Application Of Decision Rules Research Articles

An Experimental Comparison of Two Emotion‐Induction Methods and the Role of Emotion in Applying Decision Rules

AbstractVery little attention has been given to the influence of emotions on the application of decision rules (DRs). Research in decision‐making has largely pointed out the benefits of positive emotions; however, very few studies have compared emotion‐induction methods (EIMs) for their efficacy, which makes it difficult to choose a relatively better method among them for a particular purpose. We aim to study the effectiveness and comparison of two EIMs, autobiographical recollection and feedback methods, on the elicitation of positive and negative emotions in an experimental environment to see the influence of positive and negative emotions on the application of DRs and to see whether EIMs have any influence on the application of DRs. Three hundred and twenty‐four students were randomly divided in equal numbers to one of the EIMs with the intention to elicit either positive or negative emotion. The Positive Affectivity and Negative Affectivity Schedule was administered before and after EIMs. Subsequently, complete data from 300 students were analyzed. Analysis of variance results suggest both EIMs were effective in emotion induction and the negative emotional state was related to applying decision rules in problem‐solving tasks.

Application of a Thoracic CT Decision Rule in the Evaluation of Injured Children: A Quality Improvement Initiative.

Differences in injury patterns in children suggest that life-threatening chest injuries are rare. Radiation exposure from computed tomography increases cancer risk in children. Two large retrospective pediatric studies have demonstrated that thoracic computed tomography can be reserved for patients based on mechanism of injury and abnormal findings on chest radiography. Implement a decision rule to guide utilization of thoracic computed tomography in the evaluation of pediatric blunt trauma, limiting risk of unnecessary radiation exposure and clinically significant missed injuries. A protocol for thoracic computed tomography utilization in pediatric blunt trauma was implemented using a Plan-Do-Study-Act cycle at our Level I pediatric trauma center, reserving thoracic computed tomography for patients with (1) mediastinal widening on chest radiography or (2) vehicle-related mechanism and abnormal chest radiography. We modified our resuscitation order set to limit default imaging bundles. The medical record and trauma registry data were reviewed for all pediatric blunt trauma patients (younger than 18 years) over a 30-month study period before and after protocol implementation (May 2017 to July 2018 and February 2019 to April 2020), allowing for a 6-month implementation period (August 2018 to January 2019). During the study period, 1,056 blunt trauma patients were evaluated with a median (range) Injury Severity Score of 5 (0-58). There were no significant demographic differences between patients before and after protocol implementation. Thoracic computed tomography utilization significantly decreased after implementation of the protocol (26.4% [129/488] to 12.7% [72/568; p < .05]), with no increase in clinically significant missed injuries. Protocol compliance was 88%. Application of decision rules can safely limit ionizing radiation in injured children. Further limitations to thoracic computed tomography utilization may be safe and warrant continued study due to the rarity of significant injuries.

Application of decision rules on diagnosis and prognosis of renal colic: a systematic review and meta-analysis.

Renal colic is a prevalent emergency department presentation resulting from urolithiasis. Clinical decision rules for the diagnosis of urolithiasis were developed to help clinicians with better judgment. In this systematic review, we assessed the performance of prediction rules on urolithiasis diagnosis and prognosis. MEDLINE, Embase, Web of Science, and Scopus were searched for studies on the performance of a clinical decision tool for diagnosis or prognosis of urolithiasis. Performance and accuracy of the rules were the key outcomes of interest. Databases were searched from inception to March 2019. Of the 4980 articles reviewed, 28 studies were included in the present analysis. Twenty-one studies were on urolithiasis diagnosis (including eight studies on STONE rule), and 10 studies reported urolithiasis outcomes. Studies were at low to moderate risk of bias. The pooling of data on STONE showed that the prevalence of urolithiasis in low, moderate, and high risk groups were: 12% (95% confidence interval 9%-15%), 53% (95% confidence interval 43%-62%), and 83% (95% confidence interval 75%-91%), respectively. In the high risk score group, prevalence of clinically important alternative diagnosis was 1% (95% confidence interval 0%-2%) and 11% (95% confidence interval 8%-13%) of patients needed intervention. STONE scoring system is useful in estimating the prevalence of urolithiasis but high heterogeneity among the studies makes it unsuitable for application. Other decision tools were poorly studied and cannot be recommended for clinical use.

