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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ejor.2005.02.057 Byline: A. Mateos, A. Jimenez, S. Rios-Insua Keywords: Decision analysis; Group decisions and negotiations; Multiple criteria analysis; Decision support system; Additive multi-attribute utility model Abstract: In this paper we deal with group decision-making problems where several decision makers elicit their own preferences separately. The decision makers' preferences are quantified using a decision support system, which admits incomplete information concerning the decision makers' responses to the questions they are asked. Consequently, each decision maker proposes classes of utility functions and attribute weight intervals for the different attributes. We introduce an approach based on Monte Carlo simulation techniques for aggregating decision maker preferences that could be the starting point for a negotiation process, if necessary. The negotiation process would basically involve the decision maker tightening the imprecise component utilities and weights to output more meaningful results and achieve a consensus alternative. We focus on how attribute weights and the component utilities associated with a consequence are randomly generated in the aggregation process taking into account the decision-makers' preferences, i.e., their respective attribute weight intervals and classes of utility functions. Finally, an application to the evaluation of intervention strategies for restoring a radionuclide contaminated lake illustrates the usefulness and flexibility of this iterative process. Author Affiliation: Department of Artificial Intelligence, School of Computer Science, Madrid Technical University, Campus de Montegancedo s/n, 28660 Madrid, Spain Article History: Received 27 January 2004; Accepted 21 February 2005

BACKGROUND: Neonatal jaundice is treated daily at all hospitals. However, the routine, urgency, and case load of most doctors stop them from carefully analyzing all the factors that they would like to (and should) take into account. This article develops a complex decision support system for neonatal jaundice management. METHODS: The problem is represented by means of an influence diagram, including admission and treatment decisions. The corresponding uncertainty model is built with the aid of both historical data and subjective judgments. Parents and doctors were interviewed to elicit a multiattribute utility function. The decision analysis cycle is completed with sensitivity analyses and explanations of the results. RESULTS: The construction and use of this decision support system for jaundice management have induced a profound change in daily medical practice, avoiding aggressive treatments-there have been no exchange transfusions in the past 3 years-and reducing the lengths of stay at the hospital. More information is now taken into account to decide on treatments. Interestingly, after embarking on this modeling effort, physicians came to view jaundice as a much more difficult problem than they had initially thought. Comparisons between real cases and system proposals revealed that treatments by nonexpert doctors tend to be longer than what expert doctors would administer. CONCLUSION: The system is especially designed to help neonatologists in situations in which their lack of experience may lead to unnecessary treatments. Different points of view from several expert doctors and, more interestingly, from parents are taken into account. This knowledge gives a broader picture of the medical problem- incorporating new action criteria, new agents to intervene, more uncertainty variables-to get an insight into the suitability of each therapeutic decision for each patient situation. The benefits gained and the usefulness perceived by neonatologists are worth the increased and time-consuming effort of developing this complex system. Although specially designed for a specific hospital and for neonatal jaundice management, it can be easily adapted to other hospitals and problems. [ABSTRACT FROM AUTHOR]

