Decision analysis of the effectiveness of lung cancer screening using autofluorescence bronchoscopy and computed tomography

Background: Lung cancer (LC) is the leading cause of cancer death in the developed world. Most cancers are associated with tobacco smoking. A primary hope for reducing lung cancer has been prevention of smoking and successful smoking cessation programs. To date, these programs have not been as successful as anticipated. Objective: The aim of the current study was to evaluate whether lung cancer screening combining low dose computed tomography with autofluorescence bronchoscopy (combined CT & AFB) is superior to CT or AFB screening alone in improving lung cancer specific survival. In addition, the extent of improvement and ideal conditions for combined CT & AFB screening were evaluated. Methods: We applied decision analysis and Monte Carlo simulation modeling using TreeAge Software to evaluate our study aims. Histology- and stage specific probabilities of lung cancer 5-year survival proportions were taken from Surveillance and Epidemiologic End Results (SEER) Registry data. Screeningassociated data was taken from the US NCI Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), National Lung Screening Trial (NLST), and US NCI Lung Screening Study (LSS), other relevant published data and expert opinion. Results: Decision Analysis - Combined CT and AFB was the best approach at Improving 5-year survival (Overall Expected Survival (OES) in the entire screened population was 0.9863) and in lung cancer patients only (Lung Cancer Specific Expected Survival (LOSES) was 0.3256). Combined screening was slightly better than CT screening alone (OES = 0.9859; LCSES = 0.2966), and substantially better than AFB screening alone (OES = 0.9842; LCSES = 0.2124), which was considerably better than no screening (OES = 0.9829; LCSES = 0.1445). Monte Carlo simulation modeling revealed that expected survival in the screened population and lung cancer patients is highest when screened using CT and combined CT and AFB. CT alone and combined screening was substantially better than AFB screening alone or no screening. For LCSES, combined CT and AFB screening is significantly better than CT alone (0.3126 vs. 0.2938, p< 0.0001). Conclusions: Overall, these analyses suggest that combined CT and AFB is slightly better than CT alone at improving lung cancer survival, and both approaches are substantially better than AFB screening alone or no screening.

A Study of role conflict, role ambiguity, locus of control, job satisfaction and participation in decision making among front-line vocational service workers for mentally retarded adults

This study was an investigation of individual and organizational factors, as perceived by front-line vocational service workers from Adult Rehabilitation Centres (ARC Industries) for mentally retarded adults. The specific variables which were measured included role conflict/role ambiguity (role factors), internal/external locus of control (individual differences), job satisfaction with work and supervision (job attitudes) and participation in deci~ion making (organizational factor). The exploration of these constructs was conducted by means of self-report questionnaires which were completed by sixty-nine out of a total of ninety front-line employees. The surveys were distributed in booklet form to nine distinct rehabilitation facilities from St. Catharines, West Lincoln, Greater Niagara, Port Colborne, WeIland, Fort Erie, Hamilton, Guelph and Brantford. The survey data was evaluated by the statisti.cal Package for the Social Sciences (SPSS) which used the Pearson Product Moment Correlation procedure and a compar~son of means test. A comparison of correlation coefficients test was also conducted. This statistical procedure was calculated mathematically. The results obtained from the statistical evaluation confirmed the prediction that self-reported measures of participation in decision making and satisfaction (work and supervision) would be negatively correlated with role conflict and role ambiguity. As well, the speculation that perceived satisfaction (work and supervision) would be positively correlated with participation in decision making was empirically supported. Internal and external locus of control did not contribute to a significant difference in r~sponses to role perceptions (conflict and ambiguity) , satisfaction (work and supervision) or the correlational relationship between participation in decision making and satisfaction (work and supervision). Overall, the findings from this study substantiated the importance of examining employee perceptions in the workplace and the interrelationships among individual and organizational variables. This research was considered a contribution to the general area of occupational stress and to the study of individuals in work organizations.

