Patient-oriented computerized clinical guidelines for mobile decision support in gestational diabetes

The risks associated with gestational diabetes (GD) can be reduced with an active treatment able to improve glycemic control. Advances in mobile health can provide new patient-centric models for GD to create personalized health care services, increase patient independence and improve patients’ self-management capabilities, and potentially improve their treatment compliance. In these models, decision-support functions play an essential role. The telemedicine system MobiGuide provides personalized medical decision support for GD patients that is based on computerized clinical guidelines and adapted to a mobile environment. The patient’s access to the system is supported by a smartphone-based application that enhances the efficiency and ease of use of the system. We formalized the GD guideline into a computer-interpretable guideline (CIG). We identified several workflows that provide decision-support functionalities to patients and 4 types of personalized advice to be delivered through a mobile application at home, which is a preliminary step to providing decision-support tools in a telemedicine system: (1) therapy, to help patients to comply with medical prescriptions; (2) monitoring, to help patients to comply with monitoring instructions; (3) clinical assessment, to inform patients about their health conditions; and (4) upcoming events, to deal with patients’ personal context or special events. The whole process to specify patient-oriented decision support functionalities ensures that it is based on the knowledge contained in the GD clinical guideline and thus follows evidence-based recommendations but at the same time is patient-oriented, which could enhance clinical outcomes and patients’ acceptance of the whole system.

Aproximaciones del conjunto eficiente en decisión multicriterio

El conjunto eficiente en la Teoría de la Decisión Multicriterio juega un papel fundamental en los procesos de solución ya que es en este conjunto donde el decisor debe hacer su elección más preferida. Sin embargo, la generación de tal conjunto puede ser difícil, especialmente en problemas continuos y/o no lineales. El primer capítulo de esta memoria, es introductorio a la Decisión Multicriterio y en él se exponen aquellos conceptos y herramientas que se van a utilizar en desarrollos posteriores. El segundo capítulo estudia los problemas de Toma de Decisiones en ambiente de certidumbre. La herramienta básica y punto de partida es la función de valor vectorial que refleja imprecisión sobre las preferencias del decisor. Se propone una caracterización del conjunto de valor eficiente y diferentes aproximaciones con sus propiedades de encaje y convergencia. Varios algoritmos interactivos de solución complementan los desarrollos teóricos. El tercer capítulo está dedicado al caso de ambiente de incertidumbre. Tiene un desarrollo parcialmente paralelo al anterior y utiliza la función de utilidad vectorial como herramienta de modelización de preferencias del decisor. A partir de la consideración de las distribuciones simples se introduce la eficiencia en utilidad, su caracterización y aproximaciones, que posteriormente se extienden a los casos de distribuciones discretas y continuas. En el cuarto capítulo se estudia el problema en ambiente difuso, aunque de manera introductoria. Concluimos sugiriendo distintos problemas abiertos.---ABSTRACT---The efficient set of a Multicriteria Decicion-Making Problem plays a fundamental role in the solution process since the Decisión Maker's preferred choice should be in this set. However, the computation of that set may be difficult, specially in continuous and/or nonlinear problems. Chapter one introduces Multicriteria Decision-Making. We review basic concepts and tools for later developments. Chapter two studies Decision-Making problems under certainty. The basic tool is the vector valué function, which represents imprecisión in the DM's preferences. We propose a characterization of the valué efficient set and different approximations with nesting and convergence properties. Several interactive algorithms complement the theoretical results. We devote Chapter three to problems under uncertainty. The development is parallel to the former and uses vector utility functions to model the DM's preferences. We introduce utility efficiency for simple distributions, its characterization and some approximations, which we partially extend to discrete and continuous classes of distributions. Chapter four studies the problem under fuzziness, at an exploratory level. We conclude with several open problems.

Type-I intermittency with discontinuous reinjection probability density in a truncation model of the derivative nonlinear Schrödinger equation

In previous papers, the type-I intermittent phenomenon with continuous reinjection probability density (RPD) has been extensively studied. However, in this paper type-I intermittency considering discontinuous RPD function in one-dimensional maps is analyzed. To carry out the present study the analytic approximation presented by del Río and Elaskar (Int. J. Bifurc. Chaos 20:1185-1191, 2010) and Elaskar et al. (Physica A. 390:2759-2768, 2011) is extended to consider discontinuous RPD functions. The results of this analysis show that the characteristic relation only depends on the position of the lower bound of reinjection (LBR), therefore for the LBR below the tangent point the relation {Mathematical expression}, where {Mathematical expression} is the control parameter, remains robust regardless the form of the RPD, although the average of the laminar phases {Mathematical expression} can change. Finally, the study of discontinuous RPD for type-I intermittency which occurs in a three-wave truncation model for the derivative nonlinear Schrodinger equation is presented. In all tests the theoretical results properly verify the numerical data

Veto values in Group Decision Making within MAUT: aggregating complete rankings derived from dominance intensity measures

We consider a groupdecision-making problem within multi-attribute utility theory, in which the relative importance of decisionmakers (DMs) is known and their preferences are represented by means of an additive function. We allow DMs to provide veto values for the attribute under consideration and build veto and adjust functions that are incorporated into the additive model. Veto functions check whether alternative performances are within the respective veto intervals, making the overall utility of the alternative equal to 0, where as adjust functions reduce the utilty of the alternative performance to match the preferences of other DMs. Dominance measuring methods are used to account for imprecise information in the decision-making scenario and to derive a ranking of alternatives for each DM. Specifically, ordinal information about the relative importance of criteria is provided by each DM. Finally, an extension of Kemeny's method is used to aggregate the alternative rankings from the DMs accounting for the irrelative importance.

