive analysis of risks, still using the standard business language based on decisions, risks, and value.

CASING DRILLING TECHNOLOGY

Directory of Open Access Journals (Sweden)

Nediljka Gaurina-Međimurec

2005-12-01

Full Text Available Casing drilling is an alternative option to conventional drilling and uses standard oilfield casing instead of drillstring. This technology is one of the greatest developments in drilling operations. Casing drilling involves drilling and casing a well simultaneously. In casing driling process, downhole tools can be retrieved, through the casing on wire-line, meaning tool recovery or replacement of tools can take minutes versus hours under conventional methods. This process employs wireline-retrievable tools and a drill-lock assembly, permitting bit and BHA changes, coring, electrical logging and even directional or horizontal drilling. Once the casing point is reached, the casing is cemented in place without tripping pipe.

HIGH-POWER TURBODRILL AND DRILL BIT FOR DRILLING WITH COILED TUBING

Energy Technology Data Exchange (ETDEWEB)

Robert Radtke; David Glowka; Man Mohan Rai; David Conroy; Tim Beaton; Rocky Seale; Joseph Hanna; Smith Neyrfor; Homer Robertson

2008-03-31

Commercial introduction of Microhole Technology to the gas and oil drilling industry requires an effective downhole drive mechanism which operates efficiently at relatively high RPM and low bit weight for delivering efficient power to the special high RPM drill bit for ensuring both high penetration rate and long bit life. This project entails developing and testing a more efficient 2-7/8 in. diameter Turbodrill and a novel 4-1/8 in. diameter drill bit for drilling with coiled tubing. The high-power Turbodrill were developed to deliver efficient power, and the more durable drill bit employed high-temperature cutters that can more effectively drill hard and abrasive rock. This project teams Schlumberger Smith Neyrfor and Smith Bits, and NASA AMES Research Center with Technology International, Inc (TII), to deliver a downhole, hydraulically-driven power unit, matched with a custom drill bit designed to drill 4-1/8 in. boreholes with a purpose-built coiled tubing rig. The U.S. Department of Energy National Energy Technology Laboratory has funded Technology International Inc. Houston, Texas to develop a higher power Turbodrill and drill bit for use in drilling with a coiled tubing unit. This project entails developing and testing an effective downhole drive mechanism and a novel drill bit for drilling 'microholes' with coiled tubing. The new higher power Turbodrill is shorter, delivers power more efficiently, operates at relatively high revolutions per minute, and requires low weight on bit. The more durable thermally stable diamond drill bit employs high-temperature TSP (thermally stable) diamond cutters that can more effectively drill hard and abrasive rock. Expectations are that widespread adoption of microhole technology could spawn a wave of 'infill development' drilling of wells spaced between existing wells, which could tap potentially billions of barrels of bypassed oil at shallow depths in mature producing areas. At the same time, microhole

Examination of skin lesions for cancer : Which clinical decision aids and tools are available in general practice?

NARCIS (Netherlands)

Koelink, Cecile J. L.; Jonkman, Marcel F.; Van der Meer, Klaas; Van der Heide, Wouter K.

2014-01-01

Background While skin cancer incidence is rising throughout Europe, general practitioners (GP) feel unsure about their ability to diagnose skin malignancies. Objectives To evaluate whether the GP has sufficient validated clinical decision aids and tools for the examination of potentially malignant

Drilling unit

Energy Technology Data Exchange (ETDEWEB)

Umanchik, N P; Demin, A V; Khrustalev, N N; Linnik, G N; Lovchev, S V; Rozin, M M; Sidorov, R V; Sokolov, S I; Tsaregradskiy, Yu P

1981-01-01

A drilling unit is proposed which includes a hydraulic lifter, hydraulic multiple-cylinder pump with valve distribution and sectional drilling pump with separators of the working and flushing fluid. In order to reduce metal consumption and the overall dimensions of the drilling unit, the working cavity of each cylinder of the hydraulic multiple-cylinder pump is equipped with suction and injection valves and is hydraulically connected to the working cavity by one of the sections of the drilling pump.

Evaluating the utility of a patient decision aid for potential participants of a prostate cancer trial (RAVES-TROG 08.03)

International Nuclear Information System (INIS)

Sundaresan, Puma; Turner, Sandra; Kneebone, Andrew; Pearse, Maria; Butow, Phyllis

2011-01-01

Randomised controlled trials (RCTs) can be hampered by poor patient accrual and retention. Decision aids (DAs) containing simple, evidence-based information, may assist patients with decision-making regarding trial participation. The current DA was of use for 95% of participants. Further evaluation of the DA in a RCT is currently underway.

A decision aid to assist decisions on disclosure of mental health status to an employer: protocol for the CORAL exploratory randomised controlled trial

Directory of Open Access Journals (Sweden)

Henderson Claire

2012-08-01

Full Text Available Abstract Background The UK Equality Act 2010 makes it unlawful for employers to ask health questions before making an offer of employment except in certain circumstances. While the majority of employers would prefer applicants to disclose a mental illness at the application stage, many people either wait until they have accepted the job and then disclose to an occupational health professional, or do not do so at all due to the anticipation of discrimination or a wish for privacy. However, non disclosure precludes the ability to request reasonable adjustments in the workplace or to make a claim of direct discrimination. Disclosure to employers is therefore a difficult decision. A recent pilot study by our group of the CORAL decision aid showed that it helped mental health service users clarify their needs and values regarding disclosure and led to reduction in decisional conflict. The present proof of concept trial aims to determine whether a full scale randomised controlled trial (RCT is justifiable and feasible, and to optimise its design. Methods In this single blind exploratory RCT in London, a total of 80 participants (inclusion criteria: age ≥18 years, on the caseload of a specialist employment adviser working with people with mental illness; referred to the adviser either from primary care via Improving Access to Psychological Therapies or secondary mental health service; currently seeking or interested in either paid or voluntary employment, and a Decisional Conflict Scale score of 37.5 or greater and stage of decision score 1–5 will be recruited from vocational advice services. After completing a baseline assessment, participants will be randomly assigned to one of two conditions (1 Use of the CORAL Decision Aid (DA in addition to treatment as usual or (2 Treatment as usual. Those allocated to the DA condition will be given it to read and complete, and the researcher will be present to record the time taken and any content that

Decision aiding model for the evaluation of agricultural countermeasures after an accidental release of radionuclides to the environment

International Nuclear Information System (INIS)

Turcanu, C.

2009-01-01

Implementation of remedial actions after a radiological contamination of the environment has to take into account, alongside with radiological and feasibility criteria, also the acceptability of the countermeasures, ethical and environmental considerations, as well as the spatial variation and the needs of people in urban, rural and industrial environments. This highlights multi-criteria analysis as a suitable tool, since it is able to structure discussions and to facilitate a common understanding of the decision problem, with the values and priorities of the actors involved. The related theoretical framework, multi-criteria decision aid (MCDA), has emerged from the operational research field as an answer given to a couple of important questions encountered in complex decision problems. Firstly, the aim is not to replace the decision maker with a mathematical model, but to support him to construct his solution by describing and evaluating his options. Secondly, instead of using a unique criterion capturing all aspects of the problem, in MCDA one seeks to build multiple criteria, representing several points of view. The methods belonging to MCDA can be classified as multi-attribute utility/value methods, outranking methods and interactive methods. Past attempts to apply multi-criteria analysis in the context of nuclear emergency management have highlighted however the need to better integrate the operational and socio-political context of the decision-making process into the tools and models developed for decision-support. This PhD project had two main objectives: 1) to develop a multi-criteria decision aid model for the decision problem on countermeasures for contaminated milk, that better accommodates the nuclear crisis management context in Belgium and 2) to build prototype tools implementing and demonstrating the methodology developed

Decision analysis multicriteria analysis

International Nuclear Information System (INIS)

Lombard, J.

1986-09-01

The ALARA procedure covers a wide range of decisions from the simplest to the most complex one. For the simplest one the engineering judgement is generally enough and the use of a decision aiding technique is therefore not necessary. For some decisions the comparison of the available protection option may be performed from two or a few criteria (or attributes) (protection cost, collective dose,...) and the use of rather simple decision aiding techniques, like the Cost Effectiveness Analysis or the Cost Benefit Analysis, is quite enough. For the more complex decisions, involving numerous criteria or for decisions involving large uncertainties or qualitative judgement the use of these techniques, even the extended cost benefit analysis, is not recommended and appropriate techniques like multi-attribute decision aiding techniques are more relevant. There is a lot of such particular techniques and it is not possible to present all of them. Therefore only two broad categories of multi-attribute decision aiding techniques will be presented here: decision analysis and the outranking analysis

Providing Quantitative Information and a Nudge to Undergo Stool Testing in a Colorectal Cancer Screening Decision Aid: A Randomized Clinical Trial.

Science.gov (United States)

Schwartz, Peter H; Perkins, Susan M; Schmidt, Karen K; Muriello, Paul F; Althouse, Sandra; Rawl, Susan M

2017-08-01

Guidelines recommend that patient decision aids should provide quantitative information about probabilities of potential outcomes, but the impact of this information is unknown. Behavioral economics suggests that patients confused by quantitative information could benefit from a "nudge" towards one option. We conducted a pilot randomized trial to estimate the effect sizes of presenting quantitative information and a nudge. Primary care patients (n = 213) eligible for colorectal cancer screening viewed basic screening information and were randomized to view (a) quantitative information (quantitative module), (b) a nudge towards stool testing with the fecal immunochemical test (FIT) (nudge module), (c) neither a nor b, or (d) both a and b. Outcome measures were perceived colorectal cancer risk, screening intent, preferred test, and decision conflict, measured before and after viewing the decision aid, and screening behavior at 6 months. Patients viewing the quantitative module were more likely to be screened than those who did not ( P = 0.012). Patients viewing the nudge module had a greater increase in perceived colorectal cancer risk than those who did not ( P = 0.041). Those viewing the quantitative module had a smaller increase in perceived risk than those who did not ( P = 0.046), and the effect was moderated by numeracy. Among patients with high numeracy who did not view the nudge module, those who viewed the quantitative module had a greater increase in intent to undergo FIT ( P = 0.028) than did those who did not. The limitations of this study were the limited sample size and single healthcare system. Adding quantitative information to a decision aid increased uptake of colorectal cancer screening, while adding a nudge to undergo FIT did not increase uptake. Further research on quantitative information in decision aids is warranted.

Decision aiding techniques for site remediation

Energy Technology Data Exchange (ETDEWEB)

Van de Walle, B

1996-09-18

Decision making problems in the nuclear domain are known for their complexity since they usually involve a wide range of technical, social, and political considerations. Site restoration is a typical example of a complex nuclear decision problem, and more and more decision makers realize that they need new tools to assist in the decision making process. This paper reports on multi-criteria decision analysis, a powerful tool for handling complex decisions involving multiple criteria. The motivation to use multi-criteria decision analysis in the domain of site restoration is illustrated. New developments and challenges in this field are addressed.

Decision aiding techniques for site remediation

International Nuclear Information System (INIS)

Van de Walle, B.

1996-01-01

Decision making problems in the nuclear domain are known for their complexity since they usually involve a wide range of technical, social, and political considerations. Site restoration is a typical example of a complex nuclear decision problem, and more and more decision makers realize that they need new tools to assist in the decision making process. This paper reports on multi-criteria decision analysis, a powerful tool for handling complex decisions involving multiple criteria. The motivation to use multi-criteria decision analysis in the domain of site restoration is illustrated. New developments and challenges in this field are addressed

A Graphical Adversarial Risk Analysis Model for Oil and Gas Drilling Cybersecurity

Directory of Open Access Journals (Sweden)

Aitor Couce Vieira

2014-04-01

Full Text Available Oil and gas drilling is based, increasingly, on operational technology, whose cybersecurity is complicated by several challenges. We propose a graphical model for cybersecurity risk assessment based on Adversarial Risk Analysis to face those challenges. We also provide an example of the model in the context of an offshore drilling rig. The proposed model provides a more formal and comprehensive analysis of risks, still using the standard business language based on decisions, risks, and value.

Mismatch between health-care professionals' and patients' views on a diabetes patient decision aid: a qualitative study.

Science.gov (United States)

Lee, Ping Yein; Khoo, Ee Ming; Low, Wah Yun; Lee, Yew Kong; Abdullah, Khatijah Lim; Azmi, Syahidatul Akmal; Ng, Chirk Jenn

2016-04-01

Malaysia is an Asian country with population of diverse culture and health perceptions. Patient decision aid (PDA) is a new tool in Malaysia. Patients' and health-care professionals' (HCPs) expectation of a PDA is unknown. We aimed to explore patients' and health-care professionals'(HCPs) views on the information needed in a patient decision aid (PDA) on insulin initiation developed for patients with type 2 diabetes mellitus (T2DM). We used a qualitative design and thematic approach. Three main primary health-care settings in Malaysia: public university-based primary care clinics, public health-care clinics and private general practices. We conducted focus groups and one-to-one interviews with a purposive sample of health professionals and patients with type 2 diabetes. We interviewed 18 patients and 13 HCPs. Patients viewed the content of the PDA as simple and clear. However, HCPs felt the PDA might be difficult for patients with low literacy to understand. HCPs thought the PDA was too lengthy. Nevertheless, patients would prefer more information. HCPs tended to focus on benefits of insulin, while patients wanted to know the impact of insulin on their quality of life and practical issues regarding insulin and its side-effects. Patients preferred numbers to weigh the risks and benefits of treatment options. HCPs' views that presenting numbers in a PDA would be too complex for patients to understand. It is important to consider including issues related to psycho-social impact of treatment to patients when developing a patient decision aid. © 2015 John Wiley & Sons Ltd.

Women's role in reproductive health decision making and vulnerability to STD and HIV/AIDS in Ekiti, Nigeria.

Science.gov (United States)

Orubuloye, I O; Oguntimehin, F; Sadiq, T

1997-01-01

An exploratory study of women's role in reproductive decision making in Ekiti shows that women in the state are increasingly taking active decisions on matters affecting their daily lives. More women than ever before believed that they could take decisions on family size, when to have a baby and choice of spacing period. The cultural barrier against short postpartum abstinence appeared to have diminished and sex during lactation was not considered a major cultural and religious taboo. Knowledge of contraception has become universal in recent years, and the majority of women take decisions on the method and timing of family planning. All women who used family planning considered their decision in this regard very important. The ability of women to take decisions on these issues may not only enhance their bargaining power but also reduce their vulnerability to STDs including AIDS from diseased or high-risk partners.

A new drilling method-Earthworm-like vibration drilling.

Science.gov (United States)

Wang, Peng; Ni, Hongjian; Wang, Ruihe

2018-01-01

The load transfer difficulty caused by borehole wall friction severely limits the penetration rate and extended-reach limit of complex structural wells. A new friction reduction technology termed "earthworm-like drilling" is proposed in this paper to improve the load transfer of complex structural wells. A mathematical model based on a "soft-string" model is developed and solved. The results show that earthworm-like drilling is more effective than single-point vibration drilling. The amplitude and frequency of the pulse pressure and the installation position of the shakers have a substantial impact on friction reduction and load transfer. An optimization model based on the projection gradient method is developed and used to optimize the position of three shakers in a horizontal well. The results verify the feasibility and advantages of earthworm-like drilling, and establish a solid theoretical foundation for its application in oil field drilling.

Seize the data (Carpe data) : wave of computerized data capture technology sweeps drilling industry

Energy Technology Data Exchange (ETDEWEB)

Mahoney, J.

1999-02-01

The computerization of all aspects of the monitoring and collection of well drilling information is discussed. Global Link International Inc. of Calgary, has developed a computerized system for tracking and recording drilling data. This operations recording database is named the Electronic Tour Book (ETB). It is similar to the Electronic Tour Sheet (ETS) developed by Chimo Equipment Ltd. of Alberta. Both Windows-based systems represent computerized reporting mechanisms for operators, producers, loggers and rig-managers. Another Alberta company, Ryan Energy Technologies Inc., has begun marketing the Tru Vu Fusion system of hardware and software, yet another system for gathering and recording drilling data. Tru Vu Fusion can capture data and display it in a format that everybody at the wellsite can use for decision making. Another drilling data management system, entitled INSITE (for Integrated System for Information Technology and Engineering) is marketed by Sperry-Sun Drilling Services. While INSITE is intended primarily for offshore drilling applications, it can be used onshore with equal success. 4 figs.

Drilling reorganizes

Science.gov (United States)

Richman, Barbara T.

As the first in a proposed series of steps that would move scientific ocean drilling from its own niche within the National Science Foundation's (NSF) Directorate for Astronomical, Atmospheric, Earth, and Ocean Sciences (AAEO) into the agency's Division of Ocean Sciences, Grant Gross, division director, has been appointed acting director of the Office of Scientific Ocean Drilling (OSOD). Gross will retain the directorship of the division, which also is part of AAEO. Allen M. Shinn, Jr., OSOD director for nearly 2 years, has been reassigned effective July 10 to a position in NSF's Office of Planning and Resource Management.The move aims to tie drilling operations more closely to the science with which it is associated, Gross said. This first step is an organizational response to the current leaning toward using a commercial drilling vessel as the drilling platform, he said. Before the market for such commercial drill ships opened (Eos, February 22, 1983, p . 73), other ship options for scientific ocean drilling included refurbishing the aging Glomar Challenger or renovating, at great expense, the Glomar Explorer. A possible next step in the reorganization is to make OSOD the third section within the Ocean Sciences Division. Currently, the division is divided into the Oceanographic Facilities and Support Section and the Ocean Sciences Research Section.

Watchful waiting or induction of labour--a matter of informed choice: identification, analysis and critical appraisal of decision aids and patient information regarding care options for women with uncomplicated singleton late and post term pregnancies: a review.

Science.gov (United States)

Berger, Bettina; Schwarz, Christiane; Heusser, Peter

2015-05-07

Decision-making during pregnancy regarding different options of care can be difficult, particularly when risks of intervention versus no intervention for mother and baby are unclear. Unbiased information and support for decision making may be beneficial in these situations. The management of normal pregnancies at and beyond term is an example of such a situation. In order to determine the need to develop an evidence-based decision aid this paper searches, analyses and appraises patient decision aids and patient information leaflets regarding care options in cases of late term and post-term pregnancies, including complementary and alternative medicine (CAM). A literature search was carried out in a variety of lay and medical databases. written information related to uncomplicated singleton pregnancies and targeted at lay people. Analysis and appraisal of included material by means of quality criteria was set up based on the International Patient Decision Aid Standards accounting for evidence-basing of CAM options. Inclusion of two decision aids and eleven leaflets from four decision aids and sixteen leaflets. One decision aid met the quality criteria almost completely, the other one only insufficiently despite providing some helpful information. Only one leaflet is of good quality, but cannot substitute a decision aid. There is an urgent need for the design of an evidence-based decision aid of good quality for late-term or post-term pregnancy, particularly in German language.

Involving women in personalised decision-making on mode of delivery after caesarean section: the development and pilot testing of a patient decision aid.

Science.gov (United States)

Schoorel, E N C; Vankan, E; Scheepers, H C J; Augustijn, B C C; Dirksen, C D; de Koning, M; van Kuijk, S M J; Kwee, A; Melman, S; Nijhuis, J G; Aardenburg, R; de Boer, K; Hasaart, T H M; Mol, B W J; Nieuwenhuijze, M; van Pampus, M G; van Roosmalen, J; Roumen, F J M E; de Vries, R; Wouters, M G A J; van der Weijden, T; Hermens, R P M G

2014-01-01

To develop a patient decision aid (PtDA) for mode of delivery after caesarean section that integrates personalised prediction of vaginal birth after caesarean (VBAC) with the elicitation of patient preferences and evidence-based information. A PtDA was developed and pilot tested using the International Patients Decision Aid Standards (IPDAS) criteria. Obstetric health care in the Netherlands. A multidisciplinary steering group, an expert panel, and 25 future users of the PtDA, i.e. women with a previous caesarean section. The development consisted of a construction phase (definition of scope and purpose, and selection of content, framework, and format) and a pilot testing phase by interview. The process was supervised by a multidisciplinary steering group. Usability, clarity, and relevance. The construction phase resulted in a booklet including unbiased balanced information on mode of birth after caesarean section, a preference elicitation exercise, and tailored risk information, including a prediction model for successful VBAC. During pilot testing, visualisation of risks and clarity formed the main basis for revisions. Pilot testing showed the availability of tailored structured information to be the main factor involving women in decision-making. The PtDA meets 39 out of 50 IPDAS criteria (78%): 23 out of 23 criteria for content (100%) and 16 out of 20 criteria for the development process (80%). Criteria for effectiveness (n = 7) were not evaluated. An evidence-based PtDA was developed, with the probability of successful VBAC and the availability of structured information as key items. It is likely that the PtDA enhances the quality of decision-making on mode of birth after caesarean section. © 2013 Royal College of Obstetricians and Gynaecologists.

