Iowa Strategy for Homeland Security and Emergency Management 2009-2014, August 31, 2009

Address sustainability in all efforts. Sustainability should be at the core of all levels of homeland security and emergency management effort in Iowa. Capabilities need to be built for the long term, and without a sustainability plan in place, projects can quickly deplete uncertain levels of funding. Utilize an all-hazards methodology. Developing capabilities that are effective during a variety of disaster and emergency scenarios represents sound planning and resource management. Enhance capabilities through joint planning, training and exercise. Effective capabilities developed through coordinated planning efforts and an ongoing joint training and exercising program to ensure sustainment of prepared response. Utilize a collaborative approach to build capability. We will utilize whatever partnerships are necessary to build capability in the most effective manner possible. Regional partnerships have been, and will continue to be, in the forefront of the State of Iowa’s efforts to build and enhance capability. Enhance statewide capabilities. Whenever possible, we will identify and augment existing resources to provide statewide capability during a disaster or terrorist attack. Awareness, outreach and education. Open communication is critical to the success of any initiative. All projects implemented will have awareness, education and outreach components to ensure that all stakeholders are informed as to their responsibilities, capabilities and access. Information sharing and a common operating picture. The timely exchange of critical/actionable information is imperative to the success of every operation. The identification of a common operating picture allows decision makers to make informed decisions based on a unified understanding of the events around them.

Ethics and adolescent care: an international perspective.

PURPOSE OF REVIEW: This update reviews the concepts underlying ethical issues in various contexts and countries, highlighting the evolution in the use of the core values underpinning the field and practice of bioethics as applied to healthcare. RECENT FINDINGS: It stresses the specific position of the adolescent as being a unique individual searching for autonomy and, most of the time, being competent to make decisions regarding the adolescent's own health. It briefly outlines the principles of a 'deliberative' approach in which the practitioner, while keeping in mind the legal context of the country where the practitioner is working, assesses to what extent the adolescent can be considered as competent, and then discusses with the adolescent the medical and psychosocial aspects of the various actions to be taken in a situation, as well as the basic ethical values linked with each of the various options available. The deliberation can involve relevant stakeholders, provided the issues concerning confidentiality have been fully discussed with the adolescent. SUMMARY: This process forces the practitioner, the adolescent patient and those who care for the adolescent patient to look outside their usual frameworks and make a decision that is in the best interest of the young person, and is informed by various ethical values.

Au-delà de l'ennui: l'effort pour rendre l'autre intéressant [Beyond boredom: the effort to make a patient interesting]

The doctors' emotional reaction towards the patients has an impact on the doctor-patient relationship. This article focuses on a particular emotion, boredom which is evoked by certain patients. By means of a case vignette, this phenomenon is elucidated and confronted with the psycho-analytical concept of "pensée opératoire", and ways are identified to raise the interest in patients.

Ag Decision Maker, September 2014, Vol. 18, no. 11

A Business Newsletter for Agriculture

You are not alone...making an informed decision about your pregnancy, January 1997

When you are faced with a difficult decision, it’s not unusual to feel confused, frustrated, and perhaps a little frightened because you are not sure what to expect or where to turn for answers. The purpose of this handbook is to assist you in making an informed choice about your pregnancy.

Ag Decision Maker, Novmeber 2014, Vol. 19, no. 1

A Business Newsletter for Agriculture

Ag Decision Maker, October 2014, Vol. 18, no. 12

A Business Newsletter for Agriculture

'Do not attempt resuscitation' and 'cardiopulmonary resuscitation' in an inpatient setting: factors influencing physicians' decisions in Switzerland.

OBJECTIVE: To determine the prevalence of cardiopulmonary resuscitation (CPR) and do-not-attempt-resuscitation (DNAR) orders, to define factors associated with CPR/DNAR orders and to explore how physicians make and document these decisions. METHODS: We prospectively reviewed CPR/DNAR forms of 1,446 patients admitted to the General Internal Medicine Department of the Geneva University Hospitals, a tertiary-care teaching hospital in Switzerland. We additionally administered a face-to-face survey to residents in charge of 206 patients including DNAR and CPR orders, with or without patient inclusion. RESULTS: 21.2% of the patients had a DNAR order, 61.7% a CPR order and 17.1% had neither. The two main factors associated with DNAR orders were a worse prognosis and/or a worse quality of life. Others factors were an older age, cancer and psychiatric diagnoses, and the absence of decision-making capacity. Residents gave four major justifications for DNAR orders: important comorbid conditions (34%), the patients' or their family's resuscitation preferences (18%), the patients' age (14.2%), and the absence of decision-making capacity (8%). Residents who wrote DNAR orders were more experienced. In many of the DNAR or CPR forms (19.8 and 16%, respectively), the order was written using a variety of formulations. For 24% of the residents, the distinction between the resuscitation order and the care objective was not clear. 38% of the residents found the resuscitation form useful. CONCLUSION: Patients' prognosis and quality of life were the two main independent factors associated with CPR/DNAR orders. However, in the majority of cases, residents evaluated prognosis only intuitively, and quality of life without involving the patients. The distinction between CPR/DNAR orders and the care objectives was not always clear. Specific training regarding CPR/DNAR orders is necessary to improve the CPR/DNAR decision process used by physicians.

