Key Decisions Research Articles

Key Decision Making and Technical Aspects of Performing Transoral Incisionless Fundoplication

There are a wide variety of surgical therapeutic options for GERD—ranging from laparoscopic fundoplication, magnetic sphincter augmentation, to advanced endoscopic interventions (eg, transoral incisionless fundoplication, TIF). TIF has emerged as the predominant endoscopic approach for GERD, supported by several randomized trials highlighting the efficacy of this procedure. Its safety profile has similarly been well established. The key to properly utilizing this procedure is patient selection. We here in describe the efficacy, highlight key decision making and technical aspects of performing a TIF, to discuss post-operative care and complications.

The «patient casting»: a key decision in orthognathic surgery

The surgical orthodontic patient is a patient whose management is specific. The success of this protocol goes beyond of the right indication and the control of the pre-surgical orthodontic preparation of the treatment. The coordination revolves around a multidisciplinary team, namely an orthodontist, a maxillofacial surgeon, a physiotherapist, a speech therapist, a general practitioner, etc. but also with the collaboration of a specialized psychotherapist. Does the ideal «patient» exist in orthognathic surgery? The decision criteria are morphological (occlusal, aesthetic and cephalometric) but also psychosocial. A new classification called «psychological» is proposed in this article. This new classification can be considered as a key decision in the «casting» of the surgical orthodontic patient and represents a first basis for further investigations in this field.

The Impact of Customer-Reported Cybersecurity Breaches on Key Supplier Innovations and Relationship Disruption

ABSTRACT Cybersecurity breaches (CBs) negatively influence the breached firms’ business functions, including their innovative investments. Recent research documents a spillover effect of CBs into supply chain firm performance. We extend this research and investigate the impact of customers’ CBs on suppliers’ innovative investments and the disruption of supplier-customer relationships. We find a significant negative association between customers’ reported CBs and suppliers’ innovative investments in the subsequent year. In addition, we find customer-reported CBs increase the likelihood of supplier-customer relationship disruption in the subsequent year. Our study contributes to the broader understanding of the negative impacts of CBs not only on the breached firm’s financial performance but also on key supplier innovation decisions. Data Availability: Data are available from the public sources cited in the text. JEL Classifications: L14; L29; M49; O30.

Robust Design of Electric Charging Infrastructure Locations under Travel Demand Uncertainty and Driving Range Heterogeneity

The rising demand for electric vehicles (EVs), motivated by their environmental benefits, is generating an increased need for EV charging infrastructure. Also, it has been recognized that the adequacy of such infrastructure helps promote EV use. Therefore, to facilitate EV adoption, governments seek guidance on continued investments in EV charging infrastructure development. Such investment decisions, which include EV charging station locations and capacities, and the timing of such investments require robust estimates of future travel demand and EV battery range constraints. This paper develops and implements a framework to establish an optimal schedule and locations for new charging stations and decommissioning gasoline refueling stations over a long-term planning horizon, considering the uncertainty in future travel demand forecasts and the driving range heterogeneity of EVs. A robust mathematical model is proposed to solve the problem by minimizing not only the worst-case total system travel cost but also the total penalty for unused capacities of charging stations. This study uses an adaptation of the cutting-plane method to solve the proposed model. Based on two key decision criteria (travelers’ cost and charging supply sufficiency), the results indicate that the robust scheme outperforms its deterministic counterpart.

The Evolving Nature of Health Technology Assessment: A Critical Appraisal of NICE’s New Methods Manual

ObjectivesThe National Institute for Health and Care Excellence (NICE) recently completed a review of its methods for health technology assessment, involving a 2-stage public consultation. We appraise proposed methodological changes and analyze key decisions. MethodsWe categorize all changes proposed in the first consultation as “critical,” “moderate” or “limited” updates, considering the importance of the topic and the degree of change or the level of reinforcement. Proposals were followed through the review process, for their inclusion, exclusion, or amendment in the second consultation and the new manual. ResultsThe end-of-life value modifier was replaced with a new “disease severity” modifier and other potential modifiers were rejected. The usefulness of a comprehensive evidence base was emphasized, clarifying when nonrandomized studies can be used, with further guidance on “real-world” evidence developed separately. A greater degree of uncertainty was accepted in circumstances when evidence generation raised challenges, in particular for children, rare diseases, and innovative technologies. For some topics, such as health inequality, discounting, unrelated healthcare costs, and value of information, significant changes were possibly warranted, but NICE decided not to make any revisions at present. ConclusionMost of the changes to NICE’s health technology assessment methods are appropriate and modest in impact. Nevertheless, some decisions were not well justified and further research is needed on several topics, including investigation of societal preferences. Ultimately, NICE’s role of protecting National Health Services resources for valuable interventions that can contribute toward improving overall population health must be safeguarded, without accepting weaker evidence.

