Decision-making Rationale Research Articles

Strength Training Among Male Master Cyclists—Practices, Challenges, and Rationales

Background: Cycling performance declines with age due to reduced aerobic capacity, along with reductions in muscle mass and bone density. Strength training can help counter these effects. This study aims to explore the strength training practices, challenges, and decision-making rationale of male master cyclists to optimize performance and health as they age. Methods: A total of 555 male master cyclists aged 35 and above completed an online questionnaire, distributed via social media platforms, that included Likert-type, single- and multiple-selection, and open-ended questions. Participants were then divided into two age groups: 35–49 years (n = 359) and ≥50 years (n = 196). Analyses involved descriptive statistics, Wilcoxon signed-rank tests, Mann–Whitney U-tests, and chi-square tests, with qualitative data analyzed using content analysis. Results: More cyclists engaged in strength training during the off-/pre-season, with a significant reduction in both frequency and the number of cyclists engaging in strength training during the race season. The strength training practice was focused mainly on core and lower body, employing hypertrophy and maximal strength training methods. Key challenges included fatigue induced by strength training and limited time to perform strength training. The main rationale for the strength training revolved around improving cycling performance, reducing injury risk, and the health benefits of strength training. Both age categories, but the older group in particular, reported bone health as a primary rationale for strength training. Conclusions: While strength training offers performance and health benefits, issues of fatigue and time constraints remain substantial, suggesting the need for tailored training programs to improve adherence and effectiveness.

Vasectomy provider decision-making balancing autonomy and non-maleficence: qualitative interviews with providers

Background Male sterilization, or vasectomy, is 99.9% effective at preventing pregnancy with less than a 2% risk of complications. Despite the high efficacy, low risk, low cost, and gender equity benefits of vasectomy, just 2% of women reported that they and their partners relied on vasectomy as their contraceptive method globally in 2019. Health care providers can be both a facilitator and a barrier in men’s health generally, and may be in vasectomy provision as well. This study sought to describe the decision-making rationales of experienced vasectomy providers when evaluating patient candidacy in complex cases. Methods Fifteen vasectomy providers belonging to the global Vasectomy Network Google Group from seven countries participated in online interviews using a semi-structured in-depth interview guide. Providers were asked about their vasectomy training, their reasons for vasectomy provision, challenging cases they have faced, and approaches used to manage challenging cases. Vignettes were used to further elicit decision-making rationale. Thematic analysis was conducted using MAXQDA20. Results Provider decision-making was predicated on ensuring patients were well-informed, able to consent, and certain about their choice to have a vasectomy. Once those foundational conditions were met, providers filtered patient characteristics through their training, laws and policies, sociocultural norms, experience, and peer influence to produce a cost-benefit breakdown. Based on the cost-benefit analysis, providers determined whether to weigh autonomy or non-maleficence more heavily when determining vasectomy patient candidacy. Conclusions Despite clinical best practices that promote prioritizing patient autonomy over non-maleficence, some providers continued to weigh non-maleficence over autonomy in vasectomy patient candidacy evaluations. Non-maleficence was particularly prioritized in cases providers deemed to be at higher risk of regret. The findings of this study suggest vasectomy provider training should emphasize evidence-based best practices in shared decision-making and patient-centered care to facilitate vasectomy provision that honors patient autonomy and rights.

A dynamic decision-making approach for cabin unlawful interference emergency disposal using dynamic Bayesian network

Disposal of unlawful interference incidents is essential for is crucial for the advancement of aviation security. Effective emergency disposal requires a comprehensive approach that includes the perspectives of airlines, airports, and passengers. In this context, each component of the disposal process can fail randomly. The objective of this research is to optimize emergency disposal decisions to enhance the efficiency of civil aviation operations, reduce accidents, and lower costs. Given the dynamic complexity of unlawful interference incidents, a dynamic fault tree consisting of 26 nodes was constructed to analyze the emergency disposal process. To explore the relationships and priorities of each event, the Dynamic Fault Tree is converted into a dynamic Bayesian network. Based on historical statistical data, simulation analysis is conducted in three aspects: posterior probability, sensitivity, and importance. Simulation results reveal that the top three critical nodes in cabin unlawful interference incidents are “structural damage to the cabin,” “inadequate training by airlines,” and “untimely airport police takeover of disruptive passengers.” Further analysis shows that (1) most of the critical nodes are associated with airlines. (2) The decision-making rationale and pathways of the critical nodes can be clearly observed and prioritized. (3) Besides airlines, other entities such as airports can implement targeted emergency disposal measures. Through quantitative analysis and simulation, this study provides decision-making guidance for participating groups on dynamic emergency disposal, thereby enhancing civil aviation security.