A study on the role of the parent in educational decision making from the perspective of parents and teachers

ADeweyan (1916) democratic theoty ofeducation called for the participation ofall citizens in deliberating important educational issues to improve overall student learning. Thus, the move to include parents in educational decision making can be considered to be rooted in democratic principles. To gain greater insight into the issue ofparent involvement in educational decision making, one elementary school was studied and a triangulization method was employed in an attempt to clarify the important issues surrolUlding the move to include parents in the governance ofschools. The three methods to gain information included surveys, interviews, and documentation ofsignificant school events and related work. All ofthe parents and teachers ofthe school were surveyed, 10 parents and 6teachers were interviewed, and related school events were recorded. The survey design was modeled on the Parent Involvement Questionnaire (PIQ) created and reported on by Chavkin and Williams (1987). The results ofthe surveys were used as a guide for the interview questions. An interview outline was developed based on Seidman's (1991) open-ended approach and Patton's (1980) standardized open-ended interview style in which parents and teachers were asked about their experiences and opinions on anmnber ofparent involvement issues. Parents and teachers in this school indicated agreater interest in becoming more aware ofeducational issues such as school budget and school discipline policies. Although the parents indicated agreater interest in school matters and the teachers indicated awillingness to include parents in school matters, both the parents and teachers in this study perceived the role ofthe parent as advisory, not decision making. It was concluded that to ensure ameaningful and functional role for parellts as tlleir p811icipatioll ill educational matters evolves, SCllools must have a clear vision ofthe primary goal ofall schools, namely, to foster and nourish democratic citizens for ademocratic society (Glickman, 1993). Furthennore, intentional practices such as Purkey's (ad) 5-P Relay approach, based on a democratic theory and practice of education, will have to be employed in order to give parents an authentic voice in educational matters and provide an avenue for parents to acquire the necessary skills and lmowledge needed to do so. As schools, school boards, and the Ministry ofEducation implement parent involvement guidelines and policies, developmental needs ofeach school need to be considered to ensure the employment ofdemocratic practices not authoritarian mandates. Parent interest and involvement, at whatever level, should be an important element in the overall move to make schools part ofthe democratic society they were meant to be.

Decision-making theory applied to India's explosion of a nuclear device in May, 1974

This essay reviews the decision-making process that led to India exploding a nuclear device in May, 1974. An examination of the Analytic, Cybernetic and Cognitive Theories of decision, will enable a greater understanding of the events that led up to the 1974 test. While each theory is seen to be only partially useful, it is only by synthesising the three theories that a comprehensive account of the 1974 test can be given. To achieve this analysis, literature on decision-making in national security issues is reviewed, as well as the domestic and international environment in which involved decisionmakers operated. Finally, the rationale for the test in 1974 is examined. The conclusion revealed is that the explosion of a nuclear device by India in 1974 was primarily related to improving Indian international prestige among Third World countries and uniting a rapidly disintegrating Indian societal consensus. In themselves, individual decision-making theories were found to be of little use, but a combination of the various elements allowed a greater comprehension of the events leading up to the test than might otherwise have been the case.

Factors affecting treatment decision making for women with breast cancer

This study examined the factors affecting treatment decision making for young women with early stage breast cancer. Thirty women, aged 35 to 52 years, were presented information about two equally effective chemotherapy treatments following surgery for breast cancer using an educational instrument called a "decision board." Although equally effective, the treatments differ with regards to side effects and treatment schedule. The purpose of this research was to investigate what factors affect the decision-making process. Following administration of the decision board, women were given a take-home version to review and asked to return one to two weeks later with a decision, at which time they completed a questionnaire. theoretical framework for this study was constructed from the literature on self-directed learning and critical thinking. The Overall, the factors rated most important to the treatment decision were related to quality of life, side effects, and length of treatment. Five factors were found to be rated significantly different by the women who chose one treatment versus the other in terms of importance to their decision. These were side effects in general, vomiting, hair loss, family role, and the number of trips to the cancer centre required for treatment.Implications and recommendations for patient education, research, and practice evolved from the findings of this study.