Marriott’s Strategy to Survive an Economic Crisis: Invest and Reposition the Brand

As the Covid-19 pandemic subsides or becomes manageable, will travel return right back to pre-pandemic levels, or will hotel companies have to adapt to a new way of doing business? This case study looks at some of the key decisions made by Marriott International during the 2008 global financial crisis, with an eye on how this experience may inform business strategies to cope with possible pandemics that may affect the industry in the future. Rather than waiting for the tide to turn, Marriott decided to focus on investing and brand repositioning.

Dropout prediction and decision feedback supported by multi temporal sequences of learning behavior in MOOCs

The temporal sequence of learning behavior is multidimensional and continuous in MOOCs. On the one hand, it supports personalized learning methods, achieves flexible time and space. On the other hand, it also makes MOOCs produce a large number of dropouts and incomplete learning behaviors. Dropout prediction and decision feedback have become an important issue of MOOCs. This study carries out sufficient method design and decision analysis on the dropout trend. Based on a large number of learning behavior instances, we construct a multi behavior type association framework, design dropout prediction model to analyze the temporal sequence of learning behavior, then discuss the corresponding intervention measures, in order to provide adaptive monitoring mechanism for long-term tracking and short-term learning method selection, and enable adaptive decision feedback. the full experiment shows that the designed model might improve the performance of the dropout prediction, which achieves the reliability and feasibility. The whole research can provide key technical solution and decision, which has important theoretical and practical value for dropout research of MOOCs.

The role of rootstocks for grape growing adaptation to climate change. Meta-analysis of the research conducted in Spanish viticulture

Rootstock election is one of the key decisions when designing a vineyard. Although the research performed to determine the effect they induce in the behaviour of scion varieties is not scarce, it is not easy to have a global idea, as results are usually published scattered. In this work, we re-examine previous research conducted in Spain on rootstock implications on vine agronomic performance through the performance of a meta-analysis (MA). As a result, we were able to integrate the information reported in 20 articles that included rootstock experimentation conducted with 36 different varieties and 47 different rootstocks, totalling 764 individual records. However, when the information was filtered before the meta-analysis, this number decreased to 312 records, for which rootstock Response Ratios (RR) were calculated. The characteristics conferred by the rootstock were more closely related to the rootstock itself, rather than to the characteristics of the Vitis sp. crossing used to create the rootstock. Several rootstocks were identified as more suitable for adapting to future climate change conditions, as far as they were able to moderate sugar accumulation and pH (161-49 C, 41-B MGt and 420A MGt). Meanwhile, 140 Ru and 5-BB were observed to provide high pH and sugar contents despite their high yield. In conclusion, despite being based on data from a single country, the meta-analysis was shown to be a useful tool for enhancing the value of previous research on rootstocks. Combining articles from both peer-reviewed and technical journals helped in the assessment of the implications of different rootstocks, although further steps should be taken to facilitate data integration (harmonisation of measurement and reporting procedures, open data repositories, etc).

Institutional context, innovations, and energy transitions: Exploring solar photovoltaics with hydrogen storage at a secondary school in Norway

Public administrative action is crucial in facilitating sustainability transitions. Although organizational structures, cultures and established practices have been shown to lead to differing innovation results and technological diffusion at various levels of governance, little attention has been paid to the role of local government and administration in sustainable energy transitions. This study analyses renewable energy innovation at the local level of public administration in Norway. Drawing on the institutional and entrepreneurial literature, we examine the key formal decisions and organizational culture development that, combined with policy entrepreneurship, ultimately led to an unlikely and risky decision: to include a costly and unusual local energy system in the construction of a new secondary school. Tracing the administrative processes over 20 years, and drawing on document data supported by 14 interviews, we find that the strong and politically shielded administrative section, backed by a firm mandate and an established internal culture of innovation anchored in historic and local identity among the population and local industry, led to this decision. These factors were further facilitated by acts of policy entrepreneurship at crucial moments, shaping the underlying structures and institutional culture. The independence and strong direction of the administrative section can be emulated in other contexts in order to facilitate innovation. With suitable adaptations to other contexts, our findings may help to accelerate energy transitions through system innovations elsewhere.