Abstract PO2-22-11: 'A sledgehammer to crack a nut' or 'the safer option'? Understanding decision making for and against oncoplastic breast conserving surgery as an alternative to mastectomy in women with early breast cancer: The UK ANTHEM study

Abstract Background: Oncoplastic breast conserving surgery (OPBCS) may allow women with breast cancer to avoid mastectomy, but many women continue to choose more extensive surgery even when breast conserving options are offered. Reasons for women’s procedure choices are unclear. The UK prospective multicentre ANTHEM study (ISRCTN18238549) aimed to explore the feasibility of undertaking a large-scale multicentre study comparing the clinical and patient-reported outcomes of OPBCS as an alternative to mastectomy in women offered both options. The qualitative phase of the study aimed to use semi-structured interviews to explore women’s perceptions of choice and to understand factors influencing decision making for and against OPBCS in early breast cancer. Methods: Women offered OPBCS as an alternative to mastectomy were eligible to participate in the ANTHEM study. Participants underwent their surgical procedure of choice and were followed up for 12 months. Semi-structured interviews were conducted with a purposive sample of women who elected to undergo either OPBCS or mastectomy with or without immediate breast reconstruction (IBR) at multiple UK centres to explore perceptions of choice, rationale for decision-making, and factors influencing procedure choice. Thematic analysis was used to explore the qualitative interview data. Sampling, data collection and analysis were undertaken concurrently and iteratively until data saturation was achieved. Results: Twenty-seven women from 12 UK breast units were interviewed. Of these, 12 elected to have OPBCS with volume displacement (n=7) or replacement procedures (n=5) and 15 chose mastectomy with (n=10) or without (n=5) IBR. Overwhelmingly, women’s decisions were guided by their surgical teams and their understanding and interpretation of the information they received from them. Indeed, although provision of choice was a pre-requisite for study entry, almost a third of women didn’t feel they had been offered meaningful choice as their surgeon recommended either OPBCS or mastectomy for them. Several women described how choice was unexpected as they had automatically assumed that they would need a mastectomy and expressed delight at being offered OPBCS as an alternative. Having choice and needing to make a decision about surgery, however, was a difficult experience for some women who reported finding the process challenging. Decision-making for and against OPBCS was underpinned by women’s perceptions of three key inter-related factors based on the information they received from their surgical teams: i) the effectiveness of OPBCS at removing all the cancer; ii) perceived longer term oncological safety and iii) practical issues. Almost all women described concerns about whether all the cancer would be removed by OPBCS, the need for further surgery for involved surgical margins and anxieties about cancer recurrence over time. Women who felt reassured that OPBCS was oncologically safe were happy to accept this option. Women who remained very anxious about incomplete excision and cancer recurrence were more likely to opt for mastectomy as a ‘safer’ option. Practical issues such as the perceived magnitude of the surgery and duration of the recovery were also important with many women choosing OPBCS as a less invasive or radical option than mastectomy. While many women described preferring to keep their breast and maintaining their femininity, only a minority of women referred to the cosmetic benefits of OPBCS as influencing their decision-making. Conclusions: Women’s decision-making for OPBCS vs mastectomy for breast cancer is complex and heavily influenced by the attitudes and beliefs of their surgical team. Adequate, high-quality, accurate information about surgical options including appropriate reassurance about the short- and long-term oncological safety of OPBCS is vital if women are to make fully informed decisions and feel confident avoiding mastectomy if this is an option for them. Citation Format: Charlotte Davies, Carmel Conefrey, Nicola Mills, Patricia Fairbrother, Chris Holcombe, Lisa Whisker, Joanna Skillman, Paul White, Douglas MacMillan, Charles Comins, William Hollingworth, Shelley Potter. 'A sledgehammer to crack a nut' or 'the safer option'? Understanding decision making for and against oncoplastic breast conserving surgery as an alternative to mastectomy in women with early breast cancer: The UK ANTHEM study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-22-11.

