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Abstract: Objective: This article discusses the identification, selection, and refinement of topics for comparative effectiveness systematic reviews within the Agency for Healthcare Research and Quality''s Effective Health Care (EHC) program. Study Design and Setting: The EHC program seeks to align its research topic selection with the overall goals of the program, impartially and consistently apply predefined criteria to potential topics, involve stakeholders to identify high-priority topics, be transparent and accountable, and continually evaluate and improve processes. Results: A topic prioritization group representing stakeholder and scientific perspectives evaluates topic nominations that fit within the EHC program (are “appropriate”) to determine how “important” topics are as considered against seven criteria. The group then judges whether a new comparative effectiveness systematic review would be a duplication of existing research syntheses, and if not duplicative, if there is adequate type and volume of research to conduct a new systematic review. Finally, the group considers the “potential value and impact” of a comparative effectiveness systematic review. Conclusion: As the EHC program develops, ongoing challenges include ensuring the program addresses truly unmet needs for synthesized research because national and international efforts in this arena are uncoordinated, as well as engaging a range of stakeholders in program decisions while also achieving efficiency and timeliness. [Copyright &y& Elsevier]

Many Latinx and Indigenous Mexican populations in the United States Southwest live in unincorporated communities in the US-Mexico borderlands called colonias. These environmental justice communities often lack basic infrastructure, including healthcare services, prompting many to seek services across the border. However, due to geopolitical factors more vulnerable caregivers are limited to utilize healthcare services in the US. This paper reports the experiences and healthcare decision-making of caregivers living in colonias in the US-Mexico border region who care for children with respiratory health conditions. This study was carried out from September to December 2020. Focus groups and interviews were conducted with Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress. Qualitative interviews elicited caregivers' perspectives on the environmental factors affecting children's chronic health conditions and use of healthcare services. The analysis employed the concept of structure vulnerability to theorize geography as a structural determinant of health for caregivers faced with making healthcare decisions for their suffering from respiratory health conditions. A survey was administered to collect basic sociodemographic information. A total of 36 caregivers participated in the study. Structural factors including unincorporated community status and government inaction intersected with social determinants of health to prompt caregivers to cross the US-Mexico border to access healthcare services in Mexico for their children. Yet, more vulnerable caregivers (i.e., those without documentation status in the US) and their children, accessing healthcare services in the US was not an option limiting caregivers' ability to meet their children's healthcare needs. In such cases, geography acts as a structural determinant of health. This study shows the importance of geography in health. Rural unincorporated colonias located in the borderlands are precariously located and lack basic critical infrastructure including healthcare access. Within such places, historically and socially marginalized populations become invisible, are subject to the health effects of environmental hazards, and are limited depending on their positionality and thus vulnerability to healthcare services. • Municipal unincorporation contributes to health disparities among Latinx families in US-Mexico borderlands. • Latinx children in colonias are disproportionately exposed to environmental toxins. • Geography acts as a structural determinant of health for Latinx families in colonias. • A binational approach to health services should be prioritized for families in the borderlands. [ABSTRACT FROM AUTHOR]

In an increasingly information rich environment, it is important to teach students decision-making alongside information gathering and management methods. This paper examines the implementation of evidence-based decision-making in a first year introduction to management course at a large university in the Midwestern United States. Students learned decision awareness, decision-making process creation and decision practice alongside areas of management and basic business principles. Students perceived increased skill in decision-making, both individually and in groups. This venture has implications for others looking to help students not only learn experientially, but also improve critical thinking in practice. [ABSTRACT FROM AUTHOR]

In literature, many studies try to analyze healthcare usage and generated decision support systems. In this paper, the aim is to generate a decision support system for insurance companies in the United States according to the federal dataset. The data set contains variables from the United States Healthcare Administration formal data group and they are; group of age, group of healthcare insurance, group of nationality, Corporate Social Responsibility (CSR) usage, and Advance Premium Tax Credit (APTC) usage. The best model for each state in the United States is determined with the dataset from 2014 November to 2015 February. In this study, various statistical models are attempted to generate independent and optimal models for each state. In the model selection process, three different metrics are used. Accuracy rate, f1score and precision score are used in the model selection process and models are compared to each other according to these three metrics for each state uniquely. Consequently, the proposed model is used with a decision support scheme to support customer service workers in healthcare insurance companies. The decision support system under consideration can facilitate a substantial decrease in the duration of interactions between customer service representatives and clients. Additionally, this system can generate more logically sound and efficient customer offers. [ABSTRACT FROM AUTHOR]

This paper describes the design and protocol of a pragmatic, randomized trial to evaluate the comparative effectiveness of shared decision making versus motivational interviewing plus cognitive behavioral therapy for chronic pain for the voluntary tapering of opioid dose in adults with chronic noncancer pain. Integrated Services for Pain: Interventions to Reduce Pain Effectively (INSPIRE) is a multicenter, randomized trial conducted at three academic health centers in the southeastern United States. Participants are adults receiving long-term opioid therapy of at least 20 morphine milligram equivalents daily for chronic noncancer pain. Participants were randomized to either the shared decision-making intervention or the motivational interviewing session and cognitive behavioral therapy for chronic pain intervention. All participants also received guideline-concordant care supporting opioid pharmacotherapy. The primary outcome was change from baseline in average daily prescribed opioid dose at 12 months, using prescribing data from electronic health records. Secondary outcomes were Patient-Reported Outcomes Measurement Information System Pain Interference and Physical Function at 12 months. This trial evaluates the comparative effectiveness of shared decision making versus motivational interviewing plus cognitive behavioral therapy for chronic pain for the voluntary tapering of opioid dose in adults with chronic noncancer pain. Results from this study can guide clinicians, researchers, and policymakers as they seek to reduce opioid prescribing and improve management of chronic pain. ClinicalTrials.gov Identifier: NCT03454555 (https://clinicaltrials.gov/ct2/show/record/NCT03454555). Participant enrollment began on June 26, 2019. [ABSTRACT FROM AUTHOR]

