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We hope you enjoy the Winter edition of the Society for Medical Decision Making Newsletter
SMDM Newsletter
Welcome

 

Welcome

From the Editor
by Joshua A. Hemmerich, PhD

From the President
by Murray Krahn, MD, MSc, FRCPC


SMDM Meetings

 

 

SMDM Meetings

2013 North American Meeting Recap
2014 European Meeting
iHealth 2014 Conference




Commentary

Commentary

Shared Decision Making has reached a tipping point, or has it? by Arwen H. Pieterse, PhD
Health Policy Orientation Workshop
by Aurelie C. Thiele, CHFP, PhD
Applying the Evolving Science of Decision Making to Surgery
by Vlad V. Simianu, MD, Rafael Alfonso-Cristancho, MD, MSc, PhD, and David R. Flum, MD, MPH


Other News

Society Updates

SMDM Board of Trustees
Call for Board Nominations
Welcome to SMDM’s Newest Emeritus Members!
2013 SMDM Award Winners
Lusted Moderated Poster Session Début
Call for Award Nominations
Networking Committee

 

In Every Issue

In Every Issue

SMDM Connect
Medical Decision Making
Other News
Members News
Student News
Recognition of Lifetime Contributors

 

 

 

Events and Opportunities

Be sure to take advantage of all of the events and opportunities SMDM has to offer.
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Join or Renew Your Membership
Opportunities to Volunteer
2014 ESMDM Call for Abstracts  
Job Postings
Support SMDM
Join SMDM on Facebook
Contact Us



 

Editors

Editors

Joshua A. Hemmerich, PhD, Editor-in-chief, The University of Chicago
jhemmeri@medicine.bsd.uchicago.edu
Dana Alden, PhD, Senior Editor, University of Hawaii at Manoa
dalden@hawaii.edu


 

Commentators

Arwen H. Pieterse, PhD, Leiden University Medical Center, the Netherlands
Aurelie C. Thiele, CHFP, PhD, Lehigh University, Bethlehem, PA
Vlad V. Simianu, MD, University of Washington, Seattle WA
Rafael Alfonso-Cristancho, MD, MSc, PhD, University of Washington, Seattle WA
David R. Flum, MD, MPH, University of Washington, Seattle WA

 

 

Additional Contributing Authors

Murray Krahn, MD, MSc, FRCPC, University of Toronto
Jeff Van den Ende, MD, PhD, Institute of Tropical Medicine
M.G. Myriam Hunink, MD, PhD, Erasmus University Medical School
Scott Braithwaite, MD, New York University School of Medicine
Scott B. Cantor, PhD, The University of Texas MD Anderson Cancer Center
Amber E. Barnato, MD, MPH, MS, FACPM, University of Pittsburgh
Victoria Shaffer, PhD, University of Missouri


 




 

Joshua HemmerichFrom the Editor

by Joshua A. Hemmerich, PhD, Editor-in-chief, The University of Chicago

It is understandable if the future looks dark, mysterious and somewhat intimidating like the monolith from the film 2001: A Space Oddyssey. The new year brings a new dawn of healthcare in the US and continuing change around the globe with a mission to promote effective and affordable health care delivery to the Earth’s growing population of diverse patients. It seems that making good decisions, at all levels, has only grown in importance and consequence. One specific example is how Americans faced 2014 having witnessed intense political contention and technological malfunctions in rolling out a new system which is sure to present new challenges to providers and patients. As well, it is clear that the SMDM is succeeding in becoming a world-wide entity with ever-increasing international and multicultural membership. With the world’s population growing, and growing older, healthcare in our world is likely to change in dramatic ways. Fortunately, many bright and driven minds from around the globe are taking on the mission to prepare for these changes which run the gamut of strained budgets, new technologies, ethical imperatives and the challenge of educating clinicians, patients and caregivers to maximize the efficacy and satisfaction with healthcare.

This month our Letter from the President, Murray Krahn, MD, MSc, FRCPC, reflects on world change in the past 25 years. We have a recap of the North American meeting and a preview of the Biannual Meeting in Antwerp, Belgium this coming June, as well as an announcement that the society will support the American Medical Informatics Association’s (AMIA) and AcademyHealth’s iHealth 2014 conference held from January 30 to February 1 in Orlando, Florida.

This quarter’s Newsletter includes three interesting commentaries. Arwen Pieterse, PhD, presents a challenging problem for many researchers, clinicians, policy makers and patients on what must actually be done to meet the model requirements of Shared Decision Making. Aurelie Thiele, PhD, provides an informative report on AcadamyHealth’s Health Policy Orientation Workshop held in the Kaiser Family Foundation in Washington, DC, last October. There is also an article on the collaborative advancements in the study of surgical decision making, through the Comparative Effectiveness Research and TranslAtIonal Network (CERTAIN) at Washington University, a project that seeks to improve physician-level decision making in surgical care.

Additionally, there is a bevy of important societal updates and calls for nominations that you will be sure to want to check in on.

I urge you, if you haven’t already, to get connected in the SMDM Connect social network http://connect.smdm.org/. Among other things, this network can provide a forum for discussion and debate about any of the articles from the Newsletter, or any topic of interest to the members of the SMDM community.


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Murray KrahnFrom the President

by Murray Krahn, MD, MSc, FRCPC, University of Toronto

When I joined SMDM, around 1989, I felt like I found a community of people who spoke my language - a whole group of left brained, (metaphorically) beard stroking, intellectuals who thought and spoke in trees. Apart from tree, though, they mainly spoke English, and worked in the US or Canada.

The world has changed since 1989:
1. The global economic center of gravity is shifting away from North America and Europe. In 2000, the US and Europe accounted for 49% of global GDP. In 2025, these two regions will account for 36%, similar to the combined output of India and China (31%).

2. The intellectual center of gravity is shifting too. While 10/10 of the top ranked universities are still in North America or Europe (2013 QS rankings), 25 of the top 100 are not. The top 100 now includes many Asian institutions (e.g. National University of Singapore (#24), Seoul National University (#35), University of Tokyo (#32), Nanyang Technical University (#41)). By 2025, it is a safe bet that there will be more in the top 100.

