Data driven and practice-based evidence : design and development of efficient and effective clinical decision support system

Decision-making is such an integral aspect in health care routine that the ability to make the right decisions at crucial moments can lead to patient health improvements. Evidence-based practice, the paradigm used to make those informed decisions, relies on the use of current best evidence from systematic research such as randomized controlled trials. Limitations of the outcomes from randomized controlled trials (RCT), such as “quantity” and “quality” of evidence generated, has lowered healthcare professionals’ confidence in using EBP. An alternate paradigm of Practice-Based Evidence has evolved with the key being evidence drawn from practice settings. Through the use of health information technology, electronic health records (EHR) capture relevant clinical practice “evidence”. A data-driven approach is proposed to capitalize on the benefits of EHR. The issues of data privacy, security and integrity are diminished by an information accountability concept. Data warehouse architecture completes the data-driven approach by integrating health data from multi-source systems, unique within the healthcare environment.

Effective communication during disasters: What effects community decision making & action?

Study/Objective This paper describes a program of research examining emergency messaging during the response and early recovery phases of natural disasters. The objective of this suite of studies is to develop message construction frameworks and channels that maximise community compliance with instructional messaging. The research has adopted a multi-hazard approach and considers the impact of formal emergency messages, as well as informal messages (e.g., social media posts), on community compliance. Background In recent years, media reports have consistently demonstrated highly variable community compliance to instructional messaging during natural disasters. Footage of individuals watching a tsunami approaching from the beach or being over-run by floodwaters are disturbing and indicate the need for a clearer understanding of decision making under stress. This project’s multi-hazard approach considers the time lag between knowledge of the event and desired action, as well as how factors such as message fatigue, message ambiguity, and the interplay of messaging from multiple media sources are likely to play a role in an individual’s compliance with an emergency instruction. Methods To examine effective messaging strategy, we conduct a critical analysis of the literature to develop a framework for community consultation and design experiments to test the potential for compliance improvement. Results Preliminary results indicate that there is, as yet, little published evidence on which to base decisions about emergency instructional messages to threatened communities. Conclusion The research described here will contribute improvements in emergency instructional message compliance by generating an evidence-based framework that takes into account behavioural compliance theory, the psychology of decision making under stress, and multiple channels of communication including social media.

School based experiences as contributors to career decision-making: Findings from a cross-sectional survey of high-school students

This paper is based on a study examining the impact of young people’s backgrounds and educational experiences on career choice capability with the aim of informing education policy. A total of 706 students from secondary schools (Years 9-12) in New South Wales, Australia took part in an online survey. This paper focuses on the differences found between groups on the basis of their educational experiences. Participants who were uncertain of their future career plans were more likely to attend non-selective, non-metropolitan schools and were more likely to hold negative attitudes towards school. Career ‘uncertain’ students were also less likely to be satisfied with the elective subjects offered at their school and reported less access to career education sessions. It is concluded that timely career information and guidance should be provided to students and their families in order to allow them to more meaningfully make use of the resources and opportunities available to them with a view toward converting these into real world benefits.

Sartrean existentialism and ethical decision-making in business

A wide range of decision-making models have been offered to assist in making ethical decisions in the workplace. Those that are based on normative moral frameworks typically include elements of traditional moral philosophy such as consequentialist and/or deontological␣ethics. This paper suggests an alternative model drawing on Jean-Paul Sartre’s existentialism. Accordingly, the model focuses on making decisions in full awareness of one’s freedom and responsibility. The steps of the model are intended to encourage reflection of one’s projects and one’s situation and the possibility of refusing the expectations of others. A case study involving affirmative action in South Africa is used to demonstrate the workings of the model and a number of strengths and weaknesses are identified. Despite several weaknesses that can be raised regarding existential ethics, the model’s success lies in the way that it reframes ethical dilemmas in terms of individual freedom and responsibility, and in its acceptance and analysis of subjective experiences and personal situations

Competitive Smart Cities through Healthy Decision-making

This chapter examines the challenges and opportunities associated with planning for competitive, smart and healthy cities. The chapter is based on the assumptions that a healthy city is an important prerequisite for a competitive city and a fundamental outcome of smart cities. Thus, it is preeminent to understand the planning decision support system based on local determinants of health, economic and social factors. One of the major decision support systems is e-health and this chapter will focus on the role of e-health planning, by utilising web-based geographic decision support systems. The proposed novel decision support system would provide a powerful and effective platform for stakeholders to access online information for a better decision-making while empowering community participation. The chapter also highlights the need for a comprehensive conceptual framework to guide the decision process of planning for healthy cities in association with opportunities and limitations. In summary, this chapter provides the critical insights of using information science-based framework and suggest online decision support methods, as part of a broader e-health approach for creating a healthy, competitive and smart city.

