Census Studies Research Articles

Pattern of Filling up of Medical Certification of Cause of Death (MCCD) at a Tertiary Care Hospital: Pitfalls and Suggestions

The statistics provided by the Medical Certification of Cause of Death-MCCD, plays an important role in deciding the direction of public health programs, provide a feedback system for future implementation of health policies, health planning and management of epidemiological studies, vital statistics, medicolegal investigations, census studies, health research, assessment of effectiveness of public health programs. Our study focuses on the analysis of MCCD proformas filled up by residents and faculty members and common mistakes committed while filling it. This was a retrospective, cross sectional study carried out at an 800 bedded hospital associated with a medical college situated in Madhya Pradesh. The period of this study is one calendar year in 2015 in which a total of 459 deaths were reported. We could study a total of 106 certificates (23%) as in rest of the cases, the MCCD was not attached. The analytical outcome of the study revealed some major errors like wrong proforma of MCCD and some minor errors. The conclusion of our study highlights an urgent need for imparting extra efforts towards awareness, importance to undergraduates as well as postgraduate training and regarding complete and accurate filling of the Medical Certification of Cause of Death proforma.

The Budget Impact of Increased Use of Febuxostat in the Management of Gout: A US Health Plan Managed Care Pharmacy and Medical Costs Perspective

PurposeGout is a chronic disease characterized by the deposition of urate crystals in the joints and throughout the body, caused by an excess burden of serum uric acid (sUA). The study estimates pharmacy and medical cost budgetary impacts of wider adoption by US payers of febuxostat, a urate-lowering therapy (ULT) for the treatment of gout. MethodsA US payer-perspective budget impact model followed ULT patients from a 1,000,000-member plan over 3 years. The current market share scenario, febuxostat (6%) and ULT allopurinol (94%), was compared with an 18% febuxostat market share. Data were implemented from randomized controlled trials, census and epidemiologic studies, and real-world database analyses. An innovation was the inclusion of gout-related chronic kidney disease costs. Cost results were estimated as annual and cumulative incremental costs, expressed as total costs, cost per member per month, and cost per treated member per month. Clinical results were also estimated. FindingsIncreasing the febuxostat market share resulted in a 6.3% increase in patients achieving the sUA target level of <6.0 mg/dL and a 1.4% reduction in gout flares during the 3-year period. Total cost increased 1.4%, with a 49.9% increase in ULT costs, a 1.4% reduction in flare costs, a 1.2% reduction in chronic kidney disease costs, and a 2.8% reduction in gout care costs. The cumulative incremental costs were $1,307,425 in the first year, $1,939,016 through the second year, and $2,092,744 through the third year. By the third year, savings in medical costs offset most of the increase in treatment costs. Impacts on cumulative cost per member per month and cumulative cost per treated member per month followed the same pattern, with the highest impact in the first year and cumulative impacts declining during the 3-year period. The cumulative cost per member per month impact was estimated as $0.109, $0.081, and $0.058 and the cumulative cost per treated member per month impact was estimated as $12.416, $9.207, and $6.625 in the first year, through the second year, and through the third year, respectively. ImplicationsExpanding the febuxostat market share would result in improved clinical outcomes, but with an overall increase in costs over 3 years due to higher costs of treatment. By the third year, savings in medical costs, primarily in chronic kidney disease costs, would offset most of the increase in treatment costs. Expanded use of febuxostat in the treatment of all gout patients, independent of renal impairment status, should be considered based on improved clinical outcomes and longer-term medical cost savings associated with these improved outcomes.

The IC 5146 star forming complex and its surroundings with 2MASS, WISE and Spitzer

Throughout the last decade sensitive infrared observations obtained by the Spitzer Space Telescope significantly increased the known population of YSOs associated with nearby molecular clouds. With such a census recent studies have characterized pre-main sequence stars (PMS) and determined parame- ters from different wavelengths. Given the restricted Spitzer coverage of some of these clouds, relative to their extended regions, these YSO populations may represent a limited view of star formation in these regions. We are taking advantage of mid-infrared observations from the NASA Wide Field Infrared Survey Explorer (WISE), which provides an all sky view and therefore full coverage of the nearby clouds, to assess the degree to which their currently known YSO population may be representative of a more complete population. We extend the well established classification method of the Spitzer Legacy teams to archived WISE observations. We have adopted 2MASS photometry as a standard catalogue for comparisons. Besides the massive embedded cluster IC5146 we provide a multiband view of five new embedded clusters in its surroundings that we discovered with WISE. In short, the analysis in- volves the following for the presently studied cluster sample: (1) extraction of 2MASS/WISE/Spitzer photometry in a wide circular region; (2) field-star decontamination to enhance the intrinsic Colour-magnitude diagram (CMD) morphology (essential for a proper derivation of reddening, age, and distance from the Sun); and (3) construction of Colour-magnitude filters, for more contrasted stellar radial density profiles (RDPs).