The importance of decision-making aids in the energy area: from planning to the management of disorder and climate change

International Nuclear Information System (INIS)

Taverdet-Popiolek, N.

2011-01-01

The purpose of this article is to situate decision-making aids in the energy area in France and show how the tools have changed over time as a function of the changing economic and political context. The challenges faced, already important in the post-war era due to reconstruction, are now huge due to supply constraints and global warming. While it is the State's responsibility to address these issues, as the players in the energy area currently are mainly in the private sphere, we look at decisions taken both by the State and by companies. Schematically, we compare two major periods: that of post-war planning through the eighties, and that of risk management, which has been current practice since market deregulation. From the methodological standpoint, we show that decision-making aids borrow tools from varied disciplines ranging from economics through management to futurology and long range planning. (author)

Effects of a Short Drilling Implant Protocol on Osteotomy Site Temperature and Drill Torque.

Science.gov (United States)

Mihali, Sorin G; Canjau, Silvana; Cernescu, Anghel; Bortun, Cristina M; Wang, Hom-Lay; Bratu, Emanuel

2018-02-01

To establish a protocol for reducing the drilling sequence during implant site preparation based on temperature and insertion torque. The traditional conventional drilling sequence (used several drills with 0.6-mm increment each time) was compared with the proposed short drilling protocol (only used 2 drills: initial and final drill). One hundred drilling osteotomies were performed in bovine and porcine bones. Sets of 2 osteotomy sites were created in 5 bone densities using 2 types of drilling protocols. Thermographic pictures were captured throughout all drilling procedures and analyzed using ThermaCAM Researcher Professional 2.10. Torque values were determined during drilling by measuring electrical input and drill speed. There were statistically significant differences in bone temperature between the conventional and short drilling protocols during implant site preparation (analysis of variance P = 0.0008). However, there were no significant differences between the 2 types of drilling protocols for both implant diameters. Implant site preparation time was significantly reduced when using the short drilling protocol compared with the conventional drilling protocol (P drilling protocol proposed herein may represent a safe approach for implant site preparation.

Point-of-views representation for hypothetical reasoning: application to decision-aid

International Nuclear Information System (INIS)

Diaz, Antoine

1992-01-01

Most of the knowledge based Decision Support Systems must deal with two difficulties in problem solving representation: reasoning with incomplete knowledge and managing contradictory reasoning. We propose a method which answers the question of reasoning revision when a contradiction occurs, while preserving the functionalities of the De Kleer's ATMS System for simulating hypothetical reasoning. As a matter of fact, these functionalities are particularly suitable for decision aiding problems. In order to formalize the ATMS, we use a resolution method called Cat-resolution (Cayrol and Tayrac). This method allows the computation of ATMS functions relating to a set of propositional clauses by saturating this set. Owing to this choice, we can use the same principles as ATMS on the saturation trace. Each clause in the saturated set can be linked to the sets of initial clauses justifying its derivation by Cat-resolution. The reasoning inconsistency is now managed. First the user can identify the source of the inconsistency thanks to the empty clause explanation. Then he can try to restore the reasoning consistency by relaxing at least one of the initial clauses justifying the empty clause. The computation of 'partial' ATMS, representing a point of view in the decision-making problem, is more effective owing to the justifications of the derived clauses. (author) [fr

An exploration of decision aid effectiveness: the impact of promoting affective vs. deliberative processing on a health-related decision.

Science.gov (United States)

Davis, Esther L; McCaffery, Kirsten; Mullan, Barbara; Juraskova, Ilona

2015-12-01

Decision aids (DAs) are non-directive communication tools that help patients make value-consistent health-care decisions. However, most DAs have been developed without an explicit theoretical framework, resulting in a lack of understanding of how DAs achieve outcomes. To investigate the effect of promoting affective vs. deliberative processing on DA effectiveness based on dual-process theory. One hundred and forty-eight female university students participated in a randomized controlled experiment with three conditions: emotion-focused, information-focused and control. Preference-value consistency, knowledge, decisional conflict and satisfaction were compared across the conditions using planned contrast analyses. The intervention comprised two different DAs and instructional manipulations. The emotion-focused condition received a modified DA with affective content and instructions to induce an affective reaction. The information-focused and control conditions received the same DA without the affective content. The information-focused condition received additional instructions to induce deliberative processing. Controlling for the experiment-wise error rate at P processing may hinder value-consistent decision making, while deliberative processing may enhance decisional satisfaction. This investigation of the effect of affective and deliberative processes in DA-supported decision making has implications for the design and use of DAs. DA effectiveness may be enhanced by incorporating a simple instruction to focus on the details of the information. © 2014 John Wiley & Sons Ltd.

Surgical drill system and surgical drill bit to be used therein

NARCIS (Netherlands)

Margallo Balbas, E.; Wieringa, P.A.; French, P.J.; Lee, R.A.; Breedveld, P.

2007-01-01

Surgical drill system comprising a mechanical drill bit and means for imaging the vicinity of the drill bit tip, said means comprising: at least one optical fiber having a distal end and a proximal end, said distal end being located adjacent said drill bit tip, an optical processing unit, said

Slow drilling speeds for single-drill implant bed preparation. Experimental in vitro study.

Science.gov (United States)

Delgado-Ruiz, R A; Velasco Ortega, E; Romanos, G E; Gerhke, S; Newen, I; Calvo-Guirado, J L

2018-01-01

To evaluate the real-time bone temperature changes during the preparation of the implant bed with a single-drill protocol with different drill designs and different slow drilling speeds in artificial type IV bone. For this experimental in vitro study, 600 implant bed preparations were performed in 10 bovine bone disks using three test slow drilling speeds (50/150/300 rpm) and a control drilling speed (1200 rpm). The temperature at crestal and apical areas and time variations produced during drilling with three different drill designs with similar diameter and length but different geometry were recorded with real-life thermographic analysis. Statistical analysis was performed by two-way analysis of variance. Multiple comparisons of temperatures and time with the different drill designs and speeds were performed with the Tukey's test. T Max values for the control drilling speed with all the drill designs (D1 + 1200; D2 + 1200; D3 + 1200) were higher compared to those for the controls for 11 ± 1.32 °C (p drilling at 50 rpm resulted in the lowest temperature increment (22.11 ± 0.8 °C) compared to the other slow drilling speeds of 150 (24.752 ± 1.1 °C) and 300 rpm (25.977 ± 1.2 °C) (p drilling speeds compared to that for the control drilling speed. Slow drilling speeds required significantly more time to finish the preparation of the implant bed shown as follows: 50 rpm > 150 rpm > 300 rpm > control (p drill protocol with slow drilling speeds (50, 150, and 300 rpm) without irrigation in type IV bone increases the temperature at the coronal and apical levels but is below the critical threshold of 47 °C. The drill design in single-drill protocols using slow speeds (50, 150, and 300 rpm) does not have an influence on the thermal variations. The time to accomplish the implant bed preparation with a single-drill protocol in type IV bone is influenced by the drilling speed and not by the drill design. As the speed decreases, then

Reduced abrasion drilling fluid

NARCIS (Netherlands)

2010-01-01

A reduced abrasion drilling fluid system and method of drilling a borehole by circulating the reduced abrasion drilling fluid through the borehole is disclosed. The reduced abrasion drilling fluid comprises a drilling fluid, a first additive and a weighting agent, wherein the weighting agent has a

Reduced abrasion drilling fluid

NARCIS (Netherlands)

2012-01-01

A reduced abrasion drilling fluid system and method of drilling a borehole by circulating the reduced abrasion drilling fluid through the borehole is disclosed. The reduced abrasion drilling fluid comprises a drilling fluid, a first additive and a weighting agent, wherein the weighting agent has a

Core drilling of deep borehole OL-KR33 at Olkiluoto in Eurajoki 2004

Energy Technology Data Exchange (ETDEWEB)

Rautio, T. [Suomen Malmi Oy, Espoo (Finland)

2005-01-15

Posiva Oy submitted an application for the Decision in Principle to the Finnish Government in May 1999. A positive decision was made at the end of 2000 by the Government. The Finnish Parliament ratified the Decision in Principle on the final disposal facility for spent nuclear fuel at Olkiluoto, Eurajoki in May 2001. The decision makes it possible for Posiva to focus the confirming bedrock investigations at Olkiluoto, where in the next few years an underground rock characterisation facility, the ONKALO, will be constructed. As a part of the investigations Suomen Malmi Oy (Smoy) core drilled 311.02 m and 45.53 m deep boreholes with a diameter of 75.7 mm at Olkiluoto in November-December 2004. These boreholes were aimed to get additional information of the quality of bedrock and the quality and the location of the fractured zones R2, RH9 and R72. The identification numbers of the boreholes are OL-KR33 and OL-KR33B, respectively. A set of monitoring measurements and samplings from the drilling and returning water was carried out during the drilling. Both the volume and the electric conductivity of the drilling water and the returning water were recorded as well as the pressure of the drilling water. The objective of these measurements was to obtain more information about bedrock and groundwater properties. Sodium fluorescein was used as a label agent in the drilling water. The volumes of the used drilling water were about 195m{sup 3} and 14m{sup 3} and the measured volumes of the returning water were about 100 m{sup 3} and 9 m{sup 3} in boreholes OL-KR33 and OL-KR33B, respectively. The deviations of the boreholes were measured with the deviation measuring instruments EMS and Maxibor. The results of the Maxibor measurements indicate that borehole OL-KR33 deviates 15.97 m right and 31.04 m up at the borehole depth of 309 m. Uniaxial compressive strength, Young's Modulus and Poisson's ratio were measured from the core samples. The average uniaxial compressive

Use of Video Decision Aids to Promote Advance Care Planning in Hilo, Hawai?i

OpenAIRE

Volandes, Angelo E.; Paasche-Orlow, Michael K.; Davis, Aretha Delight; Eubanks, Robert; El-Jawahri, Areej; Seitz, Rae

2016-01-01

Introduction: Advance care planning (ACP) seeks to promote care delivery that is concordant with patients’ informed wishes. Scalability and cost may be barriers to widespread ACP, and video decision aids may help address such barriers. Aim Our primary hypothesis was that ACP documentation would increase in Hilo after ACP video implementation. Secondary hypotheses included increased use of hospice, fewer deaths in the hospital, and decreased costs in the last month of life. Setting: The city o...

Design and development of a decision aid to enhance shared decision making by patients with an asymptomatic abdominal aortic aneurysm

Directory of Open Access Journals (Sweden)

Dirk T Ubbink

2008-11-01

Full Text Available Dirk T Ubbink1,2, Anouk M Knops1, Sjaak Molenaar1, Astrid Goossens11Department of Quality Assurance and Process Innovation and 2Department of Surgery, Academic Medical Center, Amsterdam, The NetherlandsObjective: To design, develop, and evaluate an evidence-based decision aid (DA for patients with an asymptomatic abdominal aortic aneurysm (AAA to inform them about the pros and cons of their treatment options (ie, surgery or watchful observation and to help them make a shared decision.Methods: A multidisciplinary team defined criteria for the desired DA as to design, medical content and functionality, particularly for elderly users. Development was according to the international standard (IPDAS. Fifteen patients with an AAA, who were either treated or not yet treated, evaluated the tool.Results: A DA was developed to offer information about the disease, the risks and benefits of surgical treatment and watchful observation, and the individual possibilities and threats based on the patient’s aneurysm diameter and risk profile. The DA was improved and judged favorably by physicians and patients.Conclusion: This evidence-based DA for AAA patients, developed according to IPDAS criteria, is likely to be a simple, user-friendly tool to offer patients evidence-based information about the pros and cons of treatment options for AAA, to improve patients’ understanding of the disease and treatment options, and may support decision making based on individual values.Keywords: decision support techniques, research design, program development, abdominal aortic aneurysm, decision making

Does Patient Preference Measurement in Decision Aids Improve Decisional Conflict? A Randomized Trial in Men with Prostate Cancer.

Science.gov (United States)

Shirk, Joseph D; Crespi, Catherine M; Saucedo, Josemanuel D; Lambrechts, Sylvia; Dahan, Ely; Kaplan, Robert; Saigal, Christopher

2017-12-01

Shared decision making (SDM) has been advocated as an approach to medical decision making that can improve decisional quality. Decision aids are tools that facilitate SDM in the context of limited physician time; however, many decision aids do not incorporate preference measurement. We aim to understand whether adding preference measurement to a standard patient educational intervention improves decisional quality and is feasible in a busy clinical setting. Men with incident localized prostate cancer (n = 122) were recruited from the Greater Los Angeles Veterans Affairs (VA) Medical Center urology clinic, Olive View UCLA Medical Center, and Harbor UCLA Medical Center from January 2011 to May 2015 and randomized to education with a brochure about prostate cancer treatment or software-based preference assessment in addition to the brochure. Men undergoing preference assessment received a report detailing the relative strength of their preferences for treatment outcomes used in review with their doctor. Participants completed instruments measuring decisional conflict, knowledge, SDM, and patient satisfaction with care before and/or after their cancer consultation. Baseline knowledge scores were low (mean 62%). The baseline mean total score on the Decisional Conflict Scale was 2.3 (±0.9), signifying moderate decisional conflict. Men undergoing preference assessment had a significantly larger decrease in decisional conflict total score (p = 0.023) and the Perceived Effective Decision Making subscale (p = 0.003) post consult compared with those receiving education only. Improvements in satisfaction with care, SDM, and knowledge were similar between groups. Individual-level preference assessment is feasible in the clinic setting. Patients with prostate cancer who undergo preference assessment are more certain about their treatment decisions and report decreased levels of decisional conflict when making these decisions.

Activity plan: Directional drilling and environmental measurements while drilling

International Nuclear Information System (INIS)

Myers, D.A.

1998-01-01

This activity plan describes the testing of directional drilling combined with environmental measurements while drilling at two Hanford Site locations. A cold test is to be conducted at the 105A Mock Tank Leak Facility in the 200 East Area. A hot test is proposed to be run at the 216-B-8 tile field north of the 241-B Tank Farm in 200 East Area. Criteria to judge the success, partial success or failure of various aspects of the test are included. The TWRS program is assessing the potential for use of directional drilling because of an identified need to interrogate the vadose zone beneath the single-shell tanks. Because every precaution must be taken to assure that investigation activities do not violate the integrity of the tanks, control of the drill bit and ability to follow a predetermined drill path are of utmost importance and are being tested

Case drilling - an innovative approach to reducing drilling costs

Energy Technology Data Exchange (ETDEWEB)

Madell, G.; Tessari, R. M. [Tesco Corp., Calgary, AB (Canada); Warren, T. [Tesco Drilling Technology, Calgary, AB (Canada)

1999-11-01

Casing drilling is introduced as a new drilling technique that uses standard oil field casing to simultaneously drill and case the well. The technology includes both rig and downhole equipment, customized to function effectively as an integrated drilling system. This paper describes the testing program designed to identify and overcome technical challenges. Although not fully optimized, it appears that the system is functional. Test results indicate the need for improvements in the pump down cement float equipment and the tools and procedures for drilling up the cement plugs. The pump down latch and retrieval system also needs to be further developed and tested for high angle directional applications. Cost savings in the range of 10 to 15 per cent are expected for trouble-free wells. By eliminating the cost of unscheduled events encountered in troublesome wells, cost savings may reach as high as 30 per cent. 3 refs., 7 figs.

Activity plan: Directional drilling and environmental measurements while drilling

Energy Technology Data Exchange (ETDEWEB)

Myers, D.A.

1998-07-16

This activity plan describes the testing of directional drilling combined with environmental measurements while drilling at two Hanford Site locations. A cold test is to be conducted at the 105A Mock Tank Leak Facility in the 200 East Area. A hot test is proposed to be run at the 216-B-8 tile field north of the 241-B Tank Farm in 200 East Area. Criteria to judge the success, partial success or failure of various aspects of the test are included. The TWRS program is assessing the potential for use of directional drilling because of an identified need to interrogate the vadose zone beneath the single-shell tanks. Because every precaution must be taken to assure that investigation activities do not violate the integrity of the tanks, control of the drill bit and ability to follow a predetermined drill path are of utmost importance and are being tested.

Environmental Measurement-While-Drilling System and Horizontal Directional Drilling Technology Demonstration, Hanford Site

International Nuclear Information System (INIS)

Williams, C.V.; Lockwood, G.J.; Normann, R.A.; Myers, D.A.; Gardner, M.G.; Williamson, T.; Huffman, J.

1999-01-01

The Environmental Measurement-While-Drilling (EMWD) system and Horizontal Directional Drilling (HDD) were successfully demonstrated at the Mock Tank Leak Simulation Site and the Drilling Technology Test Site, Hanford, Washington. The use of directional drilling offers an alternative to vertical drilling site characterization. Directional drilling can develop a borehole under a structure, such as a waste tank, from an angled entry and leveling off to horizontal at the desired depth. The EMWD system represents an innovative blend of new and existing technology that provides the capability of producing real-time environmental and drill bit data during drilling operations. The technology demonstration consisted of the development of one borehole under a mock waste tank at a depth of approximately minus8 m (minus27 ft.), following a predetermined drill path, tracking the drill path to within a radius of approximately1.5 m (5 ft.), and monitoring for zones of radiological activity using the EMWD system. The purpose of the second borehole was to demonstrate the capability of drilling to a depth of ∼ -21 m (-70 ft.), the depth needed to obtain access under the Hanford waste tanks, and continue drilling horizontally. This report presents information on the HDD and EMWD technologies, demonstration design, results of the demonstrations, and lessons learned

Barriers and Facilitators to Patient-Provider Communication When Discussing Breast Cancer Risk to Aid in the Development of Decision Support Tools.

Science.gov (United States)

Yi, Haeseung; Xiao, Tong; Thomas, Parijatham S; Aguirre, Alejandra N; Smalletz, Cindy; Dimond, Jill; Finkelstein, Joseph; Infante, Katherine; Trivedi, Meghna; David, Raven; Vargas, Jennifer; Crew, Katherine D; Kukafka, Rita

2015-01-01

The purpose of this study was to identify barriers and facilitators to patient-provider communication when discussing breast cancer risk to aid in the development of decision support tools. Four patient focus groups (N=34) and eight provider focus groups (N=10) took place in Northern Manhattan. A qualitative analysis was conducted using Atlas.ti software. The coding yielded 62.3%-94.5% agreement. The results showed that 1) barriers are time constraints, lack of knowledge, low health literacy, and language barriers, and 2) facilitators are information needs, desire for personalization, and autonomy when communicating risk in patient-provider encounters. These results will inform the development of a patient-centered decision aid (RealRisks) and a provider-facing breast cancer risk navigation (BNAV) tool, which are designed to facilitate patient-provider risk communication and shared decision-making about breast cancer prevention strategies, such as chemoprevention.

The Swedish Deep Drilling Program - an emerging scientific drilling program and new infrastructure.