Developing a measure of polypharmacy appropriateness in primary care: systematic review and expert consensus study

BackgroundPolypharmacy is an increasing challenge for primary care. Although sometimes clinically justified, polypharmacy can be inappropriate, leading to undesirable outcomes. Optimising care for polypharmacy necessitates effective targeting and monitoring of interventions. This requires a valid, reliable measure of polypharmacy, relevant for all patients, that considers clinical appropriateness and generic prescribing issues applicable across all medications. Whilst there are several existing measures of potentially inappropriate prescribing, these are not specifically designed with polypharmacy in mind, can require extensive clinical input to complete, and often cover a limited number of drugs. The aim of this study was to identify what experts consider to be the key elements of a measure of prescribing appropriateness in the context of polypharmacy.MethodsFirstly, we conducted a systematic review to identify generic (not drug specific) prescribing indicators relevant to polypharmacy appropriateness. Indicators were subject to content analysis to enable categorisation. Secondly, we convened a panel of 10 clinical experts to review the identified indicators and assess their relative clinical importance. For each indicator category, a brief evidence summary was developed, based on relevant clinical and indicator literature, clinical guidance, and opinions obtained from a separate patient discussion panel. A two-stage RAND/UCLA Appropriateness Method was used to reach consensus amongst the panel on a core set of indicators of polypharmacy appropriateness.ResultsWe identified 20,879 papers for title/abstract screening, obtaining 273 full papers. We extracted 189 generic indicators, and presented 160 to the panel grouped into 18 classifications (e.g. adherence, dosage, clinical efficacy). After two stages, during which the panel introduced 18 additional indicators, there was consensus that 134 indicators were of clinical importance. Following the application of decision rules and further panel consultation, 12 indicators were placed into the final selection. Panel members particularly valued indicators concerned with adverse drug reactions, contraindications, drug-drug interactions, and the conduct of medication reviews.ConclusionsWe have identified a set of 12 indicators of clinical importance considered relevant to polypharmacy appropriateness. Use of these indicators in clinical practice and informatics systems is dependent on their operationalisation and their utility (e.g. risk stratification, targeting and monitoring polypharmacy interventions) requires subsequent evaluation.Trial registrationRegistration number: PROSPERO (CRD42016049176).

How accurate are interpretations of curriculum-based measurement progress monitoring data? Visual analysis versus decision rules

Curriculum based measurement of oral reading (CBM-R) is used to monitor the effects of academic interventions for individual students. Decisions to continue, modify, or terminate these interventions are made by interpreting time series CBM-R data. Such interpretation is founded upon visual analysis or the application of decision rules. The purpose of this study was to compare the accuracy of visual analysis and decision rules. Visual analysts interpreted 108 CBM-R progress monitoring graphs one of three ways: (a) without graphic aids, (b) with a goal line, or (c) with a goal line and a trend line. Graphs differed along three dimensions, including trend magnitude, variability of observations, and duration of data collection. Automated trend line and data point decision rules were also applied to each graph. Inferential analyses permitted the estimation of the probability of a correct decision (i.e., the student is improving – continue the intervention, or the student is not improving – discontinue the intervention) for each evaluation method as a function of trend magnitude, variability of observations, and duration of data collection. All evaluation methods performed better when students made adequate progress. Visual analysis and decision rules performed similarly when observations were less variable. Results suggest that educators should collect data for more than six weeks, take steps to control measurement error, and visually analyze graphs when data are variable. Implications for practice and research are discussed.

Extending decision making competence to special populations: a pilot study of persons on the autism spectrum.

