Investigating the influence of African American and African Caribbean race on primary care doctors' decision making about depression

This paper explores differences in how primary care doctors process the clinical presentation of depression by African American and African-Caribbean patients compared with white patients in the US and the UK. The aim is to gain a better understanding of possible pathways by which racial disparities arise in depression care. One hundred and eight doctors described their thought processes after viewing video recorded simulated patients presenting with identical symptoms strongly suggestive of depression. These descriptions were analysed using the CliniClass system, which captures information about micro-components of clinical decision making and permits a systematic, structured and detailed analysis of how doctors arrive at diagnostic, intervention and management decisions. Video recordings of actors portraying black (both African American and African-Caribbean) and white (both White American and White British) male and female patients (aged 55 years and 75 years) were presented to doctors randomly selected from the Massachusetts Medical Society list and from Surrey/South West London and West Midlands National Health Service lists, stratified by country (US v.UK), gender, and years of clinical experience (less v. very experienced). Findings demonstrated little evidence of bias affecting doctors' decision making processes, with the exception of less attention being paid to the potential outcomes associated with different treatment options for African American compared with White American patients in the US. Instead, findings suggest greater clinical uncertainty in diagnosing depression amongst black compared with white patients, particularly in the UK. This was evident in more potential diagnoses. There was also a tendency for doctors in both countries to focus more on black patients' physical rather than psychological symptoms and to identify endocrine problems, most often diabetes, as a presenting complaint for them. This suggests that doctors in both countries have a less well developed mental model of depression for black compared with white patients. © 2014 The Authors.

Vezetési és döntési rendszerek a versenyképesség szolgálatában - Összefoglaló a Vezetési és döntési rendszerek kutatócsoport munkájáról = Management and decision making systems supporting competitiveness

A „Vezetési és döntési rendszerek” alprojekt kutatói a döntéshozatal minőségének és a versenyképességnek a kapcsolatát vizsgálták. Alapkérdésünk az volt, hogy mely vállalatok a sikeresebbek, azok, amelyek a döntéshozatali közelítésmódok közül a szigorúan racionális, analitikus gondolkodást, felfogást favorizálják, vagy inkább a kreativitást ösztönző és középpontba állító, a kreatív döntéshozatali és vezetési stílust követő cégek. Azt tapasztaltuk, hogy a vállalatok menedzsmentjének egyre többször kell megbirkóznia vészhelyzetekkel és azok következményeivel. Az üzleti döntések és az üzleti teljesítmény, az üzleti siker kapcsolatának vizsgálatára külön kutatási irányt jelöltünk meg. A felelős döntéshozatal témakörében a mi kutatásunk a konkrét döntéseket helyezte előtérbe, amely új közelítésmódot jelent. Ugyanis nem csak specifikus CSR gyakorlatokkal foglalkoztunk, hanem konkrét vezetői döntésekben vizsgáltuk meg a CSR és a fenntarthatóság elemeit. ______ Within the framework of the “Management and decision-making systems” subproject we investigated the link between the quality of decision making and competitiveness. Our basic question was the following: which companies are more successful, those who are strictly follow the rational/analytical way of decision making or the others who mainly focus on creative decision making and creative management. We found that nowadays the company managements more often face to crisis situations and their consequences. We initiated a focused research on the relationship of the business decision making, business performance and business success. When we did research in the field of the responsible decision making we focused on concrete decision cases, that was a brand new approach. We have not analyzed the CSR practice, but identified CSR and sustainability elements in concrete management decisions.

Individual decision-making by top executives as a valuable resource for strategic management – A resource-based view and dynamic capability approach

Strategy is highly important for organisational success and the achievement of competitive advantage. Strategy is dynamic and it depends on accurate individual decision-making from medium and high-level managers and executives. Since managers always formulate strategy, its formulation depends mostly on their assertive decisions. Making good decisions is a complex task, even more in today’s business world where a large quantity of information and a dynamic environment forces people to decide without having complete information. As Shafir, Simonson, & Tversky (1993) point out, "the making of decisions, both big and small, is often difficult because of uncertainty and conflict". In this paper the author will explain a basic theoretical framework about top manager's individual decision-making, showing how complex the process of making high-impact decisions is; then, he will compare this theory with one of the most important streams in strategic management, the Resource-Based View (RBV) of the firm. Finally, within the context of individual decision-making and the RBV stream, the author will show how individual decision makers in top management positions constitute a valuable, rare, non-imitable and non-substitutable resource that provides sustained competitive advantage.