Science.gov (United States)

Lorenz, Henning; Juhlin, Christopher

2010-05-01

Scientific drilling projects imply numerous aspects that are difficult to handle for individual research groups. Therefore, about three years ago a joint effort was launched in the Swedish geoscientific community to establish a national program for scientific drilling, the Swedish Deep Drilling Program (SDDP). Soon afterwards, several working groups established drilling proposals with Nordic and, also, international participation. With this serious interest in scientific drilling SDDP was able to successfully promote the Swedish membership in ICDP which commenced in 2008. Two SDDP projects achieved workshop grants from the International Continental Scientific Drilling Program (ICDP) in 2009. In the same year the Swedish Research Council decided to support an application for a truck-mounted drill rig - a big success for the SDDP working group. Scientific Drilling infrastructure: SDDP envisages a mobile platform that is capable of core drilling to at least 2500 m depth. The procurement will be made during 2010 and first operations are planned for 2011. This drill rig is primarily intended for use in the SDDP drilling projects, but will be rented out to other scientific drilling projects or even commercial enterprises in the remaining time to cover maintenance and future upgrade costs. SDDP's drill rig will be unique in Europe and complementary to the deep drilling InnovaRig of the GFZ German Research Centre for Geosciences. Until now, drilling to 2000 - 3000 m implied the use of a full-sized drill rig like the InnovaRig or the mobilization of a core drill rig from another continent. This gap will now be filled by Sweden's upcoming scientific drilling infrastructure. Drilling projects and proposals: Presently, SDDP serves six projects: "Collisional Orogeny in the Scandinavian Caledonides" (COSC; ICDP workshop spring 2010), the "Postglacial Fault Drilling Project" (PFDP; ICDP workshop autumn 2010), a "Deep Rock Laboratory" (DRL), "Palaeoproterozoic Mineralized Volcanic

ATUCHA I NPP - Emergency drill practice

International Nuclear Information System (INIS)

Sanda, Alejandro; Rosales, Gabriel

2008-01-01

Full text: Atucha I NPP performs an Emergency Drill Practice once a year. Its main goals are: -) Fulfill the requirements of the Argentine Nuclear Regulatory Authority (ARN) regarding Atucha I NPP's Operating License; -) Fulfill the commitment with the community regarding the safe and reliable operation Atucha I NPP; -) Verify the response of the Civil Organizations, Security Forces, and Armed Forces, as well as the correct application of the Emergency Plan; -) Perform the 'General Alarm Drill' periodic control; -) Perform a re-training of the members of the Security Advisor Internal Committee (CIAS) on the Internal and External Aspects of the Emergency Plan and on the related procedures; -) Test the Emergency Communications System. New goals are added every year, considering the Drill's scope. This drill comprises two different kinds of practices: Internal practices (practices in the station, with our personnel) and external practices (practices outside the station with governmental organizations). Internal practices comprise: -) Internal and external communications practices; -) Acoustic alarms; -) Personnel gathering in the Meeting Points; -) Safety of selected Meeting Points; -) Personnel count, selective evacuation; -) Iodide Potassium pills distribution; -) CICE (Internal Group for Emergency Control) Coordination. External practices comprise: -) Nuclear Regulatory Authority; -) Argentine Navy, Comando Area Naval Fluvial, Base Naval Zarate; -) Lima firemen; -) Zarate firemen; -) Municipal Civil Defense (Zarate and Lima); -) National Guard, Escuadron Atucha; -) Zarate Regional Hospital; -) Lima Police Department; -) Zarate Police Department; -) Argentine Coast Guard, Zarate; -) Local radios: Radio FM Libre, FM El Sitio; -) First Aid clinic. The following activities are performed together with the aforementioned organizations: -) Formation of an 'Operative committee'; -) Evacuation of citizens in a 3 km radio; -) Control of every access to Lima; -) Control of

Drilling cost analysis

International Nuclear Information System (INIS)

Anand, A.B.

1992-01-01

Drilling assumes greater importance in present day uranium exploration which emphasizes to explore more areas on the basis of conceptual model than merely on surface anomalies. But drilling is as costly as it is important and consumes a major share (50% to 60%) of the exploration budget. As such the cost of drilling has great bearing on the exploration strategy as well as on the overall cost of the project. Therefore, understanding the cost analysis is very much important when planning or intensifying an exploration programme. This not only helps in controlling the current operations but also in planning the budgetary provisions for future operations. Also, if the work is entrusted to a private party, knowledge of in-house cost analysis helps in fixing the rates of drilling in different formations and areas to be drilled. Under this topic, various factors that contribute to the cost of drilling per meter as well as ways to minimize the drilling cost for better economic evaluation of mineral deposits are discussed. (author)

Space weather effects on drilling accuracy in the North Sea

Directory of Open Access Journals (Sweden)

S. J. Reay

2005-11-01

Full Text Available The oil industry uses geomagnetic field information to aid directional drilling operations when drilling for oil and gas offshore. These operations involve continuous monitoring of the azimuth and inclination of the well path to ensure the target is reached and, for safety reasons, to avoid collisions with existing wells. Although the most accurate method of achieving this is through a gyroscopic survey, this can be time consuming and expensive. An alternative method is a magnetic survey, where measurements while drilling (MWD are made along the well by magnetometers housed in a tool within the drill string. These MWD magnetic surveys require estimates of the Earth's magnetic field at the drilling location to correct the downhole magnetometer readings. The most accurate corrections are obtained if all sources of the Earth's magnetic field are considered. Estimates of the main field generated in the core and the local crustal field can be obtained using mathematical models derived from suitable data sets. In order to quantify the external field, an analysis of UK observatory data from 1983 to 2004 has been carried out. By accounting for the external field, the directional error associated with estimated field values at a mid-latitude oil well (55° N in the North Sea is shown to be reduced by the order of 20%. This improvement varies with latitude, local time, season and phase of the geomagnetic activity cycle. By accounting for all sources of the field, using a technique called Interpolation In-Field Referencing (IIFR, directional drillers have access to data from a "virtual" magnetic observatory at the drill site. This leads to an error reduction in positional accuracy that is close to matching that of the gyroscopic survey method and provides a valuable independent technique for quality control purposes.

Exploring the requirements for a decision aid on familial breast cancer in the UK context: a qualitative study with patients referred to a cancer genetics service.

NARCIS (Netherlands)

Iredale, R.; Rapport, F.; Sivell, S.; Jones, W.; Edwards, A.; Gray, J.; Elwyn, G.

2008-01-01

RATIONALE: Patients concerned about a family history of breast cancer can face difficult decisions about screening, prophylactic surgery and genetic testing. Decision aids can facilitate patient decision making and currently include leaflets and computerized tools. These are largely aimed at the

Robotic Planetary Drill Tests

Science.gov (United States)

Glass, Brian J.; Thompson, S.; Paulsen, G.

2010-01-01

Several proposed or planned planetary science missions to Mars and other Solar System bodies over the next decade require subsurface access by drilling. This paper discusses the problems of remote robotic drilling, an automation and control architecture based loosely on observed human behaviors in drilling on Earth, and an overview of robotic drilling field test results using this architecture since 2005. Both rotary-drag and rotary-percussive drills are targeted. A hybrid diagnostic approach incorporates heuristics, model-based reasoning and vibration monitoring with neural nets. Ongoing work leads to flight-ready drilling software.

Drilling trends in the nineties

International Nuclear Information System (INIS)

1993-01-01

At a conference on various aspects of well drilling in the 1990s, papers were presented on drilling waste management, well completion and workovers, drilling fluids, drilling rig equipment and design, drilling mechanics, drill stem testing and materials, cementing, business management, health and safety, environmental issues, and directional drilling technology. Separate abstracts have been prepared for 46 papers from this conference

Scientific Drilling with the Sea Floor Drill Rig MeBo

Directory of Open Access Journals (Sweden)

Gerold Wefer

2007-09-01

Full Text Available In March 2007 the sea floor drill rig MeBo (short for “Meeresboden-Bohrgerät”, ‘sea floor drill rig’ in German returned from a 17-day scientific cruise with the new German research vessel Maria S. Merian. Four sites between 350 m and 1700 m water depth were sampled at the continental slope off Morocco by push coring and rotary drilling. Up to 41.5-m-long sediment cores were recovered from Miocene, Pliocene, and Pleistocene marls. MeBo bridges the gapbetween conventional sampling methods from standard multipurpose research vessels (gravity corer, piston corer, dredges and drill ships. Most bigger research vessels will be able to support deployment of the MeBo. Since the drill system can be easily transported within 20-ft containers, worldwide operation from vessels of opportunity is possible. With the MeBo a new system is available for marine geosciences that allows the recovery of high quality samples from soft sediments and hard rock from the deep sea withoutrelying on the services of expensive drilling vessels.

Drilling contract issues

International Nuclear Information System (INIS)

Davison, G.B.; Worden, D.R.; Borbridge, G.K.D.

1997-01-01

Some selected issues which are facing both operators and contractors in drilling for oil and gas, such as the allocation of risk by contract and by statute and the implementation of new technologies, were discussed. There are three varieties of written drilling contracts used in Canada: (1) day work and meterage contracts, (2) master drilling agreements, and (3) contracts that are used in construction projects that do not specifically relate to drilling. Issues relevant to the contractual allocation of risk, to implementing new drilling technologies, to reconciling contract and statute liability, and the formation of strategic alliances for mutual benefit, and the factors contributing to the success of such alliances were explored. 12 refs

Decommissioning: dismantling of thickwalled steel structures using the contact-arc-metal-drilling technique. Final report

International Nuclear Information System (INIS)

Bach, F.W.; Lindemaier, J.; Philipp, E.

1998-01-01

1. Status of the technology: Today austenitic steel components with a material thickness of more than 200 mm cannot be cut surely by using conventional thermal cutting techniques. A reduction of the wall thickness, by using an effective cutting technique with low restoring forces, is necessary but not available, now. 2. Objectives: Target of the project was the qualification of the thermal contact-arc-metal-drilling technique, based on the contact-arc-metal-cutting technique for the reduction of the wall thickness of steel components in preparation for other cutting techniques to finish the dismantling task if necessary. 3. Methode: Development of the contact-arc-metal-drilling technique for the production of deep (>200 mm) blind holes with non-circular cross sections. Optimization of the drilling parameters and quantification of the released emissions under a radiological aspect. Development of a monitoring system for the electrode wear and a device for changing weared electrodes automatically. 4. Result: The contact-arc-metal-drilling technique was qualified by producing blind holes with a depth of 230 mm. The aerosols, hydrosols and gas emissions of the process were quantified and various monitoring techniques for the wear of the electrode were tested. A pneumatically aided clamping and changing device for electrodes was designed and tested. 5. Applications: The designed clamping device with its integrated pneumatically aided electrode release can be adapted directly to a tool guiding machine. Using this cutting technique steel components with a material thickness of 230 mm can be reduced to a remaining wall thickness and the released emissions can be estimated. (orig.) [de

Cultural and linguistic adaptation of a multimedia colorectal cancer screening decision aid for Spanish-speaking Latinos.

Science.gov (United States)

Ko, Linda K; Reuland, Daniel; Jolles, Monica; Clay, Rebecca; Pignone, Michael

2014-01-01

As the United States becomes more linguistically and culturally diverse, there is a need for effective health communication interventions that target diverse, vulnerable populations, including Latinos. To address such disparities, health communication interventionists often face the challenge to adapt existing interventions from English into Spanish in a way that retains essential elements of the original intervention while also addressing the linguistic needs and cultural perspectives of the target population. The authors describe the conceptual framework, context, rationale, methods, and findings of a formative research process used in creating a Spanish-language version of an evidence-based (English language) multimedia colorectal cancer screening decision aid. The multistep process included identification of essential elements of the existing intervention, literature review, assessment of the regional context and engagement of key stakeholders, and solicitation of direct input from target population. The authors integrated these findings in the creation of the new adapted intervention. They describe how they used this process to identify and integrate sociocultural themes such as personalism (personalismo), familism (familismo), fear (miedo), embarrassment (verguenza), power distance (respeto), machismo, and trust (confianza) into the Spanish-language decision aid.

Towards the Significance of Decision Aid in Building Information Modeling (BIM Software Selection Process

Directory of Open Access Journals (Sweden)

Omar Mohd Faizal

2014-01-01

Full Text Available Building Information Modeling (BIM has been considered as a solution in construction industry to numerous problems such as delays, increased lead in times and increased costs. This is due to the concept and characteristic of BIM that will reshaped the way construction project teams work together to increase productivity and improve the final project outcomes (cost, time, quality, safety, functionality, maintainability, etc.. As a result, the construction industry has witnesses numerous of BIM software available in market. Each of this software has offers different function, features. Furthermore, the adoption of BIM required high investment on software, hardware and also training expenses. Thus, there is indentified that there is a need of decision aid for appropriated BIM software selection that fulfill the project needs. However, research indicates that there is limited study attempt to guide decision in BIM software selection problem. Thus, this paper highlight the importance of decision making and support for BIM software selection as it is vital to increase productivity, construction project throughout building lifecycle.

South African drilling

International Nuclear Information System (INIS)

Anon.

1984-01-01

According to the president of the South African Drilling Association, the drilling industry is meeting head-on the challenges created by the worldwide recession. The paper is a synopsis of several of the papers presented at the SADA symposium and a look at several mining-related drilling projects in South Africa. These papers include grouting techniques, the use of impregnated bits in hard rock drilling, tunnel boring for mines, surveying improvement methods and the use of explosives to increase groundwater yield

A new drilling method—Earthworm-like vibration drilling

Science.gov (United States)

Wang, Peng; Wang, Ruihe

2018-01-01

The load transfer difficulty caused by borehole wall friction severely limits the penetration rate and extended-reach limit of complex structural wells. A new friction reduction technology termed “earthworm-like drilling” is proposed in this paper to improve the load transfer of complex structural wells. A mathematical model based on a “soft-string” model is developed and solved. The results show that earthworm-like drilling is more effective than single-point vibration drilling. The amplitude and frequency of the pulse pressure and the installation position of the shakers have a substantial impact on friction reduction and load transfer. An optimization model based on the projection gradient method is developed and used to optimize the position of three shakers in a horizontal well. The results verify the feasibility and advantages of earthworm-like drilling, and establish a solid theoretical foundation for its application in oil field drilling. PMID:29641615

Preliminary evaluation of uranium deposits. A geostatistical study of drilling density in Wyoming solution fronts

International Nuclear Information System (INIS)

Sandefur, R.L.; Grant, D.C.

1976-01-01

Studies of a roll-front uranium deposit in Shirley Basin Wyoming indicate that preliminary evaluation of the reserve potential of an ore body is possible with less drilling than currently practiced in industry. Estimating ore reserves from sparse drilling is difficult because most reserve calculation techniques do not give the accuracy of the estimate. A study of several deposits with a variety of drilling densities shows that geostatistics consistently provides a method of assessing the accuracy of an ore reserve estimate. Geostatistics provides the geologist with an additional descriptive technique - one which is valuable in the economic assessment of a uranium deposit. Closely spaced drilling on past properties provides both geological and geometric insight into the occurrence of uranium in roll-front type deposits. Just as the geological insight assists in locating new ore bodies and siting preferential drill locations, the geometric insight can be applied mathematically to evaluate the accuracy of a new ore reserve estimate. By expressing the geometry in numerical terms, geostatistics extracts important geological characteristics and uses this information to aid in describing the unknown characteristics of a property. (author)

New optimized drill pipe size for deep-water, extended reach and ultra-deep drilling

Energy Technology Data Exchange (ETDEWEB)

Jellison, Michael J.; Delgado, Ivanni [Grant Prideco, Inc., Hoston, TX (United States); Falcao, Jose Luiz; Sato, Ademar Takashi [PETROBRAS, Rio de Janeiro, RJ (Brazil); Moura, Carlos Amsler [Comercial Perfuradora Delba Baiana Ltda., Rio de Janeiro, RJ (Brazil)

2004-07-01

A new drill pipe size, 5-7/8 in. OD, represents enabling technology for Extended Reach Drilling (ERD), deep water and other deep well applications. Most world-class ERD and deep water wells have traditionally been drilled with 5-1/2 in. drill pipe or a combination of 6-5/8 in. and 5-1/2 in. drill pipe. The hydraulic performance of 5-1/2 in. drill pipe can be a major limitation in substantial ERD and deep water wells resulting in poor cuttings removal, slower penetration rates, diminished control over well trajectory and more tendency for drill pipe sticking. The 5-7/8 in. drill pipe provides a significant improvement in hydraulic efficiency compared to 5-1/2 in. drill pipe and does not suffer from the disadvantages associated with use of 6-5/8 in. drill pipe. It represents a drill pipe assembly that is optimized dimensionally and on a performance basis for casing and bit programs that are commonly used for ERD, deep water and ultra-deep wells. The paper discusses the engineering philosophy behind 5-7/8 in. drill pipe, the design challenges associated with development of the product and reviews the features and capabilities of the second-generation double-shoulder connection. The paper provides drilling case history information on significant projects where the pipe has been used and details results achieved with the pipe. (author)

The Hans Tausen drill

DEFF Research Database (Denmark)

Johnsen, Sigfus Johann; Dahl-Jensen, Dorthe; Steffensen, Jørgen Peder

2007-01-01

In the mid-1990s, excellent results from the GRIP and GISP2 deep drilling projects in Greenland opened up funding for continued ice-coring efforts in Antarctica (EPICA) and Greenland (NorthGRIP). The Glaciology Group of the Niels Bohr Institute, University of Copenhagen, was assigned the task...... of providing drilling capability for these projects, as it had done for the GRIP project. The group decided to further simplify existing deep drill designs for better reliability and ease of handling. The drill design decided upon was successfully tested on Hans Tausen Ice Cap, Peary Land, Greenland, in 1995....... The 5.0 m long Hans Tausen (HT) drill was a prototype for the ~11 m long EPICA and NorthGRIP versions of the drill which were mechanically identical to the HT drill except for a much longer core barrel and chips chamber. These drills could deliver up to 4 m long ice cores after some design improvements...

Cognitive Systems Engineering Tool Survey - A Subtask in Support of Commander's Decision Aids for Predictive Battle-Space Awareness (CDA4PBA)

National Research Council Canada - National Science Library

Sanders, Mary; Fitzhugh, Elisabeth

2005-01-01

...) DO 6, Commander's Decision Aids for Predictive Battle-Space Awareness, (CDA4PBA) is to identify system requirements necessary to capture the entire software and systems engineering process from concept...

Drilling contracts and incentives

International Nuclear Information System (INIS)

Osmundsen, Petter; Sorenes, Terje; Toft, Anders

2008-01-01

Shortages of rigs and personnel have encouraged discussion of designing incentive contracts in the drilling sector. However, for the drilling contracts, there are not a large variety of contract types in use. This article describes and analyses incentives for drilling contractors. These are directly represented by the compensation formats utilised in the present and in the consecutive drilling contracts. Indirectly, incentives are also provided by the evaluation criteria that oil companies use for awarding drilling assignments. Changes in contract format pose a number of relevant questions relating to resource management, and the article takes an in-depth look at some of these. Do evaluation criteria for awarding drilling assignments encourage the development of new technology and solutions? How will a stronger focus on drilling efficiency influence reservoir utilisation?

A clinical decision aid for the selection of antithrombotic therapy for the prevention of stroke due to atrial fibrillation

DEFF Research Database (Denmark)

LaHaye, Stephen Andrew; Gibbens, Sabra Lynn; Ball, David Gerald Andrew

2012-01-01

The availability of new antithrombotic agents, each with a unique efficacy and bleeding profile, has introduced a considerable amount of clinical uncertainty with physicians. We have developed a clinical decision aid in order to assist clinicians in determining an optimal antithrombotic regime...

Decision making in the reactor control room

International Nuclear Information System (INIS)

Nelson, W.R.

1982-01-01

One of the most important roles of the nuclear reactor operator is that of decision maker. This paper discusses a simple model of the decision process used by the reactor operator. Resources that must be available so that he can perform the decision process are presented. Decision aids which have been investigated at EG and G Idaho, Inc., as part of the LOFT Augmented Operator Capability Program are briefly discussed. Some general concepts of computerized decision aiding are developed, and the promises and pitfalls of such decision aids are explored

Study on drilling induced delamination of woven kenaf fiber reinforced epoxy composite using carbide drills

Science.gov (United States)

Suhaily, M.; Hassan, C. H. Che; Jaharah, A. G.; Azmi, H.; Afifah, M. A.; Khairusshima, M. K. Nor

2018-04-01

In this research study, it presents the influences of drilling parameters on the delamination factor during the drilling of woven kenaf fiber reinforced epoxy composite laminates when using the carbide drill bits. The purpose of this study is to investigate the influence of drilling parameters such as cutting speed, feed rate and drill sizes on the delamination produced when drilling woven kenaf reinforced epoxy composite using the non-coated carbide drill bits. The damage generated on the woven kenaf reinforced epoxy composite laminates were observed both at the entrance and exit surface during the drilling operation. The experiments were conducted according to the Box Behnken experimental designs. The results indicated that the drill diameter has a significant influence on the delamination when drilling the woven kenaf fiber reinforced epoxy composites.