Introduction: Previously, a web-based, patient-facing decision aid for lung cancer screening, shouldiscreen.com, was developed and evaluated. An initial evaluation was completed before the Medicare coverage decision and recruited a nondiverse sample of mostly former smokers, limiting the understanding of the potential effectiveness of the tool among diverse populations. This study evaluates shouldiscreen.com among African Americans in Metro Detroit.Methods: Using insights obtained from participatory workshops in this population, content changes to shouldiscreen.com were implemented, and this modified version was evaluated with a before-after study. Measures included knowledge of lung cancer screening, decisional conflict, and concordance between individual preference and screening eligibility. Surveys occurred between April and July 2018. Participants were contacted 6 months after the survey to assess subsequent screening behaviors. Analysis took place in 2019.Results: Data were collected from 74 participants aged 45-77 years, who were current/former smokers with no history of lung cancer. The average knowledge score increased by 25% from 5.7 (SD=1.94) before to 7.1 (SD=2.30) after (out of 13 points). Decisional conflict was halved between before and after. Concordance between individual preference and eligibility for screening increased from 22% (SD=41) to 35% (SD=47). Half of the participants felt uncomfortable answering surveys electronically and requested paper versions.Conclusions: The use of the tool led to small improvements in lung cancer screening knowledge and increased concordance with current recommendations. Additional design modifications and modes of information delivery of these decision aids should be considered to increase their efficacy in helping populations with lower educational attainment and computer literacy. [ABSTRACT FROM AUTHOR]

The ocean plays host to a vast array of sources of energy. These energies simply need to be developed efficiently and effectively, as well as harmonized and collected. This paper will present and discuss two major sources of sustainable ocean energy—wind and wave—which can be combined effectively into one multi-purpose structure. These dynamic structures are emerging as useful in many international settings. However, the United States' (U.S.) areas are slow to adopt. This research presents a hierarchical analysis for decision makers to utilize in strategic offshore location planning with regard to these platforms. Surprisingly, the Gulf of Mexico (GOM) proves to be in a favorable position for entities considering use of such multi-purpose platforms. • Combinatory analysis of energy collection modes. • Provides a conceptual framework using a hierarchical analysis tool. • Optimal location decisions for U.S. coastal regions. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to describe the 4-step process (consent, selection, protection, and abstraction) of acquiring a large sample of chiropractic patient records from multiple practices and subsequent data abstraction. From April 2017 to December 2017, RAND acquired patient records from 99 chiropractic practices across the United States. The records included patients enrolled in a survey e-study (prospective sample) and a random sample of all clinic patients (retrospective sample) with chronic back or neck pain. Clinic staff were trained to collect the sample, scan, and transfer the records. We designed an online data collection tool for abstraction. Protocols were instituted to protect patient confidentiality. Doctors of chiropractic were selected and trained as abstractors, and a system was established to monitor data collection. In compliance with data protection protocols, 3603 patient records were scanned, including 1475 in the prospective sample and 2128 in the random sample. A total of 1716 patients (prospective sample) consented to having their records scanned, but only 1475 could be retrieved. Of records scanned, 19% were unusable owing to illegibility, no care during the period of interest, or poor scanning. The abstractor interrater reliability for appropriateness of care decisions was fair to moderate (κ.38-.48). The acquisition, handling, and abstraction of a large sample of chiropractic records was a complex task with challenges that necessitated adapting planned approaches. Of the records abstracted, many revealed incomplete provider documentation regarding the details of and rationale for care. Better documentation and more standardized record keeping would facilitate future research using patient records. [ABSTRACT FROM AUTHOR]

Abstract: Coastal decision-making is impacted by global climate change and region-specific changes related to population growth, economic activities and the natural environment. This results in complex and interdependent problems. Addressing these problems requires the involvement of decision-makers, researchers and other societal actors in knowledge production. However, such means of knowledge production are poorly understood when it comes to coastal regions. Using a conceptual framework that makes a distinction between project arrangements and knowledge arrangements, this paper analyses interactive knowledge development in a nature restoration project on the US West Coast. The project adopted a collaborative approach, and involved diverse organisations in developing knowledge for reaching its restoration solutions. The case study analysis results in seven causal mechanisms. The mechanisms are divided into two groups. One group discusses processes that affect interactive knowledge development, such as the need for public support. The other group explains how interactive knowledge development functions, for example through facilitation and the creation of safe environments for researchers and regulators. Through identifying these mechanisms, this paper contributes to an improved understanding of interactive knowledge development in coastal regions. [Copyright &y& Elsevier]

Abstract: Rural amenity communities attract in-migrants with natural scenery, recreational opportunities, and cultural charm. But the demographic story of amenity destinations in the United States is not one of simply arrivals, but of cyclical and simultaneous arrivals and departures. While scholars of amenity migration paint detailed portraits of the people moving toward amenities, far less is written about those who leave amenity communities. Accessing a sample of reverse amenity migrants is both beyond the purview of most research and difficult to achieve logistically, but learning from these reverse migrants will sharpen the academic rendering of amenity communities. This paper analyzes content from online forums in which reverse amenity migrants from one region of the American Midwest reflect upon their experiences. It examines the extent to which they attribute their move to unmet social and material expectations, finding that divisions based on wealth are not only present among posts but addressed directly in posts. The paper considers the implications of contrasting expectations, and proposes that online forums can help researchers more easily investigate factors that influence modern migration decisions. [Copyright &y& Elsevier]

Abstract: The impact climate change will have on the alpine ski sector has received increasing attention from tourism scholars and industry representatives. This paper uses the US Northeast as a case study to examine the integrated regional impacts of climate change by modeling local-level impacts at all 103-ski areas operating in the region. Failing to examine an entire marketplace – as has been done in much of the climate change and ski tourism literature – means it is difficult to understand the regional implications that vulnerability at one ski area could mean for an adjacent ski area, for the regional ski marketplace, or for communities and individuals reliant on the sector generally. This paper presents the results of this comprehensive analysis, provides a discussion of the implications of change, and proposes a decision-making tool intended to help guide ski resort management in light of projected climate change. [Copyright &y& Elsevier]

Abstract: The United States and Australia confront the challenge of meeting multi-faceted Indigenous water requirements within the wider context of intensified competition for freshwater supplies and expiation of historic inequality of access. Fulfilment of Indigenous water claims requires acceptance of currently unrecognised uses that may be in conflict with water planning in irrigation-dominated basins. Adaptive governance regimes have been applied to deal with uncertainly and change in water planning and allocation decisions, including changes related to the recognition of Indigenous water claims, values, and knowledge. This paper examines the prospects of adaptive governance regimes to combine: (a) insights into decision-making and policy learning in contexts of high levels of uncertainty over the information base and legal and policy arrangements; with (b) institutional arrangements to coordinate decision-making and accountability across multiple decision-making units, values and jurisdictions, to accommodate Indigenous water claims. In both countries, efforts have involved (re)allocation of water entitlements and greater participation in multi-stakeholder basin planning. In this paper we find that a mix of these adaptive governance mechanisms shows greatest promise for overcoming resistance to the recognition of Indigenous water claims. [Copyright &y& Elsevier]

