Comprehensive Decision Support Tool Research Articles

Developing an interprofessional decision support tool for diabetic foot ulcers management in primary care within the family medicine group model: a Delphi study in Canada

BackgroundPrimary care professionals encounter difficulties coordinating the continuum of care between primary care providers and second-line specialists and adhere to practice guidelines pertaining to diabetic foot ulcers management. Family medicine groups are providing primary care services aimed to improve access, interdisciplinary care, coordination and quality of health services, and reduce emergency department visits. Most professionals working in family medicine groups are primary care physicians and registered nurses. The aim of this study was to develop and validate an interprofessional decision support tool to guide the management of diabetic foot ulcers for primary care professionals working within the family medicine group model.MethodsA one-page decision tool developed by the research team was validated by an expert panel using a three-round Delphi protocol held between December 2019 and August 2021. The tool includes 43 individual actions and a care pathway from initial presentation to secondary prevention. Data collection was realized with both paper and electronic questionnaires, and answers were compiled in an electronic spreadsheet. Data was analyzed with use of descriptive statistics, and consensus for each item was defined as ≥ 80% agreement.ResultsExperts from 12 pre-identified professions of the diabetic foot ulcer interdisciplinary care team were included, 39 participants out of the 59 invited to first round (66.1%), 34 out of 39 for second (87.2%) and 22 out of 34 for third (64.7%) rounds. All items included in the final version of the decision support tool reached consensus and were deemed clear, relevant and feasible. One or more professionals were identified to be responsible for every action to be taken.ConclusionsThis study provided a comprehensive decision support tool to guide primary care professionals in the management of diabetic foot ulcers. Implementation and evaluation in the clinical setting will need to be undertaken in the future.

Assessment of Impacts and Sustainable Practices in Sediment Management via the Verbois Dam

This research thoroughly investigates the multifaceted challenges of sediment management at the Verbois Dam, a project that intersects technical, financial, social, and environmental dimensions. Recognizing the intricate nature of this task, the Services Industriels de Geneve (SIG) adopted a holistic approach that transcends traditional hydraulic methodologies. The primary aim was to develop a comprehensive decision support tool that encompasses two integral components: an analysis grid for assessing effects and a grid for evaluating durability. These elements work in tandem to facilitate a detailed scrutiny and assessment of current sediment evacuation tactics. Additionally, the tool’s adaptable architecture permits the exploration and refinement of novel management strategies. The findings of this study endeavor to make a substantial contribution to the sustainable handling of sediment in dam operations, effectively marrying technical efficacy with wider environmental and social considerations.

Development of comprehensive decision support tools in distance learning quality management processes

The object of this study is the quality of distance learning. The need for procedures to assess the quality of this form of education was manifested most clearly in connection with the COVID-19 pandemic, wars, and other global problems, which predetermine the relevance of the study. The study considers the construction of a decision support model for assessing the quality of distance learning. Underlying the method is a combination of the method of expert assessments and the criterion model of data analysis, the basic method for analyzing the data obtained is the method of hierarchy analysis. Structural and functional schemes of the quality management system for distance learning are proposed. During the study, 10 criteria and 52 indicators were selected, and the weight of each indicator was calculated. Based on the weight values obtained, a scheme of the criteria model of decision support was built to assess the quality of distance learning. During the expert evaluation of the criteria and indicators, it was determined that the weight of indicators within the criterion ranges from 0.09953 to 0.34262. Such a difference in weight values indicates the optimality of the set of indicators within the criterion. Due to the combination of a criteria-based approach to data analysis in combination with the method of expert assessments, the model can be easily adapted for a point assessment of individual components and finding problem areas in the implementation of distance learning and management decision-making. The results of the study reported here may be of interest to both heads of educational institutions and employees of services involved in processing information about the organization and reporting for strategic decision-making.

A systematic conservation planning approach to maintaining ecosystem service provision in working landscapes

Balancing human well-being with the maintenance of ecosystem services (ES) for future generations has become one of the central sustainability challenges of the 21st century. In working landscapes, past and ongoing production-centered objectives have resulted in the conversion of ecosystems into simple land-use types, which has also altered the provision of most ES. These inevitable trade-offs between the efficient production of individual provisioning ES and the maintenance of regulating and cultural ES call for the development of a land-use strategy based on the multifunctional use of the landscape. Due to the heterogeneous nature of working landscapes, both protection and restoration actions are needed to improve their multifunctionality. Systematic conservation planning (SCP) offers a decision support framework that can support landscape multifunctionality by indicating where ES management efforts should be implemented. We describe an approach that we developed to include ES provision protection and restoration objectives in SCP with the goal of providing ongoing benefits to society. We explain the general framework of this approach and discuss concepts, challenges, innovations, and prospects for the further development of a comprehensive decision support tool. We illustrate our approach with two case studies implemented in the pan-Canadian project ResNet.