Dog and cat management through sterilization: Implications for population dynamics and veterinary public policies

The present study aimed to compare different sterilization scenarios allowing the adoption of the most adequate strategy to control owned dog and cat population sizes as the official veterinary public policy for animal control in an urban area of Campinas municipality, Brazil.To achieve this goal, the vital parameters of the owned pet population were measured in a neighborhood of Campinas called Jardim Vila Olimpia through questionnaires used in two census studies performed in February 2012 and June 2013.Different hypothetical sterilization scenarios were compared with the scenario of a single sterilization campaign performed in the study area between the census studies. Using a deterministic mathematical model, population dynamics were simulated for these different scenarios. We have observed that for both owned dogs and cats, the impact on the population size achieved by a single sterilization campaign would be diluted over the years, equating to the impact achieved by the usual sterilization rate practiced before the sterilization campaign yearly. Moreover, using local and global sensitivity analyses, we assessed the relative influence on animal population evolution of each vital parameter used in the mathematical models. The more influential parameters for both species were the carrying capacity of the environment and sterilization rates of males and females (for both species).We observed that even with sterilizing 100% of the intact animals annually, it would not be possible to obtain proportions greater than 86% and 88% of sterilized dogs and cats, respectively, after 20 years due to the high introduction of new intact animals. There is no public dog and cat sterilization service in place in the city, and sporadic and local sterilization campaigns are performed with a prior communication to the owners to bring their animals to be sterilized in a selected veterinary facility. If a sterilization campaign was performed annually in the study area, it would have the most favorable cost effectiveness ratio after 20 years compared to the scenarios of 50% and 100% sterilization of intact animals annually.These results allowed the veterinary public policy stakeholders to make decisions based on scientific evidence to implement adequate control of dog and cat populations in urban areas, aiming to reduce zoonosis transmission to humans and other problems associated with uncontrolled animal populations.

EVENTS

The present study aimed to compare different sterilization scenarios allowing the adoption of the most adequate strategy to control owned dog and cat population sizes as the official veterinary public policy for animal control in an urban area of Campinas municipality, Brazil.To achieve this goal, the vital parameters of the owned pet population were measured in a neighborhood of Campinas called Jardim Vila Olimpia through questionnaires used in two census studies performed in February 2012 and June 2013.Different hypothetical sterilization scenarios were compared with the scenario of a single sterilization campaign performed in the study area between the census studies. Using a deterministic mathematical model, population dynamics were simulated for these different scenarios. We have observed that for both owned dogs and cats, the impact on the population size achieved by a single sterilization campaign would be diluted over the years, equating to the impact achieved by the usual sterilization rate practiced before the sterilization campaign yearly. Moreover, using local and global sensitivity analyses, we assessed the relative influence on animal population evolution of each vital parameter used in the mathematical models. The more influential parameters for both species were the carrying capacity of the environment and sterilization rates of males and females (for both species).We observed that even with sterilizing 100% of the intact animals annually, it would not be possible to obtain proportions greater than 86% and 88% of sterilized dogs and cats, respectively, after 20 years due to the high introduction of new intact animals. There is no public dog and cat sterilization service in place in the city, and sporadic and local sterilization campaigns are performed with a prior communication to the owners to bring their animals to be sterilized in a selected veterinary facility. If a sterilization campaign was performed annually in the study area, it would have the most favorable cost effectiveness ratio after 20 years compared to the scenarios of 50% and 100% sterilization of intact animals annually.These results allowed the veterinary public policy stakeholders to make decisions based on scientific evidence to implement adequate control of dog and cat populations in urban areas, aiming to reduce zoonosis transmission to humans and other problems associated with uncontrolled animal populations.

