Decision-Making Incapacity Among Nursing Home Residents: Results From the 1987 NMES Survey.

Recent legislative and regulatory developments have focused attention on older adults' capacity for involvement in health care decision-making. The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) focused attention on the rights of nursing home residents to be involved in health care decision-making to the fullest extent possible. This article uses data from the 1987 National Medical Expenditure Survey (NMES) to examine rates of incapacity for health care decision-making among nursing home residents. Elements of the Oklahoma statute were used to operationalize decision-making incapacity: disability or disorder, difficulty in decision-making or communicating decisions, and functional disability. Fifty-three percent of nursing home residents had a combination of either physical or mental impairment and an impairment in either self-care or money management. The discussion focuses on the policy and practice implications of significant rates of incapacity among nursing home residents.

Changes in Psychological Characteristics of Working Adults in Different Stages of Economic Transition in Lithuania

Global economic changes have psychological consequences and Mr. Lepeska set out to assess these changes in working adults in Lithuania between 1993 and 1997. He surveyed two groups of working adults, with a total of 200 people, randomly selected and representing different organisations and professions. In both groups around 30% of participants were managers, with the remainder working in non-managerial positions. The participants were surveyed twice, once in 1993 and the second time in 1997,using various psychodiagnostic tools to measure their psychological characteristics. The results showed that strategies for coping with stress have changed, with problem solving strategies being used more often, and avoidance behaviour or seeking social support less. Men tended to have rejected these strategy more radically than women. Attitudes towards work had become more positive, with managers' attitudes having changed more significantly than those of employees from lower levels of organisations. Younger people were more positive towards work-related changes, while situational anxiety tended to increase with age, although overall it remained low. Mr. Lepeska found that while there were some indications of an increasing individualist in relation to peers, the traditional collective orientation of Lithuanian adults had if anything increased. People have become more accepting of an unequal distribution of power, making it difficult to increase the participation of subordinates in decision making. He also noted a tendency for Lithuanians to see their organisations as traditional families, expecting them to take care of them physically and economically in return for loyalty. The strong feminine orientation with its stress on interpersonal relations and overall quality of life has also strengthened, but the ability of Lithuanians to take initiative and control their environment was relatively low. Mr. Lepeska concludes that organisations should seek to recruit people who are able to adjust more easily to changes and consider measuring dominance, individualism, and attitudes to work-related change and situational anxiety in the process of professional selection. There should also be more emphasis on team building and on training managers to maintain closer relationships with their subordinates so as to increase the latter's participation in decision making. Good interpersonal relations can be a strong work motivator, as may be special attention to the security needs of older employees.

Extracapsular tumor spread and the risk of local, axillary and supraclavicular recurrence in node-positive, premenopausal patients with breast cancer

BACKGROUND: Extracapsular tumor spread (ECS) has been identified as a possible risk factor for breast cancer recurrence, but controversy exists regarding its role in decision making for regional radiotherapy. This study evaluates ECS as a predictor of local, axillary, and supraclavicular recurrence. PATIENTS AND METHODS: International Breast Cancer Study Group Trial VI accrued 1475 eligible pre- and perimenopausal women with node-positive breast cancer who were randomly assigned to receive three to nine courses of classical combination chemotherapy with cyclophosphamide, methotrexate, and fluorouracil. ECS status was determined retrospectively in 933 patients based on review of pathology reports. Cumulative incidence and hazard ratios (HRs) were estimated using methods for competing risks analysis. Adjustment factors included treatment group and baseline patient and tumor characteristics. The median follow-up was 14 years. RESULTS: In univariable analysis, ECS was significantly associated with supraclavicular recurrence (HR = 1.96; 95% confidence interval 1.23-3.13; P = 0.005). HRs for local and axillary recurrence were 1.38 (P = 0.06) and 1.81 (P = 0.11), respectively. Following adjustment for number of lymph node metastases and other baseline prognostic factors, ECS was not significantly associated with any of the three recurrence types studied. CONCLUSIONS: Our results indicate that the decision for additional regional radiotherapy should not be based solely on the presence of ECS.

Using technology to enhance decision making

We focus here on decision making in the everyday clinical situation and do not address decision making in politics and administration, although obviously it affects clinical practice and vice versa. For example, decisions against providing sufficient face-to-face psychotherapy is one factor that may increase the demand for Internet therapy, and vice versa—that is, the use of technology for therapy, as in Internet therapy, might influence to what extent face-to-face therapy needs to be provided. It is obvious that the aggregation of information for political and administrative decisions can take advantage of technology. If technology is used professionally, this should contribute to better informed decisions and less dependency on information provided by lobbyists who might not work in the interest of high-quality service for those who need it. An optimistic view is thus that technology works in favor of patients on this level as well. In the interest of keeping the focus of this chapter manageable, we also do not address treatments fully delivered over the Internet or computers, as for the example described in Comer and Barlow (2014), although such treatments, as they unfold, of course also include decision making.

