Group Decision Process Support

DEFF Research Database (Denmark)

Gøtze, John; Hijikata, Masao

1997-01-01

Introducing the notion of Group Decision Process Support Systems (GDPSS) to traditional decision-support theorists.......Introducing the notion of Group Decision Process Support Systems (GDPSS) to traditional decision-support theorists....

Refurbishment decision support tools review—Energy and life cycle as key aspects to sustainable refurbishment projects

International Nuclear Information System (INIS)

Ferreira, Joaquim; Pinheiro, Manuel Duarte; Brito, Jorge de

2013-01-01

Europe is facing one of its most challenging crises since Great Depression and the construction sector is one of the worst affected. Refurbishment is therefore often suggested as one of the most useful solutions for the current real estate crisis in consolidated areas like the EU. On the other hand, it is imperative to construct buildings according to sustainable principles regarding economic, environmental and social issues. Therefore, proper decision-support methods are needed to help designers, investors and policy makers to choose the most sustainable solution for a refurbishment project, especially for energy retrofit works. This paper reviews the works relating to sustainable refurbishment decision-support tools which have already been developed. For this purpose we have analysed and classified 40 different methods, with particular focus on their main common aims. They are also compared with other classifications proposed. This paper further highlights the role of energy as a driving factor and discusses what other research developments are needed to create related tools for the future that could respond to actual construction requirements. - Highlights: • Sustainable refurbishment as an important challenge. • Proper decision-support methods are needed to refurbishment. • The paper reviews 40 different methods, focusing their main common aims. • The paper highlights the role of the energy as key factor to search sustainability. • It also stresses the importance of life cycle approach in refurbishment projects

Life-sustaining support: ethical, cultural, and spiritual conflicts part I: Family support--a neonatal case study.

Science.gov (United States)

Stutts, Amy; Schloemann, Johanna

2002-04-01

As medical knowledge and technology continue to increase, so will types of life-sustaining support as well as the public's expectations for use of this support with positive outcomes. Health care professionals will continue to be challenged by the issues surrounding the appropriate use of life-sustaining support and the issues it raises. This is especially apparent in the NICU. When parents' belief systems challenge the health care team's ethical commitment to beneficence and nonmaleficence, a shared decision-making model based on mutual understanding of and respect for different viewpoints can redirect the focus onto the baby's best interest. This article addresses three questions: 1. How do nonmaleficence, beneficence, and concern about quality of life guide the use of life-sustaining support? 2. To what extent should parental autonomy and spirituality influence treatment decisions? 3. What efforts can the health care team make to support the family?

Withholding and withdrawing life-support therapy in an Emergency Department: prospective survey.

Science.gov (United States)

Le Conte, Philippe; Baron, Denis; Trewick, David; Touzé, Marie Dominique; Longo, Céline; Vial, Irshaad; Yatim, Danielle; Potel, Gille

2004-12-01

Few studies have focused on decisions to withdraw or withhold life-support therapies in the emergency department. Our objectives were to identify clinical situations where life-support was withheld or withdrawn, the criteria used by physicians to justify their decisions, the modalities necessary to implement these decisions, patient disposition, and outcome. Prospective unicenter survey in an Emergency Department of a tertiary care teaching hospital. All non-trauma patients (n=119) for whom a decision to withhold or withdraw life-sustaining treatments was taken between January and September 1998. Choice of criteria justifying the decision to withhold or withdraw life-sustaining treatments, time interval from ED admission to the decision; type of decision implemented, outcome. Fourteen thousand eight hundred and seventy-five non-trauma patients were admitted during the study period, 119 were included, mean age 75+/-13 years. Resuscitation procedures were instituted for 96 (80%) patients before a subsequent decision was taken. Physicians chose on average 6+/-2 items to justify their decision; the principal acute medical disorder and futility of care were the two criteria most often used. Median time interval to reach the decision was 187 min. Withdrawal involved 37% of patients and withholding 63% of patients. The family was involved in the decision-making process in 72% of patients. The median time interval from the decision to death was 16 h (5 min to 140 days). Withdrawing and withholding life-support therapy involved elderly patients with underlying chronic cardiopulmonary disease or metastatic cancer or patients with acute non-treatable illness.

The enactment stage of end-of-life decision-making for children.

Science.gov (United States)

Sullivan, Jane Elizabeth; Gillam, Lynn Heather; Monagle, Paul Terence

2018-01-11

Typically pediatric end-of-life decision-making studies have examined the decision-making process, factors, and doctors' and parents' roles. Less attention has focussed on what happens after an end-of-life decision is made; that is, decision enactment and its outcome. This study explored the views and experiences of bereaved parents in end-of-life decision-making for their child. Findings reported relate to parents' experiences of acting on their decision. It is argued that this is one significant stage of the decision-making process. A qualitative methodology was used. Semi-structured interviews were conducted with bereaved parents, who had discussed end-of-life decisions for their child who had a life-limiting condition and who had died. Data were thematically analysed. Twenty-five bereaved parents participated. Findings indicate that, despite differences in context, including the child's condition and age, end-of-life decision-making did not end when an end-of-life decision was made. Enacting the decision was the next stage in a process. Time intervals between stages and enactment pathways varied, but the enactment was always distinguishable as a separate stage. Decision enactment involved making further decisions - parents needed to discern the appropriate time to implement their decision to withdraw or withhold life-sustaining medical treatment. Unexpected events, including other people's actions, impacted on parents enacting their decision in the way they had planned. Several parents had to re-implement decisions when their child recovered from serious health issues without medical intervention. Significance of results A novel, critical finding was that parents experienced end-of-life decision-making as a sequence of interconnected stages, the final stage being enactment. The enactment stage involved further decision-making. End-of-life decision-making is better understood as a process rather than a discrete once-off event. The enactment stage has particular

Lebenszykluskostenanalyse zur Entscheidungsunterstützung in der chemischen Prozessentwicklung = Life cycle cost analysis for decision support in chemical process development

NARCIS (Netherlands)

Sell, I.; Ott-Reinhardt, D.; Kralisch, D.

2013-01-01

The need for environmentally benign processes as a crucial basis of future competitiveness is in the focus of today's chemical industry. Decision support in the development of such processes can be provided by life cycle assessment. New technologies, however, can be established only if they lead to

Deferred Personal Life Decisions of Women Physicians.

Science.gov (United States)

Bering, Jamie; Pflibsen, Lacey; Eno, Cassie; Radhakrishnan, Priya

2018-05-01

Inadequate work-life balance can have significant implications regarding individual performance, retention, and on the future of the workforce in medicine. The purpose of this study was to determine whether women physicians defer personal life decisions in pursuit of their medical career. We conducted a survey study of women physicians ages 20-80 from various medical specialties using a combination of social media platforms and women physicians' professional listservs with 801 survey responses collected from May through November 2015. The primary endpoint was whether women physicians deferred personal life decisions in pursuit of their medical career. Secondary outcomes include types of decisions deferred and correlations with age, hours worked per week, specialty, number of children, and career satisfaction. Respondents were categorized into deferred and nondeferred groups. Personal decision deferments were reported by 64% of respondents. Of these, 86% reported waiting to have children and 22% reported waiting to get married. Finally, while 85% of women in the nondeferment group would choose medicine again as a career, only 71% of women in the deferment group would do so (p job satisfaction, and insurance/administrative burden. The results of this survey have significant implications on the future of the workforce in medicine. Overall, our analysis shows that 64% of women physicians defer important life decisions in pursuit of their medical career. With an increase in the number of women physicians entering the workforce, lack of support and deferred personal decisions have a potential negative impact on individual performance and retention. Employers must consider the economic impact and potential workforce shortages that may develop if these issues are not addressed.

Research Needs and Challenges from Science to Decision Support. Lesson Learnt from the Development of the International Reference Life Cycle Data System (ILCD) Recommendations for Life Cycle Impact Assessment

DEFF Research Database (Denmark)

Sala, Serenella; Pant, Rana; Hauschild, Michael Zwicky

2012-01-01

Environmental implications of the whole supply-chain of products, both goods and services, their use, and waste management, i.e., their entire life cycle from "cradle to grave" have to be considered to achieve more sustainable production and consumption patterns. Progress toward environmental...... sustainability requires enhancing the methodologies for quantitative, integrated environmental assessment and promoting the use of these methodologies in different domains. In the context of Life Cycle Assessment (LCA) of products, in recent years, several methodologies have been developed for Life Cycle Impact...... Assessment (LCIA). The Joint Research Center of the European Commission (EC-JRC) led a "science to decision support" process which resulted in the International Reference Life Cycle Data System (ILCD) Handbook, providing guidelines to the decision and application of methods for LCIA. The Handbook...

Whose decision is it anyway? How clinicians support decision-making participation after acquired brain injury.

Science.gov (United States)

Knox, Lucy; Douglas, Jacinta M; Bigby, Christine

2013-01-01

To raise professional awareness of factors that may influence the support offered by clinicians to people with acquired brain injury (ABI), and to consider the potential implications of these factors in terms of post-injury rehabilitation and living. A review of the literature was conducted to identify factors that determine how clinicians provide support and influence opportunities for individuals with ABI to participate in decision making across the rehabilitation continuum. Clinical case studies are used to highlight two specific issues: (1) hidden assumptions on the part of the practitioner, and (2) perceptions of risk operating in clinical practice. There are a range of factors which may influence the decision-making support provided by clinicians and, ultimately, shape lifetime outcomes for individuals with ABI. A multidimensional framework may assist clinicians to identify relevant factors and consider their potential implications including those that influence how clinicians involved in supporting decision making approach this task. Participation in decision making is an undisputed human right and central to the provision of person-centred care. Further research is required to understand how clinical practice can maximise both opportunities and support for increased decision-making participation by individuals with ABI. There is an increasing focus on the rights of all individuals to be supported to participate in decision making about their life. A number of changes associated with ABI mean that individuals with ABI will require support with decision making. Clinicians have a critical role in providing this support over the course of the rehabilitation continuum. Clinicians need to be aware of the range of factors that may influence the decision-making support they provide. A multidimensional framework may be used by clinicians to identify influences on the decision-making support they provide.

IT for advanced Life Support in English

DEFF Research Database (Denmark)

Sejerø Pedersen, Birgitte; Jeberg, Kirsten Ann; Koerner, Christian

2009-01-01

In this study we analyzed how IT support can be established for the treatment and documentation of advanced life support (ALS) in a hospital. In close collaboration with clinical researchers, a running prototype of an IT solution to support the clinical decisions in ALS was developed and tried out...... in a full scale simulation environment. We have named this IT solution the CardioData Prototype....

Influence of physicians' life stances on attitudes to end-of-life decisions and actual end-of-life decision-making in six countries

DEFF Research Database (Denmark)

Cohen, J; van Delden, J; Mortier, F

2008-01-01

AIM: To examine how physicians' life stances affect their attitudes to end-of-life decisions and their actual end-of-life decision-making. METHODS: Practising physicians from various specialties involved in the care of dying patients in Belgium, Denmark, The Netherlands, Sweden, Switzerland......) and Protestants (up to 20.4% in The Netherlands) reported ever having made such a decision. DISCUSSION: The results suggest that religious teachings influence to some extent end-of-life decision-making, but are certainly not blankly accepted by physicians, especially when dealing with real patients...... large life-stance groups in each country. RESULTS: Only small differences in life stance were found in all countries in general attitudes and intended and actual behaviour with regard to various end-of-life decisions. However, with regard to the administration of drugs explicitly intended to hasten...

Group decision support system for customer-driven product design

Science.gov (United States)

Lin, Zhihang; Chen, Hang; Chen, Kuen; Che, Ada

2000-10-01

This paper describes the work on the development of a group decision support system for customer driven product design. The customer driven is to develop products, which meet all customer requirements in whole life cycle of products. A process model of decision during product primary design is proposed to formulate the structured, semi-structured and unstructured decision problems. The framework for the decision support system is presented that integrated both advances in the group decision making and distributed artificial intelligent. The system consists of the product primary design tool kit and the collaborative platform with multi-agent structure. The collaborative platform of the system and the product primary design tool kit, including the VOC (Voice of Customer) tool, QFD (Quality Function Deployment) tool, the Conceptual design tool, Reliability analysis tool and the cost and profit forecasting tool, are indicated.

End-of-life decisions for people with intellectual disabilities, an interview study with patient representatives.

Science.gov (United States)

Wagemans, Annemieke M A; Van Schrojenstein Lantman-de Valk, Henny M J; Proot, Ireen M; Metsemakers, Job; Tuffrey-Wijne, Irene; Curfs, Leopold M G

2013-09-01

Not much is known about the process of end-of-life decision-making for people with intellectual disabilities. To clarify the process of end-of-life decision-making for people with intellectual disabilities from the perspective of patient representatives. A qualitative study based on semi-structured interviews, recorded digitally and transcribed verbatim. Data were analysed using Grounded Theory procedures. We interviewed 16 patient representatives after the deaths of 10 people with intellectual disabilities in the Netherlands. The core category 'Deciding for someone else' describes the context in which patient representatives took end-of-life decisions. The patient representatives felt highly responsible for the outcomes. They had not involved the patients in the end-of-life decision-making process, nor any professionals other than the doctor. The categories of 'Motives' and 'Support' were connected to the core category of 'Deciding for someone else'. 'Motives' refers to the patient representatives' ideas about quality of life, prevention from suffering, patients who cannot understand the burden of interventions and emotional reasons reported by patient representatives. 'Support' refers to the support that patient representatives wanted the doctors to give to them in the decision-making process. From the perspective of the patient representatives, the process of end-of-life decision-making can be improved by ensuring clear roles and an explicit description of the tasks and responsibilities of all participants. Regular discussion between everyone involved including people with intellectual disabilities themselves can improve knowledge about each other's motives for end-of-decisions and can clarify expectations towards each other.

End-of-life decisions: Christian perspectives.

Science.gov (United States)

Stempsey, William E

1997-12-01

While legal rights to make medical treatment decisions at the end of one's life have been recognized by the courts, particular religious traditions put axiological and metaphysical meat on the bare bones of legal rights. Mere legal rights do not capture the full reality, meaning and importance of death. End-of-life decisions reflect not only the meaning we find in dying, but also the meaning we have found in living. The Christian religions bring particular understandings of the vision of life as a gift from God, human responsibility for stewardship of that life, the wholeness of the person, and the importance of the dying process in preparing spiritually for life beyond earthly life, to bear on end-of-life decisions.

Supported Decision Making: A Synthesis of the Literature across Intellectual Disability, Mental Health, and Aging

Science.gov (United States)

Shogren, Karrie A.; Wehmeyer, Michael L.; Lassmann, Heather; Forber-Pratt, Anjali J.

2017-01-01

Supported decision making (SDM) has begun to receive significant attention as means to enable people to exercise autonomy and self-determination over decisions about their life. Practice frameworks that can be used to promote the provision of supports for decision making are needed. This paper integrates the literature across intellectual and…

Decisions at hand: a decision support system on handhelds.

Science.gov (United States)

Zupan, B; Porenta, A; Vidmar, G; Aoki, N; Bratko, I; Beck, J R

2001-01-01

One of the applications of clinical information systems is decision support. Although the advantages of utilizing such aids have never been theoretically disputed, they have been rarely used in practice. The factor that probably often limits the utility of clinical decision support systems is the need for computing power at the very site of decision making--at the place where the patient is interviewed, in discussion rooms, etc. The paper reports on a possible solution to this problem. A decision-support shell LogReg is presented, which runs on a handheld computer. A general schema for handheld-based decision support is also proposed, where decision models are developed on personal computers/workstations, encoded in XML and then transferred to handhelds, where the models are used within a decision support shell. A use case where LogReg has been applied to clinical outcome prediction in crush injury is presented.

Patient and caregiver perspectives on decision support for symptom and quality of life management during cancer treatment: Implications for eHealth.

Science.gov (United States)

Cooley, Mary E; Nayak, Manan M; Abrahm, Janet L; Braun, Ilana M; Rabin, Michael S; Brzozowski, Jane; Lathan, Christopher; Berry, Donna L

2017-08-01

Adequate symptom and quality-of-life (SQL) management is a priority during cancer treatment. eHealth is a timely way to enhance patient-engagement, facilitate communication, and improve health outcomes. The objectives of this study were to describe patient and caregivers' perspectives for providing, processing, and managing SQL data to enhance communication and identify desired components for decision support. Data were collected from 64 participants through questionnaires and focus groups. Analysis was conducted using NVivo. Open and axial coding was completed, grouping commonalities and large constructs into nodes to identify and synthesize themes. Face-to-face meetings with clinicians were the prime time to communicate, and patients strove to understand treatment options and the effect on SQL by bringing caregivers to their visits, taking notes, tracking symptoms, and creating portable health records. Patients/caregivers struggled to self-manage their symptoms and were uncertain when to contact clinicians when experiencing uncontrolled symptoms. Most participants identified eHealth solutions for decision support. However, 38% of participants (n = 24) rarely used computers and identified non-eHealth options for decision support. Core components for both eHealth and non-eHealth systems were access to (1) cancer information, (2) medical records, (3) peer support, and (4) improved support and understanding on when to contact clinicians. Patients were faced with an overwhelming amount of information and relied on their caregivers to help navigate the complexities of cancer care and self-manage SQL. Health technologies can provide informational support; however, decision support needs to span multiple venues to avoid increasing disparities caused by a digital divide. Copyright © 2017 John Wiley & Sons, Ltd.

Advanced intelligent computational technologies and decision support systems

CERN Document Server

Kountchev, Roumen

2014-01-01

This book offers a state of the art collection covering themes related to Advanced Intelligent Computational Technologies and Decision Support Systems which can be applied to fields like healthcare assisting the humans in solving problems. The book brings forward a wealth of ideas, algorithms and case studies in themes like: intelligent predictive diagnosis; intelligent analyzing of medical images; new format for coding of single and sequences of medical images; Medical Decision Support Systems; diagnosis of Down’s syndrome; computational perspectives for electronic fetal monitoring; efficient compression of CT Images; adaptive interpolation and halftoning for medical images; applications of artificial neural networks for real-life problems solving; present and perspectives for Electronic Healthcare Record Systems; adaptive approaches for noise reduction in sequences of CT images etc.

Decision support systems

DEFF Research Database (Denmark)

Jørgensen, L.N.; Noe, E.; Langvad, A.M.

2007-01-01

system Crop Protection Online is widely used by advisors and as a learning tool for students. Although the system has been validated in many field trials over the years and has shown reliable results, the number of end-users among farmers has been relatively low during the last 10 years (approximately...... 1000 farmers). A sociological investigation of farmers' decision-making styles in the area of crop protection has shown that arable farmers can be divided into three major groups: (a) system-orientated farmers, (b) experience-based farmers and (c) advisory-orientated farmers. The information required...... by these three groups to make their decisions varies and therefore different ways of using decision support systems need to be provided. Decision support systems need to be developed in close dialogue and collaboration with user groups....

Tactical decision making under stress (TADMUS) decision support system

OpenAIRE

Morrison, Jeffrey G.; Kelly, Richard T.; Moore, Ronald A.; Hutchins, Susan G.

1996-01-01

A prototype decision support system (DSS) was developed to enhance Navy tactical decision making based on naturalistic decision processes. Displays were developed to support critical decision making tasks through recognition-primed and explanation-based reasoning processes and cognitive analysis of the decision making problems faced by Navy tactical officers in a shipboard Combat Information Center. Baseline testing in high intensity, peace keeping, littoral scenarios indicated...

Perceived risks around choice and decision making at end-of-life: a literature review.

Science.gov (United States)

Wilson, F; Gott, M; Ingleton, C

2013-01-01

the World Health Organization identifies meeting patient choice for care as central to effective palliative care delivery. Little is known about how choice, which implies an objective balancing of options and risks, is understood and enacted through decision making at end-of-life. to explore how perceptions of 'risk' may inform decision-making processes at end-of-life. an integrative literature review was conducted between January and February 2010. Papers were reviewed using Hawker et al.'s criteria and evaluated according to clarity of methods, analysis and evidence of ethical consideration. All literature was retained as background data, but given the significant international heterogeneity the final analysis specifically focused on the UK context. the databases Medline, PsycINFO, Assia, British Nursing Index, High Wire Press and CINAHL were explored using the search terms decision*, risk, anxiety, hospice and palliative care, end-of-life care and publication date of 1998-2010. thematic analysis of 25 papers suggests that decision making at end-of-life is multifactorial, involving a balancing of risks related to caregiver support; service provider resources; health inequalities and access; challenges to information giving; and perceptions of self-identity. Overall there is a dissonance in understandings of choice and decision making between service providers and service users. the concept of risk acknowledges the factors that shape and constrain end-of-life choices. Recognition of perceived risks as a central factor in decision making would be of value in acknowledging and supporting meaningful decision making processes for patients with palliative care needs and their families.

Decision support, analytics, and business intelligence

CERN Document Server

Power, Daniel J

2013-01-01

Competition is becoming more intense and decision makers are encountering increasing complexity, rapid change, and higher levels of risk. In many situations, the solution is more and better computerized decision support, especially analytics and business intelligence. Today managers need to learn about and understand computerized decision support. If a business is to succeed, managers must know much more about information technology solutions. This second edition of a powerful introductory book is targeted at busy managers and MBA students who need to grasp the basics of computerized decision support, including the following: What are analytics? What is a decision support system? How can managers identify opportunities to create innovative computerized support? Inside, the author addresses these questions and some 60 more fundamental questions that are key to understanding the rapidly changing realm of computerized decision support. In a short period of time, you'll "get up to speed" on decision support, anal...

Automation of information decision support to improve e-learning resources quality

Directory of Open Access Journals (Sweden)

A.L. Danchenko

2013-06-01

Full Text Available Purpose. In conditions of active development of e-learning the high quality of e-learning resources is very important. Providing the high quality of e-learning resources in situation with mass higher education and rapid obsolescence of information requires the automation of information decision support for improving the quality of e-learning resources by development of decision support system. Methodology. The problem is solved by methods of artificial intelligence. The knowledge base of information structure of decision support system that is based on frame model of knowledge representation and inference production rules are developed. Findings. According to the results of the analysis of life cycle processes and requirements to the e-learning resources quality the information model of the structure of the knowledge base of the decision support system, the inference rules for the automatically generating of recommendations and the software implementation are developed. Practical value. It is established that the basic requirements for quality are performance, validity, reliability and manufacturability. It is shown that the using of a software implementation of decision support system for researched courses gives a growth of the quality according to the complex quality criteria. The information structure of a knowledge base system to support decision-making and rules of inference can be used by methodologists and content developers of learning systems.

Decision support models for solid waste management: Review and game-theoretic approaches

International Nuclear Information System (INIS)

Karmperis, Athanasios C.; Aravossis, Konstantinos; Tatsiopoulos, Ilias P.; Sotirchos, Anastasios

2013-01-01

Highlights: ► The mainly used decision support frameworks for solid waste management are reviewed. ► The LCA, CBA and MCDM models are presented and their strengths, weaknesses, similarities and possible combinations are analyzed. ► The game-theoretic approach in a solid waste management context is presented. ► The waste management bargaining game is introduced as a specific decision support framework. ► Cooperative and non-cooperative game-theoretic approaches to decision support for solid waste management are discussed. - Abstract: This paper surveys decision support models that are commonly used in the solid waste management area. Most models are mainly developed within three decision support frameworks, which are the life-cycle assessment, the cost–benefit analysis and the multi-criteria decision-making. These frameworks are reviewed and their strengths and weaknesses as well as their critical issues are analyzed, while their possible combinations and extensions are also discussed. Furthermore, the paper presents how cooperative and non-cooperative game-theoretic approaches can be used for the purpose of modeling and analyzing decision-making in situations with multiple stakeholders. Specifically, since a waste management model is sustainable when considering not only environmental and economic but also social aspects, the waste management bargaining game is introduced as a specific decision support framework in which future models can be developed

Decision support models for solid waste management: Review and game-theoretic approaches

Energy Technology Data Exchange (ETDEWEB)

Karmperis, Athanasios C., E-mail: athkarmp@mail.ntua.gr [Sector of Industrial Management and Operational Research, School of Mechanical Engineering, National Technical University of Athens, Iroon Polytechniou 9, 15780 Athens (Greece); Army Corps of Engineers, Hellenic Army General Staff, Ministry of Defence (Greece); Aravossis, Konstantinos; Tatsiopoulos, Ilias P.; Sotirchos, Anastasios [Sector of Industrial Management and Operational Research, School of Mechanical Engineering, National Technical University of Athens, Iroon Polytechniou 9, 15780 Athens (Greece)

2013-05-15

Highlights: ► The mainly used decision support frameworks for solid waste management are reviewed. ► The LCA, CBA and MCDM models are presented and their strengths, weaknesses, similarities and possible combinations are analyzed. ► The game-theoretic approach in a solid waste management context is presented. ► The waste management bargaining game is introduced as a specific decision support framework. ► Cooperative and non-cooperative game-theoretic approaches to decision support for solid waste management are discussed. - Abstract: This paper surveys decision support models that are commonly used in the solid waste management area. Most models are mainly developed within three decision support frameworks, which are the life-cycle assessment, the cost–benefit analysis and the multi-criteria decision-making. These frameworks are reviewed and their strengths and weaknesses as well as their critical issues are analyzed, while their possible combinations and extensions are also discussed. Furthermore, the paper presents how cooperative and non-cooperative game-theoretic approaches can be used for the purpose of modeling and analyzing decision-making in situations with multiple stakeholders. Specifically, since a waste management model is sustainable when considering not only environmental and economic but also social aspects, the waste management bargaining game is introduced as a specific decision support framework in which future models can be developed.

Medical futility in children's nursing: making end-of-life decisions.

Science.gov (United States)

Brien, Irene O; Duffy, Anita; Shea, Ellen O

Caring for infants at end of life is challenging and distressing for parents and healthcare professionals, especially in relation to making decisions regarding withholding or withdrawal of treatment. The concept of medical futility must be considered under these circumstances. Parents and healthcare professionals should be involved together in making these difficult decisions. However, for some parents, emotions and guilt often are unbearable and, understandably, parents can be reluctant to make a decision. Despite the recognition of parental autonomy, if parents disagree with a decision made by medical staff, the case will be referred to and solved by the courts. The courts' decisions are often based on the best interest of the child. In this article, the authors discuss the concepts of 'parental autonomy' and 'the child's best interests' when determining medical futility for infants or neonates. The role of the nurse when caring for the dying child and their family is multifaceted. While nurses do not have a legitimate role in decision making at the end of life, it is often nurses who, through their advocacy role, inform doctors about parents' wishes and it is often nurses who support parents during this difficult time. Furthermore, nurses caring for dying children should be familiar to the family, experienced in end-of-life care and comfortable talking to parents about death and dying and treatment choices. Children's nurses therefore require advanced communication skills and an essential understanding of the ethical and legal knowledge relating to medical futility in end-of-life children's nursing.

Medical futility in children's nursing: making end-of-life decisions.

LENUS (Irish Health Repository)

Brien, Irene O

2012-02-01

Caring for infants at end of life is challenging and distressing for parents and healthcare professionals, especially in relation to making decisions regarding withholding or withdrawal of treatment. The concept of medical futility must be considered under these circumstances. Parents and healthcare professionals should be involved together in making these difficult decisions. However, for some parents, emotions and guilt often are unbearable and, understandably, parents can be reluctant to make a decision. Despite the recognition of parental autonomy, if parents disagree with a decision made by medical staff, the case will be referred to and solved by the courts. The courts\\' decisions are often based on the best interest of the child. In this article, the authors discuss the concepts of \\'parental autonomy\\' and \\'the child\\'s best interests\\' when determining medical futility for infants or neonates. The role of the nurse when caring for the dying child and their family is multifaceted. While nurses do not have a legitimate role in decision making at the end of life, it is often nurses who, through their advocacy role, inform doctors about parents\\' wishes and it is often nurses who support parents during this difficult time. Furthermore, nurses caring for dying children should be familiar to the family, experienced in end-of-life care and comfortable talking to parents about death and dying and treatment choices. Children\\'s nurses therefore require advanced communication skills and an essential understanding of the ethical and legal knowledge relating to medical futility in end-of-life children\\'s nursing.

Life-sustaining support: ethical, cultural, and spiritual conflicts. Part II: Staff support--a neonatal case study.

Science.gov (United States)

Stutts, Amy; Schloemann, Johanna

2002-06-01

As medical knowledge and technology continue to increase, so will the ability to provide life-sustaining support to patients who otherwise would not survive. Along with these advances comes the responsibility of not only meeting the clinical needs of our patients, but also of understanding how the family's culture and spirituality will affect their perception of the situation and their decision-making process. As the U.S. continues to become a more culturally diverse society, health care professionals will need to make changes in their practice to meet the psychosocial needs of their patients and respect their treatment decisions. Part I of this series (April 2002) discussed how the cultural and spiritual belief systems of Baby S's family affected their decision-making processes and also their ability to cope with the impending death of their infant. The development of a culturally competent health care team can help bridge the gap between culturally diverse individuals. This article addresses the following questions: 1. What legal alternatives are available to the staff to protect the patient from suffering associated with the continuation of futile life-sustaining support? 2. What conflicts might the staff experience as a result of the continuation of futile life-sustaining support? 3. What efforts can be made to support members of the staff? 4. What can be done to prepare others in the health care professions to deal more effectively with ethical/cultural issues?

Using a group decision support system to make investment prioritisation decisions

OpenAIRE

Read, Martin; Gear, Tony; Minkes, Leonard; Irving, Ann

2013-01-01

This paper is concerned with how decision making groups involved in making investment prioritisation decisions involving funding of technology and science projects may be supported by a group decision support system (GDSS). While interested in decision outcomes, the primary focus of this paper is the role of a group support system as an aid to developing shared understanding within a group. The paper develops the conceptual framework of decision-making, communication and group support, and de...

Implications of Decision Making Research for Decision Support and Displays

OpenAIRE

Morrison, Jeffrey G.; Kelly, Richard T.; Moore, Ronald A.; Hutchins, Susan G.

1998-01-01

To appear in J. A. Cannon-Bowers & E. Salas (Eds.), Decision Making Under Stress: Implications for Training and Simulation. A prototype decision support system (DSS) was developed to enhance Navy tactical decision making based on naturalistic decision processes. Displays were developed to support critical decision making tasks through recognition-primed and explanation-based reasoning processes, and cognitive analysis was conducted of the decision making problems faced by Navy ...

[End-of-life care and end-of-life medical decisions: the ITAELD study].

Science.gov (United States)

Miccinesi, Guido; Puliti, Donella; Paci, Eugenio

2011-01-01

To describe the attitudes towards end of life care and the practice of end-of-life medical decisions with possible life-shortening effect among Italian physicians. Cross sectional study (last death among the assisted patients in the last 12 months was considered). In the year 2007, 5,710 GPs and 8,950 hospital physicians were invited all over Italy to participate in the ITAELDstudy through anonymous mail questionnaire. Proportion of agreement with statements on end-of-life care issues. Proportion of deaths with an end-of-life medical decision. The response rate was 19.2%. The 65% of respondents agreed with the duty to respect any non-treatment request of the competent patient, the 55% agreed with the same duty in case of advanced directives, the 39% in case of proxy's request. The 53% of respondents agreed with the ethical acceptability of active euthanasia in selected cases. Among 1,850 deaths the 57.7% did not receive any end-of-life medical decision. For a further 21.0% no decision was possible, being sudden and unexpected deaths. In the remaining 21.3% at least one end-of-life medical decision was reported: 0.8% was classified as physician assisted death, 20.5% as non-treatment decision. Among all deceased the 19.6% were reported to have been deeply sedated. Being favourable to the use of opioids in terminal patients was associated to non-treatment decisions with possible but non-intentional life shortening effect; agreeing with the duty to fully respect any actual non-treatment request of the competent patient was associated to end-of life medical decisions with intentional life-shortening effect (adjusted OR>10 in both cases). The life stance and ethical beliefs of physicians determine their behaviour at the end of life wherever specific statements of law are lacking. Therefore education and debate are needed on these issues.

Constitutional and legal protection for life support limitation in India

Directory of Open Access Journals (Sweden)

R K Mani

2015-01-01

Full Text Available Appropriate treatment limitations towards the end of life to reduce unwanted burdens require ethical clarity that is supported by appropriate legislation. The lack of knowledge of enabling legal provisions, physicians feel vulnerable to legal misinterpretation of treatment limiting decisions. In India the lack of societal awareness, inadequate exploration of the gray areas of bio-ethics and unambiguous legal position relating to terminal illness have resulted in poor quality end of life care. Much of the perceived vulnerability by the physician is attributable to insufficient knowledge and understanding of existing constitutional and legal position in India. While we await informed legal and legislative opinion, this paper highlights possible legal liabilities arising from treatment limitation decisions with available defense. It is hoped that such clarity would lead to more confident ethical decisions and improved end of life care for patients.

Computer-Based Decision Support for Railroad Transportation Systems: an Investment Case Study

Directory of Open Access Journals (Sweden)

Luminita DUTA

2009-01-01

Full Text Available In the last decade the development of the economical and social life increased the complexity of transportation systems. In this context, the role of Decision Support Systems (DSS became more and more important. The paper presents the characteristics, necessity, and usage of DSS in transportation and describes a practical application in the railroad field. To compute the optimal transportation capacity and flow on a certain railroad, specialized decision-support software which is available on the market was used.

Decision support for large-scale remediation strategies by fused urban metabolism and life cycle assessment

DEFF Research Database (Denmark)

Ohms, Pernille; Andersen, Camilla; Landgren, Mathilde

2018-01-01

Purpose: This paper seeks to identify the most environmental friendly way of conducting a refurbishment of Broendby Strand, with focus on PCB remediation. The actual identification is conducted by comparing four remediation techniques using urban metabolism fused with life cycle assessment (UM......-LCA) in combination with information relating to cost and efficiency of the compared techniques. The methodological goal of our paper is to test UM-LCA as a decision support tool and discuss application of the method in relation to large refurbishment projects. Methods: To assess the environmental performance of PCB......-remediation techniques, the UM-LCA method was applied. By combining UM and LCA methodologies, the total environmental impact potentials of the remediation techniques were calculated. To build an inventory for each technique, we contacted and interviewed experts and studied existing literature, cases, and projects...

What parents want from doctors in end-of-life decision-making for children.

Science.gov (United States)

Sullivan, J; Monagle, P; Gillam, L

2014-03-01

End-of-life decision-making is difficult for everyone involved, as many studies have shown. Within this complexity, there has been little information on how parents see the role of doctors in end-of-life decision-making for children. This study aimed to examine parents' views and experiences of end-of-life decision-making. A qualitative method with a semistructured interview design was used. Parent participants were living in the community. Twenty-five bereaved parents. Parents reported varying roles taken by doctors: being the provider of information without opinion; giving information and advice as to the decision that should be taken; and seemingly being the decision maker for the child. The majority of parents found their child's doctor enabled them to be the ultimate decision maker for their child, which was what they very clearly wanted to be, and consequently enabled them to exercise their parental autonomy. Parents found it problematic when doctors took over decision-making. A less frequently reported, yet significant role for doctors was to affirm decisions after they had been made by parents. Other important aspects of the doctor's role were to provide follow-up support and referral. Understanding the role that doctors take in end-of-life decisions, and the subsequent impact of that role from the perspective of parents can form the basis of better informed clinical practice.

An expandable software model for collaborative decision making during the whole building life cycle

International Nuclear Information System (INIS)

Papamichael, K.; Pal, V.; Bourassa, N.; Loffeld, J.; Capeluto, G.

2000-01-01

Decisions throughout the life cycle of a building, from design through construction and commissioning to operation and demolition, require the involvement of multiple interested parties (e.g., architects, engineers, owners, occupants and facility managers). The performance of alternative designs and courses of action must be assessed with respect to multiple performance criteria, such as comfort, aesthetics, energy, cost and environmental impact. Several stand-alone computer tools are currently available that address specific performance issues during various stages of a building's life cycle. Some of these tools support collaboration by providing means for synchronous and asynchronous communications, performance simulations, and monitoring of a variety of performance parameters involved in decisions about a building during building operation. However, these tools are not linked in any way, so significant work is required to maintain and distribute information to all parties. In this paper we describe a software model that provides the data management and process control required for collaborative decision making throughout a building's life cycle. The requirements for the model are delineated addressing data and process needs for decision making at different stages of a building's life cycle. The software model meets these requirements and allows addition of any number of processes and support databases over time. What makes the model infinitely expandable is that it is a very generic conceptualization (or abstraction) of processes as relations among data. The software model supports multiple concurrent users, and facilitates discussion and debate leading to decision making. The software allows users to define rules and functions for automating tasks and alerting all participants to issues that need attention. It supports management of simulated as well as real data and continuously generates information useful for improving performance prediction and

Family members' informal roles in end-of-life decision making in adult intensive care units.

Science.gov (United States)

Quinn, Jill R; Schmitt, Madeline; Baggs, Judith Gedney; Norton, Sally A; Dombeck, Mary T; Sellers, Craig R

2012-01-01

To support the process of effective family decision making, it is important to recognize and understand informal roles that various family members may play in the end-of-life decision-making process. To describe some informal roles consistently enacted by family members involved in the process of end-of-life decision making in intensive care units. Ethnographic study. Data were collected via participant observation with field notes and semistructured interviews on 4 intensive care units in an academic health center in the mid-Atlantic United States from 2001 to 2004. The units studied were a medical, a surgical, a burn and trauma, and a cardiovascular intensive care unit. Health care clinicians, patients, and family members. Informal roles for family members consistently observed were primary caregiver, primary decision maker, family spokesperson, out-of-towner, patient's wishes expert, protector, vulnerable member, and health care expert. The identified informal roles were part of families' decision-making processes, and each role was part of a potentially complicated family dynamic for end-of-life decision making within the family system and between the family and health care domains. These informal roles reflect the diverse responses to demands for family decision making in what is usually a novel and stressful situation. Identification and description of these informal roles of family members can help clinicians recognize and understand the functions of these roles in families' decision making at the end of life and guide development of strategies to support and facilitate increased effectiveness of family discussions and decision-making processes.

Competence and Quality in Real-Life Decision Making.

Science.gov (United States)

Geisler, Martin; Allwood, Carl Martin

2015-01-01

What distinguishes a competent decision maker and how should the issue of decision quality be approached in a real-life context? These questions were explored in three studies. In Study 1, using a web-based questionnaire and targeting a community sample, we investigated the relationships between objective and subjective indicators of real-life decision-making success. In Study 2 and 3, targeting two different samples of professionals, we explored if the prevalent cognitively oriented definition of decision-making competence could be beneficially expanded by adding aspects of competence in terms of social skills and time-approach. The predictive power for each of these three aspects of decision-making competence was explored for different indicators of real-life decision-making success. Overall, our results suggest that research on decision-making competence would benefit by expanding the definition of competence, by including decision-related abilities in terms of social skills and time-approach. Finally, the results also indicate that individual differences in real-life decision-making success profitably can be approached and measured by different criteria.

Competence and Quality in Real-Life Decision Making

Science.gov (United States)

2015-01-01

What distinguishes a competent decision maker and how should the issue of decision quality be approached in a real-life context? These questions were explored in three studies. In Study 1, using a web-based questionnaire and targeting a community sample, we investigated the relationships between objective and subjective indicators of real-life decision-making success. In Study 2 and 3, targeting two different samples of professionals, we explored if the prevalent cognitively oriented definition of decision-making competence could be beneficially expanded by adding aspects of competence in terms of social skills and time-approach. The predictive power for each of these three aspects of decision-making competence was explored for different indicators of real-life decision-making success. Overall, our results suggest that research on decision-making competence would benefit by expanding the definition of competence, by including decision-related abilities in terms of social skills and time-approach. Finally, the results also indicate that individual differences in real-life decision-making success profitably can be approached and measured by different criteria. PMID:26545239

Assessment of decisions in the context of life attitudes

Directory of Open Access Journals (Sweden)

Klamut Ryszard

2012-01-01

Full Text Available Presented article attempts to show sense of life perspective as a determinant of decision making. It is assumed that the sense of life perspective described as life attitudes is significant in assessment of decision problem defined in the predecision phase of the decision making process. The predicted dependence was analysed in three categories of decision: self-development, financial and voting. The research was conducted on two groups of 186 and 86 participants. Two methods were used in the research: the Life Attitude Profile -Revised (LAP-R and the Decision Assessment Questionnaire. In statistical analysis, the canonical correlation analysis was used. The scores show that the life attitudes (especially: Purpose, Coherence, Life Control and Existential Vacuum are correlated with the assessment factor (especially: Cognitive Analysis and Affective Assessment of each tested category of decision. However, the most significant relationship is found in the self-development decision.

End-of-life decisions in the intensive care unit

DEFF Research Database (Denmark)

Jensen, Hanne Irene

2012-01-01

be interdisciplinary, but the literature shows that this is not always the case. Research on end-of-life issues in Danish ICUs is limited. Aim The aims of this thesis were to • Examine Danish practices regarding end-of-life decisions in the ICU. • Examine the opinions of nurses and physicians who work in Danish ICUs...... and decision-making. Hypotheses • Nurses, intensivists, and primary physicians have different experiences of interdisciplinary collaboration regarding end-of-life decision-making in the ICU. • Specific interventions targeting end-of-life decision-making in the ICU, such as interdisciplinary audits......Background When making end-of-life decisions in intensive care units, the different staff groups have different roles in the decision-making process and may not always assess the situation identically. Practice recommendations for withholding or withdrawing therapy state that decisions should...