Managing Transformation of Rural India through Rural Non-Farm Economy

Over the last three decades, economy has undergone a structural transformation as the share of rural non-farm sector (RNFS) is increasing in a country like India where 68% of people live in rural areas contributing 56% of Indias income, 64% of expenditure, and 33% of savings. A significant proportion of salaried (39%) and non-agricultural self-employed households (46%) are located in rural areas. RNFS also provides forward and backward linkage to the urban economy by way of supplying agricultural produces, food, vegetables, dairy products and semi-skilled &amp; skilled manpower. Despite various policies, programmes, schemes, and strategies for rural development since the initiation of planned approach in 1951, rural India is still deprived of the socio-economic well-being as revealed by the latest Social, Economic and Caste Census, 2011 (SECC) and other studies. The factors responsible for the growth of Rural Non-Farm Economy (RNFE) are, lower productivity of farms, sluggish growth rate of agriculture, shrinking farm size, increasing cultivation cost, rapid pace of urbanization, squeezing boundaries of rural-urban divide, increased wage rates in non-farm sector, accelerated pace of rural non-farm employment, and spiraling share of non-farm GDP. The present paper is a review paper attempting to examine and analyze the present status of Rural Non-Farm Economy (RNFE) and propose the strategies for managing this transformation for achieving rural inclusive development.

Detecting complexity changes for heart rate variability in the case of missing data

Data are frequently missing in the analysis of large databases, such as those for census, environmental, and medical longitudinal studies, causing significant difficulties for data analysis and application. And it is very important to maintain stability of analysis results in the case of missing data when determining the quality of a data processing method. To simulate the case of general data loss in this paper, we developed an approach to generate synthetic signals, which randomly wiped data from the original dataset according to a Gaussian distribution and an exponential distribution. We then used two methods of entropy measure-base-scale entropy and approximate entropy-to perform a complexity comparative analysis. Research has shown that two key parameters-the percentage and average length of missing data segments-can cause changes to sequence complexity. However, no matter what kind of distribution is used for the length of the missing data segments, it has little effect on the results of the analysis. Moreover, approximate entropy has strong sensitivity to missing data, so it was unsuitable for the analysis of signals with missing data. However, the calculation results had preferable stability for base-scale entropy, whose superiority suits it for analysis of actual signals.

Updates to the spectrum model to estimate key HIV indicators for adults and children.

Background:The Spectrum program is used to estimate key HIV indicators for national programmes. The purpose of the study is to describe the key updates made to Spectrum in the last 2 years to produce the version used in the 2013 global estimates of HIV/AIDS.Methods:The United Nations Programme on HIV/AIDS (UNAIDS) Reference Group on Estimates, Models and Projections regularly reviews new data and information needs and recommends updates to the methodology and assumptions used in Spectrum. The latest data from surveys, census and special studies are used to estimate key parameter values for countries and regions.Results:Country-specific life tables prepared by the United National Population Division (UNPD) have been incorporated into Spectrum's demographic projections replacing the model life tables used previously. This update includes revised estimates of non-AIDS life expectancy. Incidence among all adults 15–49 years generated from curve fitting to surveillance and survey data is now split by age using incidence rate ratios derived from Analysing Longitudinal Population-based HIV/AIDS data on Africa Network data for generalized epidemics. Methods for estimating the number of AIDS orphans have been updated to include the changing effects of PMTCT and antiretroviral therapy programmes. Procedures for estimating the number of adults eligible for treatment have been updated to reflect the 2013 WHO guidelines. Program data on AIDS mortality has been used to estimate prevalence trends in Argentina, Brazil and Mexico for the 2013 estimates.Conclusion:Spectrum was updated for the 2013 round of HIV estimates in order to support national programmes with improved methods and data to estimating national indicators.

Challenges in the use of genetic mark-recapture to estimate the population size of Bwindi mountain gorillas (Gorilla beringei beringei)

Monitoring the population dynamics of endangered species is a critical component of conservation management strategies, but attaining accurate and precise estimates of population sizes using cost and time effective methods can be challenging. Routine censuses of the two populations of critically endangered mountain gorillas (Gorilla beringei beringei) have been conducted over the last decades to monitor populations and evaluate the effectiveness of conservation strategies. A census in 2006 of the mountain gorillas in Bwindi Impenetrable National Park, Uganda, showed the value of genetic analysis of fecal samples collected at nest sites by revealing discrepancies between the numbers of nests and uniquely identified gorillas. In this study, we censused the Bwindi gorilla population using a ‘mark-recapture’ method which involved genetic analysis of fecal samples collected in 2011 during two ‘sweep’ surveys of the entire park. We found that a notable proportion of gorillas were missed in either of the two sweeps (minimum 35% and 31%, respectively). Based on the number of genotyped gorillas and correction factors, we estimated the population to contain a minimum of 400 individuals. Using the mark-recapture approach, we infer possibly as many as 430 gorillas (95% confidence interval: 398–487). As the 2010 census of the Virunga Massif population found 480 gorillas, the total number of mountain gorillas worldwide is at least 880 individuals. Simulations using different mark-recapture models suggest that a future census of Bwindi mountain gorillas would benefit by increasing the number of sweeps in order to achieve accurate and precise results. Finally, based on our results, we recommend a sequential approach incorporating a pilot study and simulations for optimizing time and resources in large mammal genetic census studies.

