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Department of Urban and Environmental Engineering (Disaster Management Engineering)Seismic risk assessment has recently emerged as an important issue for infrastructure systems because of their vulnerability to seismic hazards. Earthquakes can have significant impacts on transportation networks such as bridge collapse and the resulting disconnections in a network. One of the main concerns is the accurate estimation of the seismic risk caused by the physical damage of bridges and the reduced performance of the associated transportation network. This requires estimating the performance of a bridge transportation network at the system level. Moreover, it is necessary to deal with various possible earthquake scenarios and the associated damage states of component bridges considering the uncertainty of earthquake locations and magnitudes. To perform the seismic risk assessment of a bridge transportation network, system reliability is required. It is a challenging task for several reasons. First, the seismic risk itself contains a great deal of uncertainty, which comprises location, magnitude, and the resulting intensity of possible earthquakes in a target network. Second, the system performance of a bridge transportation network after the seismic event needs to be estimated accurately, especially for realistic and complex networks. Third, the seismic risk assessment employing system reliability may increase the computational costs and can be time-consuming tasks, because it requires dealing with various possible earthquake scenarios and the resulting seismic fragility of component bridges. Fourth, a precise performance measure of the system needs to be introduced. In this study, a new method is proposed to assess the system-level seismic risk of bridge transportation networks considering earthquake uncertainty. In addition, a new performance measure is developed to help risk-informed decision-making regarding seismic hazard mitigation and disaster management. For the tasks, first of all, a matrix-based system reliability framework is developed, which performs the estimation of a bridge transportation network subjected to earthquakes. Probabilistic seismic hazard analysis (PSHA) is introduced to enable the seismic fragility estimation of the component bridges, considering the uncertainty of earthquake locations and magnitudes. This is systemically used to carry out a post-hazard bridge network flow analysis by employing the matrix-based framework. Secondly, two different network performance measures are used to quantify the network performance after a seismic event. Maximum flow capacity was originally used for a bridge transportation network, however the numerical example using this measure is further developed for applications to more accurate system performance analysis using total system travel time (TSTT). Finally, a new method for system-level seismic risk assessment is proposed to carry out a bridge network flow analysis based on TSTT by employing the matrix-based system reliability (MSR) method. In the proposed method, the artificial neuron network (ANN) is introduced to approximate the network performance, which can reduce the computational cost of network analysis. The proposed method can provide statistical moments of the network performance and component importance measures, which can be used by decision-makers to reduce the seismic risk of a target area. The proposed method is tested by application to a numerical example of an actual transportation network in South Korea. In the seismic risk assessment of the example, PSHA is successfully integrated with the matrix-based framework to perform system reliability analysis in a computationally efficient manner.clos

Questioning the Quantitative Imperative: Decision Aids, Prevention, and the Ethics of Disclosure

Patients should not always receive hard data about the risks and benefits of a medical intervention. That information should always be available to patients who expressly ask for it, but it should be part of standard disclosure only sometimes, and only for some patients. And even then, we need to think about how to offer it

Perceived efficacy and attitudes towards genetic science and science governance

This is the postprint version of the Article. The official published version can be obtained from the link below - © 2010 SAGE Publications.Arguments for public involvement in science and technology are often based on ideas of developing a more capable public and the assumed effects this may have for science. However, such a relationship is yet to be sufficiently explored and recent work indicates that a more involved public may have counterintuitive effects. Using nationally representative survey data for the UK and Northern Ireland, the effects of the public's own beliefs about involvement are explored. Developing the concept of "belief in public efficacy," findings suggest those who believe that the public might be able to affect the course of decision making have less approving attitudes towards future applications of genetic science; however, an individual's political efficacy does not significantly influence these attitudes. Furthermore, political efficacy and belief in public efficacy have some distinct and opposing relationships with the principles of governance people prefer. Overall, findings provide support for suggestions that it is simplistic to consider increasing public involvement as a way of increasing the approval of risky new technologies

GRADE Evidence to Decision (EtD) frameworks : a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines

