Investigating the influence of African American and African Caribbean race on primary care doctors' decision making about depression

This paper explores differences in how primary care doctors process the clinical presentation of depression by African American and African-Caribbean patients compared with white patients in the US and the UK. The aim is to gain a better understanding of possible pathways by which racial disparities arise in depression care. One hundred and eight doctors described their thought processes after viewing video recorded simulated patients presenting with identical symptoms strongly suggestive of depression. These descriptions were analysed using the CliniClass system, which captures information about micro-components of clinical decision making and permits a systematic, structured and detailed analysis of how doctors arrive at diagnostic, intervention and management decisions. Video recordings of actors portraying black (both African American and African-Caribbean) and white (both White American and White British) male and female patients (aged 55 years and 75 years) were presented to doctors randomly selected from the Massachusetts Medical Society list and from Surrey/South West London and West Midlands National Health Service lists, stratified by country (US v.UK), gender, and years of clinical experience (less v. very experienced). Findings demonstrated little evidence of bias affecting doctors' decision making processes, with the exception of less attention being paid to the potential outcomes associated with different treatment options for African American compared with White American patients in the US. Instead, findings suggest greater clinical uncertainty in diagnosing depression amongst black compared with white patients, particularly in the UK. This was evident in more potential diagnoses. There was also a tendency for doctors in both countries to focus more on black patients' physical rather than psychological symptoms and to identify endocrine problems, most often diabetes, as a presenting complaint for them. This suggests that doctors in both countries have a less well developed mental model of depression for black compared with white patients. © 2014 The Authors.

Classifying flexible measures in data envelopment analysis:a slack-based measure

Data envelopment analysis (DEA) has gained a wide range of applications in measuring comparative efficiency of decision making units (DMUs) with multiple incommensurate inputs and outputs. The standard DEA method requires that the status of all input and output variables be known exactly. However, in many real applications, the status of some measures is not clearly known as inputs or outputs. These measures are referred to as flexible measures. This paper proposes a flexible slacks-based measure (FSBM) of efficiency in which each flexible measure can play input role for some DMUs and output role for others to maximize the relative efficiency of the DMU under evaluation. Further, we will show that when an operational unit is efficient in a specific flexible measure, this measure can play both input and output roles for this unit. In this case, the optimal input/output designation for flexible measure is one that optimizes the efficiency of the artificial average unit. An application in assessing UK higher education institutions used to show the applicability of the proposed approach. © 2013 Elsevier Ltd. All rights reserved.

Unsupervised KDD to creatively support managers' decision making with fuzzy association rules:a distribution channel application

To be competitive in contemporary turbulent environments, firms must be capable of processing huge amounts of information, and effectively convert it into actionable knowledge. This is particularly the case in the marketing context, where problems are also usually highly complex, unstructured and ill-defined. In recent years, the development of marketing management support systems has paralleled this evolution in informational problems faced by managers, leading to a growth in the study (and use) of artificial intelligence and soft computing methodologies. Here, we present and implement a novel intelligent system that incorporates fuzzy logic and genetic algorithms to operate in an unsupervised manner. This approach allows the discovery of interesting association rules, which can be linguistically interpreted, in large scale databases (KDD or Knowledge Discovery in Databases.) We then demonstrate its application to a distribution channel problem. It is shown how the proposed system is able to return a number of novel and potentially-interesting associations among variables. Thus, it is argued that our method has significant potential to improve the analysis of marketing and business databases in practice, especially in non-programmed decisional scenarios, as well as to assist scholarly researchers in their exploratory analysis. © 2013 Elsevier Inc.

Using genetic programming and decision trees for generating structural descriptions of four bar mechanisms

Four bar mechanisms are basic components of many important mechanical devices. The kinematic synthesis of four bar mechanisms is a difficult design problem. A novel method that combines the genetic programming and decision tree learning methods is presented. We give a structural description for the class of mechanisms that produce desired coupler curves. Constructive induction is used to find and characterize feasible regions of the design space. Decision trees constitute the learning engine, and the new features are created by genetic programming.

