A Generic Rapid Evaluation Support Tool (GREST) for Clinical and Commissioning Decisions.

A fast and frugal generic tool can provide decision support to those making decisions about individual cases, particularly clinicians and clinical commissioners operating within the budget and time constraints of their practices. The multi-national Generic Rapid Evaluation Support Tool (GREST) is a standard preference-sensitive Multi-Criteria Decision Analysis-based tool, but innovatory insofar as an equity criterion is introduced as one of six. Equity impact reflects the number of population QALYs lost or gained in moving from Old (current intervention) to New (contemplated intervention). In the exemplar UK implementation Claxton's NHS Willingness to Pay per QALY is the numeraire. Any weight from 0 to 100% may be assigned to the equity criterion but its presence affirms that it is persons-as-citizens who experience any opportunity harms or benefits arising from actions within the health service commons. A fully-operational but demonstration-only version is available on open access, as proof of concept and method

A Multi-Criterial Support Tool for the Multimorbidity Decision in General Practice.

The magnitude and seriousness of the challenge posed by heterogeneous multimorbidity in most health services is now unquestioned. Equally well-acknowledged is the fact that existing guidelines essentially set out the principles of best practice in an idealised setting, concentrating on information gathering and not providing any personalisable decision support for the general practitioner aiming to share decision making with a person with multiple morbidities in the reality of routine practice. Existing decision aids have been developed largely within the single condition context and can draw on a body of robust research largely absent in the multimorbidity context. The need for a more flexible and generic approach which draws more on the clinician's expertise-based judgments has been called for, and we introduce a Decision Support Tool, GREST CLIN, in response to this call. Based on Multi-Criteria Decision Analysis it reflects the quantitative calculation approach to decision support rather than the deliberative reasoning of mainstream decision aids. It is emphasised that any evaluation should use the current decision making process as empirical comparator, rather than idealised normative standards, and that the primary outcome measure should be decision quality at the point of care, not downstream outcomes. A demonstration version of the tool is available online as proof of method

Evaluations of Decision Support Tools Are Preference-Sensitive and Interest-Conflicted: The Case of Deliberation Aids.

The questions 'What constitutes a good health care decision?', and, by extension, 'What constitutes good healthcare decision support?' continue to be asked. The most developed answers focus largely, often exclusively, on the quality of the 'deliberation' component as the determinant of the quality of the decision or decision aid. We argue that these answers and resulting aids reflect the preferences of healthcare professionals and aid developers and that these preferences are closely aligned with their interests. Some interests are material, but many professional, institutional, intellectual, methodological, and ethical. Successful promotion of a particular preference-sensitive, interest-conflicted decision aid does not change its ontological nature. Conflicts of interest are therefore universal and of concern only when this ontology is denied and if aids based on alternative interest-based preferences, such as technologies involving numerical analytic calculation, are subjected to discrimination

COVID-19, the Swedish 'Experiment', and Me.

In this personal vision paper the Swedish approach to COVID-19 prompts an exploration of how and why assuming individual rationality coupled with minimal social restriction may be as good a solution as any and better than most. A COVID sub-model is developed and populated with probabilities for four outcomes of infecting another person (asymptomatic, sick, hospitalized, dead), conditional on three observable characteristics (sex, age, and BMI), and (dis)utilities for three categories of person (nearest/dearest, friends/colleagues and unknown others) experiencing those outcomes. The implications for a liberal democracy are drawn, based on the assumptions that individual citizens will and should maximise their informed expected utility, exhibiting 'commons sense' as well as common sense

Holistic environmental assessment of oil and gas field development

This study has developed a new life-of-field, goal orientated process of analysis called Holistic Environmental Assessment (HEA). HEA assesses the total environmental risk associated with a proposed oil and gas field development. It prioritises environmental risks and identifies cost effective strategies to reduce them. For the first time the process was applied to a real 'case study' field development programme to test its effectiveness. The application identified that it is a useful tool to help design eco-efficient and costeffective oil and gas field developments. Furthermore, it was discovered that much of the information required by HEA could be obtained in a quick and user-friendly format. The new assessment process was developed after a review of the interaction of the offshore oil and gas industry with the environment, and techniques employed to evaluate this interaction. The review identified that the industry interacts with the environment in a number of different ways, and that the level of interaction transgresses the boundaries of sea, air and land locally, regionally and internationally. Legislation and public concern demand no damage to the environment from offshore oil and gas field exploration and development. UK environmental legislation and people's expectations for environmental performance are in a state of change. This change, coupled with the uncertainty over how resilient the environment is to perturbation, and the increasing risk of environmental liability presents a need for operators to clearly manage environmental information and assess total environmental risk. It was discovered that Environmental Assessment, Lifecycle Analysis and Cost Benefit Analysis, when used separately, failed to assess total environmental risk, but when used in combination under the HEA process could. Many organisations, such as the British Medical Association, European Oilfield Speciality Chemicals Association, the Royal Ministry of Petroleum and Energy (Norway) and Shell Expro, now recognise that a holistic approach is essential to assess total environmental risk. The author proposes that HEA would be effective as a software tool to analyse different environmental risk mitigation systems. This would facilitate the identification of a system that steers an operator towards the triple bottom line of Sustainable Development.Schlumberger LimitedEngineering and Physical Sciences Research Counci

Science-Policy Interfaces and Academic Boundary-Spannersin a Global City: Can Internationalized Higher Learning Make Local Knowledge More Salient in Times of Crisis?

Session 1.1: Setting the SceneThe Conference Precedings can be viewed at: http://mams.rmit.edu.au/4khvnp345yqe.pdfConference Theme: Local Communities in the Sustainable and Healthy Learning CityThis discussion paper explores the challenges of universities embarking on building science-policy interfaces to increase the salience of public knowledge in times of global crisis. How can universities and their stakeholder communities create effective boundary spanners for prompt inquiry and response to emergencies when there is insufficient data and local resources are disabled? With increasing cross-border interdependencies in higher learning, science-policy interfaces acquire a meaning greater than simply interdisciplinary collaboration or knowledge transfer. Serving the public good in a crisis entails risk-taking in spite of political stigma, knowledge limitations and loss of life. The case of the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak in Hong Kong illustrates some critical dilemmas faced by academics generating a wider network of knowledge for productive synergies across jurisdictional, cultural and professional boundaries

Clemson Catalog, 2010-2011, Volume 85

https://tigerprints.clemson.edu/clemson_catalog/1160/thumbnail.jp

University of Montana Report of the President 1950-1951

An annual report of the activities of the University, published by University of Montana Office of the President and submitted to the Montana State Board of Education.https://scholarworks.umt.edu/presidentsreports_asc/1055/thumbnail.jp