Funding: Work on this article has been partially funded by the European Commission FP7 Program (grant agreement 258583) as part of the DECIDE project. Sole responsibility lies with the authors; the European Commission is not responsible for any use that may be made of the information contained therein.Peer reviewedPublisher PD

Improving Patient Decision-Making in Health Care

Outlines regional variations within Minnesota in rates of patients with similar conditions receiving elective surgery, the concept of shared decision making, treatment choices for eight conditions, and steps for ensuring patients make informed decisions

Bayesian data assimilation to support informed decision-making in individualized chemotherapy

An essential component of therapeutic drug/biomarker monitoring (TDM) is to combine patient data with prior knowledge for model-based predictions of therapy outcomes. Current Bayesian forecasting tools typically rely only on the most probable model parameters (maximum a-posteriori (MAP) estimate). This MAP-based approach, however, does neither necessarily predict the most probable outcome nor does it quantify the risks of treatment inefficacy or toxicity. Bayesian data assimilation (DA) methods overcome these limitations by providing a comprehensive uncertainty quantification. We compare DA methods with MAP-based approaches and show how probabilistic statements about key markers related to chemotherapy-induced neutropenia can be leveraged for more informative decision support in individualized chemotherapy. Sequential Bayesian DA proved to be most computational efficient for handling interoccasion variability and integrating TDM data. For new digital monitoring devices enabling more frequent data collection, these features will be of critical importance to improve patient care decisions in various therapeutic areas

Releasing Authority Chairs: A Comparative Snapshot Across Three Decades

This report provides a comparative analysis of releasing authority chairs' views of the issues and challenges confronting them at two points in time: 1988 and 2015. Drawing from two surveys, one conducted during the tenure of an ACA Parole Task Force that functioned from 1986-1988, and the other a survey published in 2016 by the Robina Institute called The Continuing Leverage of Releasing Authorities: Findings from a National Survey, this new publication highlights both change and constancy relative to a wide range of comparative markers including, but not limited to, structured decision tools, prison crowding and risk aversion, and the myriad factors considered in granting or denying parole

Discussing uncertainty and risk in primary care: recommendations of a multi-disciplinary panel regarding communication around prostate cancer screening.

BackgroundShared decision making improves value-concordant decision-making around prostate cancer screening (PrCS). Yet, PrCS discussions remain complex, challenging and often emotional for physicians and average-risk men.ObjectiveIn July 2011, the Centers for Disease Control and Prevention convened a multidisciplinary expert panel to identify priorities for funding agencies and development groups to promote evidence-based, value-concordant decisions between men at average risk for prostate cancer and their physicians.DesignTwo-day multidisciplinary expert panel in Atlanta, Georgia, with structured discussions and formal consensus processes.ParticipantsSixteen panelists represented diverse specialties (primary care, medical oncology, urology), disciplines (sociology, communication, medical education, clinical epidemiology) and market sectors (patient advocacy groups, Federal funding agencies, guideline-development organizations).Main measuresPanelists used guiding interactional and evaluation models to identify and rate strategies that might improve PrCS discussions and decisions for physicians, patients and health systems/society. Efficacy was defined as the likelihood of each strategy to impact outcomes. Effort was defined as the relative amount of effort to develop, implement and sustain the strategy. Each strategy was rated (1-7 scale; 7 = maximum) using group process software (ThinkTank(TM)). For each group, intervention strategies were grouped as financial/regulatory, educational, communication or attitudinal levers. For each strategy, barriers were identified.Key resultsHighly ranked strategies to improve value-concordant shared decision-making (SDM) included: changing outpatient clinic visit reimbursement to reward SDM; development of evidence-based, technology-assisted, point-of-service tools for physicians and patients; reframing confusing prostate cancer screening messages; providing pre-visit decision support interventions; utilizing electronic health records to promote benchmarking/best practices; providing additional training for physicians around value-concordant decision-making; and using re-accreditation to promote training.ConclusionsConference outcomes present an expert consensus of strategies likely to improve value-concordant prostate cancer screening decisions. In addition, the methodology used to obtain agreement provides a model of successful collaboration around this and future controversial cancer screening issues, which may be of interest to funding agencies, educators and policy makers