The Reliability and Validity of a Child and Adolescent Participation in Decision Making Questionnaire

Background
There is a growing impetus across the research, policy and practice communities for children and young people to participate in decisions that affect their lives. Furthermore, there is a dearth of general instruments that measure children and young people’s views on their participation in decision making. This paper presents the reliability and validity of the Child and Adolescent Participation in Decision Making Questionnaire (CAP-DMQ) and specifically looks at a population of looked-after children where a lack of participation in decision making is an acute issue.
Methods
The participants were 151 looked after children and adolescents between 10-23 years of age who completed the 10 item CAP-DMQ. Of the participants 113 were in receipt of an advocacy service that had an aim of increasing participation in decision-making with the remaining participants not having received this service.
Results
The results showed that the CAP-DMQ had good reliability (Cronbach’s alpha = .94) and showed promising uni-dimensional construct validity through an exploratory factor analysis. The items in the CAP-DMQ also demonstrated good content validity by overlapping with prominent models of child and adolescent participation (Lundy 2007) and decision making (Halpern 2014). A regression analysis showed that age and gender were not significant predictors of CAP-DMQ scores but receipt of advocacy was a significant predictor of scores (effect size d=.88), thus showing appropriate discriminant criterion validity.
Conclusion
Overall, the CAP-DMQ showed good reliability and validity. Therefore, the measure has excellent promise for theoretical investigation in the area of child and adolescent participation in decision making and equally shows empirical promise for use as a measure in evaluating services which have increasing the participation of children and adolescents in decision making as an intended outcome.

The relationship between health literacy and indicators of informed decision making for colorectal cancer screening among African Americans

African Americans are disproportionately affected by colorectal cancer (CRC) incidence and mortality. CRC early detection leads to better treatment outcomes and, depending on the screening test, can prevent the development of CRC. African Americans, however, are screened less often than Whites. Aspects of decision making (e.g., decisional conflict, decision self-efficacy) can impact decision making outcomes and may be influenced by social determinants of health, including health literacy. However the relationship between social determinants of health and indicators of decision making in this population is not fully understood. Additionally, individuals have a choice between different CRC screening tests and an individual’s desire to use a particular screening test may be associated with social determinants of health such as health literacy. This study aimed to examine the relationship between social determinants of health and indicators of decision making for CRC screening among African Americans. A total of 111 participants completed a baseline and 14-month follow-up survey assessing decisional conflict, decision self-efficacy, decisional preference (shared versus informed decision making), and CRC test preference. Health literacy was negatively associated with decisional conflict and positively associated with decision self-efficacy (ps < .05). Individuals who were unemployed or working part-time had significantly greater decisional conflict than individuals working full-time (ps < .05). Individuals with a first-degree family history of CRC had significantly lower decision self-efficacy than individuals without a family history (p < .05). Women were significantly more likely to prefer making a shared decision rather than an informed decision compared to men (p < .05). Lastly, previous CRC screening behavior was significantly associated with CRC test preference (e.g., individuals previously screened using colonoscopy were significantly more likely to prefer colonoscopy for their next screening test; ps < .05). These findings begin to identify social determinants of health (e.g., health literacy, employment) that are related to indicators of decision making for CRC among African Americans. Furthermore, these findings suggest further research is needed to better understand these relationships to help with the future development and improvement of interventions targeting decision making outcomes for CRC screening in this population.

Increasing the Information available to Coroners : the effect on autopsy decision making

This paper details research completed in 2007 which investigated autopsy decision making in a death investigation. The data was gathered during the first year of operation of a new Coroners Act in Queensland, Australia, which changed the process of death investigation in three ways which are important to this paper. First, it required a greater amount of information to be gathered at the scene by police, and this included a thorough investigation of the circumstances of the death, including statements from witnesses, friends and family, as well as evidence gathering at the scene. Second, it required Coroners, for the first time, to determine the level of invasiveness of the autopsy required to complete the death investigation. Third, it enabled the communication of a genuine family concern, to be communicated to the Coroner. The outcome of such information was threefold. First, a greater amount of information offered to the Coroner led to a decrease in the number of full internal autopsies ordered, but an increase in the number of partial internal autopsies ordered. Second, this shift in autopsy decision making by Coroners saw certain factors given greater importance than others in decisions to order full internal or external only autopsies. Third, a raised family concern had a significant impact on autopsy decision making and tended to decrease the invasiveness of the autopsy ordered by Coroners.

Planning online : a community-based interactive decision-making model

The first use of computing technologies and the development of land use models in order to support decision-making processes in urban planning date back to as early as mid 20th century. The main thrust of computing applications in urban planning is their contribution to sound decision-making and planning practices. During the last couple of decades many new computing tools and technologies, including geospatial technologies, are designed to enhance planners' capability in dealing with complex urban environments and planning for prosperous and healthy communities. This chapter, therefore, examines the role of information technologies, particularly internet-based geographic information systems, as decision support systems to aid public participatory planning. The chapter discusses challenges and opportunities for the use of internet-based mapping application and tools in collaborative decision-making, and introduces a prototype internet-based geographic information system that is developed to integrate public-oriented interactive decision mechanisms into urban planning practice. This system, referred as the 'Community-based Internet GIS' model, incorporates advanced information technologies, distance learning, sustainable urban development principles and community involvement techniques in decision-making processes, and piloted in Shibuya, Tokyo, Japan.