The influence of financial risk tolerance and risk perception on individual investment decision-making in a financial advice context

The aim of this thesis is to examine how risk tolerance and risk perception, two important but often misunderstood constructs, jointly influence client investment decisions in a financial advice context. By distinguishing the roles of these two risk constructs in client decision-making, in this thesis a new direction in studying financial/investment risks is provided while practice and regulation in the financial services industry is potentially informed. Based on the literature relating to risks and individual decision-making, a theoretical framework is developed and relevant hypotheses are tested in two studies with financial adviser clients in Australia. Results reveal that financial risk tolerance influences asset allocation both directly and indirectly through risk perception. The intervening role of risk perception suggests that risk tolerance affects how clients perceive the riskiness of an investment product which influences client decision-making.

Design and evaluation of decision and control strategies for autonomous vision-based see and avoid systems

This paper details the design and performance assessment of a unique collision avoidance decision and control strategy for autonomous vision-based See and Avoid systems. The general approach revolves around re-positioning a collision object in the image using image-based visual servoing, without estimating range or time to collision. The decision strategy thus involves determining where to move the collision object, to induce a safe avoidance manuever, and when to cease the avoidance behaviour. These tasks are accomplished by exploiting human navigation models, spiral motion properties, expected image feature uncertainty and the rules of the air. The result is a simple threshold based system that can be tuned and statistically evaluated by extending performance assessment techniques derived for alerting systems. Our results demonstrate how autonomous vision-only See and Avoid systems may be designed under realistic problem constraints, and then evaluated in a manner consistent to aviation expectations.

Using decision trees to understand structure in missing data

Objectives Demonstrate the application of decision trees – classification and regression trees (CARTs), and their cousins, boosted regression trees (BRTs) – to understand structure in missing data. Setting Data taken from employees at three different industry sites in Australia. Participants 7915 observations were included. Materials and Methods The approach was evaluated using an occupational health dataset comprising results of questionnaires, medical tests, and environmental monitoring. Statistical methods included standard statistical tests and the ‘rpart’ and ‘gbm’ packages for CART and BRT analyses, respectively, from the statistical software ‘R’. A simulation study was conducted to explore the capability of decision tree models in describing data with missingness artificially introduced. Results CART and BRT models were effective in highlighting a missingness structure in the data, related to the Type of data (medical or environmental), the site in which it was collected, the number of visits and the presence of extreme values. The simulation study revealed that CART models were able to identify variables and values responsible for inducing missingness. There was greater variation in variable importance for unstructured compared to structured missingness. Discussion Both CART and BRT models were effective in describing structural missingness in data. CART models may be preferred over BRT models for exploratory analysis of missing data, and selecting variables important for predicting missingness. BRT models can show how values of other variables influence missingness, which may prove useful for researchers. Conclusion Researchers are encouraged to use CART and BRT models to explore and understand missing data.

Effective clinical decision-making from practice-based evidence

This is an ongoing research investigating the use of health information technologies (HIT) to improve clinical decision-making processes. Effective and timely clinical decision-making can lead to positive improvements in patient’s health outcome...

Perfusion fMRI evidence for priming of shared feature-to-lexical connections during cumulative semantic interference in spoken word production

The speed at which target pictures are named increases monotonically as a function of prior retrieval of other exemplars of the same semantic category and is unaffected by the number of intervening items. This cumulative semantic interference effect is generally attributed to three mechanisms: shared feature activation, priming and lexical-level selection. However, at least two additional mechanisms have been proposed: (1) a 'booster' to amplify lexical-level activation and (2) retrieval-induced forgetting (RIF). In a perfusion functional Magnetic Resonance Imaging (fMRI) experiment, we tested hypotheses concerning the involvement of all five mechanisms. Our results demonstrate that the cumulative interference effect is associated with perfusion signal changes in the left perirhinal and middle temporal cortices that increase monotonically according to the ordinal position of exemplars being named. The left inferior frontal gyrus (LIFG) also showed significant perfusion signal changes across ordinal presentations; however, these responses did not conform to a monotonically increasing function. None of the cerebral regions linked with RIF in prior neuroimaging and modelling studies showed significant effects. This might be due to methodological differences between the RIF paradigm and continuous naming as the latter does not involve practicing particular information. We interpret the results as indicating priming of shared features and lexical-level selection mechanisms contribute to the cumulative interference effect, while adding noise to a booster mechanism could account for the pattern of responses observed in the LIFG.