Interventions to restore radionuclide contaminated aquatic ecosystems may reduce individual and collective radiation doses, but may also result in detrimental ecological, social and economic effects. Decision makers must carefully evaluate possible impacts before choosing a countermeasure, hence decision analysis methods constitute an important aid to rank intervention strategies after the contamination of an aquatic ecosystem. We describe MOIRA, a decision support system for the identification of optimal remedial strategies to restore water systems after accidental introduction of radioactive substances. MOIRA includes an evaluation module based on a multi-attribute value model to rank alternatives and a module to perform multiparametric sensitivity analyses, both with respect to weights and values, to allow us to gain insights into the problem. The problem is under certainty since the validation of models used to quantify countermeasure impacts suggests little uncertainty in policy effects. The system is implemented in a PC based decision support system which allows the inclusion of all relevant information. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of TNF inhibitors (adalimumab (ADA) and infliximab (IFX)) vs tocilizumab (TCZ) in patients with refractory cystoid macular edema (CME) due to Behçet's disease (BD)., Methods: Multicenter study of patients with BD-associated CME refractory to conventional and/or biological immunosuppressive drugs. From a cohort of 177 patients treated with anti-TNF and 14 patients treated with TCZ, we selected those with CME at baseline. We analyzed the evolution of macular thickness (main outcome), best-corrected visual acuity (BCVA) and intraocular inflammation (Tyndall and vitritis) from baseline up to 4 years in the 3 groups mentioned., Results: 49 patients and 72 eyes with CME were included. ADA was used in 25 patients (40 eyes), IFX in 15 (21 eyes) and TCZ in 9 (11 eyes). No statistically significant baseline differences were observed between the 3 groups except for a lower basal BCVA in TCZ group and a higher basal degree of intraocular inflammation in ADA group. Most patients from all groups had received several conventional immunosuppressive drugs. In addition, most patients in the group of TCZ had also received anti-TNF agents. Biological therapy was used in monotherapy (n=8) or combined with conventional immunosuppressive drugs (n=41). Macular thickness progressively decreased in the 3 groups, with no signs of CME after 1 year of treatment. Similarly, BCVA improvement and inflammatory intraocular remission was achieved in all groups., Conclusion: Refractory CME associated with BD uveitis can be effectively treated either with ADA, IFX or TCZ. Furthermore, TCZ is effective in patients resistant to anti-TNF therapy., Competing Interests: Declaration of Competing Interest Disclosures that might be interpreted as constituting of possible conflict(s) of interest for the study: B. Atienza-Mateo received grants/research supports from Abbvie and Roche and had consultation fees/participation in company-sponsored speaker´s bureau from Pfizer, Celgene, Novartis, Sanofi, Janssen, UCB and Lilly. I. Ferraz-Amaro has received grants/research supports from Abbott, MSD, Jansen and Roche and had consultation fees/participation in company-sponsored speaker´s bureau from Abbott, Pfizer, Roche, Sanofi, Sobi, Amgen, Celgene and MSD. D. Prieto-Peña is supported by a research contract from the Carlos III Health Institute of Spain (Río Hortega program, ref. CM20/00006) and has received research support from UCB Pharma, Roche, Sanofi, Pfizer, Jansen, Amgen, AbbVie, Novartis and Lilly. A. Adán received grants/research supports from Abbvie and UCB. M. Cordero-Coma had consultation fees/participation in company-sponsored speaker´s bureau from Abbvie, Merck Sharp & Dohme, Allergan and UCB. He also participated in Advisory Boards from Abbvie and Allergan. He also had travel grants from Abbvie, UCB and Allergan. J.M. Nolla received grants/research supports from BMS, Galápagos, Kern, Lilly and UCB. V. Calvo-Río had consultation fees/participation in company-sponsored speaker's bureau from AbbVie, Lilly, MSD, UCB Pharma, Grünenthal Pharma and Celgene. S. Castañeda has received grants/research support from Amgen, MSD and Pfizer, and has received consultation fees in company sponsored speaker's bureau from Amgen, Bristol-Myers-Squibb, Grünenthal Pharma, Janssen, Lilly, MSD, Novartis, Sanofi, Sobi, Stata and UCB. S. Castañeda is also associated professor of the UAM-Roche chair, EPID-Future, Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain. Miguel A. González-Gay received grants/research supports from Abbvie, MSD, and Roche, and had consultation fees/participation in company-sponsored speaker´s bureau from Pfizer, Celgene, Novartis, Roche, Sanofi, and Lilly. R. Blanco received grants/research supports from Abbvie, MSD, and Roche, and had consultation fees/participation in company-sponsored speaker´s bureau from Abbvie, Pfizer, Roche, BMS, Janssen, Lilly and MSD. No financial disclosure declared: N. Barroso-García, E. Beltrán, M. Hernández-Garfella, L. Martínez-Costa, M. Díaz-Llopis, J.M. Herreras, O. Maíz-Alonso, I. Torre-Salaberri, A. De Vicente-Delmás, D. Díaz-Valle, A. Atanes-Sandoval, F. Francisco, S. Insua, J. Sánchez, R. Almodóvar-González, A. Jiménez-Sosa, O. Ruiz-Moreno, M. Gandía Martínez., (Copyright © 2022. Published by Elsevier Inc.)

Objective: To compare the efficacy of infliximab (IFX) versus adalimumab (ADA) as a first-line biologic drug over 1 year of treatment in a large series of patients with refractory uveitis due to Behçet's disease (BD)., Methods: We conducted an open-label multicenter study of IFX versus ADA for BD-related uveitis refractory to conventional nonbiologic treatment. IFX or ADA was chosen as the first-line biologic agent based on physician and patient agreement. Patients received 3-5 mg/kg intravenous IFX at 0, 2, and 6 weeks and every 4-8 weeks thereafter, or 40 mg subcutaneous ADA every other week without a loading dose. Ocular parameters were compared between the 2 groups., Results: The study included 177 patients (316 affected eyes), of whom 103 received IFX and 74 received ADA. There were no significant baseline differences between treatment groups in main demographic features, previous therapy, or ocular sign severity. After 1 year of therapy, we observed an improvement in all ocular parameters in both groups. However, patients receiving ADA had significantly better outcomes in some parameters, including improvement in anterior chamber inflammation (92.31% versus 78.18% for IFX; P = 0.06), improvement in vitritis (93.33% versus 78.95% for IFX; P = 0.04), and best-corrected visual acuity (mean ± SD 0.81 ± 0.26 versus 0.67 ± 0.34 for IFX; P = 0.001). A nonsignificant difference was seen for macular thickness (mean ± SD 250.62 ± 36.85 for ADA versus 264.89 ± 59.74 for IFX; P = 0.15), and improvement in retinal vasculitis was similar between the 2 groups (95% for ADA versus 97% for IFX; P = 0.28). The drug retention rate was higher in the ADA group (95.24% versus 84.95% for IFX; P = 0.042)., Conclusion: Although both IFX and ADA are efficacious in refractory BD-related uveitis, ADA appears to be associated with better outcomes than IFX after 1 year of follow-up., (© 2019, American College of Rheumatology.)

