Mental Health Pharmacists Views on Shared Decision-Making for Antipsychotics in Serious Mental Illness

A qualitative study to look at the views of pharmacists working in mental health settings in relation to shared decision making, particularly as applied to decisions about the prescription of antipsychotics for those diagnosed with severe and enduring mental illnesses.

The role of muscarinic cholinergic signaling in cost-benefit decision making

Thesis (Ph.D.)--University of Washington, 2016-08

Exercise Prescription for Patients with Non-specific Chronic Low Back Pain: a Qualitative Study of Patients' Experiences in Decision Making

Background The culture of current clinical practice calls for collaboration between therapists and patients, sharing power and responsibility. This paper reports on the findings of a qualitative study of exercise prescription for patients with NSCLBP, taking into account issues such as decision making and how this accords with patient preferences and experiences. Objective To understand the treatment decision making experiences, information and decision support needs of patients with NSCLBP who have been offered exercise as part of their management plan. Design A qualitative study using a philosophical hermeneutic approach. Methods Semi-structured interviews with eight patients (including use of brief patient vignettes) was undertaken to explore their personal experiences of receiving exercise as part of the management of their NSCLBP, and their involvement in decisions regarding their care. Findings The findings provide a detailed insight into patients’ perceptions and experiences of receiving exercise-based management strategies. Four themes were formed from the texts: (1) patients’ expectations and patients’ needs are not synonymous, (2) information is necessary but often not sufficient, (3) not all decisions need to be shared, and (4) wanting to be treated as an individual. Conclusions Shared decision making did not appear to happen in physiotherapy clinical practice, but equally may not be what every patient wants. The overall feeling of the patients was that the therapist was dominant in structuring the interactions, leaving the patients feeling disempowered to question and contribute to the decision making.

Choosing best components for an amputee: a methodology for the best decision-making

Introduction - The harmony between the stump and the prosthesis is critical to allow it to fulfill its function enabling an efficient gait. A well fitted socket, with an efficient and comfortable suspension, allows the amputee to continue their daily living activities, maintaining the stump functional, making this correlation between socket and suspension very important in the functionality of the prosthesis, mobility and overall satisfaction with the device. Of our knowledge, the quantitative correlation between all of these factors as not yet been assessed. The objective of this study is to verify and confirm the process of decision-making for four different trans-tibial prostheses with suspension systems: Hypobaric(A), PIN(B), Classic Suction(C) and Vacuum Active –VASS(D) according data provided by gait efficiency (mlO2/kg/m) imagiology (pistonning) and amputee perception.

Decision-making process in Portuguese Erasmus student mobility: case study

With the evolution of nowadays knowledge-based economies, the labour class becomes more competitive. As a way of getting skills that bring benefits to their careers, university students take advantage of the many opportunities available and go abroad to study. This study develops and empirically tests a structural model that examines the antecedents that influence the decision-making process of an Erasmus student under mobility for studies (EMS) in Aveiro, Coimbra and Porto (2014-2015). Reliability analysis, exploratory factor analysis and linear regressions were used to evaluate the model. Based on a survey with a sample of 872 valid responses, this study has demonstrated that EMS students are also influenced by touristic factors, which gives support to what has recently been approached by other authors. Conclusions and suggestions can be applied by other organizations, mainly Higher Education Institutions in order to attract more EMS students.

Decision making models embedded into a web-based tool for assessing pest infestation risk

Current practices in agricultural management involve the application of rules and techniques to ensure high quality and environmentally friendly production. Based on their experience, agricultural technicians and farmers make critical decisions affecting crop growth while considering several interwoven agricultural, technological, environmental, legal and economic factors. In this context, decision support systems and the knowledge models that support them, enable the incorporation of valuable experience into software systems providing support to agricultural technicians to make rapid and effective decisions for efficient crop growth. Pest control is an important issue in agricultural management due to crop yield reductions caused by pests and it involves expert knowledge. This paper presents a formalisation of the pest control problem and the workflow followed by agricultural technicians and farmers in integrated pest management, the crop production strategy that combines different practices for growing healthy crops whilst minimising pesticide use. A generic decision schema for estimating infestation risk of a given pest on a given crop is defined and it acts as a metamodel for the maintenance and extension of the knowledge embedded in a pest management decision support system which is also presented. This software tool has been implemented by integrating a rule-based tool into web-based architecture. Evaluation from validity and usability perspectives concluded that both agricultural technicians and farmers considered it a useful tool in pest control, particularly for training new technicians and inexperienced farmers.

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).