Prevalence of Cannabis Lifetime Use in Iranian High School and College Students: A Systematic Review, Meta-Analyses, and Meta-Regression.

Cannabis is the most widely used substance in the world. This study aimed to estimate the prevalence of cannabis lifetime use (CLU) in high school and college students of Iran and also to determine factors related to changes in prevalence. A systematic review of literature on cannabis use in Iran was conducted according to MOOSE guideline. Domestic scientific databases, PubMed/Medline, ISI Web of Knowledge, and Google Scholar, relevant reference lists, and relevant journals were searched up to April, 2014. Prevalences were calculated using the variance stabilizing double arcsine transformation and confidence intervals (CIs) estimated using the Wilson method. Heterogeneity was assessed by Cochran's Q statistic and I(2) index and causes of heterogeneity were evaluated using meta-regression model. In electronic database search, 4,000 citations were retrieved, producing a total of 33 studies. CLU was reported with a random effects pooled prevalence of 4.0% (95% CI = 3.0% to 5.0%). In subgroups of high school and college students, prevalences were 5.0% (95% CI = 3.0% to -7.0%) and 2.0% (95% CI = 2.0% to -3.0%), respectively. Meta-regression model indicated that prevalence is higher in college students (β = 0.089, p < .001), male gender (β = 0.017, p < .001), and is lower in studies with sampling versus census studies (β = -0.096, p < .001). This study reported that prevalence of CLU in Iranian students are lower than industrialized countries. In addition, gender, level of education, and methods of sampling are highly associated with changes in the prevalence of CLU across provinces.

An internet census taken by an illegal botnet

On March 17, 2013, an Internet census data set and an accompanying report were released by an anonymous author or group of authors. It created an immediate media buzz, mainly because of the unorthodox and unethical data collection methodology (i.e., exploiting default passwords to form the Carna botnet), but also because of the alleged unprecedented large scale of this census (even though legitimate census studies of similar and even larger sizes have been performed in the past). Given the unknown source of this released data set, little is known about it. For example, can it be ruled out that the data is faked? Or if it is indeed real, what is the quality of the released data? The purpose of this paper is to shed light on these and related questions and put the contributions of this anonymous Internet census study into perspective. Indeed, our findings suggest that the released data set is real and not faked, but that the measurements suffer from a number of methodological flaws and also lack adequate meta-data information. As a result, we have not been able to verify several claims that the anonymous author(s) made in the published report. In the process, we use this study as an educational example for illustrating how to deal with a large data set of unknown quality, hint at pitfalls in Internet-scale measurement studies, and discuss ethical considerations concerning third-party use of this released data set for publications.

Getting the Right Data Up Front: A Key Challenge

ABSTRACT Rational decisions require transforming data into useful information by appropriate analyses. Such analyses, however, can be only as good as the data upon which they are based. In this article, we urge that careful consideration be given, up front, to procuring the right data and provide some guidelines. We begin by distinguishing briefly between four different approaches to data procurement: designed experiments, census and random sampling studies, observational studies, and so-called systems development studies. We then present and illustrate some key concepts to consider in obtaining the right data and propose a disciplined step-by-step process for data gathering, illustrating this with a study to assess the reliability of a newly designed washing machine. We conclude by commenting on some practical challenges.