Withholding and withdrawing of life support from patients with severe head injury.

Science.gov (United States)

O'Callahan, J G; Fink, C; Pitts, L H; Luce, J M

1995-09-01

To characterize the withholding or withdrawing of life support from patients with severe head injury. San Francisco General Hospital, a city and county hospital with a Level I trauma center. A standardized questionnaire was used to collect data on demographics and functional outcome of severely head-injured (Glasgow Coma Score of family members. Forty-seven patients who were admitted to a medical-surgical intensive care unit over a 1-yr period. Twenty-four patients had life support withheld or withdrawn, and 23 patients did not. Physician and family separately assessed patient's probable functional outcome, degree of communication between them, reasons important in recommending or deciding on discontinuation of life support, and the result of action taken. Six months later, the families reviewed the process of their decision, how well physician(s) had communicated, and what might have improved communication. Of 24 patients with life support discontinued, 22 died; two were discharged from the hospital. Twenty-three of the 24 patients had a poor prognosis on admission. Of the 23 patients who were continued on life support for the duration of their hospitalization, ten had a poor (p Family's assessment of prognosis agreed with physician's assessment in 22 of the 24 patients from whom life support was discontinued (p families' assessments. Physicians' considerations in recommending limitation of care and families' considerations in making decisions were the same, primarily an inevitably poor prognosis. Neither physician nor families cited cost or availability of care as a deciding factor. Two families disagreed with the recommendation to limit care after initial agreement because the patients' prognosis improved from "likely death" to "vegetative." Care was therefore continued, and both patients remained vegetative 6 months after admission to the hospital and discharge to chronic care facilities. Life support is commonly withheld or withdrawn from patients with severe

Radwaste Decision Support System

International Nuclear Information System (INIS)

Westrom, G.; Vance, J.N.; Gelhaus, F.E.

1989-01-01

The purpose of the Radwaste Decision Support System (RDSS) is to provide expert advice, analysis results and instructional material relative to the treatment, handling, transport and disposal of low-level radioactive waste produced in nuclear power plants. This functional specification addresses the following topics: Functions of the RDSS, Relationships and interfaces between the function, Development of the decisions and logic tree structures embodied in waste management, Elements of the database and the characteristics required to support the decision-making process, Specific User requirements for the RDSS, Development of the user interface, Basic software architecture, and Concepts for the RDSS usage including updating and maintenance

Decision support for emergency management

International Nuclear Information System (INIS)

Andersen, V.

1989-05-01

A short introduction will be given to the Nordic project ''NKA/INF: Information Technology for Accident and Emergency Management'', which is now in its final phase. To perform evaluation of the project, special scenarious have been developed, and experiments based on these will be fulfilled and compared with experiments without use of the decision support system. Furthermore, the succeeding European project, ''IT Support for Emergency Management - ISEM'', with the purpose of developing a decision support system for complex and distributed decision making in emergency management in full scale, will be described and the preliminary conceptual model for the system will be presented. (author)

Caring Decisions: The Development of a Written Resource for Parents Facing End-of-Life Decisions.

Science.gov (United States)

Xafis, Vicki; Gillam, Lynn; Hynson, Jenny; Sullivan, Jane; Cossich, Mary; Wilkinson, Dominic

2015-11-01

Written resources in adult intensive care have been shown to benefit families facing end of life (EoL) decisions. There are few resources for parents making EoL decisions for their child and no existing resources addressing ethical issues. The Caring Decisions handbook and website were developed to fill these gaps. We discuss the development of the resources, modification after reviewer feedback and findings from initial pilot implementation. A targeted literature review-to identify resources and factors that impact on parental EoL decision-making; development phase-guided by the literature and the researchers' expertise; consultation process-comprised a multi-disciplinary panel of experts and parents; pilot evaluation study-hard-copy handbook was distributed as part of routine care at an Australian Children's Hospital. Twelve experts and parents formed the consultation panel. Eight parents of children with life-limiting conditions and clinicians were interviewed in the pilot study. Numerous factors supporting/impeding EoL decisions were identified. Caring Decisions addressed issues identified in the literature and by the multidisciplinary research team. The consultation panel provided overwhelmingly positive feedback. Pilot study parents found the resources helpful and comforting. Most clinicians viewed the resources as very beneficial to parents and identified them as ideal for training purposes. The development of the resources addressed many of the gaps in existing resources. The consultation process and the pilot study suggest these resources could be of significant benefit to parents and clinicians.

Termination of life support after major trauma.

Science.gov (United States)

Sullivan, D J; Hansen-Flaschen, J

2000-06-01

As the population continues to age, greater numbers and more severely injured elderly patients require care in ICUs. With the attendant increase in the medical complexity of such patients, investigators anticipate that trauma and critical care resources will become increasingly stretched. Because of economic and societal forces, it will become increasingly important for trauma surgeons to appropriately counsel patients and their families regarding the outcome from their injuries and to become comfortable approaching families about withdrawal of support when medical futility is recognized. The authors propose the following guidelines for discussing limitation or termination of life support with patients and their families. Physicians should (1) discuss the patient's wishes regarding life support on admission or early in the hospital course; (2) at the initial discussion, establish who the decision maker will be if the patient is or becomes incapacitated; (3) maintain regular communication and continuity of care; and (4) inevitably, when conflict occurs, involve consultants and a hospital ethics committee for assistance in its resolution.

Rules of Thumb in Life-Cycle Saving Decisions

OpenAIRE

Winter, Joachim; Schlafmann, Kathrin; Rodepeter, Ralf

2011-01-01

We analyse life-cycle saving decisions when households use simple heuristics, or rules of thumb, rather than solve the underlying intertemporal optimization problem. We simulate life-cycle saving decisions using three simple rules and compute utility losses relative to the solution of the optimization problem. Our simulations suggest that utility losses induced by following simple decision rules are relatively low. Moreover, the two main saving motives re ected by the canonical life-cyc...

Breastfeeding Support in the Workplace: The Relationships Among Breastfeeding Support, Work-Life Balance, and Job Satisfaction.

Science.gov (United States)

Jantzer, Amanda M; Anderson, Jenn; Kuehl, Rebecca A

2018-05-01

Women are increasingly faced with decisions about how to combine breastfeeding with work, but few researchers have directly measured how breastfeeding relates to the work-life interface. Research aim: The authors examined how perceptions of work enhancement of personal life and work interference with personal life were influenced by workplace breastfeeding support, including organizational, manager, and coworker support, as well as adequate time to express human milk. Then, we examined how workplace breastfeeding support predicted work-life variables and job satisfaction. Using a self-report, survey design, the authors analyzed online surveys from 87 women in a rural, community sample who indicated that they had pumped at work or anticipated needing to pump in the future. According to regression results, provision of workplace breastfeeding support, particularly providing adequate time for human milk expression, predicted work enhancement of personal life. Conversely, we found that as workplace support diminished, employees perceived greater work interference with personal life. Results of path analysis further suggested that providing time for expressing milk improved job satisfaction via a partially mediated relationship where work enhancement of personal life acted as a mediator. These results suggest that employers can enhance the lives of their breastfeeding employees both at work and at home by providing workplace breastfeeding support, especially through providing time for expressing human milk in the workplace.

Risk-based emergency decision support

International Nuclear Information System (INIS)

Koerte, Jens

2003-01-01

In the present paper we discuss how to assist critical decisions taken under complex, contingent circumstances, with a high degree of uncertainty and short time frames. In such sharp-end decision regimes, standard rule-based decision support systems do not capture the complexity of the situation. At the same time, traditional risk analysis is of little use due to variability in the specific circumstances. How then, can an organisation provide assistance to, e.g. pilots in dealing with such emergencies? A method called 'contingent risk and decision analysis' is presented, to provide decision support for decisions under variable circumstances and short available time scales. The method consists of nine steps of definition, modelling, analysis and criteria definition to be performed 'off-line' by analysts, and procedure generation to transform the analysis result into an operational decision aid. Examples of pilots' decisions in response to sudden vibration in offshore helicopter transport method are used to illustrate the approach

Communication and Decision-Making About End-of-Life Care in the Intensive Care Unit.

Science.gov (United States)

Brooks, Laura Anne; Manias, Elizabeth; Nicholson, Patricia

2017-07-01

Clinicians in the intensive care unit commonly face decisions involving withholding or withdrawing life-sustaining therapy, which present many clinical and ethical challenges. Communication and shared decision-making are key aspects relating to the transition from active treatment to end-of-life care. To explore the experiences and perspectives of nurses and physicians when initiating end-of-life care in the intensive care unit. The study was conducted in a 24-bed intensive care unit in Melbourne, Australia. An interpretative, qualitative inquiry was used, with focus groups as the data collection method. Intensive care nurses and physicians were recruited to participate in a discipline-specific focus group. Focus group discussions were audio-recorded, transcribed, and subjected to thematic data analysis. Five focus groups were conducted; 17 nurses and 11 physicians participated. The key aspects discussed included communication and shared decision-making. Themes related to communication included the timing of end-of-life care discussions and conducting difficult conversations. Implementation and multidisciplinary acceptance of end-of-life care plans and collaborative decisions involving patients and families were themes related to shared decision-making. Effective communication and decision-making practices regarding initiating end-of-life care in the intensive care unit are important. Multidisciplinary implementation and acceptance of end-of-life care plans in the intensive care unit need improvement. Clear organizational processes that support the introduction of nurse and physician end-of-life care leaders are essential to optimize outcomes for patients, family members, and clinicians. ©2017 American Association of Critical-Care Nurses.

Supported Decision-Making from Theory to Practice: Implementing the Right to Enjoy Legal Capacity

Directory of Open Access Journals (Sweden)

Rosie Harding

2018-04-01

Full Text Available The right to equal recognition before the law, protected by Article 12 of the United Nations (UN Convention on the Rights of Persons with Disabilities (CRPD, mandates the use of supported decision-making practices to enable disabled people, particularly those with intellectual and/or psychosocial disabilities, to enjoy their legal capacity. Finding ways to translate this theoretical mandate into practice poses a number of particularly challenging socio-legal issues, which this research seeks to address. The English Mental Capacity Act 2005 (MCA sets out a right to support with decision-making (s.1(3, underpinned by a presumption of capacity (s.1(2. Qualitative interviews with intellectually disabled people, their supporters, and care and support professionals were undertaken to explore how disabled people make decisions in their everyday lives, the kinds of support they need, and the strategies for supported decision-making used in practice. Analysis of these interviews suggests that a range of supported decision-making techniques have been developed in practice and are effective in supporting everyday preferences and some life choices. Paradoxically, it appears that as decisions become more complex, the support available to disabled people reduces. Specifically, much less support is available for more difficult decisions around finances, healthcare and legal matters. We argue that the reasons for this are due to a web of regulatory, social and policy issues. We conclude that implementing the right to enjoy legal capacity through supported decision-making will require a combination of regulatory reform, social change and policy amendment.

Decision support for customers in electronic environments

Directory of Open Access Journals (Sweden)

František Dařena

2011-01-01

Full Text Available Due to the rapid spread of computer technologies into day-to-day lives many purchases or purchase-related decisions are made in the electronic environment of the Web. In order to handle information overload that is the result of the availability of many web-based stores, products and services, consumers use decision support aids that help with need recognition, information retrieval, filtering, comparisons and choice making. Decision support systems (DSS discipline spreads about 40 years back and was mostly focused on assisting managers. However, online environments and decision support in such environments bring new opportunities also to the customers. The focus on decision support for consumers is also not investigated to the large extent and not documented in the literature. Providing customers with well designed decision aids can lead to lower cognitive decision effort associated with the purchase decision which results in significant increase of consumer’s confidence, satisfaction, and cost savings. During decision making process the subjects can chose from several methods (optimizing, reasoning, analogizing, and creating, DSS types (data-, model-, communication-, document-driven, and knowledge-based and benefit from different modern technologies. The paper investigates popular customer decision making aids, such as search, filtering, comparison, ­e-negotiations and auctions, recommendation systems, social network systems, product design applications, communication support etc. which are frequently related to e-commerce applications. Results include the overview of such decision supporting tools, specific examples, classification according the way how the decisions are supported, and possibilities of applications of progressive technologies. The paper thus contributes to the process of development of the interface between companies and the customers where customer decisions take place.

Artificial intelligence tools decision support systems in condition monitoring and diagnosis

CERN Document Server

Galar Pascual, Diego

2015-01-01

Artificial Intelligence Tools: Decision Support Systems in Condition Monitoring and Diagnosis discusses various white- and black-box approaches to fault diagnosis in condition monitoring (CM). This indispensable resource: Addresses nearest-neighbor-based, clustering-based, statistical, and information theory-based techniques Considers the merits of each technique as well as the issues associated with real-life application Covers classification methods, from neural networks to Bayesian and support vector machines Proposes fuzzy logic to explain the uncertainties associated with diagnostic processes Provides data sets, sample signals, and MATLAB® code for algorithm testing Artificial Intelligence Tools: Decision Support Systems in Condition Monitoring and Diagnosis delivers a thorough evaluation of the latest AI tools for CM, describing the most common fault diagnosis techniques used and the data acquired when these techniques are applied.

Toward the Modularization of Decision Support Systems

Science.gov (United States)

Raskin, R. G.

2009-12-01

Decision support systems are typically developed entirely from scratch without the use of modular components. This “stovepiped” approach is inefficient and costly because it prevents a developer from leveraging the data, models, tools, and services of other developers. Even when a decision support component is made available, it is difficult to know what problem it solves, how it relates to other components, or even that the component exists, The Spatial Decision Support (SDS) Consortium was formed in 2008 to organize the body of knowledge in SDS within a common portal. The portal identifies the canonical steps in the decision process and enables decision support components to be registered, categorized, and searched. This presentation describes how a decision support system can be assembled from modular models, data, tools and services, based on the needs of the Earth science application.

Decision support for organ offers in liver transplantation.

Science.gov (United States)

Volk, Michael L; Goodrich, Nathan; Lai, Jennifer C; Sonnenday, Christopher; Shedden, Kerby

2015-06-01

Organ offers in liver transplantation are high-risk medical decisions with a low certainty of whether a better liver offer will come along before death. We hypothesized that decision support could improve the decision to accept or decline. With data from the Scientific Registry of Transplant Recipients, survival models were constructed for 42,857 waiting-list patients and 28,653 posttransplant patients from 2002 to 2008. Daily covariate-adjusted survival probabilities from these 2 models were combined into a 5-year area under the curve to create an individualized prediction of whether an organ offer should be accepted for a given patient. Among 650,832 organ offers from 2008 to 2013, patient survival was compared by whether the clinical decision was concordant or discordant with model predictions. The acceptance benefit (AB)--the predicted gain or loss of life by accepting a given organ versus waiting for the next organ--ranged from 3 to -22 years (harm) and varied geographically; for example, the average benefit of accepting a donation after cardiac death organ ranged from 0.47 to -0.71 years by donation service area. Among organ offers, even when AB was >1 year, the offer was only accepted 10% of the time. Patient survival from the time of the organ offer was better if the model recommendations and the clinical decision were concordant: for offers with AB > 0, the 3-year survival was 80% if the offer was accepted and 66% if it was declined (P decision support may improve patient survival in liver transplantation. © 2015 American Association for the Study of Liver Diseases.

Recommendations on future development of decision support systems

DEFF Research Database (Denmark)

MCarthur, Stephen; Chen, Minjiang; Marinelli, Mattia

Deliverable 8.3 reports on the consolidation of experiences from visualisation, decision support prototypes experiments and recommendations on future developments of decision support systems......Deliverable 8.3 reports on the consolidation of experiences from visualisation, decision support prototypes experiments and recommendations on future developments of decision support systems...

A systematic review of decision support needs of parents making child health decisions

Science.gov (United States)

Jackson, Cath; Cheater, Francine M.; Reid, Innes

2008-01-01

Abstract Objective  To identify the decision support needs of parents attempting to make an informed health decision on behalf of a child. Context  The first step towards implementing patient decision support is to assess patients’ information and decision‐making needs. Search strategy  A systematic search of key bibliographic databases for decision support studies was performed in 2005. Reference lists of relevant review articles and key authors were searched. Three relevant journals were hand searched. Inclusion criteria  Non‐intervention studies containing data on decision support needs of parents making child health decisions. Data extraction and synthesis  Data were extracted on study characteristics, decision focus and decision support needs. Studies were quality assessed using a pre‐defined set of criteria. Data synthesis used the UK Evidence for Policy and Practice Information and Co‐ordinating Centre approach. Main results  One‐hundred and forty nine studies were included across various child health decisions, settings and study designs. Thematic analysis of decision support needs indicated three key issues: (i) information (including suggestions about the content, delivery, source, timing); (ii) talking to others (including concerns about pressure from others); and (iii) feeling a sense of control over the process that could be influenced by emotionally charged decisions, the consultation process, and structural or service barriers. These were consistent across decision type, study design and whether or not the study focused on informed decision making. PMID:18816320

Preparing for a decision support system.

Science.gov (United States)

Callan, K

2000-08-01

The increasing pressure to reduce costs and improve outcomes is driving the health care industry to view information as a competitive advantage. Timely information is required to help reduce inefficiencies and improve patient care. Numerous disparate operational or transactional information systems with inconsistent and often conflicting data are no longer adequate to meet the information needs of integrated care delivery systems and networks in competitive managed care environments. This article reviews decision support system characteristics and describes a process to assess the preparedness of an organization to implement and use decision support systems to achieve a more effective, information-based decision process. Decision support tools included in this article range from reports to data mining.

Development of the Supported Decision Making Inventory System.

Science.gov (United States)

Shogren, Karrie A; Wehmeyer, Michael L; Uyanik, Hatice; Heidrich, Megan

2017-12-01

Supported decision making has received increased attention as an alternative to guardianship and a means to enable people with intellectual and developmental disabilities to exercise their right to legal capacity. Assessments are needed that can used by people with disabilities and their systems of supports to identify and plan for needed supports to enable decision making. This article describes the steps taken to develop such an assessment tool, the Supported Decision Making Inventory System (SDMIS), and initial feedback received from self-advocates with intellectual disability. The three sections of the SDMIS (Supported Decision Making Personal Factors Inventory, Supported Decision Making Environmental Demands Inventory, and Decision Making Autonomy Inventory) are described and implications for future research, policy, and practice are discussed.

End-of-Life Decisions and Advanced Old Age

Directory of Open Access Journals (Sweden)

Stoyles

2014-07-01

Full Text Available Despite the fact that most people die in advanced old age, little attention is given to cases involving older people in debates about the moral and legal dimensions of end-of-life decision making. The purpose of this paper is to establish some of the ways our discussions should change as we pay attention to important factors influencing end-of-life decisions for people in advanced old age. Focusing on the prevalence of comorbidities and the likelihood that people in advanced old age will experience an extended period of declining function before death, I argue that our debates should be expanded to include greater consideration of how we want to live in the final stages of life. With this, I am arguing against the tendency to think that “end-of-life” decision making concerns only making decisions about when and how it is appropriate to terminate a person’s life. I argue, further, that we should move away from the medicalization of dying.

Simulation and modeling efforts to support decision making in healthcare supply chain management.

Science.gov (United States)

AbuKhousa, Eman; Al-Jaroodi, Jameela; Lazarova-Molnar, Sanja; Mohamed, Nader

2014-01-01

Recently, most healthcare organizations focus their attention on reducing the cost of their supply chain management (SCM) by improving the decision making pertaining processes' efficiencies. The availability of products through healthcare SCM is often a matter of life or death to the patient; therefore, trial and error approaches are not an option in this environment. Simulation and modeling (SM) has been presented as an alternative approach for supply chain managers in healthcare organizations to test solutions and to support decision making processes associated with various SCM problems. This paper presents and analyzes past SM efforts to support decision making in healthcare SCM and identifies the key challenges associated with healthcare SCM modeling. We also present and discuss emerging technologies to meet these challenges.

Simulation and Modeling Efforts to Support Decision Making in Healthcare Supply Chain Management

Directory of Open Access Journals (Sweden)

Eman AbuKhousa

2014-01-01

Full Text Available Recently, most healthcare organizations focus their attention on reducing the cost of their supply chain management (SCM by improving the decision making pertaining processes’ efficiencies. The availability of products through healthcare SCM is often a matter of life or death to the patient; therefore, trial and error approaches are not an option in this environment. Simulation and modeling (SM has been presented as an alternative approach for supply chain managers in healthcare organizations to test solutions and to support decision making processes associated with various SCM problems. This paper presents and analyzes past SM efforts to support decision making in healthcare SCM and identifies the key challenges associated with healthcare SCM modeling. We also present and discuss emerging technologies to meet these challenges.

Flexible Decision Support in Dynamic Interorganizational Networks

NARCIS (Netherlands)

J. Collins (John); W. Ketter (Wolfgang); M. Gini (Maria)

2008-01-01

textabstractAn effective Decision Support System (DSS) should help its users improve decision-making in complex, information-rich, environments. We present a feature gap analysis that shows that current decision support technologies lack important qualities for a new generation of agile business

Competence and Quality in Real-Life Decision Making

OpenAIRE

Geisler, Martin; Allwood, Carl Martin

2015-01-01

What distinguishes a competent decision maker and how should the issue of decision quality be approached in a real-life context? These questions were explored in three studies. In Study 1, using a web-based questionnaire and targeting a community sample, we investigated the relationships between objective and subjective indicators of real-life decision-making success. In Study 2 and 3, targeting two different samples of professionals, we explored if the prevalent cognitively oriented definiti...

Decision making in extreme situations involving children : withholding or withdrawal of life supporting treatment in paediatric care. Statement of the ethics working group of the Confederation of the European Specialists of Paediatrics (CESP)

NARCIS (Netherlands)

Kurz, R

Paediatricians increasingly find themselves in situations in which decisions must be made regarding withholding or withdrawing life-supporting treatment in the care of a paediatric patient. There comes a point when the artificial prolongation of life only contributes to extending the act of dying

Decision support system for Wamakersvallei Winery

CSIR Research Space (South Africa)

Van Der Merwe, A

2007-09-01

Full Text Available The goal of the study is to lend decision support to management a a wine cellar in three areas of expertise, with Wamakersvallei Winery serving as a special case study. This decision support system is to be delivered in the form of Excel spreadsheet...

DECISIONS, METHODS AND TECHNIQUES RELATED TO DECISION SUPPORT SYSTEMS (DSS

Directory of Open Access Journals (Sweden)

Boghean Florin

2015-07-01

Full Text Available Generalised uncertainty, a phenomenon that today’s managers are facing as part of their professional experience, makes it impossible to anticipate the way the business environment will evolve or what will be the consequences of the decisions they plan to implement. Any decision making process within the company entails the simultaneous presence of a number of economic, technical, juridical, human and managerial variables. The development and the approval of a decision is the result of decision making activities developed by the decision maker and sometimes by a decision support team or/and a decision support system (DSS. These aspects related to specific applications of decision support systems in risk management will be approached in this research paper. Decisions in general and management decisions in particular are associated with numerous risks, due to their complexity and increasing contextual orientation. In each business entity, there are concerns with the implementation of risk management in order to improve the likelihood of meeting objectives, the trust of the parties involved, increase the operational safety and security as well as the protection of the environment, minimise losses, improve organisational resilience in order to diminish the negative impact on the organisation and provide a solid foundation for decision making. Since any business entity is considered to be a wealth generator, the analysis of their performance should not be restricted to financial efficiency alone, but will also encompass their economic efficiency as well. The type of research developed in this paper entails different dimensions: conceptual, methodological, as well as empirical testing. Subsequently, the conducted research entails a methodological side, since the conducted activities have resulted in the presentation of a simulation model that is useful in decision making processes on the capital market. The research conducted in the present paper

Decision support software technology demonstration plan

Energy Technology Data Exchange (ETDEWEB)

SULLIVAN,T.; ARMSTRONG,A.

1998-09-01

The performance evaluation of innovative and alternative environmental technologies is an integral part of the US Environmental Protection Agency's (EPA) mission. Early efforts focused on evaluating technologies that supported the implementation of the Clean Air and Clean Water Acts. In 1986 the Agency began to demonstrate and evaluate the cost and performance of remediation and monitoring technologies under the Superfund Innovative Technology Evaluation (SITE) program (in response to the mandate in the Superfund Amendments and Reauthorization Act of 1986 (SARA)). In 1990, the US Technology Policy was announced. This policy placed a renewed emphasis on making the best use of technology in achieving the national goals of improved quality of life for all Americans, continued economic growth, and national security. In the spirit of the technology policy, the Agency began to direct a portion of its resources toward the promotion, recognition, acceptance, and use of US-developed innovative environmental technologies both domestically and abroad. Decision Support Software (DSS) packages integrate environmental data and simulation models into a framework for making site characterization, monitoring, and cleanup decisions. To limit the scope which will be addressed in this demonstration, three endpoints have been selected for evaluation: Visualization; Sample Optimization; and Cost/Benefit Analysis. Five topics are covered in this report: the objectives of the demonstration; the elements of the demonstration plan; an overview of the Site Characterization and Monitoring Technology Pilot; an overview of the technology verification process; and the purpose of this demonstration plan.

Attitudes towards end-of-life decisions and the subjective concepts of consciousness: an empirical analysis.

Directory of Open Access Journals (Sweden)

Lorella Lotto

Full Text Available BACKGROUND: People have fought for their civil rights, primarily the right to live in dignity. At present, the development of technology in medicine and healthcare led to an apparent paradox: many people are fighting for the right to die. This study was aimed at testing whether different moral principles are associated with different attitudes towards end-of-life decisions for patients with a severe brain damage. METHODOLOGY: We focused on the ethical decisions about withdrawing life-sustaining treatments in patients with severe brain damage. 202 undergraduate students at the University of Padova were given one description drawn from four profiles describing different pathological states: the permanent vegetative state, the minimally conscious state, the locked-in syndrome, and the terminal illness. Participants were asked to evaluate how dead or how alive the patient was, and how appropriate it was to satisfy the patient's desire. PRINCIPAL FINDINGS: We found that the moral principles in which people believe affect not only people's judgments concerning the appropriateness of the withdrawal of life support, but also the perception of the death status of patients with severe brain injury. In particular, we found that the supporters of the Free Choice (FC principle perceived the death status of the patients with different pathologies differently: the more people believe in the FC, the more they perceived patients as dead in pathologies where conscious awareness is severely impaired. By contrast, participants who agree with the Sanctity of Life (SL principle did not show differences across pathologies. CONCLUSIONS: These results may shed light on the complex aspects of moral consensus for supporting or rejecting end-of-life decisions.

Experiential Knowledge Complements an LCA-Based Decision Support Framework

Directory of Open Access Journals (Sweden)

Heng Yi Teah

2015-09-01

Full Text Available A shrimp farmer in Taiwan practices innovation through trial-and-error for better income and a better environment, but such farmer-based innovation sometimes fails because the biological mechanism is unclear. Systematic field experimentation and laboratory research are often too costly, and simulating ground conditions is often too challenging. To solve this dilemma, we propose a decision support framework that explicitly utilizes farmer experiential knowledge through a participatory approach to alternatively estimate prospective change in shrimp farming productivity, and to co-design options for improvement. Data obtained from the farmer enable us to quantitatively analyze the production cost and greenhouse gas (GHG emission with a life cycle assessment (LCA methodology. We used semi-quantitative graphical representations of indifference curves and mixing triangles to compare and show better options for the farmer. Our results empower the farmer to make decisions more systematically and reliably based on the frequency of heterotrophic bacteria application and the revision of feed input. We argue that experiential knowledge may be less accurate due to its dependence on varying levels of farmer experience, but this knowledge is a reasonable alternative for immediate decision-making. More importantly, our developed framework advances the scope of LCA application to support practically important yet scientifically uncertain cases.

Nurses' Clinical Decision Making on Adopting a Wound Clinical Decision Support System.

Science.gov (United States)

Khong, Peck Chui Betty; Hoi, Shu Yin; Holroyd, Eleanor; Wang, Wenru

2015-07-01

Healthcare information technology systems are considered the ideal tool to inculcate evidence-based nursing practices. The wound clinical decision support system was built locally to support nurses to manage pressure ulcer wounds in their daily practice. However, its adoption rate is not optimal. The study's objective was to discover the concepts that informed the RNs' decisions to adopt the wound clinical decision support system as an evidence-based technology in their nursing practice. This was an exploratory, descriptive, and qualitative design using face-to-face interviews, individual interviews, and active participatory observation. A purposive, theoretical sample of 14 RNs was recruited from one of the largest public tertiary hospitals in Singapore after obtaining ethics approval. After consenting, the nurses were interviewed and observed separately. Recruitment stopped when data saturation was reached. All transcribed interview data underwent a concurrent thematic analysis, whereas observational data were content analyzed independently and subsequently triangulated with the interview data. Eight emerging themes were identified, namely, use of the wound clinical decision support system, beliefs in the wound clinical decision support system, influences of the workplace culture, extent of the benefits, professional control over nursing practices, use of knowledge, gut feelings, and emotions (fear, doubt, and frustration). These themes represented the nurses' mental outlook as they made decisions on adopting the wound clinical decision support system in light of the complexities of their roles and workloads. This research has provided insight on the nurses' thoughts regarding their decision to interact with the computer environment in a Singapore context. It captured the nurses' complex thoughts when deciding whether to adopt or reject information technology as they practice in a clinical setting.

The end of life decisions -- should physicians aid their patients in dying?

Science.gov (United States)

Sharma, B R

2004-06-01

Decisions pertaining to end of life whether legalized or otherwise, are made in many parts of the world but not reported on account of legal implications. The highly charged debate over voluntary euthanasia and physician assisted suicide was brought into the public arena again when two British doctors confessed to giving lethal doses of drugs to hasten the death of terminally ill patients. Lack of awareness regarding the distinction between different procedures on account of legal status granted to them in some countries is the other area of concern. Some equate withdrawal of life support measures to physician assisted suicide whereas physician assisted suicide is often misinterpreted as euthanasia. Debate among the medical practitioners, law makers and the public taking into consideration the cultural, social and religious ethos will lead to increased awareness, more safeguards and improvement of medical decisions concerning the end of life. International Human Rights Law can provide a consensual basis for such a debate on euthanasia.

End-of-life decision making in the ICU.

Science.gov (United States)

Siegel, Mark D

2009-03-01

A large proportion of deaths, particularly in the developed world, follows admission to an ICU. Therefore, end-of life decision making is an essential facet of critical care practice. For intensivists, managing death in the critically ill has become a key professional skill. They must be thoroughly familiar with the ethical framework that guides end-of-life decision making. Decisions should generally be made collaboratively by clinicians partnering with patients' families. Treatment choices should be crafted to meet specific, achievable goals. A rational, empathic approach to working with families should encourage appropriate, mutually satisfactory outcomes.

Disclosure strategies, social support, and quality of life in infertile women.

Science.gov (United States)

Steuber, Keli R; High, Andrew

2015-07-01

Do the strategies women use to disclose information about their infertility to social network members impact the quality of the support they receive and their quality of life? The data showed that women who disclosed infertility-related information in direct ways, rather than in indirect ways (e.g. by incremental disclosures or through third parties), to social network members perceived higher quality support and reported greater quality of life related to their infertility experience. Social support has been shown to buffer stress associated with various health issues including infertility. The way people disclose information about stressors has been associated with the quality of the support they receive. Disclosing information in a way that most effectively elicits support is beneficial because women with infertility who have lower levels of stress are more likely to seek and remain in treatment. This cross-sectional study of 301 infertile women was conducted in the USA. To determine the variation in length of infertility and treatment decisions, we conducted an online survey of 301 American women coping with infertility. We investigated the strategies women used to disclose infertility-related information with social network members, their perceptions of support from friends and family, and their quality of life both in general (overall quality of life) and related to the experience of infertility (fertility quality of life). Direct disclosure of experiences related to infertility was positively and significantly associated with the perceived quality of social support received (P women's fertility quality of life (95% CI: 0.18, 1.05) and overall quality of life (95% CI: 0.10, 0.30). This effect is particularly noteworthy for the model predicting fertility quality of life, which exhibited a non-significant main effect with direct disclosures. The non-significant main effect combined with the significant indirect effect suggests that perceived support quality

Basic life support and children with profound and multiple learning disabilities.

Science.gov (United States)

Cash, Stefan; Shinnick-Page, Andrea

2008-10-01

Nurses and other carers of people with learning disabilities must be able to manage choking events and perform basic life support effectively. UK guidelines for assessment of airway obstruction and for resuscitation do not take account of the specific needs of people with profound multiple learning disability. For example, they fail to account for inhibited gag and coughing reflexes, limited body movements or chest deformity. There are no national guidelines to assist in clinical decisions and training for nurses and carers. Basic life support training for students of learning disability nursing at Birmingham City University is supplemented to address these issues. The authors ask whether such training should be provided for all nurses including those caring for children and young people. They also invite comment and discussion on questions related to chest compression and training in basic life support for a person in a seated position.

Evaluating Ethical Responsibility in Inverse Decision Support

Directory of Open Access Journals (Sweden)

Ahmad M. Kabil

2012-01-01

Full Text Available Decision makers have considerable autonomy on how they make decisions and what type of support they receive. This situation places the DSS analyst in a different relationship with the client than his colleagues who support regular MIS applications. This paper addresses an ethical dilemma in “Inverse Decision Support,” when the analyst supports a decision maker who requires justification for a preconceived selection that does not correspond to the best option that resulted from the professional resolution of the problem. An extended application of the AHP model is proposed for evaluating the ethical responsibility in selecting a suboptimal alternative. The extended application is consistent with the Inverse Decision Theory that is used extensively in medical decision making. A survey of decision analysts is used to assess their perspective of using the proposed extended application. The results show that 80% of the respondents felt that the proposed extended application is useful in business practices. 14% of them expanded the usability of the extended application to academic teaching of the ethics theory. The extended application is considered more usable in a country with a higher Transparency International Corruption Perceptions Index (TICPI than in a country with a lower one.

Advanced decision support for winter road maintenance

Science.gov (United States)

2008-01-01

This document provides an overview of the Federal Highway Administration's winter Maintenance Decision Support System (MDSS). The MDSS is a decision support tool that has the ability to provide weather predictions focused toward the road surface. The...

Starship Life Support

Science.gov (United States)

Jones, Harry W.

2009-01-01

The design and mass cost of a starship and its life support system are investigated. The mission plan for a multi generational interstellar voyage to colonize a new planet is used to describe the starship design, including the crew habitat, accommodations, and life support. Only current technology is assumed. Highly reliable life support systems can be provided with reasonably small additional mass, suggesting that they can support long duration missions. Bioregenerative life support, growing crop plants that provide food, water, and oxygen, has been thought to need less mass than providing stored food for long duration missions. The large initial mass of hydroponics systems is paid for over time by saving the mass of stored food. However, the yearly logistics mass required to support a bioregenerative system exceeds the mass of food solids it produces, so that supplying stored dehydrated food always requires less mass than bioregenerative food production. A mixed system that grows about half the food and supplies the other half dehydrated has advantages that allow it to breakeven with stored dehydrated food in about 66 years. However, moderate increases in the hydroponics system mass to achieve high reliability, such as adding spares that double the system mass and replacing the initial system every 100 years, increase the mass cost of bioregenerative life support. In this case, the high reliability half food growing, half food supplying system does not breakeven for 389 years. An even higher reliability half and half system, with three times original system mass and replacing the system every 50 years, never breaks even. Growing food for starship life support requires more mass than providing dehydrated food, even for multigeneration voyages of hundreds of years. The benefits of growing some food may justify the added mass cost. Much more efficient recycling food production is wanted but may not be possible. A single multigenerational interstellar voyage to

Application of decision support systems in county urban planning: a proposal for Macaé county

Directory of Open Access Journals (Sweden)

GALANTE, A. C.

2008-06-01

Full Text Available The Macaé County is one of the greatest economy of the state of Rio de Janeiro. With the use of the information technology is possible to create a powerful tool for supporting the decision making processing for this County, aiding the process of improvement of life quality. For that one, intends to use a Decision Support System able to give different kind of information of County areas, like health and education. For the union of all information the datawarehouse technology will be used. For query implementation the technologies of OLAP and GIS are used together. Therefore, those technologies together make a powerful tool for aiding the decision making process of the Macaé County.

Critical infrastructure protection decision support system decision model : overview and quick-start user's guide.

Energy Technology Data Exchange (ETDEWEB)

Samsa, M.; Van Kuiken, J.; Jusko, M.; Decision and Information Sciences

2008-12-01

The Critical Infrastructure Protection Decision Support System Decision Model (CIPDSS-DM) is a useful tool for comparing the effectiveness of alternative risk-mitigation strategies on the basis of CIPDSS consequence scenarios. The model is designed to assist analysts and policy makers in evaluating and selecting the most effective risk-mitigation strategies, as affected by the importance assigned to various impact measures and the likelihood of an incident. A typical CIPDSS-DM decision map plots the relative preference of alternative risk-mitigation options versus the annual probability of an undesired incident occurring once during the protective life of the investment, assumed to be 20 years. The model also enables other types of comparisons, including a decision map that isolates a selected impact variable and displays the relative preference for the options of interest--parameterized on the basis of the contribution of the isolated variable to total impact, as well as the likelihood of the incident. Satisfaction/regret analysis further assists the analyst or policy maker in evaluating the confidence with which one option can be selected over another.

Scalable software architectures for decision support.

Science.gov (United States)

Musen, M A

1999-12-01

Interest in decision-support programs for clinical medicine soared in the 1970s. Since that time, workers in medical informatics have been particularly attracted to rule-based systems as a means of providing clinical decision support. Although developers have built many successful applications using production rules, they also have discovered that creation and maintenance of large rule bases is quite problematic. In the 1980s, several groups of investigators began to explore alternative programming abstractions that can be used to build decision-support systems. As a result, the notions of "generic tasks" and of reusable problem-solving methods became extremely influential. By the 1990s, academic centers were experimenting with architectures for intelligent systems based on two classes of reusable components: (1) problem-solving methods--domain-independent algorithms for automating stereotypical tasks--and (2) domain ontologies that captured the essential concepts (and relationships among those concepts) in particular application areas. This paper highlights how developers can construct large, maintainable decision-support systems using these kinds of building blocks. The creation of domain ontologies and problem-solving methods is the fundamental end product of basic research in medical informatics. Consequently, these concepts need more attention by our scientific community.

Multi-Criteria Decision Support Queries in Exploratory & Open World Settings

DEFF Research Database (Denmark)

Mortensen, Michael Lind

2016-01-01

the theory and intent of multi-criteria decision support queries and how users actually analyze their options and make decisions in real life. The thesis is separated into two parts. In the first part, we investigate the use of skyline queries for exploratory search, in which users pose a string of related...... of usability and trust issues, they have yet to enjoy wide adoption in either practical scientific or industrial applications. Simply put, the theoretical gain and intent of these tools do not match the reality of how users make decisions. In this thesis, we take a step forward in bridging the gap between......Throughout the past decade, data sources have increased significantly in both their size, availability, richness, complexity and dynamics. This data surplus is not only enabling new businesses, scientific achievements and economic growth; it can also enable normal people to make better real...

Support System Model for Value based Group Decision on Roof System Selection

Directory of Open Access Journals (Sweden)

Christiono Utomo

2011-02-01

Full Text Available A group decision support system is required on a value-based decision because there are different concern caused by differing preferences, experiences, and background. It is to enable each decision-maker to evaluate and rank the solution alternatives before engaging into negotiation with other decision-makers. Stakeholder of multi-criteria decision making problems usually evaluates the alternative solution from different perspective, making it possible to have a dominant solution among the alternatives. Each stakeholder needs to identify the goals that can be optimized and those that can be compromised in order to reach an agreement with other stakeholders. This paper presents group decision model involving three decision-makers on the selection of suitable system for a building’s roof. The objective of the research is to find an agreement options model and coalition algorithms for multi person decision with two main preferences of value which are function and cost. The methodology combines value analysis method using Function Analysis System Technique (FAST; Life Cycle Cost analysis, group decision analysis method based on Analytical Hierarchy Process (AHP in a satisfying options, and Game theory-based agent system to develop agreement option and coalition formation for the support system. The support system bridges theoretical gap between automated design in construction domain and automated negotiation in information technology domain by providing a structured methodology which can lead to systematic support system and automated negotiation. It will contribute to value management body of knowledge as an advanced method for creativity and analysis phase, since the practice of this knowledge is teamwork based. In the case of roof system selection, it reveals the start of the first negotiation round. Some of the solutions are not an option because no individual stakeholder or coalition of stakeholders desires to select it. The result indicates

Fault Isolation for Shipboard Decision Support

DEFF Research Database (Denmark)

Lajic, Zoran; Blanke, Mogens; Nielsen, Ulrik Dam

2010-01-01

Fault detection and fault isolation for in-service decision support systems for marine surface vehicles will be presented in this paper. The stochastic wave elevation and the associated ship responses are modeled in the frequency domain. The paper takes as an example fault isolation of a containe......Fault detection and fault isolation for in-service decision support systems for marine surface vehicles will be presented in this paper. The stochastic wave elevation and the associated ship responses are modeled in the frequency domain. The paper takes as an example fault isolation...... to the quality of decisions given to navigators....