Abstract: This paper applies Agent-Based Modeling to the auto industry. The auto industry might be considered as a complicated rather than a complex system, because it is characterized by adaptation and emergence, two of the three major characteristics of complex systems . Yet some characteristics residing in human could lead us to consider the auto industry as a quasi-complex system because individual agents diffuse information and act based on adaptation. The roles of differentiated agents, including dealers, are significant: diverse agents function as autonomous decision makers who rely on localized information, thereby influencing the evolution of the current industry as it looks forward to a new phase of power propulsion development, such as hybrid, electric, and hydrogen fuel cell vehicles. The impact of rising oil prices on potential customers’ decisions, as well as what this paper identifies as the emotion factor between buyers and dealers, are incorporated to determine dynamics in terms of sales volumes. We are also interested in the extent and speed with which the new technology is adopted. Because of the consumer preferences and the long life cycles of cars, the adoption of new technology will be delayed given the current environment and policies in the United States. [Copyright &y& Elsevier]

Abstract: In the past several decades, decision makers in the United States have increasingly called upon publicly funded science to provide “usable” information for policy making, whether in the case of acid rain, famine prevention or climate change policy. As demands for usability become more prevalent for publicly accountable scientific programs, there is a need to better understand opportunities and constraints to science use in order to inform policy design and implementation. Motivated by recent critique of the decision support function of the US Global Change Research Program, this paper seeks to address this issue by specifically examining the production and use of climate science. It reviews empirical evidence from the rich scholarship focused on climate science use, particularly seasonal climate forecasts, to identify factors that constrain or foster usability. It finds, first, that climate science usability is a function both of the context of potential use and of the process of scientific knowledge production itself. Second, nearly every case of successful use of climate knowledge involved some kind of iteration between knowledge producers and users. The paper argues that, rather than an automatic outcome of the call for the production of usable science, iterativity is the result of the action of specific actors and organizations who ‘own’ the task of building the conditions and mechanisms fostering its creation. Several different types of institutional arrangements can accomplish this task, depending on the needs and resources available. While not all of the factors that enhance usability of science for decision making are within the realm of the scientific enterprise itself, many do offer opportunities for improvement. Science policy mechanisms such as the level of flexibility afforded to research projects and the metrics used to evaluate the outcomes of research investment can be critical to providing the necessary foundation for iterativity and production of usable science to occur. [Copyright &y& Elsevier]

Abstract: Climate change presents a significant planning challenge for water management agencies in the western United States. Changing precipitation and temperature patterns will disrupt their supply and extensive distribution systems over the coming decades, but the precise timing and extent of these impacts remain deeply uncertain, complicating decisions on needed investments in infrastructure and other system improvements. Adaptive strategies represent an obvious solution in principle, but are often difficult to develop and implement in practice. This paper describes work helping the Inland Empire Utilities Agency (IEUA) explicitly develop adaptive policies to respond to climate change and integrating these policies into the organizations'' long-range planning processes. The analysis employs Robust Decision Making (RDM), a quantitative decision- analytic approach for supporting decisions under conditions of deep uncertainty. RDM studies use simulation models to assess the performance of agency plans over thousands of plausible futures, use statistical “scenario discovery” algorithms to concisely summarize those futures where the plans fail to perform adequately, and use these resulting scenarios to help decisionmakers understand the vulnerabilities of their plans and assess the options for ameliorating these vulnerabilities. This paper demonstrates the particular value of RDM in helping decisionmakers to design and evaluate adaptive strategies. For IEUA, the RDM analysis suggests the agency''s current plan could perform poorly and lead to high shortage and water provisioning costs under conditions of: (1) large declines in precipitation, (2) larger-than-expected impacts of climate change on the availability of imported supplies, and (3) reductions in percolation of precipitation into the region''s groundwater basin. Including adaptivity in the current plan eliminates 72% of the high-cost outcomes. Accelerating efforts in expanding the size of one of the agency''s groundwater banking programs and implementing its recycling program, while monitoring the region''s supply and demand balance and making additional investments in efficiency and storm-water capture if shortages are projected provides one promising robust adaptive strategy — it eliminates more than 80% of the initially-identified high-cost outcomes. [Copyright &y& Elsevier]

Abstract: Land-use systems are characterized by complex interactions between human decision-makers and their biophysical environment. Mismatches between the scale of human drivers and the impacts of human decisions potentially threaten the ecological sustainability of these systems. This article reviews sources of complexity in land-use systems, moving from the human decision level to human interactions to effects over space, time and scale. Selected challenges in modeling such systems and potential resolutions are discussed, including strategies to empiricize complex models and methods for linking models across human and natural systems. Illustrative examples from published literature and an ongoing research project focused on timber harvest and carbon sequestration are used throughout the paper. The paper concludes with a brief discussion of remaining challenges to modeling indirect and cross-scale linkages and of the potential utility of complex models of land systems. [Copyright &y& Elsevier]

This article examines past, current, and future trends in the relationship between science, technology, and society. The evolution of current science policy in the USA is described. The paper then examines a shift in the current scientific and research environment that is calling forth new research collaborations, and a new relationship between science and society. This shift is demanding greater public participation in science and technology decision making, changing the traditional ‘trust us, we’re experts’ science–society relationship. The paper offers several methodologies used worldwide that provide citizens with the opportunity to participate in science and technology decision-making processes. It then examines how such methodologies are affecting research and funding agencies, and argues that such efforts need to be expanded. [Copyright &y& Elsevier]

Abstract: During the last decade, countries around the world - especially the U.S., Brazil, and many in Europe - have worked to accelerate the commercialization of a biofuel industry. As pilot plant studies for the second-generation biofuel (e.g., cellulosic biofuel) currently seek to determine the most viable feedstocks and processing technologies, it is an opportune time to formulate operations research (OR) models of the biofuel supply chain (SC) so they might be used to implement the technologies that prove to be most promising. This paper provides a literature review of research on the biofuel SC. It classifies prior research according to decision time frame (i.e., strategic, tactical, operational, and integrated) as well as level in the supply chain (i.e., upstream, midstream, and downstream). In addition, it reviews related research on agri-products, which have some commonalities relative to harvesting and perishability; petroleum-based fuels, which have some commonalities related to distribution (some biofuels can be mixed with gasoline but others cannot); and generic supply chains, which provide some applicable modeling structures. Finally, this paper emphasizes unique needs to support decisions that integrate the farm with commercial levels (e.g., storage, pre-processing, refining, and distribution) and identifies fertile avenues for future research on the biofuel supply chain. OR models are needed to help assure the economic viability of the biofuel industry. They can be used by growers, processors, and distributors to design and manage an integrated system and by government to inform policies needed to stimulate the growth of the industry and, perhaps, subsidize it. [Copyright &y& Elsevier]