Bridging the Gap: Exploring Interpretability in Deep Learning Models for Brain Tumor Detection and Diagnosis from MRI Images

The advent of deep learning (DL) has revolutionized medical imaging, offering unprecedented avenues for accurate disease classification and diagnosis. DL models have shown remarkable promise for classifying brain tumors from Magnetic Resonance Imaging (MRI) scans. However, despite their impressive performance, the opaque nature of DL models poses challenges in understanding their decision-making mechanisms, particularly crucial in medical contexts where interpretability is essential. This paper explores the intersection of medical image analysis and DL interpretability, aiming to elucidate the decision-making rationale of DL models in brain tumor classification. Leveraging ten state-of-the-art DL frameworks with transfer learning, we conducted a comprehensive evaluation encompassing both classification accuracy and interpretability. These models underwent thorough training, testing, and fine-tuning, resulting in EfficientNetB0, DenseNet121, and Xception outperforming the other models. These top-performing models were examined using adaptive path-based techniques to understand the underlying decision-making mechanisms. Grad-CAM and Grad-CAM++ highlighted critical image regions where the models identified patterns and features associated with each class of the brain tumor. The regions where the models identified patterns and features correspond visually to the regions where the tumors are located in the images. This result shows that DL models learn important features and patterns in the regions where tumors are located for decision-making.

Autonomous Policy Explanations for Effective Human-Machine Teaming

Policy explanation, a process for describing the behavior of an autonomous system, plays a crucial role in effectively conveying an agent's decision-making rationale to human collaborators and is essential for safe real-world deployments. It becomes even more critical in effective human-robot teaming, where good communication allows teams to adapt and improvise successfully during uncertain situations by enabling value alignment within the teams. This thesis proposal focuses on improving human-machine teaming by developing novel human-centered explainable AI (xAI) techniques that empower autonomous agents to communicate their capabilities and limitations via multiple modalities, teach and influence human teammates' behavior as decision-support systems, and effectively build and manage trust in HRI systems.

Ethical Issues in Clinical Decision-Making about Involuntary Psychiatric Treatment: A Scoping Review.

In mental health and psychiatric care, the use of involuntary psychiatric treatment for people with mental disorders is still a central and contentious issue. The main objective of this scoping review was to map and systematize the literature on ethical issues in clinical decision-making about involuntary psychiatric treatment. Five databases (Embase, PsycINFO, CINAHL, Medline, and Scopus) were searched for articles on this topic. Out of a total of 342 articles found, 35 studies from 14 countries were included based on the selection criteria. The articles were analyzed using the inductive content analysis approach. The following main categories were identified: (1) ethical foundations that guide clinical decision-making; (2) criteria for involuntary psychiatric treatment; (3) gaps, barriers, and risks associated with involuntary psychiatric treatment; (4) strategies used to reduce, replace, and improve the negative impact of involuntary treatment; and (5) evidence-based recommendations. Most of the selected articles discuss the logic underlying involuntary treatment of the mentally ill, exploring ethical principles such as autonomy, beneficence, non-maleficence, or justice, as well as how these should be properly balanced. During the process of involuntary psychiatric admission, there was a notable absence of effective communication and a significant power imbalance that disenfranchised those seeking services. This disparity was further intensified by professionals who often use coercive measures without a clear decision-making rationale and by family members who strongly depend on hospital admission. Due to the pluralistic and polarized nature of opinions regarding legal capacity and the complexity and nuance of involuntary admission, further studies should be context-specific and based on co-production and participatory research.

Warning: Humans cannot reliably detect speech deepfakes.

Speech deepfakes are artificial voices generated by machine learning models. Previous literature has highlighted deepfakes as one of the biggest security threats arising from progress in artificial intelligence due to their potential for misuse. However, studies investigating human detection capabilities are limited. We presented genuine and deepfake audio to n = 529 individuals and asked them to identify the deepfakes. We ran our experiments in English and Mandarin to understand if language affects detection performance and decision-making rationale. We found that detection capability is unreliable. Listeners only correctly spotted the deepfakes 73% of the time, and there was no difference in detectability between the two languages. Increasing listener awareness by providing examples of speech deepfakes only improves results slightly. As speech synthesis algorithms improve and become more realistic, we can expect the detection task to become harder. The difficulty of detecting speech deepfakes confirms their potential for misuse and signals that defenses against this threat are needed.