Future of electronic health records: implications for decision support.

Science.gov (United States)

Rothman, Brian; Leonard, Joan C; Vigoda, Michael M

2012-01-01

The potential benefits of the electronic health record over traditional paper are many, including cost containment, reductions in errors, and improved compliance by utilizing real-time data. The highest functional level of the electronic health record (EHR) is clinical decision support (CDS) and process automation, which are expected to enhance patient health and healthcare. The authors provide an overview of the progress in using patient data more efficiently and effectively through clinical decision support to improve health care delivery, how decision support impacts anesthesia practice, and how some are leading the way using these systems to solve need-specific issues. Clinical decision support uses passive or active decision support to modify clinician behavior through recommendations of specific actions. Recommendations may reduce medication errors, which would result in considerable savings by avoiding adverse drug events. In selected studies, clinical decision support has been shown to decrease the time to follow-up actions, and prediction has proved useful in forecasting patient outcomes, avoiding costs, and correctly prompting treatment plan modifications by clinicians before engaging in decision-making. Clinical documentation accuracy and completeness is improved by an electronic health record and greater relevance of care data is delivered. Clinical decision support may increase clinician adherence to clinical guidelines, but educational workshops may be equally effective. Unintentional consequences of clinical decision support, such as alert desensitization, can decrease the effectiveness of a system. Current anesthesia clinical decision support use includes antibiotic administration timing, improved documentation, more timely billing, and postoperative nausea and vomiting prophylaxis. Electronic health record implementation offers data-mining opportunities to improve operational, financial, and clinical processes. Using electronic health record data

Decision support for utility environmental risk management

International Nuclear Information System (INIS)

Balson, W.E.; Wilson, D.S.

1991-01-01

This paper reviews a number of decision support methods developed and applied by Decision Focus Incorporated to help utility personnel manage current environmental problems. This work has been performed for the Environmental Risk Analysis Program of EPRI's Environment Division, and also for a number of electric utilities across the country. These are two distinct types of decision support software tools that have been created: economic risk management and environmental risk analysis. These types differ primarily in the identification of who will make a decision. Economic risk management tools are directed primarily at decisions made by electric utilities. Environmental risk analysis tools are directed primarily at decisions made by legislative or regulatory agencies, about which a utility may wish to comment

A decision-support system for sustainable urban metabolism in Europe

Energy Technology Data Exchange (ETDEWEB)

Gonzalez, Ainhoa, E-mail: ainhoag@yahoo.com [Trinity Centre for Biodiversity Research, School of Natural Sciences, Trinity College Dublin, College Green, Dublin 2 (Ireland); Donnelly, Alison, E-mail: donnelac@tcd.ie [Centre for the Environment, School of Natural Sciences, Trinity College Dublin (Ireland); Jones, Mike, E-mail: mike.jones@tcd.ie [Discipline of Botany, School of Natural Sciences, Trinity College Dublin (Ireland); Chrysoulakis, Nektarios, E-mail: zedd2@iacm.forth.gr [Foundation for Research and Technology-Hellas, Institute of Applied and Computational Mathematics (Greece); Lopes, Myriam, E-mail: myr@ua.pt [Departamento de Ambiente e Ordenamento and CESAM, University of Aveiro (Portugal)

2013-01-15

Urban metabolism components define the energy and material exchanges within a city and, therefore, can provide valuable information on the environmental quality of urban areas. Assessing the potential impact of urban planning alternatives on urban metabolism components (such as energy, water, carbon and pollutants fluxes) can provide a quantitative estimation of their sustainability performance. Urban metabolism impact assessment can, therefore, contribute to the identification of sustainable urban structures with regards, for example, to building types, materials and layout, as well as to location and capacity of transportation and infrastructural developments. In this way, it enables the formulation of planning and policy recommendations to promote efficient use of resources and enhance environmental quality in urban areas. The European FP7 project BRIDGE (sustainaBle uRban plannIng Decision support accountinG for urban mEtabolism) has developed a decision-support system (DSS) that systematically integrates urban metabolism components into impact assessment processes with the aim of accurately quantifying the potential effects of proposed planning interventions. The DSS enables integration of multiple spatial and non-spatial datasets (e.g. physical flows of energy and material with variables of social and economic change) in a systematic manner to obtain spatially defined assessment results and to thus inform planners and decision-makers. This multi-criteria approach also enables incorporation of stakeholders' perceptions in order to prioritise decisive assessment criteria. This paper describes the methodological framework used to develop the DSS and critically examines the results of its practical application in five European cities. - Highlights: Black-Right-Pointing-Pointer Urban metabolism in sustainability assessment of planning alternatives. Black-Right-Pointing-Pointer European FP7 project applied to 5 real life case studies across Europe. Black

A decision-support system for sustainable urban metabolism in Europe

International Nuclear Information System (INIS)

González, Ainhoa; Donnelly, Alison; Jones, Mike; Chrysoulakis, Nektarios; Lopes, Myriam

2013-01-01

Urban metabolism components define the energy and material exchanges within a city and, therefore, can provide valuable information on the environmental quality of urban areas. Assessing the potential impact of urban planning alternatives on urban metabolism components (such as energy, water, carbon and pollutants fluxes) can provide a quantitative estimation of their sustainability performance. Urban metabolism impact assessment can, therefore, contribute to the identification of sustainable urban structures with regards, for example, to building types, materials and layout, as well as to location and capacity of transportation and infrastructural developments. In this way, it enables the formulation of planning and policy recommendations to promote efficient use of resources and enhance environmental quality in urban areas. The European FP7 project BRIDGE (sustainaBle uRban plannIng Decision support accountinG for urban mEtabolism) has developed a decision-support system (DSS) that systematically integrates urban metabolism components into impact assessment processes with the aim of accurately quantifying the potential effects of proposed planning interventions. The DSS enables integration of multiple spatial and non-spatial datasets (e.g. physical flows of energy and material with variables of social and economic change) in a systematic manner to obtain spatially defined assessment results and to thus inform planners and decision-makers. This multi-criteria approach also enables incorporation of stakeholders' perceptions in order to prioritise decisive assessment criteria. This paper describes the methodological framework used to develop the DSS and critically examines the results of its practical application in five European cities. - Highlights: ► Urban metabolism in sustainability assessment of planning alternatives. ► European FP7 project applied to 5 real life case studies across Europe. ► Decision support system enables incorporating scientific

Computer-supported collaborative decision-making

CERN Document Server

Filip, Florin Gheorghe; Ciurea, Cristian

2017-01-01

This is a book about how management and control decisions are made by persons who collaborate and possibly use the support of an information system. The decision is the result of human conscious activities aiming at choosing a course of action for attaining a certain objective (or a set of objectives). The act of collaboration implies that several entities who work together and share responsibilities to jointly plan, implement and evaluate a program of activities to achieve the common goals. The book is intended to present a balanced view of the domain to include both well-established concepts and a selection of new results in the domains of methods and key technologies. It is meant to answer several questions, such as: a) “How are evolving the business models towards the ever more collaborative schemes?”; b) “What is the role of the decision-maker in the new context?” c) “What are the basic attributes and trends in the domain of decision-supporting information systems?”; d) “Which are the basic...

Rapid Deterioration of Basic Life Support Skills in Dentists With Basic Life Support Healthcare Provider.

Science.gov (United States)

Nogami, Kentaro; Taniguchi, Shogo; Ichiyama, Tomoko

2016-01-01

The aim of this study was to investigate the correlation between basic life support skills in dentists who had completed the American Heart Association's Basic Life Support (BLS) Healthcare Provider qualification and time since course completion. Thirty-six dentists who had completed the 2005 BLS Healthcare Provider course participated in the study. We asked participants to perform 2 cycles of cardiopulmonary resuscitation on a mannequin and evaluated basic life support skills. Dentists who had previously completed the BLS Healthcare Provider course displayed both prolonged reaction times, and the quality of their basic life support skills deteriorated rapidly. There were no correlations between basic life support skills and time since course completion. Our results suggest that basic life support skills deteriorate rapidly for dentists who have completed the BLS Healthcare Provider. Newer guidelines stressing chest compressions over ventilation may help improve performance over time, allowing better cardiopulmonary resuscitation in dental office emergencies. Moreover, it may be effective to provide a more specialized version of the life support course to train the dentists, stressing issues that may be more likely to occur in the dental office.

Evaluation of decision support systems for nuclear accidents

International Nuclear Information System (INIS)

Sdouz, G.; Mueck, K.

1998-05-01

In order to adopt countermeasures to protect the public after an accident in a nuclear power plant in an appropriate and optimum way, decision support systems offer a valuable assistance in supporting the decision maker in choosing and optimizing protective actions. Such decision support systems may range from simple systems to accumulate relevant parameters for the evaluation of the situation over prediction models for the rapid evaluation of the dose to be expected to systems which permit the evaluation and comparison of possible countermeasures. Since the establishment of a decision support systems obviously is also required in Austria, an evaluation of systems available or in the state of development in other countries or unions was performed. The aim was to determine the availability of decision support systems in various countries and to evaluate them with regard to depth and extent of the system. The evaluation showed that in most industrialized countries the requirement for a decision support system was realized, but in only few countries actual systems are readily available and operable. Most systems are limited to early phase consequences, i.e. dispersion calculations of calculated source terms and the estimation of exposure in the vicinity of the plant. Only few systems offer the possibility to predict long-term exposures by ingestion. Few systems permit also an evaluation of potential countermeasures, in most cases, however, limited to a few short-term countermeasures. Only one system which is presently not operable allows the evaluation of a large number of agricultural countermeasures. In this report the different systems are compared. The requirements with regard to an Austrian decision support system are defined and consequences for a possible utilization of a DSS or parts thereof for the Austrian decision support system are derived. (author)

Evaluation of selected environmental decision support software

International Nuclear Information System (INIS)

Sullivan, T.M.; Moskowitz, P.D.; Gitten, M.

1997-06-01

Decision Support Software (DSS) continues to be developed to support analysis of decisions pertaining to environmental management. Decision support systems are computer-based systems that facilitate the use of data, models, and structured decision processes in decision making. The optimal DSS should attempt to integrate, analyze, and present environmental information to remediation project managers in order to select cost-effective cleanup strategies. The optimal system should have a balance between the sophistication needed to address the wide range of complicated sites and site conditions present at DOE facilities, and ease of use (e.g., the system should not require data that is typically unknown and should have robust error checking of problem definition through input, etc.). In the first phase of this study, an extensive review of the literature, the Internet, and discussions with sponsors and developers of DSS led to identification of approximately fifty software packages that met the preceding definition

Issues surrounding end-of-life decision-making

Directory of Open Access Journals (Sweden)

Tejwani V

2013-08-01

Full Text Available Vickram Tejwani,1,* YiFan Wu,1,* Sabrina Serrano,2 Luis Segura,2 Michael Bannon,3 Qi Qian1 1Department of Medicine, Division of Nephrology and Hypertension, 2Mayo Graduate School, 3Department of Trauma, Critical Care, and General Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA *These authors contributed equally to this work Abstract: End-of-life decision-making is a complex process that can be extremely challenging. We describe a 42-year-old woman in an irreversible coma without an advance directive. The case serves to illustrate the complications that can occur in end-of-life decision-making and challenges in resolving difficult futility disputes. We review the role of advance directives in planning end-of-life care, the responsibility and historical performance of patient surrogates, the genesis of futility disputes, and approaches to resolving disputes. Keywords: end-of-life care, advance directive, surrogate, futility dispute, conflict resolution

Biometric and intelligent decision making support

CERN Document Server

Kaklauskas, Arturas

2015-01-01

This book presents different methods for analyzing the body language (movement, position, use of personal space, silences, pauses and tone, the eyes, pupil dilation or constriction, smiles, body temperature and the like) for better understanding people’s needs and actions, including biometric data gathering and reading. Different studies described in this book indicate that sufficiently much data, information and knowledge can be gained by utilizing biometric technologies. This is the first, wide-ranging book that is devoted completely to the area of intelligent decision support systems, biometrics technologies and their integrations. This book is designated for scholars, practitioners and doctoral and master’s degree students in various areas and those who are interested in the latest biometric and intelligent decision making support problems and means for their resolutions, biometric and intelligent decision making support systems and the theory and practice of their integration and the opportunities fo...

Using Visualization in Cockpit Decision Support Systems

Energy Technology Data Exchange (ETDEWEB)

Aragon, Cecilia R.

2005-07-01

In order to safely operate their aircraft, pilots must makerapid decisions based on integrating and processing large amounts ofheterogeneous information. Visual displays are often the most efficientmethod of presenting safety-critical data to pilots in real time.However, care must be taken to ensure the pilot is provided with theappropriate amount of information to make effective decisions and notbecome cognitively overloaded. The results of two usability studies of aprototype airflow hazard visualization cockpit decision support systemare summarized. The studies demonstrate that such a system significantlyimproves the performance of helicopter pilots landing under turbulentconditions. Based on these results, design principles and implicationsfor cockpit decision support systems using visualization arepresented.

Theory, Software and Testing Examples for Decision Support Systems

OpenAIRE

Lewandowski, A.; Wierzbicki, A.P.

1987-01-01

Research in methodology of Decision Support Systems is one of the activities within the System and Decision Sciences Program which was initiated seven years ago and is still in the center of interests of SDS. During these years several methodological approaches and software tools have been developed; among others the DIDAS (Dynamic Interactive Decision Analysis and Support) and SCDAS (Selection Committed Decision Analysis and Support). Both methodologies gained a certain level of popularity a...

Modelling risk aversion to support decision-making for controlling zoonotic livestock diseases.

Science.gov (United States)

van Asseldonk, M A P M; Bergevoet, R H M; Ge, L

2013-12-01

Zoonotic infectious livestock diseases are becoming a significant burden for both animal and human health and are rapidly gaining the attention of decision-makers who manage public health programmes. If control decisions have only monetary components, governments are generally regarded as being risk-neutral and the intervention strategy with the highest expected benefit (lowest expected net costs) should be preferred. However, preferences will differ and alternative intervention plans will prevail if (human) life and death outcomes are involved. A rational decision framework must therefore consider risk aversion in the decision-maker and controversial values related to public health. In the present study, risk aversion and its impact on both the utility for the monetary component and the utility for the non-monetary component is shown to be an important element when dealing with emerging zoonotic infectious livestock diseases and should not be ignored in the understanding and support of decision-making. The decision framework was applied to several control strategies for the reduction of human cases of brucellosis (Brucella melitensis) originating from sheep in Turkey.

[Habitability and life support systems].

Science.gov (United States)

Nefedov, Iu G; Adamovich, B A

1988-01-01

This paper discusses various aspects of space vehicle habitability and life support systems. It describes variations in the chemical and microbial composition of an enclosed atmosphere during prolonged real and simulated flights. The paper gives a detailed description of life support systems and environmental investigations onboard the Mir station. It also outlines the development of space vehicle habitability and life support systems as related to future flights.

Applying the Wildland Fire Decision Support System (WFDSS) to support risk-informed decision making: The Gold Pan Fire, Bitterroot National Forest, Montana, USA

Science.gov (United States)

Erin K. Noonan-Wright; Tonja S. Opperman

2015-01-01

In response to federal wildfire policy changes, risk-informed decision-making by way of improved decision support, is increasingly becoming a component of managing wildfires. As fire incidents escalate in size and complexity, the Wildland Fire Decision Support System (WFDSS) provides support with different analytical tools as fire conditions change. We demonstrate the...

Using Visualization in Cockpit Decision Support Systems

Science.gov (United States)

Aragon, Cecilia R.

2005-01-01

In order to safely operate their aircraft, pilots must make rapid decisions based on integrating and processing large amounts of heterogeneous information. Visual displays are often the most efficient method of presenting safety-critical data to pilots in real time. However, care must be taken to ensure the pilot is provided with the appropriate amount of information to make effective decisions and not become cognitively overloaded. The results of two usability studies of a prototype airflow hazard visualization cockpit decision support system are summarized. The studies demonstrate that such a system significantly improves the performance of helicopter pilots landing under turbulent conditions. Based on these results, design principles and implications for cockpit decision support systems using visualization are presented.

Nuclear plant life - A business decision

International Nuclear Information System (INIS)

Joosten, J.K.

1995-01-01

Regarding the future of the nuclear power option, many scenarios have been put forth over the years. The most commonly accepted projections for installed nuclear capacity show it growing at a rate of about 2% per year throughout the next few decades. These projections appear modes on the surface. However, underlying the projections are critical assumptions and sometimes misconceptions about the lifetimes of existing reactors and how they are determined. The notion of a 40 year plant life is very common. Consequently, many projections start either with the assumption that no plants will be retired in the near terms or with the assumption that each retired plant will be replaced by another nuclear plant after 40 years. Effectively, these assumptions yield future projections for installed capacity that might be characterized as low growth, medium growth and high growth scenarios - or grow, grow, grow. The question remains as to whether or not these assumptions accurately model the driving forces and constraints to nuclear development. After all, there is no scientific basis for believing that all plants, PWRs BWRs, RBMKs, etc., should have the same 40 year life. Most power plant owners purchase the plant for the main reason of supplying electrical power to their consumer. For these owners, electricity production is a day to day commercial activity with various alternatives on how to achieve the prime objective. The decision of which electricity generation alternative to select (gas, coal, nuclear or renewable energy) and how long to operate the plant before replacing it with a new one is essentially a business decision. The paper discusses ageing, the nuclear plant life decision process, the factors which influence the decision and their ramifications regarding the near term growth of nuclear power capacity. The modelling of nuclear plant lifetimes is also discussed. (author). 5 refs, 10 figs, 1 tab

Decision Performance Using Spatial Decision Support Systems: A Geospatial Reasoning Ability Perspective

Science.gov (United States)

Erskine, Michael A.

2013-01-01

As many consumer and business decision makers are utilizing Spatial Decision Support Systems (SDSS), a thorough understanding of how such decisions are made is crucial for the information systems domain. This dissertation presents six chapters encompassing a comprehensive analysis of the impact of geospatial reasoning ability on…

Composite decision support by combining cost-benefit and multi-criteria decision

DEFF Research Database (Denmark)

Barfod, Michael Bruhn; Salling, Kim Bang; Leleur, Steen

2011-01-01

This paper concerns composite decision support based on combining cost-benefit analysis (CBA) with multi-criteria decision analysis (MCDA) for the assessment of economic as well as strategic impacts within transport projects. Specifically a composite model for assessment (COSIMA) is presented...

Grand Challenges in Clinical Decision Support v10

Science.gov (United States)

Sittig, Dean F.; Wright, Adam; Osheroff, Jerome A.; Middleton, Blackford; Teich, Jonathan M.; Ash, Joan S.; Campbell, Emily; Bates, David W.

2008-01-01

There is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating, and maintaining all types of clinical decision support capabilities for clinicians, patients and consumers. Using an iterative, consensus-building process we identified a rank-ordered list of the top 10 grand challenges in clinical decision support. This list was created to educate and inspire researchers, developers, funders, and policy-makers. The list of challenges in order of importance that they be solved if patients and organizations are to begin realizing the fullest benefits possible of these systems consists of: Improve the human-computer interface; Disseminate best practices in CDS design, development, and implementation; Summarize patient-level information; Prioritize and filter recommendations to the user; Create an architecture for sharing executable CDS modules and services; Combine recommendations for patients with co-morbidities; Prioritize CDS content development and implementation; Create internet-accessible clinical decision support repositories; Use freetext information to drive clinical decision support; Mine large clinical databases to create new CDS. Identification of solutions to these challenges is critical if clinical decision support is to achieve its potential and improve the quality, safety and efficiency of healthcare. PMID:18029232

Tsunami early warning and decision support

Directory of Open Access Journals (Sweden)

T. Steinmetz

2010-09-01

Full Text Available An innovative newly developed modular and standards based Decision Support System (DSS is presented which forms part of the German Indonesian Tsunami Early Warning System (GITEWS. The GITEWS project stems from the effort to implement an effective and efficient Tsunami Early Warning and Mitigation System for the coast of Indonesia facing the Sunda Arc along the islands of Sumatra, Java and Bali. The geological setting along an active continental margin which is very close to densely populated areas is a particularly difficult one to cope with, because potential tsunamis' travel times are thus inherently short. National policies require an initial warning to be issued within the first five minutes after an earthquake has occurred. There is an urgent requirement for an end-to-end solution where the decision support takes the entire warning chain into account. The system of choice is based on pre-computed scenario simulations and rule-based decision support which is delivered to the decision maker through a sophisticated graphical user interface (GUI using information fusion and fast information aggregation to create situational awareness in the shortest time possible. The system also contains risk and vulnerability information which was designed with the far end of the warning chain in mind – it enables the decision maker to base his acceptance (or refusal of the supported decision also on regionally differentiated risk and vulnerability information (see Strunz et al., 2010. While the system strives to provide a warning as quickly as possible, it is not in its proper responsibility to send and disseminate the warning to the recipients. The DSS only broadcasts its messages to a dissemination system (and possibly any other dissemination system which is operated under the responsibility of BMKG – the meteorological, climatological and geophysical service of Indonesia – which also hosts the tsunami early warning center. The system is to be seen

Introduction to Life Support Systems

Science.gov (United States)

Perry, Jay

2017-01-01

This course provides an introduction to the design and development of life support systems to sustain humankind in the harsh environment of space. The life support technologies necessary to provide a respirable atmosphere and clean drinking water are emphasized in the course. A historical perspective, beginning with open loop systems employed aboard the earliest crewed spacecraft through the state-of-the-art life support technology utilized aboard the International Space Station today, will provide a framework for students to consider applications to possible future exploration missions and destinations which may vary greatly in duration and scope. Development of future technologies as well as guiding requirements for designing life support systems for crewed exploration missions beyond low-Earth orbit are also considered in the course.

Decision support frameworks and tools for conservation

Science.gov (United States)

Schwartz, Mark W.; Cook, Carly N.; Pressey, Robert L.; Pullin, Andrew S.; Runge, Michael C.; Salafsky, Nick; Sutherland, William J.; Williamson, Matthew A.

2018-01-01

The practice of conservation occurs within complex socioecological systems fraught with challenges that require transparent, defensible, and often socially engaged project planning and management. Planning and decision support frameworks are designed to help conservation practitioners increase planning rigor, project accountability, stakeholder participation, transparency in decisions, and learning. We describe and contrast five common frameworks within the context of six fundamental questions (why, who, what, where, when, how) at each of three planning stages of adaptive management (project scoping, operational planning, learning). We demonstrate that decision support frameworks provide varied and extensive tools for conservation planning and management. However, using any framework in isolation risks diminishing potential benefits since no one framework covers the full spectrum of potential conservation planning and decision challenges. We describe two case studies that have effectively deployed tools from across conservation frameworks to improve conservation actions and outcomes. Attention to the critical questions for conservation project planning should allow practitioners to operate within any framework and adapt tools to suit their specific management context. We call on conservation researchers and practitioners to regularly use decision support tools as standard practice for framing both practice and research.

Decision Strategy Research: Policy Support

International Nuclear Information System (INIS)

Hardeman, F.

2000-01-01

The objective of SCK-CEN's R and D programme on decision strategy research are (1) to support and advise the Belgian authorities on specific problems concerning existing and potential hazards from exposure to ionising radiation, both in normal and emergency situations; (2) to perform research on relevant topics that might have an important impact on decision making related to nuclear applications, including social and economic sciences. Main achievements in this area in 1999 are described

75 FR 68334 - Record of Decision (ROD) for Training Range and Garrison Support Facilities Construction and...

Science.gov (United States)

2010-11-05

... decision sites ranges and support facilities in locations that reflect the proper balance of initiatives for the protection of the environment, mission needs, and Soldier and Family quality of life..., Directorate of Public Works, Prevention and Compliance Branch, Environmental Division, 1550 Frank Cochran...

Demonstration of decision support for real time operation

DEFF Research Database (Denmark)

Catterson, Victoria; MCarthur, Stephen; Chen, Minjiang

ELECTRA Deliverable 8.2 reports on the demonstration of decision support within the future control room in light of voltage and frequency control in the 2030+ power system. The decision support must identify key threats and vulnerabilities, and propose and prioritise appropriate interventions....

Clinical Decision Support (CDS) Inventory

Data.gov (United States)

U.S. Department of Health & Human Services — The Clinical Decision Support (CDS) Inventory contains descriptions of past and present CDS projects across the Federal Government. It includes Federal projects,...

LCA-IWM: A decision support tool for sustainability assessment of waste management systems

International Nuclear Information System (INIS)

Boer, J. den; Boer, E. den; Jager, J.

2007-01-01

The paper outlines the most significant result of the project 'The use of life cycle assessment tools for the development of integrated waste management strategies for cities and regions with rapid growing economies', which was the development of two decision-support tools: a municipal waste prognostic tool and a waste management system assessment tool. The article focuses on the assessment tool, which supports the adequate decision making in the planning of urban waste management systems by allowing the creation and comparison of different scenarios, considering three basic subsystems: (i) temporary storage; (ii) collection and transport and (iii) treatment, disposal and recycling. The design and analysis options, as well as the assumptions made for each subsystem, are shortly introduced, providing an overview of the applied methodologies and technologies. The sustainability assessment methodology used in the project to support the selection of the most adequate scenario is presented with a brief explanation of the procedures, criteria and indicators applied on the evaluation of each of the three sustainability pillars

Solutions for decision support in university management

Directory of Open Access Journals (Sweden)

Andrei STANCIU

2009-06-01

Full Text Available The paper proposes an overview of decision support systems in order to define the role of a system to assist decision in university management. The authors present new technologies and the basic concepts of multidimensional data analysis using models of business processes within the universities. Based on information provided by scientific literature and on the authors’ experience, the study aims to define selection criteria in choosing a development environment for designing a support system dedicated to university management. The contributions consist in designing a data warehouse model and models of OLAP analysis to assist decision in university management.

Decision support using nonparametric statistics

CERN Document Server

Beatty, Warren

2018-01-01

This concise volume covers nonparametric statistics topics that most are most likely to be seen and used from a practical decision support perspective. While many degree programs require a course in parametric statistics, these methods are often inadequate for real-world decision making in business environments. Much of the data collected today by business executives (for example, customer satisfaction opinions) requires nonparametric statistics for valid analysis, and this book provides the reader with a set of tools that can be used to validly analyze all data, regardless of type. Through numerous examples and exercises, this book explains why nonparametric statistics will lead to better decisions and how they are used to reach a decision, with a wide array of business applications. Online resources include exercise data, spreadsheets, and solutions.

Decision support to enable sustainability in development projects

CSIR Research Space (South Africa)

Meyer, IA

2014-10-01

Full Text Available that are not always explicitly linked to development outcomes. Throughout this process, scope exists to aid decision makers, through a simplistic set of decision models, to make better decisions. The emphasis is on decisions that support long-term value creation...

Labelling of end-of-life decisions by physicians

NARCIS (Netherlands)

Deyaert, J.; Chambaere, K.; Cohen, J.; Roelands, M.; Deliens, L.

2014-01-01

Objectives: Potentially life-shortening medical end-oflife practices (end-of-life decisions (ELDs)) remain subject to conceptual vagueness. This study evaluates how physicians label these practices by examining which of their own practices (described according to the precise act, the intention, the

Developing a Support Tool for Global Product Development Decisions

DEFF Research Database (Denmark)

Søndergaard, Erik Stefan; Ahmed-Kristensen, Saeema

2016-01-01

This paper investigates how global product development decisions are made through a multiple-case study in three Danish engineering. The paper identifies which information and methods are applied for making decisions and how decision-making can be supported based on previous experience. The paper...... presents results from 51 decisions made in the three companies, and based on the results of the studies a framework for a decision-support tool is outlined and discussed. The paper rounds off with an identification of future research opportunities in the area of global product development and decision-making....

Can basic life support personnel safely determine that advanced life support is not needed?

Science.gov (United States)

Cone, D C; Wydro, G C

2001-01-01

To determine whether firefighter/emergency medical technicians-basic (FF/EMT-Bs) staffing basic life support (BLS) ambulances in a two-tiered emergency medical services (EMS) system can safely determine when advanced life support (ALS) is not needed. This was a prospective, observational study conducted in two academic emergency departments (EDs) receiving patients from a large urban fire-based EMS system. Runs were studied to which ALS and BLS ambulances were simultaneously dispatched, with the patient transported by the BLS unit. Prospectively established criteria for potential need for ALS were used to determine whether the FF/EMT-B's decision to cancel the ALS unit was safe, and simple outcomes (admission rate, length of stay, mortality) were examined. In the system studied, BLS crews may cancel responding ALS units at their discretion; there are no protocols or medical criteria for cancellation. A convenience sample of 69 cases was collected. In 52 cases (75%), the BLS providers indicated that they cancelled the responding ALS unit because they did not feel ALS was needed. Of these, 40 (77%) met study criteria for ALS: 39 had potentially serious chief complaints, nine had abnormal vital signs, and ten had physical exam findings that warranted ALS. Forty-five (87%) received an intervention immediately upon ED arrival that could have been provided in the field by an ALS unit, and 16 (31%) were admitted, with a median length of stay of 3.3 days (range 1.1-73.4 days). One patient died. Firefighter/EMT-Bs, working without protocols or medical criteria, cannot always safely determine which patients may require ALS intervention.

Psychiatry: life events and social support in late life depression

Directory of Open Access Journals (Sweden)

Clóvis Alexandrino-Silva

2011-01-01

Full Text Available OBJECTIVES: To examine the association of life events and social support in the broadly defined category of depression in late life. INTRODUCTION: Negative life events and lack of social support are associated with depression in the elderly. Currently, there are limited studies examining the association between life events, social support and late-life depression in Brazil. METHODS: We estimated the frequency of late-life depression within a household community sample of 367 subjects aged 60 years or greater with associated factors. ''Old age symptomatic depression'' was defined using the Composite International Diagnostic Interview 1.1 tool. This diagnostic category included only late-life symptoms and consisted of the diagnoses of depression and dysthymia as well as a subsyndromal definition of depression, termed ''late subthreshold depression''. Social support and life events were assessed using the Comprehensive Assessment and Referral Evaluation (SHORT-CARE inventory. RESULTS: ''Old age symptomatic depression'' occurred in 18.8% of the patients in the tested sample. In univariate analyses, this condition was associated with female gender, lifetime anxiety disorder and living alone. In multivariate models, ''old age symptomatic depression'' was associated with a perceived lack of social support in men and life events in women. DISCUSSION: Social support and life events were determined to be associated with late-life depression, but it is important to keep in mind the differences between genders. Also, further exploration of the role of lifetime anxiety disorder in late-life depression may be of future importance. CONCLUSIONS: We believe that this study helps to provide insight into the role of psychosocial factors in late-life depression.

'My kidneys, my choice, decision aid': supporting shared decision making.

Science.gov (United States)

Fortnum, Debbie; Smolonogov, Tatiana; Walker, Rachael; Kairaitis, Luke; Pugh, Debbie

2015-06-01

For patients with chronic kidney disease (CKD) who are progressing to end-stage kidney disease (ESKD) a decision of whether to undertake dialysis or conservative care is a critical component of the patient journey. Shared decision making for complex decisions such as this could be enhanced by a decision aid, a practice which is well utilised in other disciplines but limited for nephrology. A multidisciplinary team in Australia and New Zealand (ANZ) utilised current decision-making theory and best practice to develop the 'My Kidneys, My Choice', a decision aid for the treatment of kidney disease. A patient-centred, five-sectioned tool is now complete and freely available to all ANZ units to support the ESKD education and shared decision-making process. Distribution and education have occurred across ANZ and evaluation of the decision aid in practice is in the first phase. Development of a new tool such as an ESKD decision aid requires vision, multidisciplinary input and ongoing implementation resources. This tool is being integrated into ANZ, ESKD education practice and is promoting the philosophy of shared decision making. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

An integrated decision support system for wastewater nutrient recovery and recycling to agriculture

Science.gov (United States)

Roy, E. D.; Bomeisl, L.; Cornbrooks, P.; Mo, W.

2017-12-01

Nutrient recovery and recycling has become a key research topic within the wastewater engineering and nutrient management communities. Several technologies now exist that can effectively capture nutrients from wastewater, and innovation in this area continues to be an important research pursuit. However, practical nutrient recycling solutions require more than capable nutrient capture technologies. We also need to understand the role that wastewater nutrient recovery and recycling can play within broader nutrient management schemes at the landscape level, including important interactions at the nexus of food, energy, and water. We are developing an integrated decision support system that combines wastewater treatment data, agricultural data, spatial nutrient balance modeling, life cycle assessment, stakeholder knowledge, and multi-criteria decision making. Our goals are to: (1) help guide design decisions related to the implementation of sustainable nutrient recovery technology, (2) support innovations in watershed nutrient management that operate at the interface of the built environment and agriculture, and (3) aid efforts to protect aquatic ecosystems while supporting human welfare in a circular nutrient economy. These goals will be realized partly through the assessment of plausible alternative scenarios for the future. In this presentation, we will describe the tool and focus on nutrient balance results for the New England region. These results illustrate that both centralized and decentralized wastewater nutrient recovery schemes have potential to transform nutrient flows in many New England watersheds, diverting wastewater N and P away from aquatic ecosystems and toward local or regional agricultural soils where they can offset a substantial percentage of imported fertilizer. We will also highlight feasibility criteria and next steps to integrate stakeholder knowledge, economics, and life cycle assessment into the tool.

Supporting Formulary Decisions: The Discovery of New Facts or Constructed Evidence?

Directory of Open Access Journals (Sweden)

Paul C Langley

2016-07-01

Full Text Available A critical question, given the growing importance of more targeted therapies to support personalized and precision medicine, is the credibility of the evidence base to support formulary decisions and pricing. On the one hand, for those who subscribe to the reference case model of the National Institute of Health and Care Excellence (NICE in the UK, the decision rests upon the creation of modeled or simulated imaginary worlds and the application of threshold willingness-to-pay cost-per-QALY thresholds. On the other hand, for those who subscribe to the standards of normal science, the decision rests upon the ability to evaluate competing claims, both clinical and cost-effective, in a timeframe that is meaningful to a formulary committee. If we subscribe to the scientific method where the focus is on the discovery of new facts, untestable claims for clinical benefit and cost-effectiveness, such as created claims for lifetime cost per-quality-adjusted discounted life years (QALYs, are properly relegated to the category of pseudoscience. We have no idea, and will never know, whether the claims are right or even if they are wrong. If formulary decisions are to respect the standards of normal science then there has to be a commitment to claims evaluation. A willingness to accept new products provisionally, subject to an agreed protocol to support the evaluation of clinical and cost-effectiveness claims. This dichotomy between the standards of normal science and pseudoscience is explored in the context of published claims for cost-effectiveness and recommendations for product pricing in the US.   Type: Commentary

Decision making across the life span

NARCIS (Netherlands)

Li, S.C.; Ridderinkhof, K.R.; Samanez-Larkin, G.R.

2014-01-01

Learning to choose adaptively between different behavioral options in order to reach goals is a pervasive task in life for people of all ages. Individuals are often confronted with complex, uncertain situations that nonetheless require decisive actions that would facilitate the pursuit of short-term

Decision support tools for policy and planning

International Nuclear Information System (INIS)

Jacyk, P.; Schultz, D.; Spangenberg, L.

1995-01-01

A decision support system (DSS) is being developed at the Radioactive Liquid Waste Treatment Facility, Los Alamos National Laboratory (LANL). The DSS will be used to evaluate alternatives for improving LANL's existing central radioactive waste water treatment plant and to evaluate new site-wide liquid waste treatment schemes that are required in order to handle the diverse waste streams produced at LANL. The decision support system consists of interacting modules that perform the following tasks: rigorous process simulation, configuration management, performance analysis, cost analysis, risk analysis, environmental impact assessment, transportation modeling, and local, state, and federal regulation compliance checking. Uncertainty handling techniques are used with these modules and also with a decision synthesis module which combines results from the modules listed above. We believe the DSS being developed can be applied to almost any other industrial water treatment facility with little modification because in most situations the waste streams are less complex, fewer regulations apply, and the political environment is simpler. The techniques being developed are also generally applicable to policy and planning decision support systems in the chemical process industry

Data Mining for Education Decision Support: A Review

Directory of Open Access Journals (Sweden)

Suhirman Suhirman

2014-12-01

Full Text Available Management of higher education must continue to evaluate on an ongoing basis in order to improve the quality of institutions. This will be able to do the necessary evaluation of various data, information, and knowledge of both internal and external institutions. They plan to use more efficiently the collected data, develop tools so that to collect and direct management information, in order to support managerial decision making. The collected data could be utilized to evaluate quality, perform analyses and diagnoses, evaluate dependability to the standards and practices of curricula and syllabi, and suggest alternatives in decision processes. Data minings to support decision making are well suited methods to provide decision support in the education environments, by generating and presenting relevant information and knowledge towards quality improvement of education processes. In educational domain, this information is very useful since it can be used as a base for investigating and enhancing the current educational standards and managements. In this paper, a review on data mining for academic decision support in education field is presented. The details of this paper will review on recent data mining in educational field and outlines future researches in educational data mining.

Making decisions at the end of life when caring for a person with dementia: a literature review to explore the potential use of heuristics in difficult decision-making.

Science.gov (United States)

Mathew, R; Davies, N; Manthorpe, J; Iliffe, S

2016-07-19

Decision-making, when providing care and treatment for a person with dementia at the end of life, can be complex and challenging. There is a lack of guidance available to support practitioners and family carers, and even those experienced in end of life dementia care report a lack of confidence in decision-making. It is thought that the use of heuristics (rules of thumb) may aid decision-making. The aim of this study is to identify whether heuristics are used in end of life dementia care, and if so, to identify the context in which they are being used. A narrative literature review was conducted taking a systematic approach to the search strategy, using the Centre for Reviews and Dissemination guidelines. Rapid appraisal methodology was used in order to source specific and relevant literature regarding the use of heuristics in end of life dementia care. A search using terms related to dementia, palliative care and decision-making was conducted across 4 English language electronic databases (MEDLINE, EMBASE, PsycINFO and CINAHL) in 2015. The search identified 12 papers that contained an algorithm, guideline, decision tool or set of principles that we considered compatible with heuristic decision-making. The papers addressed swallowing and feeding difficulties, the treatment of pneumonia, management of pain and agitation, rationalising medication, ending life-sustaining treatment, and ensuring a good death. The use of heuristics in palliative or end of life dementia care is not described in the research literature. However, this review identified important decision-making principles, which are largely a reflection of expert opinion. These principles may have the potential to be developed into simple heuristics that could be used in practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Nurse involvement in end-of-life decision making: the ETHICUS Study

DEFF Research Database (Denmark)

Benbenishty, Julie; Ganz, Freda DeKeyser; Lippert, Anne

2006-01-01

The purpose was to investigate physicians' perceptions of the role of European intensive care nurses in end-of-life decision making.......The purpose was to investigate physicians' perceptions of the role of European intensive care nurses in end-of-life decision making....

Methodological Challenges in Studies Comparing Prehospital Advanced Life Support with Basic Life Support.

Science.gov (United States)

Li, Timmy; Jones, Courtney M C; Shah, Manish N; Cushman, Jeremy T; Jusko, Todd A

2017-08-01

Determining the most appropriate level of care for patients in the prehospital setting during medical emergencies is essential. A large body of literature suggests that, compared with Basic Life Support (BLS) care, Advanced Life Support (ALS) care is not associated with increased patient survival or decreased mortality. The purpose of this special report is to synthesize the literature to identify common study design and analytic challenges in research studies that examine the effect of ALS, compared to BLS, on patient outcomes. The challenges discussed in this report include: (1) choice of outcome measure; (2) logistic regression modeling of common outcomes; (3) baseline differences between study groups (confounding); (4) inappropriate statistical adjustment; and (5) inclusion of patients who are no longer at risk for the outcome. These challenges may affect the results of studies, and thus, conclusions of studies regarding the effect of level of prehospital care on patient outcomes should require cautious interpretation. Specific alternatives for avoiding these challenges are presented. Li T , Jones CMC , Shah MN , Cushman JT , Jusko TA . Methodological challenges in studies comparing prehospital Advanced Life Support with Basic Life Support. Prehosp Disaster Med. 2017;32(4):444-450.

Supporting multi-stakeholder environmental decisions.

Science.gov (United States)

Hajkowicz, Stefan A

2008-09-01

This paper examines how multiple criteria analysis (MCA) can be used to support multi-stakeholder environmental management decisions. It presents a study through which 48 stakeholders from environmental, primary production and community interest groups used MCA to prioritise 30 environmental management problems in the Mackay-Whitsunday region of Queensland, Australia. The MCA model, with procedures for aggregating multi-stakeholder output, was used to inform a final decision on the priority of the region's environmental management problems. The result was used in the region's environmental management plan as required under Australia's Natural Heritage Trust programme. The study shows how relatively simple MCA methods can help stakeholders make group decisions, even when they hold strongly conflicting preferences.

Decision-making on olympic urban development - multi-actor decision support tool

NARCIS (Netherlands)

Heurkens, E.W.T.M.

Subject of study is the possible organisation of the Olympic Games of 2028 in the Netherlands, as seen from an urban development viewpoint. The project focuses on the decision-making process in the initiative phase. Aim of the project is the development of a decision support tool for the complex,

Decision aids that support decisions about prenatal testing for Down syndrome: an environmental scan.

