Evaluating the use of system dynamics for improving stakeholder decision maKing

When lay stakeholders are involved in complex environmental decision making, the ensuing decision does not always effectively solve the problem of focus. This can be due to the fact that standard facilitation methods commonly used to manage such efforts frequently fail to promote thorough and rational decision analysis. A review of classical and behavioral decision theory, stakeholder research and standard facilitation practices suggests that standard facilitation methods tend to enable behavioral decision making strategies which oversimplify decision making tasks, rather than employing classical rational strategies which stress a more thorough decision analysis and maximization of decision outcomes; To test this hypothesis, I conducted a comparative experiment involving 196 stakeholders who attended a solid waste management public meeting in Los Angeles. Participants were randomly assigned to a control and experimental group. The control group was facilitated with standard methods and the experimental group was facilitated with a more classically rational method, specifically system dynamics-based facilitation. Pre- and post-intervention surveys were administered to measure participants\u27 ability to identify effective solutions, their level of focus on the presented materials and their level of procedural satisfaction. I hypothesized that the experimental group would score higher in each of these areas; The results supported my first two hypotheses by showing that the experimental group was better at helping its participants identify more effective outcomes and maintain a greater focus on relevant information. However, the results failed to support the third hypothesis that the experimental group would have a higher level of procedural satisfaction than the control group. Instead, the results showed that the standard facilitation methods used in the control group were better at promoting participant satisfaction and self confidence than were the system dynamics methods; If the objective of stakeholder involvement in complex environmental decision making is the development of effective decisions to solve pressing environmental problems, this experiment shows that system dynamics-based facilitation is an effective tool for managing stakeholder involvement. The results also show that the identification of effective solutions does not guarantee participant satisfaction and confidence

Rehabilitation interventions for foot drop in neuromuscular disease

"Foot drop" or "Floppy foot drop" is the term commonly used to describe weakness or contracture of the muscles around the ankle joint. It may arise from many neuromuscular diseases

Handling Policy Conflicts in Call Control

Policies are becoming increasingly important in modern computer systems as a mechanism for end users and organisations to exhibit a level of control over software. Policies have long been established as an effective mechanism for enabling appropriate access control over resources, and for enforcing security considerations. However they are now becoming valued as a more general management mechanism for large-scale heterogeneous systems, including those exhibiting adaptive or autonomic behaviour. In the telecommunications domain, features have been widely used to provide users with (limited) control over calls. However, features have the disadvantage that they are low-level and implementation-oriented in nature. Furthermore, apart from limited parameterisation of some features, they tend to be very inflexible. Policies, in contrast, have the potential to be much higher-level, goaloriented, and very flexible. This paper presents an architecture and its realisation for distributed and hierarchical policies within the telecommunications domain. The work deals with the important issue of policy conflict – the analogy of feature interaction

Symptomatic Therapy and Rehabilitation in Primary Progressive Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating disease of the central nervous system and a major cause of chronic neurological disability in young adults. Primary progressive MS (PPMS) constitutes about 10% of cases, and is characterized by a steady decline in function with no acute attacks. The rate of deterioration from disease onset is more rapid than relapsing remitting and secondary progressive MS types. Multiple system involvement at onset and rapid early progression have a worse prognosis. PPMS can cause significant disability and impact on quality of life. Recent studies are biased in favour of relapsing remitting patients as treatment is now available for them and they are more likely to be seen at MS clinics. Since prognosis for PPMS is worse than other types of MS, the focus of rehabilitation is on managing disability and enhancing participation, and application of a “neuropalliative” approach as the disease progresses. This chapter presents the symptomatic treatment and rehabilitation for persons with MS, including PPMS. A multidisciplinary approach optimizes the intermediate and long-term medical, psychological and social outcomes in this population. Restoration and maintenance of functional independence and societal reintegration, and issues relating to quality of life are addressed in rehabilitation processes