Evidence-Based Medicine and Pharmacotherapy Content Alignment

ObjectiveWhen effectively executed, content alignment can aid student performance in associated courses. Limited research exists for content alignment of evidence-based medicine (EBM) and pharmacotherapy courses. This study assesses the impact of EBM and pharmacotherapy course alignment on student performance. MethodsContent alignment included assignment of 6 landmark trials in EBM coursework. The articles were identified by pharmacotherapy instructors as “landmark” to management of associated diseases in the aligned pharmacotherapy semester. Articles were the basis for quizzes over skills taught in the EBM course and were referenced during pharmacotherapy lectures. ResultsDuring the alignment semester, students were more likely to cite specific guidelines and/or primary literature to rationalize pharmacotherapeutic plans on examinations compared with the prealignment period (54% vs 34%). Overall, pharmacotherapy case performance and plan rationale scores were significantly higher in the alignment semester compared with prealignment. Student performance on the Assessing Competency in Evidence-Based Medicine tool improved from the start of the semester (8.64, SD 1.66) to the end (9.5, SD 1.49; mean score +0.86). Comfort in applying EBM analysis to primary literature increased significantly between the first and final assignments, with 6.7% and 71.7% of students self-reporting a high degree of confidence, respectively. Students (73%) reported an enhanced understanding of pharmacotherapy due to alignment compared with a previous semester of pharmacotherapy without alignment. ConclusionThe use of landmark trial assignments to align EBM and pharmacotherapy coursework demonstrated a positive impact on student rationale for clinical decision-making and student confidence in evaluating primary literature.

Dapatkah Siswa Sekolah Dasar Mengambil Keputusan terkait Perubahan iklim? Sebuah Penelitian Deskriptif

One of the reasons why climate change is a contentious socioscientific topic is the swift advancement of research and technology. Based on sound judgment, controlling climate change becomes an urgent matter. This study intends to gain an overview of the factual circumstances of elementary school pupils' decision-making skills with reference to the subject of combating climate change. Descriptive quantitative research methodology is employed. The test is a multiple-choice test with 10 questions that were created using criteria for rational decision-making. 612 pupils at ten public elementary schools in the city of Bandung took the test offline. Descriptive statistics were used to assess the data and categorize it in accordance with the rationale for decision-making. The study's findings show that judgments about climate change are difficult for elementary school pupils to make. Most of their decisions are made using intuitive principles. This study has implications for the significance of discussing climate change with elementary school pupils and having them practice making critical decisions.

Прийняття рішень із монетарної політики щодо ключової ставки в європейських країнах та їхній вплив на інфляцію

Introduction. For many years central banks around the world kept low rates. In 2021-2022 European countries experienced rising inflation in response to which the European Central Bank, as well as the central banks of countries with their own currencies, raised rates to the highest level in decades. At the same time, the effect of changes in accounting (key) rates turned out to be much weaker than expected. Problem Statement. The research is based on the popular hypothesis that the central bank will raise the key (accounting) rate as a tool to curb inflation. Purpose. To determine the correlation between inflation and the accounting (key) rate of the monetary policy body and approaches to the formation of the composition of bodies that make decisions on the accounting rate. Methods. Economic and statistical methods are used to assess the correlation and volatility of inflation rates and key rates of central banks, comparison, descriptive method, analysis, generalization and induction. Results. A comparative analysis of inflation dynamics in 2022–2023 in European countries and the key rate of central banks was carried out. Countries that are direct participants in the military conflict - Ukraine, Russia, and Belarus - should be considered separately, which is why they are excluded from the analysis. Particular attention is paid to the rationale and procedure for decision-making by monetary policy bodies on revising the key rate. Conclusions. In the euro area, under the conditions of a single policy regarding the key rate, a significant range of inflation rates among countries is allowed in the observation period of 2022-2023 in a wide range. The effect of reducing inflation comes in about 6 months after the key rate increase, however, the impact of non-monetary factors (fluctuations in world prices for oil, gas and grain) may be considered decisive in such a reduction. Accordingly, the discount rate increase has a greater effect not in terms of curbing inflation, but in the context of slowing economic growth. In the countries of the euro zone, inflation has increased and is returning to a moderate level, but the range of fluctuations of its inflation rates is very high. This contradicts the postulates of European market integration. Also, changes in inflation rates are very similar to the dynamics of global energy and food prices. In general, non-monetary factors of inflation remained the main ones, and the effectiveness of the key rate as a tool for reducing inflation in theory seems overestimated. In addition, a comparison of inflation rates and the level of the key rate in a sample of countries produces different ratios: in most countries, inflation exceeds the key rate many times over. Decisions about its level attract attention of market participants, and they are mostly expected (increase, preservation, decrease), but sometimes unexpected situations occur regarding the scale and direction of changes. The decision-making procedure and information disclosure are characterized by a high level of transparency and attention to the consequences and impact on the national economy. In the leading countries of the world, the decision on the level of the discount rate is always made by a collegial body, the composition of which is formed according to different approaches, despite the status of the central bank as independent from political influence.

