The role of chaplains in end-of-life decision making: Results of a pilot survey.

OBJECTIVE: The overall aim of this study was to discover how chaplains assess their role within ethically complex end-of-life decisions. METHODS: A questionnaire was sent to 256 chaplains working for German health care institutions. Questions about their role and satisfaction as well as demographic data were collected, which included information about the chaplains' integration within multi-professional teams. RESULTS: The response rate was 59%, 141 questionnaires were analyzed. Respondents reported being confronted with decisions concerning the limitation of life-sustaining treatment on average two to three times per month. Nearly 74% were satisfied with the decisions made within these situations. However, only 48% were satisfied with the communication process. Whenever chaplains were integrated within a multi-professional team there was a significantly higher satisfaction with both: the decisions made (p = 0.000) and the communication process (p = 0.000). Significance of the results: Although the results of this study show a relatively high satisfaction among surveyed chaplains with regard to the outcome of decisions, one of the major problems seems to reside in the communication process. A clear integration of chaplains within multi-professional teams (such as palliative care teams) appears to increase the satisfaction with the communication in ethically critical situations.

A new aggregation method for strategic decision making and its application in assignment theory

A new aggregation method for decision making is presented by using induced aggregation operators and the index of maximum and minimum level. Its main advantage is that it can assess complex reordering processes in the aggregation that represent complex attitudinal characters of the decision maker such as psychological or personal factors. A wide range of properties and particular cases of this new approach are studied. A further generalization by using hybrid averages and immediate weights is also presented. The key issue in this approach against the previous model is that we can use the weighted average and the ordered weighted average in the same formulation. Thus, we are able to consider the subjective attitude and the degree of optimism of the decision maker in the decision process. The paper ends with an application in a decision making problem based on the use of the assignment theory.

Decision making: singin' in the brain.

Which neurons in the brain "decide" to initiate particular behaviors in response to sensory information? In this issue of Neuron, two papers (Kohatsu et al. and von Philipsborn et al.) identify candidates in the courtship circuitry of Drosophila. The activity of these neurons is both regulated by sex pheromones and necessary and sufficient to trigger male love song.

Weber's law in decision making: integrating behavioral data in humans with a neurophysiological model

Recent single-cell studies in monkeys (Romo et al., 2004) show that the activity of neurons in the ventral premotor cortex covaries with the animal's decisions in a perceptual comparison task regarding the frequency of vibrotactile events. The firing rate response of these neurons was dependent only on the frequency differences between the two applied vibrations, the sign of that difference being the determining factor for correct task performance. We present a biophysically realistic neurodynamical model that can account for the most relevant characteristics of this decision-making-related neural activity. One of the nontrivial predictions of this model is that Weber's law will underlie the perceptual discrimination behavior. We confirmed this prediction in behavioral tests of vibrotactile discrimination in humans and propose a computational explanation of perceptual discrimination that accounts naturally for the emergence of Weber's law. We conclude that the neurodynamical mechanisms and computational principles underlying the decision-making processes in this perceptual discrimination task are consistent with a fluctuation-driven scenario in a multistable regime.

Multiple sclerosis decreases explicit counterfactual processing and risk taking in decision making.

INTRODUCTION: Deficits in decision making (DM) are commonly associated with prefrontal cortical damage, but may occur with multiple sclerosis (MS). There are no data concerning the impact of MS on tasks evaluating DM under explicit risk, where different emotional and cognitive components can be distinguished. METHODS: We assessed 72 relapsing-remitting MS (RRMS) patients with mild to moderate disease and 38 healthy controls in two DM tasks involving risk with explicit rules: (1) The Wheel of Fortune (WOF), which probes the anticipated affects of decisions outcomes on future choices; and (2) The Cambridge Gamble Task (CGT) which measures risk taking. Participants also underwent a neuropsychological and emotional assessment, and skin conductance responses (SCRs) were recorded. RESULTS: In the WOF, RRMS patients showed deficits in integrating positive counterfactual information (p<0.005) and greater risk aversion (p<0.001). They reported less negative affect than controls (disappointment: p = 0.007; regret: p = 0.01), although their implicit emotional reactions as measured by post-choice SCRs did not differ. In the CGT, RRMS patients differed from controls in quality of DM (p = 0.01) and deliberation time (p = 0.0002), the latter difference being correlated with attention scores. Such changes did not result in overall decreases in performance (total gains). CONCLUSIONS: The quality of DM under risk was modified by MS in both tasks. The reduction in the expression of disappointment coexisted with an increased risk aversion in the WOF and alexithymia features. These concomitant emotional alterations may have implications for better understanding the components of explicit DM and for the clinical support of MS patients.