Abstract: Evidence Based Policy has been articulated and practiced in Europe, particularly under the ‘New Labour’ policies of the former Labour government in the United Kingdom. In the United States, the impact of research on policy has been inconsistent due to differing relationships between researchers and policy makers. This paper gives an overview of evidence based policy and presents critiques based on its reliance on positivist methods and technical approach to policy making. Using these critiques as a framework, the paper discusses the case of Housing First, a policy adopted by the Bush Administration in order to address the problem of chronic homelessness. The case is an example of research driven policy making but also resulted in a progressive policy being promoted by a conservative administration. In discussing the case, the paper elaborates on the relationship between evidence and policy, arguing that evidence based policy fails to integrate evidence and values into policy deliberations. The paper concludes with alternative models of policy decision making and their implications for research. [Copyright &y& Elsevier]

Abstract: Electricity systems models are software tools used to manage electricity demand and the electricity systems, to trade electricity and for generation expansion planning purposes. Various portfolios and scenarios are modelled in order to compare the effects of decision making in policy and on business development plans in electricity systems so as to best advise governments and industry on the least cost economic and environmental approach to electricity supply, while maintaining a secure supply of sufficient quality electricity. The modelling techniques developed to study vertically integrated state monopolies are now applied in liberalised markets where the issues and constraints are more complex. This paper reviews the changing role of electricity systems modelling in a strategic manner, focussing on the modelling response to key developments, the move away from monopoly towards liberalised market regimes and the increasing complexity brought about by policy targets for renewable energy and emissions. The paper provides an overview of electricity systems modelling techniques, discusses a number of key proprietary electricity systems models used in the USA and Europe and provides an information resource to the electricity analyst not currently readily available in the literature on the choice of model to investigate different aspects of the electricity system. [ABSTRACT FROM AUTHOR]

Objectives: To identify what factors affect women's' decisions to delay childbearing, and to explore women's' experiences and their perceptions of associated risks. Design: Systematic procedures were used for search strategy, study selection, data extraction and analysis. Findings were synthesised using an approach developed from meta-ethnography. Data sources: We included qualitative papers, not confined to geographical area (1980–2009). Databases included CINAHL, MEDLINE, EMBASE, PsycInfo, ASSIA, MIDIRS, British Nursing Index and the National Research Register. We selected qualitative empirical studies exploring the views and experiences of women of advanced maternal age who were childless or primigravidae with a singleton pregnancy or primiparous. Review methods: Twelve papers fulfilled the selection criteria and were included for synthesis. Results: Women appear to face an issue of ‘informed and uninformed decision making’; those who believe they are informed but may not be, those who are not informed and find out they are at risk once pregnant, and those who are well informed but choose to delay pregnancy anyway. Maternity services could provide information to enable informed choice regarding timing of childbearing. Conclusions: Health professionals need to be mindful of the fact that women delay childbearing for various reasons. A strategy of pre-conception education may be beneficial in informing childbearing decisions. Obstetricians and midwives should be sensitive to the fact that women may not be aware of all the risks associated with delayed childbearing. [Copyright &y& Elsevier]

Abstract: This paper revisits the concept of medicalisation and considers its value as a framework for understanding the ongoing development of new reproductive technologies, and their impact on women’s reproductive decision-making. This evaluation is drawn from a qualitative discourse analysis of the public debate about the first extended cycle oral contraception (ECOC) to suppress menstruation in the United States of America in 2003/2004, and subsequent interviews with women living in Australia who had already extended their cycles without it being medically approved for widespread practice. Firstly, the debates about menstrual suppression are couched within a discussion of the ongoing usefulness of medicalisation as an analytical tool. It is posited that medicalisation occurs in a particular social and cultural moment, and is a dynamic process where dominant social relations can be both reproduced and challenged. Secondly, qualitative interviews with women about practices of menstrual suppression are used to explore the productive nature of agency in this particular medicalisation contest. Specifically, the ways in which these women engage with the discourses of ‘risk’, ‘choice’ and ‘nature’, as canvassed by menstrual suppression advocates, reveal accommodation and modification as much as resistance and contradiction. This paper suggests that if the concept of medicalisation is to have ongoing traction as a frame of analysis, such a critique must incorporate a generative discussion of agency. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) continues to present a challenge to international healthcare systems and structures of public health. The focus on optimizing antibiotic prescribing in human populations has challenged healthcare systems charged with making responsible their physician-prescribers. In the United States, physicians in almost every specialty and role use antibiotics as part of their therapeutic armamentariums. In United States hospitals, most patients are administered antibiotics during their stay. Therefore, antibiotic prescribing and utilization is a commonly accepted part of medical practice. In this paper, we utilize social science work on antibiotic prescribing to examine a critical space of care in United States hospital settings. From March to August 2018, we used ethnographic methods to study hospital-based medical intensive care unit physicians at the offices and hospital floors they frequent in two urban United States teaching hospitals. We focused on eliciting the interactions and discussions surrounding antibiotic decision-making that are uniquely influenced by the context of medical intensive care units. We argue that antibiotic use in the medical intensive care units under study was shaped by urgency, hierarchy, and uncertainty representative of the medical intensive care unit's role within the larger hospital system. We conclude that by studying the culture of antibiotic prescribing in medical intensive care units, we can see more clearly both the vulnerability of the looming antimicrobial resistance crisis and by contrast the perceived insignificance of stewarding antibiotic use when considered alongside the fragility of life amidst acute medical concerns regularly experienced in the unit. • Antibiotic prescribing in the intensive care unit was shaped by existing workflows. • The pressure to treat patients in an urgent manner led to increased antibiotic use. • Felt urgency combined with complicated patient cases fostered uncertainty. • Participants recognized an interconnectedness with other teams working in the unit. • Participants used timeliness as a rationale for antibiotic prescribing. [ABSTRACT FROM AUTHOR]

