Changes In Management Decisions Research Articles

Making decisions under demographic, management, and monitoring uncertainty with value of information

AbstractLearning and resolving uncertainty should be important components of management decisions, but not every type of uncertainty is equally important to resolve. For rare, threatened, and endangered species, information may be limited and there is often great urgency to halt potential population declines. Therefore, the most important uncertainties are those that would lead to different decisions intended to improve outcomes for species of interest. The New England cottontail (Sylvilagus transitionalis) is an endemic species to the northeastern United States and is listed as a species of special concern, threatened, or endangered in all states in its current range. States within the historical New England cottontail range have made substantial investments in habitat management, captive breeding, and research, but considerable demographic, management, and monitoring uncertainties remain. Connecticut is the geographic core of the current range of the species and therefore has been the focus of many management efforts, including improving habitat, creating new habitat patches, removing eastern cottontails (Sylvilagus floridanus), and releasing captive‐bred New England cottontails. We used a value of information analysis to identify the optimal management decision given current uncertainty and to evaluate how sources of uncertainty might lead to changes in management decisions. Given the current understanding of the New England cottontail in Connecticut, we identified the optimal management decision as improving existing habitat patches without monitoring for the species and managers could expect a 3.4% increase in populations if decision‐making uncertainty could be fully resolved. Multiple sources of uncertainty influenced results, but variation in New England cottontail density and the response of the species to the removal of eastern cottontails were most likely to result in changes to management decisions. At lower New England cottontail densities, releasing captive‐bred individuals competed with improving habitat as the optimal management action. Accounting for the value of information benefits New England cottontail management by guiding research efforts toward information that is most beneficial for decision‐makers and providing insights into parameter thresholds that would lead to changes in management decisions.

RISK MANAGEMENT IN IT-BUSINESS

Introduction. The article is devoted to topical issues of analysis, assessment and management of IT-risks in the business environment. The application of appropriate technologies enables companies to identify, assess and minimize risks in the decision-making process. Such technologies may include data analysis, risk modeling, and simulation, as well as risk management strategies. Data analysis can help businesses to identify trends and predict possible risks based on previous data. Risk modelling and simulations can help companies to estimate the possibilities that certain risks will become a reality and what are the consequences. For effective business-risk management, it is also necessary to understand what risks types exist. Risks can be associated with changes in management decisions, financial, personnel and infrastructure risks, etc. An important aspect of risk management is the provision of security-related risks, which are becoming increasingly relevant in the context of growing cyber threats and other forms of cybercrimes. The purpose of the article is to reveal the types, methods of risk research in the IT-business, their management and the justification of ways and measures to prevent and avoid them. Results. The types of IT risks are considered, the activities of successful companies in the IT sphere are studied in order to identify tools for influencing the magnitude of risk. The technologies of analysis, evaluation, management of business risks for systematization and development of measures for their prevention and avoidance are studied. The theoretical and practical significance is manifested in the fact that risk analysis in the management of business processes allows enterprises to avoid negative consequences for business and increase the efficiency of financial and economic activities. The factors influencing risks in business are substantiated, an assessment of potential security threats that may arise in the process of working with IT systems is carried out. Conclusions. The conducted analysis of the activities of successful IT companies shows that reducing the level of risk can be achieved with the help of the introduction of technologies, improvement of the company's products/services, the use of insurance poles, the implementation of financial measures, and other tools. Effective risk management at the enterprise is the key to its successful operation.

Soil Microbial Indicators within Rotations and Tillage Systems.