Application of Naïve Bayesian sequential analysis to primary care optometry

The objective of this study was to investigate the effects of circularity, comorbidity, prevalence and presentation variation on the accuracy of differential diagnoses made in optometric primary care using a modified form of naïve Bayesian sequential analysis. No such investigation has ever been reported before. Data were collected for 1422 cases seen over one year. Positive test outcomes were recorded for case history (ethnicity, age, symptoms and ocular and medical history) and clinical signs in relation to each diagnosis. For this reason only positive likelihood ratios were used for this modified form of Bayesian analysis that was carried out with Laplacian correction and Chi-square filtration. Accuracy was expressed as the percentage of cases for which the diagnoses made by the clinician appeared at the top of a list generated by Bayesian analysis. Preliminary analyses were carried out on 10 diagnoses and 15 test outcomes. Accuracy of 100% was achieved in the absence of presentation variation but dropped by 6% when variation existed. Circularity artificially elevated accuracy by 0.5%. Surprisingly, removal of Chi-square filtering increased accuracy by 0.4%. Decision tree analysis showed that accuracy was influenced primarily by prevalence followed by presentation variation and comorbidity. Analysis of 35 diagnoses and 105 test outcomes followed. This explored the use of positive likelihood ratios, derived from the case history, to recommend signs to look for. Accuracy of 72% was achieved when all clinical signs were entered. The drop in accuracy, compared to the preliminary analysis, was attributed to the fact that some diagnoses lacked strong diagnostic signs; the accuracy increased by 1% when only recommended signs were entered. Chi-square filtering improved recommended test selection. Decision tree analysis showed that accuracy again influenced primarily by prevalence, followed by comorbidity and presentation variation. Future work will explore the use of likelihood ratios based on positive and negative test findings prior to considering naïve Bayesian analysis as a form of artificial intelligence in optometric practice.

Investigating mental health risk assessment in primary care and the potential role of a structured decision support tool, GRiST

Aim: To explore current risk assessment processes in general practice and Improving Access to Psychological Therapies (IAPT) services, and to consider whether the Galatean Risk and Safety Tool (GRiST) can help support improved patient care. Background: Much has been written about risk assessment practice in secondary mental health care, but little is known about how it is undertaken at the beginning of patients' care pathways, within general practice and IAPT services. Methods: Interviews with eight general practice and eight IAPT clinicians from two primary care trusts in the West Midlands, UK, and eight service users from the same region. Interviews explored current practice and participants' views and experiences of mental health risk assessment. Two focus groups were also carried out, one with general practice and one with IAPT clinicians, to review interview findings and to elicit views about GRiST from a demonstration of its functionality. Data were analysed using thematic analysis. Findings Variable approaches to mental health risk assessment were observed. Clinicians were anxious that important risk information was being missed, and risk communication was undermined. Patients felt uninvolved in the process, and both clinicians and patients expressed anxiety about risk assessment skills. Clinicians were positive about the potential for GRiST to provide solutions to these problems. Conclusions: A more structured and systematic approach to risk assessment in general practice and IAPT services is needed, to ensure important risk information is captured and communicated across the care pathway. GRiST has the functionality to support this aspect of practice.

An efficient knowledge transfer solution to a novel SMDP formalization of a broker's decision problem

This paper introduces a new technique for optimizing the trading strategy of brokers that autonomously trade in re- tail and wholesale markets. Simultaneous optimization of re- tail and wholesale strategies has been considered by existing studies as intractable. Therefore, each of these strategies is optimized separately and their interdependence is generally ignored, with resulting broker agents not aiming for a glob- ally optimal retail and wholesale strategy. In this paper, we propose a novel formalization, based on a semi-Markov deci- sion process (SMDP), which globally and simultaneously op- timizes retail and wholesale strategies. The SMDP is solved using hierarchical reinforcement learning (HRL) in multi- agent environments. To address the curse of dimensionality, which arises when applying SMDP and HRL to complex de- cision problems, we propose an ecient knowledge transfer approach. This enables the reuse of learned trading skills in order to speed up the learning in new markets, at the same time as making the broker transportable across market envi- ronments. The proposed SMDP-broker has been thoroughly evaluated in two well-established multi-agent simulation en- vironments within the Trading Agent Competition (TAC) community. Analysis of controlled experiments shows that this broker can outperform the top TAC-brokers. More- over, our broker is able to perform well in a wide range of environments by re-using knowledge acquired in previously experienced settings.

