Decision-making Priorities Research Articles

Factors associated with effective coverage of child health services in Burkina Faso.

To identify factors associated with both crude and effective health service coverage of under-fives in rural Burkina Faso. In a cross-sectional study, 494 first-line health facilities, 7347 households and 12 497 under-fives were surveyed. Two sequential logistic random effects models were conducted to assess factors associated with crude and effective coverage. Of 614 children under-five with a reported illness episode, 427 (69.5%) received care at a health facility. Of those, 274 (64.1%) received care at a health facility providing at least the minimum threshold of service quality. We found that younger age, having a severe illness, shorter distance between household and health facility, and being from wealthier households were positively associated with crude coverage. In addition, low patient caseload and longer consultation had a positive association, while frequent facility supervisions had a negative association with effective coverage. Moreover, the nurse to clinical staff ratio at the health facility was positively associated with both crude and effective coverage. Our study found that crude coverage is associated with pre-disposing and enabling factors of health care access, while the availability of nurses is a strong predictor for both crude and effective coverage. This suggests that in the context of scarcity of resources, investing in human resources in health sector could be one of the priorities for decision-makers to ensure children in need not only access to healthcare but also good quality of care.

How interacting constraints shape emergent decision-making of national-level football referees

ABSTRACTHere, using a grounded theory methodology, we explored the experiential knowledge of nine national-level Association Football referees (aged 23–35 yrs; 3.8 yrs mean minimum national-level experience) with the aim of better understanding why referees make decisions during performance. Results indicated that referee decision-making actions were not predominantly aimed at traditional notions of decision-making accuracy (e.g. correctly identifying rule transgressions), but were instead focussed on meeting two overarching task goals: maintaining control and preserving the integrity of the competitive game. These objectives were, in part, informed by co-invested task outcomes, which referees perceived that players, spectators, coaches and fellow referees had about ‘how the game should be played’. Analysis revealed four decision-making priorities (‘four pillars’) used to meet these expectations; these were conceptual notions of: safety, fairness, accuracy and entertainment. We discuss how these results provide a case that: (i) referees co-construct the game with players and (ii) referee decision-making is an emergent process of the performer–environment relationship nested within task goals. Finally, we recommend that future research investigate decision-making accuracy within the context of a competitive match and that distinctions be made between types of bias and the complex strategies referees use to manage the game.

Where can obesity management policy make the largest impact? Evaluating sub-populations through a microsimulation approach

Background: There is a critical need to focus limited resources on sub-groups of patients with obesity where we expect the largest return on investment. This paper identifies patient sub-groups where an investment may result in larger positive economic and health outcomes.Methods: The baseline population with obesity was derived from a public survey database and divided into sub-populations defined by demographics and disease status. In 2016, a validated model was used to simulate the incidence of diabetes, absenteeism, and direct medical cost in five care settings. Research findings were derived from the difference in population outcomes with and without weight loss over 15 years. Modeled weight loss scenarios included initial 5% or 12% reduction in body mass index followed by a gradual weight regain. Additional simulations were conducted to show alternative outcomes from different time courses and maintenance scenarios.Results: Univariate analyses showed that age 45–64, pre-diabetes, female, or obesity class III are independently predictive of larger savings. After considering the correlation between these factors, multivariate analyses projected young females with obesity class I as the optimal sub-group to control obesity-related medical expenditures. In contrast, the population aged 20–35 with obesity class III will yield the best health outcomes. Also, the sub-group aged 45–54 with obesity class I will produce the biggest productivity improvement. Each additional year of weight loss maintained showed increased financial benefits.Conclusions: This paper studied the heterogeneity between many sub-populations affected by obesity and recommended different priorities for decision-makers in economic, productivity, and health realms.

Renewable energy selection for net-zero energy communities: Life cycle based decision making under uncertainty

Developing net-zero energy communities powered by renewable energy (RE) resources has become a popular concept. To make the best choices for community-level net-zero energy systems, it is necessary to identify the best energy technologies at local level. Evaluation of RE technologies has to be extended from technical and economic aspects to include environmental and social wellbeing. It is possible to identify the true costs and benefits of energy use by taking a cradle-to-grave life cycle perspective. In this study, a RE screening and multi-stage energy selection framework was developed. A fuzzy multi-criteria decision making approach was used in ranking the technologies to incorporate the conflicting requirements, stakeholder priorities, and uncertainties. Different scenarios were investigated to reflect different decision maker priorities. Under a pro-environment scenario, small hydro, onshore wind, and biomass combustion technologies perform best. Under a pro-economic decision scenario, biomass combustion, small hydro, and landfill gas have the best rankings. Triple bottom line sustainability was combined with technical feasibility through a ruled-based approach to avoid the theoretical pitfalls inherent in energy-related decision making. This assessment is geared towards providing decision makers with flexible tools, and is expected to aid in the pre-project planning stage of RE projects.