The Identification of Seasonality in the Housing Market Using the X13-ARIMA-SEATS Model

Aim: In the conducted research, profiles of seasonality in the housing market were determined, which provided an opportunity to answer two fundamental questions: what is the nature of harmonic variation in the seasonality and periodicity of the studied components of the construction process? what parameters of the ARIMA model optimally describe the construction market? Methodology: In the conducted research, using the X13-ARIMA-SEATS model, seasonal decomposition was carried out in the various stages of the housing construction process. Results: The research process conducted to identify seasonal fluctuations in the housing construction market showed that harmonic fluctuation profiles can be identified on an annual basis. An analysis of seasonal fluctuations was carried out for each of the three stages of the housing construction process, while also checking how these profiles function for Poland in general, and for individual investors, and for those building apartments for sale or to rent. The study showed that the market for real estate development activity differs in its seasonal characteristics from that of individual investors. Implications and recommendations: The conclusions obtained from the research can provide support in the decision-making process, both from a macro and microeconomic perspective. Parameterisation of the occurring fluctuations, and taking them into account in the process of developing a forecast can provide decision-making rationale in the implementation of macroprudential and financial stability policies Originality/Value: A novelty is in the demonstration that the residential real estate market in Poland shows different seasonal parameters, divided into the market of individual investors and investors who build apartments for sale or rent.

Modeling the mechanical properties of recycled aggregate concrete using hybrid machine learning algorithms

To explore the complicated functional relationship between key parameters such as the recycled aggregate properties, mix proportion and compressive strength of recycled aggregate concrete (RAC), a complete database involving 607 records from relevant published literature was built. Two standard algorithms (artificial neural network (ANN) and support vector regression (SVR)) and two optimized hybrid models (Particle Swarm Optimization based SVR (PSO-SVR) and grey Wolf optimizer based SVR (GWO-SVR)) were adopted. Furthermore, two interpretable algorithms (Partial Dependence Plot (PDP) and SHapley Additive exPlanations (SHAP)) were utilized to assess the global and local approaches independent of machine learning models, contributing towards decision-making rationales. Results indicated that the coefficient of determination (R2) of ANN, SVR, PSO-SVR and GWO-SVR were 0.7569, 0.5914, 0.8995 and 0.9056 respectively, showing that hybrid models outperformed the conventional models. However, GWO-SVR was the most problematic with overfitting when analyzing its three subsets. The two feature importance analyses revealed cement content, water content, natural fine aggregates, and water absorption as significant characteristics that affect mechanical performance.

Business Process Outsourcing (BPO): Current and Future Trends

Business process outsourcing (BPO) is a widely popular way that companies are conducting business all around the world. Employing such techniques can have a dramatic effect on your bottom line, but also open you up to many more advantages that ultimately help your business function more efficiently. The purpose of this report is to critically review past literature on the topic to gain a better understanding of why businesses will choose to outsource processes. This report will also seek to provide greater insights into the effects outsourcing has on the company and also the host country being outsourced. We found that there is an overwhelming trend to outsource processes from Australia and that brings other benefits such as getting closer to new market opportunities. The main body of this report outlines when and why a company should choose to outsource and the decision-making rationale around such concepts. Research also indicated that there is a booming industry for companies that assist in aiding the outsourcing process and connecting you with partners in various host nations. This report discovered that there are also some ethical and moral obligations that need to be carefully considered as recent criticisms have damaged the reputations of some businesses. Overall, the implications of our research hovered around a few key findings, the cost benefits associated with outsourcing and the greater efficiencies and quality in tasks that can be utilized in partnering with the right host company.

"More is not always better": Park's sweet spot theory-driven implementation strategy for viable optimal safe nurse staffing policy in practice.

