Multiple Criteria Decision Analysis (MCDA) for evaluating cancer treatments in hospital-based health technology assessment: The Paraconsistent Value Framework.

BACKGROUND: In recent years, the potential of multi-criteria decision analysis (MCDA) in the health field has been discussed widely. However, most MCDA methodologies have given little attention to the aggregation of different stakeholder individual perspectives. OBJECTIVE: To illustrate how a paraconsistent theory-based MCDA reusable framework, designed to aid hospital-based Health Technology Assessment (HTA), could be used to aggregate individual expert perspectives when valuing cancer treatments. METHODS: An MCDA methodological process was adopted based on paraconsistent theory and following ISPOR recommended steps in conducting an MCDA study. A proof-of-concept exercise focusing on identifying and assessing the global value of first-line treatments for metastatic colorectal cancer (mCRC) was conducted to foster the development of the MCDA framework. RESULTS: On consultation with hospital-based HTA committee members, 11 perspectives were considered in an expert panel: medical oncology, oncologic surgery, radiotherapy, palliative care, pharmacist, health economist, epidemiologist, public health expert, health media expert, pharmaceutical industry, and patient advocate. The highest weights were assigned to the criteria "overall survival" (mean 0.22), "burden of disease" (mean 0.21) and "adverse events" (mean 0.20), and the lowest weights were given to "progression-free survival" and "cost of treatment" (mean 0.18 for both). FOLFIRI and mFlox scored the highest global value score of 0.75, followed by mFOLFOX6 with a global value score of 0.71. mIFL was ranked last with a global value score of 0.62. The paraconsistent analysis (para-analysis) of 6 first-line treatments for mCRC indicated that FOLFIRI and mFlox were the appropriate options for reimbursement in the context of this study. CONCLUSION: The Paraconsistent Value Framework is proposed as a step beyond the current MCDA practices, in order to improve means of dealing with individual expert perspectives in hospital-based HTA of cancer treatments.

A Heuristic and Data Mining Model for Predicting Broiler House Environment Suitability.

The proper combination of environment and flock-based variables plays a critical role in broiler production. However, the housing environment control is mainly focused on temperature monitoring during the broiler growth process. The present study developed a novel predictive model to predict the broiler (Gallus gallus domesticus) rearing conditions' suitability using a data-mining process centered on flock-based and environmental variables. Data were recorded inside four commercial controlled environment broiler houses. The data analysis was conducted in three steps. First, we performed an exploratory and descriptive analysis of the environmental data. In the second step, we labeled the target variable that led to a specific broiler-rearing scenario depending on the age of the birds, the environmental dry-bulb temperature and relative humidity, the ammonia concentration, and the ventilation rate. The output (final rearing condition) was discretized into four categories ('Excellent', 'Good', 'Moderate', and 'Inappropriate'). In the third step, we used the dataset to develop tree models using the data-mining process. The random-tree model only presented accuracy for predicting the 'Excellent' and 'Moderate' rearing conditions. The decision-tree model had high accuracy and indicated that broiler age, relative humidity, and ammonia concentration play a critical role in proper rearing conditions. Using a large amount of data allows the data-mining approach to building up 'if-then' rules that indicate suitable environmental control decision-making by broiler farmers.

Paraconsistent Annotated Logic Algorithms Applied in Management and Control of Communication Network Routes.

This paper presents a computational method based on non-classical logic dedicated to routing management and information stream control in communication networks. Paraconsistent logic (PL) was used to create an algorithmic structure whose main property is to accept contradiction. Moreover, a computational structure, the denominated paraconsistent data analyzer (PDAPAL2v), was constructed to perform routing management in communication networks. Direct comparisons of PDAPAL2v with a classical logic system that simulates routing conditions were made in the laboratory. In the conventional system, the paraconsistent algorithms were considered as binary logic gates, and in the tests, the same adjustment limits of PDAPAL2v were applied. Using a database with controlled insertion of noise, we obtained an efficacy of 97% in the detection of deteriorated packets with PDAPAL2v and 72% with the conventional simulation system. Functional tests were carried out, showing that PDAPAL2v is able to assess the conditions and degradation of links and perform the analysis and correlation of various inputs and variables, even if the signals have contradictory values. From practical tests in the laboratory, the proposed method represents a new way of managing and controlling communication network routes with good performance.