Objective: The aim of this study was to assess the efficacy of anti-TNF-α therapy in refractory uveitis due to Behçet's disease (BD)., Methods: We performed a multicentre study of 124 patients with BD uveitis refractory to conventional treatment including high-dose corticosteroids and at least one standard immunosuppressive agent. Patients were treated for at least 12 months with infliximab (IFX) (3-5 mg/kg at 0, 2 and 6 weeks and then every 4-8 weeks) or adalimumab (ADA) (usually 40 mg every 2 weeks). The main outcome measures were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness and immunosuppression load., Results: Sixty-eight men and 56 women (221 affected eyes) were studied. The mean age was 38.6 years (s.d. 10.4). HLA-B51 was positive in 66.1% of patients and uveitis was bilateral in 78.2%. IFX was the first biologic agent in 77 cases (62%) and ADA was first in 47 (38%). In most cases anti-TNF-α drugs were used in combination with conventional immunosuppressive drugs. At the onset of anti-TNF-α therapy, anterior chamber and vitreous inflammation was observed in 57% and 64.4% of patients, respectively. In both conditions the damage decreased significantly after 1 year. At baseline, 50 patients (80 eyes) had macular thickening [optical coherence tomography (OCT) >250 μm] and 35 (49 eyes) had cystoid macular oedema (OCT>300 μm) that improved from 420 μm (s.d. 119.5) at baseline to 271 μm (s.d. 45.6) at month 12 (P < 0.01). The best-corrected visual acuity and the suppression load also showed significant improvement. After 1 year of follow-up, 67.7% of patients were inactive. Biologic therapy was well tolerated in most cases., Conclusion: Anti-TNF-α therapy is effective and relatively safe in refractory BD uveitis., (© The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Recent evidence showing host specificity of colonizing bacteria supports the view that multicellular organisms are holobionts comprised of the macroscopic host in synergistic interdependence with a heterogeneous and host-specific microbial community. Whereas host-bacteria interactions have been extensively investigated, comparatively little is known about host-virus interactions and viral contribution to the holobiont. We sought to determine the viral communities associating with different Hydra species, whether these viral communities were altered with environmental stress, and whether these viruses affect the Hydra-associated holobiont. Here we show that each species of Hydra harbors a diverse host-associated virome. Primary viral families associated with Hydra are Myoviridae, Siphoviridae, Inoviridae, and Herpesviridae. Most Hydra-associated viruses are bacteriophages, a reflection of their involvement in the holobiont. Changes in environmental conditions alter the associated virome, increase viral diversity, and affect the metabolism of the holobiont. The specificity and dynamics of the virome point to potential viral involvement in regulating microbial associations in the Hydra holobiont. While viruses are generally regarded as pathogenic agents, our study suggests an evolutionary conserved ability of viruses to function as holobiont regulators and, therefore, constitutes an emerging paradigm shift in host-microbe interactions.

Background: The life cycle of scyphozoan cnidarians alternates between sessile asexual polyps and pelagic medusa. Transition from one life form to another is triggered by environmental signals, but the molecular cascades involved in the drastic morphological and physiological changes remain unknown., Results: We show in the moon jelly Aurelia aurita that the molecular machinery controlling transition of the sessile polyp into a free-swimming jellyfish consists of two parts. One is conserved and relies on retinoic acid signaling. The second, novel part is based on secreted proteins that are strongly upregulated prior to metamorphosis in response to the seasonal temperature changes. One of these proteins functions as a temperature-sensitive "timer" and encodes the precursor of the strobilation hormone of Aurelia., Conclusions: Our findings uncover the molecule framework controlling the polyp-to-jellyfish transition in a basal metazoan and provide insights into the evolution of complex life cycles in the animal kingdom., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

A multi-attribute analysis by means of the general multi-attribute analysis (GMAA) decision support system was performed in order to rank different strategies for good water quality with respect to trophic state, and good conditions for waterfowl, in the lagoon Ringkøbing Fjord, Denmark. The remedial strategies included nutrient abatement and the construction of facilities to increase the water exchange between the lagoon and the sea. The analysis showed that it is essential to keep the mean annual salinity level constant, since a drastic change in salinity may cause massive destruction of the macrophyte belt with large effects on the water quality and waterfowl abundance. It may be cost-effective to build and maintain a saltwater pumping station or a second sluice to increase the seawater inflow. Further nutrient abatement may not be cost-effective, at least not on time-scales shorter than 20 years, but the utility from nutrient abatement increases if a second sluice is built additionally. However, all of the remedial strategies, except decreasing the salinity, were projected to cause rather small changes in the effect variables compared to the no action alternative.