This paper aims to propose Park's sweet spot theory-driven implementation strategy, which makes optimal safe staffing policy really work in nursing practice. For the last 40 years, mainstream nursing workforce research has emphasized that having more registered nurses leads to better patient outcomes, and yet staffing policies have failed to implement this crucial concept. Meanwhile, global nursing shortages have become rampant, a problem that only dilutes the skill-mix ratios in the nursing workforce. Low fertility and an aging population worldwide are then accelerating these shortages. These dire circumstances may be persisting because of unclear, unsubstantiated cost-efficiency in the nursing workforce. For this reason, there remains a dearth of well-researched evidence for a clear threshold on optimal safe staffing levels that could maximize quality of care relative to cost given limited healthcare financial budgets and which could also be fitted into each care setting. Along with that, an implementation strategy for optimal safe staffing levels is nonexistent. An implementation strategy has been developed through interdisciplinary consilience-based theory synthesis of both prospective theory and regulatory focus theory combined with Park's optimized nursing staffing (sweet spot) estimation theory. A theory-driven novel implementation strategy is proposed, which functions as a nudge strategy that uses the synchronous balance of quality of care, nurse staffing, and cost. It illustrates (1) how to create shared value among patients, nurses, and stakeholders through robust evidence-based, informed shared decision-making rationales on the optimal safe nurse staffing levels and (2) how to induce stakeholders to overcome resistance to innovation and improve their nursing workforce through value chain in management science. This novel implementation strategy may be a viable solution to mitigate the nursing shortage by leading stakeholders (1) to compete with each other (on the basis of nursing sufficiency) and (2) to competitively demonstrate the patient-centered value (patient-perceived care quality relative to cost) of their institutions.

HPR39 Characterizing US Payer Coverage Policies and Associated Rationale When Those Policies Differ from the Institute for Clinical and Economic Review (ICER) Assessment Determinations

ICER’s “Assessment of Barriers to Fair Access” demonstrated that 96% of payers publish coverage policies that are concordant with ICER’s assessments (ICER, 2021). The authors reviewed US payer coverage policies and compared them to ICER assessments of FDA-approved health technologies to understand the decision-making rationale associated specifically with discordant payer policies. By focusing on policies that do not align with ICER’s recommendations, the authors will specify factors, such as clinical evidence, contracting or other, which drive coverage decisions beyond cost-effectiveness analyses.

A Survey of Clinicians Regarding Goals of Care for Patients with Severe Comorbid Illnesses Hospitalized for an Acute Deterioration.

BackgroundPatients with terminal illnesses hospitalized with acute deteriorations often suffer from unnecessary/inappropriate therapies at the end of their lives. Appropriate advance care planning (ACP) practices aligned to patients’ goals of care may mitigate this.Materials and methodsTo explore the rationale for clinical decision-making in hospitalized patients with terminal illnesses and formulate a practice pathway to streamline care. Between May and December 2018, a questionnaire survey with three case vignettes derived from intensive care unit (ICU) patients was emailed to ICU, respiratory and renal doctors, and nurses in two Sydney hospitals. Respondents chose various management options ranging from all active therapies to palliation. The primary outcome was the proportion of responses for each management option. With these and a thematic analysis of responses to identify barriers to ACP practice, a practice pathway was formulated.ResultsOf the 310 invited clinicians, 178 responded (57.4%). About 89.2% of respondents reported caring for dying patients frequently. Sixty percent saw patients suffering from prolonged therapies. Most respondents deemed patients in the case vignettes to be terminally ill, warranting ACP discussions. However, many still wanted to treat the acute deterioration with active ICU-level interventions. Most respondents reported being comfortable in having ACP discussions.ConclusionThe survey showed discordance between the stated opinions and the choice of management options for terminally ill patients with acute deteriorations; possibly due to the lack of a considered approach in choosing management options that align with medical consensus and the patient's/family's wishes, a practice pathway is suggested to improve management.How to cite this articleSarangi RK, Rajamani A, Lakshmanan R, Srinivasan S, Arvind H. A Survey of Clinicians Regarding Goals of Care for Patients with Severe Comorbid Illnesses Hospitalized for an Acute Deterioration. Indian J Crit Care Med 2022;26(4):457–463.

