A concept-based framework for retrieving evidence to support emergency physician decision making at the point of care

The goal of evidence-based medicine is to uniformly apply evidence gained from scientific research to aspects of clinical practice. In order to achieve this goal, new applications that integrate increasingly disparate health care information resources are required. Access to and provision of evidence must be seamlessly integrated with existing clinical workflow and evidence should be made available where it is most often required - at the point of care. In this paper we address these requirements and outline a concept-based framework that captures the context of a current patient-physician encounter by combining disease and patient-specific information into a logical query mechanism for retrieving relevant evidence from the Cochrane Library. Returned documents are organized by automatically extracting concepts from the evidence-based query to create meaningful clusters of documents which are presented in a manner appropriate for point of care support. The framework is currently being implemented as a prototype software agent that operates within the larger context of a multi-agent application for supporting workflow management of emergency pediatric asthma exacerbations. © 2008 Springer-Verlag Berlin Heidelberg.

Measuring and modelling the influence of investor behaviour on investment decision making

Guest editorial

Decision making in nuclear waste management:the use of the synoptic approach

This thesis is concerned with the use of the synoptic approach within decision making concerning nuclear waste management. The synoptic approach to decision making refers to an approach to rational decision making that assumes as an ideal, comprehensiveness of information and analysis. Two case studies are examined in which a high degree of synoptic analysis has been used within the decision making process. The case studies examined are the Windscale Inquiry into the decision to build the THORP reprocessing plant and the Nirex safety assessment of nuclear waste disposal. The case studies are used to test Lindblom's hypothesis that a synoptic approach to decision making is not achievable. In the first case study Lindblom's hypothesis is tested through the evaluation of the decision to build the THORP plant, taken following the Windscale Inquiry. It is concluded that the incongruity of this decision supports Lindblom's hypothesis. However, it has been argued that the Inquiry should be seen as a legitimisation exercise for a decision that was effectively predetermined, rather than a rigorous synoptic analysis. Therefore, the Windscale Inquiry does not provide a robust test of the synoptic method. It was concluded that a methodology was required, that allowed robust conclusions to be drawn, despite the ambiguity of the role of the synoptic method in decision making. Thus, the methodology adopted for the second case study was modified. In this case study the synoptic method was evaluated directly. This was achieved through the analysis of the cogency of the Nirex safety assessment. It was concluded that the failure of Nirex to provide a cogent synoptic analysis supported Lindblom's criticism of the synoptic method. Moreover, it was found that the synoptic method failed in the way that Lindblom predicted that it would.

Teacher logs and interactive decision-making:a case study of contingencies in an EFL organizational culture and the implications for teacher development for part-time teachers

This is a case study of a program of native speaker part-time EFL (English as a Foreign Language) teachers in a junior college in Japan. It has grown out of a curiosity to ascertain how the teachers have formed and continue to maintain a coordinated program in what would seem to be a disadvantageous national context where as part-time foreign teachers they are expected to do little more than just teach a few classes of mainly oral English. This study investigates the organizational culture the teachers have formed for themselves within their staffroom, and looks at the implications of this for part-time teachers in such an environment. More specifically, the study highlights that central to the program is an interactive decision-making function engaged in by all the teachers which has not only created but also continually enables an identifiable staffroom culture. This organizational culture is contingent on college and staffroom conditions, program affordances such as shared class logs and curriculum sharing, and on the interactive decision-making itself. It is postulated that the contingencies formed in this created and continually creating shared world not only offer the teachers a proficient way to work in their severely time-constricted environment, but also provide them with fertile ground for the self-regulation of a thus created zone of covert staffroom ‘on-the-job’ teacher development.

