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Background The coronavirus pandemic has provoked discussions among healthcare providers how to manage cancer patients when faced with the threat of severe acute respiratory syndrome related coronavirus 2 (SARS-CoV-2) infection. Immune checkpoint inhibitor (ICI) containing regimens are standard of care in the majority of metastatic clear cell renal cell carcinoma (mccRCC) patients. It remains unclear whether therapies should be modified in response to the COVID-19 pandemic. Methods We performed an online survey among physicians involved in the treatment of mccRCC, and 41 experts responded. Questions focused on criteria relevant for treatment decision outside the pandemic and the modifications of systemic therapy during COVID-19. Findings For the majority of experts (73%), the combination of International metastatic renal cell carcinoma Database Consortium (IMDC) risk category and patient fitness are two important factors for decision-making. The main treatment choice in fit, favourable risk patients outside the pandemic is pembrolizumab/axitinib for 53%, avelumab/axitinib, sunitinib or pazopanib for 13% of experts each. During the pandemic, ICI-containing regimens are chosen less often in favour of a tyrosine kinase inhibitors (TKI) monotherapy, mainly sunitinib or pazopanib (35%). In fit, intermediate/poor-risk patients outside the pandemic, over 80% of experts choose ipilimumab/nivolumab, in contrast to only 41% of physicians during COVID-19, instead more TKI monotherapies are given. In patients responding to established therapies with ICI/ICI or ICI/TKI combinations, most participants modify treatment regimen by extending cycle length, holding one ICI or even both. Conclusion mccRCC treatment modifications in light of the coronavirus pandemic are variable, with a shift from ICI/ICI to ICI/TKI or TKI monotherapy. CA extern

Background: The management of patients with metastatic pancreatic cancer (mPC) is challenging, and the optimal treatment strategy is debated among experts. In an attempt to identify treatment decision criteria and to investigate variations in the first-line management of this disease, we performed an analysis of treatment algorithms among experts in the field of pancreatic cancer. The aim of this study was to identify relevant criteria in the complex process of patient selection and decision making for the management of mPC patients. Methods: Experts from the ABCSG (Austrian Breast and Colorectal Cancer Study Group) Pancreatic Cancer Club were contacted and agreed to participate in this analysis. Eight experts from seven centers in Austria provided their decision algorithms for the first-line treatment of patients with mPC. Their responses were converted into decision trees based on the objective consensus methodology. The decision trees were used to identify consensus and discrepancies. Results: The final treatment algorithms included four decision criteria (performance status, age, comorbidities, and symptomatic disease) and six treatment options: mFOLFIRINOX, gemcitabine + nab-paclitaxel, gemcitabine mono, 5-FU mono, gemcitabine/erlotinib, and best supportive care (BSC). Conclusions: We identified consensus for the treatment of young and fit patients with mFOLFIRINOX. With higher age and reduced performance status, gemcitabine + nab-paclitaxel was increasingly used. For patients with Eastern Co-operative Oncology Group Performance Status (ECOG PS) 4, BSC was the treatment of choice. Among experts, different decision criteria and treatment options are implemented in clinical routine. Despite multiple options in current recommendations, a consensus for specific recommendations was identified.

The emergence of emergency orders, in the course of services already underway, in an electricity distribution concessionaire is inevitable, characterizing a dynamic scenario. Minimizing the delays resulting from these emergencies is a challenge for companies that provide this type of service. In this way, such companies need strategies to meet the needs of customers while meeting regulatory requirements. Aiming at this routing problem, the following work aims to identify evaluation criteria in the dispatch of these emergency orders and the impacts that these criteria will result in the execution times of these work orders in an electricity distribution company. As findings of this research, we verify that the demand exceeds the capacity of the teams and that the orders end up being passed on to the next day. Through the criteria, it was possible to prioritize commercial and emergency orders and analyze the impact generated.

Aim There is no general consensus on the optimal treatment for prostate cancer (PC) patients with intrapelvic nodal oligorecurrences after radical prostatectomy. Besides androgen deprivation therapy (ADT) as standard of care, both elective nodal radiotherapy (ENRT) and stereotactic body radiotherapy (SBRT) as well as salvage lymph node dissection (sLND) are common treatment options. The aim of our study was to assess decision making and practice patterns for salvage radiotherapy (RT) in this setting. Methods Treatment recommendations from 14 Swiss radiation oncology centers were collected and converted into decision trees. An iterative process using the objective consensus methodology was applied to assess differences and consensus. Results PSMA PET/CT was recommended by 93% of the centers as restaging modality. For unfit patients defined by age, comorbidities or low performance status, androgen deprivation therapy (ADT) alone was recommended by more than 70%. For fit patients with unfavorable tumor characteristics such as short prostate-specific antigen (PSA) doubling time or initial high-risk disease, the majority of the centers (57–71%) recommended ENRT + ADT for 1–4 lesions. For fit patients with favorable tumor characteristics, there were low levels of consensus and a wide variety of recommendations. For 1–4 nodal lesions, focal SBRT was offered by 64% of the centers, most commonly as a 5-fraction course. Conclusions As an alternative to ADT, ENRT or SBRT for pelvic nodal oligorecurrences of PC are commonly offered to selected patients, with large treatment variations between centers. The exact number of lymph nodes had a major impact on treatment selection.

