Design and implementation of a multicriteria medical decision support system for diagnosis and treatment

Health care providers face the problem of trying to make decisions with inadequate information and also with an overload of (often contradictory) information. Physicians often choose treatment long before they know which disease is present. Indeed, uncertainty is intrinsic to the practice of medicine. Decision analysis can help physicians structure and work through a medical decision problem, and can provide reassurance that decisions are rational and consistent with the beliefs and preferences of other physicians and patients. ^ The primary purpose of this research project is to develop the theory, methods, techniques and tools necessary for designing and implementing a system to support solving medical decision problems. A case study involving “abdominal pain” serves as a prototype for implementing the system. The research, however, focuses on a generic class of problems and aims at covering theoretical as well as practical aspects of the system developed. ^ The main contributions of this research are: (1) bridging the gap between the statistical approach and the knowledge-based (expert) approach to medical decision making; (2) linking a collection of methods, techniques and tools together to allow for the design of a medical decision support system, based on a framework that involves the Analytic Network Process (ANP), the generalization of the Analytic Hierarchy Process (AHP) to dependence and feedback, for problems involving diagnosis and treatment; (3) enhancing the representation and manipulation of uncertainty in the ANP framework by incorporating group consensus weights; and (4) developing a computer program to assist in the implementation of the system. ^

Incidence of breast cancer in first-degree female relatives of men with newly diagnosed prostate cancer

Prostate cancer is the most common incident cancer and the second leading cause of death in men in the United States. Although numerous attempts have been made to identify risk factors associated with prostate cancer, the results have been inconsistent and conflicting. The only established risk factors are age and ethnicity. A positive family history of prostate cancer has also been shown to increase the risk two- to three-fold among close relatives.^ There are several similarities between breast and prostate cancer that make the relationship between the two of interest. (1) Histologically, both cancers are predominantly adenocarcinomas, (2) both organs have a sexual and/or reproductive role, (3) both cancers occur in hormone-responsive tissue, (4) therapy often consists of hormonal manipulation, (5) worldwide distribution patterns of prostate and breast cancer are positively correlated.^ A family history study was conducted to evaluate the aggregation of prostate cancer and co-aggregation of breast cancer in 149 patients referred to The University of Texas, M.D. Anderson Cancer Center with newly diagnosed prostate cancer. All patients were white, less than 75 years of age at diagnosis and permanent residents of the United States. Through a personal interview with the proband, family histories were collected on 1,128 first-degree relatives. Cancer diagnoses were verified through medical records or death certificate. Standardized incidence ratios were calculated using a computer program by Monson incorporating data from Connecticut Tumor Registry.^ In this study, familial aggregation of prostate cancer was verified only among the brothers, not among fathers. Although a statistically significant excess of breast cancer was not found, the increased point estimates in mothers, sisters and daughters are consistent with a co-aggregation hypothesis. Rather surprising was the finding of a seven-fold increased risk of prostate cancer and a three-fold increased risk of breast cancer among siblings in the presence of a maternal history of any cancer. Larger family history studies including high risk (African-Americans) and lower-risk groups (Hispanics) and incorporating molecular genetic evaluations should be conducted to determine if genetic differences play a role in the differential incidence rates across ethnic groups. ^

Dating analysis from DSDP Hole 90-594

Date-32 is a fast and easily used computer program developed to date Quaternary deep-sea cores by associating variations in the earth's orbit with recurring oscillations in core properties, such as carbonate content or isotope composition. Starting with known top and bottom dates, distortions in the periodicities of the core properties due to varying sedimentation rates are realigned by fast Fourier analysis so as to maximise the spectral energy density at the orbital frequencies. This allows age interpolation to all parts of the core to an accuracy of 10 kyrs, or about 1.5% of the record duration for a typical Brunhes sequence. The influence of astronomical forcing is examined and the method is applied to provide preliminary dates in a high-resolution Brunhes record from DSDP Site 594 off southeastern New Zealand.