'Artificial Immune Systems: A new Decision Making Paradigm for Operational Research'

Over the last few years, more and more heuristic decision making techniques have been inspired by nature, e.g. evolutionary algorithms, ant colony optimisation and simulated annealing. More recently, a novel computational intelligence technique inspired by immunology has emerged, called Artificial Immune Systems (AIS). This immune system inspired technique has already been useful in solving some computational problems. In this keynote, we will very briefly describe the immune system metaphors that are relevant to AIS. We will then give some illustrative real-world problems suitable for AIS use and show a step-by-step algorithm walkthrough. A comparison of AIS to other well-known algorithms and areas for future work will round this keynote off. It should be noted that as AIS is still a young and evolving field, there is not yet a fixed algorithm template and hence actual implementations might differ somewhat from the examples given here

Structured decision making as a tool for facilitating stakeholder engagement in non-renewable resource management: using the case study of hydraulic fracturing in the Green Point Shale formation in western Newfoundland

This thesis examines the importance of effective stakeholder engagement that complies with the doctrines of social justice in non-renewable resources management decision-making. It uses hydraulic fracturing in the Green Point Shale Formation in Western Newfoundland as a case study. The thesis uses as theoretical background John Rawls’ and David Miller’ theory of social justice, and identifies the social justice principles, which are relevant to stakeholder engagement. The thesis compares the method of stakeholder engagement employed by the Newfoundland and Labrador Hydraulic Fracturing Review Panel (NLHFRP), with the stakeholder engagement techniques recommended by the Structured Decision Making (SDM) model, as applied to a simulated case study involving hydraulic fracturing in the Green Point Shale Formation. Using the already identified social justice principles, the thesis then developed a framework to measure the level of compliance of both stakeholder engagement techniques with social justice principles. The main finding of the thesis is that the engagement techniques prescribed by the SDM model comply more closely with the doctrines of social justice than the engagement techniques applied by the NLHFRP. The thesis concludes by recommending that the SDM model be more widely used in non- renewable resource management decision making in order to ensure that all stakeholders’ concerns are effectively heard, understood and transparently incorporated in the nonrenewable resource policies to make them consistent with local priorities and goals, and with the social justice norms and institutions.

SCHOOL DISTRICT GOVERNANCE AND KNOWLEDGE-FIT IN DECISION RIGHTS: HOW DISTRICTS RECRUIT AND HIRE SCHOOL LIBRARIANS

This study examines the organizational structures and decision-making processes used by school districts to recruit and hire school librarians. For students to acquire the information and technology literacy education they need, school libraries must be staffed with qualified individuals who can fulfill the librarian’s role as leader, teacher, instructional partner, information specialist, and program administrator. Principals are typically given decision rights for hiring staff, including school librarians. Research shows that principals have limited knowledge of the skills and abilities of the school librarian or the specific needs and functions of the library program. Research also indicates that those with specific knowledge of school library programs, namely school district library supervisors, are only consulted on recruiting and hiring about half the time. School districts entrust library supervisors with responsibilities such as professional development of school librarians only after they are hired. This study uses a theoretical lens from research on IT governance, which focuses on the use of knowledge-fit in applying decision rights in an organization. This framework is appropriate because of its incorporation of a specialist with a specific knowledge set in determining the placement of input and decision rights in the decision-making processes. The method used in this research was a multiple-case study design using five school districts as cases, varying by the involvement of the supervisors and other individuals in the hiring process. The data collected from each school district were interviews about the district’s recruiting and hiring practices with principals, an individual in HR, library supervisors, and recently hired school librarians. Data analysis was conducted through iterative coding from themes in the research questions, with continuous adjustments as new themes developed. Results from the study indicate that governance framework is applicable to evaluating the decision-making processes used in recruiting and hiring school librarians. However, a district’s use of governance did not consistently use knowledge-fit in the determination of input and decision rights. In the hiring process, governance was more likely to be based on placing decision rights at a certain level of the district hierarchy rather than the location of specific knowledge, most often resulting in site-based governance for decision rights at the school-building level. The governance of the recruiting process was most affected by the shortage or surplus of candidates available to the district to fill positions. Districts struggling with a shortage of candidates typically placed governance for the decision-making process on recruiting at the district level, giving the library supervisor more opportunity for input and collaboration with human resources. In districts that use site-based governance and that place all input and decision rights at the building level, some principals use their autonomy to eliminate the school library position in the allotment phase or hire librarians that, while certified through testing, do not have the same level of expertise as those who achieve certification through LIS programs. The principals in districts who use site-based governance for decision rights but call on the library supervisor for advisement stated how valuable they found the supervisor’s expertise in evaluating candidates for hire. In no district was a principal or school required to involve the library supervisor in the hiring of school librarians. With a better understanding of the tasks involved, the effect of district governance on decision-making, and the use of knowledge to assign input and decision rights, it is possible to look at how all of these factors affect the outcome in the quality of the hire. A next step is to look at the hiring process that school librarians went through and connect those with the measurable outcomes of hiring: school librarian success, retention, and attrition; the quality of school library program services, outreach, and involvement in a school; and the perceptions of the success of the school librarian and the library program as seen from students, teachers, administrators, parents, and other community stakeholders.