Shared decision making is a process in which patients are involved as active partners with the clinician in clarifying acceptable medical options and in choosing a preferred course of clinical care. Shared decision making offers a way of individualizing recommendations, according to patients'' special needs and preferences, when some patients may benefit from an intervention but others may not. This paper clarifies how the U.S. Preventive Services Task Force (USPSTF) envisions the application of shared decision making in the execution of screening and chemoprevention. Unlike conventional USPSTF reports, this paper is neither a systematic review nor a formal recommendation. Instead, it is a concept paper that includes a commentary on the current thinking and evidence regarding shared decision making.Although the USPSTF does not endorse a specific style of decision making, it does encourage informed and joint decisions. This means that patients should be informed about preventive services before they are performed, and that the patient–clinician partnership is central to decision making. The USPSTF suggests that clinicians inform patients about preventive services for which there is clear evidence of net benefit, and, if time permits, about other services with high visibility or special individual importance. Clinicians should make sure that balanced, evidence-based information about the service (including the potential benefits and harms, alternatives, and uncertainties) is available to the patient if needed. For preventive services for which the balance of potential benefits and harms is a close call, or for which the evidence is insufficient to guide a decision for or against screening, clinicians should additionally assist patients in determining whether individual characteristics and personal preferences favor performing or not performing the preventive service.The USPSTF believes that clinicians generally have no obligation to initiate discussion about services that have either no benefit or net harm. Nonetheless, clinicians should be prepared to explain why these services are discouraged and should consider a proactive discussion for services with high visibility or special individual importance or for services for which new evidence has prompted withdrawal of previous recommendations. [Copyright &y& Elsevier]

Many irreversible long-run capital investments entail opportunities for managers to respond flexibly to changes in the economic environment. However, common levelized cost measures used to guide decision-making, such as the levelized cost of electricity, implicitly assume that the values of random economic variables are known with certainty when investment decisions are made. This assumption implies, often incorrectly, that managerial flexibility carries zero value. This paper improves levelized cost measures by deriving an expansion that accounts for both uncertainties in relevant variables and the value of managerial flexibility in responding to them. This method is applied to quantify the value of flexibility in two example decision problems. In one, an operator of a natural gas electricity generation facility evaluates whether to invest in carbon capture capabilities. Another considers retirement decisions for U.S. nuclear plants. These examples illustrate that simplified cost metrics can inaccurately guide decision-making by inflating cost estimates relative to the proposed levelized cost measure that accounts for uncertainty and flexibility. [ABSTRACT FROM AUTHOR]

To equalize differences in health plan premiums due to differences in risk pools, the German legislature introduced a simple Risk Adjustment Scheme (RAS) based on age, gender and disability status in 1994. In addition, effective 1996, consumers gained the freedom to choose among hundreds of existing health plans, across employers and state-borders. This paper (a) estimates RAS pass-through rates on premiums, financial reserves, and expenditures and assesses the overall RAS impact on market price dispersion. Moreover, it (b) characterizes health plan switchers and investigates their annual and cumulative switching rates over time. Our main findings are based on representative enrollee panel data linked to administrative RAS and health plan data. We show that sickness funds with bad risk pools and high pre-RAS premiums lowered their total premiums by 42 cents per additional euro allocated by the RAS. Consequently, post-RAS, health plan prices converged but not fully. Because switchers are more likely to be white collar, young and healthy, the new consumer choice resulted in more risk segregation and the amount of money redistributed by the RAS increased over time. [ABSTRACT FROM AUTHOR]

Research on next generation agricultural systems models shows that the most important current limitation is data, both for on-farm decision support and for research investment and policy decision making. One of the greatest data challenges is to obtain reliable data on farm management decision making, both for current conditions and under scenarios of changed bio-physical and socio-economic conditions. This paper presents a framework for the use of farm-level and landscape-scale models and data to provide analysis that could be used in NextGen knowledge products, such as mobile applications or personal computer data analysis and visualization software. We describe two analytical tools - AgBiz Logic and TOA-MD - that demonstrate the current capability of farmlevel and landscape-scale models. The use of these tools is explored with a case study of an oilseed crop, Camelina sativa , which could be used to produce jet aviation fuel. We conclude with a discussion of innovations needed to facilitate the use of farm and policy-level models to generate data and analysis for improved knowledge products. [ABSTRACT FROM AUTHOR]

• Mothers have experienced a significant amount of stress during the COVID-19 pandemic stay-at-home orders in the US, which can have major implications for children's health and development; attention should be paid to developmental timing and unfolding of developmental trajectories following this pandemic. • Mothers have used a variety of strategies to cope; as more parents navigate social disruptions, they may benefit from additional resources and supports, such as innovations in childcare modalities, paid leave policies, and strengthening whole family processes using adaptive coping mechanisms. • Mothers with low income and/or children with special needs may experience more vulnerability to the sequalae of the pandemic; it is important to provide financial security, mental health, and educational and social support to relieve stress during the pandemic. This paper presents the results of a qualitative study of mothers' lived experiences during the COVID-19 lockdown in the United States. An analysis of open-ended interviews with 44 mothers who had children ages zero-to-five identified two main themes: (1) increased stress among mothers; and (2) resilience through the use of coping mechanisms. The findings indicate that the COVID-19 pandemic has led to higher stress among mothers due to issues of work-family life balance, family and children's needs, decision-making about getting sick, concerns for children's development, and lack of clarity from government officials. Mothers described using a variety of problem-focused and emotion-focused methods to cope with this stress. The lived experiences of mothers during the pandemic highlights the need for innovations in childcare modalities, paid leave policies to relieve stress, and strengthening whole family processes and resilience through the use of coping mechanisms. [ABSTRACT FROM AUTHOR]

• Discovered the industry recipe constructs for the Hollywood Film Industry and how they link with scenario planning strategies. • Created a framework that provides a contextual narrative for scenario planning experts. • Solved the problem of practitioner engagement with scenario planning. • Discovered niche areas for scenario planning strategies using the IL approach. This paper creates a theoretical construct through the synthetization of industry recipes in the Hollywood film industry and scenario planning's intuitive logics approach. It illustrates how the incumbent-challenger paradox coupled with the industry recipes framework can provide a robust scenario narrative. Through a multiple case study approach, an industry recipe is constructed, the industry recipe factors are identified. Then the intuitive logics approach is blended with the industry recipe factors through the creation of scenario recipe factors and represented in a theoretical framework. The underlying premise of the paper purports that exploration of the industry recipes framework can help advance the intuitive logics approach through narrative development. [ABSTRACT FROM AUTHOR]

Dyslipidemia is a common pathology throughout the industrialized world, and HMG-CoA reductase inhibitors (statins) are often administered to treat elevated lipid levels. Substantial concern has been raised regarding the aggressive clinical lowering of cholesterol, particularly in light of a growing body of research linking low circulating lipid levels with negative behavioral outcomes in both human samples and non-human primate models. In 2009, Goldstein and colleagues tentatively speculated that the greed, impulsiveness, and lack of foresight that lead to the worldwide economic collapse in 2007-2008 could have been caused (in part) by depressed population cholesterol levels resulting from the widespread use of statins by workers in the financial services industry. This paper reviews the literature that links low circulating lipid levels with neurobehavioral dysfunction, develops Goldstein and colleagues' initial speculation into a formal hypothesis, and proposes several specific studies that could rigorously empirically evaluate this hypothesis. [ABSTRACT FROM AUTHOR]