Bat recording under controlled conditions: A replicable chamber for comparable results

In ecology, bats have become a major subject of study. Some pollinate and disperse the seeds of many tropical plants; some help to control insect populations; a few affect livestock by sucking blood, but in all cases bats are indispensable links in ecosystems. Bats use of sound waves make echolocation calls monitoring a powerful tool for distribution, census, and present studies. This technique depends on having a reliable database of sounds for species identification purposes. Although there are several databases of echolocation sounds; the signal emitted by a bat depends on environmental conditions (vegetation, weather conditions), biotic factors (prey size, movement, defensive measures), and the specific task (seek, flee, pursue, evade, wandering, obstacle avoiding). This variability makes comparisons among databases difficult. A portable chamber made of common materials for in situ recording under controlled conditions is presented. The use of the chamber is proposed as a tool which might help to generate databases that could be reliable compared. Nine species of desert bats from the northwest region of Mexico were recorder using the chamber under controlled conditions and compared with field recordings. The performance of the chamber and the utility of the database generated for filed identification are presented.

Population-based HIV-1 incidence in France, 2003–08: a modelling analysis

Routine national incidence testing with enzyme immunoassay for recent HIV-1 infections (EIA-RI) has been done in France since January, 2003. From the reported number of HIV infections diagnosed as recent, and accounting for testing patterns and under-reporting, we aimed to estimate the incidence of HIV infection in France in 2003-08. We analysed reports from the French National Institute for Public Health Surveillance for patients who were newly diagnosed with HIV between January, 2003, and December, 2008. Missing data were imputed with multiple imputation. Patients were classified with non-recent or recent infection on the basis of an EIA-RI test, which was calibrated with serial measurements from HIV seroconverters from the French ANRS-PRIMO cohort. We used an adapted stratified extrapolation approach to calculate the number of new HIV infections in men who have sex with men (MSM), injecting drug users (IDUs), and heterosexual men and women by nationality. Population sizes were obtained from the national census and national behavioural studies. After accounting for under-reporting, there were 6480 (95% CI 6190-6780) new diagnoses of HIV infection in France in 2008. We estimate that there were 6940 (6200-7690) new HIV infections in 2008, suggesting an HIV incidence of 17 per 100 000 person-years. In 2008, there were 3550 (3040-4050) new infections in heterosexuals (incidence of 9 per 100 000 person-years), 3320 (2830-3810) in MSM (incidence of 1006 per 100 000 person-years), and 70 (0-190) in IDUs (incidence of 86 per 100 000 person-years). Overall HIV incidence decreased between 2003 and 2008 (p<0·0001), but remained comparatively high and stable in MSM. In France, HIV transmission disproportionately affects certain risk groups and seems to be out of control in the MSM population. Incidence should be tracked to monitor transmission dynamics in the various population risk groups and to help to target and assess prevention strategies. French National Institute for Public Health Surveillance (InVS) and French National Agency for Research on AIDS and Viral Hepatitis (ANRS).

Estimation of Species Identification Error: Implications for Raptor Migration Counts and Trend Estimation

Abstract:One of the primary assumptions associated with many wildlife and population trend studies is that target species are correctly identified. This assumption may not always be valid, particularly for species similar in appearance to co‐occurring species. We examined size overlap and identification error rates among Cooper's (Accipiter cooperii) and sharp‐shinned (A. striatus) hawks specific to a raptor migration count station along the Pacific Coast of North America. Illustrating the difficulty of distinguishing between these 2 species, we found overlap in 7 metrics among species‐sex groups and in 2 metrics between species, and a principal components analysis revealed a continuum of discrete clusters for each species‐sex combination in morphospace. Among juvenile hawks (n= 940), we found the greatest misidentification rate for male Cooper's hawks (23% of the 156 males were identified as sharp‐shinned), lesser error rates for female Cooper's (8%,n= 339) and female sharp‐shinned (6%,n= 246), and the lowest misidentification rate for male sharp‐shinned hawks (0%,n= 199). We observed a similar pattern of misidentification among adult hawks (n= 48). We attempted to use conditional probabilities (identification rates) from calibration data to calculate the true number of adult and juvenile Cooper's hawks and sharp‐shinned hawks. Discrepancies between total number of observed accipiters and estimated number using calibration data suggest that daily observer misclassification rates are higher than misclassification rates estimated from calibration data and prevent correction of the raw data. Our results illustrate the importance of testing for and quantifying observer error in species identification in wildlife census and population trend studies particularly when target species may be easily confused with other nontarget species.