A Novel Decision Aid to Support Informed Decision-Making Process in Patients with a Symptomatic Nonlower Pole Renal Stone <20 mm in Diameter.

Science.gov (United States)

Gökce, Mehmet İlker; Esen, Barış; Sancı, Adem; Akpınar, Cağrı; Süer, Evren; Gülpınar, Ömer

2017-07-01

Stone disease is an important health problem, and patients have different treatment choices. Shared decision making is recommended for deciding the treatment type, but patient education is necessary. Decision aids (DAs) are used for this aim, and herein, we developed a novel DA for patients with symptomatic nonlower pole renal stones group assessment resulted in a total score of 50/54. Patient evaluation of the DA resulted in favorable outcomes, and patients generally recommended its use by other patients. This novel DA for patients with a symptomatic nonlower pole renal stone <20 mm showed promising results and was well accepted by the patients. We believe that this DA will have a positive impact on patients' level of knowledge. Increased level of knowledge will also improve the patients' contribution to the shared decision-making process. A further prospective randomized trial to compare with the standard patient informing process is also planned.

Drilling Performance of Rock Drill by High-Pressure Water Jet under Different Configuration Modes

Directory of Open Access Journals (Sweden)

Songyong Liu

2017-01-01

Full Text Available In the rock drilling progress, the resistant force results in tools failure and the low drilling efficiency; thus, it is necessary to reduce the tools failure and enhance the drilling efficiency. In this paper, different configuration modes of drilling performance assisted with water jet are explored based on the mechanism and experiment analysis of rock drilling assisted with water jet. Moreover, the rotary sealing device with high pressure is designed to achieve the axial and rotation movement simultaneously as well as good sealing effect under high-pressure water jet. The results indicate that the NDB and NFB have better effects on drilling performance compared with that of NSB. Moreover, the high-pressure water jet is helpful not only to reduce the drill rod deflection, but also to reduce the probability of drill rod bending and improve the drill rod service life.

"Provoking conversations": case studies of organizations where Option Grid™ decision aids have become 'normalized'.

Science.gov (United States)

Scalia, Peter; Elwyn, Glyn; Durand, Marie-Anne

2017-08-18

Implementing patient decision aids in clinic workflow has proven to be a challenge for healthcare organizations and physicians. Our aim was to determine the organizational strategies, motivations, and facilitating factors to the routine implementation of Option Grid™ encounter decision aids at two independent settings. Case studies conducted by semi-structured interview, using the Normalization Process Theory (NPT) as a framework for thematic analysis. Twenty three interviews with physicians, nurses, hospital staff and stakeholders were conducted at: 1) CapitalCare Medical Group in Albany, New York; 2) HealthPartners Clinics in Minneapolis, Minnesota. 'Coherent' motivations were guided by financial incentives at CapitalCare, and by a 'champion' physician at HealthPartners. Nurses worked 'collectively' at both settings and played an important role at sites where successful implementation occurred. Some physicians did not understand the perceived utility of Option Grid™, which led to varying degrees of implementation success across sites. The appraisal work (reflexive monitoring) identified benefits, particularly in terms of information provision. Physicians at both settings, however, were concerned with time pressures and the suitability of the tool for patients with low levels of health literacy. Although both practice settings illustrated the mechanisms of normalization postulated by the theory, the extent to which Option Grid™ was routinely embedded in clinic workflow varied between sites, and between clinicians. Implementation of new interventions will require attention to an identified rationale (coherence), and to the collective action, cognitive participation, and assessment of value by organizational members of the organization.

The development and use of decision aiding techniques for establishing intervention levels

International Nuclear Information System (INIS)

Kelly, G.N.; Sinnaeve, J.

1989-01-01

Following the Chernobyl accident there has been considerable international discussion on the principles underlying the choice of intervention levels and their practical application. While there is broad agreement on the underlying principles - that is to put potentially exposed individuals into a better position in the sense that lower overall risks are achieved at reasonable cost in financial and social terms - the determination of what constitutes the most appropriate type and level of intervention in any particular circumstances is more complex. Within the CEC Radiation Protection Research Programme techniques are being developed to aid well founded and more transparent decisions on the choice of intervention levels. The techniques are described and areas identified where they might usefully be applied

The Wind Atlas for South Africa (WASA): A tool to aid developers and decision makers

CSIR Research Space (South Africa)

Mabille, E

2015-10-01

Full Text Available ): A tool to aid developers and decision makers Eugene Mabille The WASA Project Team SANEDI South African National Energy Development Institute • executing agency – contracting the implementing partners • coordination and dissemination UCT... to produce wind atlas for generalised surface conditions (uniform terrain and roughness). Files compatible with WAsP software.  Used for the first WASA published in 2012.  KAMM/WAsP method, numerically very cheap, gives good results  underestimation...

Study of environmental concerns: offshore oil and gas drilling and production

Energy Technology Data Exchange (ETDEWEB)

Baker, R

1978-01-01

Material on the environmental concerns associated with offshore drilling and production activities has been synthesized with Department of Fisheries and Environment files on specific projects, these being the primary information source. Recommendations to resolve these concerns have also been provided. Most of the environmental concerns identified in this study are traceable to specific weaknesses in offshore drilling and production procedures and management systems. Hardware weaknesses are seldom of central importance. Areas of concern include the gradual deposition of pollutants from rigs, underwater pipelines and onshore ancillary structures, and the quality of the following: action plans to deal with oil spills, standards for safety and anti-pollution equipment, information provided on the environmental hazards in offshore drilling and production areas, environmental impact assessments, and communication links between those having environmental concerns and expertise (including the public-at-large) and those who make the decisions regarding offshore oil and gas development.

Environmental Measurement-While-Drilling system for real-time field screening of contaminants

International Nuclear Information System (INIS)

Lockwood, G.J.; Normann, R.A.; Bishop, L.B.; Floran, R.J.; Williams, C.V.

1995-01-01

Sampling during environmental drilling is essential to fully characterize the spatial distribution and migration of near surface contaminants. However, the analysis of these samples is not only expensive, but can take weeks or months when sent to an off-site laboratory. In contrast, measurement-while-drilling (MWD) screening capability could save money and valuable time by quickly distinguishing between contaminated and uncontaminated areas. Real-time measurements provided by a MVM system would enable on-the-spot decisions to be made regarding sampling strategies, enhance worker safety, and provide the added flexibility of being able to ''steer'' the drill bit in or out hazardous zones. During measurement-while-drilling, down-hole sensors are located behind the drill bit and linked by a rapid data transmission system to a computer at the surface. As drilling proceeds, data are collected on the nature and extent of the subsurface contamination in real-time. The down-hole sensor is a Geiger-Mueller tube (GMT) gamma radiation detector. In addition to the GMT signal, the MWD system monitors these required down-hole voltages and two temperatures associated with the detector assembly. The Gamma Ray Detection System (GRDS) and electronics package are discussed in as well as the results of the field test. Finally, our conclusions and discussion of future work are presented

Drilling technologies in hydrogeological survey

OpenAIRE

Vorlíček, Petr

2014-01-01

This work deals with the drilling technologies used in hydrogeology. The main aim of the work is to explore types of drilling technologies used at hydrogeological drilling wells and modern technologies that could potentially be used in the future. The work also summarizes a historical development of drilling techniques, a drilling process procedure, information obtained from boreholes and the most common types of drilling fluids.

Design and Exploitation Problems of Drill String in Directional Drilling

Directory of Open Access Journals (Sweden)

Bednarz Stanislaw

2004-09-01

Full Text Available Drill string design for directional drilling requires accounting for a number of factors. First, types and expected values of loads should be determined. Then, elements of the drill string should be so selected as to enable realization of the plan at specified loads. Some of additional factors, e. g. purchase, exploitation cost, geological conditions in the bore-hole, washing of the bore-hole, stability, trajectory, rig parameters, accuracy of gauges, pumps parameters remain in conflict. Drill pipes are made of rolled pipes, upset and welded with tool joints to 9,5 m long; the shorter ones can be made of hot forged rods. Exploitation requirements, being a result of practical experience supported by theoretical and laboratory analyses should be a part of syllabuses of technical staff educational programs. Apart from designing the string, it is also vital to lower the risk of a drilling failure. The significance of these aspects seems to be unquestionable.

Diagnostic System of Drill Condition in Laminated Chipboard Drilling Process

Directory of Open Access Journals (Sweden)

Swiderski Bartosz

2017-01-01

Full Text Available The paper presents an on-line automatic system for recognition of the drill condition in a laminated chipboard drilling process. Two states of the drill are considered: the sharp enough (still able to drill holes acceptable for processing quality and worn out (excessive drill wear, not satisfactory from the quality point of view of the process. The automatic system requires defining the diagnostic features, which are used as the input attributes to the classifier. The features have been generated from 5 registered signals: feed force, cutting torque, noise, vibration and acoustic emission. The statistical parameters defined on the basis of the auto regression model of these signals have been used as the diagnostic features. The sequential step-wise feature selection is applied for choosing the most discriminative set of features. The final step of recognition is done by support vector machine classifier working in leave one out mode. The results of numerical experiments have confirmed good quality of the proposed diagnostic system.

Horizontal drilling under Lake Erie

Energy Technology Data Exchange (ETDEWEB)

Meller, R.

2001-07-01

Drilling oil wells under Lake Erie calls for horizontal drilling wells to be drilled from shore out into the pay-zone under the lake. The nature and characteristics of horizontal wells as compared to vertical wells are explored. Considerations that have to be taken into account in drilling horizontal wells are explained (the degree of curvature, drilling fluid quality, geosteering in the pay-zone, steering instrumentation, measurements while drilling (MWD), logging while drilling (LWD)). The concept and reasons for extended reach wells are outlined, along with characteristic features of multilateral wells.

Effect of decision aid for breast cancer prevention on decisional conflict in women with a BRCA1 or BRCA2 mutation: a multisite, randomized, controlled trial.

Science.gov (United States)

Metcalfe, Kelly A; Dennis, Cindy-Lee; Poll, Aletta; Armel, Susan; Demsky, Rochelle; Carlsson, Lindsay; Nanda, Sonia; Kiss, Alexander; Narod, Steven A

2017-03-01

Women with a BRCA1 or BRCA2 mutation are at high risk for breast cancer and must make important decisions about breast cancer prevention and screening. In the current study, we report a multisite, randomized, controlled trial evaluating the effectiveness of a decision aid for breast cancer prevention in women with a BRCA mutation with no previous diagnosis of cancer. Within 1 month of receiving a positive BRCA result, women were randomized to receive either usual care (control group) or decision aid (intervention group). Participants were followed at 3, 6, and 12 months; were asked about preventive measures; and completed standardized questionnaires assessing decision making and psychosocial functioning. One hundred fifty women were randomized. Mean cancer-related distress scores were significantly lower in the intervention group compared with the control group at 6 months (P = 0.01) and at 12 months postrandomization (P = 0.05). Decisional conflict scores declined over time for both groups and at no time were there statistical differences between the two groups. The decision aid for breast cancer prevention in women with a BRCA1 or BRCA2 mutation is effective in significantly decreasing cancer-related distress within the year following receipt of positive genetic test results.Genet Med 19 3, 330-336.

Alteration in the IRDP drill hole compared with other drill holes in Iceland

Science.gov (United States)

Kristmannsdóttir, Hrefna

1982-08-01

The overall alteration pattern in the drill hole at Reydarfjördur is very similar to alteration patterns observed in Icelandic geothermal areas and in low-grade metamorphosed basalts in deep crustal sections elsewhere in Iceland. However more detail is obtained by the study of the IRDP drill core than by study of drill cuttings sampled in previous drill holes in Iceland. A comparatively high fossil thermal gradient is obtained at Reydarfjördur by a combination of mineral stability data and the observed occurence of secondary minerals. This high gradient is consistent with the measured dike dilation at the drill site and the location of the drill site adjacent to a central volcano.

Effect of decision making on ultrasonic examination performance

International Nuclear Information System (INIS)

Harris, D.H.

1992-05-01

A decision aid was developed to overcome examiner limitations in information processing and decision making during ultrasonic examinations. The aid provided a means of noting signal characteristics as they were observed during the examination, and of presenting them simultaneously for decision making. The aid also served as a way of providing detailed feedback on examination performance during training. The aid was incorporated into worksheets used for the conduct of practice examinations during ultrasonic examination training. To support the introduction and use of the decision aid, one hour of supplementary training was inserted in an existing 64-hour training course on ultrasonic detection of defects. This study represented a modest step in improving the performance of ultrasonic examinations in nuclear power plants. Findings indicated that aided decision making supported by limited training can significantly improve ultrasonic detection performance

A self propelled drilling system for hard-rock, horizontal and coiled tube drilling

Energy Technology Data Exchange (ETDEWEB)

Biglin, D.; Wassell, M.

1997-12-31

Several advancements are needed to improve the efficiency and reliability of both hard rock drilling and extended reach drilling. This paper will present a Self Propelled Drilling System (SPDS) which can grip the borehole wall in order to provide a stable platform for the application of weight on bit (WOB) and resisting the reactive torque created by the downhole drilling motor, bit and formation interaction. The system will also dampen the damaging effects of drill string vibration. This tool employs two hydraulically activated anchors (front and rear) to grip the borehole wall, and a two-way thrust mandrel to apply both the drilling force to the bit, and a retraction force to pull the drill string into the hole. Forward drilling motion will commence by sequencing the anchor pistons and thrust mandrel to allow the tool to walk in a stepping motion. The SPDS has a microprocessor to control valve timing, sensing and communication functions. An optional Measurement While Drilling (MWD) interface can provide two-way communication of critical operating parameters such as hydraulic pressure and piston location. This information can then be telemetered to the surface, or used downhole to autonomously control system parameters such as anchor and thrust force or damping characteristics.

Modeling pellet impact drilling process

Science.gov (United States)

Kovalyov, A. V.; Ryabchikov, S. Ya; Isaev, Ye D.; Ulyanova, O. S.

2016-03-01

The paper describes pellet impact drilling which could be used to increase the drilling speed and the rate of penetration when drilling hard rocks. Pellet impact drilling implies rock destruction by metal pellets with high kinetic energy in the immediate vicinity of the earth formation encountered. The pellets are circulated in the bottom hole by a high velocity fluid jet, which is the principle component of the ejector pellet impact drill bit. The experiments conducted has allowed modeling the process of pellet impact drilling, which creates the scientific and methodological basis for engineering design of drilling operations under different geo-technical conditions.

Developing an Android-Based Patient Decision Aid Based on Ottawa Standards for Patients After Kidney Transplant and Its Usability Evaluation.

Science.gov (United States)

Zare Moayedi, Mahboobeh; Aslani, Azam; Fakhrahmad, Mostafa; Ezzatzadegan J, Shahrokh

2018-01-01

This study was conducted to develop an android based patient decision aid (PDA) as a self-care instrument for patients after kidney transplant and its usability evaluation. In this study, the systematic development process of Android-based self-care application for patients after kidney transplant based on Ottawa standard was included: scoping, assemble steering group, analysis of requirements, designing, develop of a prototype and system evaluation. The PDA is a self-triage system that will help early identification of risk symptoms in patients, and help manage them. System recommendations for risk signs are: Refer to the nearest hospital or healthcare center without delay, refer to the doctor and tell your doctor in the next visit. To identify patient care needs, a semi-structured interview with members of steering group, including patients and clinical experts, was conducted by the researchers. A prototype of the decision aid was made according to identified needs in the previous step. Finally, in order to evaluate its usability rate by using the System Usability Scale (SUS) questionnaire, it was used by exerts and patients. This study identified information needs, risk signs and steps that patients need to make appropriate decisions about them. The main capabilities of the decision aid are features such as reminders for appointment/test, time of taking medication, registration of symptoms, weight, blood pressure, body temperature, advising to patient in case of signs of risk, weight, blood pressure, body temperature and test results which were reported in the diagram. The mean score of system's usability evaluated by medical informatics specialists, clinicians, and patients were 88.33, 95, and 91. PDAs was usable and desirable from the point of view of medical informatics specialists, clinicians and patients.

Cultural and Linguistic Adaptation of a Multimedia Colorectal Cancer Screening Decision Aid for Spanish Speaking Latinos

Science.gov (United States)

Ko, Linda K.; Reuland, Daniel; Jolles, Monica; Clay, Rebecca; Pignone, Michael

2014-01-01

As the United States becomes more linguistically and culturally diverse, there is a need for effective health communication interventions that target diverse and most vulnerable populations. Latinos also have the lowest colorectal (CRC) screening rates of any ethnic group in the U.S. To address such disparities, health communication interventionists are often faced with the challenge to adapt existing interventions from English into Spanish in a way that retains essential elements of the original intervention while also addressing the linguistic needs and cultural perspectives of the target population. We describe the conceptual framework, context, rationale, methods, and findings of a formative research process used in creating a Spanish language version of an evidenced-based (English language) multimedia CRC screening decision aid. Our multi-step process included identification of essential elements of the existing intervention, literature review, assessment of the regional context and engagement of key stakeholders, and solicitation of direct input from target population. We integrated these findings in the creation of the new adapted intervention. We describe how we used this process to identify and integrate socio-cultural themes such as personalism (personalismo), familism (familismo), fear (miedo), embarrassment (verguenza), power distance (respeto), machismo, and trust (confianza) into the Spanish language decision aid. PMID:24328496

Environmental assessment: Uranium Geologic Drilling Project, Winnemucca Dry Lake, Pershing, Nevada

International Nuclear Information System (INIS)

This environmental assessment has been prepared to provide the environmental input into the DOE decision to drill and log ten (10) holes of under 7-in. diameters to depths of 100 to 1500 feet in the northern margin of Winnemucca Dry Lake, Pershing County, Nevada, to obtain subsurface information related to uranium favorability

Decision-Aiding and Optimization for Vertical Navigation of Long-Haul Aircraft

Science.gov (United States)

Patrick, Nicholas J. M.; Sheridan, Thomas B.

1996-01-01

different airspace design and air traffic management policies. A decision aid is proposed which would combine the pilot's notion of optimality with the GA-based optimization, provide the pilot with a number of alternative pareto-optimal trajectories, and allow him to consider unmodelled attributes and constraints in choosing among them. A solution to the problem of displaying alternatives in a multi-attribute decision space is also presented.

Review of decision aids for nuclear-plant operators

International Nuclear Information System (INIS)

Kisner, R.A.

1983-01-01

Responses to various computer-based operational aids varied widely in detail, thus forcing distillation of the salient features of many operational aids from information sources other than the initial questionnaire. These sources included technical and management presentations, technical papers and reports, personal discussions, taped responses, sales brochures, system specifications and schematics, and other documents. The data base is dynamic, not static, owing to the nature of current trends in operational aid development. The information contained in it is subject to review and revision by the developing organizations. More systems are pending review and entry into the data base; hence the list is incomplete

Impact of a web-based prostate cancer treatment decision aid on patient-reported decision process parameters: results from the Prostate Cancer Patient Centered Care trial.

Science.gov (United States)

Cuypers, Maarten; Lamers, Romy E D; Kil, Paul J M; van de Poll-Franse, Lonneke V; de Vries, Marieke

2018-05-12

To compare patients' evaluation of the treatment decision-making process in localized prostate cancer between counseling that included an online decision aid (DA) and standard counseling. Eighteen Dutch hospitals were randomized to DA counseling (n = 235) or the control group with standard counseling (n = 101) in a pragmatic, cluster randomized controlled trial. The DA was provided to patients at, or soon after diagnosis. Decisional conflict, involvement, knowledge, and satisfaction with information were assessed with a questionnaire after treatment decision-making. Anxiety and depression served as covariates. The levels of decision involvement and conflict were comparable between patients in both groups. Patients with a DA felt more knowledgeable but scored equally well on a knowledge test as patients without a DA. Small significant negative effects were found on satisfaction with information and preparation for decision-making. A preference for print over online and depression and anxiety symptoms was negatively associated with satisfaction and conflict scores in the DA group. The DA aimed to support shared decision-making, while outcomes for a majority of DA users were comparable to patients who received standard counseling. Patients, who are less comfortable with the online DA format or experience anxiety or depression symptoms, could require more guidance toward shared decision-making. To evaluate long-term DA effects, follow-up evaluation on treatment satisfaction and decisional regret will be done.