Despite some reductions in recent years, African American children in the United States continue to be disproportionately placed into out-of-home care. This paper describes a secondary analysis of data collected by Minnesota's African American Disparities Committee to identify whether factors in the casework process were contributing to Minnesota's extreme rates of disproportionality. The study, first described in a 2005 Minnesota Department of Human Services report, identified over 200 non-Hispanic, non-immigrant, white and African American child neglect cases substantiated in 2001 in four counties. Cases were then followed until case closure or for at least 18 months following the time of report to detail the casework process. This analysis used recursive partitioning to more accurately identify primary factors and potential interactions related to worker decision-making. African American and white children were matched by type of neglect, gender, age group, and county using administrative data. After rigorous data cleaning, 81 matched pairs were identified from a final sample of 180 cases. The progress of the children through the system was evaluated for potential race-based differences in the decision to refer a child for ongoing placement. Number of children, age, history of maltreatment, and report source were associated with placement decisions. Logistical regression follow-ups did not identify race-based interaction effects on placement decisions. However, African American cases statistically differed from white counterparts on presence of biological father and number of children in the household, identity of the perpetrator, parental and household risk factors, and whether an informal placement was arranged by police, some of which were associated with placement. Results are informed by a more detailed, qualitative follow-up analysis in a separate article. [ABSTRACT FROM AUTHOR]

Each time a user of a carsharing service reserves a vehicle they choose from a selection of vehicles that vary in attributes including rental price, the distance of the vehicle from their current location, the availability of the vehicle at their desired reservation time, and the type of vehicle (e.g., gasoline, Hybrid, Plug-in Hybrid or Electric). In this paper we analyze the results of a discrete choice survey administered to members of a leading North American carsharing organization. We quantify how carsharing users value price, distance from them, schedule and vehicle type. We find that for an average user, traveling one mile for a vehicle or rescheduling a trip by up to one hour are each approximately equivalent to a US$2/hour increase in vehicle price. We find that carsharing acts as a conduit to introduce users to new vehicle technology: more than half users report having driven a Hybrid vehicle through carsharing, representing 400 users exposed for every one Hybrid vehicle in service. All else being equal, users most prefer Hybrid vehicles. Users who report driving longer distances prefer not to take either electric vehicles or Plug-in Hybrids, despite the fact that Plug-in Hybrids do not have significant range limitations. [ABSTRACT FROM AUTHOR]

Users of International Land Ports of Entries (LPOEs) at the US – Mexico border experience excessive wait times on a daily basis. This contributes to the increased transportation costs, and also generates health and environmental problems in border regions. Traffic simulation models are effective tools for evaluating passenger vehicle, pedestrian and commercial traffic operations. These tools can be used to assess various scenarios and visualize current traffic conditions. Results obtained from these tools should be taken into account in congestion relief decision making processes. The research team developed, calibrated and validated three traffic models of the Ysleta-Zaragoza LPOE using three different software packages (i.e., TransModeler, VISSIM, and Aimsun). This paper presents advantages and disadvantages of each tool when modeling international LPOEs. Results presented herein can be used by practitioners to decide which tool should to be used for modeling LPOEs at the U.S. – Mexico border. [ABSTRACT FROM AUTHOR]

Care at the end-of-life in the United States has expanded in the past decade in large part due to structural changes such as increased access to hospice care, the integration of palliative care, policy mandates, and financial incentives. Despite these shifts, research shows that appropriate end-of-life care continues to be underutilized. This paper uses conversation analytic (CA) and ethnographic methods to examine doctor-patient interactions among a sample of 14 Stage IV cancer patients and the way decisions unfold about next steps in treatment during a moment that larger policy changes began to take place following passage of the Affordable Care Act. This work reveals that, despite structures designed to better facilitate end-of-life care transitions for patients in late life, doctors continue to demonstrate interactional hesitancy in discussing the possibility of a patient's end-of-life in treatment discussions and an orientation to the treatment imperative. Examining doctor-patient interaction as one key trouble source in end-of-life care implementation shows in situ evidence that the treatment imperative supersedes the structural shifts supporting less medical intervention in late life. • Despite policies supporting end-of-life care, doctors are hesitant to offer such treatment. • Doctors demonstrate pursuit of the treatment imperative in recommending treatment. • Analyzing micro-interactions offers critical insights into institutional inertia. [ABSTRACT FROM AUTHOR]

Most people want to be both happy and healthy. But which matters most when there is a trade-off between them? This paper addresses this question by asking 4000 members of the UK and US public to make various choices between being happy or being physically healthy. The results suggest that these trade-offs are determined in substantial part by the respondent's own levels of happiness and health, with unhappy people more likely to choose unhappy lives and unhealthy people more likely to choose unhealthy ones: "better the devil you know, than the devil you don't". Age also plays an important role; older people are more likely to choose being healthy over being happy. Information about adaptation to physical health conditions matters too, but less so than respondent characteristics. These results further our understanding of public preferences with important implications for policymakers concerned with satisfying those preferences. • Most people want to be both happy and healthy, but which matters most? • We trade-off levels of happiness and physical health in the UK and the US. • Choices are determined by respondents' own levels of happiness and health. • Information about adaptation to physical health conditions matters too. • The results have implications for policymakers seeking to satisfy those preferences. [ABSTRACT FROM AUTHOR]

Individuals in the early stages of the behavioral variant of frontotemporal dementia (bvFTD), a progressive neurodegenerative disorder marked by atrophy to the brain's frontal regions, exhibit severe disturbances to social and moral processing and decision-making after the onset of the disorder. These behavioral impairments, underlain by the neural deficits associated with the disorder, can often lead individuals with bvFTD to criminally offend. As such, behavioral and frontotemporal lobe abnormalities exhibited by offenders with bvFTD potentially represent several complex challenges for the legal system. This paper examines some of the ways in which the behavioral and neural impairments associated with bvFTD may influence issues surrounding the criminal responsibility, specifically legal insanity, and sentencing of offenders with bvFTD in the U.S. legal system. As there is very little literature in these areas concerning bvFTD, the existing academic dialogue on psychopathy, a disorder with similar behavioral symptoms and neural deficits, is used to frame the discussion on these issues. [ABSTRACT FROM AUTHOR]