The area of decision making has much to offer in our effort to understand special populations. This pilot study is an example of just such a project, where we illustrate how traditional decision making tools and tasks can be used to uncover strengths and weaknesses within a growing population of young adults with autism. In this pilot project we extended accounts of autistic behavior such as those derived from “theory of mind” to predict key components of decision making in high-functioning young adults on the autism spectrum. A battery of tests was administered to 15 high-functioning college students with autism spectrum disorder (ASD), focusing on decision making competence (DMC) and other aspects of decision making related to known deficits associated with autism. Data from this group were compared to data from unselected college students receiving the same measures. First, as a test of a key social deficit associated with autism, the target group scored much lower on the Empathy Quotient scale. Traditional elements of decision making competency such as Numeracy and application of decision rules were comparable across groups. However, there were differences in thinking style, with the ASD group showing lesser ability and engagement in intuitive thinking, and they showed lower levels of risk taking. For comparisons within the ASD group, autobiographical reports concerning individual lifestyles and outcomes were used to derive a scale of Social Functioning. The lowest scoring individuals showed the lowest levels of intuitive thinking, the lowest perceived levels of others’ endorsement of socially undesirable behaviors, and the lowest ability to discriminate between “good” and “bad” risks. Results are discussed in terms of interventions that might aid high-functioning young adults with ASD in their everyday decision making.

Equity, discrimination and remote policy: Investigating the centralization of remote service delivery in the Northern Territory

Two hypotheses have been advanced to explain the spatial patterning of service accessibility. The bureaucratic hypothesis holds that spatial inequalities are unpatterned and result from the application of decisions rules, while the competing political hypothesis suggests that politically-motivated decision making results in discriminatory outcomes. We use the example of the centralization of service provision in remote Indigenous communities in Australia's Northern Territory to show that these hypotheses may in fact be complementary. In recent years, government rhetoric about Australia's remote Indigenous communities has moved to focus on economic viability instead of social justice. One policy realization of this rhetoric has been the designation of ‘growth towns’ and ‘priority communities’ to act as service hubs for surrounding communities. The introduction of such hubs was examined and substantial inequality in access to service hubs was found. Inequality and overall system efficiency could be reduced with by optimizing the selection of hubs but the imposition of any hub-and-spoke mode in the study area was associated with racially-patterned patterned inequality of access. We conclude that when policy contexts are politically motivated, the application of racially-blind decision rules may result in racially-discriminatory spatial inequalities.

Manipulation of working memory contents selectively impairs metacognitive sensitivity in a concurrent visual discrimination task.

What are the cognitive mechanisms underlying perceptual metacognition? Prior research indicates that prefrontal cortex (PFC) contributes to metacognitive performance, suggesting that metacognitive judgments are supported by high-level cognitive operations. We explored this hypothesis by investigating metacognitive performance for a visual discrimination task in the context of a concurrent working memory (WM) task. We found that, overall, high WM load caused a nonspecific decrease in visual discrimination performance as well as metacognitive performance. However, active manipulation of WM contents caused a selective decrease in metacognitive performance without impairing visual discrimination performance. These behavioral findings are consistent with previous neuroscience findings that high-level PFC is engaged by and necessary for (i) visual metacognition, and (ii) active manipulation of WM contents, but not mere maintenance. The selective interference of WM manipulation on metacognition suggests that these seemingly disparate cognitive functions in fact recruit common cognitive mechanisms. The common cognitive underpinning of these tasks may consist in (i) higher-order re-representation of lower-level sensory information, and/or (ii) application of decision rules in order to transform representations in PFC into definite cognitive/motor responses.

An Application of Binary Decision Trees to Pattern Recognition

Decision rules are a key technique in decision making, data mining and knowledge discovery in databases. We introduce an application of decision rules, handwriting pattern classification. When decision rules are applied to pattern recognition, one rule forms a hyperrectangle in feature space, i.e., each decision rule corresponds to one hyperrectangle. This means that a set of decision rules is considered a classification system, called the subclass method. We apply decision rules to handwritten Japanese character recognition, showing experimental results.

