Overdue choices : how information and role in decision-making influence women's preferences for induction for prolonged pregnancy

Background: Enabling women to make informed decisions is a crucial component of consumer-focused maternity care. Current evidence suggests that health care practitioners’ communication of care options may not facilitate patient involvement in decision-making. The aim of this study was to investigate the effect of specific variations in health caregiver communication on women’s preferences for induction of labor for prolonged pregnancy. Methods: A convenience sample of 595 female participants read a hypothetical scenario in which an obstetrician discusses induction of labor with a pregnant woman. Information provided on induction and the degree of encouragement for the woman’s involvement in decision-making was manipulated to create four experimental conditions. Participants indicated preference with respect to induction, their perceptions of the quality of information received, and other potential moderating factors. Results: Participants who received information that was directive in favor of medical intervention were significantly more likely to prefer induction than those given nondirective information. No effect of level of involvement in decision-making was found. Participants’ general trust in doctors moderated the relationship between health caregiver communication and preferences for induction, such that the influence of information provided on preferences for induction differed across levels of involvement in decision-making for women with a low trust in doctors, but not for those with high trust. Many women were not aware of the level of information required to make an informed decision. Conclusions: Our findings highlight the potential value of strategies such as patient decision aids and health care professional education to improve the quality of information available to women and their capacity for informed decision-making during pregnancy and birth. (BIRTH 39:3 September 2012)

A flexible asset maintenance decision-making process model

Optimal Asset Maintenance decisions are imperative for efficient asset management. Decision Support Systems are often used to help asset managers make maintenance decisions, but high quality decision support must be based on sound decision-making principles. For long-lived assets, a successful Asset Maintenance decision-making process must effectively handle multiple time scales. For example, high-level strategic plans are normally made for periods of years, while daily operational decisions may need to be made within a space of mere minutes. When making strategic decisions, one usually has the luxury of time to explore alternatives, whereas routine operational decisions must often be made with no time for contemplation. In this paper, we present an innovative, flexible decision-making process model which distinguishes meta-level decision making, i.e., deciding how to make decisions, from the information gathering and analysis steps required to make the decisions themselves. The new model can accommodate various decision types. Three industrial case studies are given to demonstrate its applicability.

Ironmongeries life cycle costing and quality satisfaction

Most commonly, residents are always arguing about the satisfaction of sustainability and quality of their high rise residential property. This paper aim is to maintain the best quality satisfaction of the door hardware by introducing the whole life cycle costing approach to the property manager of the public housing in Johor. This paper looks into the current situation of ironmongeries (door hardware) of 2 public housings in Johor, Malaysia and testing the whole life cycle costing approach towards them. The calculation and the literature review are conducted. The questionnaire surveys of 2 public housings were conducted to make clear the occupants’ evaluation about the actual quality conditions of the ironmongeries in their house. As a result, the quality of door hardware based on the whole life cycle costing approach is one of the best among their previous decision making tool that have been applied. Practitioners can benefit from this paper as it provides information on calculating the whole life costing and making the decisions about ironmongeries selection of their properties.

Whole life cycle costing and quality satisfaction : public housing floor material

Most commonly, residents are always arguing about the satisfaction of sustainability and quality of their high rise residential property. This paper aim is to maintain the best quality satisfaction of the floor materials by introducing the whole life cycle costing approach to the property manager of the public housing in Johor. This paper looks into the current situation of floor material of two public housings in Johor, Malaysia and testing the whole life cycle costing approach towards them. The cost figures may be implemented to justify higher investments, for examples, in the quality or flexibility of building solutions through a long-term cost reduction. The calculation and the literature review are conducted. The questionnaire surveys of two public housings were conducted to make clear the occupants’ evaluation about the actual quality conditions of the floor material in their house. As a result, the quality of floor material based on the whole life cycle costing approach is one of the best among their previous decision making tool that was applied. Practitioners can benefit from this paper as it provides information on calculating the whole life costing and making the decisions for floor material selection for their properties.