We (i.e. SMDM) are changing too:
1. Our membership outside North America has grown. In 1990, very few of our members were from outside North America. In 2013, 24% of our members are.

2. We now have a thriving European meeting - at the last meeting in Oslo in 2012, there was a real sense that a critical mass had been reached, and that the European meeting had both high numbers and incredible intellectual vitality.

3. Through the efforts of Bruce Schackman, PhD, and others, we now have a successful international scholarship program that has made it possible for dozens of students and scholars to attend the North American and European meetings. We’ve also started to expand our internship program. After starting with the AHRQ-SMDM fellowship program, DIMDI, the German health technology agency, has agreed to sponsor a fellow, and CADTH, the Canadian agency, is enthusiastic about sponsoring a fellow as well. We are hoping to expand to other HTA agencies as well.

4. As I write this, the first ever 2014 Asia meeting is winding down. We had over 165 attendees from 26 countries. It looks as though we actually are going to be able to successfully engage scholars, students, government officials, and industry from Asia in our increasing global conversation about making decisions in health and medicine.

The world is big, bigger than it has historically appeared to be from our meetings in Baltimore, Toronto, and Chicago. My hope and aspiration is that the next decade sees us as a society opening up to people and ideas from Asia, Latin America, and Africa. To grow as a society, in all of the important ways, we need to think about ways in which we can be at the heart of a truly global conversation about making decisions in health and medicine, and to become a truly international society.


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North American Meeting: Enjoyed by All

The 35th SMDM Annual North American Meeting, held October 19-23, 2013, in Baltimore, Maryland, was a huge success. This year's event included innovative and engaging sessions related to all aspects of medical decision making and plenty of opportunities for networking and career development. Special thanks to co-chairs Heather Taffet Gold, PhD, New York University School of Medicine, Elena Elkin, PhD, Memorial Sloan-Kettering Cancer Center, and the entire committee for planning such an informative and enriching event. Mark your calendar now for the 2014 North American Meeting, October 18-22 in Miami, Florida, USA.

2013 North American Meeting Photos
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Biennial SMDM-Europe Conference in Antwerp, June 2014

by Jeff Van den Ende, MD, PhD, Institute of Tropical Medicine and M.G. Myriam Hunink, MD, PhD, Erasmus University Medical School, Meeting Chairs

Antwerp Meeting ChairsThe 15th Biennial European Meeting of the Society for Medical Decision Making will take place at the Elzenveld Hotel and Congress Centre, Antwerp, Belgium, June 8-10, 2014. The venue is a superb old monastery, where posters will be set up and coffee and meals served in a century old ward of infectious diseases.

The special focus will be: “clinical decision making in the era of personalized medicine’’. Clinical decision making got a great boast in the seventies, with the famous publications by Pauker and Kassirer. After a few decades of relative silence, interest in this discipline is again rising, especially in personalized medicine, shared decision making and undergraduate training. The threshold concept they conceived has been proven a cornerstone in clinical practice. Apart from the special focus, the broad field of medical decision making will be addressed in symposia, workshops, pre-conference courses, presentations and poster sessions.

Abstract submission is now open for oral and poster presentations, panels and workshops. The deadline for submissions is February 10.

As is tradition, the meeting offers a social program to enable participants to socialize and network. On June 9, participants can opt to join the conference dinner at the Felix Pakhuis which is located in Antwerp's old port area, opposite to the famous new MAS museum.

The Felix Pakhuis (Felix Warehouse), designed by architect Felix Pauwels, was built in 1858 and was used to store a wide array of goods, from coffee, grain and cheese to wine and tobacco. In 1861 the warehouse burned down but it was immediately reconstructed using material that was recovered from the rubble. After the city's port activity moved, the building stood empty until 2006, when Antwerp's municipal archives were moved into the building. Located right on the dockside the Felix Pakhuis is an impressive and picturesque venue for the meeting dinner.

The MAS is of course first and foremost a museum, but it is also an extraordinary building in its own right, occupying an extraordinary site in an extraordinary location. The MAS is an eye-catching building. Its design was inspired by a sixteenth-century storehouse or ‘Hanzehuis’. The galleries are stacked up like ‘boxes’ creating a spiral tower with large expanses of glass. As you go up on the escalators from the ground floor to +9, you have a constantly changing view of Antwerp: city, port and river in a single glance. The MAS was designed by architects Neutelings and Riedijk. The outside consists of red stone from India and curved expanses of glass six metres high. The radiant red MAS tower is covered with 3,000 hands in aluminum which sparkle in the sunlight.

At the conclusion of the meeting on June 10, all participants are invited by the Mayor of the City of Antwerp to a special reception at the City Hall. The City Hall (Stadhuis) stands on the side of Antwerp's Great Market Square (Grote Markt). The Hall was constructed between 1561 and 1565 under the supervision of the master builder Cornelis II Floris de Vriendt and several other architects and artists, including Nicolo Scarini. The design of the building is in the Flemish-Italian Renaissance style, also known as the Floris style.

We look forward to welcoming you to SMDM Europe 2014 in Antwerp!

Jef Van den Ende
Peder A. Halvorsen
Myriam G.M. Hunink
Ivar Sønbø Kristiansen

SMDM Belgium Header
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SMDM Announces Support for iHealth 2014 Conference


iHealthSMDM is pleased to support the iHealth 2014 conference convened by the American Medical Informatics Association (AMIA) and co-hosted by AcademyHealth from January 30 to February 1 in Orlando, Florida. The purpose of the conference is to facilitate collaborations among clinical informatics leaders in a step toward the transformation of healthcare delivery.

SMDM Members Steven Downs, MD, MS, and Scott Braithwaite, MD, are developing a session for the conference.

At the iHealth conference, some of the most influential voices in healthcare and clinical informatics will have the opportunity to discuss opportunities and challenges in the field, and forge new ways to translate the power of informatics into the clinical setting. The emergence of “Big Data” and a more robust health IT infrastructure has meant growing interest and traction within health systems.

Other conference speakers will include leading innovators in the field, such as keynote speaker Mark B. McClellan, MD, PhD, MPA, Director of the Engelberg Center for Health Care Reform; Lisa Simpson, MB, BCh, MPH, President and CEO of AcademyHealth; and Elizabeth McGlynn, PhD, Director of the Kaiser Permanente Center for Effectiveness and Safety Research.