A group decision-making methodology with incomplete individual beliefs applied to e-Democracy

We consider the situation where there are several alternatives for investing a quantity of money to achieve a set of objectives. The choice of which alternative to apply depends on how citizens and political representatives perceive that such objectives should be achieved. All citizens with the right to vote can express their preferences in the decision-making process. These preferences may be incomplete. Political representatives represent the citizens who have not taken part in the decision-making process. The weight corresponding to political representatives depends on the number of citizens that have intervened in the decision-making process. The methodology we propose needs the participants to specify for each alternative how they rate the different attributes and the relative importance of attributes. On the basis of this information an expected utility interval is output for each alternative. To do this, an evidential reasoning approach is applied. This approach improves the insightfulness and rationality of the decision-making process using a belief decision matrix for problem modeling and the Dempster?Shafer theory of evidence for attribute aggregation. Finally, we propose using the distances of each expected utility interval from the maximum and the minimum utilities to rank the alternative set. The basic idea is that an alternative is ranked first if its distance to the maximum utility is the smallest, and its distance to the minimum utility is the greatest. If only one of these conditions is satisfied, a distance ratio is then used.

Household decision making : an exploratory study /

"This study is designed to gain insights into various aspects of family decision making. Specifically, the study examines the prevalance of autonomous versus joint decision making, the incidence of conflict in joint decision making, and the tactics used by individual household members in resolving conflict."

Collaborative decision-making processes for maintaining biodiversity: Two Australian case studies

There have been many models developed by scientists to assist decision-makers in making socio-economic and environmental decisions. It is now recognised that there is a shift in the dominant paradigm to making decisions with stakeholders, rather than making decisions for stakeholders. Our paper investigates two case studies where group model building has been undertaken for maintaining biodiversity in Australia. The first case study focuses on preservation and management of green spaces and biodiversity in metropolitan Melbourne under the umbrella of the Melbourne 2030 planning strategy. A geographical information system is used to collate a number of spatial datasets encompassing a range of cultural and natural assets data layers including: existing open spaces, waterways, threatened fauna and flora, ecological vegetation covers, registered cultural heritage sites, and existing land parcel zoning. Group model building is incorporated into the study through eliciting weightings and ratings of importance for each datasets from urban planners to formulate different urban green system scenarios. The second case study focuses on modelling ecoregions from spatial datasets for the state of Queensland. The modelling combines collaborative expert knowledge and a vast amount of environmental data to build biogeographical classifications of regions. An information elicitation process is used to capture expert knowledge of ecoregions as geographical descriptions, and to transform this into prior probability distributions that characterise regions in terms of environmental variables. This prior information is combined with measured data on the environmental variables within a Bayesian modelling technique to produce the final classified regions. We describe how linked views between descriptive information, mapping and statistical plots are used to decide upon representative regions that satisfy a number of criteria for biodiversity and conservation. This paper discusses the advantages and problems encountered when undertaking group model building. Future research will extend the group model building approach to include interested individuals and community groups.

Exchange fairness and employee performance:An examination of the relationship between organizational politics and procedural justice

Data obtained from a manufacturing firm and a newspaper firm in India were used to examine the relationship between organizational politics and procedural justice in three separate studies. Study 1 constructively replicated research on the distinctiveness of the two constructs. Confirmatory factor analyses in which data from the manufacturing firm served as the development sample and data from the newspaper firm served as the validation sample demonstrated the distinctiveness of organizational politics and procedural justice. Study 2 examined the antecedents of the two constructs using data from the manufacturing firm. Structural equation modeling (SEM) results revealed formalization and participation in decision making to be positively related to procedural justice but negatively related to organizational politics. Further, authority hierarchy and spatial distance were positively related to organizational politics but unrelated to procedural justice. Study 3 examined the consequences of the two constructs in terms of task and contextual performance using data from the newspaper firm. Results of SEM analysis revealed procedural justice but not organizational politics to be related to task performance and the contextual performance dimensions of interpersonal facilitation and job dedication. © 2004 Elsevier Inc. All rights reserved.

The work situation and class position of Brazilian engineers

This thesis analyses the work situation and class position of Brazilian engineers through a Marxist perspective. The research is based on two case studies, one focused on a large German steel company based in Brazil and the other on a large Brazilian energy corporation. The fieldwork involved 114 interviews, with engineers from different hierarchical positions in these two companies. Data was also gathered through interviews with representatives from the companies, the Council of Engineering, the Engineering Education System and the Engineers Trade Unions. The findings show that the engineering profession in Brazil has shifted from its initial condition as a liberal profession to an organizational profession, with the country's industrial deployment. Both companies consider all salaried workers as employees, including managers. Hence they are subject to the company's general personnel policies. The multinational company controls labour more rigidly than the national company, as well as reserving its top positions for its home country's executives. Although no deskilling process was found, engineers of both companies performed simple work, which required less engineering knowledge than they had learned from school. Engineers have little autonomy, authority and participation in decision making and are subject to direct supervision, performance evaluation, time control, overtime work, productivity and to poor working conditions in the multinational company. The majority of the engineers supervised other workers without being in a managerial position. They found that to move into management, was a good way to improve their autonomy, authority, prestige, salary, status, power and professional pride. Despite ideological divisions between capital and labour, most of the engineers were unionised and saw unions as the right way to deal with the employer.