Application of multi-criteria decision making methods to compression ignition engine efficiency and gaseous, particulate and greenhouse gas emissions

Compression ignition (CI) engine design is subject to many constraints which presents a multi-criteria optimisation problem that the engine researcher must solve. In particular, the modern CI engine must not only be efficient, but must also deliver low gaseous, particulate and life cycle greenhouse gas emissions so that its impact on urban air quality, human health, and global warming are minimised. Consequently, this study undertakes a multi-criteria analysis which seeks to identify alternative fuels, injection technologies and combustion strategies that could potentially satisfy these CI engine design constraints. Three datasets are analysed with the Preference Ranking Organization Method for Enrichment Evaluations and Geometrical Analysis for Interactive Aid (PROMETHEE-GAIA) algorithm to explore the impact of 1): an ethanol fumigation system, 2): alternative fuels (20 % biodiesel and synthetic diesel) and alternative injection technologies (mechanical direct injection and common rail injection), and 3): various biodiesel fuels made from 3 feedstocks (i.e. soy, tallow, and canola) tested at several blend percentages (20-100 %) on the resulting emissions and efficiency profile of the various test engines. The results show that moderate ethanol substitutions (~20 % by energy) at moderate load, high percentage soy blends (60-100 %), and alternative fuels (biodiesel and synthetic diesel) provide an efficiency and emissions profile that yields the most “preferred” solutions to this multi-criteria engine design problem. Further research is, however, required to reduce Reactive Oxygen Species (ROS) emissions with alternative fuels, and to deliver technologies that do not significantly reduce the median diameter of particle emissions.

Decision-making about hormone replacement therapy by women in England and Scotland

OBJECTIVE: The aim of this study was to explore women's decision-making about the balance of risks and benefits of taking hormone replacement therapy (HRT) based on the latest evidence from the Women's Health Initiative (WHI) trial of combined HRT. METHODS: Women aged 50-69 years, who were eligible for the Women's International Study of long Duration Oestrogen after Menopause (WISDOM) trial, were invited to participate in one of eight focus groups. Participants were asked to discuss their views about taking HRT based on the latest international evidence. RESULTS AND CONCLUSIONS: Eighty-two women participated overall. Qualitative content analysis was applied to the discussion transcripts. Women regarded the decisions they make about taking HRT as highly personal, and, for women currently taking HRT, the overwhelming reason for continuation was perceived improvement in quality of life regardless of either the risks or the benefits in the longer term.

Linking scientific evidence and decision making : A case study of hand hygiene interventions

We consider how data from scientific research should be used for decision making in health services. Whether a hand hygiene intervention to reduce risk of nosocomial infection should be widely adopted is the case study. Improving hand hygiene has been described as the most important measure to prevent nosocomial infection. 1 Transmission of microorganisms is reduced, and fewer infections arise, which leads to a reduction in mortality2 and cost savings.3 Implementing a hand hygiene program is itself costly, so the extra investment should be tested for cost-effectiveness.4,5 The first part of our commentary is about cost-effectiveness models and how they inform decision making for health services. The second part is about how data on the effectiveness of hand hygiene programs arising from scientific studies are used, and 2 points are made: the threshold for statistical inference of .05 used to judge effectiveness studies is not important for decision making,6,7 and potentially valuable evidence about effectiveness might be excluded by decision makers because it is deemed low quality.8 The ideas put forward will help researchers and health services decision makers to appraise scientific evidence in a more powerful way.

Information quality in social media : a conceptual model

Social Media (SM) is increasingly being integrated with business information in decision making. Unique characteristics of social media (e.g. wide accessibility, permanence, global audience, recentness, and ease of use) raise new issues with information quality (IQ); quite different from traditional considerations of IQ in information systems (IS) evaluation. This paper presents a preliminary conceptual model of information quality in social media (IQnSM) derived through directed content analysis and employing characteristics of analytic theory in the study protocol. Based in the notion of ‘fitness for use’, IQnSM is highly use and user centric and is defined as “the degree to which information is suitable for doing a specified task by a specific user, in a certain context”. IQnSM is operationalised as hierarchical, formed by the three dimensions (18 measures): intrinsic quality, contextual quality and representational quality. A research plan for empirically validating the model is proposed.