Sustainability : driver for decision making in infrastructure

With the growing importance of sustainability assessment in the construction industry, many green building rating schemes have been adopted in the building sector of Australia. However, there is an abnormal delay in the similar adoption in the infrastructure sector. This prolonged delay in practice poses a challenge in mapping the project objectives with sustainability outcomes. Responding to the challenge of sustainable development in infrastructure, it is critical to create a set of decision indicators for sustainability in infrastructure, which to be used in conjunction with the emerging infrastructure sustainability assessment framework of the Australian Green Infrastructure Council. The various literature sources confirm the lack of correlation between sustainability and infrastructure. This theoretical missing link signifies the crucial validation of the interrelationship and interdependency in sustainability, decision making and infrastructure. This validation is vital for the development of decision indicators for sustainability in infrastructure. Admittedly, underpinned by the serious socio-environmental vulnerability, the traditional focus on economic emphasis in infrastructure development needs to be drifted towards the appropriate decisions for sustainability enhancing the positive social and environmental outcomes. Moreover, the research findings suggest sustainability being observed as powerful socio-political and influential socio-environmental driver in deciding the infrastructure needs and its development. These newly developed sustainability decision indicators create the impetus for change leading to sustainability in infrastructure by integrating the societal cares, environmental concerns into the holistic financial consideration. Radically, this development seeks to transform principles into actions for infrastructure sustainability. Lastly, the thesis concludes with knowledge contribution in five significant areas and future research opportunities. The consolidated research outcomes suggest that the development of decision indicators has demonstrated sustainability as a pivotal driver for decision making in infrastructure.

Constructing a clinical decision-making framework for image-guided radiotherapy using a Bayesian Network

A decision-making framework for image-guided radiotherapy (IGRT) is being developed using a Bayesian Network (BN) to graphically describe, and probabilistically quantify, the many interacting factors that are involved in this complex clinical process. Outputs of the BN will provide decision-support for radiation therapists to assist them to make correct inferences relating to the likelihood of treatment delivery accuracy for a given image-guided set-up correction. The framework is being developed as a dynamic object-oriented BN, allowing for complex modelling with specific sub-regions, as well as representation of the sequential decision-making and belief updating associated with IGRT. A prototype graphic structure for the BN was developed by analysing IGRT practices at a local radiotherapy department and incorporating results obtained from a literature review. Clinical stakeholders reviewed the BN to validate its structure. The BN consists of a sub-network for evaluating the accuracy of IGRT practices and technology. The directed acyclic graph (DAG) contains nodes and directional arcs representing the causal relationship between the many interacting factors such as tumour site and its associated critical organs, technology and technique, and inter-user variability. The BN was extended to support on-line and off-line decision-making with respect to treatment plan compliance. Following conceptualisation of the framework, the BN will be quantified. It is anticipated that the finalised decision-making framework will provide a foundation to develop better decision-support strategies and automated correction algorithms for IGRT.

Clinical data warehousing for evidence based decision making

Large volumes of heterogeneous health data silos pose a big challenge when exploring for information to allow for evidence based decision making and ensuring quality outcomes. In this paper, we present a proof of concept for adopting data warehousing technology to aggregate and analyse disparate health data in order to understand the impact various lifestyle factors on obesity. We present a practical model for data warehousing with detailed explanation which can be adopted similarly for studying various other health issues.

Leibniz on Rational Decision-Making

In this study I discuss G. W. Leibniz's (1646-1716) views on rational decision-making from the standpoint of both God and man. The Divine decision takes place within creation, as God freely chooses the best from an infinite number of possible worlds. While God's choice is based on absolutely certain knowledge, human decisions on practical matters are mostly based on uncertain knowledge. However, in many respects they could be regarded as analogous in more complicated situations. In addition to giving an overview of the divine decision-making and discussing critically the criteria God favours in his choice, I provide an account of Leibniz's views on human deliberation, which includes some new ideas. One of these concerns is the importance of estimating probabilities in making decisions one estimates both the goodness of the act itself and its consequences as far as the desired good is concerned. Another idea is related to the plurality of goods in complicated decisions and the competition this may provoke. Thirdly, heuristic models are used to sketch situations under deliberation in order to help in making the decision. Combining the views of Marcelo Dascal, Jaakko Hintikka and Simo Knuuttila, I argue that Leibniz applied two kinds of models of rational decision-making to practical controversies, often without explicating the details. The more simple, traditional pair of scales model is best suited to cases in which one has to decide for or against some option, or to distribute goods among parties and strive for a compromise. What may be of more help in more complicated deliberations is the novel vectorial model, which is an instance of the general mathematical doctrine of the calculus of variations. To illustrate this distinction, I discuss some cases in which he apparently applied these models in different kinds of situation. These examples support the view that the models had a systematic value in his theory of practical rationality.