The CLIOSjre Process: A Flexible Multicriteria, Multistakeholder Decision Framework for Transportation Planning under Uncertainty

Transportation investments determine the long-term success or failure of a transportation provider. It is therefore vital for decision makers to have an in-depth understanding of the alternatives available before they choose to invest. However, often, the process of evaluating alternatives is lengthy, costly, and contentious, particularly for transportation infrastructure investment decisions that are large, complex, and interconnected with other economic development and sustainability goals. Furthermore, transportation investments involve many decision makers, each with different priorities and expertise. Therefore, there is a need for transparent, accurate, flexible, and practicable decision-making aids that can handle the complex challenges facing the decision-making bodies of transportation providers and planning organizations. This paper introduces a new decision aid—the CLIOSjre Process—that combines insights from multicriteria decision analysis, multistakeholder negotiation theory, and uncertainty analysis. The CLIOSjre Process helps decision makers compare multiple alternatives across multiple objectives and seek an informed collective transportation investment decision. Unlike other multicriteria decision aids, the CLIOSjre Process accounts for differences of opinion among decision makers and is designed to facilitate constructive negotiation among them. Finally, the CLIOSjre Process formally accounts for sources of uncertainty inherent in these decisions. In this way, the CLIOSjre Process provides a unique and flexible framework for investment analysis that can adapt to changes in transportation alternatives, decision-maker priorities, and emerging real-world conditions. The usefulness of this new decision aid is illustrated for the East Japan Railway Company’s consideration of a transportation investment opportunity in high-speed rail development on the Northeast Corridor of the United States.

Fishery policy in the European Union: A multiple criteria approach for assessing sustainable management of Coastal Development Plans in Southern Italy

Fishery planning and management require environmental, social, and economic assessment that should take into account multiple sustainability criteria as well as the preferences and priorities of decision-makers involved in these complex issues. Therefore, this research aims to identify in a straightforward way the most sustainable coastal development plan (CDP) among a set of several CDPs and to investigate in depth the effective sustainable use of the public fishery's fund among the considered CDPs. This is accomplished by implementing a multiple criteria decision aiding (MCDA) framework that has been tested by six fisheries' local action groups (FLAGs) CDPs in a territorial system strongly affected by fishery activities in the Apulia region of Southern Italy. In particular, the framework was classified into 12 criteria grouped into three sustainability dimensions according to the actions identified by the CDPs; the data collection was carried out by consulting the CDPs. After collecting the data, the MCDA framework was applied by involving the regional consultant on fishery affairs.An analysis of the results clearly showed that the best performances in the distribution of the available funding were related to the coherence of the CDPs with specific environmental, social, and economic features. The proposed MCDA framework can represent support for decision-makers and stakeholders to consider and evaluate in a systematic and robust way different possibilities for funding distribution to detect optimal alternatives within European fishery policies.

Aligning climate action with the self-interest and short-term dominated priorities of decision-makers

ABSTRACTThe global and long-term nature of climate change conflicts with the self-interest and short-term dominated priorities of decision-makers. Climate change mitigation makes sense at the global level, but not at the level of the individual decision-maker. This conflict has been and remains the main obstacle to effective global cooperation and mitigation. This paper proposes a framework that aligns climate action with short-term self-interest through results-based payments to governments. Its key components are: determining an emission benchmark for each country as well as a price for carbon saving; paying countries annually for reducing emissions below their respective benchmark; a new international fund to finance these annual payments by borrowing capital from private investors; and repaying borrowings in the long-term through payments made by countries to the fund based on a pre-determined allocation mechanism. This framework would offer important benefits over an approach focused on allocating climate action or a carbon budget among countries. These include the improved prospect of reaching an effective climate agreement and delivering fast and dramatic mitigation thanks to stronger political commitment, the transformation of short-term self-interest from an obstacle into a driver of climate action, and the additional financing created. The paper also proposes a pilot scheme focusing on hydrofluorocarbon emissions with a considerably lower financing requirement. This offers the possibility of an alternative financing mechanism, and thus a faster and more straightforward implementation path. Short-term financial incentives offered to governments could turn policy action from a burden into an opportunity from their perspective unlocking a huge potential for timely mitigation.Key policy insightsA new international framework that offers short-term, results-based payments to governments to promote mitigation action could lead to much more effective global mitigation and international cooperation.The financing of such an approach could be solved through a novel financing structure, backed by the long-term commitments of participating countries and thus aligning the timeframe of the financial costs of mitigation with its climate benefits.The effectiveness of results-based payments and the concept behind this new approach could be proven through a pilot scheme focusing on hydrofluorocarbon emissions.

