Decision aids can decrease decisional conflict in patients with hip or knee osteoarthritis: Randomized controlled trial

BACKGROUND The interest in shared decision making has increased considerably over the last couple of decades.Decision aids(DAs)can help in shared decision making.Especially when there is more than one reasonable option and outcomes between treatments are comparable.AIM To investigate if the use of DAs decreases decisional conflict in patients when choosing treatment for knee or hip osteoarthritis(OA).METHODS In this multi-center unblinded randomized controlled trial of patients with knee or hip OA were included from four secondary and tertiary referral centers.Onehundred-thirty-one patients who consulted an orthopedic surgeon for the first time with knee or hip OA were included between December 2014 and January 2016.After the first consultation,patients were randomly assigned by a computer to the control group which was treated according to standard care,or to the intervention group which was treated with standard care and provided with a DA.After the first consultation,patients were asked to complete questionnaires about decisional conflict(DCS),satisfaction,anxiety(PASS-20),gained knowledge,stage of decision making and preferred treatment.Follow-up was carried out after 26 wk and evaluated decisional conflict,satisfaction,anxiety,health outcomes(HOOS/KOOS),quality of life(EQ5D)and chosen treatment.RESULTS After the first consultation,patients in the intervention group(mean DCS:25 out of 100,SD:13)had significantly(P value:0.00)less decisional conflict compared to patients in the control group(mean DCS:39 out of 100,SD 11).The mean satisfaction score for the given information(7.6 out of 10,SD:1.8 vs 8.6 out of 10,SD:1.1)(P value:0.00),mean satisfaction score with the physician(8.3 out of 10,SD:1.7 vs 8.9 out of 10,SD:0.9)(P value:0.01)and the mean knowledge score(3.3 out of 4,SD:0.9 vs 3.7 out of,SD:0.6)(P value:0.01)were all significantly higher in the intervention group.At 26-wk follow-up,only 75 of 131 patients(57%)were available for analysis.This sample is too small for meaningful analysis.CONCLUSION Providing patients with an additional DA may have a positive effect on decisional conflict after the first consultation.Due to loss to follow-up we are unsure if this effect remains over time.

New Scenarios for a Shift towards Agroecology in Viticulture

In the light of its negative impacts on the environment and human health, conventional agriculture is currently facing new challenges;for example, reducing pesticide reliance, improving biodiversity, adapting to climate change and reconciling winegrowers with consumers, which require changes to be made to vineyard management. A shift towards more sustainable agriculture via the development of agroecological systems may be key to meeting these environmental, economic and social challenges. This study aimed to evaluate the performance of existing viticultural systems, as well as that of three new scenarios that we built to change conventional vine production systems and their related practices. The end aim is to adopt the principles of agroecology, and more virtuously, to ensure that vine production remains in line with societal expectations. First, thirty-eight different viticultural systems were chosen. Three realistic scenarios for changing these production systems were then built by working with stakeholders and incorporating the best practices that had been identified in the vineyard. Conventional practices were optimised in the first scenario and an agroecological approach was adopted for the other two scenarios: an Agroecological scenario (using synthetic chemicals) and an Agroecological-Bio scenario (organic system). All three scenarios were based on a combination of good practices which contribute to enhancing vineyard biodiversity, and which thus restore biological regulation and in turn reduce pesticides. The viticultural systems performances have been evaluated with a methodology involving multicriteria decision aid using ELECTRE Tri-C and ELECTRE III methods. Seven evaluation criteria were selected which covered socio-economic performance (economic profitability, workload and system complexity) and environmental performance (pesticide pressure, pesticide ecotoxicity, agroecological practices and pesticide drift). The best performances were achieved by the two agroecological scenarios, and this methodology can be adaptable to different production systems everywhere in different viticultural regions.

Decision Aid Model for Private-owned Electric Vehicles Participating in Frequency Regulation Ancillary Service Market

To reduce the difficulty and enhance the enthusiasm of private-owned electric vehicles(EVs)to participate in frequency regulation ancillary service market(FRASM),a decision aid model(DAM)is proposed.This paper presents three options for EV participating in FRASM,i.e.,the base mode(BM),unidirectional charging mode(UCM),and bidirectional charging/discharging mode(BCDM),based on a reasonable simplification of users'participating willingness.In BM,individual EVs will not be involved in FRASM,and DAM will assist users to set the optimal charging schemes based on travel plans under the time-of-use(TOU)price.UCM and BCDM are two modes in which EVs can take part in FRASM.DAM can assist EV users to create their quotation plan,which includes hourly upper and lower reserve capabilities and regulation market mileage prices.In UCM and BCDM,the difference is that only the charging rate can be adjusted in the UCM,and the EVs in BCDM can not only charge but also discharge if necessary.DAM can estimate the expected revenue of all three modes,and EV users can make the final decision based on their preferences.Simulation results indicate that all the three modes of DAM can reduce the cost,while BCDM can get the maximum expected revenue.

Early construction cost and time risk assessment and evaluation of large-scale underground cavern construction projects in Singapore

The applicability of the Decision Aids for Tunneling(DAT)as an early construction cost and time predicting tool for large-scale underground cavern construction projects is investigated in this study.For this purpose,three large-scale underground cavern construction projects in Singapore are presented using the proposed framework.The data from Project A,which is already completed,are used to validate the prediction outcomes.The results show that the proposed workflow can well estimate the construction cost and time at the 95%confidence level.The DAT simulation results of the other two projects,which are in the early planning stages,are compared with Project A to assess the accuracy of the predicted cost and time.The results show that the proposed workflow with the DAT as a predictor is a valuable tool in estimating construction cost and time for large-scale underground cavern projects,particularly for feasibility studies.