The roles of shared vs. Distinctive conceptual features in lexical access

Contemporary models of spoken word production assume conceptual feature sharing determines the speed with which objects are named in categorically-related contexts. However, statistical models of concept representation have also identified a role for feature distinctiveness, i.e., features that identify a single concept and serve to distinguish it quickly from other similar concepts. In three experiments we investigated whether distinctive features might explain reports of counter-intuitive semantic facilitation effects in the picture word interference (PWI) paradigm. In Experiment 1, categorically-related distractors matched in terms of semantic similarity ratings (e.g., zebra and pony) and manipulated with respect to feature distinctiveness (e.g., a zebra has stripes unlike other equine species) elicited interference effects of comparable magnitude. Experiments 2 and 3 investigated the role of feature distinctiveness with respect to reports of facilitated naming with part-whole distractor-target relations (e.g., a hump is a distinguishing part of a CAMEL, whereas knee is not, vs. an unrelated part such as plug). Related part distractors did not influence target picture naming latencies significantly when the part denoted by the related distractor was not visible in the target picture (whether distinctive or not; Experiment 2). When the part denoted by the related distractor was visible in the target picture, non-distinctive part distractors slowed target naming significantly at SOA of -150 ms (Experiment 3). Thus, our results show that semantic interference does occur for part-whole distractor-target relations in PWI, but only when distractors denote features shared with the target and other category exemplars. We discuss the implications of these results for some recently developed, novel accounts of lexical access in spoken word production.

Engaging decision makers in the business case for biophilic urbanism

The cognitive benefits of biophilia have been studied quite extensively, dating as far back as the 1980s, while studies into economic benefits are still in their infancy. Recent research has attempted to quantify a number of economic returns on biophilic elements; however knowledge in this field is still ad hoc and highly variable. Many studies acknowledge difficulties in discerning information such as certain social and aesthetic benefits. While conceptual understanding of the physiological and psychological effects of exposure to nature is widely recognised and understood, this has not yet been systematically translated into monetary terms. It is clear from the literature that further research is needed to both obtain data on the economics of biophilic urbanism, and to create the business case for biophilic urbanism. With this in mind, this paper will briefly highlight biophilic urbanism referencing previous work in the field. It will then explore a number of emergent gaps in the measurable economic understanding of these elements and suggest opportunities for engaging decision makers in the business case for biophilic urbanism. The paper concludes with recommendations for moving forward through targeted research and economic analysis.

The role of emotions in service customer decision-making

This chapter explains how customers make purchase decisions and how these decisions are influenced not only by the service marketer but also by the customers own emotions. While decision-making is described from the perspective of purchasing services rather than purchasing goods, we challenge the traditional notion that customers make informed, rational and well-thought-out decisions. Rather customers are often driven by subjective feelings such as emotions. We present evidence of how these emotions influence the behavior of customers, their attitudes and evaluation of the service, as well as final decision-making processes.

A decision-analysis-based framework for analysing stakeholder behaviour in scenario planning

Scenario planning is a method widely used by strategic planners to address uncertainty about the future. However, current methods either fail to address the future behaviour and impact of stakeholders or they treat the role of stakeholders informally. We present a practical decision-analysis-based methodology for analysing stakeholder objectives and likely behaviour within contested unfolding futures. We address issues of power, interest, and commitment to achieve desired outcomes across a broad stakeholder constituency. Drawing on frameworks for corporate social responsibility (CSR), we provide an illustrative example of our approach to analyse a complex contested issue that crosses geographic, organisational and cultural boundaries. Whilst strategies can be developed by individual organisations that consider the interests of others – for example in consideration of an organisation's CSR agenda – we show that our augmentation of scenario method provides a further, nuanced, analysis of the power and objectives of all concerned stakeholders across a variety of unfolding futures. The resulting modelling framework is intended to yield insights and hence more informed decision making by individual stakeholders or regulators.