A multiattribute utility analysis of sites nominated for characterization for the first radioactive-waste repository: A decision-aiding methodology

Energy Technology Data Exchange (ETDEWEB)

none,

1986-05-01

In December 1984, the Department of Energy (DOE) published draft environmental assessments (EAs) to support the proposed nomination of five sites and the recommendation of three sites for characterization for the first radioactive-waste repository. A chapter common to all the draft EAs (Chapter 7) presented rankings of the five sites against the postclosure and the preclosure technical siting guidelines. To determine which three sites appeared most favorable for recommendation for characterization, three simple quantitative methods were used to aggregate the rankings assigned to each site for the various technical guidelines. In response to numerous comments on the methods, the DOE has undertaken a formal application of one of them (hereafter referred to as the decision-aiding methodology) for the purpose of obtaining a more rigorous evaluation of the nominated sites. The application of the revised methodology is described in this report. The method of analysis is known as multiattribute utility analysis; it is a tool for providing insights as to which sites are preferable and why. The decision-aiding methodology accounts for all the fundamental considerations specified by the siting guidelines and uses as source information the data and evaluations reported or referenced in the EAs. It explicitly addresses the uncertainties and value judgments that are part of all siting problems. Furthermore, all scientific and value judgments are made explicit for the reviewer. An independent review of the application of the decision-aiding methodology has been conducted by the Board on Radioactive Waste Management of the National Academy of Sciences; the comments of the Board are included as an appendix to this report.

A multiattribute utility analysis of sites nominated for characterization for the first radioactive-waste repository: A decision-aiding methodology

International Nuclear Information System (INIS)

1986-05-01

In December 1984, the Department of Energy (DOE) published draft environmental assessments (EAs) to support the proposed nomination of five sites and the recommendation of three sites for characterization for the first radioactive-waste repository. A chapter common to all the draft EAs (Chapter 7) presented rankings of the five sites against the postclosure and the preclosure technical siting guidelines. To determine which three sites appeared most favorable for recommendation for characterization, three simple quantitative methods were used to aggregate the rankings assigned to each site for the various technical guidelines. In response to numerous comments on the methods, the DOE has undertaken a formal application of one of them (hereafter referred to as the decision-aiding methodology) for the purpose of obtaining a more rigorous evaluation of the nominated sites. The application of the revised methodology is described in this report. The method of analysis is known as multiattribute utility analysis; it is a tool for providing insights as to which sites are preferable and why. The decision-aiding methodology accounts for all the fundamental considerations specified by the siting guidelines and uses as source information the data and evaluations reported or referenced in the EAs. It explicitly addresses the uncertainties and value judgments that are part of all siting problems. Furthermore, all scientific and value judgments are made explicit for the reviewer. An independent review of the application of the decision-aiding methodology has been conducted by the Board on Radioactive Waste Management of the National Academy of Sciences; the comments of the Board are included as an appendix to this report

Environmental Measurement While Drilling System for Real-Time Field Screening of Contaminants

International Nuclear Information System (INIS)

Lockwood, G.J.; Normann, R.A.; Williams, C.V.

1999-01-01

Sampling during environmental drilling is essential to fully characterize the spatial distribution and migration of subsurface contaminants. However, analysis of the samples is expensive and time-consuming: off-site laboratory analysis can take weeks or months. Real-time information on environmental conditions, drill bit location and temperature during drilling is valuable in many environmental restoration operations. This type of information can be used to provide field screening data and improved efficiency of site characterization activities. The Environmental Measurement-While-Drilling (EMWD) System represents an innovative blending of new and existing technology in order to obtain real-time data during drilling. The system consists of two subsystems. The down-hole subsystem (at the drill bit) consists of sensors, a power supply, a signal conditioning and transmitter board, and a radio-frequency (RF) coaxial cable. The up-hole subsystem consists of a battery pack/coil, pickup coil, receiver, and personal computer. The system is compatible with fluid miser drill pipe, a directional drilling technique that uses minimal drilling fluids and generates little to no secondary waste. In EMWD, downhole sensors are located behind the drill bit and linked by a high-speed data transmission system to a computer at the surface. Sandia-developed Windowstrademark-based software is used for data display and storage. As drilling is conducted, data is collected on the nature and extent of contamination, enabling on-the-spot decisions regarding drilling and sampling strategies. Initially, the downhole sensor consisted of a simple gamma radiation detector, a Geiger-Mueller tube (GMT). The design includes data assurance techniques to increase safety by reducing the probability of giving a safe indication when an unsafe condition exists. The EMWD system has been improved by the integration of a Gamma Ray Spectrometer (GRS) in place of the GMT. The GRS consists of a sodium iodide

Drilling a better pair : new technologies in SAGD directional drilling

Energy Technology Data Exchange (ETDEWEB)

Zimmer, C.; Richter, D. [Statoil Canada Ltd., Calgary, AB (Canada); Person, J.; Tilley, J.; Bittar, M. [Halliburton Energy Services, Calgary, AB (Canada)

2010-07-01

The Leismer Demonstration Project (LDP) is the first of 8 proposed major steam assisted gravity drainage (SAGD) projects for Statoil's Kai Kos Dehseh (KKD) asset in the Athabasca oil sands deposit. The bitumen resources are expected to produce approximately 2.2 billion barrels of oil over approximately 35 years with a peak production of 220,000 bbl/day. To date, 23 well pairs have been drilled on 4 drilling pads. The precise placement of well pairs is among the most important factors in a successful SAGD drilling program. The producer well must be placed in relation to the reservoir boundaries. It must also be accurately twinned with the injector well. A strong focus on technological innovation is needed in order to deliver on these high expectations in unconsolidated formations, such as the McMurray oil sands. Lateral SAGD pairs are often drilled with conventional steerable mud motors and logging-while-drilling (LWD) resistivity measurements, but this combination imposes certain limitations in terms of wellbore quality and placement. Several industry firsts were successfully implemented at the Statoil LDP, including a combination of the newest and most cutting-edge directional, measurement, and LWD technology. The keystone of these industry firsts was the use of a soft formation modified, point-the-bit rotary steerable system (RSS), used on 20 horizontal wells. The RRS was combined with an ultra deep azimuthal resistivity sensor to provide precise geosteering along the bottom bed boundary in the producer wells, resulting in improved reservoir capture and reservoir characterization. This paper described the new drilling system and its impact on the progressive future of directional drilling in SAGD. 8 refs., 1 tab., 22 figs.

Validation of exposure visualization and audible distance emission for navigated temporal bone drilling in phantoms.

Directory of Open Access Journals (Sweden)

Eduard H J Voormolen

Full Text Available BACKGROUND: A neuronavigation interface with extended function as compared with current systems was developed to aid during temporal bone surgery. The interface, named EVADE, updates the prior anatomical image and visualizes the bone drilling process virtually in real-time without need for intra-operative imaging. Furthermore, EVADE continuously calculates the distance from the drill tip to segmented temporal bone critical structures (e.g. the sigmoid sinus and facial nerve and produces audiovisual warnings if the surgeon drills in too close vicinity. The aim of this study was to evaluate the accuracy and surgical utility of EVADE in physical phantoms. METHODOLOGY/PRINCIPAL FINDINGS: We performed 228 measurements assessing the position accuracy of tracking a navigated drill in the operating theatre. A mean target registration error of 1.33±0.61 mm with a maximum error of 3.04 mm was found. Five neurosurgeons each drilled two temporal bone phantoms, once using EVADE, and once using a standard neuronavigation interface. While using standard neuronavigation the surgeons damaged three modeled temporal bone critical structures. No structure was hit by surgeons utilizing EVADE. Surgeons felt better orientated and thought they had improved tumor exposure with EVADE. Furthermore, we compared the distances between surface meshes of the virtual drill cavities created by EVADE to actual drill cavities: average maximum errors of 2.54±0.49 mm and -2.70±0.48 mm were found. CONCLUSIONS/SIGNIFICANCE: These results demonstrate that EVADE gives accurate feedback which reduces risks of harming modeled critical structures compared to a standard neuronavigation interface during temporal bone phantom drilling.

Methods to ensure optimal off-bottom and drill bit distance under pellet impact drilling

Science.gov (United States)

Kovalyov, A. V.; Isaev, Ye D.; Vagapov, A. R.; Urnish, V. V.; Ulyanova, O. S.

2016-09-01

The paper describes pellet impact drilling which could be used to increase the drilling speed and the rate of penetration when drilling hard rock for various purposes. Pellet impact drilling implies rock destruction by metal pellets with high kinetic energy in the immediate vicinity of the earth formation encountered. The pellets are circulated in the bottom hole by a high velocity fluid jet, which is the principle component of the ejector pellet impact drill bit. The paper presents the survey of methods ensuring an optimal off-bottom and a drill bit distance. The analysis of methods shows that the issue is topical and requires further research.

Preparing Parents to Make An Informed Choice About Antibiotic Use for Common Acute Respiratory Infections in Children: A Randomised Trial of Brief Decision Aids in a Hypothetical Scenario.

Science.gov (United States)

Coxeter, Peter D; Del Mar, Chris B; Hoffmann, Tammy C

2017-08-01

Childhood acute respiratory infections (ARIs) are one of the most common reasons for primary care consultations and for receiving an antibiotic. Public awareness of antibiotic benefit and harms for these conditions is low. To facilitate informed decision making, ideally in collaboration with their doctor, parents need clear communication about benefits and harms. Decision aids may be able to facilitate this process. The aim of this study was to evaluate the effectiveness of three decision aids about antibiotic use for common ARIs in children. Adult parents of children aged 1-16 years (n = 120) were recruited from community settings and then randomised using a computer-generated randomisation sequence to receive a decision aid (n = 60) or fact sheet (n = 60). Allocation was concealed and used sealed and opaque sequentially numbered envelopes. Participants self-completed questionnaires at baseline and immediately post-intervention. The primary outcome was informed choice (conceptual and numerical knowledge; attitudes towards, and intention to use, antibiotics for a future ARI). Secondary outcomes were decisional conflict, decisional self-efficacy, and material acceptability. After reading the information, significantly more intervention group participants made an informed choice [57%] compared with control group participants [29%] [difference 28, 95% confidence interval (CI) 11-45%, p decision aids prepared parents to make an informed choice about antibiotic use more than fact sheets, in a hypothetical situation. Their effect within a consultation needs to be evaluated. Clinical Trials Registration Number: ACTRN12615000843550.

Ultrasonically assisted drilling of rocks

Science.gov (United States)

Mikhailova, N. V.; Onawumi, P. Y.; Roy, A.; Silberschmidt, V. V.

2018-05-01

Conventional drilling of rocks can generate significant damage in the drilled material; a material layer is often split off a back surface of a sample during drilling, negatively affecting its strength. To improve finish quality, ultrasonically assisted drilling (UAD) was employed in two rocks - sandstone and marble. Damage areas in both materials were reduced in UAD when compared to conventional drilling. Reductions in a thrust force and a torque reduction were observed only for UAD in marble; ultrasonic assistance in sandstone drilling did not result in improvements in this regard.

Decisional equipoise is not decisional conflict: avoiding the false clarity bias in the evaluation of decision aids and Shared Decision Making processes

DEFF Research Database (Denmark)

Kaltoft, Mette Kjer; Salkeld, Glenn; Cunich, Michelle

2014-01-01

not include such ‘sureness’ criteria. Methods: In the fixed criteria arm of an Australian trial of decision aids relating to PSA testing for prostate cancer 727 respondents supplied their importance weights for 5 criteria (loss of lifetime, needless biopsy, and bowel, urinary and sexual problems). Combining...... these criteria weights with the best available evidence on the performance of the two options (have or not have a PSA test) on each criterion, produced a personalised expected value score for each option on a 0 to 1 scale. The Absolute Difference (AD) between the two option scores for each individual...... was calculated and those whose AD was .01 or less were defined as being in effective equipoise. These ADs were then correlated with respondent’s scores on the self-weighted and self-rated instrument, MyDecisionQuality, which contains 8 items (Options, Effects, Importance, Chances, Trust, Support, Control...

Seismic Monitoring Prior to and During DFDP-2 Drilling, Alpine Fault, New Zealand: Matched-Filter Detection Testing and the Real-Time Monitoring System

Science.gov (United States)

Boese, C. M.; Chamberlain, C. J.; Townend, J.

2015-12-01

In preparation for the second stage of the Deep Fault Drilling Project (DFDP) and as part of related research projects, borehole and surface seismic stations were installed near the intended DFDP-2 drill-site in the Whataroa Valley from late 2008. The final four borehole stations were installed within 1.2 km of the drill-site in early 2013 to provide near-field observations of any seismicity that occurred during drilling and thus provide input into operational decision-making processes if required. The basis for making operational decisions in response to any detected seismicity had been established as part of a safety review conducted in early 2014 and was implemented using a "traffic light" system, a communications plan, and other operational documents. Continuous real-time earthquake monitoring took place throughout the drilling period, between September and late December 2014, and involved a team of up to 15 seismologists working in shifts near the drill-site and overseas. Prior to drilling, records from 55 local earthquakes and 14 quarry blasts were used as master templates in a matched-filter detection algorithm to test the capabilities of the seismic network for detecting seismicity near the drill site. The newly detected microseismicity was clustered near the DFDP-1 drill site at Gaunt Creek, 7.4 km southwest of DFDP-2. Relocations of these detected events provide more information about the fault geometry in this area. Although no detectable seismicity occurred within 5 km of the drill site during the drilling period, the region is capable of generating earthquakes that would have required an operational response had they occurred while drilling was underway (including a M2.9 event northwest of Gaunt Creek on 15 August 2014). The largest event to occur while drilling was underway was of M4.5 and occurred approximately 40 km east of the DFDP-2 drill site. In this presentation, we summarize the setup and operations of the seismic network and discuss key

To notify or not to notify : Decision aid for policy makers on whether to make an infectious disease mandatorily notifiable

NARCIS (Netherlands)

Bijkerk, Paul; Fanoy, E. B.; Kardamanidis, K.; van der Plas, S. M.; te Wierik, M. J.; Kretzschmar, M. E.; Haringhuizen, G. B.; van Vliet, H. J.; van der Sande, M. A.

2015-01-01

Mandatory notification can be a useful tool to support infectious disease prevention and control. Guidelines are needed to help policymakers decide whether mandatory notification of an infectious disease is appropriate. We developed a decision aid, based on a range of criteria previously used in the

Resource allocation within the National AIDS Control Program of Pakistan: a qualitative assessment of decision maker's opinions

Directory of Open Access Journals (Sweden)

Kadir Masood

2007-01-01

Full Text Available Abstract Background Limited resources, whether public or private, demand prioritisation among competing needs to maximise productivity. With a substantial increase in the number of reported HIV cases, little work has been done to understand how resources have been distributed and what factors may have influenced allocation within the newly introduced Enhanced National AIDS Control Program of Pakistan. The objective of this study was to identify perceptions of decision makers about the process of resource allocation within Pakistan's Enhanced National AIDS Control Program. Methods A qualitative study was undertaken and in-depth interviews of decision makers at provincial and federal levels responsible to allocate resources within the program were conducted. Results HIV was not considered a priority issue by all study participants and external funding for the program was thought to have been accepted because of poor foreign currency reserves and donor agency influence rather than local need. Political influences from the federal government and donor agencies were thought to manipulate distribution of funds within the program. These influences were thought to occur despite the existence of a well-laid out procedure to determine allocation of public resources. Lack of collaboration among departments involved in decision making, a pervasive lack of technical expertise, paucity of information and an atmosphere of ad hoc decision making were thought to reduce resistance to external pressures. Conclusion Development of a unified program vision through a consultative process and advocacy is necessary to understand goals to be achieved, to enhance program ownership and develop consensus about how money and effort should be directed. Enhancing public sector expertise in planning and budgeting is essential not just for the program, but also to reduce reliance on external agencies for technical support. Strengthening available databases for effective

Resource allocation within the National AIDS Control Program of Pakistan: a qualitative assessment of decision maker's opinions.

Science.gov (United States)

Husain, Sara; Kadir, Masood; Fatmi, Zafar

2007-01-23

Limited resources, whether public or private, demand prioritisation among competing needs to maximise productivity. With a substantial increase in the number of reported HIV cases, little work has been done to understand how resources have been distributed and what factors may have influenced allocation within the newly introduced Enhanced National AIDS Control Program of Pakistan. The objective of this study was to identify perceptions of decision makers about the process of resource allocation within Pakistan's Enhanced National AIDS Control Program. A qualitative study was undertaken and in-depth interviews of decision makers at provincial and federal levels responsible to allocate resources within the program were conducted. HIV was not considered a priority issue by all study participants and external funding for the program was thought to have been accepted because of poor foreign currency reserves and donor agency influence rather than local need. Political influences from the federal government and donor agencies were thought to manipulate distribution of funds within the program. These influences were thought to occur despite the existence of a well-laid out procedure to determine allocation of public resources. Lack of collaboration among departments involved in decision making, a pervasive lack of technical expertise, paucity of information and an atmosphere of ad hoc decision making were thought to reduce resistance to external pressures. Development of a unified program vision through a consultative process and advocacy is necessary to understand goals to be achieved, to enhance program ownership and develop consensus about how money and effort should be directed. Enhancing public sector expertise in planning and budgeting is essential not just for the program, but also to reduce reliance on external agencies for technical support. Strengthening available databases for effective decision making is required to make financial allocations based on real

Evaluating the content and development of decision aid tools for the management of menopause: A scoping review.

Science.gov (United States)

Siyam, Tasneem; Sultani, Humirah; Ross, Sue; Chatterley, Trish; Yuksel, Nese

2017-12-01

Decision-making during menopause (especially surgical menopause) can be complex given the variability in risk-benefit perceptions of menopausal treatments. Decision aid tools (DATs) help women participate in decision-making about options. Our objective is to identify and evaluate the content and development of DATs for managing menopause, with a special focus on surgical menopause. We systematically searched electronic databases, including MEDLINE and EMBASE, from inception to March 2017 for relevant records. The principal inclusion criterion was that papers reported studies on DATs for managing menopause. Search terms were derived from two concepts: menopause and DATs. Data extracted were presented in written evidence tables and narrative summaries. Our search yielded 18,801 records. Of these, 26 records met our inclusion criteria, which gave rise to 12 DATs from peer-reviewed literature and 6 from grey literature. Seventeen DATs were focused on natural menopause and two targeted surgical menopause, both identified from grey literature. More than half were published before the Women's Health Initiative (WHI) publication and 70% before the release of the International Patient Decision Aid Standards (IPDAS). Very few studies reported the full development of the DAT involved, and less than half of DATs were informed by a needs assessment to identify the decisional needs of their target population. Most DATs focused on hormone therapy as a treatment option and did not provide a comprehensive overview of other options. None of the DATs reported the steps involved in finding, appraising and summarizing scientific content of the tool. This review highlights several limitations in the content and development of DATs for managing menopause. No peer-reviewed DATs were identified for surgical menopause. A need for a complete, evidence-based DAT in the context of surgical menopause is identified. Copyright © 2017 Elsevier B.V. All rights reserved.

Patient and family communication during consultation visits: The effects of a decision aid for treatment decision-making for localized prostate cancer.

