Exercise Prescription for Patients with Non-specific Chronic Low Back Pain: a Qualitative Study of Patients' Experiences in Decision Making

Background The culture of current clinical practice calls for collaboration between therapists and patients, sharing power and responsibility. This paper reports on the findings of a qualitative study of exercise prescription for patients with NSCLBP, taking into account issues such as decision making and how this accords with patient preferences and experiences. Objective To understand the treatment decision making experiences, information and decision support needs of patients with NSCLBP who have been offered exercise as part of their management plan. Design A qualitative study using a philosophical hermeneutic approach. Methods Semi-structured interviews with eight patients (including use of brief patient vignettes) was undertaken to explore their personal experiences of receiving exercise as part of the management of their NSCLBP, and their involvement in decisions regarding their care. Findings The findings provide a detailed insight into patients’ perceptions and experiences of receiving exercise-based management strategies. Four themes were formed from the texts: (1) patients’ expectations and patients’ needs are not synonymous, (2) information is necessary but often not sufficient, (3) not all decisions need to be shared, and (4) wanting to be treated as an individual. Conclusions Shared decision making did not appear to happen in physiotherapy clinical practice, but equally may not be what every patient wants. The overall feeling of the patients was that the therapist was dominant in structuring the interactions, leaving the patients feeling disempowered to question and contribute to the decision making.

Decision making models embedded into a web-based tool for assessing pest infestation risk

Current practices in agricultural management involve the application of rules and techniques to ensure high quality and environmentally friendly production. Based on their experience, agricultural technicians and farmers make critical decisions affecting crop growth while considering several interwoven agricultural, technological, environmental, legal and economic factors. In this context, decision support systems and the knowledge models that support them, enable the incorporation of valuable experience into software systems providing support to agricultural technicians to make rapid and effective decisions for efficient crop growth. Pest control is an important issue in agricultural management due to crop yield reductions caused by pests and it involves expert knowledge. This paper presents a formalisation of the pest control problem and the workflow followed by agricultural technicians and farmers in integrated pest management, the crop production strategy that combines different practices for growing healthy crops whilst minimising pesticide use. A generic decision schema for estimating infestation risk of a given pest on a given crop is defined and it acts as a metamodel for the maintenance and extension of the knowledge embedded in a pest management decision support system which is also presented. This software tool has been implemented by integrating a rule-based tool into web-based architecture. Evaluation from validity and usability perspectives concluded that both agricultural technicians and farmers considered it a useful tool in pest control, particularly for training new technicians and inexperienced farmers.

Natural Language Generation enhances human decision-making with uncertain information.

Decision-making is often dependent on uncertain data, e.g. data associated with confidence scores or probabilities. We present a comparison of different informa- tion presentations for uncertain data and, for the first time, measure their effects on human decision-making. We show that the use of Natural Language Genera- tion (NLG) improves decision-making un- der uncertainty, compared to state-of-the- art graphical-based representation meth- ods. In a task-based study with 442 adults, we found that presentations using NLG lead to 24% better decision-making on av- erage than the graphical presentations, and to 44% better decision-making when NLG is combined with graphics. We also show that women achieve significantly better re- sults when presented with NLG output (an 87% increase on average compared to graphical presentations).

'Artificial Immune Systems: A new Decision Making Paradigm for Operational Research'

Over the last few years, more and more heuristic decision making techniques have been inspired by nature, e.g. evolutionary algorithms, ant colony optimisation and simulated annealing. More recently, a novel computational intelligence technique inspired by immunology has emerged, called Artificial Immune Systems (AIS). This immune system inspired technique has already been useful in solving some computational problems. In this keynote, we will very briefly describe the immune system metaphors that are relevant to AIS. We will then give some illustrative real-world problems suitable for AIS use and show a step-by-step algorithm walkthrough. A comparison of AIS to other well-known algorithms and areas for future work will round this keynote off. It should be noted that as AIS is still a young and evolving field, there is not yet a fixed algorithm template and hence actual implementations might differ somewhat from the examples given here

The relationship between health literacy and indicators of informed decision making for colorectal cancer screening among African Americans