Public sector investment appraisal:the place of flexibility in the decision making process

This thesis reviews the main methodological developments in public sector investment appraisal and finds growing evidence that appraisal techniques are not fulfilling their earlier promise. It is suggested that an important reason for this failure lies in the inability of these techniques to handle uncertainty except in a highly circumscribed fashion. It is argued that a more fruitful approach is to strive for flexibility. Investment projects should be formulated with a view to making them responsive to a wide range of possible future events, rather than embodying a solution which is optimal for one configuration of circumstances only. The distinction drawn in economics between the short and the long run is used to examine the nature of flexibility. The concept of long run flexibility is applied to the pre-investment range of choice open to the decisionmaker. It is demonstrated that flexibility is reduced at a very early stage of decisionmaking by the conventional system of appraisal which evaluates only a small number of options. The pre-appraisal filtering process is considered further in relation to decisionmaking models. It is argued that for public sector projects the narrowing down of options is best understood in relation to an amended mixed scanning model which places importance on the process by which the 'national interest ' is determined. Short run flexibility deals with operational characteristics, the degree to which particular projects may respond to changing demands when the basic investment is already in place. The tension between flexibility and cost is noted. A short case study on the choice of electricity generating plant is presented. The thesis concludes with a brief examination of the approaches used by successive British governments to public sector investment, particularly in relation to the nationalised industries

A reevaluation of achromatic spatio-temporal vision: nonoriented filters are monocular, they adapt, and can be used for decision making at high flicker speeds

Masking, adaptation, and summation paradigms have been used to investigate the characteristics of early spatio-temporal vision. Each has been taken to provide evidence for (i) oriented and (ii) nonoriented spatial-filtering mechanisms. However, subsequent findings suggest that the evidence for nonoriented mechanisms has been misinterpreted: those experiments might have revealed the characteristics of suppression (eg, gain control), not excitation, or merely the isotropic subunits of the oriented detecting mechanisms. To shed light on this, we used all three paradigms to focus on the ‘high-speed’ corner of spatio-temporal vision (low spatial frequency, high temporal frequency), where cross-oriented achromatic effects are greatest. We used flickering Gabor patches as targets and a 2IFC procedure for monocular, binocular, and dichoptic stimulus presentations. To account for our results, we devised a simple model involving an isotropic monocular filter-stage feeding orientation-tuned binocular filters. Both filter stages are adaptable, and their outputs are available to the decision stage following nonlinear contrast transduction. However, the monocular isotropic filters (i) adapt only to high-speed stimuli—consistent with a magnocellular subcortical substrate—and (ii) benefit decision making only for high-speed stimuli (ie, isotropic monocular outputs are available only for high-speed stimuli). According to this model, the visual processes revealed by masking, adaptation, and summation are related but not identical.

Design of a novel solar thermal collector using a multi-criteria decision-making methodology

Three novel solar thermal collector concepts derived from the Linear Fresnel Reflector (LFR) are developed and evaluated through a multi-criteria decision-making methodology, comprising the following techniques: Quality Function Deployment (QFD), the Analytical Hierarchy Process (AHP) and the Pugh selection matrix. Criteria are specified by technical and customer requirements gathered from Gujarat, India. The concepts are compared to a standard LFR for reference, and as a result, a novel 'Elevation Linear Fresnel Reflector' (ELFR) concept using elevating mirrors is selected. A detailed version of this concept is proposed and compared against two standard LFR configurations, one using constant and the other using variable horizontal mirror spacing. Annual performance is analysed for a typical meteorological year. Financial assessment is made through the construction of a prototype. The novel LFR has an annual optical efficiency of 49% and increases exergy by 13-23%. Operational hours above a target temperature of 300 C are increased by 9-24%. A 17% reduction in land usage is also achievable. However, the ELFR suffers from additional complexity and a 16-28% increase in capital cost. It is concluded that this novel design is particularly promising for industrial applications and locations with restricted land availability or high land costs. The decision analysis methodology adopted is considered to have a wider potential for applications in the fields of renewable energy and sustainable design. © 2013 Elsevier Ltd. All rights reserved.

Too old to choose? The effects of age and age related constructs on consumer decision making

Ageing of societies is a major challenge to academic research as well as to management. The unstoppable trend of an aging society in most western societies offers opportunities and challenges at the same time. This paper sheds light on the impact of age as well as age-related constructs on relevant consumer attitudes and behavior. More precisely, the empirical study, conducted in the market for cars, examining the relationships between four distinct age constructs and assesses the impact of these age constructs on information gathering, a consumer’s evoked set, and on rand loyalty.