Do people with autism spectrum disorders show normal selection for attention? Evidence from change blindness

People in the general population are typically very poor at detecting changes in pictures of complex scenes. The degree of this ‘change blindness’, however, varies with the content of the scene: when an object is semantically important or contextually inappropriate, people may be more effective at detecting changes. Two experiments investigated change blindness in people with autism, who are known from previous research to be efficient in detecting features yet poor at processing stimuli for meaning and context. The first experiment measured the effect of semantic information while the second investigated the role of context in directing attention. In each task, participants detected the dissimilarity between pairs of images. Both groups showed a main effect of image type in both experimental tasks, showing that their attention was directed to semantically meaningful and contextually inappropriate items. However, the autistic group also showed a greater difficulty detecting changes to semantically marginal items in the first experiment. Conclusions point to a normal selection of items for attention in people with autism spectrum disorders, although this may be combined with difficulty switching or disengaging attention

Development and initial validation of the Northwick Park Therapy Dependency Assessment

Objectives: To describe the development and initial validation of the Northwick Park Therapy Dependency Assessment (NPTDA) as a measure of therapy interventions in neurorehabilitation

Conceptualisation and development of the Leg Activity Measure (LegA) for patient and carer reported assessment of activity (function) in the paretic leg in people with acquired brain injury

Daily newspaper from Muskogee, Indian Territory that includes local, territorial, and national news along with advertising

Cost-efficiency of specialist inpatient rehabilitation for working-aged adults with complex neurological disabilities: A multicentre cohort analysis of a national clinical dataset

OBJECTIVES: To evaluate functional outcomes, care needs and cost-efficiency of specialist rehabilitation for a multicentre cohort of inpatients with complex neurological disability, comparing different diagnostic groups across 3 levels of dependency. DESIGN: A multicentre cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database, 2010–2015. SETTING: All 62 specialist (levels 1 and 2) rehabilitation services in England. PARTICIPANTS: Working-aged adults (16–65 years) with complex neurological disability. Inclusion criteria: all episodes with length of stay (LOS) 8–400 days and complete outcome measures recorded on admission and discharge. Total N=5739: acquired brain injury n=4182 (73%); spinal cord injury n=506 (9%); peripheral neurological conditions n=282 (5%); progressive conditions n=769 (13%). INTERVENTION: Specialist inpatient multidisciplinary rehabilitation. OUTCOME MEASURES: Dependency and care costs: Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA). Functional independence: UK Functional Assessment Measure (UK Functional Independence Measure (FIM)+FAM). Cost-efficiency: (1) time taken to offset rehabilitation costs by savings in NPCNA-estimated costs of ongoing care, (2) FIM efficiency (FIM gain/LOS days), (3) FIM+FAM efficiency (FIM+FAM gain/LOS days). Patients were analysed in 3 groups of dependency. RESULTS: Mean LOS 90.1 (SD 66) days. All groups showed significant reduction in dependency between admission and discharge on all measures (paired t tests: p<0.001). Mean reduction in ‘weekly care costs’ was greatest in the high-dependency group at £760/week (95% CI 726 to 794)), compared with the medium-dependency (£408/week (95% CI 370 to 445)), and low-dependency (£130/week (95% CI 82 to 178)), groups. Despite longer LOS, time taken to offset the cost of rehabilitation was 14.2 (95% CI 9.9 to 18.8) months in the high-dependency group, compared with 22.3 (95% CI 16.9 to 29.2) months (medium dependency), and 27.7 (95% CI 15.9 to 39.7) months (low dependency). FIM efficiency appeared greatest in medium-dependency patients (0.54), compared with the low-dependency (0.37) and high-dependency (0.38) groups. Broadly similar patterns were seen across all 4 diagnostic groups. CONCLUSIONS: Specialist rehabilitation can be highly cost-efficient for all neurological conditions, producing substantial savings in ongoing care costs, especially in high-dependency patients