Sediment and porewater geochemistry of core GIK13725, Wester Baltic Sea

Based on chemical-thermodynamical balances the species distributions and mineral stabilities of the chemical compositions of the pressed pore solutions taken from a Baltic Sea mudsediment are evualuated by means of the computer program WATEQF (PLUMMER et al., 1976). According to these evaluations calcite and aragonite are to be found in supersaturation throughout the whole profile. The SiO2 concentration of the pore solutions is mainly controlled by the dissolutions of amorphous silica present in minimal undersaturation. By means of SEM pictures idiomorph quartzcrystals as well as presumptive clay minerals transformation and reformations could be proved as stable transformation phases of the dissolved SiO2 species. The stability of the solid phases containing Al-components as of feldspars and clayminerals decreases with increasing dept and is mainly controlled by AIF3 complexes higher concentrated with increasing depth.

LiDAR simulation in modelled orchards to optimise the use of terretrial laser scanners and derived vegetative measures

Light detection and ranging (LiDAR) technology is beginning to have an impact on agriculture. Canopy volume and/or fruit tree leaf area can be estimated using terrestrial laser sensors based on this technology. However, the use of these devices may have different options depending on the resolution and scanning mode. As a consequence, data accuracy and LiDAR derived parameters are affected by sensor configuration, and may vary according to vegetative characteristics of tree crops. Given this scenario, users and suppliers of these devices need to know how to use the sensor in each case. This paper presents a computer program to determine the best configuration, allowing simulation and evaluation of different LiDAR configurations in various tree structures (or training systems). The ultimate goal is to optimise the use of laser scanners in field operations. The software presented generates a virtual orchard, and then allows the scanning simulation with a laser sensor. Trees are created using a hidden Markov tree (HMT) model. Varying the foliar structure of the orchard the LiDAR simulation was applied to twenty different artificially created orchards with or without leaves from two positions (lateral and zenith). To validate the laser sensor configuration, leaf surface of simulated trees was compared with the parameters obtained by LiDAR measurements: the impacted leaf area, the impacted total area (leaves and wood), and th impacted area in the three outer layers of leaves.

Estructuras espaciales desmontables y desplegables. Estudio de la obra del arquitecto Emilio Pérez Pinero.

La presente tesis estudia las realizaciones del arquitecto Emilio Pérez Pinero, todas dentro de las estructuras espaciales de barras desmontables y desplegables, elabora la documentación que hace transmisible su investigación y generaliza el estudio del comportamiento en la parcela de las desplegables. La obra de este arquitecto forma un conjunto original, atractivo y sin continuadores, y por otra parte, no abundan las" investigaciones sobre este tipo de estructuras ( mucho menos las realizaciones), en las que hay que resolver tanto su definición como su movilidad y comportamiento estructural. El contenido de la parte correspondiente a las estructuras desmontables se limita a las cúpulas reticuladas de una capa, con el sistema de reticulado y montaje ideado por Pinero, por considerar que se debe documentar su aportación pero no incidir mas en un campo de investigación que cuenta con abundantes estudios. Se aporta la solución matemática y un programa de ordenador para la definición geométrica completa del reticulado empleado. Las estructuras desplegables se caracterizan por el empleo de barras dispuestas en "x" en el espesor de la estructura, con generación de superficies tanto planas como curvas. En ambos casos se analiza la movilidad en fase de mecanismo, tanto a las soluciones de Pinero como a las complementarlas que se exponen. Se estudian las relaciones geométricas que deben de cumplirse para que sea posible el movimiento de las barras, relaciones particularmente complejas en las desplegables según superficies esféricas, y que determinan su definición geométrica. En la fase de estructura, además de analizar lo realizado por Pinero, documentando y definiendo sus componentes, se proponen varias estructuras posibles para cada mecanismo, y se desarrolla en detalle el tipo de los emparrillados de canto constante, donde se incluye un estudio comparativo de nueve variantes distintas. Se muestra el amplio campo de uso posible para estas estructuras. ABSTRACT The • present doctoral dissertation studies the work of de spanish architect Emilio Pérez Pinero, all of it within de field of spatial demountable and deployable structures. This contribution compiles the necessary documentation for research in this field and, besides, generalizes the theoretical background for the analysis of this type of structures. Pérez Pinero's contributions are original and attractive, but, so far, he has not any followers ; on the other hand research in this field is scarce (much less actual realizations). In the part corresponding to demountable structures the research is limited to reticulated domes of only one layer, following Pérez Pinero's sys~ tem, trying to give a comprehensive documentation of it. The mathematical solution is given and so is a computer program for the complete definition of the geometry of the structure. One characteristic of deployable structures is the use of struts placed - formix "X" in the thickness of the structure, making possible the generation of plañe as well as curved surfaces. In both cases, the operation in the phase of mechanism is studied, both fot Pinero's solution and for the other schemes presented. The geometrical relationships that must be maintained in order to guarantee strut's movements, are studied; these relationships are particularly complex in the case of spherical surfaces, and, in this last casey determine completely its geometrical definition. In regard of the structure behaviour, besides analysing Pinero's works, a variety of solutions are proposed for each mechanism. Particularly, the configuration for double layer grids of constant thickness is developed with great detall, and a comparative study of nine different solutions of this special case is included. A wide range of the possible applications of this structural type is shown.