Validation of CD4+ T-cell and viral load data from the HIV-Brazil Cohort Study using secondary system data.

BACKGROUND: The HIV-Brazil Cohort Study (HIV-BCS) is a research primarily based on data collection from medical records of people living with HIV/AIDS in Brazil. The aim of this study was to present the validating design and results for the laboratory biomarkers viral load and CD4+ T-cell count from the HIV-Brazil Cohort Study. METHODS: A total of 8007 patients who were started cART from 2003 to 2013 were considered eligible for this study. Total follow-up time was 32,397 years. The median duration of follow-up was 3.51 years (interquartile range - IQR 1.63-6.13 years; maximum 11.51 years). We used secondary data from the Brazilian Laboratory Tests Control System (SISCEL). Incidence of lab testing rates per 100 person years (100 py) were used to compare the number of laboratory tests carried out among cohort sites considering different databases for CD4+ T-cell counts and HIV viral load assessments. Descriptive statistics including 95% confidence interval, Pearson correlation coefficient, Bland-Altman agreement analysis and kappa coefficient agreement were applied for analysis. RESULTS: A total of 80,302 CD4+ T-cell counts and 79,997 HIV viral load assessments were observed in HIV-BCS versus 94,083 CD4+ T-cell counts and 84,810 viral loads from the Brazilian Laboratory Tests Control System. The general CD4+ T-cell HIV-BCS testing rate was 247 per 100 py versus 290 per 100 py and the viral load HIV-BCS testing rate was 246 per 100 py versus 261 per 100 py. The general correlation observed for the lowest quantitative CD4+ T-cell count before cART was 0.970 (p < 0.001) and for the log of the highest viral load before cART was 0.971 (p < 0.001). The general agreement coefficient for categorized CD4+ T-cell count was 0.932 (p < 0.001) and for viral load was 0.996 (p < 0.001). CONCLUSIONS: The current study confirms that biomarkers CD4+ T-cell count and viral load from the HIV-BCS have a high correlation and agreement with data from SISCEL, rendering both databases reliable and useful for epidemiological studies on HIV care in Brazil.

[Multi-criteria decision analysis for health technology resource allocation and assessment: so far and so near?] / Análise de decisão multicritério para alocação de recursos e avaliação de tecnologias em saúde: tão longe e tão perto?

Multi-criteria decision analysis (MCDA) is an emerging tool that allows the integration of relevant factors for health technology assessment (HTA). This study aims to present a summary of the methodological characteristics of MCDA: definitions, approaches, applications, and implementation stages. A case study was conducted in the São Paulo State Cancer Institute (ICESP) in order to understand the perspectives of decision-makers in the process of drafting a recommendation for the incorporation of technology in the Brazilian Unified National Health System (SUS), through a report by the Brazilian National Commission for the Incorporation of Technologies in the SUS (CONITEC). Paraconsistent annotated evidential logic Eτ was the methodological approach adopted in the study, since it can serve as an underlying logic for constructs capable of synthesizing objective information (from the scientific literature) and subjective information (from experts' values and preferences in the area of knowledge). It also allows the incorporation of conflicting information (contradictions), as well as vague and even incomplete information in the valuation process, resulting from imperfection of the available scientific evidence. The method has the advantages of allowing explicit consideration of the criteria that influenced the decision, facilitating follow-up and visualization of process stages, allowing assessment of the contribution of each criterion separately, and in aggregate, to the decision's outcome, facilitating the discussion of diverging perspectives by different stakeholder groups, and increasing the understanding of the resulting recommendations. The use of an explicit MCDA approach should facilitate conflict mediation and optimize participation by different stakeholder groups.