African Americans are disproportionately affected by colorectal cancer (CRC) incidence and mortality. CRC early detection leads to better treatment outcomes and, depending on the screening test, can prevent the development of CRC. African Americans, however, are screened less often than Whites. Aspects of decision making (e.g., decisional conflict, decision self-efficacy) can impact decision making outcomes and may be influenced by social determinants of health, including health literacy. However the relationship between social determinants of health and indicators of decision making in this population is not fully understood. Additionally, individuals have a choice between different CRC screening tests and an individual’s desire to use a particular screening test may be associated with social determinants of health such as health literacy. This study aimed to examine the relationship between social determinants of health and indicators of decision making for CRC screening among African Americans. A total of 111 participants completed a baseline and 14-month follow-up survey assessing decisional conflict, decision self-efficacy, decisional preference (shared versus informed decision making), and CRC test preference. Health literacy was negatively associated with decisional conflict and positively associated with decision self-efficacy (ps < .05). Individuals who were unemployed or working part-time had significantly greater decisional conflict than individuals working full-time (ps < .05). Individuals with a first-degree family history of CRC had significantly lower decision self-efficacy than individuals without a family history (p < .05). Women were significantly more likely to prefer making a shared decision rather than an informed decision compared to men (p < .05). Lastly, previous CRC screening behavior was significantly associated with CRC test preference (e.g., individuals previously screened using colonoscopy were significantly more likely to prefer colonoscopy for their next screening test; ps < .05). These findings begin to identify social determinants of health (e.g., health literacy, employment) that are related to indicators of decision making for CRC among African Americans. Furthermore, these findings suggest further research is needed to better understand these relationships to help with the future development and improvement of interventions targeting decision making outcomes for CRC screening in this population.

A New Paradigm for Heuristic Decision Making, Invited Keynote Talk

Over the last few years, more and more heuristic decision making techniques have been inspired by nature, e.g. evolutionary algorithms, ant colony optimisation and simulated annealing. More recently, a novel computational intelligence technique inspired by immunology has emerged, called Artificial Immune Systems (AIS). This immune system inspired technique has already been useful in solving some computational problems. In this keynote, we will very briefly describe the immune system metaphors that are relevant to AIS. We will then give some illustrative real-world problems suitable for AIS use and show a step-by-step algorithm walkthrough. A comparison of AIS to other well-known algorithms and areas for future work will round this keynote off. It should be noted that as AIS is still a young and evolving field, there is not yet a fixed algorithm template and hence actual implementations might differ somewhat from the examples given here.

Using an end-of-life care pathway in acute stroke: a mixed methods study of decision-making and care experiences

Background: The evidence base on end-of-life care in acute stroke is limited, particularly with regard to recognising dying and related decision-making. There is also limited evidence to support the use of end-of-life care pathways (standardised care plans) for patients who are dying after stroke. Aim: This study aimed to explore the clinical decision-making involved in placing patients on an end-of-life care pathway, evaluate predictors of care pathway use, and investigate the role of families in decision-making. The study also aimed to examine experiences of end-of-life care pathway use for stroke patients, their relatives and the multi-disciplinary health care team. Methods: A mixed methods design was adopted. Data were collected in four Scottish acute stroke units. Case-notes were identified prospectively from 100 consecutive stroke deaths and reviewed. Multivariate analysis was performed on case-note data. Semi-structured interviews were conducted with 17 relatives of stroke decedents and 23 healthcare professionals, using a modified grounded theory approach to collect and analyse data. The VOICES survey tool was also administered to the bereaved relatives and data were analysed using descriptive statistics and thematic analysis of free-text responses. Results: Relatives often played an important role in influencing aspects of end-of-life care, including decisions to use an end-of-life care pathway. Some relatives experienced enduring distress with their perceived responsibility for care decisions. Relatives felt unprepared for and were distressed by prolonged dying processes, which were often associated with severe dysphagia. Pro-active information-giving by staff was reported as supportive by relatives. Healthcare professionals generally avoided discussing place of care with families. Decisions to use an end-of-life care pathway were not predicted by patients’ demographic characteristics; decisions were generally made in consultation with families and the extended health care team, and were made within regular working hours. Conclusion: Distressing stroke-related issues were more prominent in participants’ accounts than concerns with the end-of-life care pathway used. Relatives sometimes perceived themselves as responsible for important clinical decisions. Witnessing prolonged dying processes was difficult for healthcare professionals and families, particularly in relation to the management of persistent major swallowing difficulties.

Typologies and spatialization of agricultural production systems in Rondônia, Brazil: linking land use, socioeconomics and territorial configuration.

The current Amazon landscape consists of heterogeneous mosaics formed by interactions between the original forest and productive activities. Recognizing and quantifying the characteristics of these landscapes is essential for understanding agricultural production chains, assessing the impact of policies, and in planning future actions. Our main objective was to construct the regionalization of agricultural production for Rondônia State (Brazilian Amazon) at the municipal level. We adopted a decision tree approach, using land use maps derived from remote sensing data (PRODES and TerraClass) combined with socioeconomic data. The decision trees allowed us to allocate municipalities to one of five agricultural production systems: (i) coexistence of livestock production and intensive agriculture; (ii) semi-intensive beef and milk production; (iii) semi-intensive beef production; (iv) intensive beef and milk production, and; (v) intensive beef production. These production systems are, respectively, linked to mechanized agriculture (i), traditional cattle farming with low management, with (ii) or without (iii) a significant presence of dairy farming, and to more intensive livestock farming with (iv) or without (v) a significant presence of dairy farming. The municipalities and associated production systems were then characterized using a wide variety of quantitative metrics grouped into four dimensions: (i) agricultural production; (ii) economics; (iii) territorial configuration, and; (iv) social characteristics. We found that production systems linked to mechanized agriculture predominate in the south of the state, while intensive farming is mainly found in the center of the state. Semi-intensive livestock farming is mainly located close to the southwest frontier and in the north of the state, where human occupation of the territory is not fully consolidated. This distributional pattern reflects the origins of the agricultural production system of Rondônia. Moreover, the characterization of the production systems provides insights into the pattern of occupation of the Amazon and the socioeconomic consequences of continuing agricultural expansion.