Coupled model of initiation and propagation of corrosion in reinforced concrete

Corrosion of reinforcing steel in concrete due to chloride ingress is one of the main causes of the deterioration of reinforced concrete structures. Structures most affected by such a corrosion are marine zone buildings and structures exposed to de-icing salts like highways and bridges. Such process is accompanied by an increase in volume of the corrosión products on the rebarsconcrete interface. Depending on the level of oxidation, iron can expand as much as six times its original volume. This increase in volume exerts tensile stresses in the surrounding concrete which result in cracking and spalling of the concrete cover if the concrete tensile strength is exceeded. The mechanism by which steel embedded in concrete corrodes in presence of chloride is the local breakdown of the passive layer formed in the highly alkaline condition of the concrete. It is assumed that corrosion initiates when a critical chloride content reaches the rebar surface. The mathematical formulation idealized the corrosion sequence as a two-stage process: an initiation stage, during which chloride ions penetrate to the reinforcing steel surface and depassivate it, and a propagation stage, in which active corrosion takes place until cracking of the concrete cover has occurred. The aim of this research is to develop computer tools to evaluate the duration of the service life of reinforced concrete structures, considering both the initiation and propagation periods. Such tools must offer a friendly interface to facilitate its use by the researchers even though their background is not in numerical simulation. For the evaluation of the initiation period different tools have been developed: Program TavProbabilidade: provides means to carry out a probability analysis of a chloride ingress model. Such a tool is necessary due to the lack of data and general uncertainties associated with the phenomenon of the chloride diffusion. It differs from the deterministic approach because it computes not just a chloride profile at a certain age, but a range of chloride profiles for each probability or occurrence. Program TavProbabilidade_Fiabilidade: carries out reliability analyses of the initiation period. It takes into account the critical value of the chloride concentration on the steel that causes breakdown of the passive layer and the beginning of the propagation stage. It differs from the deterministic analysis in that it does not predict if the corrosion is going to begin or not, but to quantifies the probability of corrosion initiation. Program TavDif_1D: was created to do a one dimension deterministic analysis of the chloride diffusion process by the finite element method (FEM) which numerically solves Fick’second Law. Despite of the different FEM solver already developed in one dimension, the decision to create a new code (TavDif_1D) was taken because of the need to have a solver with friendly interface for pre- and post-process according to the need of IETCC. An innovative tool was also developed with a systematic method devised to compare the ability of the different 1D models to predict the actual evolution of chloride ingress based on experimental measurements, and also to quantify the degree of agreement of the models with each others. For the evaluation of the entire service life of the structure: a computer program has been developed using finite elements method to do the coupling of both service life periods: initiation and propagation. The program for 2D (TavDif_2D) allows the complementary use of two external programs in a unique friendly interface: • GMSH - an finite element mesh generator and post-processing viewer • OOFEM – a finite element solver. This program (TavDif_2D) is responsible to decide in each time step when and where to start applying the boundary conditions of fracture mechanics module in function of the amount of chloride concentration and corrosion parameters (Icorr, etc). This program is also responsible to verify the presence and the degree of fracture in each element to send the Information of diffusion coefficient variation with the crack width. • GMSH - an finite element mesh generator and post-processing viewer • OOFEM – a finite element solver. The advantages of the FEM with the interface provided by the tool are: • the flexibility to input the data such as material property and boundary conditions as time dependent function. • the flexibility to predict the chloride concentration profile for different geometries. • the possibility to couple chloride diffusion (initiation stage) with chemical and mechanical behavior (propagation stage). The OOFEM code had to be modified to accept temperature, humidity and the time dependent values for the material properties, which is necessary to adequately describe the environmental variations. A 3-D simulation has been performed to simulate the behavior of the beam on both, action of the external load and the internal load caused by the corrosion products, using elements of imbedded fracture in order to plot the curve of the deflection of the central region of the beam versus the external load to compare with the experimental data.