Science.gov (United States)

Leiva Portocarrero, Maria Esther; Garvelink, Mirjam M; Becerra Perez, Maria Margarita; Giguère, Anik; Robitaille, Hubert; Wilson, Brenda J; Rousseau, François; Légaré, France

2015-09-24

Prenatal screening tests for Down syndrome (DS) are routine in many developed countries and new tests are rapidly becoming available. Decisions about prenatal screening are increasingly complex with each successive test, and pregnant women need information about risks and benefits as well as clarity about their values. Decision aids (DAs) can help healthcare providers support women in this decision. Using an environmental scan, we aimed to identify publicly available DAs focusing on prenatal screening/diagnosis for Down syndrome that provide effective support for decision making. Data sources searched were the Decision Aids Library Inventory (DALI) of the Ottawa Patient Decision Aids Research Group at the Ottawa Health Research Institute; Google searches on the internet; professional organizations, academic institutions and other experts in the field; and references in existing systematic reviews on DAs. Eligible DAs targeted pregnant women, focused on prenatal screening and/or diagnosis, applied to tests for fetal abnormalities or aneuploidies, and were in French, English, Spanish or Portuguese. Pairs of reviewers independently identified eligible DAs and extracted characteristics including the presence of practical decision support tools and features to aid comprehension. They then performed quality assessment using the 16 minimum standards established by the International Patient Decision Aids Standards (IPDASi v4.0). Of 543 potentially eligible DAs (512 in DALI, 27 from experts, and four on the internet), 23 were eligible and 20 were available for data extraction. DAs were developed from 1996 to 2013 in six countries (UK, USA, Canada, Australia, Sweden, and France). Five DAs were for prenatal screening, three for prenatal diagnosis and 12 for both). Eight contained values clarification methods (personal worksheets). The 20 DAs scored a median of 10/16 (range 6-15) on the 16 IPDAS minimum standards. None of the 20 included DAs met all 16 IPDAS minimum standards

System for selecting relevant information for decision support.

Science.gov (United States)

Kalina, Jan; Seidl, Libor; Zvára, Karel; Grünfeldová, Hana; Slovák, Dalibor; Zvárová, Jana

2013-01-01

We implemented a prototype of a decision support system called SIR which has a form of a web-based classification service for diagnostic decision support. The system has the ability to select the most relevant variables and to learn a classification rule, which is guaranteed to be suitable also for high-dimensional measurements. The classification system can be useful for clinicians in primary care to support their decision-making tasks with relevant information extracted from any available clinical study. The implemented prototype was tested on a sample of patients in a cardiological study and performs an information extraction from a high-dimensional set containing both clinical and gene expression data.

Aggregate assessments support improved operational decision making

International Nuclear Information System (INIS)

Bauer, R.

2003-01-01

At Darlington Nuclear aggregate assessment of plant conditions is carried out in support of Operational Decision Making. This paper discusses how aggregate assessments have been applied to Operator Workarounds leading to improved prioritisation and alignment of work programs in different departments. As well, aggregate assessment of plant and human performance factors has been carried out to identify criteria which support conservative decision making in the main control room during unit transients. (author)

Dyadic fertility decisions in a life course perspective.

Science.gov (United States)

Bauer, Gerrit; Kneip, Thorsten

2014-09-01

This paper focuses on how couples arrive at joint decisions with regard to fertility behaviour. We build upon previous work on decision rules that couples might apply as heuristics in order to arrive at joint action in cases in which partners' fertility preferences differ. Previous research found either stronger effects of women's desires or symmetrical effects of both spouses' desires and net benefits associated with (further) children on proceptive behaviour. The latter finding is in line with the notion of household utility maximisation, in which both partners' preferences enter into a joint utility function with equal weight. On the other hand, some evidence indicates that one partner can exercise a 'veto' if he or she anticipates individual utility losses from a further child (due to opportunity costs arising in other life domains). We now enhance previous research by applying a life-course perspective. Our analysis makes use of variation in initial conditions due to previous births: couples decide on fertility in different situations as they find themselves in different life course stages and have had certain experiences. Parity-specific differences affect not only fertility outcomes but also the decision-making process itself. Our findings show that the decision to have a first child is made jointly, and each partner may exercise a veto. On the other hand, women appear to dominate decisions on higher parity births, not per se, but because they are (still) the ones more affected by the concomitant housework. Copyright © 2013 Elsevier Ltd. All rights reserved.

Barriers to and facilitators of implementing shared decision making and decision support in a paediatric hospital: A descriptive study.

Science.gov (United States)

Boland, Laura; McIsaac, Daniel I; Lawson, Margaret L

2016-04-01

To explore multiple stakeholders' perceived barriers to and facilitators of implementing shared decision making and decision support in a tertiary paediatric hospital. An interpretive descriptive qualitative study was conducted using focus groups and interviews to examine senior hospital administrators', clinicians', parents' and youths' perceived barriers to and facilitators of shared decision making and decision support implementation. Data were analyzed using inductive thematic analysis. Fifty-seven stakeholders participated. Six barrier and facilitator themes emerged. The main barrier was gaps in stakeholders' knowledge of shared decision making and decision support. Facilitators included compatibility between shared decision making and the hospital's culture and ideal practices, perceptions of positive patient and family outcomes associated with shared decision making, and positive attitudes regarding shared decision making and decision support. However, youth attitudes regarding the necessity and usefulness of a decision support program were a barrier. Two themes were both a barrier and a facilitator. First, stakeholder groups were uncertain which clinical situations are suitable for shared decision making (eg, new diagnoses, chronic illnesses, complex decisions or urgent decisions). Second, the clinical process may be hindered if shared decision making and decision support decrease efficiency and workflow; however, shared decision making may reduce repeat visits and save time over the long term. Specific knowledge translation strategies that improve shared decision making knowledge and match specific barriers identified by each stakeholder group may be required to promote successful shared decision making and decision support implementation in the authors' paediatric hospital.

Becoming a Mother: Supported Decision-Making in Context

Science.gov (United States)

Jamieson, Rhiann; Theodore, Kate; Raczka, Roman

2016-01-01

Little is known about how women with intellectual disabilities make decisions in relation to pregnancy. Social support is important for mothers with intellectual disabilities in many areas. This study explored how the support network influenced the decision-making of women with intellectual disabilities in relation to pregnancy. The study extended…

Fault Detection for Shipboard Monitoring and Decision Support Systems

DEFF Research Database (Denmark)

Lajic, Zoran; Nielsen, Ulrik Dam

2009-01-01

In this paper a basic idea of a fault-tolerant monitoring and decision support system will be explained. Fault detection is an important part of the fault-tolerant design for in-service monitoring and decision support systems for ships. In the paper, a virtual example of fault detection...... will be presented for a containership with a real decision support system onboard. All possible faults can be simulated and detected using residuals and the generalized likelihood ratio (GLR) algorithm....

How Decision Support Systems Can Benefit from a Theory of Change Approach

Science.gov (United States)

Allen, Will; Cruz, Jennyffer; Warburton, Bruce

2017-06-01

Decision support systems are now mostly computer and internet-based information systems designed to support land managers with complex decision-making. However, there is concern that many environmental and agricultural decision support systems remain underutilized and ineffective. Recent efforts to improve decision support systems use have focused on enhancing stakeholder participation in their development, but a mismatch between stakeholders' expectations and the reality of decision support systems outputs continues to limit uptake. Additional challenges remain in problem-framing and evaluation. We propose using an outcomes-based approach called theory of change in conjunction with decision support systems development to support both wider problem-framing and outcomes-based monitoring and evaluation. The theory of change helps framing by placing the decision support systems within a wider context. It highlights how decision support systems use can "contribute" to long-term outcomes, and helps align decision support systems outputs with these larger goals. We illustrate the benefits of linking decision support systems development and application with a theory of change approach using an example of pest rabbit management in Australia. We develop a theory of change that outlines the activities required to achieve the outcomes desired from an effective rabbit management program, and two decision support systems that contribute to specific aspects of decision making in this wider problem context. Using a theory of change in this way should increase acceptance of the role of decision support systems by end-users, clarify their limitations and, importantly, increase effectiveness of rabbit management. The use of a theory of change should benefit those seeking to improve decision support systems design, use and, evaluation.

How Decision Support Systems Can Benefit from a Theory of Change Approach.

Science.gov (United States)

Allen, Will; Cruz, Jennyffer; Warburton, Bruce

2017-06-01

Decision support systems are now mostly computer and internet-based information systems designed to support land managers with complex decision-making. However, there is concern that many environmental and agricultural decision support systems remain underutilized and ineffective. Recent efforts to improve decision support systems use have focused on enhancing stakeholder participation in their development, but a mismatch between stakeholders' expectations and the reality of decision support systems outputs continues to limit uptake. Additional challenges remain in problem-framing and evaluation. We propose using an outcomes-based approach called theory of change in conjunction with decision support systems development to support both wider problem-framing and outcomes-based monitoring and evaluation. The theory of change helps framing by placing the decision support systems within a wider context. It highlights how decision support systems use can "contribute" to long-term outcomes, and helps align decision support systems outputs with these larger goals. We illustrate the benefits of linking decision support systems development and application with a theory of change approach using an example of pest rabbit management in Australia. We develop a theory of change that outlines the activities required to achieve the outcomes desired from an effective rabbit management program, and two decision support systems that contribute to specific aspects of decision making in this wider problem context. Using a theory of change in this way should increase acceptance of the role of decision support systems by end-users, clarify their limitations and, importantly, increase effectiveness of rabbit management. The use of a theory of change should benefit those seeking to improve decision support systems design, use and, evaluation.

Decision support systems for recovery of endangered species

International Nuclear Information System (INIS)

Armstrong, C.E.

1995-01-01

The listing of a species as endangered under the Endangered Species Act invokes a suite of responses to help improve conditions for the recovery of that species, to include identification of stressors contributing to population loss, decision analysis of the impacts of proposed recovery options, and implementation of optimal recovery measures. The ability of a decision support system to quantify inherent stressor uncertainties and to identify the key stressors that can be controlled or eliminated becomes key to ensuring the recovery of an endangered species. The listing of the Snake River sockeye, spring/summer chinook, and fall chinook salmon species in the Snake River as endangered provides a vivid example of the importance of sophisticated decision support systems. Operational and physical changes under consideration at eight of the hydroelectric dams along the Columbia and Lower Snake River pose significant financial impacts to a variety of stakeholders involved in the salmon population recovery process and carry significant uncertainties of outcome. A decision support system is presented to assist in the identification of optimal recovery actions for this example that includes the following: creation of datamarts of information on environmental, engineering, and ecological values that influence species survival; incorporation of decision analysis tools to determine optimal decision policies; and the use of geographic information systems (GIS) to provide a context for decision analysis and to communicate the impacts of decision policies

A life cycle framework to support materials selection for Ecodesign: A case study on biodegradable polymers

International Nuclear Information System (INIS)

Ribeiro, I.; Peças, P.; Henriques, E.

2013-01-01

Highlights: • Life cycle framework to support material selection in Ecodesign. • Early design stage estimates and sensitivity analyses based on process-based models. • Sensitivity analysis to product geometry, industrial context and EoL scenarios. • Cost and environmental performance comparison – BDP vs. fossil based polymers. • Best alternatives mapping integrating cost and environmental performances. - Abstract: Nowadays society compels designers to develop more sustainable products. Ecodesign directs product design towards the goal of reducing environmental impacts. Within Ecodesign, materials selection plays a major role on product cost and environmental performance throughout its life cycle. This paper proposes a comprehensive life cycle framework to support Ecodesign in material selection. Dealing with new materials and technologies in early design stages, process-based models are used to represent the whole life cycle and supply integrated data to assess material alternatives, considering cost and environmental dimensions. An integrated analysis is then proposed to support decision making by mapping the best alternative materials according to the importance given to upstream and downstream life phases and to the environmental impacts. The proposed framework is applied to compare the life cycle performance of injection moulded samples made of four commercial biodegradable polymers with different contents of Thermo Plasticized Starch and PolyLactic Acid and a common fossil based polymer, Polypropylene. Instead of labelling materials just as “green”, the need to fully capture all impacts in the whole life cycle was shown. The fossil based polymer is the best economic alternative, but polymers with higher content of Thermo Plasticized Starch have a better environmental performance. However, parts geometry and EoL scenarios play a major role on the life cycle performance of candidate materials. The selection decision is then supported by mapping

IBM’s Health Analytics and Clinical Decision Support

Science.gov (United States)

Sun, J.; Knoop, S.; Shabo, A.; Carmeli, B.; Sow, D.; Syed-Mahmood, T.; Rapp, W.

2014-01-01

Summary Objectives This survey explores the role of big data and health analytics developed by IBM in supporting the transformation of healthcare by augmenting evidence-based decision-making. Methods Some problems in healthcare and strategies for change are described. It is argued that change requires better decisions, which, in turn, require better use of the many kinds of healthcare information. Analytic resources that address each of the information challenges are described. Examples of the role of each of the resources are given. Results There are powerful analytic tools that utilize the various kinds of big data in healthcare to help clinicians make more personalized, evidenced-based decisions. Such resources can extract relevant information and provide insights that clinicians can use to make evidence-supported decisions. There are early suggestions that these resources have clinical value. As with all analytic tools, they are limited by the amount and quality of data. Conclusion Big data is an inevitable part of the future of healthcare. There is a compelling need to manage and use big data to make better decisions to support the transformation of healthcare to the personalized, evidence-supported model of the future. Cognitive computing resources are necessary to manage the challenges in employing big data in healthcare. Such tools have been and are being developed. The analytic resources, themselves, do not drive, but support healthcare transformation. PMID:25123736

Improving clinical decision support using data mining techniques

Science.gov (United States)

Burn-Thornton, Kath E.; Thorpe, Simon I.

1999-02-01

Physicians, in their ever-demanding jobs, are looking to decision support systems for aid in clinical diagnosis. However, clinical decision support systems need to be of sufficiently high accuracy that they help, rather than hinder, the physician in his/her diagnosis. Decision support systems with accuracies, of patient state determination, of greater than 80 percent, are generally perceived to be sufficiently accurate to fulfill the role of helping the physician. We have previously shown that data mining techniques have the potential to provide the underpinning technology for clinical decision support systems. In this paper, an extension of the work in reverence 2, we describe how changes in data mining methodologies, for the analysis of 12-lead ECG data, improve the accuracy by which data mining algorithms determine which patients are suffering from heart disease. We show that the accuracy of patient state prediction, for all the algorithms, which we investigated, can be increased by up to 6 percent, using the combination of appropriate test training ratios and 5-fold cross-validation. The use of cross-validation greater than 5-fold, appears to reduce the improvement in algorithm classification accuracy gained by the use of this validation method. The accuracy of 84 percent in patient state predictions, obtained using the algorithm OCI, suggests that this algorithm will be capable of providing the required accuracy for clinical decision support systems.

Evaluation of Retention of Knowledge and Skills Imparted to First-Year Medical Students through Basic Life Support Training

Science.gov (United States)

Pande, Sushma; Pande, Santosh; Parate, Vrushali; Pande, Sanket; Sukhsohale, Neelam

2014-01-01

Poor awareness among medical graduates about basic life support (BLS) is a matter of great concern. The presence of a trained rescuer is the key determinant of ultimate survival from life-threatening emergencies. To achieve this goal, early exposure to such life-saving skills is the right decision to foster these skills for medical students, which…

Design Rules for Life Support Systems

Science.gov (United States)

Jones, Harry

2002-01-01

This paper considers some of the common assumptions and engineering rules of thumb used in life support system design. One general design rule is that the longer the mission, the more the life support system should use recycling and regenerable technologies. A more specific rule is that, if the system grows more than half the food, the food plants will supply all the oxygen needed for the crew life support. There are many such design rules that help in planning the analysis of life support systems and in checking results. These rules are typically if-then statements describing the results of steady-state, "back of the envelope," mass flow calculations. They are useful in identifying plausible candidate life support system designs and in rough allocations between resupply and resource recovery. Life support system designers should always review the design rules and make quick steady state calculations before doing detailed design and dynamic simulation. This paper develops the basis for the different assumptions and design rules and discusses how they should be used. We start top-down, with the highest level requirement to sustain human beings in a closed environment off Earth. We consider the crew needs for air, water, and food. We then discuss atmosphere leakage and recycling losses. The needs to support the crew and to make up losses define the fundamental life support system requirements. We consider the trade-offs between resupplying and recycling oxygen, water, and food. The specific choices between resupply and recycling are determined by mission duration, presence of in-situ resources, etc., and are defining parameters of life support system design.

Formalisation for decision support in anaesthesiology

NARCIS (Netherlands)

Renardel de Lavalette, G R; Groenboom, R.; Rotterdam, E; van Harmelen, F; ten Teije, A; de Geus, F.

1997-01-01

This paper reports on research for decision support for anaesthesiologists at the University Hospital in Groningen, the Netherlands. Based on CAROLA, an existing automated operation documentation system, we designed a support environment that will assist in real-time diagnosis. The core of the work

End-of-life medical decisions in France: a death certificate follow-up survey 5 years after the 2005 act of parliament on patients' rights and end of life.

Science.gov (United States)

Pennec, Sophie; Monnier, Alain; Pontone, Silvia; Aubry, Régis

2012-12-03

The "Patients' Rights and End of Life Care" Act came into force in France in 2005. It allows withholding/withdrawal of life-support treatment, and intensified use of medications that may hasten death through a double effect, as long as hastening death is not the purpose of the decision. It also specifies the requirements of the decision-making process. This study assesses the situation by examining the frequency of end-of-life decisions by patients' and physicians' characteristics, and describes the decision-making processes. We conducted a nationwide retrospective study of a random sample of adult patients who died in December 2009. Questionnaires were mailed to the physicians who certified/attended these deaths. Cases were weighted to adjust for response rate bias. Bivariate analyses and logistic regressions were performed for each decision. Of all deaths, 16.9% were sudden deaths with no information about end of life, 12.2% followed a decision to do everything possible to prolong life, and 47.7% followed at least one medical decision that may certainly or probably hasten death: withholding (14.6%) or withdrawal (4.2%) of treatments, intensified use of opioids and/or benzodiazepines (28.1%), use of medications to deliberately hasten death (i.e. not legally authorized) (0.8%), at the patient's request (0.2%) or not (0.6%). All other variables held constant, cause of death, patient's age, doctor's age and specialty, and place of death, influenced the frequencies of decisions. When a decision was made, 20% of the persons concerned were considered to be competent. The decision was discussed with the patient if competent in 40% (everything done) to 86% (intensification of alleviation of symptoms) of cases. Legal requirements regarding decision-making for incompetent patients were frequently not complied with. This study shows that end-of-life medical decisions are common in France. Most are in compliance with the 2005 law (similar to some other European countries

How Do Lessons Learned on the International Space Station (ISS) Help Plan Life Support for Mars?

Science.gov (United States)

Jones, Harry W.; Hodgson, Edward W.; Gentry, Gregory J.; Kliss, Mark H.

2016-01-01

How can our experience in developing and operating the International Space Station (ISS) guide the design, development, and operation of life support for the journey to Mars? The Mars deep space Environmental Control and Life Support System (ECLSS) must incorporate the knowledge and experience gained in developing ECLSS for low Earth orbit, but it must also meet the challenging new requirements of operation in deep space where there is no possibility of emergency resupply or quick crew return. The understanding gained by developing ISS flight hardware and successfully supporting a crew in orbit for many years is uniquely instructive. Different requirements for Mars life support suggest that different decisions may be made in design, testing, and operations planning, but the lessons learned developing the ECLSS for ISS provide valuable guidance.

Family factors in end-of-life decision-making: family conflict and proxy relationship.

Science.gov (United States)

Parks, Susan Mockus; Winter, Laraine; Santana, Abbie J; Parker, Barbara; Diamond, James J; Rose, Molly; Myers, Ronald E

2011-02-01

Few studies have examined proxy decision-making regarding end-of-life treatment decisions. Proxy accuracy is defined as whether proxy treatment choices are consistent with the expressed wishes of their index elder. The purpose of this study was to examine proxy accuracy in relation to two family factors that may influence proxy accuracy: perceived family conflict and type of elder-proxy relationship. Telephone interviews with 202 community-dwelling elders and their proxy decision makers were conducted including the Life-Support Preferences Questionnaire (LSPQ), and a measure of family conflict, and sociodemographic characteristics, including type of relationship. Elder-proxy accuracy was associated with the type of elder-proxy relationship. Adult children demonstrated the lowest elder-proxy accuracy and spousal proxies the highest elder-proxy accuracy. Elder-proxy accuracy was associated with family conflict. Proxies reporting higher family conflict had lower elder-proxy accuracy. No interaction between family conflict and relationship type was revealed. Spousal proxies were more accurate in their substituted judgment than adult children, and proxies who perceive higher degree of family conflict tended to be less accurate than those with lower family conflict. Health care providers should be aware of these family factors when discussing advance care planning.

Computer-based tools for decision support at the Hanford Site

International Nuclear Information System (INIS)

Doctor, P.G.; Mahaffey, J.A.; Cowley, P.J.; Freshley, M.D.; Hassig, N.L.; Brothers, J.W.; Glantz, C.S.; Strachan, D.M.

1992-11-01

To help integrate activities in the environmental restoration and waste management mission of the Hanford Site, the Hanford Integrated Planning Project (HIPP) was established and funded by the US Department of Energy. The project is divided into three key program elements, the first focusing on an explicit, defensible and comprehensive method for evaluating technical options. Based on the premise that computer technology can be used to support the decision-making process and facilitate integration among programs and activities, the Decision Support Tools Task was charged with assessing the status of computer technology for those purposes at the Site. The task addressed two types of tools: tools need to provide technical information and management support tools. Technical tools include performance and risk assessment models, information management systems, data and the computer infrastructure to supports models, data, and information management systems. Management decision support tools are used to synthesize information at a high' level to assist with making decisions. The major conclusions resulting from the assessment are that there is much technical information available, but it is not reaching the decision-makers in a form to be used. Many existing tools provide components that are needed to integrate site activities; however, some components are missing and, more importantly, the ''glue'' or connections to tie the components together to answer decision-makers questions is largely absent. Top priority should be given to decision support tools that support activities given in the TPA. Other decision tools are needed to facilitate and support the environmental restoration and waste management mission

Computer-based tools for decision support at the Hanford Site

Energy Technology Data Exchange (ETDEWEB)

Doctor, P.G.; Mahaffey, J.A.; Cowley, P.J.; Freshley, M.D.; Hassig, N.L.; Brothers, J.W.; Glantz, C.S.; Strachan, D.M.

1992-11-01

To help integrate activities in the environmental restoration and waste management mission of the Hanford Site, the Hanford Integrated Planning Project (HIPP) was established and funded by the US Department of Energy. The project is divided into three key program elements, the first focusing on an explicit, defensible and comprehensive method for evaluating technical options. Based on the premise that computer technology can be used to support the decision-making process and facilitate integration among programs and activities, the Decision Support Tools Task was charged with assessing the status of computer technology for those purposes at the Site. The task addressed two types of tools: tools need to provide technical information and management support tools. Technical tools include performance and risk assessment models, information management systems, data and the computer infrastructure to supports models, data, and information management systems. Management decision support tools are used to synthesize information at a high' level to assist with making decisions. The major conclusions resulting from the assessment are that there is much technical information available, but it is not reaching the decision-makers in a form to be used. Many existing tools provide components that are needed to integrate site activities; however, some components are missing and, more importantly, the glue'' or connections to tie the components together to answer decision-makers questions is largely absent. Top priority should be given to decision support tools that support activities given in the TPA. Other decision tools are needed to facilitate and support the environmental restoration and waste management mission.

Computer-based tools for decision support at the Hanford Site

Energy Technology Data Exchange (ETDEWEB)

Doctor, P.G.; Mahaffey, J.A.; Cowley, P.J.; Freshley, M.D.; Hassig, N.L.; Brothers, J.W.; Glantz, C.S.; Strachan, D.M.

1992-11-01

To help integrate activities in the environmental restoration and waste management mission of the Hanford Site, the Hanford Integrated Planning Project (HIPP) was established and funded by the US Department of Energy. The project is divided into three key program elements, the first focusing on an explicit, defensible and comprehensive method for evaluating technical options. Based on the premise that computer technology can be used to support the decision-making process and facilitate integration among programs and activities, the Decision Support Tools Task was charged with assessing the status of computer technology for those purposes at the Site. The task addressed two types of tools: tools need to provide technical information and management support tools. Technical tools include performance and risk assessment models, information management systems, data and the computer infrastructure to supports models, data, and information management systems. Management decision support tools are used to synthesize information at a high` level to assist with making decisions. The major conclusions resulting from the assessment are that there is much technical information available, but it is not reaching the decision-makers in a form to be used. Many existing tools provide components that are needed to integrate site activities; however, some components are missing and, more importantly, the ``glue`` or connections to tie the components together to answer decision-makers questions is largely absent. Top priority should be given to decision support tools that support activities given in the TPA. Other decision tools are needed to facilitate and support the environmental restoration and waste management mission.

Text summarization as a decision support aid

Directory of Open Access Journals (Sweden)

Workman T

2012-05-01

Full Text Available Abstract Background PubMed data potentially can provide decision support information, but PubMed was not exclusively designed to be a point-of-care tool. Natural language processing applications that summarize PubMed citations hold promise for extracting decision support information. The objective of this study was to evaluate the efficiency of a text summarization application called Semantic MEDLINE, enhanced with a novel dynamic summarization method, in identifying decision support data. Methods We downloaded PubMed citations addressing the prevention and drug treatment of four disease topics. We then processed the citations with Semantic MEDLINE, enhanced with the dynamic summarization method. We also processed the citations with a conventional summarization method, as well as with a baseline procedure. We evaluated the results using clinician-vetted reference standards built from recommendations in a commercial decision support product, DynaMed. Results For the drug treatment data, Semantic MEDLINE enhanced with dynamic summarization achieved average recall and precision scores of 0.848 and 0.377, while conventional summarization produced 0.583 average recall and 0.712 average precision, and the baseline method yielded average recall and precision values of 0.252 and 0.277. For the prevention data, Semantic MEDLINE enhanced with dynamic summarization achieved average recall and precision scores of 0.655 and 0.329. The baseline technique resulted in recall and precision scores of 0.269 and 0.247. No conventional Semantic MEDLINE method accommodating summarization for prevention exists. Conclusion Semantic MEDLINE with dynamic summarization outperformed conventional summarization in terms of recall, and outperformed the baseline method in both recall and precision. This new approach to text summarization demonstrates potential in identifying decision support data for multiple needs.

The conceptual foundation of environmental decision support.

Science.gov (United States)

Reichert, Peter; Langhans, Simone D; Lienert, Judit; Schuwirth, Nele

2015-05-01

Environmental decision support intends to use the best available scientific knowledge to help decision makers find and evaluate management alternatives. The goal of this process is to achieve the best fulfillment of societal objectives. This requires a careful analysis of (i) how scientific knowledge can be represented and quantified, (ii) how societal preferences can be described and elicited, and (iii) how these concepts can best be used to support communication with authorities, politicians, and the public in environmental management. The goal of this paper is to discuss key requirements for a conceptual framework to address these issues and to suggest how these can best be met. We argue that a combination of probability theory and scenario planning with multi-attribute utility theory fulfills these requirements, and discuss adaptations and extensions of these theories to improve their application for supporting environmental decision making. With respect to (i) we suggest the use of intersubjective probabilities, if required extended to imprecise probabilities, to describe the current state of scientific knowledge. To address (ii), we emphasize the importance of value functions, in addition to utilities, to support decisions under risk. We discuss the need for testing "non-standard" value aggregation techniques, the usefulness of flexibility of value functions regarding attribute data availability, the elicitation of value functions for sub-objectives from experts, and the consideration of uncertainty in value and utility elicitation. With respect to (iii), we outline a well-structured procedure for transparent environmental decision support that is based on a clear separation of scientific prediction and societal valuation. We illustrate aspects of the suggested methodology by its application to river management in general and with a small, didactical case study on spatial river rehabilitation prioritization. Copyright © 2015 The Authors. Published by

Preference Construction Processes for Renewable Energies: Assessing the Influence of Sustainability Information and Decision Support Methods

Directory of Open Access Journals (Sweden)

Kiyotada Hayashi

2016-11-01

Full Text Available Sustainability information and decision support can be two important driving forces for making sustainable transitions in society. However, not enough knowledge is available on the effectiveness of these two factors. Here, we conducted an experimental study to support the hypotheses that acquisition of sustainability information and use of decision support methods consistently construct preferences for renewable power generation technologies that use solar power, wind power, small-scale hydroelectric power, geothermal power, wood biomass, or biogas as energy sources. The sustainability information was prepared using a renewable energy-focused input-output model of Japan and contained life cycle greenhouse gas emissions, electricity generation costs, and job creation. We measured rank-ordered preferences in the following four steps in experimental workshops conducted for municipal officials: provision of (1 energy-source names; (2 sustainability information; (3 additional explanation of public value; and (4 knowledge and techniques about multi-attribute value functions. The degree of changes in preference orders was evaluated using Spearman’s rank correlation coefficient. The consistency of rank-ordered preferences among participants was determined by using the maximum eigenvalue for the coefficient matrix. The results show: (1 the individual preferences evolved drastically in response to the sustainability information and the decision support method; and (2 the rank-ordered preferences were more consistent during the preference construction processes. These results indicate that provision of sustainability information, coupled with decision support methods, is effective for decision making regarding renewable energies.

PATHway: Decision Support in Exercise Programmes for Cardiac Rehabilitation.

Science.gov (United States)

Filos, Dimitris; Triantafyllidis, Andreas; Chouvarda, Ioanna; Buys, Roselien; Cornelissen, Véronique; Budts, Werner; Walsh, Deirdre; Woods, Catherine; Moran, Kieran; Maglaveras, Nicos

2016-01-01

Rehabilitation is important for patients with cardiovascular diseases (CVD) to improve health outcomes and quality of life. However, adherence to current exercise programmes in cardiac rehabilitation is limited. We present the design and development of a Decision Support System (DSS) for telerehabilitation, aiming to enhance exercise programmes for CVD patients through ensuring their safety, personalising the programme according to their needs and performance, and motivating them toward meeting their physical activity goals. The DSS processes data originated from a Microsoft Kinect camera, a blood pressure monitor, a heart rate sensor and questionnaires, in order to generate a highly individualised exercise programme and improve patient adherence. Initial results within the EU-funded PATHway project show the potential of our approach.

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.

A simulation based optimization approach to model and design life support systems for manned space missions

Science.gov (United States)

Aydogan, Selen

This dissertation considers the problem of process synthesis and design of life-support systems for manned space missions. A life-support system is a set of technologies to support human life for short and long-term spaceflights, via providing the basic life-support elements, such as oxygen, potable water, and food. The design of the system needs to meet the crewmember demand for the basic life-support elements (products of the system) and it must process the loads generated by the crewmembers. The system is subject to a myriad of uncertainties because most of the technologies involved are still under development. The result is high levels of uncertainties in the estimates of the model parameters, such as recovery rates or process efficiencies. Moreover, due to the high recycle rates within the system, the uncertainties are amplified and propagated within the system, resulting in a complex problem. In this dissertation, two algorithms have been successfully developed to help making design decisions for life-support systems. The algorithms utilize a simulation-based optimization approach that combines a stochastic discrete-event simulation and a deterministic mathematical programming approach to generate multiple, unique realizations of the controlled evolution of the system. The timelines are analyzed using time series data mining techniques and statistical tools to determine the necessary technologies, their deployment schedules and capacities, and the necessary basic life-support element amounts to support crew life and activities for the mission duration.

Real-life decision making in college students. I: Consistency across specific decisions.

Science.gov (United States)

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

2014-01-01

First-year undergraduates participated in a short-term longitudinal study of real-life decision making over their first 14 months of college. They were surveyed about 7 different decisions: choosing courses for an upcoming term (3 different terms), choosing an academic major (twice), planning for the upcoming summer, and planning for sophomore-year housing. Participants showed moderate levels of consistency in the options they considered and in the criteria they used to decide between options, with about half of the options or criteria being used at 2 different points on the decision repeatedly studied. Participants varied somewhat in structural consistency, the tendency to consider the same number of options or criteria across decisions. They also varied in the way they integrated information across decision-making tasks. We suggest that people attempt to keep the information demands of the task within workable limits, sometimes sacrificing consistency as a result.

Making interactive decision support for patients a reality.

NARCIS (Netherlands)

Evans, R.W.; Elwyn, G.; Edwards, A.

2004-01-01

Interactive decision support applications might help patients to make difficult decisions about their health care. They lie in the context of traditional decision aids, which are known to have effects on a number of patient outcomes, including knowledge and decisional conflict. The problem of

What is a “good” treatment decision?: Decisional control, knowledge, treatment decision-making, and quality of life in men with clinically localized prostate cancer

Science.gov (United States)

Orom, Heather; Biddle, Caitlin; Underwood, Willie; Nelson, Christian J.; Homish, D. Lynn

2016-01-01

Objective We explored whether active patient involvement in decision making and greater patient knowledge are associated with better treatment decision making experiences and better quality of life (QOL) among men with clinically localized prostate cancer. Localized prostate cancer treatment decision-making is an advantageous model for studying patient treatment decision-making dynamics as there are multiple treatment options and a lack of empirical evidence to recommend one over the other; consequently, it is recommended that patients be fully involved in making the decision. Methods Men with newly diagnosed clinically localized prostate cancer (N=1529) completed measures of decisional control, prostate cancer knowledge, and their decision-making experience (decisional conflict, and decision-making satisfaction and difficulty) shortly after they made their treatment decision. Prostate cancer-specific QOL was assessed 6-months after treatment. Results More active involvement in decision making and greater knowledge were associated with lower decisional conflict and higher decision-making satisfaction, but greater decision-making difficulty. An interaction between decisional control and knowledge revealed that greater knowledge was only associated with greater difficulty for men actively involved in making the decision (67% of sample). Greater knowledge, but not decisional control predicted better QOL 6-months post-treatment. Conclusion Although men who are actively involved in decision making and more knowledgeable may make more informed decisions, they could benefit from decisional support (e.g., decision-making aids, emotional support from providers, strategies for reducing emotional distress) to make the process easier. Men who were more knowledgeable about prostate cancer and treatment side effects at the time they made their treatment decision may have appraised their QOL as higher because they had realistic expectations about side effects. PMID:26957566

Temporal reasoning for decision support in medicine.

Science.gov (United States)

Augusto, Juan Carlos

2005-01-01

Handling time-related concepts is essential in medicine. During diagnosis it can make a substantial difference to know the temporal order in which some symptoms occurred or for how long they lasted. During prognosis the potential evolutions of a disease are conceived as a description of events unfolding in time. In therapy planning the different steps of treatment must be applied in a precise order, with a given frequency and for a certain span of time in order to be effective. This article offers a survey on the use of temporal reasoning for decision support-related tasks in medicine. Key publications of the area, mainly circumscribed to the latest two decades, are reviewed and classified according to three important stages of patient treatment requiring decision support: diagnosis, prognosis and therapy planning/management. Other complementary publications, like those on time-centered information storage and retrieval, are also considered as they provide valuable support to the above mentioned three stages. Key areas are highlighted and used to organize the latest contributions. The survey of previous research is followed by an analysis of what can still be improved and what is needed to make the next generation of decision support systems for medicine more effective. It can be observed that although the area has been considerably developed, there are still areas where more research is needed to make time-based systems of widespread use in decision support-related areas of medicine. Several suggestions for further exploration are proposed as a result of the survey.

Future directions for resuscitation research. V. Ultra-advanced life support.

Science.gov (United States)

Tisherman, S A; Vandevelde, K; Safar, P; Morioka, T; Obrist, W; Corne, L; Buckman, R F; Rubertsson, S; Stephenson, H E; Grenvik, A; White, R J

1997-06-01

Standard external cardiopulmonary resuscitation (SECPR) frequently produces very low perfusion pressures, which are inadequate to achieve restoration of spontaneous circulation (ROSC) and intact survival, particularly when the heart is diseased. Ultra-advanced life support (UALS) techniques may allow support of vital organ systems until either the heart recovers or cardiac repair or replacement is performed. Closed-chest emergency cardiopulmonary bypass (CPB) provides control of blood flow, pressure, composition and temperature, but has so far been applied relatively late. This additional low-flow time may preclude conscious survival. An easy, quick method for vessel access and a small preprimed system that could be taken into the field are needed. Open-chest CPR (OCCPR) is physiologically superior to SECPR, but has also been initiated too late in prior studies. Its application in the field has recently proven feasible. Variations of OCCPR, which deserve clinical trials inside and outside hospitals, include 'minimally invasive direct cardiac massage' (MIDCM), using a pocket-size plunger-like device inserted via a small incision and 'direct mechanical ventricular actuation' (DMVA), using a machine that pneumatically drives a cup placed around the heart. Other novel UALS approaches for further research include the use of an aortic balloon catheter to improve coronary and cerebral blood flow during SECPR, aortic flush techniques and a double-balloon aortic catheter that could allow separate perfusion (and cooling) of the heart, brain and viscera for optimal resuscitation of each. Decision-making, initiation of UALS methods and diagnostic evaluations must be rapid to maximize the potential for ROSC and facilitate decision-making regarding long-term circulatory support versus withdrawal of life support for hopeless cases. Research and development of UALS techniques needs to be coordinated with cerebral resuscitation research.

Clinical Decision Support Tools: The Evolution of a Revolution

NARCIS (Netherlands)

Mould, D. R.; D'Haens, G.; Upton, R. N.

2016-01-01

Dashboard systems for clinical decision support integrate data from multiple sources. These systems, the newest in a long line of dose calculators and other decision support tools, utilize Bayesian approaches to fully individualize dosing using information gathered through therapeutic drug

Storytelling in the Early Bereavement Period to Reduce Emotional Distress Among Surrogates Involved in a Decision to Limit Life Support in the ICU: A Pilot Feasibility Trial.

Science.gov (United States)

Barnato, Amber E; Schenker, Yael; Tiver, Greer; Dew, Mary Amanda; Arnold, Robert M; Nunez, Eduardo R; Reynolds, Charles F

2017-01-01

Surrogate decision makers involved in decisions to limit life support for an incapacitated patient in the ICU have high rates of adverse emotional health outcomes distinct from normal processes of grief and bereavement. Narrative self-disclosure (storytelling) reduces emotional distress after other traumatic experiences. We sought to assess the feasibility, acceptability, and tolerability of storytelling among bereaved surrogates involved in a decision to limit life support in the ICU. Pilot single-blind trial. Five ICUs across three hospitals within a single health system between June 2013 and November 2014. Bereaved surrogates of ICU patients. Storytelling and control conditions involved printed bereavement materials and follow-up assessments. Storytelling involved a single 1- to 2-hour home or telephone visit by a trained interventionist who elicited the surrogate's story. The primary outcomes were feasibility (rates of enrollment, intervention receipt, 3- and 6-mo follow-up), acceptability (closed and open-ended end-of-study feedback at 6 mo), and tolerability (acute mental health services referral). Of 53 eligible surrogates, 32 (60%) consented to treatment allocation. Surrogates' mean age was 55.5 (SD, 11.8), and they were making decisions for their parent (47%), spouse (28%), sibling (13%), child (3%), or other relation (8%). We allocated 14 to control and 18 to storytelling, 17 of 18 (94%) received storytelling, 14 of 14 (100%) and 13 of 14 (94%) control subjects and 16 of 18 (89%) and 17 of 18 (94%) storytelling subjects completed their 3- and 6-month telephone assessments. At 6 months, nine of 13 control participants (69%) and 16 of 17 storytelling subjects (94%) reported feeling "better" or "much better," and none felt "much worse." One control subject (8%) and one storytelling subject (6%) said that the study was burdensome, and one control subject (8%) wished they had not participated. No subjects required acute mental health services referral. A

Economic modelling for life extension decision making

International Nuclear Information System (INIS)

Farber, M.A.; Harrison, D.L.; Carlson, D.D.