Cooperation versus competition effects on information sharing and use in group decision making

Information processing in groups has long been seen as a cooperative process. In contrast with this assumption, group members were rarely found to behave cooperatively: They withhold unshared information and stick to initial incorrect decisions. In the present article, we examined how group members' cooperative and competitivemotives impact on group information processing and propose that information sharing and use in groups could be seen as strategic behavior. We reviewed the latest developments in the literature investigating different forms of strategic information processing and their underlying mechanisms. This review suggests that explicit cooperative goals are needed for effective group decision-making.

To analyse a trace or not? Evaluating the decision-making process in the criminal investigation

In order to broaden our knowledge and understanding of the decision steps in the criminal investigation process, we started by evaluating the decision to analyse a trace and the factors involved in this decision step. This decision step is embedded in the complete criminal investigation process, involving multiple decision and triaging steps. Considering robbery cases occurring in a geographic region during a 2-year-period, we have studied the factors influencing the decision to submit biological traces, directly sampled on the scene of the robbery or on collected objects, for analysis. The factors were categorised into five knowledge dimensions: strategic, immediate, physical, criminal and utility and decision tree analysis was carried out. Factors in each category played a role in the decision to analyse a biological trace. Interestingly, factors involving information available prior to the analysis are of importance, such as the fact that a positive result (a profile suitable for comparison) is already available in the case, or that a suspect has been identified through traditional police work before analysis. One factor that was taken into account, but was not significant, is the matrix of the trace. Hence, the decision to analyse a trace is not influenced by this variable. The decision to analyse a trace first is very complex and many of the tested variables were taken into account. The decisions are often made on a case-by-case basis.

Group preference structures in AHP–group decision making

This paper presents a procedure that allows us to determine the preference structures(PS) associated to each of the different groups of actors that can be identified in a groupdecision making problem with a large number of individuals. To that end, it makesuse of the Analytic Hierarchy Process (AHP) (Saaty, 1980) as the technique to solvediscrete multicriteria decision making problems. This technique permits the resolutionof multicriteria, multienvironment and multiactor problems in which subjective aspectsand uncertainty have been incorporated into the model, constructing ratio scales correspondingto the priorities relative to the elements being compared, normalised in adistributive manner (wi = 1). On the basis of the individuals’ priorities we identifydifferent clusters for the decision makers and, for each of these, the associated preferencestructure using, to that end, tools analogous to those of Multidimensional Scaling.The resulting PS will be employed to extract knowledge for the subsequent negotiationprocesses and, should it be necessary, to determine the relative importance of thealternatives being compared using anyone of the existing procedures