Science.gov (United States)

Song, Lixin; Tyler, Christina; Clayton, Margaret F; Rodgiriguez-Rassi, Eleanor; Hill, Latorya; Bai, Jinbing; Pruthi, Raj; Bailey, Donald E

2017-02-01

To analyze the effects of a decision aid on improving patients' and family members' information giving and question asking during consultations for prostate cancer treatment decision-making. This study is a secondary analysis of archived audio-recorded real-time consultation visits with participants from a randomized clinical trial. Participants were randomly assigned into three groups: TD-intervention targeted patient-only; TS-intervention targeted patients and family members; and control-a handout on staying healthy during treatment. We conducted content analysis using a researcher-developed communication coding system. Using SAS 9.3, we conducted Chi-square/Fisher's exact test to examine whether information giving and question asking among patients and family members varied by groups when discussing different content/topics. Compared with those in the TS and control groups, significantly higher percentages of participants in the TD group demonstrated information giving in discussing topics about diagnosis, treatment options, risks and benefits, and preferences; and engaged in question asking when discussing diagnosis, watchful waiting/active surveillance, risks and benefits, and preferences for treatment impacts. Information support and communication skills training for patients were effective in improving communication during treatment decision-making consultations. Providing information about prostate cancer and communication skills training empower patients and their family members. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Review of casing while drilling technology

Directory of Open Access Journals (Sweden)

Pavković Bojan

2016-01-01

Full Text Available Conventional drilling methods have been plagued with huge operational and financial challenges, such as cost of purchasing, inspecting, handling, transporting the drill equipment and most importantly, tripping in-and-out of the drill string whenever the Bottom Hole Assembly (BHA needs a replacement, needs of wiper trip or when total depth is reached. The tripping in-and-out of the drill string not only contributes to Non Productive Time (NPT but also leads to well control difficulties including wellbore instability and lost circulation. All this has led Oil and Gas industry, as well as any other engineering industry, to seek for new ways and methods in order to reduce these problems. Thanks to the advances in technical solutions and constant improvements of conventional drilling methods, a new drilling method - casing while drilling has been developed. Casing Drilling encompasses the process of simultaneously drilling and casing a well, using the active casing and thus optimizes the production. This paper presents a review of casing while drilling method (CwD and its practical usage in drilling wells. The comparison of conventional drilling method and casing while drilling is also presented. The CwD method achieves significantly better results than conventional drilling method.

Deep drilling KLX 02. Drilling and documentation of a 1700 m deep borehole at Laxemar, Sweden

Energy Technology Data Exchange (ETDEWEB)

Andersson, O [VBB VIAK AB, Malmoe (Sweden)

1994-08-01

In this report the preparation and execution of the deep core drilling KLX 02 is described. The hole was drilled with the wireline methods, NQ dimension (diameter 76 mm), to a final depth of 1700.5 m. Prior to core drilling a diameter 215 mm pilot hole was pre drilled to 200 m with controlled hammer drilling (DTH). In this hole casing and air-lift equipment was installed with the aim to support the circulation of drilling fluid. During core drilling there was a measurement of major drilling parameters and drilling fluid in and out of hole. As a fluid tracer uranine was used. Each 300 m of core drilling air-lift pump tests were performed. After completion a flow-meter log was run to finalize the project phase. It can be concluded that both the pre drilling and core drilling methods used proved to be successful. No severe technical problem occurred. However, potential risks have been pointed at in the report. The air-lift system functioned only partly and has to be modified for further use. Also the technique for monitoring of drilling parameters needs improvement as does the method for air-lift pump tests with packer. The organisation model for planning and realization functioned satisfactory and can be recommended for similar future projects. 9 refs, numerous tabs and figs.

Deep drilling KLX 02. Drilling and documentation of a 1700 m deep borehole at Laxemar, Sweden

International Nuclear Information System (INIS)

Andersson, O.

1994-08-01

In this report the preparation and execution of the deep core drilling KLX 02 is described. The hole was drilled with the wireline methods, NQ dimension (diameter 76 mm), to a final depth of 1700.5 m. Prior to core drilling a diameter 215 mm pilot hole was pre drilled to 200 m with controlled hammer drilling (DTH). In this hole casing and air-lift equipment was installed with the aim to support the circulation of drilling fluid. During core drilling there was a measurement of major drilling parameters and drilling fluid in and out of hole. As a fluid tracer uranine was used. Each 300 m of core drilling air-lift pump tests were performed. After completion a flow-meter log was run to finalize the project phase. It can be concluded that both the pre drilling and core drilling methods used proved to be successful. No severe technical problem occurred. However, potential risks have been pointed at in the report. The air-lift system functioned only partly and has to be modified for further use. Also the technique for monitoring of drilling parameters needs improvement as does the method for air-lift pump tests with packer. The organisation model for planning and realization functioned satisfactory and can be recommended for similar future projects. 9 refs, numerous tabs and figs

Drilling subsurface wellbores with cutting structures

Science.gov (United States)

Mansure, Arthur James; Guimerans, Rosalvina Ramona

2010-11-30

A system for forming a wellbore includes a drill tubular. A drill bit is coupled to the drill tubular. One or more cutting structures are coupled to the drill tubular above the drill bit. The cutting structures remove at least a portion of formation that extends into the wellbore formed by the drill bit.

New technology for preparing drilling solutions

Energy Technology Data Exchange (ETDEWEB)

Proselkov, Y M; Minenkov, V M

1981-01-01

It is indicated that it is possible to provide the necessary indices of structural-mechanical properties of solution with additional dispersion of clay particles in water at the initial stage of preparation of solutions. In the process of dispersion the indices of rheological properties of the solution vary: static SNS and dynamic of shear stress, plastic viscosity. With consideration of the aforementioned a new technology has been developed for preparing solutions from powdery materials. To carry out the technological process we use serial blocks BPR-70 with ejector hydromixer, drilling or centrifuge pump, standard capacity of circulation system, and hydraulic dispersing agent. The technology for preparing the solution is as follow (see figure). Water is poured into tank 4 in an amount equal to half the volume of the prepared portion of solution. In hydraulic disperser 6 packing is installed with a diameter in accordance with the productivity of the drilling pump 5. After this aeration is switched on for 5-7 minutes in the silo 1 of BPR with excess air pressure of 0.2-0.3 kg/cm/sup 2/. Then the drilling pump is switched on and water is pumped through in the following order: tank 4, hydraulic disperser 6, ejector hydromixer 3, tank 4. Pressure at the pump discharge should be 120-150 kg/cm/sup 2/, and the vacuum in the chamber of the electronic hydromixer is at least 0.2 kg/cm/sup 2/. With the aid of a regulating fan 2 we must create a vacuum in the chamber of the hydromixer amounting to 0.08-0.12 kg/cm/sup 2/, and as a consequence of this the fan can regulate the rate and evenness of clay powder feed.

To drill or not to drill? An econometric analysis of US public opinion

International Nuclear Information System (INIS)

Mukherjee, Deep; Rahman, Mohammad Arshad

2016-01-01

Offshore drilling in the United States (US) has been the subject of public and political discourse due to multiple reasons which include economic impact, energy security, and environmental hazard. Consequently, several polls have been conducted over time to gauge public attitude towards offshore drilling. Nevertheless, the economic literature on this issue is sparse. This paper contributes to the literature and analyzes support for offshore drilling based on demographic, economic, social, belief, and shock (e.g. spill) factors. The data is taken from ten nationwide surveys conducted before, during and after the British Petroleum (BP) oil spill and analyzed within the framework of discrete choice model. The results from an ordinal probit model demonstrate that age, annual household income, affiliation to Republican Party, and residence in oil-rich states positively affect the probability of strong support and reduce the probability of strong opposition for offshore drilling. In contrast, the female gender, higher education, association to Democratic Party, and environmental concern affect opinion in opposite direction. Marginal effects show that belief about environmental consequences of drilling has the highest impact on opinion. Binary probit model also yields a similar result and suggests that BP oil disaster resulted in a transient decrease in support for offshore drilling. - Highlights: •US public opinion on offshore drilling is analyzed based on ten national polls. •Ordinal and binary probit models are utilized to identify the underlying factors that shape public opinion. •Belief about environmental cost of drilling and educational attainment have the highest negative impact on opinion. •Age, income, affiliation to Republican party and oil-rich states positively affect support for drilling. •BP oil spill resulted in a transient decrease in support for offshore drilling.

Percussive Augmenter of Rotary Drills for Operating as a Rotary-Hammer Drill

Science.gov (United States)

Aldrich, Jack Barron (Inventor); Bar-Cohen, Yoseph (Inventor); Sherrit, Stewart (Inventor); Badescu, Mircea (Inventor); Bao, Xiaoqi (Inventor); Scott, James Samson (Inventor)

2014-01-01

A percussive augmenter bit includes a connection shaft for mounting the bit onto a rotary drill. In a first modality, an actuator percussively drives the bit, and an electric slip-ring provides power to the actuator while being rotated by the drill. Hammering action from the actuator and rotation from the drill are applied directly to material being drilled. In a second modality, a percussive augmenter includes an actuator that operates as a hammering mechanism that drives a free mass into the bit creating stress pulses that fracture material that is in contact with the bit.

Multi-criteria decision aid approach for the selection of the best compromise management scheme for ELVs: the case of Cyprus.

Science.gov (United States)

Mergias, I; Moustakas, K; Papadopoulos, A; Loizidou, M

2007-08-25

Each alternative scheme for treating a vehicle at its end of life has its own consequences from a social, environmental, economic and technical point of view. Furthermore, the criteria used to determine these consequences are often contradictory and not equally important. In the presence of multiple conflicting criteria, an optimal alternative scheme never exists. A multiple-criteria decision aid (MCDA) method to aid the Decision Maker (DM) in selecting the best compromise scheme for the management of End-of-Life Vehicles (ELVs) is presented in this paper. The constitution of a set of alternatives schemes, the selection of a list of relevant criteria to evaluate these alternative schemes and the choice of an appropriate management system are also analyzed in this framework. The proposed procedure relies on the PROMETHEE method which belongs to the well-known family of multiple criteria outranking methods. For this purpose, level, linear and Gaussian functions are used as preference functions.

In-process and post-process measurements of drill wear for control of the drilling process

Science.gov (United States)

Liu, Tien-I.; Liu, George; Gao, Zhiyu

2011-12-01

Optical inspection was used in this research for the post-process measurements of drill wear. A precision toolmakers" microscope was used. Indirect index, cutting force, is used for in-process drill wear measurements. Using in-process measurements to estimate the drill wear for control purpose can decrease the operation cost and enhance the product quality and safety. The challenge is to correlate the in-process cutting force measurements with the post-process optical inspection of drill wear. To find the most important feature, the energy principle was used in this research. It is necessary to select only the cutting force feature which shows the highest sensitivity to drill wear. The best feature selected is the peak of torque in the drilling process. Neuro-fuzzy systems were used for correlation purposes. The Adaptive-Network-Based Fuzzy Inference System (ANFIS) can construct fuzzy rules with membership functions to generate an input-output pair. A 1x6 ANFIS architecture with product of sigmoid membership functions can in-process measure the drill wear with an error as low as 0.15%. This is extremely important for control of the drilling process. Furthermore, the measurement of drill wear was performed under different drilling conditions. This shows that ANFIS has the capability of generalization.

S4HARA: System for HIV/AIDS resource allocation.

Science.gov (United States)

Lasry, Arielle; Carter, Michael W; Zaric, Gregory S

2008-03-26

HIV/AIDS resource allocation decisions are influenced by political, social, ethical and other factors that are difficult to quantify. Consequently, quantitative models of HIV/AIDS resource allocation have had limited impact on actual spending decisions. We propose a decision-support System for HIV/AIDS Resource Allocation (S4HARA) that takes into consideration both principles of efficient resource allocation and the role of non-quantifiable influences on the decision-making process for resource allocation. S4HARA is a four-step spreadsheet-based model. The first step serves to identify the factors currently influencing HIV/AIDS allocation decisions. The second step consists of prioritizing HIV/AIDS interventions. The third step involves allocating the budget to the HIV/AIDS interventions using a rational approach. Decision-makers can select from several rational models of resource allocation depending on availability of data and level of complexity. The last step combines the results of the first and third steps to highlight the influencing factors that act as barriers or facilitators to the results suggested by the rational resource allocation approach. Actionable recommendations are then made to improve the allocation. We illustrate S4HARA in the context of a primary healthcare clinic in South Africa. The clinic offers six types of HIV/AIDS interventions and spends US$750,000 annually on these programs. Current allocation decisions are influenced by donors, NGOs and the government as well as by ethical and religious factors. Without additional funding, an optimal allocation of the total budget suggests that the portion allotted to condom distribution be increased from 1% to 15% and the portion allotted to prevention and treatment of opportunistic infections be increased from 43% to 71%, while allocation to other interventions should decrease. Condom uptake at the clinic should be increased by changing the condom distribution policy from a pull system to a push

Assessing the acceptability and usability of an interactive serious game in aiding treatment decisions for patients with localized prostate cancer.

Science.gov (United States)

Reichlin, Lindsey; Mani, Nithya; McArthur, Kara; Harris, Amy M; Rajan, Nithin; Dacso, Clifford C

2011-01-12

Men diagnosed with localized prostate cancer face a potentially life-altering treatment decision that can be overwhelming. Enhancing patient knowledge through education can significantly reduce feelings of uncertainty while simultaneously increasing confidence in decision making. Serious games have been shown in other populations to increase health knowledge and assist with the health decision-making process. We developed an interactive serious game, Time After Time, which translates evidence-based treatment outcome data into an accessible and understandable format that men can utilize in their prostate cancer treatment decision-making process. The game specifically aims to raise men's awareness and understanding of the impact of health-related quality of life issues associated with the major treatment options and to enrich their conversations with their health care providers. This study determined the acceptability and usability of the alpha version of Time After Time, an interactive decision aid for men diagnosed with localized prostate cancer, in order to inform future iterations of the serious game. The study employed a mixed methods approach to assess the acceptability and usability of the Time After Time serious game using qualitative focus groups and a quantitative Likert scale survey. A total of 13 men who had already completed treatment for localized prostate cancer completed the survey and participated in focus group meetings. The majority of the study participants rated Time After Time as an appropriate decision tool for localized prostate cancer and verified that it meets its goals of increasing focus on side effects and generating questions for the patient's health care team. However, participants also expressed concerns about game usability and the diversity of information covered regarding treatment options and potential treatment outcomes. Serious games are a promising approach to health education and decision support for older men. Participants

Computer-Aided Facilities Management Systems (CAFM).

Science.gov (United States)

Cyros, Kreon L.

Computer-aided facilities management (CAFM) refers to a collection of software used with increasing frequency by facilities managers. The six major CAFM components are discussed with respect to their usefulness and popularity in facilities management applications: (1) computer-aided design; (2) computer-aided engineering; (3) decision support…

A Randomized Controlled Trial of a Mobile Clinical Decision Aid to Improve Access to Kidney Transplantation: iChoose Kidney

Directory of Open Access Journals (Sweden)

Rachel E. Patzer

2016-05-01

Discussion: Engaging patients in health care choices can increase patient empowerment and improve knowledge and understanding of treatment choices. If the effectiveness of iChoose Kidney has a greater impact on patients with low health literacy, lower socioeconomic status, and minority race, this decision aid could help reduce disparities in access to kidney transplantation.

Active Suppression of Drilling System Vibrations For Deep Drilling

Energy Technology Data Exchange (ETDEWEB)

Raymond, David W.; Blankenship, Douglas A.; Buerger, Stephen; Mesh, Mikhail; Radigan, William Thomas; Su, Jiann-Cherng

2015-10-01

The dynamic stability of deep drillstrings is challenged by an inability to impart controllability with ever-changing conditions introduced by geology, depth, structural dynamic properties and operating conditions. A multi-organizational LDRD project team at Sandia National Laboratories successfully demonstrated advanced technologies for mitigating drillstring vibrations to improve the reliability of drilling systems used for construction of deep, high-value wells. Using computational modeling and dynamic substructuring techniques, the benefit of controllable actuators at discrete locations in the drillstring is determined. Prototype downhole tools were developed and evaluated in laboratory test fixtures simulating the structural dynamic response of a deep drillstring. A laboratory-based drilling applicability demonstration was conducted to demonstrate the benefit available from deployment of an autonomous, downhole tool with self-actuation capabilities in response to the dynamic response of the host drillstring. A concept is presented for a prototype drilling tool based upon the technical advances. The technology described herein is the subject of U.S. Patent Application No. 62219481, entitled "DRILLING SYSTEM VIBRATION SUPPRESSION SYSTEMS AND METHODS", filed September 16, 2015.

Randomized controlled trial of a patient decision-making aid for orthodontics.

Science.gov (United States)

Parker, Kate; Cunningham, Susan J; Petrie, Aviva; Ryan, Fiona S

2017-08-01

Patient decision-making aids (PDAs) are instruments that facilitate shared decision making and enable patients to reach informed, individual decisions regarding health care. The objective of this study was to assess the efficacy of a PDA compared with traditional information provision for adolescent patients considering fixed appliance orthodontic treatment. Before treatment, orthodontic patients were randomly allocated into 2 groups: the intervention group received the PDA and standard information regarding fixed appliances, and the control group received the standard information only. Decisional conflict was measured using the Decisional Conflict Scale, and the levels of decisional conflict were compared between the 2 groups. Seventy-two patients were recruited and randomized in a ratio of 1:1 to the PDA and control groups. Seventy-one patients completed the trial (control group, 36; PDA group, 35); this satisfied the sample size calculation. The median total Decisional Conflict Scale score in the PDA group was lower than in the control group (15.63 and 19.53, respectively). However, this difference was not statistically significant (difference between groups, 3.90; 95% confidence interval of the difference, -4.30 to 12.11). Sex, ethnicity, age, and the time point at which patients were recruited did not have significant effects on Decisional Conflict Scale scores. No harm was observed or reported for any participant in the study. The results of this study showed that the provision of a PDA to adolescents before they consented for fixed appliances did not significantly reduce decisional conflict. There may be a benefit in providing a PDA for some patients, but it is not yet possible to say how these patients could be identified. This trial was registered with the Harrow National Research Ethics Committee (reference 12/LO/0279). The protocol was not published before trial commencement. Copyright © 2017. Published by Elsevier Inc.

Experience in a Climate Microworld: Influence of Surface and Structure Learning, Problem Difficulty, and Decision Aids in Reducing Stock-Flow Misconceptions

Directory of Open Access Journals (Sweden)

Medha Kumar

2018-03-01

Full Text Available Research shows that people’s wait-and-see preferences for actions against climate change are a result of several factors, including cognitive misconceptions. The use of simulation tools could help reduce these misconceptions concerning Earth’s climate. However, it is still unclear whether the learning in these tools is of the problem’s surface features (dimensions of emissions and absorptions and cover-story used or of the problem’s structural features (how emissions and absorptions cause a change in CO2 concentration under different CO2 concentration scenarios. Also, little is known on how problem’s difficulty in these tools (the shape of CO2 concentration trajectory, as well as the use of these tools as a decision aid influences performance. The primary objective of this paper was to investigate how learning about Earth’s climate via simulation tools is influenced by problem’s surface and structural features, problem’s difficulty, and decision aids. In experiment 1, we tested the influence of problem’s surface and structural features in a simulation called Dynamic Climate Change Simulator (DCCS on subsequent performance in a paper-and-pencil Climate Stabilization (CS task (N = 100 across four between-subject conditions. In experiment 2, we tested the effects of problem’s difficulty in DCCS on subsequent performance in the CS task (N = 90 across three between-subject conditions. In experiment 3, we tested the influence of DCCS as a decision aid on subsequent performance in the CS task (N = 60 across two between-subject conditions. Results revealed a significant reduction in people’s misconceptions in the CS task after performing in DCCS compared to when performing in CS task in the absence of DCCS. The decrease in misconceptions in the CS task was similar for both problems’ surface and structural features, showing both structure and surface learning in DCCS. However, the proportion of misconceptions was similar across

Intelligent decision support system for operators of the supply ...