1987-01-01

This paper presents a methodology for the economic and financial analysis of nuclear plant life extension under uncertainty and demonstrates its use in a case analysis. While the economic and financial evaluation of life extension does not require new analytical tools, such studies should be based on the following three premises. First, the methodology should examine effects at the level of the company or utility system, because the most important economic implications of life extension relate to the altered generation system expansion plan. Second, it should focus on the implications of uncertainty in order to understand the factors that most affect life extension benefits and identify risk management efforts. Third, the methodology should address multiple objectives, at a minimum, both economic and financial objectives. An analysis of the role of life extension for Virginia Power's generating system was performed using the MIDAS model, developed by the Electric Power Research Institute. MIDAS is particularly well suited to this type of study because of its decision analysis framework. The model incorporates modules for load analysis, capacity expansion, production costing, financial analysis, and rates. The decision tree structure facilitates the multiple-scenario analysis of uncertainty. The model's output includes many economic and financial measures, including capital expenditures, fuel and purchases power costs, revenue requirements, average rates, external financing requirements, and coverage ratio. Based on findings for Virginia Power's Surry 1 plant, nuclear plant life extension has economic benefits for a utility's customers and financial benefits for the utility's investors. These benefits depend on a number of economic, technical and regulatory factors. The economic analysis presented in this paper identifies many of the key factors and issues relevant to life extension planning

On developing a prospecting tool for wind industry and policy decision support

International Nuclear Information System (INIS)

McKeown, Charles; Adelaja, Adesoji; Calnin, Benjamin

2011-01-01

This paper presents the rudiments of a Wind Prospecting Tool designed to inform private and public decision makers involved in wind industry development in reducing transaction costs associated with identifying areas of mutual focus within a state. The multiple layer decision support framework has proven to be valuable to industry, state government and local decision makers. Information on wind resources, land availability, potential land costs, potential NIMBYism concerns and economic development potential were integrated to develop a framework for decision support. The paper also highlights implications for decision support research and the role of higher education in providing anticipatory science to enhance private and public choices in economic development. - Research Highlights: →In this paper we explore the building and value of a wind industry location decision support tool. →We examine the development process from the industry perspective. →We discuss the creation of a decision support tool that was designed for industry, state policy makers and local decision makers. →We build a model framework for wind prospecting decision support. →Finally we discuss the impact on local and state decision making as a result of being informed by science based decision support.

A Hyperknowledge Framework of Decision Support Systems.

Science.gov (United States)

Chang, Ai-Mei; And Others

1994-01-01

Presents a hyperknowledge framework of decision support systems (DSS). This framework formalizes specifics about system functionality, representation of knowledge, navigation of the knowledge system, and user-interface traits as elements of a DSS environment that conforms closely to human cognitive processes in decision making. (Contains 52…

Space station environmental control and life support systems test bed program - an overview

Science.gov (United States)

Behrend, Albert F.

As the National Aeronautics and Space Administration (NASA) begins to intensify activities for development of the Space Station, decisions must be made concerning the technical state of the art that will be baselined for the initial Space Station system. These decisions are important because significant potential exists for enhancing system performance and for reducing life-cycle costs. However, intelligent decisions cannot be made without an adequate assessment of new and ready technologies, i.e., technologies which are sufficiently mature to allow predevelopment demonstrations to prove their application feasibility and to quantify the risk associated with their development. Therefore, the NASA has implemented a technology development program which includes the establishment of generic test bed capabilities in which these new technologies and approaches can be tested at the prototype level. One major Space Station subsystem discipline in which this program has been implemented is the environmental control and life support system (ECLSS). Previous manned space programs such as Gemini, Apollo, and Space Shuttle have relied heavily on consumables to provide environmental control and life support services. However, with the advent of a long-duration Space Station, consumables must be reduced within technological limits to minimize Space Station resupply penalties and operational costs. The use of advanced environmental control and life support approaches involving regenerative processes offers the best solution for significant consumables reduction while also providing system evolutionary growth capability. Consequently, the demonstration of these "new technologies" as viable options for inclusion in the baseline that will be available to support a Space Station initial operational capability in the early 1990's becomes of paramount importance. The mechanism by which the maturity of these new regenerative life support technologies will be demonstrated is the Space

A conceptual evolutionary aseismic decision support framework for hospitals

Science.gov (United States)

Hu, Yufeng; Dargush, Gary F.; Shao, Xiaoyun

2012-12-01

In this paper, aconceptual evolutionary framework for aseismic decision support for hospitalsthat attempts to integrate a range of engineering and sociotechnical models is presented. Genetic algorithms are applied to find the optimal decision sets. A case study is completed to demonstrate how the frameworkmay applytoa specific hospital.The simulations show that the proposed evolutionary decision support framework is able to discover robust policy sets in either uncertain or fixed environments. The framework also qualitatively identifies some of the characteristicbehavior of the critical care organization. Thus, by utilizing the proposedframework, the decision makers are able to make more informed decisions, especially toenhance the seismic safety of the hospitals.

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

Closed ecological life-support systems and their applications

Science.gov (United States)

Gitelson, Josef I.

The advent of man-made closed ecosystems (CES) is a solution of the fundamental problem-egress of humans beyond the Earth's biosphere, providing biological basis for exploitation of Space and celestial bodies. Yet, before proceeding to these ambitious project elements of closed life-support biotechnologies, there can be found diverse applications on Earth in human settlements providing for high quality of life under extreme environment conditions: high latitudes, deserts, mountains and industrially polluted areas. This presentation considers these variations of terrestrial applications of CELSS technologies. The version of CES under development is based on making direct use of the light energy in plant photosynthesis. In this case life support of one man on the Earth orbit requires solar light collected from 5-10m2. Among terrestrial applications of prime importance is the development of an ecohome designed to provide people with a high quality of life in Arctic and Antarctic territories. The developed technology of cascade employment of energy makes possible (expending 10-15 kw of installed power per a house-3-5 member family) to provide for: permanent supply of fresh vitamin-full vegetables, absorption and processing oaf excreta, purification of water and air in the living quarters, habitual colour and light conditions in the premises in winter making up to sensorial deprivation and, finally, psychological comfort of close contact with the plants during the long polar night. Ecohabitat based on the technology described in realistic today and depends only on the energy available and the resolution and readiness (sagacity) of the decision-makers to be committed with ecohome assigning. The ecological and economical significance of construction of ecohabitats for the northern territories of Canada, Alaska and Russia is apparent. This principle can be used (with considerable economy of energy and construction costs) to maintain normal partial pressure of oxygen inside

Towards ethical decision support and knowledge management in neonatal intensive care.

Science.gov (United States)

Yang, L; Frize, M; Eng, P; Walker, R; Catley, C

2004-01-01

Recent studies in neonatal medicine, clinical nursing, and cognitive psychology have indicated the need to augment current decision-making practice in neonatal intensive care units with computerized, intelligent decision support systems. Rapid progress in artificial intelligence and knowledge management facilitates the design of collaborative ethical decision-support tools that allow clinicians to provide better support for parents facing inherently difficult choices, such as when to withdraw aggressive treatment. The appropriateness of using computers to support ethical decision-making is critically analyzed through research and literature review. In ethical dilemmas, multiple diverse participants need to communicate and function as a team to select the best treatment plan. In order to do this, physicians require reliable estimations of prognosis, while parents need a highly useable tool to help them assimilate complex medical issues and address their own value system. Our goal is to improve and structuralize the ethical decision-making that has become an inevitable part of modern neonatal care units. The paper contributes to clinical decision support by outlining the needs and basis for ethical decision support and justifying the proposed development efforts.

Decision Making Based On Management Information System and Decision Support System

Directory of Open Access Journals (Sweden)

Şükrü Ada

2015-04-01

Full Text Available Information hasbecome an essentialresource for managing modern organizations. This is so because today’sbusiness environment is volatile, dynamic, turbulent and necessitates the burgeoning demand for accurate, relevant, complete,timely and economical information needed to drive the decision-making process in order to accentuate organizational abilities to manage opportunities and threat. MIS work on online mode with an average processing speed. Generally, it is used by low level management. Decision support system are powerful tool that assist corporate executives, administrators and other senior officials in making decision regarding the problem. Management Information Systems is a useful tool that provided organized and summarized information in a proper time to decision makers and enable making accurate decision for managers in organizations. This paper will discuss the concept, characteristics, types of MIS, the MIS model, and in particular it will highlight the impact and role of MIS on decision making.

Simulation-based decision support for evaluating operational plans

Directory of Open Access Journals (Sweden)

Johan Schubert

2015-12-01

Full Text Available In this article, we describe simulation-based decision support techniques for evaluation of operational plans within effects-based planning. Using a decision support tool, developers of operational plans are able to evaluate thousands of alternative plans against possible courses of events and decide which of these plans are capable of achieving a desired end state. The objective of this study is to examine the potential of a decision support system that helps operational analysts understand the consequences of numerous alternative plans through simulation and evaluation. Operational plans are described in the effects-based approach to operations concept as a set of actions and effects. For each action, we examine several different alternative ways to perform the action. We use a representation where a plan consists of several actions that should be performed. Each action may be performed in one of several different alternative ways. Together these action alternatives make up all possible plan instances, which are represented as a tree of action alternatives that may be searched for the most effective sequence of alternative actions. As a test case, we use an expeditionary operation with a plan of 43 actions and several alternatives for these actions, as well as a scenario of 40 group actors. Decision support for planners is provided by several methods that analyze the impact of a plan on the 40 actors, e.g., by visualizing time series of plan performance. Detailed decision support for finding the most influential actions of a plan is presented by using sensitivity analysis and regression tree analysis. Finally, a decision maker may use the tool to determine the boundaries of an operation that it must not move beyond without risk of drastic failure. The significant contribution of this study is the presentation of an integrated approach for evaluation of operational plans.

Spill operation system decision support system

International Nuclear Information System (INIS)

Clark, R.

1992-01-01

The MSRC Spill Operation System (SOS) is a tool for the support of decision-making at the time of a catastrophic oil spill. SOS provides MSRC decision-makers with access to information about the source of the spill, the spill environment, and the availability of spill response resources. This system is designed to meet the information needs of a Response Supervisor, an Environmental Advisor, Logistics/Maintenance Supervisor, Operations Supervisor, and the MSRC Regional General Manager. The SOS project Objectives are: (1) integrate currently available data, systems, and technologies; (2) develop an application that effectively supports mobilized operations and can be adapted to support normal operations; (3) ensure that the development of computer applications is driven by user needs and not by technology; and (4) coordinate with government and other industry organizations to avoid duplication of effort. Design Objectives for SOS are: (1) centralize management information storage while decentralizing decision making capabilities; (2) boost User confidence by providing a system that is easy to learn, easy to use, and is open-quotes Sailor Proofclose quotes; and (3) use visualization technology in providing spill related information. This approach includes the use of Geographic Information System (GIS) technology for maps and geographically associated resource; and support MSRC's concept of operation which includes - a swift notification of response personnel; fast mobilization of response resources; and accurate tracking of resources during a spill. MSRC is organized into five responsibility regions

Checklist and Decision Support in Nutritional Care for Burned Patients

Science.gov (United States)

2016-10-01

able to construct a checklist of a clinical and physiologic model and then a computerised decision support system that will perform two functions: the...the provision of nutritional therapy, and assessment of use by nursing and physician staff KEYWORDS Nutrition, severe burn, decision support... clinical testing. Checklist and Decision Support in Nutritional Care for Burned Patients Proposal Number: 12340011 W81XWH-12-2-0074 PI: Steven E

Development of a decision support model for determining building life-cycle strategies in the Netherlands

NARCIS (Netherlands)

Binnemars, S.; Halman, Johannes I.M.; Durmisevic, Elma; Durmisevic, E.; Pasic, A.

2012-01-01

Over recent years, it has become increasingly apparent that there is a growing need for so-called green buildings with a lower environmental impact over the whole building life-cycle. The construction industry demands strategies that support a drastic change of the way we develop, construct and

Marketing Decision Making and Decision Support: Challenges and Perspectives for Successful Marketing Management Support Systems

NARCIS (Netherlands)

G.H. van Bruggen (Gerrit); B. Wierenga (Berend)

2009-01-01

textabstractMarketing management support systems (MMSS) are computer-enabled devices that help marketers to make better decisions. Marketing processes can be quite complex, involving large numbers of variables and mostly outcomes are the results of the actions of many different stakeholders (e.g.,

Decision support methods for the environmental assessment of contamination at mining sites.

Science.gov (United States)

Jordan, Gyozo; Abdaal, Ahmed

2013-09-01

Polluting mine accidents and widespread environmental contamination associated with historic mining in Europe and elsewhere has triggered the improvement of related environmental legislation and of the environmental assessment and management methods for the mining industry. Mining has some unique features such as natural background pollution associated with natural mineral deposits, industrial activities and contamination located in the three-dimensional sub-surface space, the problem of long-term remediation after mine closure, problem of secondary contaminated areas around mine sites and abandoned mines in historic regions like Europe. These mining-specific problems require special tools to address the complexity of the environmental problems of mining-related contamination. The objective of this paper is to review and evaluate some of the decision support methods that have been developed and applied to mining contamination. In this paper, only those methods that are both efficient decision support tools and provide a 'holistic' approach to the complex problem as well are considered. These tools are (1) landscape ecology, (2) industrial ecology, (3) landscape geochemistry, (4) geo-environmental models, (5) environmental impact assessment, (6) environmental risk assessment, (7) material flow analysis and (8) life cycle assessment. This unique inter-disciplinary study should enable both the researcher and the practitioner to obtain broad view on the state-of-the-art of decision support methods for the environmental assessment of contamination at mine sites. Documented examples and abundant references are also provided.

Attitudes of Dutch nurses towards their involvement in end-of-life decisions with a possible life-shortening effect.

NARCIS (Netherlands)

Albers, G.; Francke, A.L.; Veer, A.J. de; Onwuteaka-Philipsen, B.D.

2012-01-01

Background: Nurses are often involved in end-of-life decision making as they play an important role in caring for terminally ill patients. Aim: To investigate nurses’ attitudes towards their involvement in end-of-life decisions with a possible lifeshortening effect, and a possible relationship with

Visual Decision Support Tool for Supporting Asset ...

Science.gov (United States)

Abstract:Managing urban water infrastructures faces the challenge of jointly dealing with assets of diverse types, useful life, cost, ages and condition. Service quality and sustainability require sound long-term planning, well aligned with tactical and operational planning and management. In summary, the objective of an integrated approach to infrastructure asset management is to assist utilities answer the following questions:•Who are we at present?•What service do we deliver?•What do we own?•Where do we want to be in the long-term?•How do we get there?The AWARE-P approach (www.aware-p.org) offers a coherent methodological framework and a valuable portfolio of software tools. It is designed to assist water supply and wastewater utility decision-makers in their analyses and planning processes. It is based on a Plan-Do-Check-Act process and is in accordance with the key principles of the International Standards Organization (ISO) 55000 standards on asset management. It is compatible with, and complementary to WERF’s SIMPLE framework. The software assists in strategic, tactical, and operational planning, through a non-intrusive, web-based, collaborative environment where objectives and metrics drive IAM planning. It is aimed at industry professionals and managers, as well as at the consultants and technical experts that support them. It is easy to use and maximizes the value of information from multiple existing data sources, both in da

Intelligent Decision Support in Proportional–Stop-Loss Reinsurance Using Multiple Attribute Decision-Making (MADM

Directory of Open Access Journals (Sweden)

Shirley Jie Xuan Wang

2017-11-01

Full Text Available This article addresses the possibility of incorporating intelligent decision support systems into reinsurance decision-making. This involves the insurance company and the reinsurance company, and is negotiated through reinsurance intermediaries. The article proposes a decision flow to model the reinsurance design and selection process. This article focuses on adopting more than one optimality criteria under a more generic combinational design of commonly used reinsurance products, i.e., proportional reinsurance and stop-loss reinsurance. In terms of methodology, the significant contribution of the study the incorporation of the well-established decision analysis tool multiple-attribute decision-making (MADM into the modelling of reinsurance selection. To illustrate the feasibility of incorporating intelligent decision supporting systems in the reinsurance market, the study includes a numerical case study using the simulation software @Risk in modeling insurance claims, as well as programming in MATLAB to realize MADM. A list of managerial implications could be drawn from the case study results. Most importantly, when choosing the most appropriate type of reinsurance, insurance companies should base their decisions on multiple measurements instead of single-criteria decision-making models so that their decisions may be more robust.

Big-Data Based Decision-Support Systems to Improve Clinicians' Cognition.

Science.gov (United States)

Roosan, Don; Samore, Matthew; Jones, Makoto; Livnat, Yarden; Clutter, Justin

2016-01-01

Complex clinical decision-making could be facilitated by using population health data to inform clinicians. In two previous studies, we interviewed 16 infectious disease experts to understand complex clinical reasoning. For this study, we focused on answers from the experts on how clinical reasoning can be supported by population-based Big-Data. We found cognitive strategies such as trajectory tracking, perspective taking, and metacognition has the potential to improve clinicians' cognition to deal with complex problems. These cognitive strategies could be supported by population health data, and all have important implications for the design of Big-Data based decision-support tools that could be embedded in electronic health records. Our findings provide directions for task allocation and design of decision-support applications for health care industry development of Big data based decision-support systems.

Environmental and economic assessment methods for waste management decision-support: possibilities and limitations.

Science.gov (United States)

Finnveden, Göran; Björklund, Anna; Moberg, Asa; Ekvall, Tomas

2007-06-01

A large number of methods and approaches that can be used for supporting waste management decisions at different levels in society have been developed. In this paper an overview of methods is provided and preliminary guidelines for the choice of methods are presented. The methods introduced include: Environmental Impact Assessment, Strategic Environmental Assessment, Life Cycle Assessment, Cost-Benefit Analysis, Cost-effectiveness Analysis, Life-cycle Costing, Risk Assessment, Material Flow Accounting, Substance Flow Analysis, Energy Analysis, Exergy Analysis, Entropy Analysis, Environmental Management Systems, and Environmental Auditing. The characteristics used are the types of impacts included, the objects under study and whether the method is procedural or analytical. The different methods can be described as systems analysis methods. Waste management systems thinking is receiving increasing attention. This is, for example, evidenced by the suggested thematic strategy on waste by the European Commission where life-cycle analysis and life-cycle thinking get prominent positions. Indeed, life-cycle analyses have been shown to provide policy-relevant and consistent results. However, it is also clear that the studies will always be open to criticism since they are simplifications of reality and include uncertainties. This is something all systems analysis methods have in common. Assumptions can be challenged and it may be difficult to generalize from case studies to policies. This suggests that if decisions are going to be made, they are likely to be made on a less than perfect basis.

Computerized Clinical Decision Support: Contributions from 2015

Science.gov (United States)

Bouaud, J.

2016-01-01

Summary Objective To summarize recent research and select the best papers published in 2015 in the field of computerized clinical decision support for the Decision Support section of the IMIA yearbook. Method A literature review was performed by searching two bibliographic databases for papers related to clinical decision support systems (CDSSs) and computerized provider order entry (CPOE) systems. The aim was to identify a list of candidate best papers from the retrieved papers that were then peer-reviewed by external reviewers. A consensus meeting between the two section editors and the IMIA editorial team was finally conducted to conclude in the best paper selection. Results Among the 974 retrieved papers, the entire review process resulted in the selection of four best papers. One paper reports on a CDSS routinely applied in pediatrics for more than 10 years, relying on adaptations of the Arden Syntax. Another paper assessed the acceptability and feasibility of an important CPOE evaluation tool in hospitals outside the US where it was developed. The third paper is a systematic, qualitative review, concerning usability flaws of medication-related alerting functions, providing an important evidence-based, methodological contribution in the domain of CDSS design and development in general. Lastly, the fourth paper describes a study quantifying the effect of a complex, continuous-care, guideline-based CDSS on the correctness and completeness of clinicians’ decisions. Conclusions While there are notable examples of routinely used decision support systems, this 2015 review on CDSSs and CPOE systems still shows that, despite methodological contributions, theoretical frameworks, and prototype developments, these technologies are not yet widely spread (at least with their full functionalities) in routine clinical practice. Further research, testing, evaluation, and training are still needed for these tools to be adopted in clinical practice and, ultimately, illustrate

Parametric vs. Nonparametric Regression Modelling within Clinical Decision Support

Czech Academy of Sciences Publication Activity Database

Kalina, Jan; Zvárová, Jana

2017-01-01

Roč. 5, č. 1 (2017), s. 21-27 ISSN 1805-8698 R&D Projects: GA ČR GA17-01251S Institutional support: RVO:67985807 Keywords : decision support systems * decision rules * statistical analysis * nonparametric regression Subject RIV: IN - Informatics, Computer Science OBOR OECD: Statistics and probability

Advanced Life Support Project Plan

Science.gov (United States)

2002-01-01

Life support systems are an enabling technology and have become integral to the success of living and working in space. As NASA embarks on human exploration and development of space to open the space frontier by exploring, using and enabling the development of space and to expand the human experience into the far reaches of space, it becomes imperative, for considerations of safety, cost, and crew health, to minimize consumables and increase the autonomy of the life support system. Utilizing advanced life support technologies increases this autonomy by reducing mass, power, and volume necessary for human support, thus permitting larger payload allocations for science and exploration. Two basic classes of life support systems must be developed, those directed toward applications on transportation/habitation vehicles (e.g., Space Shuttle, International Space Station (ISS), next generation launch vehicles, crew-tended stations/observatories, planetary transit spacecraft, etc.) and those directed toward applications on the planetary surfaces (e.g., lunar or Martian landing spacecraft, planetary habitats and facilities, etc.). In general, it can be viewed as those systems compatible with microgravity and those compatible with hypogravity environments. Part B of the Appendix defines the technology development 'Roadmap' to be followed in providing the necessary systems for these missions. The purpose of this Project Plan is to define the Project objectives, Project-level requirements, the management organizations responsible for the Project throughout its life cycle, and Project-level resources, schedules and controls.

The application of reduced-processing decision support systems to facilitate the acquisition of decision-making skills.

Science.gov (United States)

Perry, Nathan C; Wiggins, Mark W; Childs, Merilyn; Fogarty, Gerard

2013-06-01

The study was designed to examine whether the availability of reduced-processing decision support system interfaces could improve the decision making of inexperienced personnel in the context of Although research into reduced-processing decision support systems has demonstrated benefits in minimizing cognitive load, these benefits have not typically translated into direct improvements in decision accuracy because of the tendency for inexperienced personnel to focus on less-critical information. The authors investigated whether reduced-processing interfaces that direct users' attention toward the most critical cues for decision making can produce improvements in decision-making performance. Novice participants made incident command-related decisions in experimental conditions that differed according to the amount of information that was available within the interface, the level of control that they could exert over the presentation of information, and whether they had received decision training. The results revealed that despite receiving training, participants improved in decision accuracy only when they were provided with an interface that restricted information access to the most critical cues. It was concluded that an interface that restricts information access to only the most critical cues in the scenario can facilitate improvements in decision performance. Decision support system interfaces that encourage the processing of the most critical cues have the potential to improve the accuracy and timeliness of decisions made by inexperienced personnel.

Comparison of Multi-Criteria Decision Support Methods for Integrated Rehabilitation Prioritization

Directory of Open Access Journals (Sweden)

Franz Tscheikner-Gratl

2017-01-01

Full Text Available The decisions taken in rehabilitation planning for the urban water networks will have a long lasting impact on the functionality and quality of future services provided by urban infrastructure. These decisions can be assisted by different approaches ranging from linear depreciation for estimating the economic value of the network over using a deterioration model to assess the probability of failure or the technical service life to sophisticated multi-criteria decision support systems. Subsequently, the aim of this paper is to compare five available multi-criteria decision-making (MCDM methods (ELECTRE, AHP, WSM, TOPSIS, and PROMETHEE for the application in an integrated rehabilitation management scheme for a real world case study and analyze them with respect to their suitability to be used in integrated asset management of water systems. The results of the different methods are not equal. This occurs because the chosen score scales, weights and the resulting distributions of the scores within the criteria do not have the same impact on all the methods. Independently of the method used, the decision maker must be familiar with its strengths but also weaknesses. Therefore, in some cases, it would be rational to use one of the simplest methods. However, to check for consistency and increase the reliability of the results, the application of several methods is encouraged.

Real-time decision support and information gathering system for financial domain

Science.gov (United States)

Tseng, Chiu-Che; Gmytrasiewicz, Piotr J.

2006-05-01

The challenge of the investment domain is that a large amount of diverse information can be potentially relevant to an investment decision, and that, frequently, the decisions have to be made in a timely manner. This presents the potential for better decision support, but poses the challenge of building a decision support agent that gathers information from different sources and incorporates it for timely decision support. These problems motivate us to investigate ways in which the investors can be equipped with a flexible real-time decision support system to be practical in time-critical situations. The flexible real-time decision support system considers a tradeoff between decision quality and computation cost. For this purpose, we propose a system that uses the object oriented Bayesian knowledge base (OOBKB) design to create a decision model at the most suitable level of detail to guide the information gathering activities, and to produce an investment recommendation within a reasonable length of time. The decision models our system uses are implemented as influence diagrams. We validate our system with experiments in a simplified investment domain. The experiments show that our system produces a quality recommendation under different urgency situations. The contribution of our system is that it provides the flexible decision recommendation for an investor under time constraints in a complex environment.

Supporting Informed Decision Making in Prevention of Prostate Cancer

Directory of Open Access Journals (Sweden)

Constantino MARTINS

2015-05-01

Full Text Available Identifying and making the correct decision on the best health treatment or screening test option can become a difficult task. Therefore is important that the patients get all types of information appropriate to manage their health. Decision aids can be very useful when there is more than one reasonable option about a treatment or uncertain associated with screening tests. The decision aids tools help people to understand their clinical condition, through the description of the different options available. The purpose of this paper is to present the project “Supporting Informed Decision Making In Prevention of Prostate Cancer” (SIDEMP. This project is focused on the creation of a Web-based decision platform specifically directed to screening prostate cancer, that will support the patient in the process of making an informed decision

A Mashup Application to Support Complex Decision Making for Retail Consumers

OpenAIRE

Steven Walczak; Deborah L. Kellogg; Dawn G. Gregg

2010-01-01

Purchase processes often require complex decision making and consumers frequently use Web information sources to support these decisions. However, increasing amounts of information can make finding appropriate information problematic. This information overload, coupled with decision complexity, can increase time required to make a decision and reduce decision quality. This creates a need for tools that support these decision-making processes. Online tools that bring together data and partial ...

Developing Sustainable Life Support System Concepts

Science.gov (United States)

Thomas, Evan A.

2010-01-01

Sustainable spacecraft life support concepts may allow the development of more reliable technologies for long duration space missions. Currently, life support technologies at different levels of development are not well evaluated against each other, and evaluation methods do not account for long term reliability and sustainability of the hardware. This paper presents point-of-departure sustainability evaluation criteria for life support systems, that may allow more robust technology development, testing and comparison. An example sustainable water recovery system concept is presented.

Research Needs and Challenges from Science to Decision Support. Lesson Learnt from the Development of the International Reference Life Cycle Data System (ILCD Recommendations for Life Cycle Impact Assessment

Directory of Open Access Journals (Sweden)

Serenella Sala

2012-06-01

Full Text Available Environmental implications of the whole supply-chain of products, both goods and services, their use, and waste management, i.e., their entire life cycle from “cradle to grave” have to be considered to achieve more sustainable production and consumption patterns. Progress toward environmental sustainability requires enhancing the methodologies for quantitative, integrated environmental assessment and promoting the use of these methodologies in different domains. In the context of Life Cycle Assessment (LCA of products, in recent years, several methodologies have been developed for Life Cycle Impact Assessment (LCIA. The Joint Research Center of the European Commission (EC-JRC led a “science to decision support” process which resulted in the International Reference Life Cycle Data System (ILCD Handbook, providing guidelines to the decision and application of methods for LCIA. The Handbook is the result of a comprehensive process of evaluation and selection of existing methods based on a set of scientific and stakeholder acceptance criteria and involving review and consultation by experts, advisory groups and the public. In this study, we report the main features of the ILCD LCIA recommendation development highlighting relevant issues emerged from this “from science to decision support” process in terms of research needs and challenges for LCIA. Comprehensiveness of the assessment, as well as acceptability and applicability of the scientific developments by the stakeholders, are key elements for the design of new methods and to guarantee the mainstreaming of the sustainability concept.

Big-Data Based Decision-Support Systems to Improve Clinicians’ Cognition

Science.gov (United States)

Roosan, Don; Samore, Matthew; Jones, Makoto; Livnat, Yarden; Clutter, Justin

2016-01-01

Complex clinical decision-making could be facilitated by using population health data to inform clinicians. In two previous studies, we interviewed 16 infectious disease experts to understand complex clinical reasoning. For this study, we focused on answers from the experts on how clinical reasoning can be supported by population-based Big-Data. We found cognitive strategies such as trajectory tracking, perspective taking, and metacognition has the potential to improve clinicians’ cognition to deal with complex problems. These cognitive strategies could be supported by population health data, and all have important implications for the design of Big-Data based decision-support tools that could be embedded in electronic health records. Our findings provide directions for task allocation and design of decision-support applications for health care industry development of Big data based decision-support systems. PMID:27990498

Decision-making heuristics and biases across the life span

Science.gov (United States)

Strough, JoNell; Karns, Tara E.; Schlosnagle, Leo

2013-01-01

We outline a contextual and motivational model of judgment and decision-making (JDM) biases across the life span. Our model focuses on abilities and skills that correspond to deliberative, experiential, and affective decision-making processes. We review research that addresses links between JDM biases and these processes as represented by individual differences in specific abilities and skills (e.g., fluid and crystallized intelligence, executive functioning, emotion regulation, personality traits). We focus on two JDM biases—the sunk-cost fallacy (SCF) and the framing effect. We trace the developmental trajectory of each bias from preschool through middle childhood, adolescence, early adulthood, and later adulthood. We conclude that life-span developmental trajectories differ depending on the bias investigated. Existing research suggests relative stability in the framing effect across the life span and decreases in the SCF with age, including in later life. We highlight directions for future research on JDM biases across the life span, emphasizing the need for process-oriented research and research that increases our understanding of JDM biases in people’s everyday lives. PMID:22023568

Decision-making heuristics and biases across the life span.

Science.gov (United States)

Strough, Jonell; Karns, Tara E; Schlosnagle, Leo

2011-10-01

We outline a contextual and motivational model of judgment and decision-making (JDM) biases across the life span. Our model focuses on abilities and skills that correspond to deliberative, experiential, and affective decision-making processes. We review research that addresses links between JDM biases and these processes as represented by individual differences in specific abilities and skills (e.g., fluid and crystallized intelligence, executive functioning, emotion regulation, personality traits). We focus on two JDM biases-the sunk-cost fallacy (SCF) and the framing effect. We trace the developmental trajectory of each bias from preschool through middle childhood, adolescence, early adulthood, and later adulthood. We conclude that life-span developmental trajectories differ depending on the bias investigated. Existing research suggests relative stability in the framing effect across the life span and decreases in the SCF with age, including in later life. We highlight directions for future research on JDM biases across the life span, emphasizing the need for process-oriented research and research that increases our understanding of JDM biases in people's everyday lives. © 2011 New York Academy of Sciences.

Support Vector Machines for decision support in electricity markets׳ strategic bidding

DEFF Research Database (Denmark)

Pinto, Tiago; Sousa, Tiago M.; Praça, Isabel

2015-01-01

. The ALBidS system allows MASCEM market negotiating players to take the best possible advantages from the market context. This paper presents the application of a Support Vector Machines (SVM) based approach to provide decision support to electricity market players. This strategy is tested and validated...... by being included in ALBidS and then compared with the application of an Artificial Neural Network (ANN), originating promising results: an effective electricity market price forecast in a fast execution time. The proposed approach is tested and validated using real electricity markets data from MIBEL......׳ research group has developed a multi-agent system: Multi-Agent System for Competitive Electricity Markets (MASCEM), which simulates the electricity markets environment. MASCEM is integrated with Adaptive Learning Strategic Bidding System (ALBidS) that works as a decision support system for market players...

Development of transportation asset management decision support tools : final report.

Science.gov (United States)

2017-08-09

This study developed a web-based prototype decision support platform to demonstrate the benefits of transportation asset management in monitoring asset performance, supporting asset funding decisions, planning budget tradeoffs, and optimizing resourc...

Informed decision making about predictive DNA tests: arguments for more public visibility of personal deliberations about the good life.

Science.gov (United States)

Boenink, Marianne; van der Burg, Simone

2010-05-01

Since its advent, predictive DNA testing has been perceived as a technology that may have considerable impact on the quality of people's life. The decision whether or not to use this technology is up to the individual client. However, to enable well considered decision making both the negative as well as the positive freedom of the individual should be supported. In this paper, we argue that current professional and public discourse on predictive DNA-testing is lacking when it comes to supporting positive freedom, because it is usually framed in terms of risk and risk management. We show how this 'risk discourse' steers thinking on the good life in a particular way. We go on to argue that empirical research into the actual deliberation and decision making processes of individuals and families may be used to enrich the environment of personal deliberation in three ways: (1) it points at a richer set of values that deliberators can take into account, (2) it acknowledges the shared nature of genes, and (3) it shows how one might frame decisions in a non-binary way. We argue that the public sharing and discussing of stories about personal deliberations offers valuable input for others who face similar choices: it fosters their positive freedom to shape their view of the good life in relation to DNA-diagnostics. We conclude by offering some suggestions as to how to realize such public sharing of personal stories.

Designing Effective Interactions for Concordance around End-of-Life Care Decisions: Lessons from Hospice Admission Nurses

Directory of Open Access Journals (Sweden)

Carey Candrian

2017-04-01

Full Text Available Near the end of life, hospice care reduces symptom-related distress and hospitalizations while improving caregiving outcomes. However, it takes time for a person to gain a sufficient understanding of hospice and decide to enroll. This decision is influenced by knowledge of hospice and its services, emotion and fear, cultural and religious beliefs, and an individual’s acceptance of diagnosis. Hospice admission interactions, a key influence in shaping decisions regarding hospice care, happen particularly late in the illness trajectory and are often complex, unpredictable, and highly variable. One goal of these interactions is ensuring patients and families have accurate and clear information about hospice care to facilitate informed decisions. So inconsistent are practices across hospices in consenting patients that a 2016 report from the Office of Inspector General (OIG entitled “Hospices should improve their election statements and certifications of terminal illness” called for complete and accurate election statements to ensure that hospice patients and their caregivers can make informed decisions and understand the costs and benefits of choosing hospice care. Whether complete and accurate information at initial admission visits improves interactions and outcomes is unknown. Our recent qualitative work investigating interactions between patients, caregivers, and hospice nurses has uncovered diverse and often diverging stakeholder-specific expectations and perceptions which if not addressed can create discordance and inhibit decision-making. This paper focuses on better understanding the communication dynamics and practices involved in hospice admission interactions in order to design more effective interactions and support the mandate from the OIG to provide hospice patients and their caregivers with accurate and complete information. This clarity is particularly important when discussing the non-curative nature of hospice care, and the

A Benchmark Usability Study of the Tactical Decision Making Under Stress Decision Support System

National Research Council Canada - National Science Library

Schmorrow, Dylan

1998-01-01

This study evaluates the usability of a U.S. Navy Decision Support System (DSS). The DSS was developed to enhance the performance of tactical decision makers within a Navy Combat Information Center...

Decision Support System for Hepatitis Disease Diagnosis using Bayesian Network

Directory of Open Access Journals (Sweden)

Shamshad Lakho

2017-12-01

Full Text Available Medical judgments are tough and challenging as the decisions are often based on the deficient and ambiguous information. Moreover, the result of decision process has direct effects on human lives. The act of human decision declines in emergency situations due to the complication, time limit, and high risks. Therefore, provision of medical diagnosis plays a dynamic role, specifically in the preliminary stage when a physician has limited diagnosis experience and identifies the directions to be taken for the treatment process. Computerized Decision Support Systems have brought a revolution in the medical diagnosis. These automatic systems support the diagnosticians in the course of diagnosis. The major role of Decision Support Systems is to support the medical personnel in decision-making procedures regarding disease diagnosis and treatment recommendation. The proposed system provides easy support in Hepatitis disease recognition. The system is developed using the Bayesian network model. The physician provides the input to the system in the form of symptoms stated by the patient. These signs and symptoms match with the casual relationships present in the knowledge model. The Bayesian network infers conclusion from the knowledge model and calculates the probability of occurrence of Hepatitis B, C and D disorders.

END-OF-LIFE DECISIONS IN DUTCH NEONATOLOGY

NARCIS (Netherlands)

Moratti, Sofia

2010-01-01

This contribution describes the regulation of end-of-life decisions in neonatology in the Netherlands. An account is given of the process of formulating rules, which includes a report by the Dutch Association for Paediatrics, two Court rulings, a report by a Consultation Group appointed by the

Life cycle assessment in support of sustainable transportation

Science.gov (United States)

Eckelman, Matthew J.

2013-06-01

In our rapidly urbanizing world, sustainable transportation presents a major challenge. Transportation decisions have considerable direct impacts on urban society, both positive and negative, for example through changes in transit times and economic productivity, urban connectivity, tailpipe emissions and attendant air quality concerns, traffic accidents, and noise pollution. Much research has been dedicated to quantifying these direct impacts for various transportation modes. Transportation planning decisions also result in a variety of indirect environmental and human health impacts, a portion of which can accrue outside of the transit service area and so outside of the local decision-making process. Integrated modeling of direct and indirect impacts over the life cycle of different transportation modes provides decision support that is more comprehensive and less prone to triggering unintended consequences than a sole focus on direct tailpipe emissions. The recent work of Chester et al (2013) in this journal makes important contributions to this research by examining the environmental implications of introducing bus rapid transit and light rail in Los Angeles using life cycle assessment (LCA). Transport in the LA region is dominated by automobile trips, and the authors show that potential shifts to either bus or train modes would reduce energy use and emissions of criteria air pollutants, on an average passenger mile travelled basis. This work compares not just the use of each vehicle, but also upstream impacts from its manufacturing and maintenance, as well as the construction and maintenance of the entire infrastructure required for each mode. Previous work by the lead author (Chester and Horvath 2009), has shown that these non-operational sources and largely non-local can dominate life cycle impacts from transportation, again on an average (or attributional) basis, for example increasing rail-related GHG emissions by >150% over just operational emissions

Implementation of workflow engine technology to deliver basic clinical decision support functionality.

Science.gov (United States)

Huser, Vojtech; Rasmussen, Luke V; Oberg, Ryan; Starren, Justin B

2011-04-10

Workflow engine technology represents a new class of software with the ability to graphically model step-based knowledge. We present application of this novel technology to the domain of clinical decision support. Successful implementation of decision support within an electronic health record (EHR) remains an unsolved research challenge. Previous research efforts were mostly based on healthcare-specific representation standards and execution engines and did not reach wide adoption. We focus on two challenges in decision support systems: the ability to test decision logic on retrospective data prior prospective deployment and the challenge of user-friendly representation of clinical logic. We present our implementation of a workflow engine technology that addresses the two above-described challenges in delivering clinical decision support. Our system is based on a cross-industry standard of XML (extensible markup language) process definition language (XPDL). The core components of the system are a workflow editor for modeling clinical scenarios and a workflow engine for execution of those scenarios. We demonstrate, with an open-source and publicly available workflow suite, that clinical decision support logic can be executed on retrospective data. The same flowchart-based representation can also function in a prospective mode where the system can be integrated with an EHR system and respond to real-time clinical events. We limit the scope of our implementation to decision support content generation (which can be EHR system vendor independent). We do not focus on supporting complex decision support content delivery mechanisms due to lack of standardization of EHR systems in this area. We present results of our evaluation of the flowchart-based graphical notation as well as architectural evaluation of our implementation using an established evaluation framework for clinical decision support architecture. We describe an implementation of a free workflow technology

Implementation of workflow engine technology to deliver basic clinical decision support functionality

Science.gov (United States)

2011-01-01

Background Workflow engine technology represents a new class of software with the ability to graphically model step-based knowledge. We present application of this novel technology to the domain of clinical decision support. Successful implementation of decision support within an electronic health record (EHR) remains an unsolved research challenge. Previous research efforts were mostly based on healthcare-specific representation standards and execution engines and did not reach wide adoption. We focus on two challenges in decision support systems: the ability to test decision logic on retrospective data prior prospective deployment and the challenge of user-friendly representation of clinical logic. Results We present our implementation of a workflow engine technology that addresses the two above-described challenges in delivering clinical decision support. Our system is based on a cross-industry standard of XML (extensible markup language) process definition language (XPDL). The core components of the system are a workflow editor for modeling clinical scenarios and a workflow engine for execution of those scenarios. We demonstrate, with an open-source and publicly available workflow suite, that clinical decision support logic can be executed on retrospective data. The same flowchart-based representation can also function in a prospective mode where the system can be integrated with an EHR system and respond to real-time clinical events. We limit the scope of our implementation to decision support content generation (which can be EHR system vendor independent). We do not focus on supporting complex decision support content delivery mechanisms due to lack of standardization of EHR systems in this area. We present results of our evaluation of the flowchart-based graphical notation as well as architectural evaluation of our implementation using an established evaluation framework for clinical decision support architecture. Conclusions We describe an implementation of

Making cognitive decision support work: Facilitating adoption, knowledge and behavior change through QI.

Science.gov (United States)

Weir, Charlene; Brunker, Cherie; Butler, Jorie; Supiano, Mark A

2017-07-01

This paper evaluates the role of facilitation in the successful implementation of Computerized Decision Support (CDS). Facilitation processes include education, specialized computerized decision support, and work process reengineering. These techniques, as well as modeling and feedback enhance self-efficacy, which we propose is one of the factors that mediate the effectiveness of any CDS. In this study, outpatient clinics implemented quality improvement (QI) projects focused on improving geriatric care. Quality Improvement is the systematic process of improving quality through continuous measurement and targeted actions. The program, entitled "Advancing Geriatric Education through Quality Improvement" (AGE QI), consisted of a 6-month, QI based, intervention: (1) 2h didactic session, (2) 1h QI planning session, (3) computerized decision support design and implementation, (4) QI facilitation activities, (5) outcome feedback, and (6) 20h of CME. Specifically, we examined the impact of the QI based program on clinician's perceived self-efficacy in caring for older adults and the relationship of implementation support and facilitation on perceived success. The intervention was implemented at 3 institutions, 27 community healthcare system clinics, and 134 providers. This study reports the results of pre/post surveys for the forty-nine clinicians who completed the full CME program. Self-efficacy ratings for specific clinical behaviors related to care of older adults were assessed using a Likert based instrument. Self-ratings of efficacy improved across the following domains (depression, falls, end-of-life, functional status and medication management) and specifically in QI targeted domains and were associated with overall clinic improvements. Published by Elsevier Inc.