Estimation of Species Identification Error: Implications for Raptor Migration Counts and Trend Estimation

One of the primary assumptions associated with many wildlife and population trend studies is that target species are correctly identified. This assumption may not always be valid, particularly for species similar in appearance to co-occurring species. We examined size overlap and identification error rates among Cooper's (Accipiter cooperii) and sharp-shinned (A. striatus) hawks specific to a raptor migration count station along the Pacific Coast of North America. Illustrating the difficulty of distinguishing between these 2 species, we found overlap in 7 metrics among species–sex groups and in 2 metrics between species, and a principal components analysis revealed a continuum of discrete clusters for each species–sex combination in morphospace. Among juvenile hawks (n = 940), we found the greatest misidentification rate for male Cooper's hawks (23% of the 156 males were identified as sharp-shinned), lesser error rates for female Cooper's (8%, n = 339) and female sharp-shinned (6%, n = 246), and the lowest misidentification rate for male sharp-shinned hawks (0%, n = 199). We observed a similar pattern of misidentification among adult hawks (n = 48). We attempted to use conditional probabilities (identification rates) from calibration data to calculate the true number of adult and juvenile Cooper's hawks and sharp-shinned hawks. Discrepancies between total number of observed accipiters and estimated number using calibration data suggest that daily observer misclassification rates are higher than misclassification rates estimated from calibration data and prevent correction of the raw data. Our results illustrate the importance of testing for and quantifying observer error in species identification in wildlife census and population trend studies particularly when target species may be easily confused with other nontarget species.

Neighborhoods and health

Features of neighborhoods or residential environments may affect health and contribute to social and race/ethnic inequalities in health. The study of neighborhood health effects has grown exponentially over the past 15 years. This chapter summarizes key work in this area with a particular focus on chronic disease outcomes (specifically obesity and related risk factors) and mental health (specifically depression and depressive symptoms). Empirical work is classified into two main eras: studies that use census proxies and studies that directly measure neighborhood attributes using a variety of approaches. Key conceptual and methodological challenges in studying neighborhood health effects are reviewed. Existing gaps in knowledge and promising new directions in the field are highlighted.

A re-evaluation of morphological differences in the Karoo Thrush Turdus smithi – Olive Thrush Turdus olivaceus species complex

There is confusion in the literature concerning the taxonomic status of the Turdus smithi—T. olivaceus species complex. Here we attempt to clarify morphological differences within this complex. In addition, we attempt to clarify identification of the respective taxa. Although mean measurements of morphometric features differed significantly between species and subspecies, these features are not useful in separating species or subspecies due to considerable overlap in measurements. Furthermore, there were often larger differences between subspecies of T. olivaceus (particularly the geographically isolated T. o. swynnertoni) than between T. olivaceus and T. smithi. We therefore suggest that further work investigates the elevation of T. o. swynnertoni to full species status. Plumage characteristics proved more useful in separating T. olivaceus and T. smithi in the field, except in regions where the distributions overlap (potential hybridisation zones). We highlight the importance of clarifying the delineation of separate species particularly with respect to bird census data (e.g. Southern African Bird Atlas Project 2) and studies related to these species.

When Is a Male Turtle Not a Male?—Observations on Intersex Turtles

Abstract We report on an intersex green turtle, Chelonia mydas, observed at Raine Island, Australia that externally resembled an adult male but internally—based on laparoscopic examination—had both ovarian and testicular structures resembling those of an adult. This individual was the first intersex turtle that has been recorded on a nesting beach during the 39 years of extensive census studies in Queensland. Its observation confirms that the definitive identification of sex with marine turtles remains dependent on observations of their gonads or on observing eggs being laid.

The Merits of a Just-In-Time Knowledge Management (JITKM) Approach to Decision-Making Support

This paper advances the argument that, a knowledge base, rather than playing a crucial role in expediting the delivery of knowledge, obscures the process. The paper therefore offers an alternative strategy by way of the Just-In-Time knowledge delivery concept. The concept's benefits are demonstrated empirically, and the results are used to recommend strategies for maximising the benefits from the use of knowledge bases. The results of this study confirm that focussed and timely delivery of knowledge through a Just-in-Time Knowledge Management (JITKM) concept may be more effective than traditional decision support systems for decision-making support. This paper offers a novel and innovative information system, the Intelligent Just-in-Time Decision-Making Support System (IJDSS) to implement the JITKM concept in practice. The study also shows that simulation can be used to generate quality data for information system testing and evaluation. Moreover, this study suggests that simulation can be used to replace a subject-based empirical approach. As census studies, the results from such evaluations should be more generalisable in comparison to sample studies that use limited samples of subjects. Adaptations of these simulation models could also be used in diverse sectors.