An ABC for decision making

The present study was aimed at proposing a systematic evaluation of cranial computed tomography, identifying the main aspects to be analyzed in order to facilitate the decision making process regarding diagnosis and management in emergency settings. The present descriptive study comprised a literature review at the following databases: Access Medicine and Access Emergency Medicine (McGraw- Hill Education); British Medical Journal Evidence Center; UptoDate; Bireme; PubMed; Lilacs; SciELO; ProQuest; Micromedex (Thomson Reuters); Embase. Once the literature review was completed, the authors identified the main diseases with tomographic repercussions and proposed the present system to evaluate cranial computed tomography images. An easy-to-memorize ABC system will facilitate the decision making in emergency settings, as it covers the main diseases encountered by intensivists and emergency physicians, and provides a sequential guidance about anatomical structures to be investigated as well as their respective alterations.

Magnetic resonance imaging of the vagina: an overview for radiologists with emphasis on clinical decision making

AbstractMagnetic resonance imaging is a method with high contrast resolution widely used in the assessment of pelvic gynecological diseases. However, the potential of such method to diagnose vaginal lesions is still underestimated, probably due to the scarce literature approaching the theme, the poor familiarity of radiologists with vaginal diseases, some of them relatively rare, and to the many peculiarities involved in the assessment of the vagina. Thus, the authors illustrate the role of magnetic resonance imaging in the evaluation of vaginal diseases and the main relevant findings to be considered in the clinical decision making process.

To analyse a trace or not? Evaluating the decision-making process in the criminal investigation

In order to broaden our knowledge and understanding of the decision steps in the criminal investigation process, we started by evaluating the decision to analyse a trace and the factors involved in this decision step. This decision step is embedded in the complete criminal investigation process, involving multiple decision and triaging steps. Considering robbery cases occurring in a geographic region during a 2-year-period, we have studied the factors influencing the decision to submit biological traces, directly sampled on the scene of the robbery or on collected objects, for analysis. The factors were categorised into five knowledge dimensions: strategic, immediate, physical, criminal and utility and decision tree analysis was carried out. Factors in each category played a role in the decision to analyse a biological trace. Interestingly, factors involving information available prior to the analysis are of importance, such as the fact that a positive result (a profile suitable for comparison) is already available in the case, or that a suspect has been identified through traditional police work before analysis. One factor that was taken into account, but was not significant, is the matrix of the trace. Hence, the decision to analyse a trace is not influenced by this variable. The decision to analyse a trace first is very complex and many of the tested variables were taken into account. The decisions are often made on a case-by-case basis.

Present and future methodology for the implementation of decision support systems for traffic management

Real-time predictions are an indispensable requirement for traffic management in order to be able to evaluate the effects of different available strategies or policies. The combination of predicting the state of the network and the evaluation of different traffic management strategies in the short term future allows system managers to anticipate the effects of traffic control strategies ahead of time in order to mitigate the effect of congestion. This paper presents the current framework of decision support systems for traffic management based on short and medium-term predictions and includes some reflections on their likely evolution, based on current scientific research and the evolution of the availability of new types of data and their associated methodologies.

Expertise and decision making among clinicians in investigations of alleged child sexual abuse

