A Real Case Application of Game Theoretical Concepts in a Complex Decision-Making Process: Case Study ERTMS

Engineering systems are complex, amongst others due to the interdependencies between actor and technical aspects. This complexity has consequences for the way of designing such systems and, in particular, for the decision-making process. Recognizing the impossibility of having an optimal system design in such complex systems, this article explores how a game theoretical characterization of a decision-making process assists in the organization and design of the process itself. In contrast to a game theoretical analysis, which results in optimal outcomes, the characterization is fed back to the designers of the decision-making process during the course of the process. The study analyses how the game concept characterization was used, i.e., which strategies were defined during the game theory interventions, and what the consequences of these strategies were for the design of the decision-making process. The design of a new safety system ERTMS for the Dutch railway sector is the context in which the study was performed. The contribution is a successful approach to complex decision-making in multi-actor systems by identification of multiple game concepts over time, with periodic feedback into the designing system, and not the actual decision-making itself. In short, it supported adapting to an actor focus on the process, it affected the role and responsibilities of the program management, it contributed to (de)coupling of issues, and it influenced the capability of creating awareness amongst actors of the urgency of the decision window. The paper ends with reflections on the experience of intervening in a decision-making process with game theoretical concepts.

Use of Energy-Based Domain Knowledge as Feedback to Evolutionary Algorithms for the Optimization of Water Distribution Networks

The optimization of water distribution networks (WDN) has evolved, requiring approaches that seek to reduce capital costs and maximize the reliability of the system simultaneously. Hence, several evolutionary algorithms, such as the non-dominated sorting-based multi-objective evolutionary algorithm (NSGA-II), have been widely used despite the high computational costs required to achieve an acceptable solution. Alternatively, energy-based methods have been used to reach near-optimal solutions with reduced computational requirements. This paper presents a method to combine the domain knowledge given by energy-based methods with an evolutionary algorithm, in a way that improves the convergence rate and reduces the overall computational requirements to find near-optimal Pareto fronts (PFs). This method is divided into three steps: parameters calibration, preprocessing of the optimal power use surface (OPUS) results, and periodic feedback using OPUS in NSGA II. The method was tested in four benchmark networks with different characteristics, seeking to minimize the costs of the WDN and maximizing its reliability. Then the results were compared with a generic implementation of NSGA-II, and the performance and quality of the solutions were evaluated using two metrics: hypervolume (HV) and modified inverted generational distance (IGD+). The results showed that the feedback procedure increases the efficiency of the algorithm, particularly the first time the algorithm is retrofitted.

Factors influencing Local Community Participation in Wildlife Conservation Projects in Northeast India

Participation by local communities in wildlife conservation projects have long been advocated since it is socially just and is effective to reach conservation and development goals. Socio–economic variables that drive participation and impact of participation have been studied, but the contextual process that stir up local community participation remains understudied. In this paper, we studied factors facilitating community participation in three wildlife conservation projects in Northeast India. Through ethnographic fieldwork at these sites we identified conservation actors and examined interactions between them.We found common modes of participation at these sites and these were related to gaining material incentives, providing labour, attending consultative workshops. Levels of interaction and coercion were found to be different in three sites. Three critical factors that drive participation were: (1) trigger, (2) negotiation and (3) sustenance. Trigger factors kickstart participation through establishment of a crisis narrative and facilitation by external actors. Negotiation factors emerge from day–to–day interaction between local community and external actors and involve effective entry stage activities, income opportunity, mediating voices within the community and intra–community dynamics. Sustenance factors affect the long term participation by community in the conservation project and involve tangible/intangible results, capability development of locals, funding and availability to critical information. In our paper we argue that investment of time and fund to understand the stakeholders and their concept of participation, periodic feedback sessions, capacity development of locals for self–mobilization, innovative information dissemination and securing long term funding are necessary for effective local community participation.