Foraging Decision Rules and Prey Species Preferences of Northwestern Crows (Corvus caurinus)

AbstractCategorization of similar prey types and the application of decision rules by dietary generalists can enhance the efficiency of foraging decisions and facilitate the inclusion of novel prey types in the diet. While considerable research attention has been directed toward investigation of these concepts in invertebrates, few have assessed categorization and decision rules used by generalist vertebrate predators. In this study, we experimentally investigated decision rules and prey preferences of northwestern crows (Corvus caurinus) feeding on littleneck clams (Tapes philippinarum) and whelks (Nucella lamellosa). We presented crows with three species‐size combinations: small clams (2.0–2.9 cm length) paired with large whelks (4.0–4.9 cm), small clams paired with medium whelks (3.0–3.9 cm), and large clams (4.0–4.9 cm) with large whelks. Profitability estimates based on observations of crows feeding on these prey species indicated that clams were always the more energetically profitable option; however, in prey choice trials crows consistently selected the heavier prey species, regardless of differences in profitability. These results show that crows apply a general decision rule according to which they select heavier prey items when feeding on hard‐shelled prey requiring similar handling techniques, and that while such decision rules may approximate optimal choices they may not always follow predictions based solely on prey profitability. We discuss these results in the context of behavioural flexibility of generalist predators, and predicting impacts of intertidal avian predators on prey populations.

Quantifying headache symptoms and other headache features from chart notes.

To describe a method for quantifying headache symptoms/features in family practice charts for patients diagnosed with headache NOS (not otherwise specified, ICD-9: 784) and to determine the share of NOS headache diagnoses with clinical data strongly suggestive of migraine or probable migraine headache. Headache is one of the most common pain symptoms that brings patients to a family physician. However, the majority of headache sufferers do not receive a specific headache diagnosis when they visit physicians. We examined the chart notes of 454 patients exclusively diagnosed with one or more ICD-9 coded headache NOS diagnoses from July 1, 1995 through December 31, 1999 at a large suburban, university-affiliated practice. We developed a template containing 20 headache items combining International Headache Society diagnostic criteria and additional headache symptoms/features, and decision rules for coding symptoms/features and collected data from patient charts. We then developed decision rules and reclassified NOS headaches into categories strongly suggestive of migraine, probable migraine headache, or other diagnosis. Our main outcome measure is the consistency in the application of decision rules and diagnostic criteria. With this method we estimate 3 in 10 (29%) headache NOS patients may have had migraine (8%) or probable migraine headache (21%). Reclassified migraine visits averaged 6.5 migraine symptoms and reclassified probable migraine headache visits 4.7 migraine symptoms. Logistic regression analysis supports the consistency of diagnostic criteria for classifying headache based on coded symptoms/features--our model correctly predicted 96% of visits. Evidence of physical examination was recorded at 75% of visits suggesting that physician attention is focused on elimination of secondary headache. We think the use of our rigorous procedures reveals that a substantial amount of migraine and probable migraine headache may be missed in everyday practice. We hope our findings will provide a basis for the development of diagnostic methods more closely suited to the needs of nonspecialists, and contribute to a better standard of care for headache patients seen in primary care practice. Finally, we are hopeful that other researchers will consider using our template and guideline procedures in their efforts to identify diagnostic patterns and study headache and other health problems.

Time pressure and the application of decision rules: Choices and judgments among multiattribute alternatives

The effects of time pressure on decisions and judgments were studied and related to the use of different decision rules in a multiattribute decision task. The decision alternatives were students described by their high school grades in Swedish, Psychology and Natural Science. The subjects were asked to choose the student they thought would be most able to follow a university program and graduate as a school psychologist. On the basis of earlier findings using the same kind of decision task (Svenson et al., 1990) it was hypothesised that subjects under time pressure would prefer candidates having the maximum grade across all attributes to a greater extent than subjects under no time pressure. Furthermore, it was hypothesised that subjects under time pressure would also focus more on the most important attribute and choose the alternatives being best on that attribute. The results supported these hypotheses.