Ontologies representing multidisciplinary decision-making rationales for sustainable infrastructure developments

• Two ontologies are developed for multidisciplinary decision-making. • A tuple of 〈DMs〉, 〈DC〉, 〈DAs〉, and 〈SPIs〉 is proposed to represent MDM rationales. • They specify heterogeneous decision preferences in evaluating sustainability. • They are validated using case studies as formal, comprehensive, and reusable. • They serve as a decision support system for infrastructure professionals. A multidisciplinary decision-making (MDM) process is required for sustainable infrastructure developments in early design stage of integrated project delivery. Decision makers from multiple disciplines employ heterogeneous decision criteria when evaluating decision alternatives for the project developments. This results in uncertainty in alternative prioritization as the scoring ranges of sustainable performance indexes for those alternatives are indistinguishable. This study has formalized the rationales of decision coordinators for converting scores of sustainability performance indexes assessed by decision makers to the normalized ones based on their preferred decision criteria in a consistent and collective manner. Two ontologies have been formalized, which include 45 classes, 119 properties, 50 sub-properties and their facets. The ontologies are validated using three cases of sustainable infrastructure developments. Validation results indicate that they are formal, comprehensive, and reusable in representing MDM rationales, i.e., the interrelationships among decision makers, decision criteria, decision alternatives, and sustainability performance index. Theoretically, these two ontologies contribute to the Triple Bottom Line theory and social choice theory by specifying heterogeneous decision preferences in evaluating sustainable infrastructure developments. For practical implications, the developed ontologies serve as a computer-readable decision support tool to systematically store and communicate MDM information between multidisciplinary professionals in infrastructure project management.

The Outcomes of Percutaneous RevascularizaTIon for Management of SUrgically Ineligible Patients With Multivessel or Left Main Coronary Artery Disease (OPTIMUM) Registry: Rationale and Design

BackgroundGuidelines endorse coronary artery bypass as the preferred revascularization strategy for patients with left main and/or multivessel coronary artery disease (CAD). However, many patients are deemed excessively high risk for surgery after Heart Team evaluation. No prospective studies have examined contemporary treatment patterns, rationale for surgical decision-making, completeness of revascularization with percutaneous coronary intervention (PCI), and outcomes in this high-risk population with advanced CAD. MethodsWe designed the Outcomes of Percutaneous RevascularizaTIon for Management of SUrgically Ineligible Patients with Multivessel or Left Main Coronary Artery Disease (OPTIMUM) registry, a prospective, multicenter study of patients with “surgical anatomy” determined to be at prohibitive risk for bypass surgery. The primary outcome is comparison of observed to predicted 30-day mortality, with secondary outcomes of patient-reported health status and the association between completeness of revascularization and clinical outcomes. Patient characteristics driving surgical risk determinations will be reported, and peri-operative risk will be assessed using validated scoring methods. Angiograms will be assessed by an independent core laboratory, and clinical events will be adjudicated. ResultsClinical outcomes assessments will include 30-day and 1-year cardiovascular events, health status at 1, 6 and 12-months, and 5-year mortality. ConclusionsOPTIMUM is the first prospective, multicenter study to examine treatment strategies and outcomes among multivessel CAD patients deemed ineligible for surgical revascularization after Heart Team assessment. This registry will provide unique insights into the clinical decision-making, revascularization practices, safety, effectiveness, and health status outcomes in this high-risk population.

Black–white racial disparities in COVID-19: Awareness and framing of decision-making rationales.

Black–White racial disparities in COVID-19 have received much media attention. Yet the degree to which laypeople are aware of these disparities and support equitable ventilator allocation remains unclear. This mixed methods study investigated laypeople’s awareness and the rationales they provided for ventilator allocation. Adults from the United States (N = 249) participated in the study in April 2020. They selected between photos of two people in four comparisons, indicating who they believed was more likely to be affected by COVID-19, to whom they would allocate a ventilator, and their rationale for allocation. Black individuals were more frequently rated as affected by COVID-19 and selected to receive a ventilator. Participants who selected the Black individual to receive a ventilator cited COVID-19 statistics and structural-level need, while participants who selected the White individual cited physical appearance (weight and age) as their rationale. Public support for equitable COVID-19 health policies (e.g., finances for production of ventilators, lock-down and mask-wearing policies) can potentially be harnessed by underscoring differential rates of infection, hospitalization, death, and highlighting structural need. (PsycInfo Database Record (c) 2021 APA, all rights reserved) © 2021 American Psychological Association