ENHANCING QUALITY OF EDUCATION IN SURGERY: THE INTEGRATION OF INTERACTIVE TECHNOLOGIES

The goal of medical universities is to train highly qualified personnel who will be able to make a difference in the country's future development. One of the effective methods to achieve this is by introducing modern teaching methods and technologies that gradually update and improve the content, methods, tools, and pedagogical technologies used in the doctor’s training process, ultimately improving the quality of education. This approach is essential at all stages of training highly qualified specialists in academic disciplines at higher medical schools.
 Today, an important element of improving the quality of education is the active implementation of interactive learning technologies in higher educational institutions of Ukraine. These technologies aim to promote the individual formation of professional skills in students, optimize general erudition, stimulate the creative component of the student's personality, and develop cognitive processes such as perception, memory, attention, and imagination. They also cultivate intellectual skills such as analysis, comparison, identifying key information, critical thinking, and decision-making.
 At the Department of Surgery No. 1 of the Poltava State Medical University, a combination of traditional curriculum structure with interactive learning technologies has significantly improved students' success rate in assimilating educational material, promoted the formation of clinical thinking, and enhanced their professional skills and abilities. This approach requires a clear step-by-step implementation by teachers, with a focus on forecasting the results of the learning process, which enables faster and more effective achievement of learning goals.

Exploring how Professional Associations Influence Health System Transformation: The Case of Ontario Health Teams.

Health care system transformations that align with the principles of integrated care require the collaborative efforts of various macro-, meso- and micro-level stakeholders. Understanding the roles of various system actors can improve collaboration in ways that support purposeful health system change. Professional associations (PAs) have considerable influence, but little is known about the strategies they use to influence health system transformation. Using a qualitative descriptive approach, eight interviews with 11 senior level leaders from local PAs were conducted to learn about the strategies used to influence the province-wide reorganization of health care into Ontario Health Teams. During times of health system transformation, PAs balance: (1) supporting members, (2) negotiating with government, (3) collaborating with stakeholders, and (4) reflecting on their role. The enactment of these various functions demonstrates the strategic nature of PAs, and showcases their ability to evolve in ways that align with the dynamic nature of healthcare. PAs are highly connected groups, deeply engaged with their members and regularly engaged with other key stakeholders and decision-makers. PAs play a critical role in influencing health system transformations, by bringing forward practical solutions to government that reflect the needs of their members, often frontline clinicians. PAs strategically seek opportunities for collaboration with stakeholders that can amplify their message. Insights from this work could support health system leaders, policymakers, and researchers in leveraging the role of PAs in health system transformations via strategic collaboration.

Deprescribing and medicines optimisation, two sides of the same coin? Considerations for design of interventional studies.

Interventions to promote deprescribing are an important focus of research. Key decisions for such interventions are whether to target one or multiple medicines, and whether the intervention scope is deprescribing, or also extends to other aspects of medicines optimisation. This article reflects on how these decisions impact on developing interventions and measuring outcomes. Many behavioural strategies are common to deprescribing and medicines optimisation, however operationalisation may differ. Aspects to consider include the burden of multiple simple interventions versus one complex intervention, the extent to which the approach to deprescribing can be specified as part of the intervention, and variability in how the intervention is delivered across patients and providers. Outcomes should be selected based on the intervention target and scope and the audience for whom evidence is being produced. These may include medication changes, and process outcomes to assess intervention delivery. Targeting single medications may allow for a focus on specific clinical or symptom-related outcomes, but a broader perspective may be needed in a generalist setting in the context of multimorbidity and which also considers the patient's priorities. Cost-related outcomes are also important to inform implementation decisions, and modelling approaches may be more feasible for interventions targeting single medications.

