Prophylactic mastectomy and oophorectomy for women at risk of breast and ovarian cancer: Incorporating preferences in a decision analysis

The discoveries of the BRCA1 and BRCA2 genes have made it possible for women of families with hereditary breast/ovarian cancer to determine if they carry cancer-predisposing genetic mutations. Women with germline mutations have significantly higher probabilities of developing both cancers than the general population. Since the presence of a BRCA1 or BRCA2 mutation does not guarantee future cancer development, the appropriate course of action remains uncertain for these women. Prophylactic mastectomy and oophorectomy remain controversial since the underlying premise for surgical intervention is based more upon reduction in the estimated risk of cancer than on actual evidence of clinical benefit. Issues that are incorporated in a woman's decision making process include quality of life without breasts, ovaries, attitudes toward possible surgical morbidity as well as a remaining risk of future development of breast/ovarian cancer despite prophylactic surgery. The incorporation of patient preferences into decision analysis models can determine the quality-adjusted survival of different prophylactic approaches to breast/ovarian cancer prevention. Monte Carlo simulation was conducted on 4 separate decision models representing prophylactic oophorectomy, prophylactic mastectomy, prophylactic oophorectomy/mastectomy and screening. The use of 3 separate preference assessment methods across different populations of women allows researchers to determine how quality adjusted survival varies according to clinical strategy, method of preference assessment and the population from which preferences are assessed. ^

Phenotypic evolution in a venerid bivalve species lineage from the late Middle Miocene Central Paratethys Sea: a multi-approach morphometric analysis

A morphometric analysis was performed for the late Middle Miocene bivalve species lineage of Polititapes tricuspis (Eichwald, 1829) (Veneridae: Tapetini). Specimens from various localities grouped into two stratigraphically successive biozones, i.e. the upper Ervilia Zone and the Sarmatimactra Zone, were investigated using a multi-method approach. A Generalized Procrustes Analysis was computed for fifteen landmarks, covering characteristics of the hinge, muscle scars, and pallial line. The shell outline was separately quantified by applying the Fast Fourier Transform, which redraws the outline by fitting in a combination of trigonometric curves. Shell size was calculated as centroid size from the landmark configuration. Shell thickness, as not covered by either analysis, was additionally measured at the centroid. The analyses showed significant phenotypic differentiation between specimens from the two biozones. The bivalves become distinctly larger and thicker over geological time and develop circular shells with stronger cardinal teeth and a deeper pallial sinus. Data on the paleoenvironmental changes in the late Middle Miocene Central Paratethys Sea suggest the phenotypic shifts to be functional adaptations. The typical habitats for Polititapes changed to extensive, very shallow shores exposed to high wave action and tidal activity. Caused by the growing need for higher mechanical stability, the bivalves produced larger and thicker shells with stronger cardinal teeth. The latter are additionally shifted towards the hinge center to compensate for the lacking lateral teeth and improve stability. The deepening pallial sinus is related to a deeper burrowing habit, which is considered to impede being washed out in the new high-energy settings.

Survey and brain storming studies about machines, constructions, human and environmental risk consideration in the careers of the Universidad Politécnica of Madrid

The Universidad Politécnica of Madrid (UPM) includes schools and faculties that were for engineering degrees, architecture and computer science, that are now in a quick EEES Bolonia Plan metamorphosis getting into degrees, masters and doctorate structures. They are focused towards action in machines, constructions, enterprises, that are subjected to machines, human and environment created risks. These are present in actions such as use loads, wind, snow, waves, flows, earthquakes, forces and effects in machines, vehicles behavior, chemical effects, and other environmental factors including effects of crops, cattle and beasts, forests, and varied essential economic and social disturbances. Emphasis is for authors in this session more about risks of natural origin, such as for hail, winds, snow or waves that are not exactly known a priori, but that are often considered with statistical expected distributions giving extreme values for convenient return periods. These distributions are known from measures in time, statistic of extremes and models about hazard scenarios and about responses of man made constructions or devices. In each engineering field theories were built about hazards scenarios and how to cover for important risks. Engineers must get that the systems they handle, such as vehicles, machines, firms or agro lands or forests, obtain production with enough safety for persons and with decent economic results in spite of risks. For that risks must be considered in planning, in realization and in operation, and safety margins must be taken but at a reasonable cost. That is a small level of risks will often remain, due to limitations in costs or because of due to strange hazards, and maybe they will be covered by insurance in cases such as in transport with cars, ships or aircrafts, in agro for hail, or for fire in houses or in forests. These and other decisions about quality, security for men or about business financial risks are sometimes considered with Decision Theories models, using often tools from Statistics or operational Research. The authors have done and are following field surveys about risk consideration in the careers in UPM, making deep analysis of curricula taking into account the new structures of degrees in the EEES Bolonia Plan, and they have considered the risk structures offered by diverse schools of Decision theories. That gives an aspect of the needs and uses, and recommendations about improving in the teaching about risk, that may include special subjects especially oriented for each career, school or faculty, so as to be recommended to be included into the curricula, including an elaboration and presentation format using a multi-criteria decision model.