Ag Decision Maker, December 2014, Vol. 19, no. 2

A Business Newsletter for Agriculture

Ag Decision Maker, January 2015, Vol. 19, no. 3

A Business Newsletter for Agriculture

Decision curve analysis revisited: overall net benefit, relationships to ROC curve analysis, and application to case-control studies.

ABSTRACT: BACKGROUND: Decision curve analysis has been introduced as a method to evaluate prediction models in terms of their clinical consequences if used for a binary classification of subjects into a group who should and into a group who should not be treated. The key concept for this type of evaluation is the "net benefit", a concept borrowed from utility theory. METHODS: We recall the foundations of decision curve analysis and discuss some new aspects. First, we stress the formal distinction between the net benefit for the treated and for the untreated and define the concept of the "overall net benefit". Next, we revisit the important distinction between the concept of accuracy, as typically assessed using the Youden index and a receiver operating characteristic (ROC) analysis, and the concept of utility of a prediction model, as assessed using decision curve analysis. Finally, we provide an explicit implementation of decision curve analysis to be applied in the context of case-control studies. RESULTS: We show that the overall net benefit, which combines the net benefit for the treated and the untreated, is a natural alternative to the benefit achieved by a model, being invariant with respect to the coding of the outcome, and conveying a more comprehensive picture of the situation. Further, within the framework of decision curve analysis, we illustrate the important difference between the accuracy and the utility of a model, demonstrating how poor an accurate model may be in terms of its net benefit. Eventually, we expose that the application of decision curve analysis to case-control studies, where an accurate estimate of the true prevalence of a disease cannot be obtained from the data, is achieved with a few modifications to the original calculation procedure. CONCLUSIONS: We present several interrelated extensions to decision curve analysis that will both facilitate its interpretation and broaden its potential area of application.

Decision-making with distance measures and inducedaggregation operators

[spa] Se presenta un nuevo modelo para la toma de decisiones basado en el uso de medidas de distancia y de operadores de agregación inducidos. Se introduce la distancia media ponderada ordenada inducida (IOWAD). Es un nuevo operador de agregación que extiende el operador OWA a través del uso de distancias y un proceso de reordenación de los argumentos basado en variables de ordenación inducidas. La principal ventaja el operador IOWAD es la posibilidad de utilizar una familia parametrizada de operadores de agregación entre la distancia individual máxima y la mínima. Se estudian algunas de sus principales propiedades y algunos casos particulares. Se desarrolla un ejemplo numérico en un problema de toma de decisiones sobre selección de inversiones. Se observa que la principal ventaja de este modelo en la toma de decisiones es la posibilidad de mostrar una visión más completa del proceso, de forma que el decisor está capacitado para seleccionar la alternativa que está más cerca de sus intereses.

Decision-making with distance measures and inducedaggregation operators

[spa] Se presenta un nuevo modelo para la toma de decisiones basado en el uso de medidas de distancia y de operadores de agregación inducidos. Se introduce la distancia media ponderada ordenada inducida (IOWAD). Es un nuevo operador de agregación que extiende el operador OWA a través del uso de distancias y un proceso de reordenación de los argumentos basado en variables de ordenación inducidas. La principal ventaja el operador IOWAD es la posibilidad de utilizar una familia parametrizada de operadores de agregación entre la distancia individual máxima y la mínima. Se estudian algunas de sus principales propiedades y algunos casos particulares. Se desarrolla un ejemplo numérico en un problema de toma de decisiones sobre selección de inversiones. Se observa que la principal ventaja de este modelo en la toma de decisiones es la posibilidad de mostrar una visión más completa del proceso, de forma que el decisor está capacitado para seleccionar la alternativa que está más cerca de sus intereses.