Assessing Decision Making Skill in Complex and Dynamic Environments Using Representative and Simulated Tasks

Traditional decision making research has often focused on one's ability to choose from a set of prefixed options, ignoring the process by which decision makers generate courses of action (i.e., options) in-situ (Klein, 1993). In complex and dynamic domains, this option generation process is particularly critical to understanding how successful decisions are made (Zsambok & Klein, 1997). When generating response options for oneself to pursue (i.e., during the intervention-phase of decision making) previous research has supported quick and intuitive heuristics, such as the Take-The-First heuristic (TTF; Johnson & Raab, 2003). When generating predictive options for others in the environment (i.e., during the assessment-phase of decision making), previous research has supported the situational-model-building process described by Long Term Working Memory theory (LTWM; see Ward, Ericsson, & Williams, 2013). In the first three experiments, the claims of TTF and LTWM are tested during assessment- and intervention-phase tasks in soccer. To test what other environmental constraints may dictate the use of these cognitive mechanisms, the claims of these models are also tested in the presence and absence of time pressure. In addition to understanding the option generation process, it is important that researchers in complex and dynamic domains also develop tools that can be used by `real-world' professionals. For this reason, three more experiments were conducted to evaluate the effectiveness of a new online assessment of perceptual-cognitive skill in soccer. This test differentiated between skill groups and predicted performance on a previously established test and predicted option generation behavior. The test also outperformed domain-general cognitive tests, but not a domain-specific knowledge test when predicting skill group membership. Implications for theory and training, and future directions for the development of applied tools are discussed.

Twelve Certain Men: The Impact of Emotional Appraisals on Juror Decision-Making

Our jury system is predicated upon the expectation that jurors engage in systematic processing when considering evidence and making decisions. They are instructed to interpret facts and apply the appropriate law in a fair, dispassionate manner, free of all bias, including that of emotion. However, emotions containing an element of certainty (e.g., anger and happiness, which require little cognitive effort in determining their source) can often lead people to engage in superficial, heuristic-based processing. Compare this to uncertain emotions (e.g., hope and fear, which require people to seek out explanations for their emotional arousal), which instead has the potential to lead them to engage in deeper, more systematic processing. The purpose of the current research is in part to confirm past research (Tiedens & Linton, 2001; Semmler & Brewer, 2002) that uncertain emotions (like fear) can influence decision-making towards a more systematic style of processing, whereas more certain emotional states (like anger) will lead to a more heuristic style of processing. Studies One, Two, and Three build upon this prior research with the goal of improving methodological rigor through the use of film clips to reliably induce emotions, with awareness of testimonial details serving as measures of processing style. The ultimate objective of the current research was to explore this effect in Study Four by inducing either fear, anger, or neutral emotion in mock jurors, half of whom then followed along with a trial transcript featuring eight testimonial inconsistencies, while the other participants followed along with an error-free version of the same transcript. Overall rates of detection for these inconsistencies was expected to be higher for the uncertain/fearful participants due to their more effortful processing compared to certain/angry participants. These expectations were not fulfilled, with significant main effects only for the transcript version (with or without inconsistencies) on overall inconsistency detection rates. There are a number of plausible explanations for these results, so further investigation is needed.

Enabling effective operational decision making on a Combined Heat and Power System using the 5C architecture

The use of Cyber Physical Systems (CPS) to optimise industrial energy systems is an approach which has the potential to positively impact on manufacturing sector energy efficiency. The need to obtain data to facilitate the implementation of a CPS in an industrial energy system is however a complex task which is often implemented in a non-standardised way. The use of the 5C CPS architecture has the potential to standardise this approach. This paper describes a case study where data from a Combined Heat and Power (CHP) system located in a large manufacturing company was fused with grid electricity and gas models as well as a maintenance cost model using the 5C architecture with a view to making effective decisions on its cost efficient operation. A control change implemented based on the cognitive analysis enabled via the 5C architecture implementation has resulted in energy cost savings of over €7400 over a four-month period, with energy cost savings of over €150,000 projected once the 5C architecture is extended into the production environment.