A Decision Support Tool for the Optimal Monitoring of the Microclimate Environments of Connected Smart Greenhouses

In this paper, a comprehensive decision support tool based advanced monitoring system is developed to support transition to smart greenhouses for sustainable and clean food production. The decision framework aims to optimally control and manage the microclimate environments of smart connected greenhouses, where each greenhouse is defined as a self-water producing through an enhanced water desalination process. The main advantage of the current approach lies in the ability of the greenhouses to produce their water loads locally. This paper aims to develop an efficient decision tool able of performing specific monitoring and control functionalities to optimize the operation of the greenhouses where the aim is the energy and water savings. A decision model is implemented for the precise regulation and control of the indoor microclimate defining the optimal growth conditions for the crops. Furthermore, a predictive algorithm is developed to simulate in real time the operation of the greenhouses under various conditions, to assess the response of the system to storage dynamics and renewable sources, as well to control the complex indoor microclimate, energy and water flows, as well to optimize the crops growth. The developed tool is tested through a case study where the influences of climate data on the operation of the whole network are analyzed via numerical results.

Development of a comprehensive decision support tool for strategic and tactical planning of a sustainable bioethanol supply chain: Real case study, discussions and policy implications

Abstract The demand for bioethanol has increased owing to the growing environmental and social concerns. Designing an efficient Bioethanol Supply Chain (BSC) is a precondition for commercializing the bioethanol production. In this regard, this paper proposes a comprehensive Decision Support Tool (DST) integrating Artificial Neural Network (ANN), mathematical modeling, and solution approach to carefully design and optimize a sustainable second-generation BSC while considering economic, environmental, and social aspects. A multi-objective mixed-integer linear programming model is developed for the strategic and tactical design of BSC in which the bioethanol demand is predicted using an ANN model. To solve the proposed multi-objective model, a hybrid approach based on Best-Worst Method (BWM) and Torabi-Hassini (TH) approach is proposed to find the most preferred solution regarding the decision maker’s preference towards the objective functions. The applicability of the proposed DST is demonstrated through assessing the impact of two alternative BSC expansion policies on a real case study in Iran. The results demonstrate that adapting an appropriate ethanol distribution policy over a planning horizon could result in a 33% reduction in total costs. Moreover, it is suggested that a 10% increase in the total costs can be beneficial from environmental and social perspectives.

Agronomic Basis and Strategies for Precision Water Management: A Review

Agriculture faces the challenge of feeding a growing population with limited or depleting fresh water resources. Advances in irrigation systems and technologies allow site-specific application of irrigation water within the field to improve water use efficiency or reduce water usage for sustainable crop production, especially in arid and semi-arid regions. This paper discusses recent development of variable-rate irrigation (VRI) technologies, data and information for VRI application, and impacts of VRI, including profitability using this technology, with a focus on agronomic factors in precision water management. The development in sprinkler systems enabled irrigation application with greater precision at the scale of individual nozzle control. Further research is required to evaluate VRI prescription maps integrating different soil and crop characteristics in different environments. On-farm trials and whole-field studies are needed to provide support information for practical VRI applications. Future research also needs to address the adjustment of the spatial distribution of prescription zones in response to temporal variability in soil water status and crop growing conditions, which can be evaluated by incorporating remote and proximal sensing data. Comprehensive decision support tools are required to help the user decide where to apply how much irrigation water at different crop growth stages to optimize water use and crop production based on the regional climate conditions and cropping systems.