P-Adaptive Boundary Elements

This paper presents the implementation of an adaptive philosophy to plane potential problems, using the direct boundary element method. After some considerations about the state of the art and a discussion of the standard approach features, the possibility of separately treating the modelling of variables and their interpolation through hierarchical shape functions is analysed. Then the proposed indicators and estimators are given, followed by a description of a small computer program written for an IBM PC. Finally, some examples show the kind of results to be expected.

Improvements for B.E.M. implementation in micros

This paper presents a computer program developed to run in a micro I.B.M.-P.C. wich incorporates some features in order to optimize the number of operations needed to compute the solution of plane potential problems governed by Laplace's equation by using the Boundary Integral Equation Method (B.I.E.M.). Also incorporated is a routine to plot isolines inside the domain under study.

Theoretical Simulation of the A5 VEB Structure Pyrotechnique Shock Propagation

This paper presents some of the modelling criteria that have been used for the study of pyrotechnic shock propagation in the A5 VEB Structure, as well as the main conclusions from a mathematical model of the axymmetric effects in it. The separation of the lower stage of the ARIANE 5 Vehicle Equipment Bay (VEB)Structure is to be done using a pyrotechnic device. The wave propagation effects produced by the explosion have been analyzed with a computer program using as shape functions the analytical solution to the frequency response of a Timoshenko-Rayleigh beams and shells in that way the discretization can have elements as large as possible, depending on the material properties and boundary conditions. Moreover an enormous amount of possibilities in the treatment of concentrated masses, springs and dashpots, either with respect to a fixed reference or between nodes, is open for translational as well as rotational degrees of freedom.

Estimación de la peligrosidad sísmica mediante protocolos de juicios de expertos

Este trabajo estudia la aportación que los métodos de agregación de juicios de expertos pueden realizar en el cálculo de la peligrosidad sísmica de emplazamientos. Se han realizado cálculos en dos emplazamientos de la Península Ibérica: Mugardos (La Coruña) y Cofrentes (Valencia) que están sometidos a regímenes tectónicos distintos y que, además, alojan instalaciones industriales de gran responsabilidad. Las zonas de estudio, de 320 Km de radio, son independientes. Se ha aplicado un planteamiento probabilista a la estimación de la tasa anual de superación de valores de la aceleración horizontal de pico y se ha utilizado el Método de Montecarlo para incorporar a los resultados la incertidumbre presente en los datos relativos a la definición de cada fuente sismogenética y de su sismicidad. Los cálculos se han operado mediante un programa de ordenador, desarrollado para este trabajo, que utiliza la metodología propuesta por el Senior Seismic Hazard Analysis Commitee (1997) para la NRC. La primera conclusión de los resultados ha sido que la Atenuación es la fuente principal de incertidumbre en las estimaciones de peligrosidad en ambos casos. Dada la dificultad de completar los datos históricos disponibles de esta variable se ha estudiado el comportamiento de cuatro métodos matemáticos de agregación de juicios de expertos a la hora de estimar una ley de atenuación en un emplazamiento. Los datos de partida se han obtenido del Catálogo de Isosistas del IGN. Los sismos utilizados como variables raíz se han elegido con el criterio de cubrir uniformemente la serie histórica disponible y los valores de magnitud observados. Se ha asignado un panel de expertos particular a cada uno de los dos emplazamientos y se han aplicado a sus juicios los métodos de Cooke, equipesos, Apostolakis_Mosleh y Morris. Sus propuestas se han comparado con los datos reales para juzgar su eficacia y su facilidad de operación. A partir de los resultados se ha concluido que el método de Cooke ha mostrado el comportamiento más eficiente y robusto para ambos emplazamientos. Este método, además, ha permitido identificar, razonadamente, a aquellos expertos que no deberían haberse introducido en un panel. The present work analyses the possible contribution of the mathematical methods of aggregation in the assessment of Seismic Hazzard. Two sites, in the Iberian Peninsula, have been considered: Mugardos ( La Coruña) and Cofrentes (Valencia).Both of them are subjected to different tectonic regimes an both accommodate high value industrial plants. Their areas of concern, with radius of 320 Km, are not overlapping. A probabilistic approach has been applied in the assessment the annual probability of exceedence of the horizontal peak acceleration. The Montecarlo Method has allowed to transfer the uncertainty in the models and parameters to the final results. A computer program has been developed for this purpose. The methodology proposed by the Senior Seismic Analysis Committee (1997) for the NRC has been considered. Attenuation in Ground motion has been proved to be the main source of uncertainty in seismic hazard for both sites. Taking into account the difficulties to complete existing historical data in this subject the performance of four mathematical methods of aggregation has been studied. Original data have been obtained from the catalogs of the Spanish National Institute of Geography. The seismic events considered were chosen to cover evenly the historical records and the observed values of magnitude. A panel of experts have been applied to each site and four aggregation methods have been developed : equal weights, Cooke, Apostolakis-Mosleh and Morris The four proposals have been compaired with the actual data to judge their performance and ease of application. The results have shown that the Method of Cooke have proved the most efficient and robust for both sites. This method, besides, allow the reasoned identification of those experts who should be rejected from the panel