Outsourcing and acquisition models comparison related to IT supplier selection decision analysis

This paper presents a comparison of acquisition models related to decision analysis of IT supplier selection. The main standards are: Capability Maturity Model Integration for Acquisition (CMMI-ACQ), ISO / IEC 12207 Information Technology / Software Life Cycle Processes, IEEE 1062 Recommended Practice for Software Acquisition, the IT Infrastructure Library (ITIL) and the Project Management Body of Knowledge (PMBOK) guide. The objective of this paper is to compare the previous models to find the advantages and disadvantages of them for the future development of a decision model for IT supplier selection.

Is building renovation truly sustainable? The need for applying a multi-criteria assessment through life cycle approach

The aim of the present research is to characterise the international scene in the field of building refurbishment, by thoroughly reviewing the literature relating to building renovation and systematising the results according to the different aspects considered by the authors. Even though there is certain consensus with respect to the criteria for the selection of energy efficiency measures, the assessment criteria differ broadly and widely. The present work highlights the lack of consensus on the assessment criteria and the need of harmonization. A holistic view is required in order to identify the most sustainable strategies in each particular case, considering social, environmental and economic impacts from a life cycle perspective.

Validación de sistemas constructivos de los cerramientos de la edificación mediante la aplicación de los métodos de decisión multicriterio : aplicación al catálogo de elementos constructivos del Código Técnico de la Edificación