Selection and integration of environmental impacts in the Danish transport infrastructure assessment process

ABSTRACTTransport projects have numerous consequences for the environment, society and economy, and thus an EU Directive has stated a number of impacts that need to be assessed prior to any major intervention. This paper is set in a Danish context where the EU requirements have been adopted in the Environmental Impact Assessment (EIA) regulation along with national requirements. In recent years, however, the EIAs have been criticised for an inconsistent inclusion of impacts and unclear assessment process. A selection of EIAs is for this reason reviewed and compared to the EU Directive and corresponding works in Sweden and the UK to identify potential opportunities for improvements. From the literature study, an overview table with all potential relevant impacts for transport projects is set up to assist the EIA process. For the sake of simplicity and transparency, the impacts selected from this table should, however, be further reduced in number to ensure that only the most important impacts are included in the process. To further increase simplicity and transparency in the EIA process, a novel framework for assessing different types of impacts is proposed. In this framework, a comprehensive decision support tool involving stakeholders is in focus. The framework is supplemented with a procedure for generating objectives and presenting results in an appropriate way to the many stakeholders involved. The impacts overview table and the assessment techniques are applied to a case study to illustrate the process, and finally, conclusions and perspectives for future work within the field are set out.

An Integrated Framework to Evaluate Resilient-Sustainable Urban Drainage Management Plans Using a Combined-adaptive MCDM Technique

Due to the inevitability of urban flood in presence of the rainfalls exceeding design capacity of urban drainage system, resilience approach has been recently considered instead of the conventional urban drainage management. However, acceptance of resilience approach necessitates considering sustainability in the selection of urban drainage projects due to the various aspect of flood impacts. This paper presents a new integrated framework to show how urban drainage plans are resilient and sustainable. The framework consists of several indicators including technical, economic, social, environmental and planning aspects. On the other hand, the selection of suientropy of the probability distribution p i . In fact, entropy reduces the effect of plan among available suggested plans is complicated in presence of multiplicity of the indicators. A new combined-adaptive multi criteria decision making technique including combination of Adaptive analytical hierarchical process, Entropy and TOPSIS is here introduced to facilitate the decision making process as well as dealing with uncertainties due to the subjective experts’ preferences. Moreover, presented framework are applied on a part of urban drainage system of Tehran, Capital City. Four urban drainage plans are designed and suggested to be evaluated along with existing system in terms of their sustainability and resilience. The results shows the presented framework provide comprehensive information regarding the behavior of the urban drainage plans against urban floods as well as their sustainability for urban managers. In addition, presented framework facilitates and accelerate the complicated process of decision making. Therefore, it can be employed as comprehensive decision support tool for resilient and sustainable urban drainage management.

ETank and contemporary online tools for rainwater tank outcomes analysis

This paper presents development of a comprehensive decision support tool (eTank) to analyse and optimise a rainwater tank size. The developed tool enables a simple quantitative analysis of the expected water that can be saved based on daily water balance concept. The tool produces graphs showing cumulative yearly rainwater used, overflow and augmented townwater supply. To account for climate variability, provision has been made in the tool to analyse for a particular option in three different climatic conditions (dry, average and wet). Also, the tool enables a life cycle costing and payback period analysis of any particular tank size through the simulated expected water savings per year, initial construction costs and operational. The outcomes of eTank are compared with other contemporary online tools in regards to rainwater savings. It is revealed that most of the tools overestimate the potential savings due to not considering several influencing factors.

PHP344 - Creating Useful and Comprehensive Decision Support Tools for Selecting and Designing Managed Entry Agreements

This work created a framework and tools to support decision making about managed entry agreement (MEA) strategy and design. Only scarce guidance exists in this area, and it tends to be mainly theoretical or narrowly scoped. This research aimed for an output that is 1) comprehensive and flexible enough to address a wide range of situations, 2) internally and externally valid and 3) practical and user friendly. Initial concepts/principles were built based on literature review and own experience of MEAs, and tools were created. These were then refined and validated through multiple rounds of discussions and testing with a varied range of pharma industry stakeholders and payers from countries worldwide. Feedback from the stakeholders validated a suite of tools, anchored in a conceptual framework, to 1) conduct a strategic analysis and decide whether an MEA approach is needed and for what reasons, 2) what specific MEAs are most appropriate given the product situation and country (national/local) and 3) assess the financial impact of the selected MEA solutions. Main principles for MEA selection/analysis and insight from the primary research will be presented. Practical tools and guidance to support decision making and business cases are very much needed in the area of MEAs, and will benefit to both industry and payers.