In this paper we examine the outcomes associated with an innovative change in a state-level transportation project prioritization process within the United States (U.S.). A foundational component of the innovation is the development and implementation of a novel multi-criteria analysis (MCA) tool to aid decision-makers. The pre and post-MCA project prioritization processes are described in detail for the state of Vermont, and we use a mixed methodological approach to empirically evaluate the outcomes associated with the innovative change with respect to three objectives: (1) to make the project prioritization process more transparent, (2) to improve the project prioritization process by incorporating well-defined, objective evaluation criteria into the decision-making process, and (3) to reduce inequality in the allocation of transportation project funds between the local jurisdictions. We demonstrate that the innovative change in the project prioritization process was clearly successful in accomplishing objectives 1 and 2, but does not appear to be successful with respect to accomplishing objective 3. The findings are discussed in the context of the state of Vermont, and we offer suggestions for how funding inequality might be addressed in the future. [ABSTRACT FROM AUTHOR]

Farmers are decision-makers in a complex system of cause and effect. They decide with respect to their own attitude and beliefs, according to their farm structure and they take into account programs and regulations of the overarching policy scheme. In this paper we used mail surveys with identical questions to establish a cross-national comparison of two case study areas. The questionnaire investigates farmer's perspectives on what influences their own decision-making as well as their perception of the socio-ecological environment to relate these findings to the respective policy schemes in the case study areas. The two case studies are located in Southern Illinois, United States and in central Switzerland. The analysis shows that full-time farmers of the Southern Illinois case study area rate constraining factors such as financial aspects higher than Southern Illinois part-time farmers and farmers from the central Switzerland case study area. Furthermore, it is apparent that Swiss case study-farmers rate aspects of their land use responsibility and the Illinois case study-farmers rate ecological aspects higher. The empirical findings can be qualitatively explained through analysis of agricultural policy schemes. [ABSTRACT FROM AUTHOR]

Summary: This paper exploits unrealized intentions to migrate to highlight mobility constraints. I analyze the discrepancies between Mexicans’ intention to migrate and their subsequent migration behavior using the two waves of the Mexican Family Life Survey panel (2002 and 2005–06). I first provide evidence that intentions contain behavioral information. Controlling for various shocks likely to affect the migration decision, I find that women’s probability to carry out their migration plans is systematically lower than men’s. Different interpretations are investigated, but empirical evidence suggests that women’s unrealized migration plans are due to female-specific costs and constraints. [ABSTRACT FROM AUTHOR]

Abstract: This paper explores coordination and cooperation between different levels of governance in the EU Marine Strategy Framework Directive and the US National Ocean Policy. Both policies aim at overcoming the previous sectoral organization of the marine policy field by establishing integrated approaches. As in the EU and the US, competencies in marine policies are shared between different levels of governance, the proper implementation of the Marine Strategy Framework Directive and the National Ocean Policy to large parts depends on the common efforts of all levels involved. In this submission, the co-management approach is used to analyze the coordinative procedures throughout the policy processes in the EU and the US. It derives four criteria for effective shared management from the literature, which are then applied to the Marine Strategy Framework Directive and the National Ocean Policy. It appears that the EU and the US promote different consensus-oriented procedures: while in the EU, they are mainly part of the decision-making phase, in the US, they are mostly subsequent to the National Ocean Policy's adoption. [Copyright &y& Elsevier]

Public policies are a determinant of child health disparities; sound evaluation of these programs is essential for good governance. It is impossible in most countries to randomize assignment into child health programs that directly offer benefits. In the absence of this, researchers face the threat of selection bias—the idea that there are innate, immeasurable differences between those who take-up treatment and those who don't. In the field of Program Evaluation we are most concerned with the differences between the eligible people who take-up a program and the eligible people who choose not to enroll. Using a case study of a large U.S. nutrition program, this report illustrates how the perceived benefits of participation may affect the decision to take-up a program. In turn, this highlights sources of potential selection bias. Using data from a longitudinal study of mothers and infants conducted between May and December of 2005, I show that attitudes and beliefs prenatally toward breastfeeding determine enrollment in a U.S nutrition program that offers free Infant Formula. I also find that the significance of the selection bias differs by parity. Analysis reveals that maternal attitudinal responses are more highly predictive of future behavior, compared to standard demographic variables. In sum, this paper makes a case for rigorously understanding the factors that determine take-up of a program and how those factors can modify the results of a program evaluation. [ABSTRACT FROM AUTHOR]

Abstract: This paper analyzes the state of critical transportation infrastructure in the US, its relationship to security, and how the lack of an updated national policy to resolve the serious weaknesses of the transportation infrastructure negatively impact security. The difficulties in safeguarding transportation networks are identified along with the degree to which changes enacted since 9/11 regarding intelligence and administration, notably the establishment of the Department of Homeland Security, have led to increased security. However, these efforts, however successful, must be supplemented by a decision-making approach that goes beyond prevention and recognizes the importance of resiliency and such subsidiary concepts as robustness and redundancy. [Copyright &y& Elsevier]

Abstract: In the distribution of international logistics, the choice of the ways of transportation is one of the key factors to reduce the costs of distribution. In view of the countermeasures for the outsourcing and self-run business of the distribution transportation, the author of present paper aims at establishing analytical models, providing solutions which are confirmed by a case study from the investigation conducted in the United States of America, solving the high-cost question that plagues the network of international distribution over a long time, and providing a kind of decisionmaking tools for Chinese products to squeeze into the international market and establish the distribution networks. [Copyright &y& Elsevier]

Abstract: Today millions of consumers connect with one another on travel blogs as both contributors and users. Contributors share detailed narratives of their recent experience with specific hotels/resorts leading to recommendations, while users acquire information from them to base their purchase decisions on. Hotel managers carefully monitor what previous guests say in the evaluations assuming that negative evaluations will deter future customers. Framed in the expectancy-disconfirmation paradigm, this study focused on clarifying the impact consumers who post on travel blogs have on blog users by analyzing user reactions to 134 travel matched blog recommendations. Findings demonstrate that as expected a higher percentage of blog users find multiple evaluations that are congruent with one another (both negative and positive) helpful, and that negative postings were not necessarily bad if followed by a positive counter reaction. Furthermore, the paper addresses the issue of deception attempting to determine if it exists and what effect it has on the web 2.0 medium. Implications for managers and researchers are discussed. [ABSTRACT FROM AUTHOR]