Recent advancements in agricultural metagenomics allow for characterizing microbial indicators of soil health brought on by changes in management decisions, which ultimately affect the soil environment. Field-scale studies investigating the microbial taxa from agricultural experiments are sparse, with none investigating the long-term effect of crop rotation and tillage on microbial indicator species. Therefore, our goal was to determine the effect of rotations (continuous corn, CCC; continuous soybean, SSS; and each phase of a corn-soybean rotation, Cs and Sc) and tillage (no-till, NT; and chisel tillage, T) on the soil microbial community composition following 20 years of management. We found that crop rotation and tillage influence the soil environment by altering key soil properties, such as pH and soil organic matter (SOM). Monoculture corn lowered pH compared to SSS (5.9 vs. 6.9, respectively) but increased SOM (5.4% vs. 4.6%, respectively). Bacterial indicator microbes were categorized into two groups: SOM dependent and acidophile vs. N adverse and neutrophile. Fungi preferred the CCC rotation, characterized by low pH. Archaeal indicators were mainly ammonia oxidizers with species occupying niches at contrasting pHs. Numerous indicator microbes are involved with N cycling due to the fertilizer-rich environment, prone to aquatic or gaseous losses.

Impact of Ga-68-PSMA PET/CT on management in prostate cancer patients with very early biochemical recurrence after radical prostatectomy

PurposeWith the availability of ultra-sensitive PSA assays, early biochemical relapse (eBCR) of prostate cancer is increasingly being detected at values much lower than the conventional threshold of 0.2 ng/ml. Accurate localisation of disease in this setting may allow treatment modification and improved outcomes, especially in patients with pelvis-confined or extra-pelvic oligometastasis (defined as up to three pelvic nodal or distant sites). We aimed to measure the detection rate of [68]Ga-PSMA-HBNED-CC (PSMA)-PET/CT and its influence on patient management in eBCR of prostate cancer following radical prostatectomy (RP).MethodsWe retrospectively identified 28 patients who underwent PSMA-PET/CT for post-RP eBCR (PSA < 0.5 ng/ml) at our tertiary care cancer centre. Two nuclear medicine physicians independently recorded the sites of PSMA-PET/CT positivity. Multidisciplinary meeting records were accessed to determine changes in management decisions following PSMA-PET/CT scans.ResultsThe mean age of patients was 65.6 years (range: 50–76.2 years); median PSA was 0.22 ng/ml (interquartile range: 0.15 ng/ml to 0.34 ng/ml). Thirteen patients (46.4%) had received radiotherapy in the past. PSMA-PET/CT was positive in 17 patients (60.7%). Only one patient had polymetastasis (> 3 sites); the remainder either had prostatectomy bed recurrence (n = 2), pelvic oligometastasis (n = 10), or extra-pelvic oligometastasis (n = 4). PSMA-PET/CT resulted in management change in 12 patients (42.8%), involving stereotactic body radiotherapy (n = 6), salvage radiotherapy (n = 4), and systemic treatment (n = 2).ConclusionsOur findings show that PSMA-PET/CT has a high detection rate in the eBCR setting following RP, with a large proportion of patients found to have fewer than three lesions. PSMA-PET/CT may be of value in patients with early PSA failure, and impact on the choice of potentially curative salvage treatments.

Ultrasonography for the diagnosis of patients with clinically suspected skin and soft tissue infections: a systematic review of the literature.

In patients presenting with skin and soft tissue infections (SSTI), the use of ultrasound may lead to a more accurate distinction between cellulitis and abscess compared with clinical assessment alone. This systematic review aims to determine the diagnostic accuracy of ultrasound for detecting skin abscesses. In addition, it aims to assess the impact of using ultrasound on management decisions in patients with SSTI. We searched relevant electronic databases for primary studies including MEDLINE, EMBASE, and CINAHL. We searched conference proceedings, checked references of retrieved articles, and contacted field experts. Two reviewers assessed the quality of each full-text publication using a modified QUADAS-2 tool. Five studies (n=710) fulfilled our inclusion criteria. Four studies compared the diagnostic accuracy of ultrasound with clinical examination alone (n=584). Most studies reported an improvement in diagnostic accuracy. The sensitivity of ultrasound ranged from 89 to 98% and the specificity ranged from 64 to 88%. However, the sensitivity of clinical assessment ranged from 75 to 90% and the specificity ranged from 55 to 83%; most of these results did not reach statistical significance. Sensitivity was further improved in cases of indeterminate clinical assessment. Two studies (n=176) examined the impact of ultrasound on management decisions. Use of ultrasound has led to significant and appropriate changes in management decisions in 16 to 39% of patients. The use of ultrasound could potentially improve diagnostic accuracy and lead to improved management decisions in patients with SSTI, especially in cases of indeterminate clinical assessment. Most of our findings did not achieve statistical significance. Further research is required to confirm these findings.