Treatment decision-making priorities and satisfaction among melanoma survivors.

e21618Background: Understanding priorities in making treatment decisions is essential for shared decision-making. This study examined patient priorities in making melanoma treatment decisions and s...

Realization of the rights of persons with disabilities in Rwanda.

This scoping study assessed the realization of the rights for persons with disabilities in Rwanda since the signing of the United Nations Convention on the Rights of Persons with Disabilities (UN CRPD) in 2008. Underpinned by the five-stage framework of Arksey and O’Malley, the scoping study examined peer-reviewed literature published between 2008 and 2017. Nine electronic databases were searched using keywords specific to disability in Rwanda. Data were charted by three reviewers according to pre-determined and emergent categories. Descriptive statistics were used to describe the data sources. A total of 60 scholarly articles met the inclusion criteria. Within the research, studies pertaining to the UN CRPD Articles of health, awareness raising, accessibility, and children with disabilities were the most published. The literature identified a movement towards the realization of the rights for persons with disabilities in Rwanda since the country signed the UN CRPD. Despite efforts to meet these rights, discrimination against persons with disabilities still exists and greater investment in the disability sector is needed, particularly for justice, social protection, and mental health services. Given the state of the evidence, concerning research gaps also exist in regards to deinstitutionalization and protection issues (i.e., violence and abuse). This consolidation of evidence may help to inform the decision-making priorities for government and civil society organizations in policy and programming and also direct future research.

Reported Influences on Restaurant-Type Food Selection Decision Making in a Grocery Store Chain

ObjectiveTo examine food decision-making priorities for restaurant-type foods at grocery stores and determine whether adding calorie information, as required by federal menu labeling laws, affected decision-making priorities. DesignNatural experiment: intervention and control groups with baseline and follow-up. SettingRegional grocery store chain with 9 locations. ParticipantsParticipants (n = 393; mean age, 54.8 ± 15.1 years) were primarily women (71%) and Caucasian (95%). InterventionData were collected before and after calorie information was added to restaurant-type foods at 4 intervention locations. Main Outcome Measure(s)Primary influencers of food selection decision making for restaurant-type foods and frequency of use of nutrition information. AnalysisQuantitative analysis examined the top 3 influencers of food selections and chi-square goodness of fit test determined whether the calorie labeling intervention changed food decision-making priorities. Qualitative data were used to describe responses. ResultsTaste, cost, and convenience were the most frequently reported influencers of restaurant-type food selections; 20% of participants rated calories as influential. Calorie labeling did not affect food selection decision making; 16% of participants in intervention stores noticed calorie labels. Qualitative explanations confirmed these findings. Conclusions and ImplicationsMenu labeling laws increase access to calorie information; however, use of this information is limited. Additional interventions are needed to encourage healthier restaurant-type food selections in grocery stores.

Certiorari, Universality, and a Patent Puzzle

The most important determinant of a case’s chances for Supreme Court review is a circuit split: If two courts of appeals have decided the same issue differently, review is substantially more likely. But practically every appeal in a patent case makes its way to a single court—the Court of Appeals for the Federal Circuit. How, then, does the Supreme Court decide whether to grant certiorari in a patent case? The petitions for certiorari in the Court’s patent docket suggest an answer: The Supreme Court looks for splits anyway. These splits, however, are of a different sort. Rather than consider whether two courts of appeals have decided the same issue differently, the Court looks to whether two fields of law conflict over the application of the same transsubstantive doctrine. Such “field splits” are unusual candidates for Supreme Court attention. After all, the Court’s interest in circuit splits is motivated by a desire for geographic uniformity in federal law. But field splits, unlike circuit splits, do not give rise to forum shopping concerns, do not undermine the predictability of the law, nor otherwise implicate the legal values that counsel in favor of uniformity. Instead, the Supreme Court’s attention to field splits may suggest that legal universality—consistency across substantive fields of law—is an important (but unstated) priority in certiorari decisionmaking. The exercise of this universality interest through certiorari decisions in patent cases has several consequences for the Supreme Court’s agenda. The Court must better explain why field splits merit review, and we must better understand how to distinguish those field splits that implicate the Court’s universality- related concerns from those that do not.