For more information, please visit the iHealth 2014 website.

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Commentary


The opinions stated in the following commentaries are solely those of the authors and do not reflect the opinions of the Society for Medical Decision Making.


Shared Decision Making has reached a tipping point, or has it?

by Arwen H. Pieterse, PhD, Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands

Arwen PieterseResearch worldwide on shared decision making (SDM) is booming. This collective scientific effort has not gone unnoticed by the real world - health care professionals, patients, politicians, health insurance companies, and policy makers. Calls are heard to start making the transition towards implementation of all new insights into daily clinical practice. For example, three of the eight Dutch academic medical centers signed the Salzburg Statement (BMJ 2011;342:d1745) on SDM this year, and in doing so, publicly endorsed the principle of active patient participation in decision making.

Then, what is it exactly that health care professionals, in collaboration with their patients, need to do? And when should they do it?

I’d like to briefly address three issues relating to the implementation of SDM. First, when should health care professionals aim to share decisions with patients? The distinction made between preference-sensitive and effective decisions is helpful to foster reflection on and acceptance of the idea that individuals vary in the health care goals they aim to achieve. The critical question is how to determine when preferences are more or less relevant to making the most appropriate treatment choices. Alternatively, the radical idea that any treatment decision is preference-sensitive could be adopted. The evidence suggests that a large majority of patients prefers to share decision-making with their doctors. The numbers are even larger when we include those patients who want to participate in the decision process whilst deferring responsibility for the final decision to the health care professional. At the same time, we need to be wary of making SDM an imposition. And, in all cases in which doctors and patients aim for a shared decision, doctors should refrain from leaving the decision to patients altogether, without providing them with the knowledge and guidance to make an informed treatment choice.

Second, what does it look like? An essential element of SDM is informing patients. Patients should know their options and the consequences of each option, and health care professionals are responsible for informing patients as is necessary to enable them to deliberate about the options. I’m sure that what we have observed in our studies applies to many other clinical situations and health care systems worldwide in actual practice. In our cancer studies, we have seen substantial practice variation in what surgical, radiation, and medical oncologists tell patients with similar diagnoses and treatment options, both when comparing oncologists and when comparing different consultations with the same oncologists. Also, surgical oncologists reported what they considered minimally required information about surgical options, but this was at odds with what was communicated to patients. We have yet to find determinants of why some information is or is not given. Patient questions could not explain the variance, nor could patient or oncologist characteristics.

As a first step in reducing unwarranted variation in information provision during consultations, we performed separate Delphi studies among radiation oncologists and treated rectal cancer patients to determine what radiation oncologists should tell a newly-diagnosed rectal cancer patient about pre-operative radiation. The Delphi process resulted in a manageable list of items that should be communicated to patients, on which experts (i.e., oncologists and patients) agreed. We were quite surprised that it took three (!) rounds among radiation oncologists to reach consensus – i.e., for at least 80% to agree on the necessity of telling patients what the benefit of the treatment is, i.e., better local control of the disease. In this particular clinical case, this is the raison d’être for pre-operative radiation.

Third, a key component of SDM is to incorporate patients’ preferences – their views, expectations, and concerns, in the final decision. But, just how should this be done? If these preferences already exist, are they based on relevant and complete information? And are they consistent over time? If preferences are not clear yet, in what way should they be elicited without being unintentionally influenced? We have little insight into how preferences develop in individuals’ minds and hearts. Health care professionals can only go by what the patient and present companions tell them about the patient’s preferences, and the doctors’ own appraisal of what seems most important to the patient. Our studies show that although patients face a preference- sensitive decision –about adjuvant cancer treatment or primary treatment of localized prostate cancer – there is little explicit mention of patients’ preferences during consultations. And rarely are preferences explored to any extent. Yet, how else can doctors know about their patients’ preferences, then by discussing them during the consultation? As long as we are unsure about the way informed preferences can best be fostered, we should at least teach medical students about the relevance of considering and examining patient views, expectations and concerns. And help students appreciate the value of practices known to facilitate patient involvement in discussions, such as providing opportunities to ask questions and to state concerns.

What SDM actually is, what it means to different participants in interactions, and how doctors’ and patients’ knowledge levels affect the experience of what is shared, has not yet been fully elucidated. Also, there is only scant evidence on how SDM affects patient outcomes. Many tend to draw on the evidence demonstrating positive effects of administering patient decision aids on patient outcomes – such as improved knowledge levels, lowered decisional conflict, and more realistic expectations about outcomes of care. Although patient decision aids can very well support making a shared decision, their effects should not be equated to potential effects of adhering to a SDM process.

Why then these strong calls for the implementation of SDM? Because we expect that it will make a difference. From the implementation of SDM, we expect that care will be better tailored to patients’ needs; that it will reduce the use of interventions with only minimal expected benefit; and that it is a key strategy to better respect patients’ autonomy. Some also expect that it will reduce health care costs. As long as strong evidence about the actual effects of SDM is unavailable, the call for sharing treatment decisions with patients should be based on the ethical grounds that – in most cases – it is the right thing to do.

We welcome discussion with others who are interested in joint research on this important topic. Please feel free to contact us at: a.h.pieterse@lumc.nl

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Health Policy Orientation Workshop

by Aurelie C. Thiele, CHFP, PhD, Lehigh University, Bethlehem, PA

Aurelie ThieleThe annual Health Policy Orientation Workshop, organized by AcademyHealth, was held in the offices of the Kaiser Family Foundation in Washington, DC, in late October. The workshop introduced the basics of health policy to about fifty participants with a wide range of backgrounds – from Robert Wood Johnson Nursing and Health Policy Fellows or Institute of Medicine Fellows to management associates in pharmaceutical companies, staff members of health-related nonprofit organizations and a number of faculty members in various fields.