The spillover effects of online tourism platforms on sustainable development

AbstractIn recent years, the proliferation of self‐established and third‐party online tourism platforms has impacted the visitor economy and social welfare sustainably. Tourism enterprises face the key decision of whether to join third‐party platforms or sell tourism services/products directly to consumers. Some researchers have addressed issues about online tourism platforms, but none analyse the internal mechanism and operational management, or the impact of the online tourism platform on sustainable economic growth and social welfare. To fill this gap, we establish an analytical model to explore the optimal tourism marketing and operational management of online tourism platforms for non‐profit tourist attractions and for‐profit tourism enterprises, which can help guide the decisions of managers. We construct a game‐theoretical model in which competing tourism attractions can choose only solo or dual online tourism platform promotion. When competition on a third‐party platform is intense, for‐profit tourism enterprises benefit from dual platforms. We further illustrate that with high competition, non‐profit tourist attractions provide higher social welfare when offering tourism products/services on both self‐established and third‐party tourism channels. However, with lower competition, third‐party tourism platforms harm social welfare if the tourism service/product quality is extremely high or low. Under a decentralised structure, we find that related tourism enterprises prefer to follow and collaborate with their tourist attractions' channel selection when competition in the third‐party platform is not fierce. This result indicates that a third‐party tourism platform improves the visitor economy and social welfare if the tourist attraction collaborates with its tourism‐related enterprises through the online tourism platform.

A hybrid DEMATEL-COPRAS method using interval-valued probabilistic linguistic term set for sustainable hydrogen fuel cell supplier of new energy vehicles.

With the continuous development of the global economy, global environmental pollution, climate degradation and global warming are becoming increasingly serious. In order to deal with the increasingly serious environmental problems, the government is vigorously supporting and promoting the development of new energy vehicles (NEVs). As the core unit of NEVs, one of the main challenges faced by hydrogen fuel cell (HFC) supplier is to select the best supplier for their business among all possible suppliers. Selecting the optimal supplier is a key decision in green supplier management. Therefore, it is extremely important and meaningful to select an optimal HFC supplier to provide power for NEVs. This paper proposes a new decision-making framework based on Decision-Making Trial and Evaluation Laboratory (DEMATEL) method and Complex proportional assessment (COPRAS) method under interval-valued probabilistic linguistic environment to select the appropriate HFC supplier of NEVs. Firstly, this paper establishes the evaluation criteria system of HFC supplier assessment which is the synthesis of economical, environmental, social, technical, organisation and service aspects. Then, in order to express the uncertainty of expert decision-making, this paper uses interval-valued probabilistic linguistic term set (IVPLTS) to describe the evaluation information. Next, the interval-valued probabilistic linguistic term set decision-making trial and evaluation laboratory (IVPLTS-DEMATEL) method is applied to calculate the criteria weights. Moreover, this paper constructs the interval-valued probabilistic linguistic term set Complex Proportional Assessment (IVPLTS-COPRAS) model for the selection of HFC supplier of NEVs. Finally, a case in China with sensitivity analysis and comparison analysis are executed to illustrate the feasibility and validity of the proposed approach. This paper provides valuable references for investors and companies to select the most appropriate HFC supplier of NEVs under uncertain environment.

A framework for salvaging megaprojects in Africa based on a case study of a refinery and petrochemical complex project

Navigating megaprojects to successful completion in low- and middle-income countries is fraught with challenges, often leading to numerous abandoned or underutilised projects. This study bridges a research gap by proposing a framework for salvaging distressed megaprojects using Integrated Project Delivery (IPD), derived from literature review, critical reflection, and expert consultation. The IPD framework offers strategies for immediate and sustained recovery of troubled megaprojects, including refining procurement strategies, restructuring organisational architecture, and leveraging IPD best practices. This research aids key decision-makers in understanding failure causes and equips them with strategies to salvage failing projects. It contributes to the global discourse on sustainable project management, aligning with UN's SDGs, specifically SDG 9, 8 and 17. The framework can also contribute to Africa Union's Agenda 2063, fostering infrastructure and economic development. This study provides an innovative solution to enhance the success rates of ongoing megaprojects, aligning with broader sustainable development objectives.

Optimal locations and sizes of layover charging stations for electric buses

Public transit agencies across the world are rapidly converting their bus fleets from diesel or hybrid powertrains to battery-electric propulsion systems. To realize the benefits of the transition to battery-electric buses (BEBs) while retaining acceptable quality of service and limiting capital costs, agencies must intelligently decide where to locate recharging infrastructure. While most agencies electrifying their fleets plan to install chargers at bases where buses are kept overnight, a question faced by many fleet operators is where to install layover chargers that provide additional energy while buses are in operation during the day. To address this challenge, this work presents a mixed-integer linear programming model, referred to as BEB-OCL (BEB Optimal Charger Location), that optimizes the tradeoff between upfront charging infrastructure costs and operational performance. The key decision variables include the locations at which to install chargers, the number of chargers installed at each chosen location, and the location, duration, and sequence of charger visits for each bus. We also introduce a second optimization model, referred to as BEB-BRP (BEB Block Revision Problem), that revises vehicle schedules by dispatching backup buses to serve some trips so that buses do not run out of battery and all passenger trips are still completed as scheduled. The models are applied to a case study of the highest-ridership bus routes in King County, WA, USA, where an electric bus deployment is currently underway.