A comprehensive techno-economic analysis tool to validate long-term viability of emerging biorefining processes

As recent research continues to explore possibilities for developing renewable biofuels, there arises a need for a supporting framework that can guide the research along a path that will lead to long-term techno-economic viability. Processing of biomass into various marketable products requires a well-planned strategy from an investment, agriculture, management, and policy-making perspective. This novel techno-economic analysis tool encompasses multiple process and supply chain models into a comprehensive decision support tool. Incorporation of detailed upstream and downstream processes not only gives an opportunity to accommodate fundamental research, but also allows for the incorporation of the effects of future uncertainties. This claim is further validated by performing a case study on a biological process to convert locally available corn stover to ethanol. The results obtained show that unique integration of process simulation, supply chain optimization, and discrete event simulation can be used to validate the long-term economic viability of a biorefining process. Analysis demonstrates that the developed decision support tool can be applied to estimate long-term economic and environmental viability of potential biorefining processes in any given region of interest.

LID-BMPs planning for urban runoff control and the case study in China

Low Impact Development Best Management Practices (LID-BMPs) have in recent years received much recognition as cost-effective measures for mitigating urban runoff impacts. In the present paper, a procedure for LID-BMPs planning and analysis using a comprehensive decision support tool was proposed. A case study was conducted to the planning of an LID-BMPs implementation effort at a college campus in Foshan, Guangdong Province, China. By examining information obtained, potential LID-BMPs were first selected. SUSTAIN was then used to analyze four runoff control scenarios, namely: pre-development scenario; basic scenario (existing campus development plan without BMP control); Scenario 1 (least-cost BMPs implementation); and, Scenario 2 (maximized BMPs performance). A sensitivity analysis was also performed to assess the impact of the hydrologic and water quality parameters. The optimal solution for each of the two LID-BMPs scenarios was obtained by using the non-dominated sorting genetic algorithm-II (NSGA-II). Finally, the cost-effectiveness of the LID-BMPs implementation scenarios was examined by determining the incremental cost for a unit improvement of control.

Analysis of storage volume and reliability of the rainwater harvesting tanks in the coastal area of Bangladesh

AbstractThe annual average rainfall in the coastal area of Bangladesh is more than 2,400 mm and rainwater harvesting (RWH) has been practiced for a long time for drinking water supply. For household RWH, the capacity of the storage tanks varies from 1,000 to 5,000 litres, which are the model-type storage tanks provided under several RWH programs of government and NGOs. The optimum storage tank volume has not been investigated considering family size and demand, roof types and rainfall. As a result, most of the households can avail water from rainwater tanks for about six months and rest of the year, they have to depend on other unreliable and distance sources. With the aim of developing a comprehensive decision support tool for a reliable RWH system, design curves for the storage volume were developed for three climatic conditions (i.e. dry, average, and wet years), available roof catchment area (10–50 m2), rainfall loss factor and household demand (2–12 lpcd) for a typical six members family using mass c...

Energy models from a strategic environmental assessment perspective in an EU context—What is missing concerning renewables?

Climate change and security of energy supply are main sustainability issues today and an energy systems shift towards renewable energy sources is therefore urgent. However, unless environmental impacts of such a shift are carefully taken into account, imposed resource and land use changes may counteract other sustainability goals, such as preserving biodiversity and ecosystem services. Strategic Environmental Assessment (SEA) provides a comprehensive framework for assessment of policies and plans where a full range of environmental issues are addressed. The aim of this article was to find possibilities for comprehensive sustainability assessment among published energy–environment models and the linking of renewable energy analysis to landscape and biodiversity issues through land use concerns. Based on the review of relevant energy, environmental and linking models, a survey on publications and a case study on the EU Energy Roadmap 2050, the results show that existing energy models and research have low concerns on land use, landscapes and biodiversity. Consequently, it would be difficult to provide comprehensive decision support by using only these tools. However, suitable energy models, ecological assessment models and multi-criteria approaches exist with great potential for inter-linking. The development of energy models could thus have new orientations, connecting them to involve renewable energy options with land use, landscape and biodiversity concerns, which could be advanced into powerful SEA tools for integrated policy assessment. This will enable the development of more comprehensive decision support tools for assessing future energy scenarios, integrating main policy concerns when assessing renewable energy options.

Flexible management of repetitive construction processes by an intelligent support system

Constant advances in construction planning and site management are crucial to improving construction productivity. This paper presents an intelligent system MoCCAS (a monolithic construction computer aided system), which is a comprehensive decision support tool for flexible construction site management in repetitive projects. MoCCAS aids the construction site manager in developing optimal and attainable execution scenarios by providing contextualized variants of construction strategies. The discussion is centered on the modeling procedures of repetitive processes with the special focus on the synchronization of resources and workflow continuity, which is crucial in scheduling and managing repetitive projects. The paper introduces an innovative conceptualization of the construction process and presents a dynamic three-dimensional construction process model in a temporal perspective. How the system synchronizes the work of resources combined into a balanced production sets and also supports the decision maker in creating what-if scenarios in designing execution strategies is discussed.