Developing user involvement in a UK cancer network:professionals’ and users’ perspectives

This paper explores the results of a consensus development exercise that explored diverse perspectives and sought to identify key principles for the development of user involvement in a cancer network. The exercise took place within one of 34 UK cancer networks and was a collaboration between the NHS, two universities and two voluntary sector organizations. The paper explores professionals’ and users’ perspectives on user involvement with reference to the current sociopolitical context of user participation. British policy documents have placed increasing emphasis on issues of patient and public participation in the evaluation and development of health services, and the issue of lay participation represents an important aspect of a critical public health agenda. The project presented here shows that developing user involvement may be a complex task, with lack of consensus on key issues representing a significant barrier. Further, the data suggest that professional responses can partly be understood in relation to specific occupational standpoints and strategies that potentially allow professionals to define and limit users’ involvement. The implications of these findings and the impact of the consensus development process itself are discussed.

Taiwanese faculty and administrators' perceptions and preferences toward shared governance

This study investigated the perceptions, attitudes, preferences, and actual reported degree of faculty participation in decision-making in Taiwanese universities. It was aimed at exploring possible agreements and disagreements between the faculty and administrators concerning these perceptions, and between the actual and preferred degree of faculty participation in both groups. ^ Seven questions were addressed in this study: (a) What are the most and the least reported areas of faculty involvement in decision making? (b) What are the most and the least preferred areas of faculty involvement in decision-making? (c) Is there a difference between faculty and administrators' reports of faculty involvement in decision-making? (d) Is there a difference between faculty and administrators in their preference for faculty involvement in decision-making? (e) Among the faculty, is reported involvement different from preferred involvement in decision-making? (f) Among the administrators, is their reported faculty involvement different from their preferred faculty involvement? and (g) Do faculty and administrators hold different attitudes toward faculty participation in decision-making? ^ The results indicated that: (a) Faculty had the highest level of involvement in academic decisions, and had the lowest level of involvement in developing general policies. (b) Both faculty and administrators had the highest preference for faculty involvement in academic decisions, and both of them had the lowest preference for faculty involvement in general policies. (c) Administrators reported a level of involvement for the faculty that was higher than the level that the faculty themselves reported. (d) Faculty desired a higher level of involvement than they currently have, and administrators also agreed that faculty should have greater involvement. ^ The interview results indicated that the presidents believed that faculty should participate in decision-making, but they also had negative feelings towards faculty who were enthusiastic about participating. The presidents showed their support of faculty participation in academic decisions, but not in other areas. ^ The results reflected the traditional Taiwanese social expectations of the role of faculty. When the range of decisions was narrowed to the academic context, the disagreements between the faculty, administrators, and university presidents disappeared. However, when the range of decisions was expanded, the agreement declined. ^

The socialization of adjunct faculty into the academic culture of a public community college campus

This study investigated the socialization of adjunct faculty into the academic culture of a community college campus. Because of the increased utilization of adjunct faculty, the need to socialize them to effectively function within the organizational culture has become more acute. A review of the literature revealed that when employees are socialized, they are more committed to the goals and welfare of the organization, are less likely to leave the organization, and are more productive and innovative. Therefore, it is important that administrators have programs and practices in place that would help to integrate adjunct faculty into the academic culture. The model of organizational socialization (Chao, O'Leary-Kelly, Wolf, Klein, & Gardner, 1994) formed the framework for this study, which was guided by the following research questions: How do adjunct faculty members describe their socialization into the culture of their college campus? How do administrators describe their roles and that of the organization in the socialization of adjunct faculty members? What organizational programs and activities are in place for the socialization of adjunct faculty? The North Campus of Miami Dade College was the site for this study, as it is a campus with a long history of utilizing adjunct faculty members and one that has a clearly-stated mission of adjunct faculty socialization. A qualitative case study method was used, and data collection included interviews and the review and analysis of institutional documents. The participants included 11 adjunct faculty members, 4 department chairpersons, the campus president, and the college training and development coordinator. The study revealed that there were structured and consistent professional development programs, but these conflicted with the schedules of adjunct faculty. Overall, adjunct faculty found support from the leadership; however, they revealed a need for more mentoring, more interactions with full-time faculty, and more input in decision making concerning textbooks and curricula. Implications and recommendations for practice include making professional development more accessible and relevant to adjunct faculty, developing a formal mentoring program where full-time faculty and veteran adjunct faculty mentor novice adjunct faculty, and involving adjuncts in decisions regarding curriculum and textbook selection.

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).