Increase in Hippocampal Theta Oscillations during Spatial Decision Making

The processing of spatial and mnemonic information is believed to depend on hippocampal theta oscillations (5–12 Hz). However, in rats both the power and the frequency of the theta rhythm are modulated by locomotor activity, which is a major confounding factor when estimating its cognitive correlates. Previous studies have suggested that hippocampal theta oscillations support decision-making processes. In this study, we investigated to what extent spatial decision making modulates hippocampal theta oscillations when controlling for variations in locomotion speed. We recorded local field potentials from the CA1 region of rats while animals had to choose one arm to enter for reward (goal) in a four-arm radial maze. We observed prominent theta oscillations during the decision-making period of the task, which occurred in the center of the maze before animals deliberately ran through an arm toward goal location. In speed-controlled analyses, theta power and frequency were higher during the decision period when compared to either an intertrial delay period (also at the maze center), or to the period of running toward goal location. In addition, theta activity was higher during decision periods preceding correct choices than during decision periods preceding incorrect choices. Altogether, our data support a cognitive function for the hippocampal theta rhythm in spatial decision making

A New Paradigm for Heuristic Decision Making, Invited Keynote Talk

Over the last few years, more and more heuristic decision making techniques have been inspired by nature, e.g. evolutionary algorithms, ant colony optimisation and simulated annealing. More recently, a novel computational intelligence technique inspired by immunology has emerged, called Artificial Immune Systems (AIS). This immune system inspired technique has already been useful in solving some computational problems. In this keynote, we will very briefly describe the immune system metaphors that are relevant to AIS. We will then give some illustrative real-world problems suitable for AIS use and show a step-by-step algorithm walkthrough. A comparison of AIS to other well-known algorithms and areas for future work will round this keynote off. It should be noted that as AIS is still a young and evolving field, there is not yet a fixed algorithm template and hence actual implementations might differ somewhat from the examples given here.

Combined Machine Learning Techniques for Decision Making Support in Medicine

Computational intelligent support for decision making is becoming increasingly popular and essential among medical professionals. Also, with the modern medical devices being capable to communicate with ICT, created models can easily find practical translation into software. Machine learning solutions for medicine range from the robust but opaque paradigms of support vector machines and neural networks to the also performant, yet more comprehensible, decision trees and rule-based models. So how can such different techniques be combined such that the professional obtains the whole spectrum of their particular advantages? The presented approaches have been conceived for various medical problems, while permanently bearing in mind the balance between good accuracy and understandable interpretation of the decision in order to truly establish a trustworthy ‘artificial’ second opinion for the medical expert.

Computational approaches to emotional decision making

Findings on the role that emotion plays in human behavior have transformed Artificial Intelligence computations. Modern research explores how to simulate more intelligent and flexible systems. Several studies focus on the role that emotion has in order to establish values for alternative decision and decision outcomes. For instance, Busemeyer et al. (2007) argued that emotional state affects the subjectivity value of alternative choice. However, emotional concepts in these theories are generally not defined formally and it is difficult to describe in systematic detail how processes work. In this sense, structures and processes cannot be explicitly implemented. Some attempts have been incorporated into larger computational systems that try to model how emotion affects human mental processes and behavior (Becker-Asano & Wachsmuth, 2008; Marinier, Laird & Lewis, 2009; Marsella & Gratch, 2009; Parkinson, 2009; Sander, Grandjean & Scherer, 2005). As we will see, some tutoring systems have explored this potential to inform user models. Likewise, dialogue systems, mixed-initiative planning systems, or systems that learn from observation could also benefit from such an approach (Dickinson, Brew & Meurers, 2013; Jurafsky & Martin, 2009). That is, considering emotion as interaction can be relevant in order to explain the dynamic role it plays in action and cognition (see Boehner et al., 2007).

Designing Efficient Subsidy Policies in a Regional Economy: A Multicriteria Decision-Making (MCDM)-Computable General Equilibrium (CGE) Approach

Since policy-makers usually pursue several conflicting objectives, policy-making can be understood as a multicriteria decision problem. Following the methodological proposal by André and Cardenete (2005) André, F. J. and Cardenete, M. A. 2005. Multicriteria Policy Making. Defining Efficient Policies in a General Equilibrium Model, Seville: Centro de Estudios Andaluces. Working Paper No. E2005/04, multi-objective programming is used in connection with a computable general equilibrium model to represent optimal policy-making and to obtain so-called efficient policies in an application to a regional economy (Andalusia, Spain). This approach is applied to the design of subsidy policies under two different scenarios. In the first scenario, it is assumed that the government is concerned just about two objectives: ensuring the profitability of a key strategic sector and increasing overall output. Finally, the scope of the exercise is enlarged by solving a problem with seven policy objectives, including both general and sectorial objectives. It is concluded that the observed policy could have been Pareto-improved in several directions.