Reliability analysis of rainwater tanks in Melbourne using daily water balance model

With the aim of developing a comprehensive decision support tool for the performance analysis and design of rainwater tanks, a simple spreadsheet based daily water balance model was developed using daily rainfall data, contributing roof area, rainfall loss factor, available storage volume, tank overflow and rainwater demand. In order to assess reliability of domestic rainwater tanks in augmenting partial household water demand in Melbourne (Australia) area, the developed water balance model was used for three different climatic conditions (i.e. dry, average, and wet years). Historical daily rainfall data was collected from a rainfall station near Melbourne city central. From historical rainfall data three representative years (driest, average and wettest) were selected for the current analysis. Reliability is defined as percentage of days in a year when rainwater tank was able to supply the intended partial demand for a particular condition. For the three climatic conditions, several reliability charts are presented for domestic rainwater tanks in relations to tank volume, roof area, number of people in a house (i.e. water demand) and percentage of total water demand to be satisfied by harvested rainwater. In brief, for a two-people household scenario, ∼100% reliability can be achieved with a roof size of 150–300 m 2 having a tank size of 5000–10,000 L. However, for a four-people household scenario, it is not possible to achieve a 100% reliability, even with a roof size of 300 m 2 and a tank size of 10,000 L.

Optimisation of rainwater tank design from large roofs: A case study in Melbourne, Australia

Rainwater tanks for larger roof areas need optimisation of tank size, which is often not carried out before installation of these tanks. This paper presents a case study of rainwater tank evaluation and design for large roof areas, located in Melbourne, Australia, based on observed daily rainfall data representing three different climatic regimes (i.e. dry average, and wet years). With the aim of developing a comprehensive Decision Support Tool for the performance analysis and design of rainwater tanks, a simple spreadsheet based daily water balance model is developed using daily rainfall data, contributing roof area, rainfall loss factor, available storage volume, tank overflow and irrigation water demand. In this case study, two (185 m 3 and 110 m 3) underground rainwater tanks are considered. Using the developed model, effectiveness of each tank under different climatic scenarios are assessed. The analysis shows that both the tanks are quite effective in wet and average years, however less effective in dry years. A payback period analysis of the tanks is preformed which reveals that the total construction cost of the tanks can be recovered within 15–21 years time depending on tank size, climatic conditions and future water price increase rates. For the tanks, a relationship between water price increase rates and payback periods is developed. The study highlights the need for detailed optimisation and financial analysis for large rainwater tanks to maximise the benefits.

Watershed Management Technique to Control Sediment Yield in Agriculturally Dominated Areas

Non-point source pollution is recognized internationally as a critical environmental problem. In Illinois, soil erosion from agricultural lands is the major source of such pollution. The erosion process, which has been accelerated by human activity, tends to reduce crop productivity and leads to subsequent problems from deposition on farmlands and in water bodies. Comprehensive watershed management, however, can be used to protect these natural resources. In this study, a discrete time optimal control methodology and computational model are developed for determining land use and management alternatives that minimize sediment yield from agriculturally-dominated watersheds. The solution methodology is based on an interface between a genetic algorithm and the U.S. Department of Agriculture's Soil and Water Assessment Tool. Model analyses are performed on a farm field basis to allow capture of different, local stakeholder perspectives, and crop management alternatives are based on a three-year rotation pattern. The decision support tool is applied to the Big Creek watershed located in the Cache River basin of Southern Illinois. The application demonstrates that the methodology is a valuable tool in advancing comprehensive watershed management. The study represents part of an ongoing research effort to develop an even more comprehensive decision support tool that uses multi-criteria evaluation to address social, economic, and hydrologic issues for integrative watershed management.

Total productivity management

In June 1989, Georgetown University Hospital (GUH) implemented an internally developed, Model 204 DBMS-based comprehensive Decision Support tool, the Financial Performance Report (FPR). FPR was designed to bring order out of management reporting chaos by integrating labor productivity reporting and cost accounting in a progressively detailed display that provides the basis for “Total Productivity Management”. This paper will describe the philosophy that lead to developing the tool, the objectives, the system components, and the principal features of the report.