Abstract: This paper reports on an assessment of activities undertaken to accelerate the transfer of new science into water management decision making. Current trends in science policy emphasize the need for research to demonstrate tangible benefits for decision makers, at the same time resource management decisions are recognized as involving multiple scientific disciplines embedded in specific decision contexts. SAHRA, a U.S. National Science Foundation funded Science and Technology Center for Sustainability of semi-Arid Hydrology and Riparian Areas, has developed an innovative research framework intended to respond to these trends. Examination of the SAHRA experience yielded multiple lessons on research to support decision making, including strategies for reconciling needs for advances in science with providing decision support; fostering adoption of science products; and communicating with research users. These lessons reinforce basic principles of usable science described in the literature and expand evidence-based guidance on implementation, especially in building effective knowledge networks and developing adaptive capacity within the science enterprise. Lessons learned are applicable to closing the gap between science and decision-making, and building a foundation of process knowledge to aid similar efforts by others. [ABSTRACT FROM AUTHOR]

Abstract: Beyond serving in complex decision-making, both the Analytic Hierarchy Process (AHP) and the Analytic Network Process (ANP) for the measurement of both tangibles and intangibles can be used in prediction rather effectively. This paper examines the potential of these models to help one discern current states and situations as well as suggest future outcomes. The first example uses the AHP to predict the Democratic Nominee in the 2008 United States presidential election and then uses that information to predict the overall election winner. The second example uses the ANP to predict the market share for ski equipment. The general structure of these models can be applied in many and diverse situations. [ABSTRACT FROM AUTHOR]

Abstract: Human societies depend for their survival on goods and services provided by both local and global ecosystems. For most of history, people used mainly local resources. Increasingly, however, globalization and trade enable consuming populations everywhere to support themselves on the output of distant ecosystems. This is potentially problematic because of global change and because the spatial separation of material production (including resource exploitation) from consumption eliminates the direct negative feedback that normally occurs when people dependent on local ecosystems degrade those ecosystems. With spatial separation comes psychological separation. Modern consumers remain generally unconscious of their growing reliance on biophysical goods and services produced half a world away and see no connection between their consumer lifestyles and distant ecological consequences. The purpose of this paper, therefore, is to raise a cautionary flag about unfettered trade and to show the value of accounting for trade-related physical flows and their impacts on natural capital in sustainability analyses. Using the United States as an example, we present an analytical method that can locate and measure the ecosystem area embodied in any population''s imports of renewable resources. We quantify U.S. imports from specific countries around the world; we estimate the area of terrestrial ecosystems in those countries devoted to consumers in the U.S. and we highlight both increasing U.S. imports and their potential impact on extra-territorial ecosystems. This method creates indirect (conceptual) feedback between consumption and ecosystems integrity which we hope will partially replace the physical feedback neutralized by globalization. Such analyses can help generate public and decision makers’ awareness of both their dependence and their impacts on, distant natural capital stocks. This in turn should increase interest in establishing improved co-management regimes to maintain the stability and reliability of such now obligatory relationships. [Copyright &y& Elsevier]

Abstract: There has been growing concern about the recent emergence of the critical challenges of energy availability and the impacts of climate change. Both are inextricably linked and dealing with them is fundamental to the progress of America and humanity. There are, however, a number of different views expressed, reflecting different assumptions, special interests, and partisan objectives. Decision-makers and the public need easy-to-use and transparent tools to better visualize, analyze, and understand the broader and longer-term implications of the varying underlying assumptions, policies, and strategies, including both their positive and negative impacts — both direct and indirect — and how to manage them. Threshold 21 (T21) the simulation model presented in this paper aims to become such a tool. The Millennium Institute has developed it over the last 24years. The T21-USA model results indicate that a continuation of current policies and trends will lead the US to become increasingly dependent on foreign energy resources and more vulnerable to price fluctuations. Furthermore, alternative scenarios simulating improved CAFE and Renewable Portfolio Standards (RPS) show that major reductions in the US'' resource consumption and pollution generation could be possible while stimulating the economy over the medium and longer term. Nevertheless, the model shows that unintended consequences, such as the Jevons Paradox, have to be taken into consideration when defining national energy policies. [Copyright &y& Elsevier]

Background: For several years there has been a vigorous policy debate on comparative effectiveness research (CER). This debate has focused on whether more evidence should be gathered, and who should be doing the funding and developing of evidence. There has been less emphasis on implementation of CER findings, and examining whether CER has or will have an impact on prescribing patterns, reimbursement, health outcomes, and health care spending. Objective: This paper addresses both empirical and normative aspects of CER in terms of its impact on prescribing, reimbursement, cost-containment, and health outcomes. Results: A significant gap persists between the best available evidence on therapeutic effectiveness and toler-ability and typical patterns of prescribing care, as well as patient choices. Consequently, there is room for building a more systematic evidence base in the United States, so that policymakers are better equipped to understand variation in clinical outcomes while promoting appropriate prescribing and reimbursement patterns. Methods: The author carried out a non-systematic literature review of both empirical and normative aspects pertaining to CER and its policy implications. Keywords for the Medline search were "comparative effectiveness research" and "policy implications." Conclusion: CER has a modest impact on prescribing, reimbursement, cost- containment, and health outcomes. This impact will likely intensify as funding increases and novel models to steer prescribing and reimbursement choices incorporate comparative-effectiveness evidence. [ABSTRACT FROM AUTHOR]

Summary: The Soil and Water Assessment Tool (SWAT) and the Hydrologic Simulation Program-Fortran (HSPF) are two river basin simulation models with similar scheme of watershed delineation and functionalities. Both have been selected as modeling tools to support decision and policy making in management of the Illinois River Basin, the United States. This paper reports results calibrating and evaluating SWAT and HSPF model to hydrologic data in the Illinois River Basin, with relative performance of two models in hydrologic simulation and model behaviors under calibration being further compared. In this study, two different calibration approaches, the multi-criteria and the generalized likelihood uncertainty estimation (GLUE) method, were used to quantify uncertainties originated from the use of multi-site discharge observations and the presence of equifinal solutions. It is concluded that both models achieved satisfactory performance after the calibration, and the parameter identification of each model was subject to considerable uncertainties. Furthermore, there exist parameter sets that enable the HSPF model to generate more accurate predictions of the discharges in the main stem of the Illinois River than the SWAT model does, but when the two models were run in un-calibrated mode the distributions of the model fit summary statistics for HSPF observed in the Monte Carlo sampling during GLUE calibration are more varied than those for SWAT with heavier tails on the inferior side and SWAT would have comparable performance to HSPF on average. This finding implies that the accuracy that the HSPF model can achieve in a modeling exercise may have more reliance on the efficacy of the calibration procedure, and the application of SWAT may have some advantage when calibration data are lacking or scarce. [ABSTRACT FROM AUTHOR]