A análise de decisão multicritérios (ADMC) é uma ferramenta emergente que permite a integração de fatores relevantes para os processos de avaliação de tecnologias em saúde (ATS). O objetivo deste estudo é apresentar uma síntese dos aspectos metodológicos da ADMC: definições, abordagens, aplicações e etapas de implementação. Realizou-se um estudo de caso no Instituto do Câncer do Estado de São Paulo (ICESP) com a intenção de compreender as perspectivas de tomadores de decisão no processo de elaboração de uma recomendação de incorporação de tecnologia no âmbito do Sistema Único de Saúde (SUS), por um relatório da Comissão Nacional de Incorporação de Tecnologias no SUS (CONITEC). A lógica paraconsistente anotada evidencial Eτ foi a abordagem metodológica escolhida por ser capaz de ser uma lógica subjacente para construtos capazes de sintetizar informações objetivas (provenientes da literatura científica) e subjetivas (provenientes de valores e preferências de especialistas na área de conhecimento); além de permitir a incorporação de informações conflitantes (contradições), vagas e mesmo incompletas no processo de valoração, resultantes da imperfeição das evidências científicas disponíveis. Foram identificadas como vantagens do método: permitir considerar de modo explícito os critérios que influenciaram a decisão; facilitar o acompanhamento e visualização das etapas do processo; permitir avaliar a contribuição de cada critério de modo isolado e agregado para o resultado da decisão; facilitar a discussão de perspectivas divergentes dos grupos de interesse e aumentar a compreensão das recomendações elaboradas. O emprego de uma abordagem explícita de ADMC poderá facilitar a mediação de conflitos e otimizar a participação de diferentes grupos de interesse.

El análisis de decisión multicriterio (ADMC) es una herramienta emergente que permite la integración de factores relevantes en los procesos de evaluación de tecnologías en salud (ATS). El objetivo de este estudio es presentar una síntesis de los aspectos metodológicos de la ADMC: definiciones, enfoques, aplicaciones y etapas de implementación. Se realizó un estudio de caso en el Instituto del Cáncer del Estado de São Paulo (ICESP), con la intención de comprender las perspectivas de los tomadores de decisión, en el proceso de elaboración de una recomendación para la incorporación de tecnología en el ámbito del Sistema Único de Salud (SUS), mediante informes de la Comisión Nacional de Incorporación de Tecnologías en el SUS (CONITEC). La lógica paraconsistente anotada de evidencias Eτ fue el enfoque metodológico seleccionado, al tratarse de una lógica subyacente para constructos capaces de sintetizar información objetiva (procedente de la literatura científica) y subjetiva (procedente de valores y preferencias de especialistas en el área de conocimiento); además de permitir la incorporación de información conflictiva (contradicciones), vaga e incluso incompleta en el proceso de valoración, resultante de la imperfección en las evidencias científicas disponibles. Se identificaron como ventajas de este método: permitir considerar de modo explícito los criterios que influenciaron las decisiones; facilitar el seguimiento y visualización de las etapas del proceso; permitir la evaluación de la contribución de cada criterio de modo aislado y agregado para el resultado de las decisiones; facilitar la discusión de perspectivas divergentes en los grupos de interés y aumentar la comprensión de las recomendaciones elaboradas. El empleo de un enfoque explícito de ADMC podrá facilitar la comprobación de conflictos y optimizar la participación de diferentes grupos de interés.

Análise de decisão multicritério para alocação de recursos e avaliação de tecnologias em saúde: tão longe e tão perto? / Multi-criteria decision analysis for health technology resource allocation and assessment: so far and so near? / Análisis de decisión multicriterio para la asignación de recursos y evaluación de tecnologías en salud: ¿tan lejos y tan cerca?