Distributive Justice: An Ethical Priority in Global Palliative Care

Providing care to cancer patients in resource-poor settings often demands complex trade-offs regarding resource allocation. It is estimated that over 60% of all cancer deaths worldwide occur in low- and middle-income countries, where channels to care and appropriate symptom management interventions are overstressed or obsolete. Concepts of distributive justice underlie much of global health policy. As appetites for expanding global palliative care services increase, so do questions of fair and culturally appropriate distribution. The ethical principle of distributive justice underpins questions of resource allocation at a fundamental level. One of the most challenging concepts for health care workers immersing in cross-cultural contexts is the idea that ethics are somewhat malleable; they shape and are shaped by the unique sociopolitical, economic, intracultural, and power dynamics of a particular setting. In this article, we use the case of a young woman diagnosed with terminal cancer in an underserved community in rural Uganda to illustrate the conflicting concepts of fairness, which dictate distribution of scarce resources in low- and middle-income countries. Notions of distributive justice vary across cultural, societal, and even individual norms, with some definitions allowing for discrimination based on merit or need. Resource allocation in the absence of cultural humility or a genuine willingness to understand decision-making priorities in a given culture can contribute to inequity and may have harmful consequences.

Prioritising, Ranking and Resource Implementation - A Normative Analysis.

Background: Priority setting in publicly financed healthcare systems should be guided by ethical norms and other considerations viewed as socially valuable, and we find several different approaches for how such norms and considerations guide priorities in healthcare decision-making. Common to many of these approaches is that interventions are ranked in relation to each other, following the application of these norms and considerations, and that this ranking list is then translated into a coverage scheme. In the literature we find at least two different views on how a ranking list should be translated into coverage schemes: (1) rationing from the bottom where everything below a certain ranking order is rationed; or (2) a relative degree of coverage, where higher ranked interventions are given a relatively larger share of resources than lower ranked interventions according to some "curve of coverage." Methods: The aim of this article is to provide a normative analysis of how the background set of ethical norms and other considerations support these two views. Results: The result of the analysis shows that rationing from the bottom generally gets stronger support if taking background ethical norms seriously, and with regard to the extent the ranking succeeds in realising these norms. However, in non-ideal rankings and to handle variations at individual patient level, there is support for relative coverage at the borderline of what could be covered. A more general relative coverage curve could also be supported if there is a need to generate resources for the healthcare system, by getting patients back into production and getting acceptance for priority setting decisions. Conclusion: Hence, different types of reasons support different deviations from rationing from the bottom. And it should be noted that the two latter reasons will imply a cost in terms of not living up to the background set of ethical norms.

Protocol for establishing an infant feeding database linkable with population-based administrative data: a prospective cohort study in Manitoba, Canada

IntroductionBreast feeding is associated with many health benefits for mothers and infants. But despite extensive public health efforts to promote breast feeding, many mothers do not achieve their own breastfeeding...

HOW TO MEASURE THE SAFETY CULTURE OF ORGANIZATIONS

Every organization has an interest in protecting its assets and increasing its profit. To preserve the integrity, organizations generally ensure their assets are safe. Today, especially in large organizations, asset security is a chief priority in decision-making. A factor affecting the level of an organization’s security is its safety culture. This factor is measured by the level by which the organization and its employees adopt and comply with security rules and principles. The status of a safety culture can have a positive or negative impact on the organization’s security, which directly affects its development. The aim of this article is to describe approaches for assessing the safety culture of different organizations. The study results can be used to compare several organizations, and it is possible to identify differences in the level of safety culture after applying innovative changes.

Decision making about healthcare-related tests and diagnostic test strategies. Paper 5: a qualitative study with experts suggests that test accuracy data alone is rarely sufficient for decision making

ObjectivesThe objective of the study was to identify the critical factors that determine recommendations and other decisions about healthcare-related tests and diagnostic strategies (HCTDS). MethodsWe used a qualitative descriptive approach and conducted semi-structured in-depth interviews with 24 international experts (informants) in evidence and decisions about HCTDS. ResultsAlthough test accuracy (TA) was the factor most commonly considered by organizations when developing recommendations about HCTDS, informants agreed that TA is necessary but rarely, if ever, sufficient and may be misleading when solely considered. The informants identified factors that are important for developing recommendations about HCTDS. Informants largely agreed that laying out the potential care pathways based on the test result is an essential early step but is rarely done in developing recommendations about HCTDS. Most informants also agreed that decision analysis could be useful for organizing the clinical, cost, and preference data relevant to the use of tests in the absence of direct evidence. However, they noted that using models is limited by the lack of resources and expertise required. ConclusionDeveloping guidelines about HCTDS requires consideration of factors beyond TA, but implementing this may be challenging. Further development and testing of “frameworks” that can guide this process is a priority for decision makers.