Management decision-making in nursing

This study developed a new, valid and reliable evaluation instrument to measure the level, type and pattern of management decisions of fifteen nursing students. The management decision score achieved using this instrument was correlated with two psychological determinants of management decision making: creativity and problem-solving ability. The instrument was a written patient management problem in case format, answered by a free form written response. The student responses were classified for type of management decision according to the sub-categories of technical, inter-personal, environmental and unique. Using statistical analysis a significant difference was found in the type of management decisions most frequently selected by the study sample. The students predominantly selected technical type decisions. This preference for one type of management decision may be due to a number of psychological and environmental factors. These factors may program and mold the type of management decisions student nurses make early in their career. Low but positive correlations were found between the total management score and the two psychological tests. This finding supports the authors cited in the literature who state that although creativity augments the type of management decision making, it is not present or encouraged widely in the nursing profession. These factors are worth considering when the profession becomes concerned over ritualization and lack of individuality in patient care. The tool is easy to administer, lends itself to a variety of professional settings and shows promise with further refinement for computer application.

A study of ethical decision-making in hypothetical scenarios by secondary school principals /

The purpose of the study,was to investigate the ways in which secondary school principals make decisions that have an ethical dimension, and the reasons they use to justify their choices. The ethical principles and concepts, as well as the scenarios, were adapted from The Ethics ofSchool Administration by Strike, Haller, and Soltis (1998). In this study, 32 secondary principals from a school board in Ontario were asked to complete a descriptive survey which was designed to have principals make administrative decisions in response to 5 hypothetical scenarios. The open-ended questions were expected to elicit responses that were reflective of the principals' actual decision-making strategies. The survey also required them to justify and explain their reasons for each decision. The data were analyzed and 4 major categories ofjustifications emerged: pedagogy, legalism, moral code, and democracy. The results indicate that the decisions made by principals are grounded in various perspectives. While the data did not indicate any explicit knowledge of ethical principles and concepts, the principals' responses suggest sound and valid reasoning for their decision making, addressing the principles and concepts from a variety of viewpoints and using diverse justifications.

Youth Involvement in Organizational Decision Making: The Connection to Youth Initiative and Organizational Functioning

Studying positive adolescent development requires an examination of the mutually beneficial associations between youth and their environment. These youthcontext relations include both the contributions that youth make to others and society and the youth-context interactions that might predict positive youth outcomes. Community and youth-serving organizations, where youth may be involved in decision-making roles such as service delivery, advocacy, or on boards of directors, can provide one important context for youth contributions and for positive adolescent development. Research on the outcomes of youth involvement in organizational decision-making, however, is limited, and largely consists of exploratory qualitative studies. This dissertation is formatted as an integrated article dissertation. It begins with a review of the literature on contexts of structured youth activities and positive youth development. This review is intended to describe theory on development-context relations, in which development is considered an interactive process that occurs between individuals and their contexts, as it pertains the positive development of youth who are involved in various structured activities (e.g., volunteering). This description follows with a review of current research, and conclusions and rationale for the current studies. Following this theoretical and research background, the dissertation includes reports of two studies that were designed to address gaps in the research on youth involvement in organizational decision-making. The first was a qualitative research synthesis to elucidate and summarize the extant qualitative research on the outcomes of youth involvement in organizational decision making on adults and organizations. Results of this study suggested a number of outcomes for service provision, staff, and broader organizational functioning, including both benefits to organizations as well as some costs. The second study was a quantitative analysis of the associations among youth involvement, organizations' learning culture, and youth initiative, and relied on survey data gathered from adults and youth in community-based organizations with youth involvement. As expected, greater youth involvement in organizational decision making was associated with higher learning culture within the organization. Two dimensions of youth involvement, greater program engagement and relationships with adults, were related to greater youth initiative. A third dimension, sense of ownership, was not- .-.- associated with youth's level of initiative. Moreover, the association between relationships with adults and youth initiative was only significant in organizations with relatively low learning culture. Despite some limitations, these studies contribute to the research literature by providing some indication of the potential benefits and costs of youth involvement and by making an important contribution toward the early stages of context-level analyses of youth development. Findings have important implications for practitioners, funders, future research, and lifespan development theory.