Stakeholder-Informed Hydroclimate Scenario Modeling in the Lower Santa Cruz River Basin for Water Resource Management

The Lower Santa Cruz River Basin Study (LSCRB Study) is a collaborative effort of regional and statewide water management stakeholders working with the US Bureau of Reclamation under the auspices of the 2009 SECURE Water Act. The impacts of climate change, land use, and population growth on projected water supply in the LSCRB were evaluated to (1) identify projected water supply and demand imbalances and (2) develop adaptation strategies to proactively respond over the next 40 years. A multi-step hydroclimate modeling and risk assessment process was conducted to assess a range of futures in terms of temperature, precipitation, runoff, soil moisture, and evapotranspiration, with a particular focus on implications for ecosystem health. Key hydroclimate modeling process decisions were informed by ongoing multi-stakeholder engagement. To incorporate the region’s highly variable precipitation pattern, the study used a numerical “weather generator” to develop ensembles of precipitation and temperature time series for input to surface hydrology modeling efforts. Hydroclimate modeling outcomes consistently included increasing temperatures, and generated information related to precipitation responses (season length and timing, precipitation amount) considered useful for evaluating potential ecosystem impacts. A range of risks was identified using the hydroclimate modeling outputs that allowed for development of potential adaptation strategies.

METHODS OF FORMING PERCEPTUAL-COGNITIVE EXPERIENCE IN HIGHLY QUALIFIED FOOTBALL REFEREES

Annotation. Football referees must constantly keep up with the game to ensure the correct interpretation of game moments when making key decisions in the match. The perceptual-cognitive demands of soccer refereeing are considerable, but research the repceptual and cognitive processes that influence referee decisions remains limited. In this regards, we present a study of methodological considerations, regarding the application of referee’s perceptual-cognitive experience in decision-making, as well as relationship of this experience with their motor activities during the match.

The importance of STEM

Engineering is the foundation of the infrastructure, resources, products, systems and services that serve our community. As technology advances there is high demand for science, technology, engineering and mathematics (STEM) skills to keep up with the requirements of every industry. However, the statistics and research imply that supply will not meet demand in the very near future, and, in Australia less than 15% of STEM graduates are female. Taking into consideration the industry in which we operate and Clough’s strategic priorities and ESG (environmental, social and governance) framework, we recognised the need to support STEM and to spark curiosity in these subjects during high school years when students are making the key decision about what profession they will pursue. Clough also recognised that it required collaboration between schools, universities and industry. In 2021, Clough developed a program that included: a pipeline of touch points to ensure STEM careers and industry opportunities were presented as early as Year 7; a partnership with a local university to work with girls in Year 11, targeting senior secondary students studying prerequisite mathematics to offer them exposure to engineering activities, role models and career opportunities; a partnership with Engineers Australia; Open Days at our offices for school students in Years 10–12 to provide them with an opportunity to experience engineering as a career; a revamp of Clough’s Scholarship program to support students during their first years of university; and an internship program for STEM-related functions from the first year of university.

How Endogenous System Bias Can Distort Decision-Making in Criminal Justice Systems

Most judicial, regulatory, and administrative systems, at least formally, are concerned with the fairness and transparency of their decisions concerning the public. Fairness and transparency of criminal justice operations are critical to creating trust in the legal system and assuring people that the larger social system is legitimate and worthy of support. However, deviations from objective and fair decision-making can be concealed when key actors who are responsible for deciding outcomes in their organizations are also responsible for collecting, assembling, evaluating, and presenting the information on which their decisions are based. Under these conditions such systems are at risk of what we term “endogenous system bias,” where data are acquired and altered in ways to justify desired outcomes that are neither fair nor transparent. The purpose of this paper is to: (1) develop a general model of decision-making constraints that can produce endogenous system bias, (2) review research on endogenous system bias at two key decision stages in one institution: the criminal justice system and (3) conduct an empirical examination of the potential effect of endogenous system bias on law enforcement investigations and prosecutorial charging in a sample of criminal homicide cases in the USA. Implications for law, policy, and social scientific methodology are discussed.