Individual care versus broader public health: Aqualitative study of hospital doctors' antibiotic decisions.

This study aimed to examine how hospital doctors balance competing concerns around antibiotic use and resistance, with a focus on individual care versus broader public health considerations. Sixty-four doctors across two hospitals in Australia participated in semi-structured interviews about their perspectives on antibiotic resistance and prescribing decisions. Results were analysed using the framework approach. The first theme focused on the significance of antimicrobial resistance (AMR) and the role of hospital doctors. Participants did not perceive resistance to be central to clinical decision-making, and externalised the resistance threat. They perceived themselves as separated from the issue of escalating resistance, viewing the key drivers to be overseas use, use in agriculture, and community prescribing. The second theme was around balancing risks. Immediate clinical risks were described as prioritised over long term population risk. Participants described concern around reputational and legal risks, which were perceived to be associated with under-prescribing of antibiotics. Over-prescribing was described by participants to be easier and without perceived immediate risk to them or to patients. Hospital doctors perceived antimicrobial resistance as externally produced and described clinical concerns taking precedence in individual antibiotic decisions. These dual processes mean that a population health model has limited traction in the hospital context. The externalisation of resistance leads to a sense of futility in changing practice, which combines with the pressures of acute medicine to prioritise immediate patient outcomes. Such dynamics are leading to antibiotic optimisation as a low or absent priority in hospital clinician antibiotic decision-making.

Factors influencing prostate cancer treatment decisions for African American (AA) and Caucasian (CA) men.

6517 Background: Prostate cancer causes a disproportionate burden to AA men, and AA men are less likely than CA men to receive aggressive treatment. This is the first study to examine factors influencing treatment decision-making of AA vs. CA men in a population-based cohort. Methods: 1171 men were enrolled soon after diagnosis and before treatment through Rapid Case Ascertainment of the North Carolina state cancer registry. Researchers asked patients regarding their priorities in treatment decision-making and information sources. Differences in AA and CA men were compared using the chi-square test. Results: The most important factor for both AA and CA men was curing cancer, and preserving QOL was second most important. However, AA men were more concerned about additional factors including impact on daily activities (74% very important AA vs 58% CA for intermediate/high risk disease), recovery time (81% vs 50%), cost (66% vs 32%) and treatment time (76% vs 39%) (p < .001 for each item). The most important source of information impacting treatment decisions for CA men were physician recommendations (61%), personal research (32%) and family/friend opinion (7%); for AA men, the corresponding numbers were 50%, 32% and 19%. Conclusions: AA and CA men with prostate cancer are both concerned about curing cancer, but AA men are more likely to consider multiple other social and personal factors as important in their decision-making process. Improved understanding of these differences may provide opportunities to address racial disparities in prostate cancer. [Table: see text]

ORGANIC WASTE VALORIZATION THROUGH COMPOSTING PROCESS: A FULL-SCALE CASE STUDY IN MAXIXE, MOZAMBIQUE

Organic solid waste and the current lack of sound treatment for its valorisation are of high priority for decision makers in developing countries. Despite the remarkable use of composting processes in those areas, an appropriate scientific literature as well as databases are still lacking, hampering the sustainable implementation of composting process. This paper contributes to cover this gap, presenting a full-scale case study in Maxixe, Mozambique. Technical characteristics and detailed operational data (e.g.: process duration, frequency of pile turning, pile temperature trend) of the composting plant represent useful information that can support technicians interested in designing and operating composting plants in developing countries.

Evaluation of eco-design strategies for development of multiple life-cycle products

Life-cycle thinking in the development of new products has led design engineers to rethink the way they design sustainable products. One of the most viable approaches is designing products for multiple life-cycles. For this purpose, a sustainable design tool that has a broader perspective in providing design guidelines to enhance end-of-life product recovery for multiple life-cycles is necessary. However, there are too many design requirements, some of which are conflicting. Designers are not supported by specific methodologies or tools to evaluate the weightage and importance of the design elements. Therefore, an extensive review of the design requirements of remanufacturable products was conducted in order to identify the design elements for multiple life-cycle products. A modified Analytical Hierarchy Process method was developed based on the design strategies in order to obtain the weightage that indicates the importance of each design element. The proposed approach is capable of refining and setting priorities in strategic decision-making during the design phase of a multiple life-cycle product. Verification of the strategic factors was based on an in-depth interview with an automobile engine remanufacturer. Based on the study, disassemblability and assemblability were found to be the two most important criteria in designing automobile engines for multiple lifecycles.