Background effects of emergencies on indicators of economic analysis of enterprise economic activity

The paper deals with the study of scientific works on the issue of formation and development of organizational and methodological regulations of accounting and analytical support of the economic activity of an enterprise in emergencies, which led to the conclusion about the complex character of the study of theory, methodology and economic analysis of enterprises in various sectors of national economy. The author studies the approaches to the nature and methods of economic analysis that resulted in the presentation of instructional techniques to the economic structure. In assessing the consequences of emergencies, it is necessary to determine their impact on the indices of economic analysis; so, there was the need to define areas resulting index changes as a result of emergency situations by identifying its components which may affect emergencies. After analyzing the data, it was found that the consequences of emergency situations affecting the indices of business analysis and can lead to changes in management decisions of internal and external users.

Commentary on “Impact of (18) F-fluorodeoxyglucose (FDG)-positron-emission tomography/computed tomography (PET/CT) on management of patients with carcinoma invading bladder muscle.” Mertens LS, Fioole-Bruining A, Vegt E, Vogel WV, van Rhijn BW, Horenblas S, Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam Hospital, Amsterdam, The Netherlands.: BJU Int 2013; 112(6):72934. doi:10.1111/bju.12109. [Epub 2013 Jun 24

ObjectiveTo evaluate the clinical impact of (18) F-fluorodeoxyglucose (FDG)-positron-emission tomography/computed tomography (PET/CT) scanning, compared with conventional staging with contrast-enhanced CT imaging (CECT). Patients and methodsThe FDG-PET/CT results of 96 consecutive patients with bladder cancer were analysed. Patients included in this study underwent standard CECT imaging of the chest and abdomen/pelvis<4 weeks before FDG-PET/CT. Based on the original imaging reports and recorded tumour stage before and after FDG-PET/CT imaging, the preferred treatment strategies before FDG-PET/CT and after FDG-PET/CT were determined for each patient using an institutional multidisciplinary guideline. One of the following treatment strategies was chosen: (i) local curative treatment; (ii) neoadjuvant/induction chemotherapy; or (iii) palliation. The changes in management decisions before and after FDG-PET/CT were assessed. ResultsThe median (range) interval between CECT and FDG-PET/CT was 0 (029) days. In 21.9% of the patients, stage on FDG-PET/CT and CECT were different. Upstaging by FDG-PET/CT was more frequent than downstaging (19.8 vs 2.1%). Clinical management changed for 13.5% of patients as a result of FDG-PET/CT upstaging. In eight patients, FDG-PET/CT detected second primary tumours. This led to changes of bladder cancer treatment in another four of 96 patients (4.2%). All the management changes were validated by tissue confirmation of the additional lesions. ConclusionsFDG-PET/CT provides important additional staging information, which influences the treatment of carcinoma invading bladder muscle in almost 20% of cases. Patient selection for neoadjuvant/induction chemotherapy was improved and futile attempts at curative treatment in patients found to have metastases were avoided.

