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Complex Decisions (complex + decision)
Selected AbstractsTransitioning Residents from Nursing Facilities to Community Living: Who Wants to Leave?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2008(See editorial comments by Dr. Rosalie Kane, 165)., pp 16 OBJECTIVES: To examine nursing facility residents' or their legal proxies' perspectives on transitioning out of nursing facilities by assessing residents' perceptions of their ability to live more independently, their preferences regarding leaving the facility, and the feasibility of transitioning with community support. DESIGN: Analysis of survey findings from the California Nursing Facility Transition Screen (CNFTS). SETTING: Eight nursing facilities in southern California. PARTICIPANTS: All chronic maintenance, long-stay residents receiving Medi-Cal (California's Medicaid program) were eligible for the study (n=218). Of these, 121 (56%) self-consenting residents or legal proxies were interviewed. No presumptions were made as to which residents were appropriate candidates for transition based on health or functional capacity. MEASUREMENTS: CNFTS contains 27 open- and closed-ended questions on preference, ability, and feasibility of transitioning. RESULTS: Twenty-three percent of residents and proxies believed that the resident had the ability to transition; 46% indicated a preference to transition; and after discussing potential living arrangements and services, 33% thought that transitioning would be feasible. Of those who consented to allow access to their Minimum Data Set 2.0 (MDS) information (n=41; 34% of the sample), agreement in the assessment of preference was found in 39% of cases. CONCLUSION: Transition decisions are complex and include preference, as well as perceptions of the resident's ability to live in a more independent setting and the feasibility of transitioning. Compared with the MDS, the screen identified a higher proportion of residents who want to transition, suggesting that a systematic approach to assessing the complex decision to transition is needed. [source] Predictors of Candidate Maturation Among Potential Living DonorsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2005Elizabeth C. Verna The shortage of deceased donor allografts and improved outcomes in partial organ transplantation have led to widespread application of adult-to-adult living donor liver transplantation. Donor selection limits overall utilization of this technique and predictors of candidate maturation have been inadequately studied to date. We therefore collected data on 237 consecutive potential donors including their age, sex, ethnicity, relationship to the recipient, education, employment and religious beliefs and practices. Of these 237 candidates, 91 (38%) were excluded for medical and psychosocial reasons, 53 (22%) withdrew from the process predonation and 93 (39%) underwent partial liver donation. In multivariate analyses, the relationship between the donor and the recipient was highly predictive of successful donation. For pediatric recipients, no parents voluntarily withdrew from the evaluation process. For adult recipients, spouses are the most likely to donate, followed by parents, children and siblings. Additional predictors for donation included self-description as religious but not regularly practicing, part-time employment and higher education. Race, ethnicity, gender and age did not predict donation in multivariate analysis. Further understanding of the complex decision to donate may improve donation rates as well as permit more efficient and cost-effective donor evaluation strategies. [source] Revealing Concealable Stigmatized Identities: The Impact of Disclosure Motivations and Positive First-Disclosure Experiences on Fear of Disclosure and Well-BeingJOURNAL OF SOCIAL ISSUES, Issue 3 2010Stephenie R. Chaudoir People who live with concealable stigmatized identities face complex decisions regarding disclosure. In the current work, we examine how people's motivations for disclosing a concealable stigmatized identity for the first time affect the quality of their first-disclosure experiences and how these experiences, in turn, affect current well-being. Specifically, we found that people who disclosed for ecosystem, or other-focused, reasons report more positive first-disclosure experiences which, in turn, were related to higher current self-esteem. Analyses suggest that one reason why this first-disclosure experience is related to current well-being is because positive first-disclosure experiences may serve to lessen chronic fear of disclosure. Overall, these results highlight the importance of motivational antecedents for disclosure in impacting well-being and suggest that positive first-disclosure experiences may have psychological benefits over time because they increase level of trust in others. [source] Psychological adjustment among male partners in response to women's breast/ovarian cancer risk: a theoretical review of the literaturePSYCHO-ONCOLOGY, Issue 1 2010Kerry A. Sherman Abstract Objective: For women at high risk of developing hereditary breast and/or ovarian cancer the process of undergoing genetic testing is anxiety provoking and stressful, entailing difficult and complex decisions. Partners of high-risk women are frequently perceived by the women as a source of support during this challenging time. Utilising Self Regulatory Theory, this paper provides a theoretically guided overview of existing data to delineate how partners respond emotionally and behaviourally to the woman's high-risk status. Methods: An extensive literature search was undertaken. Online searches of MEDLINE, CINAHL and PsycINFO databases were conducted, reference lists of all publications identified were examined; and the databases were searched for authors identified in these publications. Results: The systematic search yielded 10 published studies on at-risk women and their male partners; one study did not investigate male partner distress as an outcome variable. Heterogeneity of methodology in this literature precluded quantitative meta-analyses of study outcomes. Review of the evidence suggests that the genetic testing process may be distressing for some partners, particularly for partners of women identified as mutation carriers. Associations were identified between partner distress and partner beliefs about the woman's perceived breast cancer risk; partner feelings of social separation and lack of couple communication; and partner perceptions of being alienated from the testing process. Lack of partner support was found to be associated with increased distress of the tested woman at the time of testing and following results disclosure. Data are lacking on the role of partner beliefs about breast cancer, partner perceived consequences of genetic testing, and personality factors such as information processing style, on partner distress. Conclusions: The high level of behavioural and psychological interdependence that exists between a tested woman and her partner means that future research seeking to understand the coping and adjustment processes of partners needs to adopt a dyadic, transactional approach that is grounded in psychological theory. Specific suggestions for future research in this context are delineated. Copyright © 2009 John Wiley & Sons, Ltd. [source] Analysis, ranking and selection of R&D projects in a portfolioR & D MANAGEMENT, Issue 2 2002Jonathan D. Linton A method for the analysis, ranking and selection of R&D projects from a portfolio is outlined and demonstrated. It is proposed that an objective multi-criteria decision making method, Data Envelopment Analysis (DEA), be used to split a portfolio of projects into accept, consider further and reject sub-groups. Next, the ,consider further' group is examined using a subjective method, the Value Creation Model. Such an approach allows for obvious decisions to be automated and complex decisions to be given careful consideration, an approach that is more consistent with how practising managers actually make select/reject decisions. DEA allows for comparison of variables without requiring weights or conversion factors. The relation between research strategy and consideration of categorical data is considered in relation to the research portfolio of the Advanced Technology Division of Bell Laboratories. [source] Big decisions by small networksBIOESSAYS, Issue 8 2010Stefan Schuster Abstract The primate brain is able to guide complex decisions that can rapidly be adapted to changing constraints. Unfortunately, the vast numbers of highly interconnected neurons that seem to be needed make it difficult to study the cellular mechanisms that underlie the flexible combination of stored and acute information during a decision. Established simpler networks, particularly with few and identified neurons, would lend themselves more readily to such a dissection. But can simple networks implement complex and flexible decisions similarly? After a brief overview of complex decisions in primates and of decision-making in simple networks, I argue that simpler systems can combine complexity with accessibility at the cellular level. Indeed, examination of a network in fish may help in dissecting key mechanisms of complex and flexible decision-making in an established model of synaptic plasticity at the level of identified neurons. [source] | ||||||||||