The purpose of the present thesis was to explore different aspects of decision making and expertise in investigations of child sexual abuse (CSA) and subsequently shed some light on the reasons for shortcomings in the investigation processes. Clinicians’ subjective attitudes as well as scientifically based knowledge concerning CSA, CSA investigation and interviewing were explored. Furthermore the clinicians’ own view on their expertise and what enhances this expertise was investigated. Also, the effects of scientific knowledge, experience and attitudes on the decision making in a case of CSA were explored. Finally, the effects of different kinds of feedback as well as experience on the ability to evaluate CSA in the light of children’s behavior and base rates were investigated. Both explorative and experimental methods were used. The purpose of Study I was to investigate whether clinicians investigating child sexual abuse (CSA) rely more on scientific knowledge or on clinical experience when evaluating their own expertise. Another goal was to check what kind of beliefs the clinicians held. The connections between these different factors were investigated. A questionnaire covering items concerning demographic data, experience, knowledge about CSA, selfevaluated expertise and beliefs about CSA was given to social workers, child psychiatrists and psychologists working with children. The results showed that the clinicians relied more on their clinical experience than on scientific knowledge when evaluating their expertise as investigators of CSA. Furthermore, social workers possessed stronger attitudes in favor of children than the other groups, while child psychiatrists had more negative attitudes towards the criminal justice system. Male participants held less strong beliefs than female participants. The findings indicate that the education of CSA investigators should focus more on theoretical knowledge and decision making processes as well as the role of beliefs In Study II school and family counseling psychologists completed a Child Sexual Abuse Attitude and Belief Scale. Four CSA related attitude and belief subscales were identified: 1. The Disclosure subscale reflecting favoring a disclosure at any cost, 2. The Pro-Child subscale reflecting unconditional belief in children's reports, 3. The Intuition subscale reflecting favoring an intuitive approach to CSA investigations, and 4. The Anti Criminal Justice System subscale reflecting negative attitudes towards the legal system. Beliefs that were erroneous according to empirical research were analyzed separately. The results suggest that some psychologists hold extreme attitudes and many erroneous beliefs related to CSA. Some misconceptions are common. Female participants tended to hold stronger attitudes than male participants. The more training in interviewing children the participants have, the more erroneous beliefs and stronger attitudes they hold. Experience did not affect attitudes and beliefs. In Study III mental health professionals’ sensitivity to suggestive interviewing in CSA cases was explored. Furthermore, the effects of attitudes and beliefs related to CSA and experience with CSA investigations on the sensitivity to suggestive influences in the interview were investigated. Also, the effect of base rate estimates of CSA on decisions was examined. A questionnaire covering items concerning demographic data, different aspects of clinical experience, self-evaluated expertise, beliefs and knowledge about CSA and a set of ambiguous material based on real trial documents concerning an alleged CSA case was given to child mental health professionals. The experiment was based on a 2 x 2 x 2 x 2 (leading questions: yes vs no) x (stereotype induction: yes vs no) x (emotional tone: pressure to respond vs no pressure to respond) x (threats and rewards: yes vs no) between-subjects factorial design, in which the suggestiveness of the methods with which the responses of the child were obtained were varied. There was an additional condition in which the material did not contain any interview transcripts. The results showed that clinicians are sensitive only to the presence of leading questions but not to the presence of other suggestive techniques. Furthermore, the clinicians were not sensitive to the possibility that suggestive techniques could have been used when no interview transcripts had been included in the trial material. Experience had an effect on the sensitivity of the clinicians only regarding leading questions. Strong beliefs related to CSA lessened the sensitivity to leading questions. Those showing strong beliefs on the belief scales used in this study were even more prone to prosecute than other participants when other suggestive influences than leading questions were present. Controversy exists regarding effects of experience and feedback on clinical decision making. In Study IV the impact of the number of handled cases and of feedback on the decisions in cases of alleged CSA was investigated. One-hundred vignettes describing cases of suspected CSA were given to students with no experience with investigating CSA. The vignettes were based on statistical data about symptoms and prevalence of CSA. According to the theoretical likelihood of CSA the children described were categorized as abused or not abused. The participants were asked to decide whether abuse had occurred. They were divided into 4 groups: one received feedback on whether their decision was right or wrong, one received information about cognitive processes involved in decision making, one received both, and one did not receive feedback at all. The results showed that participants who received feedback on their performance made more correct positive decisions and participants who got information about decision making processes made more correct negative decisions. Feedback and information combined decreased the number of correct positive decisions but increased the number of correct negative decisions. The number of read cases had in itself a positive effect on correct positive decision.

Development of a Filter Aid Proportioning, Mixing, and Feeding System for a Polishing Filter

The purpose of this work was to study the characteristics of the most commonly used filter aid materials and their influences on the design of proportioning, mixing, and feeding system for polishing filter family. Based on the literature survey and hands-on experience a system was designed with defined equipment and capital and operating costs. The system was designed to serve precoating and bodyfeeding applications and is easily extended to be used in multiple filter processes. Also a test procedure was carried out where influences of flux and filter cloths to accumulated cake were studied. Filter aid is needed in challenging conditions to improve filtration efficiency and cleaning, and thus extend the operating life of the filter media. Filter aid preparation and feeding system was designed for the use of two different filter aids; precoat and bodyfeed. Precoating is used before the filtration step initiates. If the solids in the filterable solution have a tendency to clog the filter bag easily, precoat is used on the filter bag to obtain better filtration efficiency and quality. Diatomite or perlite is usually used as a precoating substance. The intention is to create a uniform cake to the overall surface of the filter cloth, with predetermined thickness, 2 – 5 mm. This ensures that the clogging of the filter cloth is reduced and the filtration efficiency is increased. Bodyfeed is used if the solids in the filterable solution have a tendency to form a sticky impermeable filter cake. The cake properties are enhanced by maintaining the permeability of the accumulating cake by using the filter aid substance as bodyfeed during the filtration process.

Determinants of the decision to appeal against motor bodily injury settlements awarded by Spanish trial courts

Automobile bodily injury disputes represent one of the main causes of litigation faced by Spanish Courts. In this paper a multinomial model is implemented to analyse which factors determine the decision to appeal against the verdicts of trial courts. Use of a dataset of motor insurance claims revealed differences between the determinants of a claimant’s decision to appeal and those of insurers. Among other results it is shown that discrepancies regarding the permanent disability sustained affect the insurer’s decision to appeal. In contrast, the claimant pays more attention to differences in the stated temporary disability. Conclusions are drawn regarding which factors could reduce the percentage of appealed cases.