Hierarchical boundary elements

In this paper we show the possibility of applying adaptive procedures as an alternative to the well-known philosophy of standard Boundary Elements. The three characteristic steps of adaptive procedures, i.e. hierarchical shape functions families, indicator criteria, and a posteriori estimation, can be defined in order to govern an automatic refinement and stopping of the solution process. A computer program to treat potential problems, called QUEIMADA, has been developed to show the capabilities of the new idea.

A contribution to the optimal numbering of tree structures

This paper develops an automatic procedure for the optimal numbering of members and nodes in tree structures. With it the stiffness matrix is optimally conditioned either if a direct solution algorithm or a frontal one is used to solve the system of equations. In spite of its effectiveness, the procedure is strikingly simple and so is the computer program shown below.

Elaboración de un nuevo modelo económico para la contribución al desarrollo sostenible de países del África subsahariana: implementación en Guinea Bissau

El escaso crecimiento de los países del África subsahariana, lleva a la necesidad de plantear un tipo de modelo económico que se adapte a sus especiales características y que en definitiva, conduzca a las sociedades que viven en estos países a un aumento de su calidad de vida, mediante mejoras en todos los campos sociales tales como: la enseñanza, la salud y la nutrición, que puedan ayudar a transformar las perspectivas del crecimiento económico, especialmente en los países objeto de estudio, que se caracterizan por presentar bajos ingresos y escaso desarrollo humano. Se puede concluir, por tanto, diciendo que en definitiva, el fin es el desarrollo humano y que el crecimiento económico es un medio. El propósito del crecimiento económico debe ser enriquecer la vida de la gente. Los adelantos a corto plazo en materia de desarrollo humano son posibles, merced a un mayor crecimiento económico que a su vez no debe desligarse del respeto por el medioambiente y el entorno. Para conseguir estos objetivos, se plantea en la presente tesis un modelo económico, elaborado siguiendo las directrices de la Dinámica de Sistemas, mediante el uso del programa informático VENSIM. El modelo planteado se basa en la producción de energía eléctrica, que sería capaz de abastecer a una población y generar unos excedentes que podrían ser vendidos y las ganancias reinvertidas para impulsar el crecimiento económico de la población a la que abastece. ABSTRACT Low growth in sub-Saharan Africa, leading to the need to establish a type of economic model that suits their special characteristics and ultimately lead to societies that live in these countries to increase human capacity through improvements in all social fields such as education, health and nutrition that can help transform the prospects for economic growth, especially in the countries under study, which are characterized by low income and low human development. It can be concluded, therefore, saying that ultimately, the end is human development and economic growth is a means. The purpose of economic growth should be to enrich the lives of people. The short-term advances in human development are possible, thanks to higher economic growth which in turn should not be separated from respect for the environment and intone. To achieve these objectives, we propose in this thesis an economic model, developed under the guidance of dynamic systems, using the computer program VENSIM. The proposed model is based on the production of electricity, which would be able to supply a population and generate a surplus that could be sold and the proceeds reinvested to boost economic growth in the population it serves.