African Journals Online (AJOL)

Intelligent decision support system for operators of the supply department of oil and gas extracting industry. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... abnormal situations, pre-crash sensing, industrial drilling, decision-making support systems. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT

Drilling for scientific purpose

Energy Technology Data Exchange (ETDEWEB)

Tanaka, Shoichi

1987-09-01

Drilling for scientific purpose is a process of conducting geophysical exploration at deep underground and drilling for collecting crust samples directly. This is because earth science has advanced to get a good understanding about the top of the crust and has shifted its main interest to the lower layer of the crust in land regions. The on-land drilling plan in Japan has just started, and the planned drilling spots are areas around the Minami River, Hidaka Mts., kinds of the Mesozoic and Cenozoic granite in outside zone, the extension of Japan Sea, Ogasawara Is., Minami-Tori Is., and active volcanos. The paper also outlines the present situation of on-land drilling in the world, focusing on the SG-3rd super-deep well SG-3 on the Kola Peninsula, USSR, Satori SG-1st well SG-1 in Azerbaidzhan S.S.R, V.S.S.R, Sweden's wells, Cyprus' wells, Bayearn well Plan in West Germany, and Salton Sea Scientific Drilling Program in the U.S. At its end, the paper explains the present situation and the future theme of the Japanese drilling technique and points out the necessity of developing equipment, and techniques. (14 figs, 5 tabs, 26 refs)

The International Decision Support Initiative Reference Case for Economic Evaluation: An Aid to Thought.

Science.gov (United States)

Wilkinson, Thomas; Sculpher, Mark J; Claxton, Karl; Revill, Paul; Briggs, Andrew; Cairns, John A; Teerawattananon, Yot; Asfaw, Elias; Lopert, Ruth; Culyer, Anthony J; Walker, Damian G

2016-12-01

Policymakers in high-, low-, and middle-income countries alike face challenging choices about resource allocation in health. Economic evaluation can be useful in providing decision makers with the best evidence of the anticipated benefits of new investments, as well as their expected opportunity costs-the benefits forgone of the options not chosen. To guide the decisions of health systems effectively, it is important that the methods of economic evaluation are founded on clear principles, are applied systematically, and are appropriate to the decision problems they seek to inform. The Bill and Melinda Gates Foundation, a major funder of economic evaluations of health technologies in low- and middle-income countries (LMICs), commissioned a "reference case" through the International Decision Support Initiative (iDSI) to guide future evaluations, and improve both the consistency and usefulness to decision makers. The iDSI Reference Case draws on previous insights from the World Health Organization, the US Panel on Cost-Effectiveness in Health Care, and the UK National Institute for Health and Care Excellence. Comprising 11 key principles, each accompanied by methodological specifications and reporting standards, the iDSI Reference Case also serves as a means of identifying priorities for methods research, and can be used as a framework for capacity building and technical assistance in LMICs. The iDSI Reference Case is an aid to thought, not a substitute for it, and should not be followed slavishly without regard to context, culture, or history. This article presents the iDSI Reference Case and discusses the rationale, approach, components, and application in LMICs. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Ultrasonic rotary-hammer drill

Science.gov (United States)

Bar-Cohen, Yoseph (Inventor); Badescu, Mircea (Inventor); Sherrit, Stewart (Inventor); Bao, Xiaoqi (Inventor); Kassab, Steve (Inventor)

2010-01-01

A mechanism for drilling or coring by a combination of sonic hammering and rotation. The drill includes a hammering section with a set of preload weights mounted atop a hammering actuator and an axial passage through the hammering section. In addition, a rotary section includes a motor coupled to a drive shaft that traverses the axial passage through the hammering section. A drill bit is coupled to the drive shaft for drilling by a combination of sonic hammering and rotation. The drill bit includes a fluted shaft leading to a distal crown cutter with teeth. The bit penetrates sampled media by repeated hammering action. In addition, the bit is rotated. As it rotates the fluted bit carries powdered cuttings helically upward along the side of the bit to the surface.

30 CFR 57.7052 - Drilling positions.

Science.gov (United States)

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Drilling positions. 57.7052 Section 57.7052... SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Drilling and Rotary Jet Piercing Drilling-Surface and Underground § 57.7052 Drilling positions. Persons shall not drill...

HYDRATE CORE DRILLING TESTS

Energy Technology Data Exchange (ETDEWEB)

John H. Cohen; Thomas E. Williams; Ali G. Kadaster; Bill V. Liddell

2002-11-01

The ''Methane Hydrate Production from Alaskan Permafrost'' project is a three-year endeavor being conducted by Maurer Technology Inc. (MTI), Noble, and Anadarko Petroleum, in partnership with the U.S. DOE National Energy Technology Laboratory (NETL). The project's goal is to build on previous and ongoing R&D in the area of onshore hydrate deposition. The project team plans to design and implement a program to safely and economically drill, core and produce gas from arctic hydrates. The current work scope includes drilling and coring one well on Anadarko leases in FY 2003 during the winter drilling season. A specially built on-site core analysis laboratory will be used to determine some of the physical characteristics of the hydrates and surrounding rock. Prior to going to the field, the project team designed and conducted a controlled series of coring tests for simulating coring of hydrate formations. A variety of equipment and procedures were tested and modified to develop a practical solution for this special application. This Topical Report summarizes these coring tests. A special facility was designed and installed at MTI's Drilling Research Center (DRC) in Houston and used to conduct coring tests. Equipment and procedures were tested by cutting cores from frozen mixtures of sand and water supported by casing and designed to simulate hydrate formations. Tests were conducted with chilled drilling fluids. Tests showed that frozen core can be washed out and reduced in size by the action of the drilling fluid. Washing of the core by the drilling fluid caused a reduction in core diameter, making core recovery very difficult (if not impossible). One successful solution was to drill the last 6 inches of core dry (without fluid circulation). These tests demonstrated that it will be difficult to capture core when drilling in permafrost or hydrates without implementing certain safeguards. Among the coring tests was a simulated hydrate

30 CFR 56.7052 - Drilling positions.

Science.gov (United States)

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Drilling positions. 56.7052 Section 56.7052... SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-SURFACE METAL AND NONMETAL MINES Drilling and Rotary Jet Piercing Drilling § 56.7052 Drilling positions. Persons shall not drill from— (a) Positions which hinder...

Environmental effects monitoring for exploration drilling

International Nuclear Information System (INIS)

Buchanan, R.A.; Cook, J.A.; Mathieu, A.

2003-01-01

Strategies for monitoring the environmental effects of single exploratory offshore wells on the east coast of Canada were evaluated. The report was compiled from consultations with scientists, regulators and stakeholders as well as a review of regulatory regimes and toxicity results. The aim of the report was to develop a decision tree for determining when to conduct environmental effects monitoring (EEM). Respondents evinced lower levels of concern for single exploratory wells than for production developments. A number of scientists argued for full statistical treatment of all data, and many people argued that more assurance was needed that the marine environment was not being unduly harmed. Respondents also considered that biological effects should be a primary focus, rather than the occurrence of trace chemical signals, and that seabirds and mammals should be monitored. Concern was expressed over the value of data collected from monitoring the effects of exploratory drilling activities. It was suggested that local and site-specific issues should be considered in the design of EEM programs. Respondents expressed strong concern about potential cumulative effects with other industrial activities, and suggested that test cases should be established and monitored to develop a scientific rationale for the inclusion or exclusion of specific variables in future EEM programs. A decision tree was developed based on 3 scenarios: (1) compliance monitoring only in well known areas with no sensitive issues; opportunistic EEM surveys of sediments, benthos, seabirds and marine mammals in shallow or deep areas with no known sensitive issues; and (3) custom EEM surveys for sensitive areas. Currently, there are EEM requirements for drilling exploratory wells offshore Canada's east coast. 58 refs., 2 tabs., 7 figs

Core drilling of boreholes ONK-KR1, ONK-KR2, ONK-KR3, ONK-KR4 and ONK-PVA1 in ONKALO at Olkiluoto 2005

Energy Technology Data Exchange (ETDEWEB)

Rautio, T. [Suomen Malmi Oy, Espoo (Finland)

2005-11-15

Posiva Oy submitted am application for the Decision in Principle (the final disposal facility for spent nuclear fuel at Olkiluoto, Eurajoki) to the Finnish Government in May 1999. A positive decision was made at the end of 2000 by the Government The Finnish Parliament ratified the Decision in Principle in May 2001. The decision makes it possible for Posiva to focus the confirming bedrock investigations at Olkiluoto, where in the next few years an underground rock characterisation facility, ONKALO, will be constructed. The investigation programme on the influence of grouting in ground-water chemistry will be started by Posiva. The programme consists of long-term and short-term effects of grouting and the influence of grouting at different distances from the tunnel on groundwater conditions. As a part of this Suomen Malmi oy (Smoy) core drilled four boreholes in ONKALO. The identification numbers of thee boreholes are ONK-KR1, ONK-KR2, ONK-KR3 and ONK-KR4. An additional borehole ONK-PVA1 was core drilled for long-term monitoring purposes in a place where no grouting is planned to be done.The diameter of the borehole sis 75.7 mm A set of monitoring measurements and samplings from the drilling and returning water was carried out during the drilling. The volume of the drilling water and the returning water were recorded as well as the pressure of the drilling water. The objective of these measurements was to obtain more information about bedrock and groundwater properties. Sodium fluorescein was used as a label agent in the drilling water. The volume of the used drilling water was about 16 m{sup 3} and the measured volume of the returning water was about 11 dm{sup 3} in boreholes. The deviation of the boreholes was measured with the deviation measuring instrument EMS. The main rock types are migmatitic mica gneiss and granite. Filled fractures are most common type of fractures. The average fracture frequency of the boreholes varies from 0.6 to 3.1 pcs/m. The average RQD

Core drilling of boreholes ONK-KR1, ONK-KR2, ONK-KR3, ONK-KR4 and ONK-PVA1 in ONKALO at Olkiluoto 2005

International Nuclear Information System (INIS)

Rautio, T.

2005-11-01

Posiva Oy submitted am application for the Decision in Principle (the final disposal facility for spent nuclear fuel at Olkiluoto, Eurajoki) to the Finnish Government in May 1999. A positive decision was made at the end of 2000 by the Government The Finnish Parliament ratified the Decision in Principle in May 2001. The decision makes it possible for Posiva to focus the confirming bedrock investigations at Olkiluoto, where in the next few years an underground rock characterisation facility, ONKALO, will be constructed. The investigation programme on the influence of grouting in ground-water chemistry will be started by Posiva. The programme consists of long-term and short-term effects of grouting and the influence of grouting at different distances from the tunnel on groundwater conditions. As a part of this Suomen Malmi oy (Smoy) core drilled four boreholes in ONKALO. The identification numbers of thee boreholes are ONK-KR1, ONK-KR2, ONK-KR3 and ONK-KR4. An additional borehole ONK-PVA1 was core drilled for long-term monitoring purposes in a place where no grouting is planned to be done.The diameter of the borehole sis 75.7 mm A set of monitoring measurements and samplings from the drilling and returning water was carried out during the drilling. The volume of the drilling water and the returning water were recorded as well as the pressure of the drilling water. The objective of these measurements was to obtain more information about bedrock and groundwater properties. Sodium fluorescein was used as a label agent in the drilling water. The volume of the used drilling water was about 16 m 3 and the measured volume of the returning water was about 11 dm 3 in boreholes. The deviation of the boreholes was measured with the deviation measuring instrument EMS. The main rock types are migmatitic mica gneiss and granite. Filled fractures are most common type of fractures. The average fracture frequency of the boreholes varies from 0.6 to 3.1 pcs/m. The average RQD value of

Development of a decision aid for the treatment of benign prostatic hyperplasia : A four stage method using a Delphi consensus study

NARCIS (Netherlands)

Lamers, Romy E D; Cuypers, Maarten; Garvelink, Mirjam M.; Bosch, J. L H Ruud; Kil, Paul J M

2016-01-01

Objective: To develop a web-based decision aid (DA) for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH). Methods: From February-September 2014 we performed a four-stage development method: 1: Two-round Delphi consensus method among urologists, 2:

Sandia's Geothermal Advanced Drill Rig Instrumentation Assists Critical Oil and Gas Drilling Operation

International Nuclear Information System (INIS)

Staller, George E.; Whitlow, Gary

1999-01-01

On November 23, 1998, an 18,000-foot-deep wild-cat natural gas well being drilled near Bakersfield, CA blew out and caught fire. All attempts to kill this well failed, and the well continues to flow under limited control, producing large volumes of natural gas, salt water, and some oil. The oil and some of the water is being separated and trucked off site, and the remaining gas and water is being burned at the well head. A relief well is being drilled approximately one-quarter mile away in an attempt to intercept the first well. If the relief well is successful, it will be used to cement in and kill the first well. Epoch Wellsite Services, Inc., the mud-logging company for the initial well and the relief well, requested Sandia's rolling float meter (RFM) for these critical drilling operations. The RFM is being used to measure the mud outflow rate and detect kicks while drilling the relief well, which will undoubtedly encounter reservoir conditions similar to those responsible for the blow out. Based on its prior experience with the RFM, Epoch believes that it is the only instrument capable of providing the level of accuracy and response to mudflow needed to quickly detect kicks and minimize the risk of a blowout on this second critical well. In response to the urgent request from industry, Sandia and Epoch technicians installed the RFM on the relief well return line, and completed its initial calibration. The data from the RFM is displayed in real-time for the driller, the companyman, and the toolpusher via Epochs RIGWATCH Drilling Instmmentation System. The RFM has already detected several small kicks while drilling toward the annulus of the blown out well. A conventional paddle meter is located downstream of the RFM to provide redundancy and the opportunity to compare the two meters in an actual drilling operation, The relief well is nearing 14,000 feet deep, targeting an intercept of the first well near 17,600 feet. The relief well is expected to be completed in

The NIAID Division of AIDS enterprise information system: integrated decision support for global clinical research programs

Science.gov (United States)

Gupta, Nitin; Varghese, Suresh; Virkar, Hemant

2011-01-01

The National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS (DAIDS) Enterprise Information System (DAIDS-ES) is a web-based system that supports NIAID in the scientific, strategic, and tactical management of its global clinical research programs for HIV/AIDS vaccines, prevention, and therapeutics. Different from most commercial clinical trials information systems, which are typically protocol-driven, the DAIDS-ES was built to exchange information with those types of systems and integrate it in ways that help scientific program directors lead the research effort and keep pace with the complex and ever-changing global HIV/AIDS pandemic. Whereas commercially available clinical trials support systems are not usually disease-focused, DAIDS-ES was specifically designed to capture and incorporate unique scientific, demographic, and logistical aspects of HIV/AIDS treatment, prevention, and vaccine research in order to provide a rich source of information to guide informed decision-making. Sharing data across its internal components and with external systems, using defined vocabularies, open standards and flexible interfaces, the DAIDS-ES enables NIAID, its global collaborators and stakeholders, access to timely, quality information about NIAID-supported clinical trials which is utilized to: (1) analyze the research portfolio, assess capacity, identify opportunities, and avoid redundancies; (2) help support study safety, quality, ethics, and regulatory compliance; (3) conduct evidence-based policy analysis and business process re-engineering for improved efficiency. This report summarizes how the DAIDS-ES was conceptualized, how it differs from typical clinical trial support systems, the rationale for key design choices, and examples of how it is being used to advance the efficiency and effectiveness of NIAID's HIV/AIDS clinical research programs. PMID:21816958

30 CFR 33.34 - Drilling test.

Science.gov (United States)

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Drilling test. 33.34 Section 33.34 Mineral... MINING PRODUCTS DUST COLLECTORS FOR USE IN CONNECTION WITH ROCK DRILLING IN COAL MINES Test Requirements § 33.34 Drilling test. (a) A drilling test shall consist of drilling a set of 10 test holes, without...

Computer-aided detection as a decision assistant in chest radiography

Science.gov (United States)

Samulski, Maurice R. M.; Snoeren, Peter R.; Platel, Bram; van Ginneken, Bram; Hogeweg, Laurens; Schaefer-Prokop, Cornelia; Karssemeijer, Nico

2011-03-01

Background. Contrary to what may be expected, finding abnormalities in complex images like pulmonary nodules in chest radiographs is not dominated by time-consuming search strategies but by an almost immediate global interpretation. This was already known in the nineteen-seventies from experiments with briefly flashed chest radiographs. Later on, experiments with eye-trackers showed that abnormalities attracted the attention quite fast but often without further reader actions. Prolonging one's search seldom leads to newly found abnormalities and may even increase the chance of errors. The problem of reading chest radiographs is therefore not dominated by finding the abnormalities, but by interpreting them. Hypothesis. This suggests that readers could benefit from computer-aided detection (CAD) systems not so much by their ability to prompt potential abnormalities, but more from their ability to 'interpret' the potential abnormalities. In this paper, this hypothesis was investigated by an observer experiment. Experiment. In one condition, the traditional CAD condition, the most suspicious CAD locations were shown to the subjects, without telling them the levels of suspiciousness according to CAD. In the other condition, interactive CAD condition, levels of suspiciousness were given, but only when readers requested them at specified locations. These two conditions focus on decreasing search errors and decision errors, respectively. Results of reading without CAD were also recorded. Six subjects, all non-radiologists, read 223 chest radiographs in both conditions. CAD results were obtained from the OnGuard 5.0 system developed by Riverain Medical (Miamisburg, Ohio). Results. The observer data were analyzed by Location Response Operating Characteristic analysis (LROC). It was found that: 1) With the aid of CAD, the performance is significantly better than without CAD; 2) The performance with interactive CAD is significantly better than with traditional CAD at low false

Development of computational tool to interpret real time Pd (Pressure While Drilling) data; Desenvolvimento de ferramenta computacional interpretadora de dados de PWD (Pressure While Drilling) em tempo real

Energy Technology Data Exchange (ETDEWEB)

Gandelman, Roni Abensur; Waldmann, Alex Tadeu de Almeida; Martins, Andre Leibsohn [Centro de Pesquisas da Petrobras (CENPES). Gerencia de Tecnologia de Engenharia de Poco (Brazil)], e-mails: roniag@petrobras.com.br, awaldmann@petrobras.com.br, aleibsohn@petrobras.com.br; Teixeira, Gleber Tacio; Aragao, Atila Fernando Lima [E and P Servicos. Gerencia de Servicos de Poco (Brazil)], e-mail: gleber@petrobras.com.br, atila_aragao@petrobras.com.br; Rezende, Mauricio Seiji; Kern, Eduardo; Maliska Junior, Clovis [Engineering Simulation and Scientific Software (ESSS), (Brazil)], e-mails: mauricio@esss.com.br, kern@esss.com.br, coi@esss.com.br

2008-12-15

Drilling offshore oil wells is a very expensive and complex process, in which all the efforts must be taken to keep the annular pressure between a minimum pressure (pore pressure) and a maximum pressure (fracture pressure) which define the operational window limits. Several phenomena impact the bottom hole annular pressures, such as: ineffective hole cleaning, gel breaking when circulation is resumed, drill string movement (surge and swab), trips, pills displacement, kicks, etc. The correct interpretation of pressure while drilling (PWD) data is a very powerful toll to identify and prevent these phenomena. Nowadays, an expert monitors bottom hole pressures data and identifies undesirable events. The main goal of this project is the development of a computational tool to monitor pressure (and mud logging) data in real time to identify the causes of abnormal pressure variations, helping the operators to take decisions rapidly. Besides that, the tool allows the user to handle PWD data in a flexible architecture. This flexibility allows the incorporation of new methods of events identification as they are developed. The ultimate goals is to obtain a tool which serves both for the key study of the problems and physical, specific phenomena found during drilling, both for real-time monitoring to assist professionals involved in the process. (author)

Economic environmental management of drilling operations

International Nuclear Information System (INIS)

Longwell, H.J.; Akers, T.J.

1992-01-01

This paper presents significant environmental and regulatory initiatives developed by Exxon's New Orleans Drilling Organization. Specifically, the paper will cover drilling waste minimization techniques and disposal options, recycling of drilling waste streams, and environmentally managed drilling location design considerations. The implementation of some of these initiatives at Exxon's Chalkley field land locations have resulted in a fifty percent reduction in drilling location waste management costs. Some of these same initiatives have been successfully applied to Exxon's barge drilling locations. For operations at the environmentally sensitive Mobile Bay, Exxon contracted with a local company and assisted in the development of an economically and environmentally superior drilling waste disposal and treatment system. In summary, it is possible for drilling operators to pro-actively manage escalating environmental and regulatory challenges through the implementation of economic and practical initiatives

Newberry exploratory slimhole: Drilling and testing

Energy Technology Data Exchange (ETDEWEB)

Finger, J.T.; Jacobson, R.D.; Hickox, C.E.