Como punto de partida para el desarrollo de la Tesis, se mantiene la hipótesis de que es posible establecer métodos de evaluación global sobre el grado de utilidad de los sistemas constructivos correspondientes a los cerramientos de la edificación. Tales métodos habrían de posibilitar, de entre una serie finita de sistemas alternativos, cuáles de ellos son los objetivamente más adecuados para su selección en un entorno de decisión concreto, y habrían de permitir fundamentar la justificación objetiva de tal decisión. Paralelamente a esta hipótesis de carácter general, se planteó desde el inicio la necesidad de comprobación de una hipótesis de partida particular según la cual los sistemas constructivos basados en la utilización de componentes prefabricados, o procesos de puesta en obra con un alto grado de industrialización arrojarían valores de utilidad mayores que los sistemas tradicionales basados en la albañilería. Para la verificación de estas dos hipótesis de partida se ha procedido inicialmente a la selección de un conjunto coherente de doce sistemas de cerramientos de la edificación que pudiese servir como testigo de su diversidad potencial, para proceder a su valoración comparativa. El método de valoración propuesto ha entrado a considerar una serie de factores de diversa índole que no son reducibles a un único parámetro o magnitud que permitiese una valoración de tipo lineal sobre su idoneidad relativa, ni que permitiese establecer un grado de prelación entre los distintos sistemas constructivos alternativos de manera absoluta. Para resolver este tour de force o desafío metodológico se ha acudido a la aplicación de metodologías de valoración que nos permitiesen establecer de forma racional dicha comparativa. Nos referimos a una serie de metodologías provenientes en primera instancia de las ciencias exactas, que reciben la denominación de métodos de ayuda a la decisión multicriterio, y en concreto el denominado método ELECTRE. Inicialmente, se ha planteado la aplicación del método de análisis sobre doce sistemas constructivos seleccionados de tal forma que representasen de forma adecuada las tres categorías establecidas para caracterizar la totalidad de sistemas constructivos posibles; por peso, grado de prefabricación y grado de ventilación. Si bien la combinación de las tres categorías básicas anteriormente señaladas produce un total de 18 subcategorías conceptuales, tomamos finalmente doce subcategorías dado que consideramos que es un número operativo suficiente por extenso para el análisis propuesto y elimina tipos no relevantes. Aplicado el método propuesto, a estos doce sistemas constructivos “testigo”, se constata el mayor grado de utilidad de los sistemas prefabricados, pesados y no ventilados. Al hilo del análisis realizado en la Parte II de la Tesis sobre los doce sistemas constructivos “testigo”, se ha realizado un volcado de los sistemas constructivos incluidos en el Catalogo de Elementos Constructivos del CTE (versión 2010) sobre las dieciocho subcategorías definidas en dicha Parte II para caracterizar los sistemas constructivos “testigo”. Posteriormente, se ha procedido a una parametrización de la totalidad de sistemas constructivos para cerramientos de fachadas incluidos en este Catálogo. La parametrización sistemática realizada ha permitido establecer, mediante el cálculo del valor medio que adoptan los parámetros de los sistemas pertenecientes a una misma familia de las establecidas por el Catálogo, una caracterización comparativa del grado de utilidad de dichas familias, tanto en lo relativo a cada uno de los parámetros como en una valoración global de sus valores, de carácter indicativo. Una vez realizada una parametrización completa de la totalidad de sistemas constructivos incluidos en el Catálogo, se ha realizado una simulación de aplicación de la metodología de validación desarrollada en la Parte II de la presente Tesis, con el objeto de comprobar su adecuación al caso. En conclusión, el desarrollo de una herramienta de apoyo a la decisión multicriterio aplicada al Catálogo de Elementos constructivos del CTE se ha demostrado técnicamente viable y arroja resultados significativos. Se han diseñado dos sistemas constructivos mediante la aplicación de la herramienta desarrollada, uno de fachada no ventilada y otro de fachada ventilada. Comparados estos dos sistemas constructivos mejorados con otros sistemas constructivos analizados Se comprueba el alto grado de utilidad objetiva de los dos sistemas diseñados en relación con el resto. La realización de este ejercicio de diseño de un sistema constructivo específico, que responde a los requerimientos de un decisor concreto viene a demostrar, así pues, la utilidad del algoritmo propuesto en su aplicación a los procesos de diseño de los sistemas constructivos. La tesis incorpora dos innovaciones metodológicas y tres innovaciones instrumentales. ABSTRACT The starting point for the thesis is the hypothesis that it is possible to devise suitability degree evaluation methods of building enclosure systems. Such methods should allow optimizing appraisal, given a specific domain of decision, among a finite number of alternative systems, and provide objective justification of such decision. Along with the above mentioned general assumption, a second hypothesis whereby constructive systems based on the use of prefabricated components, or high industrialization degree work processes, would throw efficiency values higher than traditional masonry systems needed to be tested. In order to validate these two hypothesis a coherent set of twelve enclosure systems that could serve as a reference sample of their potential diversity was selected and a comparative evaluation was carried out. The valuation method proposed has considered several different factors that are neither reducible to a single parameter or magnitude that would allow a linear evaluation of their relative suitability nor allow to establishing an absolute priority ranking between different alternative constructive systems. In order to resolve this tour de force or methodological challenge, valuation methodologies that enable use establishing rational assessments were used. We are referring to a number of methodologies taken from the exact sciences field, usually known as aid methods for multi-criteria decision, in particular the so-called ELECTRE method. Even though the combination of the mentioned three basic categories result in eighteen conceptual sub categories, we are finally considering just twelve since we deem it adequately extended for the our intended purpose and eliminates non relevant instances. The method of analysis was initially applied to the set of twelve selected constructive systems is a way that they could represent adequately the three previously established categories set out to characterize all possible enclosure systems, namely weight, prefabrication degree and ventilation degree. Once the proposed method is applied to the sample systems, the higher efficiency of the prefabricated, heavy and not ventilated systems was confirmed. In line with the analysis in Part II of the thesis on the twelve chosen enclosure systems, it has done an uploading data of construction systems listed in the Catalogue of constructive elements of the CTE (version 2010) according the eighteen subcategories used in this part II to characterize the construction systems taken as sample. Subsequently, a parameterization of all enclosure facade systems included in this catalog has been undertaken. The systematic parameterization has allowed to set, by means of calculating the average values of the parameters of the systems belonging to the same family of those established by the Catalog, a comparative characterization of the efficiency degree of these families, both in relation to each parameter as to an overall evaluation of its values, in a indicative way. After the parameterization of all enclosure systems included in the Catalog, a simulation of validation methodology application developed in Part II of this Thesis has been made, in order to assess its consistency to the referred case. In conclusion, the development of a multi-criteria decision aid tool, applied to the CTE Catalog of constructive elements, has proved to be technically feasible and yields significant results. Two building systems through the application of the developed tool, a non-ventilated façade and a ventilated façade have been designed. Comparing these two improved construction systems with other building systems analyzed, we were able to assess the high degree of objective efficiency of the two systems designed in relation to the rest. The exercise of designing a specific enclosure system that meets the requirements of a particular decision-maker hence shows the suitability of the proposed algorithm applied to the process of enclosure systems design. This Thesis includes two methodological innovations and three instrumental innovations.