Immediate Decision-Making and Information Needs in Intensive Care Coordination

The aim of this study was to develop a theoretical model for information integration to support the deci¬sion making of intensive care charge nurses, and physicians in charge – that is, ICU shift leaders. The study focused on the ad hoc decision-making and immediate information needs of shift leaders during the management of an intensive care unit’s (ICU) daily activities. The term ‘ad hoc decision-making’ was defined as critical judgements that are needed for a specific purpose at a precise moment with the goal of ensuring instant and adequate patient care and a fluent flow of ICU activities. Data collection and research analysis methods were tested in the identification of ICU shift leaders’ ad hoc decision-making. Decision-making of ICU charge nurses (n = 12) and physicians in charge (n = 8) was observed using a think-aloud technique in two university-affiliated Finnish ICUs for adults. The ad hoc decisions of ICU shift leaders were identified using an application of protocol analysis. In the next phase, a structured online question¬naire was developed to evaluate the immediate information needs of ICU shift leaders. A national survey was conducted in all Finnish, university-affiliated hospital ICUs for adults (n = 17). The questionnaire was sent to all charge nurses (n = 515) and physicians in charge (n = 223). Altogether, 257 charge nurses (50%) and 96 physicians in charge (43%) responded to the survey. The survey was also tested internationally in 16 Greek ICUs. From Greece, 50 charge nurses out of 240 (21%) responded to the survey. A think-aloud technique and protocol analysis were found to be applicable for the identification of the ad hoc decision-making of ICU shift leaders. During one day shift leaders made over 200 ad hoc decisions. Ad hoc decisions were made horizontally, related to the whole intensive care process, and vertically, concerning single intensive care incidents. Most of the ICU shift leaders’ ad hoc decisions were related to human resources and know-how, patient information and vital signs, and special treatments. Commonly, this ad hoc decision-making involved several multiprofessional decisions that constituted a bundle of immediate decisions and various information needs. Some of these immediate information needs were shared between the charge nurses and the physicians in charge. The majority of which concerned patient admission, the organisation and management of work, and staff allocation. In general, the information needs of charge nurses were more varied than those of physicians. It was found that many ad hoc deci-sions made by the physicians in charge produced several information needs for ICU charge nurses. This meant that before the task at hand was completed, various kinds of information was sought by the charge nurses to support the decision-making process. Most of the immediate information needs of charge nurses were related to the organisation and management of work and human resources, whereas the information needs of the physicians in charge mainly concerned direct patient care. Thus, information needs differ between professionals even if the goal of decision-making is the same. The results of the international survey confirmed these study results for charge nurses. Both in Finland and in Greece the information needs of charge nurses focused on the organisation and management of work and human resources. Many of the most crucial information needs of Finnish and Greek ICU charge nurses were common. In conclusion, it was found that ICU shift leaders make hundreds of ad hoc decisions during the course of a day related to the allocation of resources and organisation of patient care. The ad hoc decision-making of ICU shift leaders is a complex multi-professional process, which requires a lot of immediate information. Real-time support for information related to patient admission, the organisation and man¬agement of work, and allocation of staff resources is especially needed. The preliminary information integration model can be applied when real-time enterprise resource planning systems are developed for intensive care daily management

Evidencing and Sharing Value with Decision Making Models in an Industrial Maintenance Network

The objective of this thesis is to concretize the potential benefits that the industrial maintenance case network could achieve through using the value-based life-cycle model and the flexible asset management model. It is also inspected what factors prevent value creation and sharing in the maintenance contract practices of the case network. This thesis is a case study which utilizes modelling. Four scenarios were developed to demonstrate value creation in the future. The data was partly provided by the collaborating company, partly gathered from public financial statement information. The results indicate that value has been created through the past maintenance of the collaborating company’s rod mill and that profitability of the collaborating company has been mostly on satisfactory level during the past few years. Potential value might be created by increasing the share of proactive maintenance of the rod mill in the future. Profitability of the network could be improved in the future through flexible asset management operations. The main obstacle for value creation and sharing seems to be the lack of sufficient trust between the network members.

The importance of package design to Japanese consumers: The role of visual and informational elements of package design in decision making

The importance of package design as a marketing tool is growing as the competition in retail environment increases. However, there is a lack of studies on how each element of package design affects consumer decisions in different countries. The objective of this thesis is to study the role of package design to Japanese consumers. The research was conducted through an experiment with a sample of 37 Japanese female participants. They were divided into two groups and were given different tasks: one group had to choose a chocolate for themselves, and the other for a group of friends. The participants were presented with 15 different Finnish chocolate boxes to choose from. The qualitative data was gathered through observation and semi-structured interviews. In addition, data from questionnaires was quantified and all the data was triangulated. The empirical results suggest that visual elements strongly affect the decision making of Japanese consumers. Image was the most important element which acted as both, a visual and an informational aspect in the experiment. Informational elements on the other hand have little effect, especially when the context is written in a foreign language. However, informational elements affected participants who were choosing chocolates for a group of friends. A unique finding was the importance of kawaii (cuteness) to Japanese consumers.