1997-11-01

During July--November, 1995, Sandia National Laboratories, in cooperation with CE Exploration, drilled a 5,360 feet exploratory slimhole (3.895 inch diameter) in the Newberry Known Geothermal Resource Area (KGRA) near Bend, Oregon. This well was part of Sandia`s program to evaluate slimholes as a geothermal exploration tool. During and after drilling the authors performed numerous temperature logs, and at the completion of drilling attempted to perform injection tests. In addition to these measurements, the well`s data set includes: over 4,000 feet of continuous core (with detailed log); daily drilling reports from Sandia and from drilling contractor personnel; daily drilling fluid record; and comparative data from other wells drilled in the Newberry KGRA. This report contains: (1) a narrative account of the drilling and testing, (2) a description of equipment used, (3) a brief geologic description of the formation drilled, (4) a summary and preliminary interpretation of the data, and (5) recommendations for future work.

Mapping of multiple criteria for priority setting of health interventions: an aid for decision makers

Directory of Open Access Journals (Sweden)

Tromp Noor

2012-12-01

Full Text Available Abstract Background In rationing decisions in health, many criteria like costs, effectiveness, equity and feasibility concerns play a role. These criteria stem from different disciplines that all aim to inform health care rationing decisions, but a single underlying concept that incorporates all criteria does not yet exist. Therefore, we aim to develop a conceptual mapping of criteria, based on the World Health Organization’s Health Systems Performance and Health Systems Building Blocks frameworks. This map can be an aid to decision makers to identify the relevant criteria for priority setting in their specific context. Methods We made an inventory of all possible criteria for priority setting on the basis of literature review. We categorized the criteria according to both health system frameworks that spell out a country’s health system goals and input. We reason that the criteria that decision makers use in priority setting exercises are a direct manifestation of this. Results Our map includes thirty-one criteria that are distributed among five categories that reflect the goals of a health system (i.e. to improve level of health, fair distribution of health, responsiveness, social & financial risk protection and efficiency and leadership/governance one category that reflects feasibiliy based on the health system building blocks (i.e. service delivery, health care workforce , information, medical products, vaccines & technologies, financing and. Conclusions This conceptual mapping of criteria, based on well-established health system frameworks, will further develop the field of priority setting by assisting decision makers in the identification of multiple criteria for selection of health interventions.

Microgravity Drill and Anchor System

Science.gov (United States)

Parness, Aaron; Frost, Matthew A.; King, Jonathan P.

2013-01-01

This work is a method to drill into a rock surface regardless of the gravitational field or orientation. The required weight-on-bit (WOB) is supplied by a self-contained anchoring mechanism. The system includes a rotary percussive coring drill, forming a complete sampling instrument usable by robot or human. This method of in situ sample acquisition using micro - spine anchoring technology enables several NASA mission concepts not currently possible with existing technology, including sampling from consolidated rock on asteroids, providing a bolt network for astronauts visiting a near-Earth asteroid, and sampling from the ceilings or vertical walls of lava tubes and cliff faces on Mars. One of the most fundamental parameters of drilling is the WOB; essentially, the load applied to the bit that allows it to cut, creating a reaction force normal to the surface. In every drilling application, there is a minimum WOB that must be maintained for the system to function properly. In microgravity (asteroids and comets), even a small WOB could not be supported conventionally by the weight of the robot or astronaut. An anchoring mechanism would be needed to resist the reactions, or the robot or astronaut would push themselves off the surface and into space. The ability of the system to anchor itself to a surface creates potential applications that reach beyond use in low gravity. The use of these anchoring mechanisms as end effectors on climbing robots has the potential of vastly expanding the scope of what is considered accessible terrain. Further, because the drill is supported by its own anchor rather than by a robotic arm, the workspace is not constrained by the reach of such an arm. Yet, if the drill is on a robotic arm, it has the benefit of not reflecting the forces of drilling back to the arm s joints. Combining the drill with the anchoring feet will create a highly mobile, highly stable, and highly reliable system. The drilling system s anchor uses hundreds of

Influence of Drilling Parameters on Torque during Drilling of GFRP Composites Using Response Surface Methodology

Science.gov (United States)

Mohan, N. S.; Kulkarni, S. M.

2018-01-01

Polymer based composites have marked their valuable presence in the area of aerospace, defense and automotive industry. Components made of composite, are assembled to main structure by fastener, which require accurate, precise high quality holes to be drilled. Drilling the hole in composite with accuracy require control over various processes parameters viz., speed, feed, drill bit size and thickens of specimen. TRIAC VMC machining center is used to drill the hole and to relate the cutting and machining parameters on the torque. MINITAB 14 software is used to analyze the collected data. As a function of cutting and specimen parameters this method could be useful for predicting torque parameters. The purpose of this work is to investigate the effect of drilling parameters to get low torque value. Results show that thickness of specimen and drill bit size are significant parameters influencing the torque and spindle speed and feed rate have least influence and overlaid plot indicates a feasible and low region of torque is observed for medium to large sized drill bits for the range of spindle speed selected. Response surface contour plots indicate the sensitivity of the drill size and specimen thickness to the torque.

Control procedure for well drilling operations

Energy Technology Data Exchange (ETDEWEB)

Bourdon, J C

1988-09-09

A control procedure of rotary drilling operations is proposed. It uses the Drill off test. The drill-off test permits to determine the rock drill speed variation as a function of the wright applied on the top of the pipe. We can deduce from that a rock drill wear parameter. The method permits to prevent a rupture and its grave economic consequences.

Multi-state autonomous drilling for lunar exploration

Directory of Open Access Journals (Sweden)

Chen Chongbin

2016-10-01

Full Text Available Due to the lack of information of subsurface lunar regolith stratification which varies along depth, the drilling device may encounter lunar soil and lunar rock randomly in the drilling process. To meet the load safety requirements of unmanned sampling mission under limited orbital resources, the control strategy of autonomous drilling should adapt to the indeterminable lunar environments. Based on the analysis of two types of typical drilling media (i.e., lunar soil and lunar rock, this paper proposes a multi-state control strategy for autonomous lunar drilling. To represent the working circumstances in the lunar subsurface and reduce the complexity of the control algorithm, lunar drilling process was categorized into three drilling states: the interface detection, initiation of drilling parameters for recognition and drilling medium recognition. Support vector machine (SVM and continuous wavelet transform were employed for the online recognition of drilling media and interface, respectively. Finite state machine was utilized to control the transition among different drilling states. To verify the effectiveness of the multi-state control strategy, drilling experiments were implemented with multi-layered drilling media constructed by lunar soil simulant and lunar rock simulant. The results reveal that the multi-state control method is capable of detecting drilling state variation and adjusting drilling parameters timely under vibration interferences. The multi-state control method provides a feasible reference for the control of extraterrestrial autonomous drilling.

S4HARA: System for HIV/AIDS resource allocation

Directory of Open Access Journals (Sweden)

Carter Michael W

2008-03-01

Full Text Available Abstract Background HIV/AIDS resource allocation decisions are influenced by political, social, ethical and other factors that are difficult to quantify. Consequently, quantitative models of HIV/AIDS resource allocation have had limited impact on actual spending decisions. We propose a decision-support System for HIV/AIDS Resource Allocation (S4HARA that takes into consideration both principles of efficient resource allocation and the role of non-quantifiable influences on the decision-making process for resource allocation. Methods S4HARA is a four-step spreadsheet-based model. The first step serves to identify the factors currently influencing HIV/AIDS allocation decisions. The second step consists of prioritizing HIV/AIDS interventions. The third step involves allocating the budget to the HIV/AIDS interventions using a rational approach. Decision-makers can select from several rational models of resource allocation depending on availability of data and level of complexity. The last step combines the results of the first and third steps to highlight the influencing factors that act as barriers or facilitators to the results suggested by the rational resource allocation approach. Actionable recommendations are then made to improve the allocation. We illustrate S4HARA in the context of a primary healthcare clinic in South Africa. Results The clinic offers six types of HIV/AIDS interventions and spends US$750,000 annually on these programs. Current allocation decisions are influenced by donors, NGOs and the government as well as by ethical and religious factors. Without additional funding, an optimal allocation of the total budget suggests that the portion allotted to condom distribution be increased from 1% to 15% and the portion allotted to prevention and treatment of opportunistic infections be increased from 43% to 71%, while allocation to other interventions should decrease. Conclusion Condom uptake at the clinic should be increased by

Optimum fluid design for drilling and cementing a well drilled with coil tubing technology

Energy Technology Data Exchange (ETDEWEB)

Swendsen, O.; Saasen, A.; Vassoy, B. [Statoil (Norway); Skogen, E.; Mackin, F.; Normann, S. H.

1998-12-31

The strategy, design and drilling fluid and cementing operations in the first two wells drilled with coil tubing technology in the Gullfaks field in the Tampen Spur Area of the Norwegian sector of the North Sea are discussed. The drilling fluid use was a solids-free potassium formate/polymer brine-based fluid with a density of 1,50-1.56 g/cc, with flow properties characterized by very low fluid loss due to high extensional viscosity, a low viscosity at all shear rates, and a low degree of shear-thinning. The low viscous drilling fluid is considered to have been the major contributing factor in achieving excellent hole cleaning, no differential sticking, successful setting of cement kick-off plugs, problem-free running of the liner, and excellent zonal isolation when cementing the liner. These experiences led the authors to conclude that it is possible to formulate a brine-based solids-free drilling fluid with low viscosity and fluid loss properties for most formation pressure regimes, and that such a drilling fluid is well suited to drilling highly deviated slim hole wells where hole cleaning and differential sticking present special challenges. 12 refs., 2 tabs., 3 figs.

Selection of large diameter drills with the aid of a computer, between diesel and electric alternatives for sedimentary mining. Seleccion de perforadoras de gran diametro con ayuda de ordenador, alternativa diesel electrica en mineria sedimentaria

Energy Technology Data Exchange (ETDEWEB)

Colomo Gomez, M. (ENCASUR, Ciudad Real (Spain))

1988-01-01

The communication develops a rotary drill rig selection study carried out in Mina Emma, ENCASUR Puertollano (Open pit coal mine), for diameters extended from 9 7/8 to 15 inches and bench heights 10, 15 and 20 meters. Since the choice of diameters is in the transition area from diesel to electric machines, the conclusions are specially interesting in making buying decisions of this kind. 6 figs., 6 tabs.

[The adaptation and validation to Spanish of the questionnaire Aid to Capacity Evaluation (ACE), for the assessment of the ability of patients in medical decision-making].

Science.gov (United States)

Moraleda Barba, Sandra; Ballesta Rodríguez, M Isabel; Delgado Quero, Antonio Luis; Lietor Villajos, Norberto; Moreno Corredor, Andrés; Delgado Rodríguez, Miguel

2015-03-01

To adapt and validate the Spanish version of the Aid to Capacity Evaluation scale, designed to assess the capacity of the adult in medical decision-making, both in diagnosis and treatment processes. Observational study of prospective validation. Primary and hospital care of the basic health area of Jaen. One hundred twenty-nine patients. Questionnaire which included sociodemographic variables, concerning the decision (scope, type of decision, the need for written informed consent), assessment of the capacity to the Aid to Capacity Evaluation scale and other related comorbidity (hearing loss, alcoholism, cognitive level variables with the Mini-Mental State Examination and depression by Goldberg or Yesavage test). The tool is considered viable. The conclusions of the expert panel were favorable. The result of the criteria' validity, comparing the results with the assessment of the experts (forensic and psychiatrist) was very satisfying (P<.001). The intra-observer reliability was low (kappa=0,135). Interobserver reliability remained high (kappa=0.74). The internal consistency was awarded an alpha of Cronbach's 0,645 for the reduced model of 6 items. The Aid to Capacity Evaluation scale was adapted to Spanish, demonstrating adequate internal consistency and construct validity. Its use in clinical practice could contribute to the identification of patients unable to make a particular medical decision and/or to give an informed consent. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

A decision aiding and action management tool to control the energy demand - from conception to development; Un outil d`aide a la decision et de gestion des actions pour la maitrise de la demande d`energie - de la conception au developpement

Energy Technology Data Exchange (ETDEWEB)

Kaehler, J W.M.

1993-07-06

This work presents a synthesis of three points: the environment, energy and man. The consideration of these aspects allows us to confront the unequal distribution of energy resources, the constraints and political influences which determine the exploitation of these energy resources, and the concentration of the consumption of energy by one fifth of the world`s population and the perspective of future growth of energy use by the remaining four-fifths. It is understanding of the importance and the benefits of reducing energy requirements, combined with the environmental perspectives, that forms the core of the Integrated Resource Planning of Least is proposed. This framework will utilize the knowledge of the engineer for developing a system to aid with decision making and the management of information, and particularly with the notions henceforth referred to as `Demand-Site Management` as applied to the electrical grid. The model of such a Management Information System which demonstrates these theoretical advances is called SIADEME (Systeme Interactif d`Aide a la Decision et de Gestion des Actions de Maitrise de la Demande d`energie). This includes some examples for the management of electricity demand for both the lighting and refrigeration cases in large (> 2500 m{sup 2}) supermarkets for the French environmental and energy management agency (Ademe). (author) 216 refs.

Heat generated by dental implant drills during osteotomy-a review: heat generated by dental implant drills.

Science.gov (United States)

Mishra, Sunil Kumar; Chowdhary, Ramesh

2014-06-01

Osseointegration is the more stable situation and results in a high success rate of dental implants. Heat generation during rotary cutting is one of the important factors influencing the development of osseointegration. To assess the various factors related to implant drills responsible for heat generation during osteotomy. To identify suitable literature, an electronic search was performed using Medline and Pubmed database. Articles published in between 1960 to February 2013 were searched. The search is focused on heat generated by dental implant drills during osteotomy. Various factors related to implant drill such effect of number of blades; drill design, drill fatigue, drill speed and force applied during osteotomies which were responsible for heat generation were reviewed. Titles and abstracts were screened, and literature that fulfilled the inclusion criteria was selected for a full-text reading. The initial literature search resulted in 299 articles out of which only 70 articles fulfils the inclusion criteria and were included in this systematic review. Many factors related to implant drill responsible for heat generation were found. Successful preparation of an implant cavity with minimal damage to the surrounding bone depends on the avoidance of excessive temperature generation during surgical drilling. The relationship between heat generated and implant drilling osteotomy is multifactorial in nature and its complexity has not been fully studied. Lack of scientific knowledge regarding this issue still exists. Further studies should be conducted to determine the various factors which generate less heat while osteotomy such as ideal ratio of force and speed in vivo, exact time to replace a drill, ideal drill design, irrigation system, drill-bone contact area.

Technology strategy for cost-effective drilling and intervention; Technology Target Areas; TTA4 - Cost effective drilling and intervention

Energy Technology Data Exchange (ETDEWEB)

2007-07-01

The main goals of the OG21 initiative are to (1) develop new technology and knowledge to increase the value creation of Norwegian oil and gas resources and (2) enhance the export of Norwegian oil and gas technology. The OG21 Cost-effective Drilling and Intervention (CEDI) Technology Target Area (TTA) has identified some key strategic drilling and well intervention needs to help meet the goals of OG21. These key strategic drilling and well intervention needs are based on a review of present and anticipated future offshore-Norway drilling and well intervention conditions and the Norwegian drilling and well intervention industry. A gap analysis has been performed to assess the extent to which current drilling and well intervention research and development and other activities will meet the key strategic needs. Based on the identified strategic drilling and well intervention needs and the current industry res each and development and other activities, the most important technology areas for meeting the OG21 goals are: environment-friendly and low-cost exploration wells; low-cost methods for well intervention/sidetracks; faster and extended-reach drilling; deep water drilling, completion and intervention; offshore automated drilling; subsea and sub-ice drilling; drilling through basalt and tight carbonates; drilling and completion in salt formation. More specific goals for each area: reduce cost of exploration wells by 50%; reduce cost for well intervention/sidetracks by 50%; increase drilling efficiency by 40%; reduce drilling cost in deep water by 40 %; enable offshore automated drilling before 2012; enable automated drilling from seabed in 2020. Particular focus should be placed on developing new technology for low-cost exploration wells to stem the downward trends in the number of exploration wells drilled and the volume of discovered resources. The CEDI TTA has the following additional recommendations: The perceived gaps in addressing the key strategic drilling and

The Auto-Gopher Deep Drill

Science.gov (United States)

Badescu, Mircea

2014-01-01

Subsurface penetration by coring, drilling or abrading is of great importance for a large number of space and earth applications. An Ultrasonic/Sonic Drill/Corer (USDC) has been in development at JPL's Nondestructive Evaluation and Advanced Actuators (NDEAA) lab as an adaptable tool for many of these applications. The USDC uses a novel drive mechanism to transform the high frequency ultrasonic or sonic vibrations of the tip of a horn into a lower frequency sonic hammering of a drill bit through an intermediate free-flying mass. The USDC device idea has been implemented at various scales from handheld drills to large diameter coring devices. A series of computer programs that model the function and performance of the USDC device were developed and were later integrated into an automated modeling package. The USDC has also evolved from a purely hammering drill to a rotary hammer drill as the design requirements increased form small diameter shallow drilling to large diameter deep coring. A synthesis of the Auto-Gopher development is presented in this paper.

Expanding the Reach of Participatory Risk Management: Testing an Online Decision-Aiding Framework for Informing Internally Consistent Choices.

Science.gov (United States)

Bessette, Douglas L; Campbell-Arvai, Victoria; Arvai, Joseph

2016-05-01

This article presents research aimed at developing and testing an online, multistakeholder decision-aiding framework for informing multiattribute risk management choices associated with energy development and climate change. The framework was designed to provide necessary background information and facilitate internally consistent choices, or choices that are in line with users' prioritized objectives. In order to test different components of the decision-aiding framework, a six-part, 2 × 2 × 2 factorial experiment was conducted, yielding eight treatment scenarios. The three factors included: (1) whether or not users could construct their own alternatives; (2) the level of detail regarding the composition of alternatives users would evaluate; and (3) the way in which a final choice between users' own constructed (or highest-ranked) portfolio and an internally consistent portfolio was presented. Participants' self-reports revealed the framework was easy to use and providing an opportunity to develop one's own risk-management alternatives (Factor 1) led to the highest knowledge gains. Empirical measures showed the internal consistency of users' decisions across all treatments to be lower than expected and confirmed that providing information about alternatives' composition (Factor 2) resulted in the least internally consistent choices. At the same time, those users who did not develop their own alternatives and were not shown detailed information about the composition of alternatives believed their choices to be the most internally consistent. These results raise concerns about how the amount of information provided and the ability to construct alternatives may inversely affect users' real and perceived internal consistency. © 2015 Society for Risk Analysis.

Characterization of subsurface structure at Soultz HDR field by the triaxial drill-bit VSP; Sanjiku drill bit VSP ho ni yoru Soultz HDR field no chika kozo suitei

Energy Technology Data Exchange (ETDEWEB)

Asanuma, H; Niitsuma, H; Liu, H [Tohoku University, Sendai (Japan); Baria, R

1997-10-22

Triaxial drill-bit VSP (vertical seismic profiling) method is applied to the Soultz HDR (hot dry rock) field, France, where an artificial reservoir is provided inside the bedrock, and the structure inside the rockbed is estimated. An elastic wave detector is installed in the rockbed in this field, and data are acquired having frequency components up to approximately 1kHz. The trajectory of particles due to excavation noise is analyzed, and it is found that the drill-bit is the primary source of noise during excavation and that the SV-wave dominates in the emitted noise. Estimating the subsurface structure aided by the principle of the triaxial drill-bit VSP method, the lower part is detected of the artificial reservoir formed by hydraulic fracturing. As is reported in this paper, when the principle of the subject VSP method is considered, it has to be said that it is quite difficult to employ this method to extensively estimate the subsurface structure on the basis of measurements of the inside of the rockbed. There is a plan for a future study of a technique for accurately and extensively estimating subsurface structures by use of a small number of sensors. 8 refs., 7 figs.