Three and a half days were packed with presentations and panel sessions involving a total of 27 speakers from the health policy sphere. It is not possible to do justice to the depth and breadth of the sessions in just a few paragraphs, but I will attempt to provide a few highlights. The workshop started with an overview of current trends and future directions for U.S. health care, and an analysis of the executive branch. The legislative branch was also the focus of several sessions, including one on the federal budget process that was very informative in its explanations of key technical terms (such as authorizations vs appropriations) and important health-related committees.

The description of the sources of information available to the executive and legislative branches provided valuable glimpses into the attempts made to quantify the impact of potential policies. These sources of information include numerous agencies such as: MedPAC (the Medicare Payment Advisory Commission); AHRQ (the Agency for Healthcare Research Quality, pronounced “arc”); OMB (the Office of Management and Budget, puts numbers to the President’s policies); and the CBO (Congressional Budget Office, provides independent analysis for members of Congress).

The Affordable Care Act naturally occupied center stage in many of the presentations. Some included valuable resources in clarifying what the ACA actually is about and how it is expected to affect health care; others discussed its perception in public opinion, mirroring the underlying partisan differences on the appropriate role of government in health care. Polls show continuing confusion related to the ACA. It is remarkable, for instance, that a majority of respondents to a poll by the Kaiser Family Foundation were positive about all the ACA’s features except the one that is most closely associated with the ACA – the individual mandate. Additional features include: extending coverage to dependents, closing the Medicare “doughnut hole” for prescription drugs and putting limits on the medical loss ratio.

Dr. Sara Rosenbaum of George Washington University discussed the ACA from a legal perspective, describing the role of the courts and the impact of the ACA in reordering legal relationships in healthcare. She also commented on the Supreme Court’s decision to declare the mandatory Medicaid eligibility expansion unconstitutional without eliminating it.

An important theme that emerged was the interplay between federal and state authority, for instance regarding but not limited to Medicaid expansion and “dual eligibles,” i.e., people eligible both for Medicare and Medicaid. Ensuring appropriate access to care weighed heavily on many policymakers’ minds, especially with respect to new Medicaid enrollees, who now must find providers who will accept Medicaid. More broadly, the potential shortage of primary-care physicians (PCPs) and related matters, such as the role of PCPs in coordinating care and what represents adequate incentives and payment, figured prominently in the discussions.

Another issue covered during the presentations included possible reforms to Medicare such as creation of a comprehensive plan that combines Plans A, B and D, i.e., hospital inpatient stays, physician visits and drugs for the elderly or disabled. The challenges facing current Medicare recipients are many, starting with the fact that there are no limits on out-of-pocket expenses for Part A/B services and no reimbursement of dental care, hearing aids or routine eyeglasses. Whether to reform Medicare in the coming years, and if so, how, will remain a matter of debate for the foreseeable future.

Related to this topic, Dr. Karen Davis, who served as the President of the Commonwealth Fund for two decades and has now returned to the faculty of Johns Hopkins University, gave a talk on the role of evidence in policymaking. Dr. Davis has played a leading role in developing Medicare Essential, a proposal that would combine the various mandatory and adds-on parts of Medicare into one integrated whole.

Healthcare was also investigated at the state level, where many innovations are currently taking place – the Medicare expansion being only the most prominent – with examples drawn from Rhode Island and Vermont. State innovation has so far received far less attention than federal initiatives in healthcare reform, but offers many promising opportunities for researchers’ involvement at the ground level.

An important theme emphasized throughout the workshop was the importance of understanding not only the processes but also the people who drive decision-making. It is critical to identify the key players. For researchers seeking to improve the healthcare system based on scientific study, it is particularly important to target decision-makers and aides who are most receptive to research.

The workshop ended with a focus on communicating research results and enabling effective advocacy, first through an excellent, hands-on session in the offices of the Kaiser Family Foundation (hint: do not ever use the c-word, focusing on value instead of the much-dreaded cost), and then through a morning of Q&A at the AcademyHealth offices, where Congressional staffers shared their perspectives off the record.

I left the workshop impressed by the obvious and genuine commitment all speakers had to a high-quality healthcare system in the U.S. I also noticed that I was, it seemed, the only attendee with a strong quantitative mindset. While the other attendees had many fascinating insights to share and provided critical perspectives, the analytical approaches of the Society for Medical Decision Making have a real role to play in guiding health policymakers. It is hoped that more and more members will attend the workshop in the future. The first step in translating our research into practice must be to understand the health policy ecosystem.

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Applying the Evolving Science of Decision Making to Surgery

by Vlad V. Simianu, MD, Rafael Alfonso-Cristancho, MD, MSc, PhD, and David R. Flum, MD, MPH, Departments of Surgery and Health Services, University of Washington, Seattle WA

Certain LogoCollaborations in the fields of psychology, economics, marketing and neuroscience have broadened the way we think about the drivers of decision making. Surgeons routinely make decisions for, or share with, their patients by relying on their best clinical judgment, while acknowledging the uncertainty, complexity, and time constraints that are usually the case with patient care and surgical procedures. However, the limitations on our computational power, willpower, and stresses sometimes lead us to make suboptimal decisions in predictable ways. An understanding of the heuristics that guide decision making and decision-making tendencies by surgeons and their patients is starting to lead to system design to help make better choices.

To understand and advance the science of decision making in healthcare, we need healthcare research platforms that allow us to study physician behavior and perform interventions to influence decision making. In Fall 2010, support from the Agency for Healthcare Research and Quality helped transform Washington State’s hospital-wide surgical surveillance quality improvement platform (SCOAP, www.scoap.org) into a network capable of evaluating comparative healthcare strategies across all episodes of care (i.e. pre- and post-intervention). The resulting Comparative Effectiveness Research and TranslAtIonal Network (CERTAIN) incorporates healthcare stakeholder’s perspectives including clinician beliefs and patient reported outcomes. CERTAIN is working with clinicians and hospitals to optimize healthcare delivery through a partnership of research and quality improvement initiatives. Focusing on improving clinician-level decisions, we organized several academic disciplines related to decision making into the Collaborative for Healthcare research in behaviOral economIcs and decision sciEnceS (CERTAIN CHOICES). Since 2012, CERTAIN CHOICES faculty from the University of Washington’s Foster School of Business, the Department of Psychology, the School of Public Health, the Department of Global Health, the School of Pharmacy, and the various clinicians from across the School of Medicine have been collaborating on research projects. These projects involve applying behavioral economics and decision sciences to increase the use of safer surgical care, avoid procedures with questionable indications and make sure that interventional care provides the highest value.