A análise de decisão multicritérios (ADMC) é uma ferramenta emergente que permite a integração de fatores relevantes para os processos de avaliação de tecnologias em saúde (ATS). O objetivo deste estudo é apresentar uma síntese dos aspectos metodológicos da ADMC: definições, abordagens, aplicações e etapas de implementação. Realizou-se um estudo de caso no Instituto do Câncer do Estado de São Paulo (ICESP) com a intenção de compreender as perspectivas de tomadores de decisão no processo de elaboração de uma recomendação de incorporação de tecnologia no âmbito do Sistema Único de Saúde (SUS), por um relatório da Comissão Nacional de Incorporação de Tecnologias no SUS (CONITEC). A lógica paraconsistente anotada evidencial Eτ foi a abordagem metodológica escolhida por ser capaz de ser uma lógica subjacente para construtos capazes de sintetizar informações objetivas (provenientes da literatura científica) e subjetivas (provenientes de valores e preferências de especialistas na área de conhecimento); além de permitir a incorporação de informações conflitantes (contradições), vagas e mesmo incompletas no processo de valoração, resultantes da imperfeição das evidências científicas disponíveis. Foram identificadas como vantagens do método: permitir considerar de modo explícito os critérios que influenciaram a decisão; facilitar o acompanhamento e visualização das etapas do processo; permitir avaliar a contribuição de cada critério de modo isolado e agregado para o resultado da decisão; facilitar a discussão de perspectivas divergentes dos grupos de interesse e aumentar a compreensão das recomendações elaboradas. O emprego de uma abordagem explícita de ADMC poderá facilitar a mediação de conflitos e otimizar a participação de diferentes grupos de interesse.

Multi-criteria decision analysis (MCDA) is an emerging tool that allows the integration of relevant factors for health technology assessment (HTA). This study aims to present a summary of the methodological characteristics of MCDA: definitions, approaches, applications, and implementation stages. A case study was conducted in the São Paulo State Cancer Institute (ICESP) in order to understand the perspectives of decision-makers in the process of drafting a recommendation for the incorporation of technology in the Brazilian Unified National Health System (SUS), through a report by the Brazilian National Commission for the Incorporation of Technologies in the SUS (CONITEC). Paraconsistent annotated evidential logic Eτ was the methodological approach adopted in the study, since it can serve as an underlying logic for constructs capable of synthesizing objective information (from the scientific literature) and subjective information (from experts' values and preferences in the area of knowledge). It also allows the incorporation of conflicting information (contradictions), as well as vague and even incomplete information in the valuation process, resulting from imperfection of the available scientific evidence. The method has the advantages of allowing explicit consideration of the criteria that influenced the decision, facilitating follow-up and visualization of process stages, allowing assessment of the contribution of each criterion separately, and in aggregate, to the decision's outcome, facilitating the discussion of diverging perspectives by different stakeholder groups, and increasing the understanding of the resulting recommendations. The use of an explicit MCDA approach should facilitate conflict mediation and optimize participation by different stakeholder groups.

El análisis de decisión multicriterio (ADMC) es una herramienta emergente que permite la integración de factores relevantes en los procesos de evaluación de tecnologías en salud (ATS). El objetivo de este estudio es presentar una síntesis de los aspectos metodológicos de la ADMC: definiciones, enfoques, aplicaciones y etapas de implementación. Se realizó un estudio de caso en el Instituto del Cáncer del Estado de São Paulo (ICESP), con la intención de comprender las perspectivas de los tomadores de decisión, en el proceso de elaboración de una recomendación para la incorporación de tecnología en el ámbito del Sistema Único de Salud (SUS), mediante informes de la Comisión Nacional de Incorporación de Tecnologías en el SUS (CONITEC). La lógica paraconsistente anotada de evidencias Eτ fue el enfoque metodológico seleccionado, al tratarse de una lógica subyacente para constructos capaces de sintetizar información objetiva (procedente de la literatura científica) y subjetiva (procedente de valores y preferencias de especialistas en el área de conocimiento); además de permitir la incorporación de información conflictiva (contradicciones), vaga e incluso incompleta en el proceso de valoración, resultante de la imperfección en las evidencias científicas disponibles. Se identificaron como ventajas de este método: permitir considerar de modo explícito los criterios que influenciaron las decisiones; facilitar el seguimiento y visualización de las etapas del proceso; permitir la evaluación de la contribución de cada criterio de modo aislado y agregado para el resultado de las decisiones; facilitar la discusión de perspectivas divergentes en los grupos de interés y aumentar la comprensión de las recomendaciones elaboradas. El empleo de un enfoque explícito de ADMC podrá facilitar la comprobación de conflictos y optimizar la participación de diferentes grupos de interés.