Decision support tools to support the operations of traffic management centers (TMC)

Science.gov (United States)

2011-01-31

The goal of this project is to develop decision support tools to support traffic management operations based on collected intelligent transportation system (ITS) data. The project developments are in accordance with the needs of traffic management ce...

Is Shared Decision Making for End-of-Life Decisions Associated With Better Outcomes as Compared to Other Forms of Decision Making? A Systematic Literature Review

Directory of Open Access Journals (Sweden)

Negin Hajizadeh MD, MPH

2016-07-01

Full Text Available Background: Whether shared decision making (SDM has been evaluated for end-of-life (EOL decisions as compared to other forms of decision making has not been studied. Purpose: To summarize the evidence on SDM being associated with better outcomes for EOL decision making, as compared to other forms of decision making. Data Sources: PubMed, Web of Science, Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, and CINAHL databases were searched through April 2014. Study Selection: Studies were selected that evaluated SDM, compared to any other decision making style, for an EOL decision. Data Extraction: Components of SDM tested, comparators to SDM, EOL decision being assessed, and outcomes measured. Data Synthesis: Seven studies met the inclusion criteria (three experimental and four observational studies. Results were analyzed using narrative synthesis. All three experimental studies compared SDM interventions to usual care. The four observational studies compared SDM to doctor-controlled decision making, or reported the correlation between level of SDM and outcomes. Components of SDM specified in each study differed widely, but the component most frequently included was presenting information on the risks/benefits of treatment choices (five of seven studies. The outcome most frequently measured was communication, although with different measurement tools. Other outcomes included decisional conflict, trust, satisfaction, and “quality of dying.” Limitations: We could not analyze the strength of evidence for a given outcome due to heterogeneity in the outcomes reported and measurement tools. Conclusions: There is insufficient evidence supporting SDM being associated with improved outcomes for EOL decisions as opposed to other forms of decision making. Future studies should describe which components of SDM are being tested, outline the comparator decision making style, and use validated tools to measure outcomes.

Operation and safety decision-making support expert system in NPP

International Nuclear Information System (INIS)

Wei Yanhui; Su Desong; Chen Weihua; Zhang Jianbo

2014-01-01

The article first reviewed three operation support systems currently used in NPP: real-time information surveillance system, important equipment surveillance system and plant process control and monitoring system, then presents the structure and function of three expert support sub-systems (intelligent alarm monitoring system, computer-based operating procedure support system, safety information expert decision support system). Finally the article discussed the meaning of a kind of operation decision making support system. (authors)

Decision support for patient care: implementing cybernetics.

Science.gov (United States)

Ozbolt, Judy; Ozdas, Asli; Waitman, Lemuel R; Smith, Janis B; Brennan, Grace V; Miller, Randolph A

2004-01-01

The application of principles and methods of cybernetics permits clinicians and managers to use feedback about care effectiveness and resource expenditure to improve quality and to control costs. Keys to the process are the specification of therapeutic goals and the creation of an organizational culture that supports the use of feedback to improve care. Daily feedback on the achievement of each patient's therapeutic goals provides tactical decision support, enabling clinicians to adjust care as needed. Monthly or quarterly feedback on aggregated goal achievement for all patients on a clinical pathway provides strategic decision support, enabling clinicians and managers to identify problems with supposed "best practices" and to test hypotheses about solutions. Work is underway at Vanderbilt University Medical Center to implement feedback loops in care and management processes and to evaluate the effects.

An Ethical Framework for Allocating Scarce Life-Saving Chemotherapy and Supportive Care Drugs for Childhood Cancer.

Science.gov (United States)

Unguru, Yoram; Fernandez, Conrad V; Bernhardt, Brooke; Berg, Stacey; Pyke-Grimm, Kim; Woodman, Catherine; Joffe, Steven

2016-06-01

Shortages of life-saving chemotherapy and supportive care agents for children with cancer are frequent. These shortages directly affect patients' lives, compromise both standard of care therapies and clinical research, and create substantial ethical challenges. Efforts to prevent drug shortages have yet to gain traction, and existing prioritization frameworks lack concrete guidance clinicians need when faced with difficult prioritization decisions among equally deserving children with cancer. The ethical framework proposed in this Commentary is based upon multidisciplinary expert opinion, further strengthened by an independent panel of peer consultants. The two-step allocation process includes strategies to mitigate existing shortages by minimizing waste and addresses actual prioritization across and within diseases according to a modified utilitarian model that maximizes total benefit while respecting limited constraints on differential treatment of individuals. The framework provides reasoning for explicit decision-making in the face of an actual drug shortage. Moreover, it minimizes bias that might occur when individual clinicians or institutions are forced to make bedside rationing and prioritization decisions and addresses the challenge that individual clinicians face when confronted with bedside decisions regarding allocation. Whenever possible, allocation decisions should be supported by evidence-based recommendations. "Curability," prognosis, and the incremental importance of a particular drug to a given patient's outcome are the critical factors to consider when deciding how to allocate scarce life-saving cancer drugs. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Life Course Stage and Social Support Mobilization for End-of-Life Caregivers.

Science.gov (United States)

LaValley, Susan A; Gage-Bouchard, Elizabeth A

2018-04-01

Caregivers of terminally ill patients are at risk for anxiety, depression, and social isolation. Social support from friends, family members, neighbors, and health care professionals can potentially prevent or mitigate caregiver strain. While previous research documents the importance of social support in helping end-of-life caregivers cope with caregiving demands, little is known about differences in social support experiences among caregivers at different life course stages. Using life course theory, this study analyzes data from in-depth interviews with 50 caregivers of patients enrolled in hospice services to compare barriers to mobilizing social support among caregivers at two life course stages: midlife caregivers caring for parents and older adult caregivers caring for spouses/partners. Older adult caregivers reported different barriers to mobilizing social support compared with midlife caregivers. Findings enhance the understanding of how caregivers' life course stage affects their barriers to mobilization of social support resources.

Mathematical Modeling Of Life-Support Systems

Science.gov (United States)

Seshan, Panchalam K.; Ganapathi, Balasubramanian; Jan, Darrell L.; Ferrall, Joseph F.; Rohatgi, Naresh K.

1994-01-01

Generic hierarchical model of life-support system developed to facilitate comparisons of options in design of system. Model represents combinations of interdependent subsystems supporting microbes, plants, fish, and land animals (including humans). Generic model enables rapid configuration of variety of specific life support component models for tradeoff studies culminating in single system design. Enables rapid evaluation of effects of substituting alternate technologies and even entire groups of technologies and subsystems. Used to synthesize and analyze life-support systems ranging from relatively simple, nonregenerative units like aquariums to complex closed-loop systems aboard submarines or spacecraft. Model, called Generic Modular Flow Schematic (GMFS), coded in such chemical-process-simulation languages as Aspen Plus and expressed as three-dimensional spreadsheet.

Web-Based Group Decision Support System: an Economic Application

Directory of Open Access Journals (Sweden)

Ion ISTUDOR

2010-01-01

Full Text Available Decision Support Systems (DSS form a specific class of computerized information systems that support business and managerial decision-making activities. Making the right decision in business primarily depends on the quality of data. It also depends on the ability to analyze the data with a view to identifying trends that can suggest solutions and strategies. A “cooperative” decision support system means the data are collected, analyzed and then provided to a human agent who can help the system to revise or refine the data. It means that both a human component and computer component work together to come up with the best solution. This paper describes the usage of a software product (Vanguard System to a specific economic application (evaluating the financial risk assuming that the rate of the economic profitability can be under the value of the interest rate.

Technology Infusion Challenges from a Decision Support Perspective

Science.gov (United States)

Adumitroaie, V.; Weisbin, C. R.

2009-01-01

In a restricted science budget environment and increasingly numerous required technology developments, the technology investment decisions within NASA are objectively more and more difficult to make such that the end results are satisfying the technical objectives and all the organizational constraints. Under these conditions it is rationally desirable to build an investment portfolio, which has the highest possible technology infusion rate. Arguably the path to infusion is subject to many influencing factors, but here only the challenges associated with the very initial stages are addressed: defining the needs and the subsequent investment decision-support process. It is conceivable that decision consistency and possibly its quality suffer when the decision-making process has limited or no traceability. This paper presents a structured decision-support framework aiming to provide traceable, auditable, infusion- driven recommendations towards a selection process in which these recommendations are used as reference points in further discussions among stakeholders. In this framework addressing well-defined requirements, different measures of success can be defined based on traceability to specific selection criteria. As a direct result, even by using simplified decision models the likelihood of infusion can be probed and consequently improved.

Evaluation of the Effectiveness of Stormwater Decision Support Tools for Infrastructure Selection and the Barriers to Implementation

Science.gov (United States)

Spahr, K.; Hogue, T. S.

2016-12-01

Selecting the most appropriate green, gray, and / or hybrid system for stormwater treatment and conveyance can prove challenging to decision markers across all scales, from site managers to large municipalities. To help streamline the selection process, a multi-disciplinary team of academics and professionals is developing an industry standard for selecting and evaluating the most appropriate stormwater management technology for different regions. To make the tool more robust and comprehensive, life-cycle cost assessment and optimization modules will be included to evaluate non-monetized and ecosystem benefits of selected technologies. Initial work includes surveying advisory board members based in cities that use existing decision support tools in their infrastructure planning process. These surveys will qualify the decisions currently being made and identify challenges within the current planning process across a range of hydroclimatic regions and city size. Analysis of social and other non-technical barriers to adoption of the existing tools is also being performed, with identification of regional differences and institutional challenges. Surveys will also gage the regional appropriateness of certain stormwater technologies based off experiences in implementing stormwater treatment and conveyance plans. In additional to compiling qualitative data on existing decision support tools, a technical review of components of the decision support tool used will be performed. Gaps in each tool's analysis, like the lack of certain critical functionalities, will be identified and ease of use will be evaluated. Conclusions drawn from both the qualitative and quantitative analyses will be used to inform the development of the new decision support tool and its eventual dissemination.

Modem: data exchange among decision support systems

International Nuclear Information System (INIS)

Baig, S.; Zaehringer, M.

2003-01-01

The aim of the European Research and Development project MODEM (Monitoring Data and Information Exchange Among Decision Support Systems) is to achieve practical improvements for data exchange among decision support systems (DSS). Hence, the results of model calculations become comparable. This is a precondition for harmonised decision making. Based on the analysis of existing procedures, it was decided to use the PUSH-PULL concept. Notifications are actively and automatically sent by the DSS (PUSH). The data can then be downloaded form an in-formation server (PULL). The format of the data is defined in XML (extended markup language). Participants of the project are the DSS: RODOS, ARGOS and RECASS. First, the data is comprised of the source term and meteorological information. Results of the prognoses and measurement data are also to be exchanged. Exercises testing and improving the pro-cedures form an integral part of the project. (orig.)

E-DECIDER Decision Support Gateway For Earthquake Disaster Response

Science.gov (United States)

Glasscoe, M. T.; Stough, T. M.; Parker, J. W.; Burl, M. C.; Donnellan, A.; Blom, R. G.; Pierce, M. E.; Wang, J.; Ma, Y.; Rundle, J. B.; Yoder, M. R.

2013-12-01

Earthquake Data Enhanced Cyber-Infrastructure for Disaster Evaluation and Response (E-DECIDER) is a NASA-funded project developing capabilities for decision-making utilizing remote sensing data and modeling software in order to provide decision support for earthquake disaster management and response. E-DECIDER incorporates earthquake forecasting methodology and geophysical modeling tools developed through NASA's QuakeSim project in order to produce standards-compliant map data products to aid in decision-making following an earthquake. Remote sensing and geodetic data, in conjunction with modeling and forecasting tools, help provide both long-term planning information for disaster management decision makers as well as short-term information following earthquake events (i.e. identifying areas where the greatest deformation and damage has occurred and emergency services may need to be focused). E-DECIDER utilizes a service-based GIS model for its cyber-infrastructure in order to produce standards-compliant products for different user types with multiple service protocols (such as KML, WMS, WFS, and WCS). The goal is to make complex GIS processing and domain-specific analysis tools more accessible to general users through software services as well as provide system sustainability through infrastructure services. The system comprises several components, which include: a GeoServer for thematic mapping and data distribution, a geospatial database for storage and spatial analysis, web service APIs, including simple-to-use REST APIs for complex GIS functionalities, and geoprocessing tools including python scripts to produce standards-compliant data products. These are then served to the E-DECIDER decision support gateway (http://e-decider.org), the E-DECIDER mobile interface, and to the Department of Homeland Security decision support middleware UICDS (Unified Incident Command and Decision Support). The E-DECIDER decision support gateway features a web interface that

D-Side: A Facility and Workforce Planning Group Multi-criteria Decision Support System for Johnson Space Center

Science.gov (United States)

Tavana, Madjid

2005-01-01

"To understand and protect our home planet, to explore the universe and search for life, and to inspire the next generation of explorers" is NASA's mission. The Systems Management Office at Johnson Space Center (JSC) is searching for methods to effectively manage the Center's resources to meet NASA's mission. D-Side is a group multi-criteria decision support system (GMDSS) developed to support facility decisions at JSC. D-Side uses a series of sequential and structured processes to plot facilities in a three-dimensional (3-D) graph on the basis of each facility alignment with NASA's mission and goals, the extent to which other facilities are dependent on the facility, and the dollar value of capital investments that have been postponed at the facility relative to the facility replacement value. A similarity factor rank orders facilities based on their Euclidean distance from Ideal and Nadir points. These similarity factors are then used to allocate capital improvement resources across facilities. We also present a parallel model that can be used to support decisions concerning allocation of human resources investments across workforce units. Finally, we present results from a pilot study where 12 experienced facility managers from NASA used D-Side and the organization's current approach to rank order and allocate funds for capital improvement across 20 facilities. Users evaluated D-Side favorably in terms of ease of use, the quality of the decision-making process, decision quality, and overall value-added. Their evaluations of D-Side were significantly more favorable than their evaluations of the current approach. Keywords: NASA, Multi-Criteria Decision Making, Decision Support System, AHP, Euclidean Distance, 3-D Modeling, Facility Planning, Workforce Planning.

Experiences and attitudes towards end-of-life decisions amongst Danish physicians

DEFF Research Database (Denmark)

Folker, Anna Paldam; Holtug, Nils; Jensen, Annette B

1996-01-01

In this survey we have investigated the experiences and attitudes of Danish physicians regarding end-of-life decisions. Most respondents have made decisions that involve hastening the death of a patient, and almost all find it acceptable to do so. Such decisions are made more often, and considered...

Importance of Decision Support Systems About Food Safety in Raw Milk Production

Directory of Open Access Journals (Sweden)

Ecem Akan

2015-12-01

Full Text Available In raw milk production decision support systems for control of food safety hazards has not been developed but main points of this system are available. The decision support systems’ elements include data identification at critical points in the milk supply chain, an information management system and data exchange. Decision supports systems has been developed on the basis of these elements. In dairy sector decision support systems are significant for controlling of food safety hazards and preferred by producers. When these systems are implemented in the milk supply chain, it can be prevented unnecessary sampling and analysis. In this article it will be underlined effects of decision support system elements on food safety of raw milk.

Knowledge representation for decision support systems

International Nuclear Information System (INIS)

Methlie, L.B.

1985-01-01

This book is organized into three sections in accordance with the structure of the conference program. First section contains four major papers which were commissioned by the Programme Committee to set the tone for the conference and to provide a structured source of relevant material from contributing disciplines. The second section contains specific papers submitted to the conference, and concerned with the following topics of specific interest: epistemological issues for decision support systems (DSS), capturing organizational knowledge for DSS, complementarity between human and formal DSS, and representations for adaption. The third section contains the short papers on any topic of relevance to the theme of the conference. It is hoped that the two working conferences organized by WG 8.3 will contribute to the development of a coherent knowledge and understanding of the class of computerized information systems called Decision Support Systems. (Auth.)

Clinical Decision Support: Statistical Hopes and Challenges

Czech Academy of Sciences Publication Activity Database

Kalina, Jan; Zvárová, Jana

2016-01-01

Roč. 4, č. 1 (2016), s. 30-34 ISSN 1805-8698 Grant - others:Nadační fond na opdporu vědy(CZ) Neuron Institutional support: RVO:67985807 Keywords : decision support * data mining * multivariate statistics * psychiatry * information based medicine Subject RIV: BB - Applied Statistics, Operational Research

Adoption of Web-based Group Decision Support Systems: Conditions for Growth

NARCIS (Netherlands)

van Hillegersberg, Jos; Koenen, Sebastiaan

2014-01-01

While organizations have massively adopted enterprise information systems to support business processes, business meetings in which key decisions are made about products, services and processes are usually held without much support of information systems. This is remarkable as group decision support

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

[Knowledge about basic life support in European students].

Science.gov (United States)

Marton, József; Pandúr, Attila; Pék, Emese; Deutsch, Krisztina; Bánfai, Bálint; Radnai, Balázs; Betlehem, József

2014-05-25

Better knowledge and skills of basic life support can save millions of lives each year in Europe. The aim of this study was to measure the knowledge about basic life support in European students. From 13 European countries 1527 volunteer participated in the survey. The questionnaire consisted of socio-demographic questions and knowledge regarding basic life support. The maximum possible score was 18. Those participants who had basic life support training earned 11.91 points, while those who had not participated in lifesaving education had 9.6 points (pbasic life support between students from different European countries. Western European youth, and those who were trained had better performance.

Decision support system for containment and release management

Energy Technology Data Exchange (ETDEWEB)

Oosterhuis, B [Twente Univ., Enschede (Netherlands). Computer Science Dept.

1995-09-01

The Containment and Release Management project was carried out within the Reinforced Concerted Action Programme for Accident Management Support and partly financed by the European Union. In this report a prototype of an accident management support system is presented. The support system integrates several concepts from accident management research, like safety objective trees, severe accident phenomena, calculation models and an emergency response data system. These concepts are provided by the prototype in such a way that the decision making process of accident management is supported. The prototype application is demonstrated by process data taken from a severe accident scenario for a pressurized water reactor (PWR) that was simulated with the thermohydraulic computer program MAAP. The prototype was derived from a decision support framework based on a decision theory. For established and innovative concepts from accident management research it is pointed out in which way these concepts can support accident management and how these concepts can be integrated. This approach is generic in two ways; it applies to both pressurized and boiling water reactors and it applies to both in vessel management and containment and release management. The prototype application was developed in Multimedia Toolbox 3.0 and requires at least a 386 PC with 4 MB memory, 6 MB free disk space and MS Windows 3.1. (orig.).

Decision support system for containment and release management

International Nuclear Information System (INIS)

Oosterhuis, B.

1995-09-01

The Containment and Release Management project was carried out within the Reinforced Concerted Action Programme for Accident Management Support and partly financed by the European Union. In this report a prototype of an accident management support system is presented. The support system integrates several concepts from accident management research, like safety objective trees, severe accident phenomena, calculation models and an emergency response data system. These concepts are provided by the prototype in such a way that the decision making process of accident management is supported. The prototype application is demonstrated by process data taken from a severe accident scenario for a pressurized water reactor (PWR) that was simulated with the thermohydraulic computer program MAAP. The prototype was derived from a decision support framework based on a decision theory. For established and innovative concepts from accident management research it is pointed out in which way these concepts can support accident management and how these concepts can be integrated. This approach is generic in two ways; it applies to both pressurized and boiling water reactors and it applies to both in vessel management and containment and release management. The prototype application was developed in Multimedia Toolbox 3.0 and requires at least a 386 PC with 4 MB memory, 6 MB free disk space and MS Windows 3.1. (orig.)

A review of features in Internet consumer health decision-support tools.

Science.gov (United States)

Schwitzer, Gary

2002-01-01

Over the past decade, health care consumers have begun to benefit from new Web-based communications tools to guide decision making on treatments and tests. Using today's online tools, consumers who have Internet connections can: watch and listen to videos of physicians; watch and hear the stories of other consumers who have faced the same decisions; join an online social support network; receive estimates of their own chances of experiencing various outcomes; and do it all at home. To review currently-available Internet consumer health decision-support tools. Five Web sites offering consumer health decision-support tools are analyzed for their use of 4 key Web-enabled features: the presentation of outcomes probability data tailored to the individual user; the use of videotaped patient interviews in the final product to convey the experiences of people who have faced similar diagnoses in the past; the ability to interact with others in a social support network; and the accessibility of the tool to any health care consumers with an Internet connection. None of the 5 Web sites delivers all 4 target features to all Web users. The reasons for these variations in the use of key Web functionality--features that make the Web distinctive--are not immediately clear. Consumers trying to make health care decisions may benefit from current Web-based decision-support tools. But, variations in Web developers' use of 4 key Web-enabled features leaves the online decision-support experience less than what it could be. Key research questions are identified that could help in the development of new hybrid patient decision-support tools.

Decision Support for Flood Event Prediction and Monitoring

DEFF Research Database (Denmark)

Mioc, Darka; Anton, François; Liang, Gengsheng

2007-01-01

In this paper the development of Web GIS based decision support system for flood events is presented. To improve flood prediction we developed the decision support system for flood prediction and monitoring that integrates hydrological modelling and CARIS GIS. We present the methodology for data...... integration, floodplain delineation, and online map interfaces. Our Web-based GIS model can dynamically display observed and predicted flood extents for decision makers and the general public. The users can access Web-based GIS that models current flood events and displays satellite imagery and digital...... elevation model integrated with flood plain area. The system can show how the flooding prediction based on the output from hydrological modeling for the next 48 hours along the lower Saint John River Valley....

Life Support for Deep Space and Mars

Science.gov (United States)

Jones, Harry W.; Hodgson, Edward W.; Kliss, Mark H.

2014-01-01

How should life support for deep space be developed? The International Space Station (ISS) life support system is the operational result of many decades of research and development. Long duration deep space missions such as Mars have been expected to use matured and upgraded versions of ISS life support. Deep space life support must use the knowledge base incorporated in ISS but it must also meet much more difficult requirements. The primary new requirement is that life support in deep space must be considerably more reliable than on ISS or anywhere in the Earth-Moon system, where emergency resupply and a quick return are possible. Due to the great distance from Earth and the long duration of deep space missions, if life support systems fail, the traditional approaches for emergency supply of oxygen and water, emergency supply of parts, and crew return to Earth or escape to a safe haven are likely infeasible. The Orbital Replacement Unit (ORU) maintenance approach used by ISS is unsuitable for deep space with ORU's as large and complex as those originally provided in ISS designs because it minimizes opportunities for commonality of spares, requires replacement of many functional parts with each failure, and results in substantial launch mass and volume penalties. It has become impractical even for ISS after the shuttle era, resulting in the need for ad hoc repair activity at lower assembly levels with consequent crew time penalties and extended repair timelines. Less complex, more robust technical approaches may be needed to meet the difficult deep space requirements for reliability, maintainability, and reparability. Developing an entirely new life support system would neglect what has been achieved. The suggested approach is use the ISS life support technologies as a platform to build on and to continue to improve ISS subsystems while also developing new subsystems where needed to meet deep space requirements.

DECISION SUPPORT SYSTEMS IN MILITARY ACTIONS: NECESSITY, POSSIBILITIES AND CONSTRAINTS

Directory of Open Access Journals (Sweden)

Elena ŞUŞNEA

2012-01-01

Full Text Available Nowadays, modern organizations cannot resort to the decision-making process without relying on information and communication technology if they want to be successful. Thus, besides information as an important input of this process, the tools and techniques used by decision-makers are equally important in the support and validation of their decisions. All this is also valid for the military organizations and their specific tasks and activities. A fortiori military commanders face some of the most diff cult and high-stake decision issues meaningful not only at the level of the military, but also for the humankind. Under these circumstances and as a result of an increase in the diversity and complexity of conflict situations, in the information and technology means employed by opponents in warfare and in the amount of information needed to be processed in real time, decision support systems become a necessity. Starting from the aforementioned inevitable requirement, the aim of this article is to emphasize the possibilities and constraints in developing an intelligent decision support system that assists commanders in making scientific decisions on time, under the right circumstances, for the right costs.

Optimization-based decision support systems for planning problems in processing industries

OpenAIRE

Claassen, G.D.H.

2014-01-01

Summary Optimization-based decision support systems for planning problems in processing industries Nowadays, efficient planning of material flows within and between supply chains is of vital importance and has become one of the most challenging problems for decision support in practice. The tremendous progress in hard- and software of the past decades was an important gateway for developing computerized systems that are able to support decision making on different levels within enterprises. T...

Team Leadership and Cancer End-of-Life Decision Making.

Science.gov (United States)

Waldfogel, Julie M; Battle, Dena J; Rosen, Michael; Knight, Louise; Saiki, Catherine B; Nesbit, Suzanne A; Cooper, Rhonda S; Browner, Ilene S; Hoofring, Laura H; Billing, Lynn S; Dy, Sydney M

2016-11-01

End-of-life decision making in cancer can be a complicated process. Patients and families encounter multiple providers throughout their cancer care. When the efforts of these providers are not well coordinated in teams, opportunities for high-quality, longitudinal goals of care discussions can be missed. This article reviews the case of a 55-year-old man with lung cancer, illustrating the barriers and missed opportunities for end-of-life decision making in his care through the lens of team leadership, a key principle in the science of teams. The challenges demonstrated in this case reflect the importance of the four functions of team leadership: information search and structuring, information use in problem solving, managing personnel resources, and managing material resources. Engaging in shared leadership of these four functions can help care providers improve their interactions with patients and families concerning end-of-life care decision making. This shared leadership can also produce a cohesive care plan that benefits from the expertise of the range of available providers while reflecting patient needs and preferences. Clinicians and researchers should consider the roles of team leadership functions and shared leadership in improving patient care when developing and studying models of cancer care delivery.

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.

Reviewing model application to support animal health decision making.

Science.gov (United States)

Singer, Alexander; Salman, Mo; Thulke, Hans-Hermann

2011-04-01

Animal health is of societal importance as it affects human welfare, and anthropogenic interests shape decision making to assure animal health. Scientific advice to support decision making is manifold. Modelling, as one piece of the scientific toolbox, is appreciated for its ability to describe and structure data, to give insight in complex processes and to predict future outcome. In this paper we study the application of scientific modelling to support practical animal health decisions. We reviewed the 35 animal health related scientific opinions adopted by the Animal Health and Animal Welfare Panel of the European Food Safety Authority (EFSA). Thirteen of these documents were based on the application of models. The review took two viewpoints, the decision maker's need and the modeller's approach. In the reviewed material three types of modelling questions were addressed by four specific model types. The correspondence between tasks and models underpinned the importance of the modelling question in triggering the modelling approach. End point quantifications were the dominating request from decision makers, implying that prediction of risk is a major need. However, due to knowledge gaps corresponding modelling studies often shed away from providing exact numbers. Instead, comparative scenario analyses were performed, furthering the understanding of the decision problem and effects of alternative management options. In conclusion, the most adequate scientific support for decision making - including available modelling capacity - might be expected if the required advice is clearly stated. Copyright © 2011 Elsevier B.V. All rights reserved.

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

Science.gov (United States)

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

2016-01-01

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

Family Communication about End-of-Life Decisions and the Enactment of the Decision-Maker Role

Directory of Open Access Journals (Sweden)

April R. Trees

2017-06-01

Full Text Available End-of-life (EOL decisions in families are complex and emotional sites of family interaction necessitating family members coordinate roles in the EOL decision-making process. How family members in the United States enact the decision-maker role in EOL decision situations was examined through in-depth interviews with 22 individuals who participated in EOL decision-making for a family member. A number of themes emerged from the data with regard to the enactment of the decision-maker role. Families varied in how decision makers enacted the role in relation to collective family input, with consulting, informing and collaborating as different patterns of behavior. Formal family roles along with gender- and age-based roles shaped who took on the decision-maker role. Additionally, both family members and medical professionals facilitated or undermined the decision-maker’s role enactment. Understanding the structure and enactment of the decision-maker role in family interaction provides insight into how individuals and/or family members perform the decision-making role within a cultural context that values autonomy and self-determination in combination with collective family action in EOL decision-making.

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

Science.gov (United States)

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

2017-08-01

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

Decision support system for health care resources allocation.

Science.gov (United States)

Sebaa, Abderrazak; Nouicer, Amina; Tari, AbdelKamel; Tarik, Ramtani; Abdellah, Ouhab

2017-06-01

A study about healthcare resources can improve decisions regarding the allotment and mobilization of medical resources and to better guide future investment in the health sector. The aim of this work was to design and implement a decision support system to improve medical resources allocation of Bejaia region. To achieve the retrospective cohort study, we integrated existing clinical databases from different Bejaia department health sector institutions (an Algerian department) to collect information about patients from January 2015 through December 2015. Data integration was performed in a data warehouse using the multi-dimensional model and OLAP cube. During implementation, we used Microsoft SQL server 2012 and Microsoft Excel 2010. A medical decision support platform was introduced, and was implemented during the planning stages allowing the management of different medical orientations, it provides better apportionment and allotment of medical resources, and ensures that the allocation of health care resources has optimal effects on improving health. In this study, we designed and implemented a decision support system which would improve health care in Bejaia department to especially assist in the selection of the optimum location of health center and hospital, the specialty of the health center, the medical equipment and the medical staff.

Creating and sharing clinical decision support content with Web 2.0: Issues and examples.

Science.gov (United States)

Wright, Adam; Bates, David W; Middleton, Blackford; Hongsermeier, Tonya; Kashyap, Vipul; Thomas, Sean M; Sittig, Dean F

2009-04-01

Clinical decision support is a powerful tool for improving healthcare quality and patient safety. However, developing a comprehensive package of decision support interventions is costly and difficult. If used well, Web 2.0 methods may make it easier and less costly to develop decision support. Web 2.0 is characterized by online communities, open sharing, interactivity and collaboration. Although most previous attempts at sharing clinical decision support content have worked outside of the Web 2.0 framework, several initiatives are beginning to use Web 2.0 to share and collaborate on decision support content. We present case studies of three efforts: the Clinfowiki, a world-accessible wiki for developing decision support content; Partners Healthcare eRooms, web-based tools for developing decision support within a single organization; and Epic Systems Corporation's Community Library, a repository for sharing decision support content for customers of a single clinical system vendor. We evaluate the potential of Web 2.0 technologies to enable collaborative development and sharing of clinical decision support systems through the lens of three case studies; analyzing technical, legal and organizational issues for developers, consumers and organizers of clinical decision support content in Web 2.0. We believe the case for Web 2.0 as a tool for collaborating on clinical decision support content appears strong, particularly for collaborative content development within an organization.

Evolution of Decision Support Systems Research Field in Numbers

Directory of Open Access Journals (Sweden)

Ana-Maria SUDUC

2010-01-01

Full Text Available The scientific production in a certain field shows, in great extent, the research interests in that field. Decision Support Systems are a particular class of information systems which are gaining more popularity in various domains. In order to identify the evolution in time of the publications number, authors, subjects, publications in the Decision Support Systems (DSS field, and therefore the scientific world interest for this field, in November 2010 there have been organized a series of queries on three major international scientific databases: ScienceDirect, IEEE Xplore Digital Library and ACM Digital Library. The results presented in this paper shows that, even the decision support systems research field started in 1960s, the interests for this type of systems grew exponentially with each year in the last decades.

Decision Support System for Fighter Pilots

DEFF Research Database (Denmark)

Randleff, Lars Rosenberg

2007-01-01

During a mission over enemy territory a fighter aircraft may be engaged by ground based threats. The pilot can use different measures to avoid the aircraft from being detected by e.g. enemy radar systems. If the enemy detects the aircraft a missile may be fired to seek and destroy the aircraft...... and countermeasures that can be applied to mitigate threats. This work is concerned with finding proper evasive actions when a fighter aircraft is engaged by ground based threats. To help the pilot in deciding on these actions a decision support system may be implemented. The environment in which such a system must....... When new threats occur the decision support system must be able to provide suggestions within a fraction of a second. Since the time it takes to find an optimal solution to the mathematical model can not comply with this requirement solutions are sought using a metaheuristic....

Decision support system for surface irrigation design

OpenAIRE

Gonçalves, José M.; Pereira, L.S.

2009-01-01

The SADREG decision support system was developed to help decision makers in the process of design and selection of farm surface irrigation systems to respond to requirements of modernization of surface irrigation—furrow, basin, and border irrigation. It includes a database, simulation models, user-friendly interfaces, and multicriteria analysis models. SADREG is comprised of two components: design and selection. The first component applies database information, and through several si...

Computerised decision support systems for healthcare professionals: an interpretative review

Directory of Open Access Journals (Sweden)

Kathrin Cresswell

2013-03-01

Full Text Available Purpose Computerised decision support systems are designed to support clinicians in making decisions and thereby enhance the quality and safety of care. We aimed to undertake an interpretative review of the empirical evidence on computerised decision support systems, their contexts of use, and summarise evidence on the effectiveness of these tools and insights into how these can be successfully implemented and adopted.Methods We systematically searched the empirical literature to identify systematic literature reviews on computerised decision support applications and their impact on the quality and safety of healthcare delivery over a 13-year period (1997–2010. The databases searched included: MEDLINE, EMBASE, The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, The Cochrane Central Register of Controlled Trials, The Cochrane Methodology Register, The Health Technology Assessment Database, and The National Health Service (NHS Economic Evaluation Database. To be eligible for inclusion, systematic reviews needed to address computerised decision support systems, and at least one of the following: impact on safety; quality; or organisational, implementation or adoption considerations.Results Our searches yielded 121 systematic reviews relating to eHealth, of which we identified 41 as investigating computerised decision support systems. These indicated that, whilst there was a lack of investigating potential risks, such tools can result in improvements in practitioner performance in the promotion of preventive care and guideline adherence, particularly if specific information is available in real time and systems are effectively integrated into clinical workflows. However, the evidence regarding impact on patient outcomes was less clear-cut with reviews finding either no, inconsistent or modest benefits.Conclusions Whilst the potential of clinical decision support systems in improving, in particular

Computerised decision support systems for healthcare professionals: an interpretative review.

Science.gov (United States)

Cresswell, Kathrin; Majeed, Azeem; Bates, David W; Sheikh, Aziz

2012-01-01

Computerised decision support systems are designed to support clinicians in making decisions and thereby enhance the quality and safety of care. We aimed to undertake an interpretative review of the empirical evidence on computerised decision support systems, their contexts of use, and summarise evidence on the effectiveness of these tools and insights into how these can be successfully implemented and adopted. We systematically searched the empirical literature to identify systematic literature reviews on computerised decision support applications and their impact on the quality and safety of healthcare delivery over a 13-year period (1997-2010). The databases searched included: MEDLINE, EMBASE, The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, The Cochrane Central Register of Controlled Trials, The Cochrane Methodology Register, The Health Technology Assessment Database, and The National Health Service (NHS) Economic Evaluation Database. To be eligible for inclusion, systematic reviews needed to address computerised decision support systems, and at least one of the following: impact on safety; quality; or organisational, implementation or adoption considerations. Our searches yielded 121 systematic reviews relating to eHealth, of which we identified 41 as investigating computerised decision support systems. These indicated that, whilst there was a lack of investigating potential risks, such tools can result in improvements in practitioner performance in the promotion of preventive care and guideline adherence, particularly if specific information is available in real time and systems are effectively integrated into clinical workflows. However, the evidence regarding impact on patient outcomes was less clear-cut with reviews finding either no, inconsistent or modest benefits. Whilst the potential of clinical decision support systems in improving, in particular, practitioner performance is considerable, such technology may

User-centered design to improve clinical decision support in primary care.

Science.gov (United States)

Brunner, Julian; Chuang, Emmeline; Goldzweig, Caroline; Cain, Cindy L; Sugar, Catherine; Yano, Elizabeth M

2017-08-01

A growing literature has demonstrated the ability of user-centered design to make clinical decision support systems more effective and easier to use. However, studies of user-centered design have rarely examined more than a handful of sites at a time, and have frequently neglected the implementation climate and organizational resources that influence clinical decision support. The inclusion of such factors was identified by a systematic review as "the most important improvement that can be made in health IT evaluations." (1) Identify the prevalence of four user-centered design practices at United States Veterans Affairs (VA) primary care clinics and assess the perceived utility of clinical decision support at those clinics; (2) Evaluate the association between those user-centered design practices and the perceived utility of clinical decision support. We analyzed clinic-level survey data collected in 2006-2007 from 170 VA primary care clinics. We examined four user-centered design practices: 1) pilot testing, 2) provider satisfaction assessment, 3) formal usability assessment, and 4) analysis of impact on performance improvement. We used a regression model to evaluate the association between user-centered design practices and the perceived utility of clinical decision support, while accounting for other important factors at those clinics, including implementation climate, available resources, and structural characteristics. We also examined associations separately at community-based clinics and at hospital-based clinics. User-centered design practices for clinical decision support varied across clinics: 74% conducted pilot testing, 62% conducted provider satisfaction assessment, 36% conducted a formal usability assessment, and 79% conducted an analysis of impact on performance improvement. Overall perceived utility of clinical decision support was high, with a mean rating of 4.17 (±.67) out of 5 on a composite measure. "Analysis of impact on performance

The open-quotes leak-before-breakclose quotes applicability in decision support system open-quotes strengthclose quotes

International Nuclear Information System (INIS)

Torop, V.M.; Orynyak, I.V.; Kutovoy, O.L.

1997-01-01

A software decision support system, STRENGTH, for application of leak before break analysis, is described. The background methodology and sample application are outlined. The program allows multioptional computation of loading parameters for different types of defects, and variable properties for metals and welded joints. Structural strength is assessed, and service life predictions are made. The program is used to analyze specific defects identified by nondestructive testing

Decision Strategy Research and Policy Support

International Nuclear Information System (INIS)

Hardeman, F.

2002-01-01

The objective of SCK-CEN's R and D programme on decision strategies and policy support is: (1) to investigate the decision making process, with all its relevant dimensions, in the context of radiation protection or other nuclear issues (with particular emphasis on emergency preparedness); (2) to disseminate knowledge on decision making and nuclear emergencies, including the organisation of training courses, the contribution to manuals or guidelines, the participation in working groups or discussion forums; (3) to assist the authorities and the industry on any topic related to radiation protection and to make expertise and infrastructure available; (4) to participate in and contribute to initiatives related to social sciences and their implementation into SCK-CEN; (5) to co-ordinate efforts of SCK-CEN related to medical applications of ionising radiation. Principal achievements in 2001 are described

An Integrated Web-based Decision Support System in Disaster Risk Management

Science.gov (United States)

Aye, Z. C.; Jaboyedoff, M.; Derron, M. H.

2012-04-01

Nowadays, web based decision support systems (DSS) play an essential role in disaster risk management because of their supporting abilities which help the decision makers to improve their performances and make better decisions without needing to solve complex problems while reducing human resources and time. Since the decision making process is one of the main factors which highly influence the damages and losses of society, it is extremely important to make right decisions at right time by combining available risk information with advanced web technology of Geographic Information System (GIS) and Decision Support System (DSS). This paper presents an integrated web-based decision support system (DSS) of how to use risk information in risk management efficiently and effectively while highlighting the importance of a decision support system in the field of risk reduction. Beyond the conventional systems, it provides the users to define their own strategies starting from risk identification to the risk reduction, which leads to an integrated approach in risk management. In addition, it also considers the complexity of changing environment from different perspectives and sectors with diverse stakeholders' involvement in the development process. The aim of this platform is to contribute a part towards the natural hazards and geosciences society by developing an open-source web platform where the users can analyze risk profiles and make decisions by performing cost benefit analysis, Environmental Impact Assessment (EIA) and Strategic Environmental Assessment (SEA) with the support of others tools and resources provided. There are different access rights to the system depending on the user profiles and their responsibilities. The system is still under development and the current version provides maps viewing, basic GIS functionality, assessment of important infrastructures (e.g. bridge, hospital, etc.) affected by landslides and visualization of the impact

Ethics of End of Life Decisions in Pediatrics: A Narrative Review of the Roles of Caregivers, Shared Decision-Making, and Patient Centered Values

Directory of Open Access Journals (Sweden)

Jonathan D. Santoro

2018-04-01

Full Text Available Background: This manuscript reviews unique aspects of end of life decision-making in pediatrics. Methods: A narrative literature review of pediatric end of life issues was performed in the English language. Results: While a paternalistic approach is typically applied to children with life-limiting medical prognoses, the cognitive, language, and physical variability in this patient population is wide and worthy of review. In end of life discussions in pediatrics, the consideration of a child’s input is often not reviewed in depth, although a shared decision-making model is ideal for use, even for children with presumed limitations due to age. This narrative review of end of life decision-making in pediatric care explores nomenclature, the introduction of the concept of death, relevant historical studies, limitations to the shared decision-making model, the current state of end of life autonomy in pediatrics, and future directions and needs. Although progress is being made toward a more uniform and standardized approach to care, few non-institutional protocols exist. Complicating factors in the lack of guidelines include the unique facets of pediatric end of life care, including physical age, paternalism, the cognitive and language capacity of patients, subconscious influencers of parents, and normative values of death in pediatrics. Conclusions: Although there have been strides in end of life decision-making in pediatrics, further investigation and research is needed in this field.