Degree of hermeticity of a multicompartment compliance aid: Implications for the quality of professional pharmaceutical services

A multicompartment compliance aid (MCA) is a blister-type repackaging system that aims to facilitate drug administration and thereby increase patient adherence. One of the characteristics of the MCA that should be taken into account is the moisture permeability, since this atmospheric condition is one of the most important factors that can modify the stability of medicines. In the current paper we report the moisture permeability tests performed on a MCA according to the US Pharmacopeia. This information on the suitability of the device will help pharmacists implement a high-quality professional service.

An energy efficient vertical handover decision algorithm

As wireless communications evolve towards heterogeneousnetworks, mobile terminals have been enabled tohandover seamlessly from one network to another. At the sametime, the continuous increase in the terminal power consumptionhas resulted in an ever-decreasing battery lifetime. To that end,the network selection is expected to play a key role on howto minimize the energy consumption, and thus to extend theterminal lifetime. Hitherto, terminals select the network thatprovides the highest received power. However, it has been provedthat this solution does not provide the highest energy efficiency.Thus, this paper proposes an energy efficient vertical handoveralgorithm that selects the most energy efficient network thatminimizes the uplink power consumption. The performance of theproposed algorithm is evaluated through extensive simulationsand it is shown to achieve high energy efficiency gains comparedto the conventional approach.

Searching for consensus in ahp-group decision making. A bayesian perspective

This paper sets out to identify the initial positions of the different decisionmakers who intervene in a group decision making process with a reducednumber of actors, and to establish possible consensus paths between theseactors. As a methodological support, it employs one of the most widely-knownmulticriteria decision techniques, namely, the Analytic Hierarchy Process(AHP). Assuming that the judgements elicited by the decision makers follow theso-called multiplicative model (Crawford and Williams, 1985; Altuzarra et al.,1997; Laininen and Hämäläinen, 2003) with log-normal errors and unknownvariance, a Bayesian approach is used in the estimation of the relative prioritiesof the alternatives being compared. These priorities, estimated by way of themedian of the posterior distribution and normalised in a distributive manner(priorities add up to one), are a clear example of compositional data that will beused in the search for consensus between the actors involved in the resolution ofthe problem through the use of Multidimensional Scaling tools

An analytic approach to distribution logistics strategic management

Logistics management is increasingly being recognised by many companies to be of critical concern. The logistics function includes directly or indirectly many of the new areas for achieving or maintaining competitive advantage that companies have been forced to develop due to increasing competitive pressures. The key to achieving a competitive advantage is to manage the logistics function strategically which involves determining the most cost effective method of providing the necessary customer service levels from the many combinations of operating procedures in the areas of transportation, warehousing, order processing and information systems, production, and inventory management. In this thesis, a comprehensive distribution logistics strategic management process is formed by integrating the periodic strategic planning process with a continuous strategic issues management process. Strategic planning is used for defining the basic objectives for a company and assuring co operation and synergy between the different functions of a company while strategic issues management is used on a continuous basis in order to deal with environmental and internal turbulence. The strategic planning subprocess consists of the following main phases: (1) situational analyses, (2) defining the vision and strategic goals for the logistics function, (3) determining objectives and strategies, (4) drawing up tactical action plans, and (5) evaluating the implementation of the plans and making the needed adjustments. The aim of the strategic issues management subprocess is to continuously scan the environment and the organisation for early identification of the issues having a significant impact on the logistics function using the following steps: (1) the identification of trends, (2) assessing the impact and urgency of the identified trends, (3) assigning priorities to the issues, and (4) planning responses to the, issues. The Analytic Hierarchy Process (AHP) is a systematic procedure for structuring any problem. AHP is based on the following three principles: decomposition, comparative judgements, and synthesis of priorities. AHP starts by decomposing a complex, multicriteria problem into a hierarchy where each level consists of a few manageable elements which are then decomposed into another set of elements. The second step is to use a measurement methodology to establish priorities among the elements within each level of the hierarchy. The third step in using AHP is to synthesise the priorities of the elements to establish the overall priorities for the decision alternatives. In this thesis, decision support systems are developed for different areas of distribution logistics strategic management by applying the Analytic Hierarchy Process. The areas covered are: (1) logistics strategic issues management, (2) planning of logistic structure, (3) warehouse site selection, (4) inventory forecasting, (5) defining logistic action and development plans, (6) choosing a distribution logistics strategy, (7) analysing and selecting transport service providers, (8) defining the logistic vision and strategic goals, (9) benchmarking logistic performance, and (10) logistic service management. The thesis demonstrates the potential of AHP as a systematic and analytic approach to distribution logistics strategic management.