Paraconsistent analysis network applied in the treatment of Raman spectroscopy data to support medical diagnosis of skin cancer.

Paraconsistent logic (PL) is a type of non-classical logic that accepts contradiction as a fundamental concept and has produced valuable results in the analysis of uncertainties. In this work, algorithms based on a type of PL-paraconsistent annotated logic of two values (PAL2v)-are interconnected into a network of paraconsistent analysis (PANnet). PANnet was applied to a dataset comprising 146 Raman spectra of skin tissue biopsy fragments of which 30 spectra were determined to represent normal skin tissue (N), 96 were determined to represent tissue with basal cell carcinoma, and 19 were determined to be tissue with melanoma (MEL). In this database, paraconsistent analysis was able to correctly discriminate 136 out of a total of 145 fragments, obtaining a 93.793 % correct diagnostic accuracy. The application of PAL2v in the analysis of Raman spectroscopy signals produces better discrimination of cells than conventional statistical processes and presents a good graphical overview through its associated lattice structure. The technique of PAL2v-based data processing can be fundamental in the development of a computational tool dedicated to support the diagnosis of skin cancer using Raman spectroscopy.

Factors Associated with Mortality and Graft Failure in Liver Transplants: A Hierarchical Approach.

BACKGROUND: Liver transplantation has received increased attention in the medical field since the 1980s following the introduction of new immunosuppressants and improved surgical techniques. Currently, transplantation is the treatment of choice for patients with end-stage liver disease, and it has been expanded for other indications. Liver transplantation outcomes depend on donor factors, operating conditions, and the disease stage of the recipient. A retrospective cohort was studied to identify mortality and graft failure rates and their associated factors. All adult liver transplants performed in the state of São Paulo, Brazil, between 2006 and 2012 were studied. METHODS AND FINDINGS: A hierarchical Poisson multiple regression model was used to analyze factors related to mortality and graft failure in liver transplants. A total of 2,666 patients, 18 years or older, (1,482 males; 1,184 females) were investigated. Outcome variables included mortality and graft failure rates, which were grouped into a single binary variable called negative outcome rate. Additionally, donor clinical, laboratory, intensive care, and organ characteristics and recipient clinical data were analyzed. The mortality rate was 16.2 per 100 person-years (py) (95% CI: 15.1-17.3), and the graft failure rate was 1.8 per 100 py (95% CI: 1.5-2.2). Thus, the negative outcome rate was 18.0 per 100 py (95% CI: 16.9-19.2). The best risk model demonstrated that recipient creatinine ≥ 2.11 mg/dl [RR = 1.80 (95% CI: 1.56-2.08)], total bilirubin ≥ 2.11 mg/dl [RR = 1.48 (95% CI: 1.27-1.72)], Na+ ≥ 141.01 mg/dl [RR = 1.70 (95% CI: 1.47-1.97)], RNI ≥ 2.71 [RR = 1.64 (95% CI: 1.41-1.90)], body surface ≥ 1.98 [RR = 0.81 (95% CI: 0.68-0.97)] and donor age ≥ 54 years [RR = 1.28 (95% CI: 1.11-1.48)], male gender [RR = 1.19(95% CI: 1.03-1.37)], dobutamine use [RR = 0.54 (95% CI: 0.36-0.82)] and intubation ≥ 6 days [RR = 1.16 (95% CI: 1.10-1.34)] affected the negative outcome rate. CONCLUSIONS: The current study confirms that both donor and recipient characteristics must be considered in post-transplant outcomes and prognostic scores. Our data demonstrated that recipient characteristics have a greater impact on post-transplant outcomes than donor characteristics. This new concept makes liver transplant teams to rethink about the limits in a MELD allocation system, with many teams competing with each other. The results suggest that although we have some concerns about the donors features, the recipient factors were heaviest predictors for bad outcomes.