Factors influencing Local Community Participation in Wildlife Conservation Projects in Northeast India

Participation by local communities in wildlife conservation projects have long been advocated since it is socially just and is effective to reach conservation and development goals. Socio–economic variables that drive participation and impact of participation have been studied, but the contextual process that stir up local community participation remains understudied. In this paper, we studied factors facilitating community participation in three wildlife conservation projects in Northeast India. Through ethnographic fieldwork at these sites we identified conservation actors and examined interactions between them.We found common modes of participation at these sites and these were related to gaining material incentives, providing labour, attending consultative workshops. Levels of interaction and coercion were found to be different in three sites. Three critical factors that drive participation were: (1) trigger, (2) negotiation and (3) sustenance. Trigger factors kickstart participation through establishment of a crisis narrative and facilitation by external actors. Negotiation factors emerge from day–to–day interaction between local community and external actors and involve effective entry stage activities, income opportunity, mediating voices within the community and intra–community dynamics. Sustenance factors affect the long term participation by community in the conservation project and involve tangible/intangible results, capability development of locals, funding and availability to critical information. In our paper we argue that investment of time and fund to understand the stakeholders and their concept of participation, periodic feedback sessions, capacity development of locals for self–mobilization, innovative information dissemination and securing long term funding are necessary for effective local community participation.

Developing the infrastructure to support the optimisation of antibiotic prescribing using the learning healthcare system to improve healthcare services in the provision of primary care in England

IntroductionThe learning healthcare system (LHS) underpinned by data analysis and feedback to clinical care providers is thought to improve quality of care. The work aimed to implement an LHS for antibiotic prescribing in primary care in England.MethodDeidentified patient-level data from general practices were processed and analysed at regular intervals (fortnightly increments). A dashboard application was developed and implemented displaying analytical graphics to give periodic feedback to clinicians, tailored to each clinical site. Benchmarking parameters were established by the analysis of two large national primary care datasets allowing peer-to-peer comparisons. To date, the dashboard is available to 70 English practices.ConclusionsSuccessful implementation and uptake of the secure technical LHS infrastructure for the analysis and feedback to clinicians of their antibiotic prescribing demonstrate a great appetite for this type of frequent prescribing review in primary care, combining advanced data analytics with tailored feedback.

Analysis of cross matching to transfusion ratio of blood components in blood bank SKIMS, Soura: a prospective one year study

Background: Blood requisitions received in blood bank for elective and emergency procedures from surgery, trauma, Obstetrics and Gynaecology Department are often associated with excessive demand for cross matching of blood which is often more than the required blood and blood components. In this study, our goal was to use the blood stocks more efficiently and reduction in the wastage due to over dating and to prevent injudicious pre-operative cross-matching and utilization of blood.Methods: This was a prospective study conducted in the Department of Blood Transfusion and Immunohematology of Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar over a period of one year with effect from September 2017 to August 2018. Source was requisition forms and blood bank records of patients who underwent elective procedures in the hospital. For the purpose of analysis, departments were categorized into surgical and allied branches i.e Cardiovascular Surgery (CVTS), Neurosurgery, General Surgery and Obstetrics and Gynaecology. Department wise utilization of blood Components cross matching to Transfusion ratio (C/T), transfusion probability (T%) and Transfusion Index (TI) were calculated. Data was entered and analyzed using Microsoft excel window 2010. The obtained data was evaluated and presented in the tabular and diagrammatic forms.Results: A total of 3940 requests for cross matching of blood and its components were received for 3072 patients. Out of these, 2048 units were transfused. The total C/T Ratio, Transfusion Probability (T%) and Transfusion Index (TI) was 1.92, 42.5% and 0.6 respectively.Conclusions: To reduce the injudicious usage of blood, blood transfusion services need to adopt blood conserving policies. Efforts should be made to adopt more conservative transfusion thresholds, periodic feedback to improve blood ordering, conduct regular auditing, handling, distribution and utilization practices of this scarce resource.