Decision making guidelines for sustainable construction of industrialised building systems

The construction industry has an obligation to respond to sustainability expectations of our society. Solutions that integrate innovative, intelligent and sustainability deliverables are vital for us to meet new and emerging challenges. Industrialised Building Systems (IBS), or known otherwise as prefabrication, employs a combination of ready-made components in the construction of buildings. They promote quality of production, enhance simplification of construction processes and minimise waste. The unique characteristics of this construction method respond well to sustainability. Despite the promises however, IBS has yet to be effectively implemented in Malaysia. There are often misconceptions among key stakeholders about IBS applications. The existing rating schemes fail to assess IBS against sustainability measures. To ensure the capture of full sustainability potential in buildings developed, the critical factors and action plans agreeable to all participants in the development processes need to be identified. Through questionnaire survey, eighteen critical factors relevant to IBS sustainability were identified and encapsulated into a conceptual framework to coordinate a systematic IBS decision making approach. Five categories were used to separate the critical factors into: ecological performance; economic value; social equity and culture; technical quality; and implementation and enforcement. This categorisation extends the "Triple Bottom Lines" to include social, economic, environmental and institutional dimensions. Semi-structured interviews help identify strategies of actions and solutions of potential problems through a SWOT analysis framework. These tools help the decision-makers maximise the opportunities by using available strengths, avoid weaknesses, and diagnose possible threats in the examined issues. The recommendations formed an integrated action plan to present information on what and how to improve sustainability through tackling each critical factor during IBS development. It can be used as part of the project briefing documents for IBS designers. For validation and finalisation the research deliverables, three case studies were conducted. The research fills a current gap by responding to IBS project scenarios in developing countries. It also provides a balanced view for designers to better understand sustainability potential and prioritize attentions to manage sustainability issues in IBS applications.

Project governance : ethical decision making in project procurement in the Malaysian public sectors

Managing public sector projects in Malaysia is a unique challenge. This is because of the ethical issues involved during the project procurement process. These ethical issues need attention because they will have an impact on the quality, cost and time of the project itself. The ethical issues here include conflict of interest, bid shopping, collusive tendering, bid cutting, corruption and the payment game. In 2006, 17.3% of 417 Malaysian government contract projects were considered sick due to contractors' performances that failed to conduct the project according to the project plan. Some of the sick projects from these statistics are due to the ethical issues involved. These construction projects have low quality due to the selection of the contractors, done unethically due to personal relationships instead of professional qualifications. That is why it is important to govern the project procurement processes to ensure the accountability and transparency of the decision making process to ensure that these ethical issues can be avoided. Extensive research has been conducted on the ethical issues in the tendering process or the award phase of project management. There is a lack of studies looking at the role of clients, including the government client, in relation to unethical practice in project procurement in the public sector. It is important to understand that ethical issues not only involve the contractors and suppliers but also the clients. Even though there are codes of ethics in the public sectors, ethical issues still arise. Therefore, this research develops a project governance framework (PGEDM) for ethical decision making in the Malaysian public sectors. This framework combines the ethical decision making process together with the project governance principals in guiding the public sectors with ethical decision making in project procurement. A triangulation of questionnaire survey and Delphi study was employed in this research to collect required qualitative and quantitative data. A questionnaire survey was conducted among the public officials (the practitioners) who are currently working in the procurement area in the Malaysian public sectors, in identifying the ethical behaviours and factors influencing further ethical behaviour to occur. A Delphi study was also conducted with the assistance of a panel of experts consisting of practitioners that have expertise in the area of project governance and project procurement as well as academician, which further considered the relationship and the influence of the criteria and indicators of ethical decision making (EDM) and project governance (project criteria, organisational culture, contract award criteria, individual criteria, client's requirements, government procedures and professional ethics). Through the identification and integration of the factors and EDM criteria as well as the project governance criteria and EDM steps for ethical issues, a PGEDM framework was developed to promote, and drive consistent decision outcome in project procurement in the public sector. The framework contributes significantly to ethical decision making in the project procurement process. These findings not only give benefit to the people involved in project procurement but also to the public officials in guiding them to be more accountable in handling ethical issues in the future and to have a more transparent decision making process.

Condition monitoring and operational decision making in semiconductor manufacturing

Today, the majority of semiconductor fabrication plants (fabs) conduct equipment preventive maintenance based on statistically-derived time- or wafer-count-based intervals. While these practices have had relative success in managing equipment availability and product yield, the cost, both in time and materials, remains high. Condition-based maintenance has been successfully adopted in several industries, where costs associated with equipment downtime range from potential loss of life to unacceptable affects to companies’ bottom lines. In this paper, we present a method for the monitoring of complex systems in the presence of multiple operating regimes. In addition, the new representation of degradation processes will be used to define an optimization procedure that facilitates concurrent maintenance and operational decision-making in a manufacturing system. This decision-making procedure metaheuristically maximizes a customizable cost function that reflects the benefits of production uptime, and the losses incurred due to deficient quality and downtime. The new degradation monitoring method is illustrated through the monitoring of a deposition tool operating over a prolonged period of time in a major fab, while the operational decision-making is demonstrated using simulated operation of a generic cluster tool.