Two areas of interest in surgical decision making relate to the risk thresholds that surgeons and their patients are willing to take, and how individual outcomes, particularly negative ones, influence subsequent decisions. One evolving project in our collaborative has attempted to quantify risk-thresholds for physicians, and determine whether surgeons and clinicians of different levels of training make different decisions than non-physicians in situations of high uncertainty. Using a model developed by our collaborators in the Department of Psychology, we are using revealed preferences in a model of salting roads in inclement weather to describe a clinician’s inclination towards risk-avoiding choices and to see how they relate to choices made in clinical scenarios where there is uncertainty about the value of surgical intervention.

The CERTAIN CHOICES collaborative is assessing the impact of adverse events in influencing risk-avoiding behavior, specifically addressing whether intra-operative colorectal leak-testing patterns change after an adverse event. Failure of a colorectal anastomosis after colon surgery often results in a colostomy with high impact on the patient and the health care system. Intraoperative anastomotic testing with inflation of the submerged colon, akin to testing a repaired tire, is standard method to evaluate for an anastomotic leak in the operating room, before the patient is exposed to harm. Despite the simplicity and efficacy of leak testing, routine testing is still not performed. Using the SCOAP database, we are identifying patterns of use at the surgeon-level before and after anastomotic leaks to quantify the extent to which these adverse outcomes change surgeon behavior. In doing so, we are testing the availability heuristic, suggesting differential perceptions of a procedures utility based on framing events.

These projects are among several that we are developing to gain new insight into clinician and patient decision making, and showcase the value of collaborations across the decision sciences. Understanding the science of decision making in clinical care and crafting interventions to improve it is just beginning, and it remains to be determined if the effectiveness of nudges and lessons learned in the non-clinical world are relevant in day-to-day surgical decision making. We hope that the knowledge generated from this collaboration will complement, rather than replace, the many excellent decisions clinician make each day and help translate the growing body of clinical evidence into better clinical care.

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SMDM Board of Trustees

SMDM Board of Trustees

Among the many highlights of this year’s annual meeting, was the opportunity to welcome new members to the SMDM Board of Trustees. New to the Board are: President-Elect Ahmed Bayoumi, MD, Vice President-Elect Angie Fagerlin, PhD, International Trustee Olga Kostopoulou, PhD, and Trustees David Matchar, MD, and Brian Zikmund-Fisher, PhD. Please join us in welcoming these new board members. More information about the Board can be found at: http://www.smdm.org/board/about.

With the excitement of welcoming new members onto the board, we sadly said goodbye to other members who served our Society so well during their tenure. This year, SMDM thanked outgoing Past President Anne Stiggelbout, PhD, for her leadership moving SMDM to become a more international society. We thanked outgoing Vice President Uwe Siebert, MD, for his work developing an international fellowship program and Secretary-Treasurer Steve Downs, MD, for guiding SMDM to a “soft-landing” through the economic uncertainty of the past several years. We thanked Board Members Anirban Basu, PhD, for his leadership on SMDM’s inaugural conference in Asia, Lisa Prosser, PhD, for her leadership of the SMDM publications committee and through the search for a new journal editor, and Natasha Stout, PhD, for her leadership building career development programs for SMDM members. We are deeply appreciative of the time you gave to making SMDM a stronger society and for furthering the principles of medical decision making that we promote. Thank you!

The strength of our Society is reliant upon the time and talent of our volunteer leadership. All members are encouraged to become involved in SMDM by joining an interest group or committee, by submitting nominations for trustees and officers, and by sharing information about SMDM with colleagues who might be interested in our work.



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Call for Nominations
SMDM Officers and Trustees

by Scott Braithwaite, MD, MPH, PhD
SMDM Nominations Committee Chair and Past President
 
The Nominations Committee of the Society for Medical Decision Making (SMDM) is soliciting nominations for the positions of:
President-Elect
Vice President–Elect
Secretary-Treasurer Elect
Historian, and
3 Trustees (including an International Trustee).

We invite members to submit the names of SMDM members whom you believe would serve the Society well. Self-nominations are encouraged. The Nominations Committee will consider all submitted names. At least 2 nominees will be selected for each position, except for the position of Historian, for which a candidate may run unopposed. Upon approval of the slate by the Board of Trustees, the list of nominees will be sent to all SMDM members. Additional nominees then will be accepted by petition, as described by the Society’s regulations.

Please submit your nominations to Jill Metcalf at jill.metcalf@smdm.org or to any member of the nominations committee, listed below, prior to 5:00 p.m. EST, February 21, 2014. Inclusion of information about the nominee’s past service to SMDM or other professional groups is helpful to the Nominations Committee’s deliberations. All nominations will remain confidential among the Nominations Committee until a slate is chosen.

Please contact me at scott.braithwaite@nyumc.org if you have any questions regarding the nomination or election process.

2014 Nominations Committee
Scott Braithwaite, Chair
Margaret Byrne
Brendan Delane
Mark Roberts
Anne Stiggelbout

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Welcome to SMDM’s Newest Emeritus Members!

by Scott B. Cantor, PhD, The University of Texas MD Anderson Cancer Center,
Houston, TX


We honor Joseph Pliskin, PhD, and Donald A. Brand, PhD, SMDM members who have recently been awarded Emeritus status.

Joseph (“Joe” or “Yossi”) Pliskin has been a long-time SMDM member. Joe earned his doctorate in Applied Mathematics from Harvard. Currently, Joe is the Sidney Liswood Professor of Health Care Management at Ben-Gurion University of the Negev. He also has an adjunct appointment at the Harvard School of Public Health. He also has been on the faculty at Tel Aviv University and Boston University where he has taught courses in health decision sciences for many years.

Dr. Pliskin’s research interests focus on clinical decision making, operations management in health care organizations, cost-benefit and cost-effectiveness analysis in health and medicine, technology assessment, utility theory and decision analysis. He was recognized in 2004 with the Career Achievement Award. One of his most outstanding contributions to the field of medical decision making is the theoretical development of the concept of the quality-adjustment life year (“QALY”), as described in a landmark paper published in Operations Research in 1980. In the Society, Joe has been instrumental in organizing and also chaired the European SMDM meetings.