MultiDecision-2: A Multicriteria Decision Support System

The paper presents a multicriteria decision support system, called MultiDecision-2, which consists of two independent parts - MKA-2 subsystem and MKO-2 subsystem. MultiDecision-2 software system supports the decision makers (DMs) in the solving process of different problems of multicriteria analysis and linear (continues and integer) problems of multicriteria optimization. The two subsystems MKA-2 and MKO-2 of of MultiDecision-2 are briefly described in the paper in the terms of the class of the problems being solved, the system structure, the operation with the interface modules for input data entry and the information about DM’s local preferences, as well as the operation with the interface modules for visualization of the current and final solutions.

Expert System for Decision-Making Problem in Economics

An expert system (ES) is a class of computer programs developed by researchers in artificial intelligence. In essence, they are programs made up of a set of rules that analyze information about a specific class of problems, as well as provide analysis of the problems, and, depending upon their design, recommend a course of user action in order to implement corrections. ES are computerized tools designed to enhance the quality and availability of knowledge required by decision makers in a wide range of industries. Decision-making is important for the financial institutions involved due to the high level of risk associated with wrong decisions. The process of making decision is complex and unstructured. The existing models for decision-making do not capture the learned knowledge well enough. In this study, we analyze the beneficial aspects of using ES for decision- making process.

Comparative Analysis: A Feasible Software Engineering Method

The reasonable choice is a critical success factor for decision- making in the field of software engineering (SE). A case-driven comparative analysis has been introduced and a procedure for its systematic application has been suggested. The paper describes how the proposed method can be built in a general framework for SE activities. Some examples of experimental versions of the framework are brie y presented.

The Inflation Index Prognosis Based on the Method of Decision-Marking “Tree”

The description of the support system for marking decision in terms of prognosing the inflation level based on the multifactor dependence represented by the decision – marking “tree” is given in the paper. The interrelation of factors affecting the inflation level – economic, financial, political, socio-demographic ones, is considered. The perspectives for developing the method of decision – marking “tree”, and pointing out the so- called “narrow” spaces and further analysis of possible scenarios for inflation level prognosing in particular, are defined.

The value of indirect ties in citation networks:SNA analysis with OWA operator weights

This paper seeks to advance the theory and practice of the dynamics of complex networks in relation to direct and indirect citations. It applies social network analysis (SNA) and the ordered weighted averaging operator (OWA) to study a patent citations network. So far the SNA studies investigating long chains of patents citations have rarely been undertaken and the importance of a node in a network has been associated mostly with its number of direct ties. In this research OWA is used to analyse complex networks, assess the role of indirect ties, and provide guidance to reduce complexity for decision makers and analysts. An empirical example of a set of European patents published in 2000 in the renewable energy industry is provided to show the usefulness of the proposed approach for the preference ranking of patent citations.

About Problems of Decision Making in Social and Economic Systems

The reasons of a restricted applicability of the models of decision making in social and economic systems. 3 basic principles of growth of their adequacy are proposed: "localization" of solutions, direct account of influencing of the individual on process of decision making ("subjectivity of objectivity") and reduction of influencing of the individual psychosomatic characteristics of the subject (" objectivity of subjectivity ") are offered. The principles are illustrated on mathematical models of decision making in ecologically- economic and social systems.

A Multicriteria Decision Support System MultiDecision-1

* This paper is partially supported by the National Science Fund of Bulgarian Ministry of Education and Science under contract № I–1401\2004 "Interactive Algorithms and Software Systems Supporting Multicriteria Decision Making."

Extreme Situations Prediction by MultidimenSional Heterogeneous Time Series Using Logical Decision Functions

* The work is supported by RFBR, grant 04-01-00858-a