On the application of meshfree methods to the nonlinear dynamics of multibody systems

Esta tesis propone una completa formulación termo-mecánica para la simulación no-lineal de mecanismos flexibles basada en métodos libres de malla. El enfoque se basa en tres pilares principales: la formulación de Lagrangiano total para medios continuos, la discretización de Bubnov-Galerkin, y las funciones de forma libres de malla. Los métodos sin malla se caracterizan por la definición de un conjunto de funciones de forma en dominios solapados, junto con una malla de integración de las ecuaciones discretas de balance. Dos tipos de funciones de forma se han seleccionado como representación de las familias interpolantes (Funciones de Base Radial) y aproximantes (Mínimos Cuadrados Móviles). Su formulación se ha adaptado haciendo sus parámetros compatibles, y su ausencia de conectividad predefinida se ha aprovechado para interconectar múltiples dominios de manera automática, permitiendo el uso de mallas de fondo no conformes. Se propone una formulación generalizada de restricciones, juntas y contactos, válida para sólidos rígidos y flexibles, siendo estos últimos discretizados mediante elementos finitos (MEF) o libres de malla. La mayor ventaja de este enfoque reside en que independiza completamente el dominio con respecto de las uniones y acciones externas a cada sólido, permitiendo su definición incluso fuera del contorno. Al mismo tiempo, también se minimiza el número de ecuaciones de restricción necesarias para la definición de uniones realistas. Las diversas validaciones, ejemplos y comparaciones detalladas muestran como el enfoque propuesto es genérico y extensible a un gran número de sistemas. En concreto, las comparaciones con el MEF indican una importante reducción del error para igual número de nodos, tanto en simulaciones mecánicas, como térmicas y termo-mecánicas acopladas. A igualdad de error, la eficiencia numérica de los métodos libres de malla es mayor que la del MEF cuanto más grosera es la discretización. Finalmente, la formulación se aplica a un problema de diseño real sobre el mantenimiento de estructuras masivas en el interior de un reactor de fusión, demostrando su viabilidad en análisis de problemas reales, y a su vez mostrando su potencial para su uso en simulación en tiempo real de sistemas no-lineales. A new complete formulation is proposed for the simulation of nonlinear dynamic of multibody systems with thermo-mechanical behaviour. The approach is founded in three main pillars: total Lagrangian formulation, Bubnov-Galerkin discretization, and meshfree shape functions. Meshfree methods are characterized by the definition of a set of shape functions in overlapping domains, and a background grid for integration of the Galerkin discrete equations. Two different types of shape functions have been chosen as representatives of interpolation (Radial Basis Functions), and approximation (Moving Least Squares) families. Their formulation has been adapted to use compatible parameters, and their lack of predefined connectivity is used to interconnect different domains seamlessly, allowing the use of non-conforming meshes. A generalized formulation for constraints, joints, and contacts is proposed, which is valid for rigid and flexible solids, being the later discretized using either finite elements (FEM) or meshfree methods. The greatest advantage of this approach is that makes the domain completely independent of the external links and actions, allowing to even define them outside of the boundary. At the same time, the number of constraint equations needed for defining realistic joints is minimized. Validation, examples, and benchmarks are provided for the proposed formulation, demonstrating that the approach is generic and extensible to further problems. Comparisons with FEM show a much lower error for the same number of nodes, both for mechanical and thermal analyses. The numerical efficiency is also better when coarse discretizations are used. A final demonstration to a real problem for handling massive structures inside of a fusion reactor is presented. It demonstrates that the application of meshfree methods is feasible and can provide an advantage towards the definition of nonlinear real-time simulation models.

Multicriteria decision analysis applied to cover crop species andcultivars selection

Cover crop selection should be oriented to the achievement of specific agrosystem benefits. The covercrop, catch crop, green manure and fodder uses were identified as possible targets for selection. Theobjective was to apply multi-criteria decision analysis to evaluate different species (Hordeum vulgareL., Secale cereale L., ×Triticosecale Whim, Sinapis alba L., Vicia sativa L.) and cultivars according to theirsuitability to be used as cover crops in each of the uses. A field trial with 20 cultivars of the five specieswas conducted in Central Spain during two seasons (October?April). Measurements of ground cover, cropbiomass, N uptake, N derived from the atmosphere, C/N, dietary fiber content and residue quality werecollected. Aggregation of these variables through utility functions allowed ranking species and cultivarsfor each usage. Grasses were the most suitable for the cover crop, catch crop and fodder uses, while thevetches were the best as green manures. The mustard attained high ranks as cover and catch crop the firstseason, but the second decayed due to low performance in cold winters. Mustard and vetches obtainedworse rankings than grasses as fodder. Hispanic was the most suitable barley cultivar as cover and catchcrop, and Albacete as fodder. The triticale Titania attained the highest rank as cover and catch crop andfodder. Vetches Aitana and BGE014897 showed good aptitudes as green manures and catch crops. Thisanalysis allowed comparison among species and cultivars and might provide relevant information forcover crops selection and management.