Quality of life and survival in patients treated with radical chemoradiation alone for oesophageal cancer

Aims: To report cancer-specific and health-related quality-of-life outcomes in patients undergoing radical chemoradiation (CRT) alone for oesophageal cancer. Materials and methods: Between 1998 and 2005, 56 patients with oesophageal cancer received definitive radical CRT, due to local disease extent, poor general health, or patient choice. Data from European Organization for Research and Treatment of Cancer quality-of-life questionnaires QLQ-30 and QLQ-OES24 were collected prospectively. Questionnaires were completed at diagnosis, and at 3, 6 and 12 months after CRT where applicable. Results: The median follow-up was 18 months. The median overall survival was 14 months, with a 51, 26 and 13% 1-, 3- and 5-year survival, respectively. At 12 months after treatment there was a significant improvement compared with before treatment with respect to dysphagia and pain. Global health scores were not significantly affected. Conclusions: Considering the relatively short long-term survival for this cohort of patients, maximising the quality of those final months should be very carefully borne in mind from the outset. The health-related quality-of-life data reported herein helps to establish benchmarks for larger evaluation within randomised clinical trials. © 2007 The Royal College of Radiologists.

A demand-responsive decision support system for coal transportation

In this paper, a demand-responsive decision support system is proposed by integrating the operations of coal shipment, coal stockpiles and coal railing within a whole system. A generic and flexible scheduling optimisation methodology is developed to identify, represent, model, solve and analyse the coal transport problem in a standard and convenient way. As a result, the integrated train-stockpile-ship timetable is created and optimised for improving overall efficiency of coal transport system. A comprehensive sensitivity analysis based on extensive computational experiments is conducted to validate the proposed methodology. The mathematical proposition and proof are concluded as technical and insightful advices for industry practice. The proposed methodology provides better decision making on how to assign rail rolling-stocks and upgrade infrastructure in order to significantly improve capacity utilisation with the best resource-effectiveness ratio. The proposed decision support system with train-stockpile-ship scheduling optimisation techniques is promising to be applied in railway or mining industry, especially as a useful quantitative decision making tool on how to use more current rolling-stocks or whether to buy additional rolling-stocks for mining transportation.

Remote sensing and core data needed to support planning and policy decision making

A variety of sustainable development research efforts and related activities are attempting to reconcile the issues of conserving our natural resources without limiting economic motivation while also improving our social equity and quality of life. Land use/land cover change, occurring on a global scale, is an aggregate of local land use decisions and profoundly impacts our environment. It is therefore the local decision making process that should be the eventual target of many of the ongoing data collection and research efforts which strive toward supporting a sustainable future. Satellite imagery data is a primary source of data upon which to build a core data set for use by researchers in analyzing this global change. A process is necessary to link global change research, utilizing satellite imagery, to the local land use decision making process. One example of this is the NASA-sponsored Regional Data Center (RDC) prototype. The RDC approach is an attempt to integrate science and technology at the community level. The anticipated result of this complex interaction between research and the decision making communities will be realized in the form of long-term benefits to the public.

Water Quality Indices from Unbalanced Spatio-Temporal Monitoring Designs

This chapter investigates a variety of water quality assessment tools for reservoirs with balanced/unbalanced monitoring designs and focuses on providing informative water quality assessments to ensure decision-makers are able to make risk-informed management decisions about reservoir health. In particular, two water quality assessment methods are described: non-compliance (probability of the number of times the indicator exceeds the recommended guideline) and amplitude (degree of departure from the guideline). Strengths and weaknesses of current and alternative water quality methods will be discussed. The proposed methodology is particularly applicable to unbalanced designs with/without missing values and reflects the general conditions and is not swayed too heavily by the occasional extreme value (very high or very low quality). To investigate the issues in greater detail, we use as a case study, a reservoir within South-East Queensland (SEQ), Australia. The purpose here is to obtain an annual score that reflected the overall water quality, temporally, spatially and across water quality indicators for each reservoir.