Varying efficacy of Helicobacter pylori eradication regimens: cost effectiveness study using a decision analysis model

Objective: To determine how small differences in the efficacy and cost of two antibiotic regimens to eradicate Helicobacter pylori can affect the overall cost effectiveness of H pylori eradication in duodenal ulcer disease.

Dade County Trauma Task Force: a multi-system comparative analysis.

National Highway Traffic Safety Administration, Washington, D.C.

Decision analysis for abandoned mine reclamation site selection and planning : a report /

"August 1979."

Decision analysis and environmental regulations /

Mode of access: Internet.

A note on DEA models in technology selection:an improvement of Karsak and Ahiska's approach

This paper introduces a compact form for the maximum value of the non-Archimedean in Data Envelopment Analysis (DEA) models applied for the technology selection, without the need to solve a linear programming (LP). Using this method the computational performance the common weight multi-criteria decision-making (MCDM) DEA model proposed by Karsak and Ahiska (International Journal of Production Research, 2005, 43(8), 1537-1554) is improved. This improvement is significant when computational issues and complexity analysis are a concern.

An integrated multiple criteria decision making approach for resource allocation in higher education

Resource allocation is one of the major decision problems arising in higher education. Resources must be allocated optimally in such a way that the performance of universities can be improved. This paper applies an integrated multiple criteria decision making approach to the resource allocation problem. In the approach, the Analytic Hierarchy Process (AHP) is first used to determine the priority or relative importance of proposed projects with respect to the goals of the universities. Then, the Goal Programming (GP) model incorporating the constraints of AHP priority, system, and resource is formulated for selecting the best set of projects without exceeding the limited available resources. The projects include 'hardware' (tangible university's infrastructures), and 'software' (intangible effects that can be beneficial to the university, its members, and its students). In this paper, two commercial packages are used: Expert Choice for determining the AHP priority ranking of the projects, and LINDO for solving the GP model. Copyright © 2007 Inderscience Enterprises Ltd.

Developing a forest data portal to support multi-scale decision making

Forests play a pivotal role in timber production, maintenance and development of biodiversity and in carbon sequestration and storage in the context of the Kyoto Protocol. Policy makers and forest experts therefore require reliable information on forest extent, type and change for management, planning and modeling purposes. It is becoming increasingly clear that such forest information is frequently inconsistent and unharmonised between countries and continents. This research paper presents a forest information portal that has been developed in line with the GEOSS and INSPIRE frameworks. The web portal provides access to forest resources data at a variety of spatial scales, from global through to regional and local, as well as providing analytical capabilities for monitoring and validating forest change. The system also allows for the utilisation of forest data and processing services within other thematic areas. The web portal has been developed using open standards to facilitate accessibility, interoperability and data transfer.