Ethics of End of Life Decisions in Pediatrics: A Narrative Review of the Roles of Caregivers, Shared Decision-Making, and Patient Centered Values.

Science.gov (United States)

Santoro, Jonathan D; Bennett, Mariko

2018-04-26

Background: This manuscript reviews unique aspects of end of life decision-making in pediatrics. Methods: A narrative literature review of pediatric end of life issues was performed in the English language. Results: While a paternalistic approach is typically applied to children with life-limiting medical prognoses, the cognitive, language, and physical variability in this patient population is wide and worthy of review. In end of life discussions in pediatrics, the consideration of a child’s input is often not reviewed in depth, although a shared decision-making model is ideal for use, even for children with presumed limitations due to age. This narrative review of end of life decision-making in pediatric care explores nomenclature, the introduction of the concept of death, relevant historical studies, limitations to the shared decision-making model, the current state of end of life autonomy in pediatrics, and future directions and needs. Although progress is being made toward a more uniform and standardized approach to care, few non-institutional protocols exist. Complicating factors in the lack of guidelines include the unique facets of pediatric end of life care, including physical age, paternalism, the cognitive and language capacity of patients, subconscious influencers of parents, and normative values of death in pediatrics. Conclusions: Although there have been strides in end of life decision-making in pediatrics, further investigation and research is needed in this field.

A Multi-criterial Decision Support System for Forest Management

Science.gov (United States)

Donald Nute; Geneho Kim; Walter D. Potter; Mark J. Twery; H. Michael Rauscher; Scott Thomasma; Deborah Bennett; Peter Kollasch

1999-01-01

We describe a research project that has as its goal development of a full-featured decision support system for managing forested land to satisfy multiple criteria represented as timber, wildlife, water, ecological, and wildlife objectives. The decision process proposed for what was originally conceived of as a Northeast Decision Model (NED) includes data acquisition,...

Swiss doctors' attitudes towards end-of-life decisions and their determinants: a comparison of three language regions.

Science.gov (United States)

Fischer, Susanne; Bosshard, Georg; Faisst, Karin; Tschopp, Alois; Fischer, Johannes; Bär, Walter; Gutzwiller, Felix

2006-06-10

To investigate attitudes to end-of-life decisions, and the influence of cultural factors and of doctors' personal characteristics on these attitudes. As part of a European research project (EURELD), a study on attitudes towards medical end-of-life decisions was conducted among doctors in the German-, French- and Italian-speaking areas of Switzerland. A written questionnaire was sent to a random sample of nine different types of specialist; it presented 14 statements on end-of-life decisions and doctors were asked whether they agreed or disagreed with them. The response rate was 64%. 1360 questionnaires were studied. The results show general agreement with statements on the alleviation of pain and other symptoms with possible life-shortening effect, as well as on non-treatment decisions. The language region was a strong determinant of agreement on some attitudes towards end-of-life decisions. Agreement on the use of lethal drugs and alleviation of pain and other symptoms with possible life-shortening effect was higher among French-speaking than among German- and Italian-speaking doctors. For nontreatment decisions, agreement was higher in the German-speaking region than in the French- and Italian-speaking regions of the country. Italian-speaking doctors were strongly opposed to any kind of end-of-life decision. Religious believers and those who attended a larger number of terminal patients tended to disagree more often with end-of-life decisions than the other doctors. In end-of-life decision-making, Switzerland represents "Europe in miniature". The impact on end-of-life decisions of cultural factors and the number of terminal patients attended needs further consideration.

A new composite decision support framework for strategic and sustainable transport appraisals

DEFF Research Database (Denmark)

Barfod, Michael Bruhn; Salling, Kim Bang

2015-01-01

. The proposed framework is based on the use of cost-benefit analysis featuring feasibility risk assessment in combination with multi-criteria decision analysis and is supported by the concept of decision conferencing. The framework is applied for a transport related case study dealing with the complex decision....... The outcome of the case study demonstrates the decision making framework as a valuable decision support system (DSS), and it is concluded that appraisals of transport projects can be effectively supported by the use of the DSS. Finally, perspectives of the future modelling work are given.......This paper concerns the development of a new decision support framework for the appraisal of transport infrastructure projects. In such appraisals there will often be a need for including both conventional transport impacts as well as criteria of a more strategic and/or sustainable character...

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

Science.gov (United States)

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

2017-07-01

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

Preferences for autonomy in end-of-life decision making in modern Korean society.

Science.gov (United States)

Kim, Su Hyun

2015-03-01

The demand for autonomy in medical decision making is increasing among Korean people, but it is not well known why some people prefer autonomy in decision making but others do not. The aim of this study was to determine the extent to which Korean adults wished to exercise autonomy in the process of decision making regarding end-of-life treatment and to determine whether economic issues and family functioning, in particular, were associated with preferences for participation in decision making in Korean people. This study was a cross-sectional correlational study using a survey. Data were collected using structured questionnaires from 354 patients or their families who visited ambulatory departments at two general hospitals in South Korea, recruited by the proportionate quota sampling method. Data analysis was performed using multinomial logistic regression analyses. The study was approved by the hospitals' directors and the ethics committee of Kyungpook National University Hospital. Written informed consent was given by all participants. A majority of Korean people wanted to make autonomous decisions regarding treatment at the end of life. Preferences for autonomous decision making regarding end-of-life treatment, rather than relying on family, showed a significant increase in association with poor family functioning and low income. Results of this study suggested the necessity for development of alternatives to a dominant traditional "family-centered" approach in Korean people, in order to enhance end-of-life decision making for people who wish to take an active role in the decision-making process. Healthcare providers need to examine not only patients' preferred decision-making style but also any reasons for their choice, in particular, family conflict and financial burden. © The Author(s) 2014.

Life support for aquatic species - past; present; future

Science.gov (United States)

Slenzka, K.

Life Support is a basic issue since manned space flight began. Not only to support astronauts and cosmonauts with the essential things to live, however, also animals which were carried for research to space etc together with men need support systems to survive under space conditions. Most of the animals transported to space participate at the life support system of the spacecraft. However, aquatic species live in water as environment and thus need special developments. Research with aquatic animals has a long tradition in manned space flight resulting in numerous life support systems for them starting with simple plastic bags up to complex support hardware. Most of the recent developments have to be identified as part of a technological oriented system and can be described as small technospheres. As the importance arose to study our Earth as the extraordinary Biosphere we live in, the modeling of small ecosystems began as part of ecophysiological research. In parallel the investigations of Bioregenerative Life Support Systems were launched and identified as necessity for long-term space missions or traveling to Moon and Mars and beyond. This paper focus on previous developments of Life Support Systems for aquatic animals and will show future potential developments towards Bioregenerative Life Support which additionally strongly benefits to our Earth's basic understanding.

Handling risk attitudes for preference learning and intelligent decision support

DEFF Research Database (Denmark)

Franco de los Ríos, Camilo; Hougaard, Jens Leth; Nielsen, Kurt

2015-01-01

Intelligent decision support should allow integrating human knowledge with efficient algorithms for making interpretable and useful recommendations on real world decision problems. Attitudes and preferences articulate and come together under a decision process that should be explicitly modeled...

Contribution of Enterprise Asset Management (EAM) systems and CAP programs to support NPP life extension program

International Nuclear Information System (INIS)

Luanco, E.

2007-01-01

There is no specific IS (Information System) which supports the entire scope of a plant life extension, but there are a number of existing solutions that contributes to support it. Globally there are 2 categories of IS solution in the market: those supporting the Plant Life Improvement (PLIM) side of the life extension program and the others supporting the Plant Life Extension (PLEX) process side of it. The first category involves a large number of applications that span from ageing evaluation criteria programs, to monitoring solution for the critical components and to analysis and decision tools. The second category comprises solutions which support partially or globally the overall business process under a regulatory controlled manner. Both categories require 3 conditions to be satisfied: -) a comprehensive set of data (these data are often produced by various applications and the ability to correlate all the data together with a high degree of integrity is an important success factor); -) a feedback mechanism whose dual aspect is the monitoring of the ageing phenomena and the management of all the actions to be coordinated to ensure that preset objectives will be achieved in due time; and -) good people management to ensure particularly that staff will be well acquainted with new equipment or with new operating processes

MINDS - Medical Information Network Decision Support System

National Research Council Canada - National Science Library

Armenian, H. K

2008-01-01

.... The increase in and complexity of medical data at various levels of resolution has increased the need for system level advancements in clinical decision support systems that provide computer-aided...

SANDS: an architecture for clinical decision support in a National Health Information Network.

Science.gov (United States)

Wright, Adam; Sittig, Dean F

2007-10-11

A new architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support) is introduced and its performance evaluated. The architecture provides a method for performing clinical decision support across a network, as in a health information exchange. Using the prototype we demonstrated that, first, a number of useful types of decision support can be carried out using our architecture; and, second, that the architecture exhibits desirable reliability and performance characteristics.

Healthcare performance turned into decision support

DEFF Research Database (Denmark)

Sørup, Christian Michel; Jacobsen, Peter

2013-01-01

from the healthcare sector, the results obtained could be restricted to this sector. Inclusion of data from Arbejdsmarkedets Tillægspension (ATP) showed no deviation from the results in the healthcare sector. Practical implications – The product of the study is a decision support tool for leaders...

The design of patient decision support interventions: addressing the theory-practice gap.

Science.gov (United States)

Elwyn, Glyn; Stiel, Mareike; Durand, Marie-Anne; Boivin, Jacky

2011-08-01

Although an increasing number of decision support interventions for patients (including decision aids) are produced, few make explicit use of theory. We argue the importance of using theory to guide design. The aim of this work was to address this theory-practice gap and to examine how a range of selected decision-making theories could inform the design and evaluation of decision support interventions. We reviewed the decision-making literature and selected relevant theories. We assessed their key principles, theoretical pathways and predictions in order to determine how they could inform the design of two core components of decision support interventions, namely, information and deliberation components and to specify theory-based outcome measures. Eight theories were selected: (1) the expected utility theory; (2) the conflict model of decision making; (3) prospect theory; (4) fuzzy-trace theory; (5) the differentiation and consolidation theory; (6) the ecological rationality theory; (7) the rational-emotional model of decision avoidance; and finally, (8) the Attend, React, Explain, Adapt model of affective forecasting. Some theories have strong relevance to the information design (e.g. prospect theory); some are more relevant to deliberation processes (conflict theory, differentiation theory and ecological validity). None of the theories in isolation was sufficient to inform the design of all the necessary components of decision support interventions. It was also clear that most work in theory-building has focused on explaining or describing how humans think rather than on how tools could be designed to help humans make good decisions. It is not surprising therefore that a large theory-practice gap exists as we consider decision support for patients. There was no relevant theory that integrated all the necessary contributions to the task of making good decisions in collaborative interactions. Initiatives such as the International Patient Decision Aids Standards

A Decision Support System for Corporations Cybersecurity Management

OpenAIRE

Roldán-Molina, G.; Almache-Cueva, M.; Silva-Rabadão, C.; Yevseyeva, Iryna; Basto-Fernandes, V.

2017-01-01

This paper presents ongoing work on a decision aiding software intended to support cyber risks and cyber threats analysis of an information and communications technological infrastructure. The software will help corporations Chief Information Security Officers on cyber security risk analysis, decision-making, prevention measures and risk strategies for the infrastructure and information assets protection.

Decision Strategy Research and Policy Support

Energy Technology Data Exchange (ETDEWEB)

Hardeman, F

2002-04-01

The objective of SCK-CEN's R and D programme on decision strategies and policy support is: (1) to investigate the decision making process, with all its relevant dimensions, in the context of radiation protection or other nuclear issues (with particular emphasis on emergency preparedness); (2) to disseminate knowledge on decision making and nuclear emergencies, including the organisation of training courses, the contribution to manuals or guidelines, the participation in working groups or discussion forums; (3) to assist the authorities and the industry on any topic related to radiation protection and to make expertise and infrastructure available; (4) to participate in and contribute to initiatives related to social sciences and their implementation into SCK-CEN; (5) to co-ordinate efforts of SCK-CEN related to medical applications of ionising radiation. Principal achievements in 2001 are described.

A multicriteria decision support methodology for evaluating airport expansion plans

NARCIS (Netherlands)

Vreeker, R.; Nijkamp, P.; ter Welle, C.

2001-01-01

Rational decision-making requires an assessment of advantages and disadvantages of choice possibilities, including non-market effects (such as externalities). This also applies to strategic decision-making in the transport sector (including aviation). In the past decades various decision support and

Dashboard visualizations: Supporting real-time throughput decision-making.

Science.gov (United States)

Franklin, Amy; Gantela, Swaroop; Shifarraw, Salsawit; Johnson, Todd R; Robinson, David J; King, Brent R; Mehta, Amit M; Maddow, Charles L; Hoot, Nathan R; Nguyen, Vickie; Rubio, Adriana; Zhang, Jiajie; Okafor, Nnaemeka G

2017-07-01

Providing timely and effective care in the emergency department (ED) requires the management of individual patients as well as the flow and demands of the entire department. Strategic changes to work processes, such as adding a flow coordination nurse or a physician in triage, have demonstrated improvements in throughput times. However, such global strategic changes do not address the real-time, often opportunistic workflow decisions of individual clinicians in the ED. We believe that real-time representation of the status of the entire emergency department and each patient within it through information visualizations will better support clinical decision-making in-the-moment and provide for rapid intervention to improve ED flow. This notion is based on previous work where we found that clinicians' workflow decisions were often based on an in-the-moment local perspective, rather than a global perspective. Here, we discuss the challenges of designing and implementing visualizations for ED through a discussion of the development of our prototype Throughput Dashboard and the potential it holds for supporting real-time decision-making. Copyright © 2017. Published by Elsevier Inc.

Modelling of the costs of decision support for small and medium-sized enterprises

Directory of Open Access Journals (Sweden)

Viera Tomišová

2017-01-01

Full Text Available The support of decision-making activities in small and medium-sized enterprises (SME has its specific features. When suggesting steps for the implementation of decision-support tools in the enterprise, we identified two main ways of decision-making support based on the data analysis: ERP (Enterprise Resource Planning without BI (Business Intelligence and ERP with BI. In our contribution, we present costs models of both mentioned decision support systems and their practical interpretation.

Fault-Tolerant Onboard Monitoring and Decision Support Systems

DEFF Research Database (Denmark)

Lajic, Zoran

a crude and simple estimation of the actual sea state (Hs and Tz), information about the longitudinal hull girder loading, seakeeping performance of the ship, and decision support on how to operate the ship within acceptable limits. The system is able to identify critical forthcoming events and to give...... advice regarding speed and course changes to decrease the wave-induced loads. The SeaSense system is based on the combined use of a mathematical model and measurements from a set of sensors. The overall dependability of a shipboard monitoring and decision support system such as the SeaSense system can...

Knowledge-Based Information Management in Decision Support for Ecosystem Management

Science.gov (United States)

Keith Reynolds; Micahel Saunders; Richard Olson; Daniel Schmoldt; Michael Foster; Donald Latham; Bruce Miller; John Steffenson; Lawrence Bednar; Patrick Cunningham

1995-01-01

The Pacific Northwest Research Station (USDA Forest Service) is developing a knowledge-based information management system to provide decision support for watershed analysis in the Pacific Northwest region of the U.S. The decision support system includes: (1) a GIS interface that allows users to graphically navigate to specific provinces and watersheds and display a...

Mobile Health Technology for Atrial Fibrillation Management Integrating Decision Support, Education, and Patient Involvement: mAF App Trial.

Science.gov (United States)

Guo, Yutao; Chen, Yundai; Lane, Deirdre A; Liu, Lihong; Wang, Yutang; Lip, Gregory Y H

2017-12-01

Mobile Health technology for the management of patients with atrial fibrillation is unknown. The simple mobile AF (mAF) App was designed to incorporate clinical decision-support tools (CHA 2 DS 2 -VASc [Congestive heart failure, Hypertension, Age ≥75 years, Diabetes Mellitus, Prior Stroke or TIA, Vascular disease, Age 65-74 years, Sex category], HAS-BLED [Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol concomitantly], SAMe-TT 2 R 2 [Sex, Age Mobile Health technology in patients with atrial fibrillation, demonstrating that the mAF App, integrating clinical decision support, education, and patient-involvement strategies, significantly improved knowledge, drug adherence, quality of life, and anticoagulation satisfaction. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Caring Decisions: The Development of a Written Resource for Parents Facing End-of-Life Decisions

OpenAIRE

Xafis, Vicki; Gillam, Lynn; Hynson, Jenny; Sullivan, Jane; Cossich, Mary; Wilkinson, Dominic

2015-01-01

Background: Written resources in adult intensive care have been shown to benefit families facing end of life (EoL) decisions. There are few resources for parents making EoL decisions for their child and no existing resources addressing ethical issues. TheCaring Decisionshandbook and website were developed to fill these gaps. Aim: We discuss the development of the resources, modification after reviewer feedback and findings from initial pilot implementation. Design: A targeted...

End-of-life decisions in Malaysia: Adequacies of ethical codes and developing legal standards.

Science.gov (United States)

Kassim, Puteri Nemie Jahn; Alias, Fadhlina

2015-06-01

End-of-life decision-making is an area of medical practice in which ethical dilemmas and legal interventions have become increasingly prevalent. Decisions are no longer confined to clinical assessments; rather, they involve wider considerations such as a patient's religious and cultural beliefs, financial constraints, and the wishes and needs of family members. These decisions affect everyone concerned, including members of the community as a whole. Therefore it is imperative that clear ethical codes and legal standards are developed to help guide the medical profession on the best possible course of action for patients. This article considers the relevant ethical, codes and legal provisions in Malaysia governing certain aspects of end-of-life decision-making. It highlights the lack of judicial decisions in this area as well as the limitations with the Malaysian regulatory system. The article recommends the development of comprehensive ethical codes and legal standards to guide end-of-life decision-making in Malaysia.

On Decision Support for Sustainability and Resilience of Infrastructure

DEFF Research Database (Denmark)

Nielsen, Michael Havbro Faber; Qin, J.; Miragliaa, S.

2017-01-01

in Bayesian decision analysis and probabilistic systems performance modelling. A principal example for decision support at regulatory level is presented for a coupled system comprised of infrastructure, social, hazard and environmental subsystems. The infrastructure systems is modelled as multi...

Study of basic-life-support training for college students.

Science.gov (United States)

Srivilaithon, Winchana; Amnaumpatanapon, Kumpon; Limjindaporn, Chitlada; Imsuwan, Intanon; Daorattanachai, Kiattichai

2015-03-01

To study about attitude and knowledge regarding basic-life-support among college students outside medical system. The cross-sectional study in the emergency department of Thammasat Hospital. The authors included college students at least aged 18 years old and volunteers to be study subjects. The authors collected data about attitudes and knowledge in performing basic-life-support by using set of questionnaires. 250 college students participated in the two hours trainingprogram. Most ofparticipants (42.4%) were second-year college students, of which 50 of 250 participants (20%) had trained in basic-life-support program. Twenty-seven of 250 participants (10.8%) had experience in basic-life-support outside the hospital. Most of participants had good attitude for doing basic-life-support. Participants had a significant improved score following training (mean score 8.66 and 12.34, respectively, pbasic-life-support to cardiac arrest patient. The training program in basic-life-support has significant impact on knowledge after training.

Nuclear Waste Management Decision-Making Support with MCDA

Directory of Open Access Journals (Sweden)

A. Schwenk-Ferrero

2017-01-01

Full Text Available The paper proposes a multicriteria decision analysis (MCDA framework for a comparative evaluation of nuclear waste management strategies taking into account different local perspectives (expert and stakeholder opinions. Of note, a novel approach is taken using a multiple-criteria formulation that is methodologically adapted to tackle various conflicting criteria and a large number of expert/stakeholder groups involved in the decision-making process. The purpose is to develop a framework and to show its application to qualitative comparison and ranking of options in a hypothetical case of three waste management alternatives: interim storage at and/or away from the reactor site for the next 100 years, interim decay storage followed in midterm by disposal in a national repository, and disposal in a multinational repository. Additionally, major aspects of a decision-making aid are identified and discussed in separate paper sections dedicated to application context, decision supporting process, in particular problem structuring, objective hierarchy, performance evaluation modeling, sensitivity/robustness analyses, and interpretation of results (practical impact. The aim of the paper is to demonstrate the application of the MCDA framework developed to a generic hypothetical case and indicate how MCDA could support a decision on nuclear waste management policies in a “small” newcomer country embarking on nuclear technology in the future.

Decision-Making Amplification under Uncertainty: An Exploratory Study of Behavioral Similarity and Intelligent Decision Support Systems

Science.gov (United States)

Campbell, Merle Wayne

2013-01-01

Intelligent decision systems have the potential to support and greatly amplify human decision-making across a number of industries and domains. However, despite the rapid improvement in the underlying capabilities of these "intelligent" systems, increasing their acceptance as decision aids in industry has remained a formidable challenge.…

CorRECTreatment: a web-based decision support tool for rectal cancer treatment that uses the analytic hierarchy process and decision tree.

Science.gov (United States)

Suner, A; Karakülah, G; Dicle, O; Sökmen, S; Çelikoğlu, C C

2015-01-01

The selection of appropriate rectal cancer treatment is a complex multi-criteria decision making process, in which clinical decision support systems might be used to assist and enrich physicians' decision making. The objective of the study was to develop a web-based clinical decision support tool for physicians in the selection of potentially beneficial treatment options for patients with rectal cancer. The updated decision model contained 8 and 10 criteria in the first and second steps respectively. The decision support model, developed in our previous study by combining the Analytic Hierarchy Process (AHP) method which determines the priority of criteria and decision tree that formed using these priorities, was updated and applied to 388 patients data collected retrospectively. Later, a web-based decision support tool named corRECTreatment was developed. The compatibility of the treatment recommendations by the expert opinion and the decision support tool was examined for its consistency. Two surgeons were requested to recommend a treatment and an overall survival value for the treatment among 20 different cases that we selected and turned into a scenario among the most common and rare treatment options in the patient data set. In the AHP analyses of the criteria, it was found that the matrices, generated for both decision steps, were consistent (consistency ratiodecisions of experts, the consistency value for the most frequent cases was found to be 80% for the first decision step and 100% for the second decision step. Similarly, for rare cases consistency was 50% for the first decision step and 80% for the second decision step. The decision model and corRECTreatment, developed by applying these on real patient data, are expected to provide potential users with decision support in rectal cancer treatment processes and facilitate them in making projections about treatment options.

Life Support Baseline Values and Assumptions Document

Science.gov (United States)

Anderson, Molly S.; Ewert, Michael K.; Keener, John F.

2018-01-01

The Baseline Values and Assumptions Document (BVAD) provides analysts, modelers, and other life support researchers with a common set of values and assumptions which can be used as a baseline in their studies. This baseline, in turn, provides a common point of origin from which many studies in the community may depart, making research results easier to compare and providing researchers with reasonable values to assume for areas outside their experience. This document identifies many specific physical quantities that define life support systems, serving as a general reference for spacecraft life support system technology developers.

A decision support system for on-line leakage localization

OpenAIRE

Meseguer, Jordi; Mirats-Tur, Josep M.; Cembrano, Gabriela; Puig, Vicenç; Quevedo, Joseba; Pérez, Ramon; Sanz, Gerard; Ibarra, David

2014-01-01

This paper describes a model-driven decision-support system (software tool) implementing a model-based methodology for on-line leakage detection and localization which is useful for a large class of water distribution networks. Since these methods present a certain degree of complexity which limits their use to experts, the proposed software tool focuses on the integration of a method emphasizing its use by water network managers as a decision support system. The proposed software tool integr...

A generic accounting model to support operations management decisions

NARCIS (Netherlands)

Verdaasdonk, P.J.A.; Wouters, M.J.F.

2001-01-01

Information systems are generally unable to generate information about the financial consequences of operations management decisions. This is because the procedures for determining the relevant accounting information for decision support are not formalised in ways that can be implemented in

Hospital Costs Of Extracorporeal Life Support Therapy

NARCIS (Netherlands)

Oude Lansink-Hartgring, Annemieke; van den Hengel, Berber; van der Bij, Wim; Erasmus, Michiel E.; Mariani, Massimo A.; Rienstra, Michiel; Cernak, Vladimir; Vermeulen, Karin M.; van den Bergh, Walter M.

Objectives: To conduct an exploration of the hospital costs of extracorporeal life support therapy. Extracorporeal life support seems an efficient therapy for acute, potentially reversible cardiac or respiratory failure, when conventional therapy has been inadequate, or as bridge to transplant, but

Family communication and decision making at the end of life: a literature review.

Science.gov (United States)

Wallace, Cara L

2015-06-01

Patients and families coping with a terminal illness are faced with a number of decisions over the course of their disease. The role that family communication plays in the process of decision making is an important one. The objectives for this review are to examine the current state of empirical literature on the relationship between family communication and decision making about end-of-life care, to identify gaps, and to discuss implications for policy, practice, and future research. Articles were identified using systematic keyword searches within the following relevant databases: Academic Search Complete, CINAHL Plus, Communications and Mass Media Complete, ERIC, PsychINFO, MEDLINE, SocINDEX, and ProQuest. The three bodies of relevant literature that emerged during this review include: (1) the importance of family communication at the end of life (EoL); (2) family decision making at the EoL; and (3) the interrelationship of communication (both within the family and with healthcare professionals) and decision making at the EoL. While the literature highlights the role of communication between medical professionals and the patient or family members, there is very little focus on the process of how family communication among the family members themselves contributes to decision making at the end of life. Barriers to end-of-life care are important considerations for helping patients to access timely and appropriate services. Understanding the pertinent role of family communication as it relates to the decision for EoL care is the first step in working to provide another avenue for overcoming these barriers.

What information do parents need when facing end-of-life decisions for their child? A meta-synthesis of parental feedback.

Science.gov (United States)

Xafis, Vicki; Wilkinson, Dominic; Sullivan, Jane

2015-04-30

The information needs of parents facing end-of-life decisions for their child are complex due to the wide-ranging dimensions within which such significant events unfold. While parents acknowledge that healthcare professionals are their main source of information, they also turn to a variety of additional sources of written information in an attempt to source facts, discover solutions, and find hope. Much has been written about the needs of parents faced with end-of-life decisions for their child but little is known about the written information needs such parents have. Research in the adult intensive care context has shown that written resources impact positively on the understanding of medical facts, including diagnoses and prognoses, communication between families and healthcare professionals, and the emotional wellbeing of families after their relative's death. A meta-synthesis of predominantly empirical research pertaining to features which assist or impede parental end-of-life decisions was undertaken to provide insight and guidance in our development of written resources (short print and online comprehensive version) for parents. The most prominently cited needs in the literature related to numerous aspects of information provision; the quantity, quality, delivery, and timing of information and its provision impacted not only on parents' ability to make end-of-life decisions but also on their emotional wellbeing. The meta-synthesis supports the value of written materials, as these provide guidance for both parents and healthcare professionals in pertinent content areas. Further research is required to determine the impact that written resources have on parental end-of-life decision-making and on parents' wellbeing during and after their experience and time in the hospital environment.

An expert panel approach to support risk-informed decision making

International Nuclear Information System (INIS)

Pulkkinen, U.; Simola, K.

2000-01-01

The report describes the expert panel methodology developed for supporting risk-informed decision making. The aim of an expert panel is to achieve a balanced utilisation of information and expertise from several disciplines in decision-making including probabilistic safety assessment as one decision criterion. We also summarise the application of the methodology in the STUK's RI-ISI (Risk-Informed In-Service Inspection) pilot study, where the expert panel approach was used to combine the deterministic information on degradation mechanisms and probabilistic information on pipe break consequences. The expert panel served both as a critical review of the preliminary results and as a decision support for the final definition of risk categories of piping. (orig.)

Radiological emergency response for community agencies with cognitive task analysis, risk analysis, and decision support framework.

Science.gov (United States)

Meyer, Travis S; Muething, Joseph Z; Lima, Gustavo Amoras Souza; Torres, Breno Raemy Rangel; del Rosario, Trystyn Keia; Gomes, José Orlando; Lambert, James H

2012-01-01

Radiological nuclear emergency responders must be able to coordinate evacuation and relief efforts following the release of radioactive material into populated areas. In order to respond quickly and effectively to a nuclear emergency, high-level coordination is needed between a number of large, independent organizations, including police, military, hazmat, and transportation authorities. Given the complexity, scale, time-pressure, and potential negative consequences inherent in radiological emergency responses, tracking and communicating information that will assist decision makers during a crisis is crucial. The emergency response team at the Angra dos Reis nuclear power facility, located outside of Rio de Janeiro, Brazil, presently conducts emergency response simulations once every two years to prepare organizational leaders for real-life emergency situations. However, current exercises are conducted without the aid of electronic or software tools, resulting in possible cognitive overload and delays in decision-making. This paper describes the development of a decision support system employing systems methodologies, including cognitive task analysis and human-machine interface design. The decision support system can aid the coordination team by automating cognitive functions and improving information sharing. A prototype of the design will be evaluated by plant officials in Brazil and incorporated to a future trial run of a response simulation.

Conceptualizing Surrogate Decision-Making at End of Life in the Intensive Care Unit using Cognitive Task Analysis

Science.gov (United States)

Dionne-Odom, J. Nicholas; Willis, Danny G.; Bakitas, Marie; Crandall, Beth; Grace, Pamela J.

2014-01-01

Background Surrogate decision-makers (SDMs) face difficult decisions at end of life (EOL) for decisionally incapacitated intensive care unit (ICU) patients. Purpose Identify and describe the underlying psychological processes of surrogate decision-making for adults at EOL in the ICU. Method Qualitative case study design using a cognitive task analysis (CTA) interviewing approach. Participants were recruited from October 2012 to June 2013 from an academic tertiary medical center’s ICU located in the rural Northeastern United States. Nineteen SDMs for patients who had died in the ICU completed in-depth semi-structured CTA interviews. Discussion The conceptual framework formulated from data analysis reveals that three underlying, iterative, psychological dimensions: gist impressions, distressing emotions, and moral intuitions impact a SDM’s judgment about the acceptability of either the patient’s medical treatments or his or her condition. Conclusion The framework offers initial insights about the underlying psychological processes of surrogate decision-making and may facilitate enhanced decision support for SDMs. PMID:25982772

MOIDSS?- Mobile Online Intelligent Decision Support System, Phase II

Data.gov (United States)

National Aeronautics and Space Administration — GRID has had a successfully completed Phase I 'Mobile Online Intelligent Decision Support System' (MOIDSS). The system developed into a total solution that supports...

A decision support framework for characterizing and managing dermal exposures to chemicals during Emergency Management and Operations.

Science.gov (United States)

Dotson, G Scott; Hudson, Naomi L; Maier, Andrew

2015-01-01

Emergency Management and Operations (EMO) personnel are in need of resources and tools to assist in understanding the health risks associated with dermal exposures during chemical incidents. This article reviews available resources and presents a conceptual framework for a decision support system (DSS) that assists in characterizing and managing risk during chemical emergencies involving dermal exposures. The framework merges principles of three decision-making techniques: 1) scenario planning, 2) risk analysis, and 3) multicriteria decision analysis (MCDA). This DSS facilitates dynamic decision making during each of the distinct life cycle phases of an emergency incident (ie, preparedness, response, or recovery) and identifies EMO needs. A checklist tool provides key questions intended to guide users through the complexities of conducting a dermal risk assessment. The questions define the scope of the framework for resource identification and application to support decision-making needs. The framework consists of three primary modules: 1) resource compilation, 2) prioritization, and 3) decision. The modules systematically identify, organize, and rank relevant information resources relating to the hazards of dermal exposures to chemicals and risk management strategies. Each module is subdivided into critical elements designed to further delineate the resources based on relevant incident phase and type of information. The DSS framework provides a much needed structure based on contemporary decision analysis principles for 1) documenting key questions for EMO problem formulation and 2) a method for systematically organizing, screening, and prioritizing information resources on dermal hazards, exposures, risk characterization, and management.

Decision Support Systems: Usage And Applications In Logistics Services

Directory of Open Access Journals (Sweden)

Eyüp AKÇETİN

2014-06-01

Full Text Available Competitive advantage in logistics operations is possible by analyzing data to create information and turning that information into decision. Supply chain optimization depends on effective management of chain knowledge. Analyzing data from supply chain and making a decision creates complex operations. Therefore, these operations require benefitting from information technology. In today’s global world, businesses use outsourcing for logistics services to focus on their own field, so are seeking to achieve competitive advantage against competitors. Outsourcing requires sharing of various information and data with companies that provide logistical support. Effective strategies are based on well-analyzed the data and information. Best options for right decisions can be created only from good analysis. That’s why companies that supply logistics services achieve competitive advantage using decision support systems (DSS in industrial competition. In short, DSS has become driving force for every business in today’s knowledge-based economy.

Personalised Multi-Criterial Online Decision Support for Siblings Considering Stem Cell Donation

DEFF Research Database (Denmark)

Kaltoft, Mette Kjer; Salkeld, Glenn; Dowie, Jack

2016-01-01

Person-centred decision support combines the best available information on the considerations that matter to the individual, with the importance the person attaches to those considerations. Nurses and other health professionals can benefit from being able to draw on this support within a clinical...... of a decision. By interactive decision support within a clinical conversation, each stakeholder can gain a personalised opinion, as well as increased generic health decision literacy [2]....... conversation. A case study and storyline on four siblings facing a transplant coordinator's call to donate stem cells to their brother [1] is 'translated' and used to demonstrate how an interactive multi-criteria aid can be developed for each within a conversational mode. The personalized dialogue and decision...

Decision support systems and expert systems for risk and safety analysis

International Nuclear Information System (INIS)

Baybutt, P.

1986-01-01

During the last 1-2 years, rapid developments have occurred in the development of decision support systems and expert systems to aid in decision making related to risk and safety of industrial plants. These activities are most noteworthy in the nuclear industry where numerous systems are under development with implementation often being made on personal computers. An overview of some of these developments is provided, and an example of one recently developed decision support system is given. This example deals with CADET, a system developed to aid the U.S. Nuclear Regulatory Commission in making decisions related to the topical issue of source terms resulting from degraded core accidents in light water reactors. The paper concludes with some comments on the likely directions of future developments in decision support systems and expert systems to aid in the management of risk and safety in industrial plants. (author)

Evolution of the Pediatric Advanced Life Support course: enhanced learning with a new debriefing tool and Web-based module for Pediatric Advanced Life Support instructors.

Science.gov (United States)

Cheng, Adam; Rodgers, David L; van der Jagt, Élise; Eppich, Walter; O'Donnell, John

2012-09-01

To describe the history of the Pediatric Advanced Life Support course and outline the new developments in instructor training that will impact the way debriefing is conducted during Pediatric Advanced Life Support courses. The Pediatric Advanced Life Support course, first released by the American Heart Association in 1988, has seen substantial growth and change over the past few decades. Over that time, Pediatric Advanced Life Support has become the standard for resuscitation training for pediatric healthcare providers in North America. The incorporation of high-fidelity simulation-based learning into the most recent version of Pediatric Advanced Life Support has helped to enhance the realism of scenarios and cases, but has also placed more emphasis on the importance of post scenario debriefing. We developed two new resources: an online debriefing module designed to introduce a new model of debriefing and a debriefing tool for real-time use during Pediatric Advanced Life Support courses, to enhance and standardize the quality of debriefing by Pediatric Advanced Life Support instructors. In this article, we review the history of Pediatric Advanced Life Support and Pediatric Advanced Life Support instructor training and discuss the development and implementation of the new debriefing module and debriefing tool for Pediatric Advanced Life Support instructors. The incorporation of the debriefing module and debriefing tool into the 2011 Pediatric Advanced Life Support instructor materials will help both new and existing Pediatric Advanced Life Support instructors develop and enhance their debriefing skills with the intention of improving the acquisition of knowledge and skills for Pediatric Advanced Life Support students.

Mental competence and surrogate decision-making towards the end of life.

Science.gov (United States)

Strätling, M; Scharf, V E; Schmucker, P

2004-01-01

German legislation demands that decisions about the treatment of mentally incompetent patients require an 'informed consent'. If this was not given by the patient him-/herself before he/she became incompetent, it has to be sought by the physician from a guardian, who has to be formally legitimized before. Additionally this surrogate has to seek the permission of a Court of Guardianship (Vormundschaftsgericht), if he/she intends to consent to interventions, which pose significant risks to the health or the life of the person under his/her care. This includes 'end-of-life decisions'. Deviations from this procedure are only allowed in acute emergencies or cases of 'medical futility'. On the basis of epidemiological and demographical data it can be shown that the vast majority of surrogate decisions on incompetent patients in Germany is not covered by legally valid consent. Moreover, the data suggests that if consent were to be requested according to the legal regulations, both the legal and medical system could realistically never cope with the practical consequences of this. Additionally, empiric research has revealed serious deficits concerning medical 'end of life-decisions' and practical performance in palliative care. As a consequence a multidisciplinary discussion has developed in Germany about the reform of present legislation with respect to key-issues like the assessment of mental competence, the options for exercising patient self-determination via advance directives and durable powers of attorney, the improvement of palliative care facilities, the clarification of formal procedures for surrogate decision-making in health care and towards the end of life and the possibilities and their limitations of controlling these decision-making processes 'externally' (e.g., by Guardianship Courts or committees). The authors discuss those proposals, which clearly dominate the present debate: They all aim to comply with the scientific basis of German law, jurisdiction

Decision conflict and regret among surrogate decision makers in the medical intensive care unit.

Science.gov (United States)

Miller, Jesse J; Morris, Peter; Files, D Clark; Gower, Emily; Young, Michael

2016-04-01

Family members of critically ill patients in the intensive care unit face significant morbidity. It may be the decision-making process that plays a significant role in the psychological morbidity associated with being a surrogate in the ICU. We hypothesize that family members facing end-of-life decisions will have more decisional conflict and decisional regret than those facing non-end-of-life decisions. We enrolled a sample of adult patients and their surrogates in a tertiary care, academic medical intensive care unit. We queried the surrogates regarding decisions they had made on behalf of the patient and assessed decision conflict. We then contacted the family member again to assess decision regret. Forty (95%) of 42 surrogates were able to identify at least 1 decision they had made on behalf of the patient. End-of-life decisions (defined as do not resuscitate [DNR]/do not intubate [DNI] or continuation of life support) accounted for 19 of 40 decisions (47.5%). Overall, the average Decision Conflict Scale (DCS) score was 21.9 of 100 (range 0-100, with 0 being little decisional conflict and 100 being great decisional conflict). The average DCS score for families facing end-of-life decisions was 25.5 compared with 18.7 for all other decisions. Those facing end-of-life decisions scored higher on the uncertainty subscale (subset of DCS questions that indicates level of certainty regarding decision) with a mean score of 43.4 compared with all other decisions with a mean score of 27.0. Overall, very few surrogates experienced decisional regret with an average DRS score of 13.4 of 100. Nearly all surrogates enrolled were faced with decision-making responsibilities on behalf of his or her critically ill family member. In our small pilot study, we found more decisional conflict in those surrogates facing end-of-life decisions, specifically on the subset of questions dealing with uncertainty. Surrogates report low levels of decisional regret. Copyright © 2015 Elsevier

OrderRex: clinical order decision support and outcome predictions by data-mining electronic medical records.

Science.gov (United States)

Chen, Jonathan H; Podchiyska, Tanya; Altman, Russ B

2016-03-01

To answer a "grand challenge" in clinical decision support, the authors produced a recommender system that automatically data-mines inpatient decision support from electronic medical records (EMR), analogous to Netflix or Amazon.com's product recommender. EMR data were extracted from 1 year of hospitalizations (>18K patients with >5.4M structured items including clinical orders, lab results, and diagnosis codes). Association statistics were counted for the ∼1.5K most common items to drive an order recommender. The authors assessed the recommender's ability to predict hospital admission orders and outcomes based on initial encounter data from separate validation patients. Compared to a reference benchmark of using the overall most common orders, the recommender using temporal relationships improves precision at 10 recommendations from 33% to 38% (P < 10(-10)) for hospital admission orders. Relative risk-based association methods improve inverse frequency weighted recall from 4% to 16% (P < 10(-16)). The framework yields a prediction receiver operating characteristic area under curve (c-statistic) of 0.84 for 30 day mortality, 0.84 for 1 week need for ICU life support, 0.80 for 1 week hospital discharge, and 0.68 for 30-day readmission. Recommender results quantitatively improve on reference benchmarks and qualitatively appear clinically reasonable. The method assumes that aggregate decision making converges appropriately, but ongoing evaluation is necessary to discern common behaviors from "correct" ones. Collaborative filtering recommender algorithms generate clinical decision support that is predictive of real practice patterns and clinical outcomes. Incorporating temporal relationships improves accuracy. Different evaluation metrics satisfy different goals (predicting likely events vs. "interesting" suggestions). Published by Oxford University Press on behalf of the American Medical Informatics Association 2015. This work is written by US Government

Advance Directive in End of Life Decision-Making among the Yoruba of South-Western Nigeria.