ICT and internet use at the household levels:a melting pot of sub-optimum decision making in the case of E-Grocery shopping

Research shows that consumers are readily embracing the Internet to buy products. This paper proposes that, in the case of grocery shopping, this may lead to sub-optimal decisions at the household level. Decisions online on what, where and from who to buy are normally taken by one individual. In the case of grocery shopping, decisions, however, need to be ‘vetted’ by ‘other’ individuals within the household. The ‘household wide related’ decisions influence how information technologies and systems for commerce should be designed and managed for optimum decision making. This paper argues, unlike previous research, that e-grocery retailing is failing to grow to its full potential not solely because of the ‘classical’ hazards and perceived risks associated with doing grocery shopping online but because e-grocery retailing strategy has failed to acknowledge the micro-household level specificities that affect decision making. Our exploratory research is based on empirical evidence which were collected through telephone interviews. We offer an insight into how e-grocery ‘fits’ and is ‘disrupted’ by the reality of day to day consumption decision making at the household level. Our main finding is to advocate a more role-neutral, multi-user and multi-technology approach to e-grocery shopping which re-defines the concept of the main shopper/decision maker thereby reconceptualising the ‘shopping logic’ for grocery products.

Project risk management using multiple criteria decision-making technique and decision tree analysis:a case study of Indian oil refinery

This study proposes an integrated analytical framework for effective management of project risks using combined multiple criteria decision-making technique and decision tree analysis. First, a conceptual risk management model was developed through thorough literature review. The model was then applied through action research on a petroleum oil refinery construction project in the Central part of India in order to demonstrate its effectiveness. Oil refinery construction projects are risky because of technical complexity, resource unavailability, involvement of many stakeholders and strict environmental requirements. Although project risk management has been researched extensively, practical and easily adoptable framework is missing. In the proposed framework, risks are identified using cause and effect diagram, analysed using the analytic hierarchy process and responses are developed using the risk map. Additionally, decision tree analysis allows modelling various options for risk response development and optimises selection of risk mitigating strategy. The proposed risk management framework could be easily adopted and applied in any project and integrated with other project management knowledge areas.

The interactive effects of mood and trait negative affect in group decision making

Extending the growing interest in affect in work groups, we propose that groups with distributed information make higher quality decisions when they are in a negative rather than a positive mood, but that these effects are moderated by group members' trait negative affect. In support of this hypothesis, an experiment (N = 175 groups) showed that positive mood led to lower quality decisions than did negative or neutral moods when group members were low in trait negative affect, whereas such mood effects were not observed in groups higher in trait negative affect. Mediational analysis based on behavioral observations of group process confirmed that group information elaboration mediated this effect. These results provide an important caveat on the benefits of positive moods in work groups, and suggest that the study of trait × state affect interactions is an important avenue for future research.

Increased salience of gains versus decreased associative learning differentiate bipolar disorder from schizophrenia during incentive decision making

Background Abnormalities in incentive decision making, typically assessed using the Iowa Gambling Task (IGT), have been reported in both schizophrenia (SZ) and bipolar disorder (BD). We applied the Expectancy-Valence (E-V) model to determine whether motivational, cognitive and response selection component processes of IGT performance are differentially affected in SZ and BD. Method Performance on the IGT was assessed in 280 individuals comprising 70 remitted patients with SZ, 70 remitted patients with BD and 140 age-, sex-and IQ-matched healthy individuals. Based on the E-V model, we extracted three parameters, 'attention to gains or loses', 'expectancy learning' and 'response consistency', that respectively reflect motivational, cognitive and response selection influences on IGT performance. Results Both patient groups underperformed in the IGT compared to healthy individuals. However, the source of these deficits was diagnosis specific. Associative learning underlying the representation of expectancies was disrupted in SZ whereas BD was associated with increased incentive salience of gains. These findings were not attributable to non-specific effects of sex, IQ, psychopathology or medication. Conclusions Our results point to dissociable processes underlying abnormal incentive decision making in BD and SZ that could potentially be mapped to different neural circuits. © 2012 Cambridge University Press.