Exploring the Ethical Decision-Making Processes of Community Care Providers

While there has been a recent shift away from isolated, institutionalized living conditions, persons with Intellectual Disabilities (ID) may still experience restricted access to choice when it comes to making decisions about the basic aspects of their lives. A tension remains between protecting individuals from harm and promoting their right to independence and personal liberties. This tension creates complex questions and ethical concerns for care providers supporting persons with ID. This study explored the ethical decision-making processes of care providers and specifically, how care providers describe the balance of protecting supported individuals from harm while promoting their right to self-determination. Semi-structured interviews were conducted with six care providers employed by a local community agency that supports young and older adults with ID. Data were analysed using thematic analysis and broader themes were developed following phases of open and selective coding. Results indicated that care providers described ethical decision-making processes as frequent, complex, subjective, and uncomfortable. All participants described the importance of promoting independent decision-making among the individuals they support and assisting supported individuals to make informed decisions. Participants also reported work colleagues and supervisors as primary sources of information when resolving ethical concerns. This suggests that complex ethical decision-making processes are being taken seriously by care providers and supervising staff. The results of this study are well-positioned to be applied to the development of a training program for frontline care providing staff supporting individuals in community care settings.

The Influence of Arousal on Moral Decision-making for Individuals with and without Mild Head Injury

Recent research has shown that University students with a history of self-reported mild head injury (MHI) are more willing to endorse moral transgressions associated with personal, relative to impersonal, dilemmas (Chiappetta & Good, 2008). However, the terms 'personal' and 'impersonal' in these dilemmas have functionally confounded the 'intentionality' of the transgression with the 'personal impact' or 'outcome' of the transgression. In this study we used a modified version of these moral dilemmas to investigate decision-making and sympathetic nervous system responsivity. Forty-eight University students (24 with MHI, 24 with no-MHI) read 24 scenarios depicting moral dilemmas varying as a function of 'intentionality' of the act (deliberate or unintentional) and its 'outcome' (physical harm, no physical harm, non-moral) and were required to rate their willingness to engage in the act. Physiological indices of arousal (e.g., heart rate - HR) were recorded throughout. Additionally, participants completed several neurocognitive tests. Results indicated significantly lowered HR activity at baseline, prior to, and during (but not after) making a decision for each type of dilemma for participants with MHI compared to their non-injured cohort. Further, they were more likely than their cohort to authorize personal injuries that were deliberately induced. MHI history was also associated with better performance on tasks of cognitive flexibility and attention; while students' complaints of postconcussive symptoms and their social problem solving abilities did not differ as a function of MHI history. The results provide subtle support for the hypothesis that both emotional and cognitive information guide moral decision making in ambiguous and emotionally distressing situations. Persons with even a MHI have diminished physiological arousal that may reflect disruption to the neural pathways of the VMPFC/OFC similar to those with more severe injuries.

Social competence following mild head injury and moderate traumatic brain injury: Investigating the neuropsychological relationships between arousal, social decision-making and depression