Nevus and melanoma paraconsistent classification.

This paper presents the first studies on Nevus and Melanoma classification by using Paraconsistent Artificial Neural Network (PANN). Nevus is usually a small growth on the skin while Melanoma is a dangerous skin cancer. The proposed automated process classifies a set of medical images as Nevus and Melanoma based on a methodology grounded on PANN which is able to deal with conflicting, paracomplete and imprecise data directly without trivialization. Such methodology performed promising results considering only border features to classify the sample.

Paraconsistent artificial neural networks and Alzheimer disease: a preliminary study.

EEG visual analysis has proved useful in aiding AD diagnosis, being indicated in some clinical protocols. However, such analysis is subject to the inherent imprecision of equipment, patient movements, electric registers, and individual variability of physician visual analysis. OBJECTIVES: To employ the Paraconsistent Artificial Neural Network to ascertain how to determine the degree of certainty of probable dementia diagnosis. METHODS: Ten EEG records from patients with probable Alzheimer disease and ten controls were obtained during the awake state at rest. An EEG background between 8 Hz and 12 Hz was considered the normal pattern for patients, allowing a variance of 0.5 Hz. RESULTS: The PANN was capable of accurately recognizing waves belonging to Alpha band with favorable evidence of 0.30 and contrary evidence of 0.19, while for waves not belonging to the Alpha pattern, an average favorable evidence of 0.19 and contrary evidence of 0.32 was obtained, indicating that PANN was efficient in recognizing Alpha waves in 80% of the cases evaluated in this study. Artificial Neural Networks - ANN - are well suited to tackle problems such as prediction and pattern recognition. The aim of this work was to recognize predetermined EEG patterns by using a new class of ANN, namely the Paraconsistent Artificial Neural Network - PANN, which is capable of handling uncertain, inconsistent and paracomplete information. An architecture is presented to serve as an auxiliary method in diagnosing Alzheimer disease. CONCLUSIONS: We believe the results show PANN to be a promising tool to handle EEG analysis, bearing in mind two considerations: the growing interest of experts in visual analysis of EEG, and the ability of PANN to deal directly with imprecise, inconsistent, and paracomplete data, thereby providing a valuable quantitative analysis.

A análise visual de EEG tem se mostrado útil na ajuda de diagnóstico de DA, sendo indicado em alguns protocolos clínicos. Porém, tal análise está sujeita à imprecisão inerente de equipamentos, movimentos do paciente, registros elétricos e variação individual da análise visual do médico. OBJETIVOS: Utilizar a Rede Neural Artificial Paraconsistente para saber como determinar um grau de certeza no diagnóstico da doença de Alzheimer provável. MÉTODOS: Dez pacientes com doença de Alzheimer provável e 10 controles foram submetidos ao registro de exames de EEG durante a vigília em repouso. Considerou-se como padrão normal de um paciente, a atividade de base entre 8,0 Hz a 12,0 Hz, permitindo uma variação de 0.5 Hz. RESULTADOS: A RNAP foi capaz de reconhecer ondas que pertencem à banda Alfa como banda Alfa com evidência favorável de 0.30 e evidência contrária de 0.19, enquanto ondas não pertencentes ao padrão Alfa, foi obtido uma evidência favorável média de 0.19 e evidência contrária de 0.32, mostrando que a RNAP foi eficiente para reconhecer ondas Alfa, o que leva a uma concordância com o diagnóstico clínico de 80%. CONCLUSÕES: RNAP pode ser ferramenta promissora para manipular análise de EEG, tendo em mente ambas considerações: o interesse crescente de especialistas em análise visual de EEG e a capacidade da RNAP tratar diretamente dados imprecisos, inconsistentes e paracompletos, fornecendo uma interessante análise quantitativa.