Donald Brand is also a long-time member of SMDM. Currently, he is the Director of Health Outcomes Research at Winthrop University Hospital. He earned his PhD in Operations Research from Yale, and has had faculty appointments at Yale School of Medicine and School of Management, New York Medical College and Stony Brook School of Medicine.

Dr. Brand's research has focused on the development of evidence-based clinical decision aids, primarily in emergency medicine and pediatrics. He has also considered the timing of organ transplantation from the patient's point of view. For the past few years, Don has been the Senior Editor of the SMDM Newsletter, coordinating its publication with the many contributors to this publication, providing connectivity amongst the SMDM membership throughout the year.

On a personal note, I am well acquainted and interestingly connected with both of these long-time participants and supporters of SMDM. Joe Pliskin was one of my professors when I was a graduate student, and we both share the admiration of our dissertation chair Professor Howard Raiffa. Don was colleagues with several faculty with whom I studied at Yale when I was an undergraduate, and succeeded me as the SMDM Newsletter Senior Editor. When I see both of these colleagues at the meeting, I am reminded of our joint enthusiasm for the field of medical decision making and our historical connections.

Congratulations to both these decision scientists!
 

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2013 SMDM Award Winners


award winners
Award winners (l-r) Donald Redelmeier, Mark Eckman and Michael Kattan with Myriam Hunink.

Congratulations to our 2013 SMDM Award Winners who were announced at the recent North American Meeting in Baltimore, MD. They are as follows:

Career Achievement Award
recognizing seminal work in medical decision making
Donald Redelmeier, MD, MSHSR, FRCPC, FACP

Eugene Saenger Award for Distinguished Service
recognizing exceptional efforts in support of the Society
Mark Eckman, MD

John M. Eisenberg Award for Practical Application of Medical Decision Making Research
recognizing exemplary leadership in the practical application of medical decision making research
Michael Kattan, PhD

The Young Investigator Award
presented for the best paper published by a trainee or junior faculty member
Tessa Genders                                                                                                           
Genders TS, Steyerberg EW, Hunink MG for the CAD consortium. Prediction model to estimate presence of coronary artery disease: retrospective pooled analysis of existing cohorts. BMJ. 2012 Jun 12;344:e3485



Lee B. Lusted Student Prizes
awarded for outstanding presentations of research at the Annual Meeting
Emily Burger, MPhil, University of Oslo
Robert Dunlea, MD, MS, University of Utah
Patricia Guyot, MSc, Bristol University
Christopher W. Halladay, BA, Brown University

Ilene Hollin, MPH, Johns Hopkins Bloomberg School of Public Health
Jinani C. Jayasekera, BSc, MA, University of Maryland
Greggory J. Schell, MSE, University of Michigan
Logan Trenaman, BSc, University of British Columbia


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Lusted Moderated Poster Session Début at SMDM 2013

by Amber E. Barnato, MD, MPH, MS, FACPM, SMDM Vice President

After years of sprinting around dark hotel ballrooms to judge Lusted abstracts embedded in the scientific agenda, Lusted judges got to cool their heels this year in Baltimore and judge all of the abstracts in one place during the inaugural Lusted Moderated Poster Session. We added a closed poster session at the beginning of the meeting devoted to Lusted finalists. During the session, Lusted judges and presenters advanced together in 10 minute intervals across the 6 posters in the group, with 5 minutes for presentation and 5 minutes for questions and answers. As the current Vice President, I created the new format to increase fairness, by providing a “level playing field” for all Lusted finalists; efficiency, by concentrating presentation judging in one time and location; and interactivity, by ensuring a consistent audience for everyone. The format also allowed each Lusted finalist to be slotted into the scientific agenda according to topic, rather than in a manner required to facilitate judging.

Reporting from the field, John Wong noted that the experiment was “a smashing success.” All participants – judges and finalists alike, wanted to do it again in 2014. Although we worried about the burdens of presenting more than once, several trainees said they liked the opportunity to present twice during the meeting in order to get more practice with public speaking, and many enjoyed the opportunity to hear other students’ presentations in the same category. A past president, who asked to remain anonymous, said “After years of refusing to judge for fear of ruining my meeting, this innovation has changed my mind – sign me up!” More exciting yet, Elena Elkin who rung the xylophone to synchronize the presentations, received a standing ovation for her musical talents and has been invited to perform a solo xylophone concert in 2014.

The success of the experiment is attributable to the hard work and support of co-chair John Wong, MD, 2013 meeting co-chairs Heather Gold, PhD, and Elena Elkin, PhD, and Award Committee Chair Marilyn Schapira, MD, and the Lusted finalists who were willing to give it a try. We look forward to doing it again in Miami at the 2014 North American Meeting!

Lusted Award Winners
Myriam Hunink (left) and John Wong (right) congratulate the 2013 Lusted Award winners at the North American Meeting in Baltimore, MD.

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Call for Nominations
SMDM Awards

As we congratulate our distinguished winners for 2013, we look to recognize the next class of leaders in the field. Nominations for the following awards must be received no later than February 28, 2014.

Career Achievement Award
The Career Achievement Award recognizes a senior investigator who has made significant contributions to the field of medical decision making. The nominee need not be a member of SMDM.

Eugene L. Saenger Award for Distinguished Service to SMDM
This award recognizes service to SMDM in terms of leadership, role in the operations of the Society, and contributions to the scientific and educational activities of the Society. The nominee must be a member of SMDM.

John M. Eisenberg Award for Practical Application of Medical Decision Making Research
This award recognizes sustained leadership in translating medical decision making research into practice, including taking exceptional steps to communicate the principles and/or substantive findings of medical decision making research to policy makers, or clinical decision makers, or the general public. The nominee need not be a member of SMDM.