Science.gov (United States)

Jegede, Ayodele Samuel; Adegoke, Olufunke Olufunsho

2016-11-01

End-of-life decision making is value-laden within the context of culture and bioethics. Also, ethics committee role is difficult to understand on this, thus need for ethnomethodological perspective in an expanding bioethical age. Anthropological approach was utilized to document Yoruba definition and perspective of death, cultural beliefs about end-of-life decision making, factors influencing it and ethics committee role. Interviews were conducted among selected Yoruba resident in Akinyele LGA, Oyo State, Nigeria. Content analytical approach was used for data analysis. Yoruba culture, death is socially constructed having spiritual, physical and social significance. Relationship between the dying and significant others influences decision making. Hierarchy of authority informs implementing traditional advance directive. Socialization, gender, patriarchy, religious belief and tradition are major considerations in end-of-life decision making. Awareness, resource allocation and advocacy are important ethics committees' roles. Further research into cultural diversity of end-of-life decision making will strengthen ethical practice in health care delivery.

Optimization-based decision support systems for planning problems in processing industries

NARCIS (Netherlands)

Claassen, G.D.H.

2014-01-01

Summary

Optimization-based decision support systems for planning problems in processing industries

Nowadays, efficient planning of material flows within and between supply chains is of vital importance and has become one of the most challenging problems for decision support in

Bayesian networks for clinical decision support: A rational approach to dynamic decision-making under uncertainty

NARCIS (Netherlands)

Gerven, M.A.J. van

2007-01-01

This dissertation deals with decision support in the context of clinical oncology. (Dynamic) Bayesian networks are used as a framework for (dynamic) decision-making under uncertainty and applied to a variety of diagnostic, prognostic, and treatment problems in medicine. It is shown that the proposed

A distributed clinical decision support system architecture

Directory of Open Access Journals (Sweden)

Shaker H. El-Sappagh

2014-01-01

Full Text Available This paper proposes an open and distributed clinical decision support system architecture. This technical architecture takes advantage of Electronic Health Record (EHR, data mining techniques, clinical databases, domain expert knowledge bases, available technologies and standards to provide decision-making support for healthcare professionals. The architecture will work extremely well in distributed EHR environments in which each hospital has its own local EHR, and it satisfies the compatibility, interoperability and scalability objectives of an EHR. The system will also have a set of distributed knowledge bases. Each knowledge base will be specialized in a specific domain (i.e., heart disease, and the model achieves cooperation, integration and interoperability between these knowledge bases. Moreover, the model ensures that all knowledge bases are up-to-date by connecting data mining engines to each local knowledge base. These data mining engines continuously mine EHR databases to extract the most recent knowledge, to standardize it and to add it to the knowledge bases. This framework is expected to improve the quality of healthcare, reducing medical errors and guaranteeing the safety of patients by helping clinicians to make correct, accurate, knowledgeable and timely decisions.

Feasibility Risk Assessment of Transport Infrastructure Projects: The CBA-DK Decision Support Model

DEFF Research Database (Denmark)

Salling, Kim Bang; Banister, David

2010-01-01

informed decision support towards decision-makers and stakeholders in terms of accumulated descending graphs. The decision support method developed in this paper aims to provide assistance in the analysis and ultimately the choice of action, while accounting for the uncertainties surrounding any transport......This paper presents the final version of the CBA-DK decision support model for assessment of transport projects. The model makes use of conventional cost-benefit analysis resulting in aggregated single point estimates and quantitative risk analysis using Monte Carlo simulation resulting in interval...... result, and the determination of suitable probability distributions. Use is made of the reference class forecasting information, such as that developed in Optimism Bias for adjustments to investment decisions that relate to all modes of transport. The CBA-DK decision support model results in more...

Modular Architecture for Integrated Model-Based Decision Support.

Science.gov (United States)

Gaebel, Jan; Schreiber, Erik; Oeser, Alexander; Oeltze-Jafra, Steffen

2018-01-01

Model-based decision support systems promise to be a valuable addition to oncological treatments and the implementation of personalized therapies. For the integration and sharing of decision models, the involved systems must be able to communicate with each other. In this paper, we propose a modularized architecture of dedicated systems for the integration of probabilistic decision models into existing hospital environments. These systems interconnect via web services and provide model sharing and processing capabilities for clinical information systems. Along the lines of IHE integration profiles from other disciplines and the meaningful reuse of routinely recorded patient data, our approach aims for the seamless integration of decision models into hospital infrastructure and the physicians' daily work.

Extending BPM Environments of Your Choice with Performance Related Decision Support

Science.gov (United States)

Fritzsche, Mathias; Picht, Michael; Gilani, Wasif; Spence, Ivor; Brown, John; Kilpatrick, Peter

What-if Simulations have been identified as one solution for business performance related decision support. Such support is especially useful in cases where it can be automatically generated out of Business Process Management (BPM) Environments from the existing business process models and performance parameters monitored from the executed business process instances. Currently, some of the available BPM Environments offer basic-level performance prediction capabilities. However, these functionalities are normally too limited to be generally useful for performance related decision support at business process level. In this paper, an approach is presented which allows the non-intrusive integration of sophisticated tooling for what-if simulations, analytic performance prediction tools, process optimizations or a combination of such solutions into already existing BPM environments. The approach abstracts from process modelling techniques which enable automatic decision support spanning processes across numerous BPM Environments. For instance, this enables end-to-end decision support for composite processes modelled with the Business Process Modelling Notation (BPMN) on top of existing Enterprise Resource Planning (ERP) processes modelled with proprietary languages.

Pediatric advanced life support and sedation of pediatric dental patients

OpenAIRE

Kim, Jongbin

2016-01-01

Programs provided by the Korea Association of Cardiopulmonary Resuscitation include Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Korean Advanced Life Support (KALS). However, programs pertinent to dental care are lacking. Since 2015, related organizations have been attempting to develop a Dental Advanced Life Support (DALS) program, which can meet the needs of the dental environment. Generally, for initial management of emergency ...

Coping with Inflammatory Bowel Disease: Engaging with Information to Inform Health-Related Decision Making in Daily Life.

Science.gov (United States)

Restall, Gayle J; Simms, Alexandria M; Walker, John R; Haviva, Clove; Graff, Lesley A; Sexton, Kathryn A; Miller, Norine; Targownik, Laura E; Bernstein, Charles N

2017-08-01

People with inflammatory bowel disease (IBD) require disease and lifestyle information to make health-related decisions in their daily lives. Derived from a larger qualitative study of the lived experiences of people with IBD, we report on findings that explored how people with IBD engage with health-related information in their daily lives. Participants were recruited primarily from the Manitoba IBD Cohort Study. We used purposive sampling to select people with a breadth of characteristics and experiences. Individual interviews were audio-recorded and transcribed verbatim. Data were analyzed using inductive qualitative methods consistent with a phenomenological approach. Forty-five people with IBD participated; 51% were women. Findings highlighted the temporal and contextual influences on engagement with health-related information. Temporal influences were described as the changing need for health-related information over time. Participants identified 6 contextual factors influencing engagement with information to make health decisions: (1) emotional and attitudinal responses, (2) perceived benefits and risks, (3) trust in the source of the information, (4) knowledge and skills to access and use information, (5) availability of evidence to support decisions, and (6) social and economic environments. Findings illustrate the changing needs for health-related information over the course of IBD, and with evolving health and life circumstances. Practitioners can be responsive to information needs of people with IBD by having high-quality information available at the right time in a variety of formats and by supporting the incorporation of information in daily life.

Operator decision support system for sodium loop

Energy Technology Data Exchange (ETDEWEB)

Lee, Kwang Hyeang; Park, Kyu Ho; Kim, Tak Kon; Jo, Choong Ho; Seong, Kyeong A; Lee, Keon Myeong; Kim, Yeong Dal; Kim, Chang Beom; Kim, Jong Kyu; Jo, Hee Chang; Lee, Ji Hyeong; Jeong, Yoon Soo; Chio, Jong Hyeong; Jeong, Bong Joon; Hong, Joon Seong; Kim, Bong Wan; Seong, Byeong Hak [Korea Advanced Institute Science and Technology, Taejon (Korea, Republic of)

1994-07-01

The objective of this study is to develop an operator decision support system by computerizing the sodium circuit. This study developed graphical display interface for the control panel which provides the safety control of equipment, the recognition of experimental process states and sodium circuit states. In this study, basic work to develop an operator decision support real-time expert system for sodium loop was carried out. Simplification of control commands and effective operation of various real-time data and signals by equipment code standardization are studied. The cost ineffectiveness of the single processor structure provides the ground for the development of cost effective parallel processing system. The important tasks of this study are (1) design and implementation of control state surveillance panel of sodium loop, (2) requirement analysis of operator support real-time expert system for sodium loop, (3) design of standard code rule for operating equipment and research on the cost effective all purpose parallel processing system and (4) requirement analysis of expert system and design of control state variables and user interface for experimental process. 10 refs., 36 figs., 20 tabs.

End-of-life decision making is more than rational.

Science.gov (United States)

Eliott, Jaklin A; Olver, Ian N

2005-01-01

Most medical models of end-of-life decision making by patients assume a rational autonomous adult obtaining and deliberating over information to arrive at some conclusion. If the patient is deemed incapable of this, family members are often nominated as substitutes, with assumptions that the family are united and rational. These are problematic assumptions. We interviewed 23 outpatients with cancer about the decision not to resuscitate a patient following cardiopulmonary arrest and examined their accounts of decision making using discourse analytical techniques. Our analysis suggests that participants access two different interpretative repertoires regarding the construct of persons, invoking a 'modernist' repertoire to assert the appropriateness of someone, a patient or family, making a decision, and a 'romanticist' repertoire when identifying either a patient or family as ineligible to make the decision. In determining the appropriateness of an individual to make decisions, participants informally apply 'Sanity' and 'Stability' tests, assessing both an inherent ability to reason (modernist repertoire) and the presence of emotion (romanticist repertoire) which might impact on the decision making process. Failure to pass the tests respectively excludes or excuses individuals from decision making. The absence of the romanticist repertoire in dominant models of patient decision making has ethical implications for policy makers and medical practitioners dealing with dying patients and their families.

Prioritization of engineering support requests and advanced technology projects using decision support and industrial engineering models

Science.gov (United States)

Tavana, Madjid

1995-01-01

The evaluation and prioritization of Engineering Support Requests (ESR's) is a particularly difficult task at the Kennedy Space Center (KSC) -- Shuttle Project Engineering Office. This difficulty is due to the complexities inherent in the evaluation process and the lack of structured information. The evaluation process must consider a multitude of relevant pieces of information concerning Safety, Supportability, O&M Cost Savings, Process Enhancement, Reliability, and Implementation. Various analytical and normative models developed over the past have helped decision makers at KSC utilize large volumes of information in the evaluation of ESR's. The purpose of this project is to build on the existing methodologies and develop a multiple criteria decision support system that captures the decision maker's beliefs through a series of sequential, rational, and analytical processes. The model utilizes the Analytic Hierarchy Process (AHP), subjective probabilities, the entropy concept, and Maximize Agreement Heuristic (MAH) to enhance the decision maker's intuition in evaluating a set of ESR's.

Life Support Systems: Wastewater Processing and Water Management

Data.gov (United States)

National Aeronautics and Space Administration — Advanced Exploration Systems (AES) Life Support Systems project Wastewater Processing and Water Management task: Within an integrated life support system, water...

Data warehouse based decision support system in nuclear power plants

International Nuclear Information System (INIS)

Nadinic, B.

2004-01-01

Safety is an important element in business decision making processes in nuclear power plants. Information about component reliability, structures and systems, data recorded during the nuclear power plant's operation and outage periods, as well as experiences from other power plants are located in different database systems throughout the power plant. It would be possible to create a decision support system which would collect data, transform it into a standardized form and store it in a single location in a format more suitable for analyses and knowledge discovery. This single location where the data would be stored would be a data warehouse. Such data warehouse based decision support system could help make decision making processes more efficient by providing more information about business processes and predicting possible consequences of different decisions. Two main functionalities in this decision support system would be an OLAP (On Line Analytical Processing) and a data mining system. An OLAP system would enable the users to perform fast, simple and efficient multidimensional analysis of existing data and identify trends. Data mining techniques and algorithms would help discover new, previously unknown information from the data as well as hidden dependencies between various parameters. Data mining would also enable analysts to create relevant prediction models that could predict behaviour of different systems during operation and inspection results during outages. The basic characteristics and theoretical foundations of such decision support system are described and the reasons for choosing a data warehouse as the underlying structure are explained. The article analyzes obvious business benefits of such system as well as potential uses of OLAP and data mining technologies. Possible implementation methodologies and problems that may arise, especially in the field of data integration, are discussed and analyzed.(author)

Designing Tools for Supporting User Decision-Making in e-Commerce

Science.gov (United States)

Sutcliffe, Alistair; Al-Qaed, Faisal

The paper describes a set of tools designed to support a variety of user decision-making strategies. The tools are complemented by an online advisor so they can be adapted to different domains and users can be guided to adopt appropriate tools for different choices in e-commerce, e.g. purchasing high-value products, exploring product fit to users’ needs, or selecting products which satisfy requirements. The tools range from simple recommenders to decision support by interactive querying and comparison matrices. They were evaluated in a scenario-based experiment which varied the users’ task and motivation, with and without an advisor agent. The results show the tools and advisor were effective in supporting users and agreed with the predictions of ADM (adaptive decision making) theory, on which the design of the tools was based.

Decision support tools in conservation: a workshop to improve user-centred design

Directory of Open Access Journals (Sweden)

David Rose

2017-09-01

Full Text Available A workshop held at the University of Cambridge in May 2017 brought developers, researchers, knowledge brokers, and users together to discuss user-centred design of decision support tools. Decision support tools are designed to take users through logical decision steps towards an evidence-informed final decision. Although they may exist in different forms, including on paper, decision support tools are generally considered to be computer- (online, software or app-based. Studies have illustrated the potential value of decision support tools for conservation, and there are several papers describing the design of individual tools. Rather less attention, however, has been placed on the desirable characteristics for use, and even less on whether tools are actually being used in practice. This is concerning because if tools are not used by their intended end user, for example a policy-maker or practitioner, then its design will have wasted resources. Based on an analysis of papers on tool use in conservation, there is a lack of social science research on improving design, and relatively few examples where users have been incorporated into the design process. Evidence from other disciplines, particularly human-computer interaction research, illustrates that involving users throughout the design of decision support tools increases the relevance, usability, and impact of systems. User-centred design of tools is, however, seldom mentioned in the conservation literature. The workshop started the necessary process of bringing together developers and users to share knowledge about how to conduct good user-centred design of decision support tools. This will help to ensure that tools are usable and make an impact in conservation policy and practice.

Cyborg practices: call-handlers and computerised decision support systems in urgent and emergency care.

Science.gov (United States)

Pope, Catherine; Halford, Susan; Turnbull, Joanne; Prichard, Jane

2014-06-01

This article draws on data collected during a 2-year project examining the deployment of a computerised decision support system. This computerised decision support system was designed to be used by non-clinical staff for dealing with calls to emergency (999) and urgent care (out-of-hours) services. One of the promises of computerised decisions support technologies is that they can 'hold' vast amounts of sophisticated clinical knowledge and combine it with decision algorithms to enable standardised decision-making by non-clinical (clerical) staff. This article draws on our ethnographic study of this computerised decision support system in use, and we use our analysis to question the 'automated' vision of decision-making in healthcare call-handling. We show that embodied and experiential (human) expertise remains central and highly salient in this work, and we propose that the deployment of the computerised decision support system creates something new, that this conjunction of computer and human creates a cyborg practice.

Research of Simple Multi-Attribute Rating Technique for Decision Support

Science.gov (United States)

Siregar, Dodi; Arisandi, Diki; Usman, Ari; Irwan, Dedy; Rahim, Robbi

2017-12-01

One of the roles of decision support system is that it can assist the decision maker in obtaining the appropriate alternative with the desired criteria, one of the methods that could apply for the decision maker is SMART method with multicriteria decision making. This multi-criteria decision-making theory has meaning where every alternative has criteria and has value and weight, and the author uses this approach to facilitate decision making with a compelling case. The problems discussed in this paper are classified into problems of a variety Multiobjective (multiple goals to be accomplished) and multicriteria (many of the decisive criteria in reaching such decisions).

A Gaussian decision-support tool for engineering design process

NARCIS (Netherlands)

Rajabali Nejad, Mohammadreza; Spitas, Christos

2013-01-01

Decision-making in design is of great importance, resulting in success or failure of a system (Liu et al., 2010; Roozenburg and Eekels, 1995; Spitas, 2011a). This paper describes a robust decision-support tool for engineering design process, which can be used throughout the design process in either

The value of participatory development to support antimicrobial stewardship with a clinical decision support system

NARCIS (Netherlands)

Beerlage-de Jong, Nienke; Wentzel, Jobke; Hendrix, Ron; van Gemert-Pijnen, Lisette

2017-01-01

Background: Current clinical decision support systems (CDSSs) for antimicrobial stewardship programs (ASPs) are guideline- or expert-driven. They are focused on (clinical) content, not on supporting real-time workflow. Thus, CDSSs fail to optimally support prudent antimicrobial prescribing in daily

The value of participatory development to support antimicrobial stewardship with a clinical decision support system

NARCIS (Netherlands)

Beerlage-de Jong, Nienke; Wentzel, M.J.; Hendrix, Ron; van Gemert-Pijnen, Julia E.W.C.

Background Current clinical decision support systems (CDSSs) for antimicrobial stewardship programs (ASPs) are guideline- or expert-driven. They are focused on (clinical) content, not on supporting real-time workflow. Thus, CDSSs fail to optimally support prudent antimicrobial prescribing in daily

Ethical decision-making near the end of life.

Science.gov (United States)

Finucane, T E; Harper, M

1996-05-01

For ethical decision-making near the end of life, autonomy is the moral North Star. At the same time, for some treatments, the burdens so clearly outweigh benefits that physicians may make a judgment not to offer the treatment. This is often clearer in surgery. A person with colon cancer and metastases may not insist on resection of the metastases. For some reason, some treatments have escaped these logical constraints. Attempted resuscitation of a dying patient is a good example. The circumstances in which a physician may make choices on behalf of a competent, terminally-ill patient without consent, and even without notification, are hotly debated, but data suggest that physicians do so frequently. Patients who lack capacity present even more difficult challenges. Advance directives, when available, can be extremely helpful, but even with them difficult problems can remain. If advance directives have not been established, family and close friends are an obvious source of guidance. Their legal role varies in different jurisdictions; in practice, they are crucial in bedside decision-making. Guardianship and alternatives to it remain a poor last resort. Euthanasia is a very difficult problem. We believe it is semantically misleading to lump under the term "passive euthanasia" those circumstances where potentially life-sustaining treatment is withheld or withdrawn. The tension between patient autonomy and medical common sense remains unresolved within the "futility" controversy. The authors believe it serves no purpose to discuss carefully with dying patients propositions that are nonsense. At the same time, physicians must not confuse decisions about quality of life with judgements about treatment effectiveness. We believe that what many, although not all, dying patients want are physicians with intelligent compassion who can take care of them through the dying process.

Decision Support Model for Introduction of Gamification Solution Using AHP

Science.gov (United States)

2014-01-01

Gamification means the use of various elements of game design in nongame contexts including workplace collaboration, marketing, education, military, and medical services. Gamification is effective for both improving workplace productivity and motivating employees. However, introduction of gamification is not easy because the planning and implementation processes of gamification are very complicated and it needs interdisciplinary knowledge such as information systems, organization behavior, and human psychology. Providing a systematic decision making method for gamification process is the purpose of this paper. This paper suggests the decision criteria for selection of gamification platform to support a systematic decision making process for managements. The criteria are derived from previous works on gamification, introduction of information systems, and analytic hierarchy process. The weights of decision criteria are calculated through a survey by the professionals on game, information systems, and business administration. The analytic hierarchy process is used to derive the weights. The decision criteria and weights provided in this paper could support the managements to make a systematic decision for selection of gamification platform. PMID:24892075

Decision support model for introduction of gamification solution using AHP.

Science.gov (United States)

Kim, Sangkyun

2014-01-01

Gamification means the use of various elements of game design in nongame contexts including workplace collaboration, marketing, education, military, and medical services. Gamification is effective for both improving workplace productivity and motivating employees. However, introduction of gamification is not easy because the planning and implementation processes of gamification are very complicated and it needs interdisciplinary knowledge such as information systems, organization behavior, and human psychology. Providing a systematic decision making method for gamification process is the purpose of this paper. This paper suggests the decision criteria for selection of gamification platform to support a systematic decision making process for managements. The criteria are derived from previous works on gamification, introduction of information systems, and analytic hierarchy process. The weights of decision criteria are calculated through a survey by the professionals on game, information systems, and business administration. The analytic hierarchy process is used to derive the weights. The decision criteria and weights provided in this paper could support the managements to make a systematic decision for selection of gamification platform.

Decision Support Model for Introduction of Gamification Solution Using AHP

Directory of Open Access Journals (Sweden)

Sangkyun Kim

2014-01-01

Full Text Available Gamification means the use of various elements of game design in nongame contexts including workplace collaboration, marketing, education, military, and medical services. Gamification is effective for both improving workplace productivity and motivating employees. However, introduction of gamification is not easy because the planning and implementation processes of gamification are very complicated and it needs interdisciplinary knowledge such as information systems, organization behavior, and human psychology. Providing a systematic decision making method for gamification process is the purpose of this paper. This paper suggests the decision criteria for selection of gamification platform to support a systematic decision making process for managements. The criteria are derived from previous works on gamification, introduction of information systems, and analytic hierarchy process. The weights of decision criteria are calculated through a survey by the professionals on game, information systems, and business administration. The analytic hierarchy process is used to derive the weights. The decision criteria and weights provided in this paper could support the managements to make a systematic decision for selection of gamification platform.

Relational Algebra in Spatial Decision Support Systems Ontologies.

Science.gov (United States)

Diomidous, Marianna; Chardalias, Kostis; Koutonias, Panagiotis; Magnita, Adrianna; Andrianopoulos, Charalampos; Zimeras, Stelios; Mechili, Enkeleint Aggelos

2017-01-01

Decision Support Systems (DSS) is a powerful tool, for facilitates researchers to choose the correct decision based on their final results. Especially in medical cases where doctors could use these systems, to overcome the problem with the clinical misunderstanding. Based on these systems, queries must be constructed based on the particular questions that doctors must answer. In this work, combination between questions and queries would be presented via relational algebra.

Supporting decision-making processes for evidence-based mental health promotion.

Science.gov (United States)

Jané-Llopis, Eva; Katschnig, Heinz; McDaid, David; Wahlbeck, Kristian

2011-12-01

The use of evidence is critical in guiding decision-making, but evidence from effect studies will be only one of a number of factors that will need to be taken into account in the decision-making processes. Equally important for policymakers will be the use of different types of evidence including implementation essentials and other decision-making principles such as social justice, political, ethical, equity issues, reflecting public attitudes and the level of resources available, rather than be based on health outcomes alone. This paper, aimed to support decision-makers, highlights the importance of commissioning high-quality evaluations, the key aspects to assess levels of evidence, the importance of supporting evidence-based implementation and what to look out for before, during and after implementation of mental health promotion and mental disorder prevention programmes.

Investing in deliberation: a definition and classification of decision support interventions for people facing difficult health decisions.

Science.gov (United States)

Elwyn, Glyn; Frosch, Dominick; Volandes, Angelo E; Edwards, Adrian; Montori, Victor M

2010-01-01

This article provides an analysis of 'decision aids', interventions to support patients facing tough decisions. Interest has increased since the concept of shared decision making has become widely considered to be a means of achieving desirable clinical outcomes. We consider the aims of these interventions and examine assumptions about their use. We propose three categories, interventions that are used in face-to-face encounters, those designed for use outside clinical encounters and those which are mediated, using telephone or other communication media. We propose the following definition: decision support interventions help people think about choices they face; they describe where and why choice exists; they provide information about options, including, where reasonable, the option of taking no action. These interventions help people to deliberate, independently or in collaboration with others, about options, by considering relevantattributes; they support people to forecast how they might feel about short, intermediate and long-term outcomes which have relevant consequences, in ways which help the process of constructing preferences and eventual decision making, appropriate to their individual situation. Although quality standards have been published for these interventions, we are also cautious about premature closure and consider that the need for short versions for use inside clinical encounters and long versions for external use requires further research. More work is also needed on the use of narrative formats and the translation of theory into practical designs. The interest in decision support interventions for patients heralds a transformation in clinical practice although many important areas remain unresolved.

Next Generation Life Support Project Status

Science.gov (United States)

Barta, Daniel J.; Chullen, Cinda; Pickering, Karen D.; Cox, Marlon; Towsend, Neil; Campbell, Colin; Flynn, Michael; Wheeler, Raymond

2012-01-01

Next Generation Life Support (NGLS) is one of several technology development projects sponsored by NASA s Game Changing Development Program. The NGLS Project is developing life support technologies (including water recovery and space suit life support technologies) needed for humans to live and work productively in space. NGLS has three project tasks: Variable Oxygen Regulator (VOR), Rapid Cycle Amine (RCA) swing bed, and Alternative Water Processor (AWP). The RCA swing bed and VOR tasks are directed at key technology needs for the Portable Life Support System (PLSS) for an Advanced Extravehicular Mobility Unit, with focus on test article development and integrated testing in an Advanced PLSS in cooperation with the Advanced Extra Vehicular Activity (EVA) Project. An RCA swing-bed provides integrated carbon dioxide removal and humidity control that can be regenerated in real time during an EVA. The VOR technology will significantly increase the number of pressure settings available to the space suit. Current space suit pressure regulators are limited to only two settings whereas the adjustability of the advanced regulator will be nearly continuous. The AWP effort, based on natural biological processes and membrane-based secondary treatment, will result in the development of a system capable of recycling wastewater from sources expected in future exploration missions, including hygiene and laundry water. This paper will provide a status of technology development activities and future plans.

Exploring the impact of a decision support intervention on vascular access decisions in chronic hemodialysis patients: study protocol

Directory of Open Access Journals (Sweden)

Donnelly Sandra

2011-02-01

Full Text Available Abstract Background In patients with Stage 5 Chronic Kidney Disease who require renal replacement therapy a major decision concerns modality choice. However, many patients defer the decision about modality choice or they have an urgent or emergent need of RRT, which results in them starting hemodialysis with a Central Venous Catheter. Thereafter, efforts to help patients make more timely decisions about access choices utilizing education and resource allocation strategies met with limited success resulting in a high prevalent CVC use in Canada. Providing decision support tailored to meet patients' decision making needs may improve this situation. The Registered Nurses Association of Ontario has developed a clinical practice guideline to guide decision support for adults living with Chronic Kidney Disease (Decision Support for Adults with Chronic Kidney Disease. The purpose of this study is to determine the impact of implementing selected recommendations this guideline on priority provincial targets for hemodialysis access in patients with Stage 5 CKD who currently use Central Venous Catheters for vascular access. Methods/Design A non-experimental intervention study with repeated measures will be conducted at St. Michaels Hospital in Toronto, Canada. Decisional conflict about dialysis access choice will be measured using the validated SURE tool, an instrument used to identify decisional conflict. Thereafter a tailored decision support intervention will be implemented. Decisional conflict will be re-measured and compared with baseline scores. Patients and staff will be interviewed to gain an understanding of how useful this intervention was for them and whether it would be feasible to implement more widely. Quantitative data will be analyzed using descriptive and inferential statistics. Statistical significance of difference between means over time for aggregated SURE scores (pre/post will be assessed using a paired t-test. Qualitative analysis

Enhanced health E-decision literacy via interactive multi-criterial support

DEFF Research Database (Denmark)

Kaltoft, Mette Kjer; Almeida, J.; Moncho Mas, Vicent

Healthcare lacks a generic language for decisional communication. We aim to enhance health decision literacy via specific e-decision support. Given the multi-criterial, preference-sensitive nature of decision-making, we implement the Multi-Criteria Decision Analysis (MCDA) technique online...... in an interactive and visual template (Annalisa), developing decision-specific tools at the clinical/personal and group/policy levels. Our current nationally funded project on bone health caters for home-prepared, informed and preference-based consent and taps into existing e-health infrastructures towards person...

Design and realization of tourism spatial decision support system based on GIS

Science.gov (United States)

Ma, Zhangbao; Qi, Qingwen; Xu, Li

2008-10-01

In this paper, the existing problems of current tourism management information system are analyzed. GIS, tourism as well as spatial decision support system are introduced, and the application of geographic information system technology and spatial decision support system to tourism management and the establishment of tourism spatial decision support system based on GIS are proposed. System total structure, system hardware and software environment, database design and structure module design of this system are introduced. Finally, realization methods of this systemic core functions are elaborated.

The analytic hierarchy process as a support for decision making

Directory of Open Access Journals (Sweden)

Filipović Milanka

2007-01-01

Full Text Available The first part of this text deals with a convention site selection as one of the most lucrative areas in the tourism industry. The second part gives a further description of a method for decision making - the analytic hierarchy process. The basic characteristics: hierarchy constructions and pair wise comparison on the given level of the hierarchy are allured. The third part offers an example of application. This example is solved using the Super - Decision software, which is developed as a computer support for the analytic hierarchy process. This indicates that the AHP approach is a useful tool to help support a decision of convention site selection. .

Learning to Control Advanced Life Support Systems

Science.gov (United States)

Subramanian, Devika

2004-01-01

Advanced life support systems have many interacting processes and limited resources. Controlling and optimizing advanced life support systems presents unique challenges. In particular, advanced life support systems are nonlinear coupled dynamical systems and it is difficult for humans to take all interactions into account to design an effective control strategy. In this project. we developed several reinforcement learning controllers that actively explore the space of possible control strategies, guided by rewards from a user specified long term objective function. We evaluated these controllers using a discrete event simulation of an advanced life support system. This simulation, called BioSim, designed by Nasa scientists David Kortenkamp and Scott Bell has multiple, interacting life support modules including crew, food production, air revitalization, water recovery, solid waste incineration and power. They are implemented in a consumer/producer relationship in which certain modules produce resources that are consumed by other modules. Stores hold resources between modules. Control of this simulation is via adjusting flows of resources between modules and into/out of stores. We developed adaptive algorithms that control the flow of resources in BioSim. Our learning algorithms discovered several ingenious strategies for maximizing mission length by controlling the air and water recycling systems as well as crop planting schedules. By exploiting non-linearities in the overall system dynamics, the learned controllers easily out- performed controllers written by human experts. In sum, we accomplished three goals. We (1) developed foundations for learning models of coupled dynamical systems by active exploration of the state space, (2) developed and tested algorithms that learn to efficiently control air and water recycling processes as well as crop scheduling in Biosim, and (3) developed an understanding of the role machine learning in designing control systems for

Life Support with Failures and Variable Supply

Science.gov (United States)

Jones, Harry

2010-01-01

The life support system for long duration missions will recycle oxygen and water to reduce the material resupply mass from Earth. The impact of life support failures was investigated by dynamic simulation of a lunar outpost habitat life support model. The model was modified to simulate resupply delays, power failures, recycling system failures, and storage failures. Many failures impact the lunar outpost water supply directly or indirectly, depending on the water balance and water storage. Failure effects on the water supply are reduced if Extra Vehicular Activity (EVA) water use is low and the water supply is ample. Additional oxygen can be supplied by scavenging unused propellant or by production from regolith, but the amounts obtained can vary significantly. The requirements for oxygen and water can also vary significantly, especially for EVA. Providing storage buffers can improve efficiency and reliability, and minimize the chance of supply failing to meet demand. Life support failures and supply variations can be survivable if effective solutions are provided by the system design

Quality of Living and Dying: Pediatric Palliative Care and End-of-Life Decisions in the Netherlands.

Science.gov (United States)

Brouwer, Marije; Maeckelberghe, Els; DE Weerd, Willemien; Verhagen, Eduard

2018-07-01

In 2002, The Netherlands continued its leadership in developing rules and jurisdiction regarding euthanasia and end-of-life decisions by implementing the Euthanasia Act, which allows euthanasia for patients 12 years of age and older. Subsequently, in 2005, the regulation on active ending of life for newborns was issued. However, more and more physicians and parents have stated that the age gap between these two regulations-children between 1 and 12 years old-is undesirable. These children should have the same right to end their suffering as adults and newborn infants. An extended debate on pediatric euthanasia ensued, and currently the debate is ongoing as to whether legislation should be altered in order to allow pediatric euthanasia. An emerging major question regards the active ending of life in the context of palliative care: How does a request for active ending of life relate to the care that is given to children in the palliative phase? Until now, the distinction between palliative care and end-of-life decisions continues to remain unclear, making any discussion about their mutual in- and exclusiveness hazardous at best. In this report, therefore, we aim to provide insight into the relationship between pediatric palliative care and end-of-life decisions, as understood in the Netherlands. We do so by first providing an overview of the (legal) rules and regulations regarding euthanasia and active ending of life, followed by an analysis of the relationship between these two, using the Dutch National Guidelines for Palliative Care for Children. The results of this analysis revealed two major and related features of palliative care and end-of-life decisions for children: (1) palliative care and end-of-life decisions are part of the same process, one that focuses both on quality of living and quality of dying, and (2) although physicians are seen as ultimately responsible for making end-of-life decisions, the involvement of parents and children in this decision is

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

Advanced Cardiac Life Support.

Science.gov (United States)

Kirkwood Community Coll., Cedar Rapids, IA.

This document contains materials for an advanced college course in cardiac life support developed for the State of Iowa. The course syllabus lists the course title, hours, number, description, prerequisites, learning activities, instructional units, required text, six references, evaluation criteria, course objectives by units, course…

Negotiated reorienting: a grounded theory of nurses' end-of-life decision-making in the intensive care unit.

Science.gov (United States)

Gallagher, Ann; Bousso, Regina Szylit; McCarthy, Joan; Kohlen, Helen; Andrews, Tom; Paganini, Maria Cristina; Abu-El-Noor, Nasser Ibrahim; Cox, Anna; Haas, Margit; Arber, Anne; Abu-El-Noor, Mysoon Khalil; Baliza, Michelle Freire; Padilha, Katia Grillo

2015-04-01

Intensive care units (ICUs) focus on treatment for those who are critically ill and interventions to prolong life. Ethical issues arise when decisions have to be made regarding the withdrawal and withholding of life-sustaining treatment and the shift to comfort and palliative care. These issues are particularly challenging for nurses when there are varying degrees of uncertainty regarding prognosis. Little is known about nurses' end-of-life (EoL) decision-making practice across cultures. To understand nurses' EoL decision-making practices in ICUs in different cultural contexts. We collected and analysed qualitative data using Grounded Theory. Interviews were conducted with experienced ICU nurses in university or hospital premises in five countries: Brazil, England, Germany, Ireland and Palestine. Semi-structured interviews were conducted with 51 nurses (10 in Brazil, 9 in England, 10 in Germany, 10 in Ireland and 12 nurses in Palestine). They were purposefully and theoretically selected to include nurses having a variety of characteristics and experiences concerning end-of-life (EoL) decision-making. The study used grounded theory to inform data collection and analysis. Interviews were facilitated by using key questions. The comparative analysis of the data within and across data generated by the different research teams enabled researchers to develop a deeper understanding of EoL decision-making practices in the ICU. Ethical approval was granted in each of the participating countries and voluntary informed consent obtained from each participant. The core category that emerged was 'negotiated reorienting'. Whilst nurses do not make the 'ultimate' EoL decisions, they engage in two core practices: consensus seeking (involving coaxing, information cuing and voice enabling); and emotional holding (creating time-space and comfort giving). There was consensus regarding the core concept and core practices employed by nurses in the ICUs in the five countries. However

Decision support models for natural gas dispatch

Energy Technology Data Exchange (ETDEWEB)

Chin, L. (Bentley College, Waltham, MA (United States)); Vollmann, T.E. (International Inst. for Management Development, Lausanne (Switzerland))

A decision support model is presented which will give utilities the support tools to manage the purchasing of natural gas supplies in the most cost effective manner without reducing winter safety stocks to below minimum levels. In Business As Usual (BAU) purchasing quantities vary with the daily forecasts. With Material Requirements Planning (MRP) and Linear Programming (LP), two types of factors are used: seasonal weather and decision rule. Under current practices, BAU simulation uses the least expensive gas source first, then adding successively more expensive sources. Material Requirements Planning is a production planning technique which uses a parent item master production schedule to determine time phased requirements for component points. Where the MPS is the aggregate gas demand forecasts for the contract year. This satisfies daily demand with least expensive gas and uses more expensive when necessary with automatic computation of available-to-promise (ATP) gas a dispacher knows daily when extra gas supplies may be ATP. Linear Programming is a mathematical algorithm used to determine optimal allocations of scarce resources to achieve a desired result. The LP model determines optimal daily gas purchase decisions with respect to supply cost minimization. Using these models, it appears possible to raise gross income margins 6 to 10% with minimal additions of customers and no new gas supply.

Decision support models for natural gas dispatch

International Nuclear Information System (INIS)

Chin, L.; Vollmann, T.E.

1992-01-01

A decision support model is presented which will give utilities the support tools to manage the purchasing of natural gas supplies in the most cost effective manner without reducing winter safety stocks to below minimum levels. In Business As Usual (BAU) purchasing quantities vary with the daily forecasts. With Material Requirements Planning (MRP) and Linear Programming (LP), two types of factors are used: seasonal weather and decision rule. Under current practices, BAU simulation uses the least expensive gas source first, then adding successively more expensive sources. Material Requirements Planning is a production planning technique which uses a parent item master production schedule to determine time phased requirements for component points. Where the MPS is the aggregate gas demand forecasts for the contract year. This satisfies daily demand with least expensive gas and uses more expensive when necessary with automatic computation of available-to-promise (ATP) gas a dispacher knows daily when extra gas supplies may be ATP. Linear Programming is a mathematical algorithm used to determine optimal allocations of scarce resources to achieve a desired result. The LP model determines optimal daily gas purchase decisions with respect to supply cost minimization. Using these models, it appears possible to raise gross income margins 6 to 10% with minimal additions of customers and no new gas supply

Decision support for integrated water-energy planning.

Energy Technology Data Exchange (ETDEWEB)

Tidwell, Vincent Carroll; Malczynski, Leonard A.; Kobos, Peter Holmes; Castillo, Cesar; Hart, William Eugene; Klise, Geoffrey T.

2009-10-01

Currently, electrical power generation uses about 140 billion gallons of water per day accounting for over 39% of all freshwater withdrawals thus competing with irrigated agriculture as the leading user of water. Coupled to this water use is the required pumping, conveyance, treatment, storage and distribution of the water which requires on average 3% of all electric power generated. While water and energy use are tightly coupled, planning and management of these fundamental resources are rarely treated in an integrated fashion. Toward this need, a decision support framework has been developed that targets the shared needs of energy and water producers, resource managers, regulators, and decision makers at the federal, state and local levels. The framework integrates analysis and optimization capabilities to identify trade-offs, and 'best' alternatives among a broad list of energy/water options and objectives. The decision support framework is formulated in a modular architecture, facilitating tailored analyses over different geographical regions and scales (e.g., national, state, county, watershed, NERC region). An interactive interface allows direct control of the model and access to real-time results displayed as charts, graphs and maps. Ultimately, this open and interactive modeling framework provides a tool for evaluating competing policy and technical options relevant to the energy-water nexus.

The {open_quotes}leak-before-break{close_quotes} applicability in decision support system {open_quotes}strength{close_quotes}

Energy Technology Data Exchange (ETDEWEB)

Torop, V.M.; Orynyak, I.V. [Institute for Problems of Strength, Kiev (Ukraine); Kutovoy, O.L. [Institute of Structure Integrity, Kiev (Ukraine)

1997-04-01

A software decision support system, STRENGTH, for application of leak before break analysis, is described. The background methodology and sample application are outlined. The program allows multioptional computation of loading parameters for different types of defects, and variable properties for metals and welded joints. Structural strength is assessed, and service life predictions are made. The program is used to analyze specific defects identified by nondestructive testing.

Factors That Impact End-of-Life Decision Making in African Americans With Advanced Cancer

Science.gov (United States)

Campbell, Cathy L.; Williams, Ishan C.; Orr, Tamara

2013-01-01

Significance African Americans with cancer are less likely to use hospice services and more likely to die in the hospital than white patients with the same diagnosis. However, there is much that is not understood about the factors that lead African Americans to choose options for end-of-life care. Design A qualitative, descriptive design was used in this pilot study. Methods Interviews were conducted with two groups of African Americans with advanced-stage cancer (people enrolled in hospice and those who were not under hospice care). Findings End-of-life decisions were primarily guided by clinical factors, the patient-related physical, emotional, and cognitive symptoms that are sequelae of the underlying disease or medical treatments. The physician was the healthcare provider most likely to be involved in decision making with patients, family members, and caregivers. Individual factors, such as personal beliefs, influenced end-of-life decision making. Religion and spirituality were a topic in many interviews, but they did not consistently influence decision making. Discussion Future studies should include interviews with family members, caregivers, and healthcare professionals so that factors that impact end-of-life decision making can be fully described. Strategies to facilitate recruitment will need to be added to future protocols. PMID:23645999