Impact of 18F‐fluorodeoxyglucose (FDG)‐positron‐emission tomography/computed tomography (PET/CT) on management of patients with carcinoma invading bladder muscle

To evaluate the clinical impact of (18) F-fluorodeoxyglucose (FDG)-positron-emission tomography/computed tomography (PET/CT) scanning, compared with conventional staging with contrast-enhanced CT imaging (CECT). The FDG-PET/CT results of 96 consecutive patients with bladder cancer were analysed. Patients included in this study underwent standard CECT imaging of the chest and abdomen/pelvis <4 weeks before FDG-PET/CT. Based on the original imaging reports and recorded tumour stage before and after FDG-PET/CT imaging, the preferred treatment strategies before FDG-PET/CT and after FDG-PET/CT were determined for each patient using an institutional multidisciplinary guideline. One of the following treatment strategies was chosen: (i) local curative treatment; (ii) neoadjuvant/induction chemotherapy; or (iii) palliation. The changes in management decisions before and after FDG-PET/CT were assessed. The median (range) interval between CECT and FDG-PET/CT was 0 (029) days. In 21.9% of the patients, stage on FDG-PET/CT and CECT were different. Upstaging by FDG-PET/CT was more frequent than downstaging (19.8 vs 2.1%). Clinical management changed for 13.5% of patients as a result of FDG-PET/CT upstaging. In eight patients, FDG-PET/CT detected second primary tumours. This led to changes of bladder cancer treatment in another four of 96 patients (4.2%). All the management changes were validated by tissue confirmation of the additional lesions. FDG-PET/CT provides important additional staging information, which influences the treatment of carcinoma invading bladder muscle in almost 20% of cases. Patient selection for neoadjuvant/induction chemotherapy was improved and futile attempts at curative treatment in patients found to have metastases were avoided.

Association between a single-pass whole-body computed tomography policy and survival after blunt major trauma: a retrospective cohort study

IntroductionSingle-pass, whole-body computed tomography (pan-scan) remains a controversial intervention in the early assessment of patients with major trauma. We hypothesized that a liberal pan-scan policy is mainly an indicator of enhanced process quality of emergency care that may lead to improved survival regardless of the actual use of the method.MethodsThis retrospective cohort study included consecutive patients with blunt trauma referred to a trauma center prior to (2000 to 2002) and after (2002 to 2007) the introduction of a liberal single-pass pan-scan policy. The overall mortality between the two periods was compared and stratified according to the availability and actual use of the pan-scan. Logistic regression analysis was employed to adjust mortality estimates for demographic and injury-related independent variables.ResultsThe study comprised 313 patients during the pre-pan-scan period, 223 patients after the introduction of the pan-scan policy but not undergoing a pan-scan and 608 patients undergoing a pan-scan. The overall mortality was 23.3, 14.8 and 7.9% (P < 0.001), respectively. By univariable logistic regression analysis, both the availability (odds ratio (OR) 0.57, 95% confidence interval (CI): 0.36 to 0.90) and the actual use of the pan-scan (OR 0.28, 95% CI: 0.19 to 0.42) were associated with a lower mortality. The final model contained the Injury Severity Score, the Glasgow Coma Scale, age, emergency department time and the use of the pan-scan. 2.7% of the explained variance in mortality was attributable to the use of the pan-scan. This contribution increased to 7.1% in the highest injury severity quartile.ConclusionsIn this study, a liberal pan-scan policy was associated with lower trauma mortality. The causal role of the pan-scan itself must be interpreted in the context of improved structural and process quality, is apparently moderate and needs further investigation with regard to the diagnostic yield and changes in management decisions. (The Pan-Scan for Trauma Resuscitation [PATRES] Study Group, ISRCTN35424832 and ISRCTN41462125)

Should macular optical coherence tomography be part of routine preoperative cataract assessment?

Should macular optical coherence tomography be part of routine preoperative cataract assessment?

Reconciling Uncertain Costs and Benefits in Bayes Nets for Invasive Species Management

Bayes nets are used increasingly to characterize environmental systems and formalize probabilistic reasoning to support decision making. These networks treat probabilities as exact quantities. Sensitivity analysis can be used to evaluate the importance of assumptions and parameter estimates. Here, we outline an application of info-gap theory to Bayes nets that evaluates the sensitivity of decisions to possibly large errors in the underlying probability estimates and utilities. We apply it to an example of management and eradication of Red Imported Fire Ants in Southern Queensland, Australia and show how changes in management decisions can be justified when uncertainty is considered.