Self Assessment-Based Decision Making for Multiagent Cooperative Search

This paper addresses a search problem with multiple limited capability search agents in a partially connected dynamical networked environment under different information structures. A self assessment-based decision-making scheme for multiple agents is proposed that uses a modified negotiation scheme with low communication overheads. The scheme has attractive features of fast decision-making and scalability to large number of agents without increasing the complexity of the algorithm. Two models of the self assessment schemes are developed to study the effect of increase in information exchange during decision-making. Some analytical results on the maximum number of self assessment cycles, effect of increasing communication range, completeness of the algorithm, lower bound and upper bound on the search time are also obtained. The performance of the various self assessment schemes in terms of total uncertainty reduction in the search region, using different information structures is studied. It is shown that the communication requirement for self assessment scheme is almost half of the negotiation schemes and its performance is close to the optimal solution. Comparisons with different sequential search schemes are also carried out. Note to Practitioners-In the futuristic military and civilian applications such as search and rescue, surveillance, patrol, oil spill, etc., a swarm of UAVs can be deployed to carry out the mission for information collection. These UAVs have limited sensor and communication ranges. In order to enhance the performance of the mission and to complete the mission quickly, cooperation between UAVs is important. Designing cooperative search strategies for multiple UAVs with these constraints is a difficult task. Apart from this, another requirement in the hostile territory is to minimize communication while making decisions. This adds further complexity to the decision-making algorithms. In this paper, a self-assessment-based decision-making scheme, for multiple UAVs performing a search mission, is proposed. The agents make their decisions based on the information acquired through their sensors and by cooperation with neighbors. The complexity of the decision-making scheme is very low. It can arrive at decisions fast with low communication overheads, while accommodating various information structures used for increasing the fidelity of the uncertainty maps. Theoretical results proving completeness of the algorithm and the lower and upper bounds on the search time are also provided.

To pave or not to pave: A social landscape analysis of land use decision-making in the towns of the lamprey watershed

Population pressure in coastal New Hampshire challenges land use decision-making and threatens the ecological health and functioning of Great Bay, an estuary designated as both a NOAA National Estuarine Research Reserve and an EPA National Estuary Program site. Regional population in the seacoast has quadrupled in four decades resulting in sprawl, increased impervious surface cover and larger lot rural development (Zankel, et.al., 2006). All of Great Bay’s contributing watersheds face these challenges, resulting in calls for strategies addressing growth, development and land use planning. The communities within the Lamprey River watershed comprise this case study. Do these towns communicate upstream and downstream when making land use decisions? Are cumulative effects considered while debating development? Do town land use groups consider the Bay or the coasts in their decision-making? This presentation, a follow-up from the TCS 2008 conference and a completed dissertation, will discuss a novel social science approach to analyze and understand the social landscape of land use decision-making in the towns of the Lamprey River watershed. The methods include semi-structured interviews with GIS based maps in a grounded theory analytical strategy. The discussion will include key findings, opportunities and challenges in moving towards a watershed approach for land use planning. This presentation reviews the results of the case study and developed methodology, which can be used in watersheds elsewhere to map out the potential for moving towns towards EBM and watershed-scaled, land use planning. (PDF contains 4 pages)

Rapid tryptophan depletion improves decision-making cognition in healthy humans without affecting reversal learning or set shifting

Rapid tryptophan (Trp) depletion (RTD) has been reported to cause deterioration in the quality of decision making and impaired reversal learning, while leaving attentional set shifting relatively unimpaired. These findings have been attributed to a more powerful neuromodulatory effect of reduced 5-HT on ventral prefrontal cortex (PFC) than on dorsolateral PFC. In view of the limited number of reports, the aim of this study was to independently replicate these findings using the same test paradigms. Healthy human subjects without a personal or family history of affective disorder were assessed using a computerized decision making/gambling task and the CANTAB ID/ED attentional set-shifting task under Trp-depleted (n=17; nine males and eight females) or control (n=15; seven males and eight females) conditions, in a double-blind, randomized, parallel-group design. There was no significant effect of RTD on set shifting, reversal learning, risk taking, impulsivity, or subjective mood. However, RTD significantly altered decision making such that depleted subjects chose the more likely of two possible outcomes significantly more often than controls. This is in direct contrast to the previous report that subjects chose the more likely outcome significantly less often following RTD. In the terminology of that report, our result may be interpreted as improvement in the quality of decision making following RTD. This contrast between studies highlights the variability in the cognitive effects of RTD between apparently similar groups of healthy subjects, and suggests the need for future RTD studies to control for a range of personality, family history, and genetic factors that may be associated with 5-HT function.