A Mobile-Based Comprehensive Weight Reduction Program for the Workplace (Health-On): Development and Pilot Study

Background There is a growing interest in mobile technology for obesity management. Despite the known effectiveness of workplace-based weight loss programs, there are few studies on mobile phone–delivered interventions. Objective This study aimed to develop and verify an integrated and personalized mobile technology–based weight control program, named Health-On, optimized for workplaces. Methods A weight reduction algorithm was developed for calorie prescription, continuous monitoring, periodic feedback and reevaluation, goal resetting, and offline intervention with behavior-changing strategies. A total of 30 obese volunteers (body mass index ≥25 kg/m2) participated in the 12-week Health-On pilot program. The primary outcome was weight reduction, and secondary outcomes were improved anthropometric measures, metabolic profiles, and fat computed tomography measures, all assessed pre- and postintervention. Results Health-On incorporated proprietary algorithms and several strategies intended to maximize adherence, using compatible online and offline interventions. The mean weight of 30 participants decreased by 5.8%, and median weight also decreased from 81.3 kg (interquartile range [IQR] 77.1-87.8) before intervention to 76.6 kg (IQR 70.8-79.5) after the 12-week intervention period (P<.001). The metabolic profiles and fat measures (blood pressure, glycosylated hemoglobin, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, alanine aminotransferase, and visceral and subcutaneous adipose tissue; P<.05) also improved significantly. Conclusions In this single-group evaluation of 30 participants before and after the Health-On program, body weight decreased and metabolic profiles and fat measures improved. Follow-up studies are needed to assess effectiveness and long-term adherence.

The Effect of Midyear Report Cards on Colonoscopy Quality Measures

Introduction. Since 2011, our institution has distributed annual reports, in June, to providers with personalized data regarding adenoma detection rate (ADR), colonoscope withdrawal time (CW), and cecal intubation (CI) rate, using standardized reporting systems. We examined the impact of distribution of individualized reports at the midpoint of each year on colonoscopy outcomes in the latter half of each year. Methods. Providers with endoscopy privileges, performing ≥20 colonoscopies/year, at our center throughout a five-year period (2011-2015) were included. The three metrics recorded and reported were ADR, CW, and CI using standard benchmark rates. The mean values of each metric from January through June (1st half) and July through December (2nd half) were calculated. Curve estimation test was used to determine the significance of ADR in the respective time period. Results. Fifteen providers were eligible for the study. Collective ADR in the 1st half of all years was 26.9% and in the second half of all years was 28.1% (p=0.476). CW for all years was more than 9 minutes while CI was above 90% for all providers. There was no significant increase in the CI and CW during the 5-year study period. Overall, ADR increased from 26.43% (2011) to 33.47% (2015) (p=0.137). When examining ADR during each of the 12 months following the June report cards, there was no month-to-month trend observed (p=0.893). Conclusion. Endoscopists at our institutions met/exceeded the quality metrics in the first half of each year from the beginning of the study. Routine reporting may maintain, but not improve, outcomes. Long-term studies to determine if periodic feedback to endoscopists improves the quality of endoscopy as per national standards for detection of early colorectal cancers are required.

A Mobile-Based Comprehensive Weight Reduction Program for the Workplace (Health-On): Development and Pilot Study (Preprint)

BACKGROUND There is a growing interest in mobile technology for obesity management. Despite the known effectiveness of workplace-based weight loss programs, there are few studies on mobile phone–delivered interventions. OBJECTIVE This study aimed to develop and verify an integrated and personalized mobile technology–based weight control program, named Health-On, optimized for workplaces. METHODS A weight reduction algorithm was developed for calorie prescription, continuous monitoring, periodic feedback and reevaluation, goal resetting, and offline intervention with behavior-changing strategies. A total of 30 obese volunteers (body mass index ≥25 kg/m²) participated in the 12-week Health-On pilot program. The primary outcome was weight reduction, and secondary outcomes were improved anthropometric measures, metabolic profiles, and fat computed tomography measures, all assessed pre- and postintervention. RESULTS Health-On incorporated proprietary algorithms and several strategies intended to maximize adherence, using compatible online and offline interventions. The mean weight of 30 participants decreased by 5.8%, and median weight also decreased from 81.3 kg (interquartile range [IQR] 77.1-87.8) before intervention to 76.6 kg (IQR 70.8-79.5) after the 12-week intervention period (<italic>P</italic>&lt;.001). The metabolic profiles and fat measures (blood pressure, glycosylated hemoglobin, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, alanine aminotransferase, and visceral and subcutaneous adipose tissue; <italic>P</italic>&lt;.05) also improved significantly. CONCLUSIONS In this single-group evaluation of 30 participants before and after the Health-On program, body weight decreased and metabolic profiles and fat measures improved. Follow-up studies are needed to assess effectiveness and long-term adherence.