Dynamic adaptation of maize and wheat production to climate change

Agriculture represents the main source of livelihood for small scale farmers, and a significant fraction of the gross domestic product in the case of intensive commercial agriculture. Because crop performance at the end of a growing season is strongly linked to the observed meteorological conditions, agricultural systems have been one of the main subjects of analysis to understand the impacts of both climatic variability and climatic change. As climate scientists make progress understanding the key elements of the atmosphere and provide with better projections of climate change scenarios, more effort is devoted to impact assessment and the evaluation of adaptation strategies to reduce vulnerability of crops and farmers. The objective of this work was to document the impacts of climate change on maize and wheat yields in Chile as well as to describe the dynamics of adaptation (i.e. changes in management decisions over time) that will take place, considering that farmers can “learn” from previous crop yield outcomes. Yield outcomes were obtained using a crop simulation model run under climate change scenarios based on HadCM3 projections. A simple decision model for a risk neutral farmer was used to investigate changes in optimum management decisions over time. Maize showed yield reductions in the order of 5% to 10%. Under irrigation, the best alternative for adaptation corresponded to adjustments in sowing dates. In the case of winter wheat significant yield reductions were observed for the no adaptation case. Because this crop showed positive responses to the increase of carbon dioxide, adaptation strategies were very effective counterbalancing the impacts of a warmer and drier environment. Dynamic adaptation was referred here to the introduction of small adjustments in management based on previous observed changes in productivity. This type of adaptation strategy outperformed prescriptive decisions based on historical or projected climate change scenarios, since it was sufficiently flexible to maintain near optimum economic performance over time, as climate varied from baseline to projected future conditions.

Is Gadolinium Necessary for MRI Follow-Up Evaluation of Cystic Lesions in the Pancreas? Preliminary Results

The purpose of our study was to determine whether gadolinium is necessary in the follow-up evaluation of pancreatic cystic lesions. Fifty-six patients with pancreatic cystic lesions detected on initial MRI and who underwent follow-up MRI were identified. Mean cyst size was 1.9 cm, and mean follow-up was 9.1 months. MRI included multiacquisition T1- and T2-weighted sequences before contrast administration and 3D fat-suppressed T1-weighted images before and after gadolinium administration. Two radiologists independently reviewed the entire initial examination and follow-up MRI using only unenhanced T1- and T2-weighted sequences from the second examination. Each radiologist made one of three recommendations: 1, no follow-up necessary or follow-up imaging in 6-12 months; 2, cyst aspiration; or 3, cyst resection. Four weeks later, imaging studies were reevaluated with the contrast-enhanced images from the second examination. A second recommendation using the same outcomes was made. Interobserver and intraobserver variations for the same patient were summarized in terms of kappa coefficients and the percentage of times the decisions were concordant. A 95% CI for the percentage of times management decisions would change without and with gadolinium was calculated. Concordance between the two different readers for the interpretations (when using the same MRI interpretation technique for follow-up surveillance) was 87.5% with a kappa coefficient to assess interobserver variation of 0.075, suggesting only slight agreement between the two readers. However, treatment recommendations provided by a single reader with and without information from the contrast-enhanced images were discordant only 4.5% of the time. Recommendations were concordant without and with gadolinium 95.5% (107/112; kappa=0.67) of the time, suggesting substantial agreement. A retrospective consensus review of the five cases in which gadolinium effected a change in the observer's recommendation was performed. There was nothing on the gadolinium-enhanced sequences that would specifically alter a change in a management decision, and it is likely that the changes in management decisions in these five cases were simply related to expected variations in categorizing lesions rather than to the use of gadolinium. The use of gadolinium has minimal impact in the follow-up MR assessment of pancreatic cystic lesions.