Outstanding Paper by a Young Investigator
This award was conceived as a means of recognizing outstanding work by a young researcher and assisting the recipient in the tenure process. The award is for a paper published, online or in print, in the calendar year prior to the award (journal must be dated in 2013 for the 2014 award). The nominee must be in the first six (6) years of full-time employment after the end of “training” however that is defined within the country and field of the nominee. Any dispute about the eligibility of a nominee will be resolved by the committee.

A letter of support for your candidate and, if available, the nominee’s CV is recommended but not required. Nominations should be submitted via email to SMDM Executive Director, Jill Metcalf, at jill.metcalf@smdm.org. The awards will be presented at the 2014 SMDM Annual Meeting in Miami, Florida, USA.

For additional details, please check the website.


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Networking Committee: Spring Webinar Planned

by Victoria Shaffer, PhD, University of Missouri

The Networking Committee is planning new between meeting activities for SMDM members in 2014. Those of you who attended the meeting in Baltimore may have noticed an evaluation question that asked about your interest in between-meeting webinars. Thank you so much to everyone who answered.
 
Of those who answered, approximately 75% were interested in attending a between-meeting webinar. Respondents were interested in nearly all suggested topics, but the most popular topics related to grant writing and the identification of funding opportunities. 

Based on this interest, our first webinar will be focused on PCORI grants. The panel of speakers will include PCORI-funded investigators. We are planning a webinar for early Spring and are currently soliciting speakers. If you are interested in leading part of the webinar (or can suggest someone who might be a good speaker) please contact Victoria Shaffer (shafferv@health.missouri.edu) or Ellen Lipstein (Ellen.Lipstein@cchmc.org). We are enthusiastic about starting this series and hope it will help everyone remain connected between meetings.

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Have you Made the SMDM Connection?

SMDM Connect (our new customized social networking platform) enables members to experience a whole new way of connecting with colleagues. Create your own professional profile and build a network of connections with other SMDM members. You can post resources, syllabi, CVs and other relevant materials, and participate in topical discussions in the SMDM Member Forum.

Committee and Interest Group conversations can continue outside of meetings, as SMDM Connect features a virtual workspace designated for each group to post resources, discussions, events, and announcements. The committee groups feature has privacy settings to allow members to securely conduct business.

SMDM Connect is FREE to all SMDM members and meeting attendees. If you’re not a member of SMDM, why not join? There’s never been a better time to be a part of this exciting society and get to know a diverse group of experts from around the world. Log in by clicking the SMDM Connect button on the SMDM homepage.

http://connect.smdm.org/

Username: your primary email address
Password: same as the Online Store
Forgot your password? Click here

View the SMDM Connect demo now
 
Please contact info@smdm.org with any questions or comments. Enjoy!

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January Journal Available

We hope you enjoy the latest issue of our journal

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Other News

Modeling Approaches for HTA: a Practical Hands-On Workshop

The University for Health Sciences, Medical Informatics and Technology (UMIT) is pleased to announce their sixth 3-Day Certificate Course “Modeling Approaches for HTA: a Practical Hands-On Workshop”, June 5-7, 2014, to be held in Antwerp, Belgium as a pre-workshop for Antwerp SMDM meeting.The workshop combines theoretical concepts with practical hands-on exercises comprising five different modeling techniques applied in Public Health and HTA. Real-world case examples from different acute and chronic diseases will be discussed. This Practical Hands-On Modeling Workshop was developed and will be held in collaboration between the PATH Research Institute at McMaster University, Canada and the Department of Public Health, Medical Decision Making and HTA at UMIT, Hall i.T., Austria. Detailed information about the course and study program is available at www.umit.at/htads, via e-mail htads@umit.at or by phone +43 (0)50 8648-3901.

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Member News


A paper entitled ”Would GPs advise patients with respiratory tract infections to refrain from exercise, stay indoors or stay in bed?” recently appeared in the European Journal of General Practice. In this paper, Peder A. Halvorsen, Macieck Godycki-Cwirko, Katrine Wennevold and Hasse Melbye report that 40 – 90% of GPs would recommend against exercise when presented with different hypothetical patients with acute respiratory tract infections. Recommendations to stay indoors and stay in bed were also common. GPs in Poland were more likely to recommend such restrictions than GPs in Norway. There is not much support for such recommendations in terms of evidence based medicine. The authors discuss possible reasons for the recommendations and the observed differences between Polish and Norwegian GPs.


Good news reaches us from Marieke de Vries, PhD, Tilburg University, who reports: On September 14, 2013, our wonderful daughter Isa was born. She is doing very well and we feel blessed and grateful.  MariekedeVries@TilburgUniversity.edu


The article "An overview of patient involvement in healthcare decision making: A situational analysis of the Malaysian context" has just been published in BMC Health Services Research. This article is an overview of the state of patient involvement in health decision making in Malaysia based on systematic literature review, stakeholder views, policy documents and legal perspectives. Authors include Julia P. Engkasan, MBBS, MRM, Department of Rehabilitation Medicine, University of Malaya and Yew Kong Lee, BA (Hons), Department of Primary Care Medicine, University of Malaya. Most such overviews have focused on developed countries, and this article helps to broaden the understanding of the state of shared decision making in the developing world.  leeyk@um.edu.my



On August 31, Eric Nsiah-Boateng, MSc, MPH, Bsc, graduated with a master's degree in Public Policy and Human Development from Maastricht University, Netherlands, specializing in social protection policy design and financing. He also had his research paper entitled "Performance Assessment of Ga District Mutual Health Insurance Scheme, Greater Accra, Ghana" published in Value in Health, a Journal of the Society for Pharmacoeconomics and Outcomes Research (ISPOR).
nsiahboateng@gmail.com


Dr. Christopher Wolfe's research with the BRCA Gist Intelligent Tutoring System to help women understand and make decisions about testing for genetic breast cancer risk was featured in the Dayton Daily News and their web-based news videos. Christopher R. Wolfe, PhD, and Valerie F. Reyna, PhD, have developed BRCA Gist and conducted a number of theoretically-motivated controlled randomized studies on the efficacy of BRCA Gist in communicating complex information related to risk and testing decisions.  WolfeCR@MiamiOH.edu