Client-directed long-term rehabilitative goals and life satisfaction following head injury emphasize the importance of social inclusion, rather than cognitive or physical, outcomes. However, very little research has explored the socio-emotional factors that pose as barriers to social reintegration following injury. This study investigates social barriers following head injury (i.e., decision-making - Iowa Gambling Task [IGT] and mood – depression) and possible amelioration of those challenges (through treatment) in both highly functioning university students with and without mild head injury (MHI) and in individuals with moderate traumatic brain injury (TBI). An arousal manipulation using emotionally evocative stimuli was introduced to manipulate the subject’s physiological arousal state. Seventy-five university students (37.6% reporting a MHI) and 11 patients with documented moderate TBI were recruited to participate in this quasi-experimental study. Those with head injury were found to be physiologically underaroused (on measures of electrodermal activation [EDA] and pulse) and were less sensitive to the negative effects of punishment (i.e., losses) in the gambling task than those without head injury, with greater impairment being observed for the moderate TBI group. The arousal manipulation, while effective, was not able to maintain a higher state of arousal in the injury groups across trials (i.e., their arousal state returned to pre-manipulation levels more quickly than their non-injured cohort), and, subsequently, a performance improvement was not observed on the IGT. Lastly, head injury was found to contribute to the relationship between IGT performance and depressive symptom acknowledgment and mood status in persons with head injury. This study indicates the possible important role of physiological arousal on socio- emotional behaviours (decision-making, mood) in persons with even mild, non-complicated head injuries and across the injury severity continuum.

Educational Technology Decision-Making: A Case Study on Technology Acquisition for 746,000 Ontario Students

Very little research has examined K–12 educational technology decision-making in Canada. This collective case study explores the technology procurement process in Ontario’s publicly funded school districts to determine if it is informed by the relevant research, grounded in best practices, and enhances student learning. Using a qualitative approach, 10 senior leaders (i.e., chief information officers, superintendents, etc.) were interviewed. A combination of open-ended and closed-ended questions were used to reveal the most important factors driving technology acquisition, research support, governance procedures, data use, and assessment and return on investment (ROI) measures utilized by school districts in their implementation of educational technology. After participants were interviewed, the data were transcribed, member checked, and then submitted to “Computer-assisted NCT analysis” (Friese, 2014) using ATLAS.ti. The findings show that senior leaders are making acquisitions that are not aligned with current scholarship and not with student learning as the focus. It was also determined that districts struggle to use data-driven decision-making to support the governance of educational technology spending. Finally, the results showed that districts do not have effective assessment measures in place to determine the efficacy or ROI of a purchased technology. Although data are limited to the responses of 10 senior leaders, findings represent the technology leadership for approximately 746,000 Ontario students. The study is meant to serve as an informative resource for senior leaders and presents strategic and research-validated approaches to technology procurement. Further, the study has the potential to refine technology decision-making, policies, and practices in K–12 education.

GA approach for finding Rough Set decision rules based on bireducts

Feature selection plays an important role in knowledge discovery and data mining nowadays. In traditional rough set theory, feature selection using reduct - the minimal discerning set of attributes - is an important area. Nevertheless, the original definition of a reduct is restrictive, so in one of the previous research it was proposed to take into account not only the horizontal reduction of information by feature selection, but also a vertical reduction considering suitable subsets of the original set of objects. Following the work mentioned above, a new approach to generate bireducts using a multi--objective genetic algorithm was proposed. Although the genetic algorithms were used to calculate reduct in some previous works, we did not find any work where genetic algorithms were adopted to calculate bireducts. Compared to the works done before in this area, the proposed method has less randomness in generating bireducts. The genetic algorithm system estimated a quality of each bireduct by values of two objective functions as evolution progresses, so consequently a set of bireducts with optimized values of these objectives was obtained. Different fitness evaluation methods and genetic operators, such as crossover and mutation, were applied and the prediction accuracies were compared. Five datasets were used to test the proposed method and two datasets were used to perform a comparison study. Statistical analysis using the one-way ANOVA test was performed to determine the significant difference between the results. The experiment showed that the proposed method was able to reduce the number of bireducts necessary in order to receive a good prediction accuracy. Also, the influence of different genetic operators and fitness evaluation strategies on the prediction accuracy was analyzed. It was shown that the prediction accuracies of the proposed method are comparable with the best results in machine learning literature, and some of them outperformed it.