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Student News


James Dionne-Odom, MSN, dionneod@uab.edu
Expected Graduation: 12/01/2013
Area: Decision Psychology, Palliative Care, End of Life
Dissertation Title: A Theoretical Model of the Psychological Processes of Surrogate Decision-Making at Adult End-of-Life in the Intensive Care Unit: A Case Study Design using Cognitive Task Analysis


Ilya Ivlev, PhD, ilya.ivlev@fbmi.cvut.cz, cz.linkedin.com/pub/ilya-ivlev-m-d/33/208/127
Expected Graduation: 02/01/2014
Area: Biomedical and Clinical Technology
Advisor: Prof. Ing. Peter Kneppo, DrSc.
Position Seeking: academic; post-doc; government
Presented at SMDM: The Concept of the System of Rational Choice of Medical Equipment by an Example of MRIs / SMDM 2012
SMDM Committees: System dynamics and feedback models for decision support and Introduction to shared decision making and decision aids / SMDM 2012


Sean Carr, PhD, seancarr.ise@gmail.com
Expected Graduation: 12/18/2013
Area: Industrial Engineering / Health Economics
Advisor: Stephen D. Roberts
Dissertation Title: Simulation-based analysis of Cell-based Regenerative Medicine Production: Focus on Cost-effectiveness

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SMDM Lifetime Contributors

SMDM extends its heartfelt appreciation to members for their charitable contributions over the years. Donations received Oct. 2005 – December 9, 2013. Bold indicates donors in 2013.

Pareto Level
(Contributions total $1,000 or more)
Dana Alden (’12, ’13)
Michael Barry (’06 - ’10)
John Clarke (13)
Dennis Fryback (’05 - ’13)
Jeremy Goldhaber-Fiebert (’13)
Mark Helfand (’05, ’07, ’10, ’11)
Joseph King (’06 -’12)
William Lawrence (’06, ’10, ’11)
David Rovner & Margaret Holmes-Rovner (’05 - ’13)
Uwe Siebert ('11, ’13)
Frank Sonnenberg (’06, ’09)
Harold and Carol Sox (’10 - ’13)
Sankey Williams (’06, ’07, ’08)
John Wong (’06 - ’12)

Edwards Level
(Contributions total $750 - $999)
David Meltzer (’07, ’09)
Stephen Pauker (’06, ’09)
Marilyn Schapira (’07 - ’12)
Seema Sonnad (’06, ’07, ’09, ’12, ’13)
Joel Tsevat (’06, ’09, ’10)

Tversky Level
(Contributions total $500 - $749)
Robert Beck (’07)
Scott Cantor & Lisa Stone (’07 - ’12)
Kate Christensen (’09)
Nananda Col (’05 - ’09)
Neal Dawson (’05 - ’13)
Sara Knight (’05 - ’13)
Kathryn McDonald (’07, ’09, ’10)
Jill Metcalf (’07 - ’13)
David Paltiel (’07, ’09)
Mark Roberts (’08, ’09, ’13)
Bruce Schackman (’06, ’07, ’08, ’09, ’10, ’11)
David Sugano (’07, ’09, ’10, ’11, ’13)


von Neumann-Morgenstern Level
(Contributions total $250 - $499)
Ahmed Bayoumi (’06, ’09, ’10, ’11, ’12, ’13)
Dena Bravata (’06, ’09, ’10, ’11)
Randall Cebul (’06, ’08, ’10)
Mark Eckman (’06, ’09)
Arthur Elstein (’06, ’07, ’09, ’10)
Peder Halvorsen ('11,’13)
Karen Kuntz (’09, ’11)
Steven Kymes (’05, ’06, ’07, ’08, ’09, ’12)
James Stahl (’06, ’09, ’10, ’12)


Markov Level
(Contributions total $100 - $249)
Amber Barnato (’05, ’07, ’08, ’11, ’12)
Cathy Bradley (’07)
Scott Braithwaite (’09)
Linda Canty (’12)
Phaedra Corso (’06, ’07, ’08)
Elena Elkin (’07)
Alan Garber (’10)
Heather Taffet Gold (’08, ’11)
Robert Hamm (’06, ’08)
Myriam Hunink (’05 - ’13)
Esther Kaufmann ('11)
Sun-Young Kim (’07, ’08, ’09, ’13)
Miriam Kuppermann (’06, ’07, ’08, ’09, ’10, ’12)
Curtis Langlotz (’12)
Lisa Maillart (’10)
Richard Orr (’05, ’06)
Brian Rittenhouse (’07)
Allison Rosen (’07)
Alan Schwartz (’07, ’10, ’12, ’13)
Joanne Sutherland (’08, ’09)
Thomas Tape (’10, ’11)
John Thornbury (’05)
George Torrance (’05)
Benjavan Upatising (’13)
Jef Van den Ende (’10)
Robert Wigton (’10, ’11)
Brian Zikmund-Fisher (’08 - ’13)

Bayes Level
(Contributions total up to $100)
Hilary Bekker (’12)
Eran Bendavid (’11)
Denise Bijlenga (’08)
Kimberly Blake (’09)
Rowland Chang (’06, ’07)
Carmel Crock (’09)
James Dolan (’09)
Arna Dresser (’10, ’12)
Ted Ganiats (’05)
Lee Green (’07, ’09)
Amit Gupta (’06)
Michael Hagen (’10)
David Howard (’09)
Michael Kattan (’13)
David Katz (’08)
Job Kievit (’09)
Kerry Kilbridge (’05, ’07, ’08)
Ivar Sonbo Kristiansen (’10)
Joseph Ladapo (’12, ’13)
Andrew Scott LaJoie (’10)
Andreas Maetzel (’09)
Daniel Masica (’08)
Evan Myers (’12)
Thomas B. Newman (’10)
Jesse D. Ortendahl ('11, ’13)
Jane Pai ('10)
George Papadopoulos (’08)
Lisa Prosser (’08)
Michael Rothberg (’09, ’10, ’11, ’12)
Gillian Sanders (’07)
Jha Saurabh (’09)
Ewout Steyerberg (’06, ’09, ’11, ’13)
Anne Stiggelbout (’06)
Carol Stockman (’05)
Danielle Timmermans (’07)
Hugues Vaillancourt (’11)
Milton Weinstein (’09, ’11)
Robert Werner (’08)

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