Gabriel Tremblay,1 Christopher Livings,2 Lydia Crowe,2 Venediktos Kapetanakis,2 Andrew Briggs3 1Global Health Economics and Health Technology Assessment, Eisai Inc., Woodcliff Lake, NJ, USA; 2Health Economics, Decision Resources Group, Bicester, Oxfordshire, 3Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK Background: Cost-effectiveness models for the treatment of long-term conditions often require information on survival beyond the period of available data. Objectives: This paper aims to identify a robust and reliable method for the extrapolation of overall survival (OS) in patients with radioiodine-refractory differentiated thyroid cancer receiving lenvatinib or placebo. Methods: Data from 392 patients (lenvatinib: 261, placebo: 131) from the SELECT trial are used over a 34-month period of follow-up. A previously published criterion-based approach is employed to ascertain credible estimates of OS beyond the trial data. Parametric models with and without a treatment covariate and piecewise models are used to extrapolate OS, and a holistic approach, where a series of statistical and visual tests are considered collectively, is taken in determining the most appropriate extrapolation model. Results: A piecewise model, in which the Kaplan–Meier survivor function is used over the trial period and an extrapolated tail is based on the Exponential distribution, is identified as the optimal model. Conclusion: In the absence of long-term survival estimates from clinical trials, survival estimates often need to be extrapolated from the available data. The use of a systematic method based on a priori determined selection criteria provides a transparent approach and reduces the risk of bias. The extrapolated OS estimates will be used to investigate the potential long-term benefits of lenvatinib in the treatment of radioiodine-refractory differentiated thyroid cancer patients and populate future cost-effectiveness analyses. Keywords: survival analysis, parametric extrapolation, piecewise models, decision criteria, radioiodine-refractory differentiated thyroid cancer

Cloud computing is emerging as key a technology platform for banking operations globally. In Asia, the progress of cloud application is relatively slow. This paper considers the major factors which influence a bank’s decision to contract with a technology service provider to implement a cloud based strategy. This research study identifies the trends in applying cloud computing in global banking with a focus on banks in Thailand. It will analyze the criteria IT executives in banks use to decide on the selection of technology service providers. Banks require the service provider to meet specific requirements for a cloud implementation project in a bank. A survey approach was used to identify the important criteria IT executives in banks use to select an IT technology provider for cloud applications. The sample included 367 bank IT executives and professionals in Thai and international banks based in Bangkok. SEM was used to analyze the data. Interviews were conducted with 21 IT executives for insights into their decision criteria. Service quality which is based on the conventional SERVQUAL indicators strongly influence the decision to choose a technology service provider. This selection is also influenced by the capability of service provider, their technical capability and the cloud application features. There are few studies in the literature on the decision criteria that banks use to select a provider for cloud computing application.

Species translocations are popular tools in conservation, but may be increasingly motivated by species’ popularity, rather than their threat status. We analyzed relative contributions of threat status (a surrogate for extinction risk) and popularity (an estimate of the degree of public knowledge, awareness or notoriety) to the likelihood of developing translocation projects for a representative whole regional fauna (174 conservation translocations during the last two decades for 82 out of the 527 species of Spanish terrestrial vertebrates). Three measures of threat status were obtained from technical (IUCN) and legal sources. Popularity estimates were obtained from body size data and two different Internet search protocols. All combinations of the three factors used to estimate threat status were correlated, as were the three indicators of species popularity (internet popularity indexes and body mass). Selected estimates unbiasedly captured differences in both threat and popularity among species. Threat and popularity were only weakly correlated, as expected when considering faunas as a whole rather than the better-studied subsets. Threat status and popularity had significant and equivalent contributions to explain the development of conservation translocations. Popularity, or lack thereof, partly explained the development of projects for non-threatened but popular species, as well as the lack of projects for several highly endangered species unknown by the public. Observed mismatches between technical and social criteria can be prevented by (a) strict separation of conservation translocations from translocations directed to cover other social demands or (b) development of explicit, quantitative decision-making criteria aimed at rigorous ex-ante evaluations of translocations., This paper is a contribution to the projects REMEDINAL3-CM (S2013/MAE-2719) and VEABA (ECO2013-42110-P), funded by regional and national Spanish agencies, respectively.

Software developing organizations nowadays have a wide choice when it comes to sourcing software components. This choice ranges from developing or adapting in-house developed components via buying closed source components to utilizing open source components. This study aims at structured decision support in this type of decision. As a basis for this study an initial set of criteria is taken, that has been identified and validated in a particular software development environment in a previous study on the subject (Kusters et al, 2016). In the paper at hand we report on the results of the application and validation of the initial set of sourcing criteria in a completely different case study environment, namely a software environment in that. medical embedded software is being developed. In addition, and based on the outcomes of our case study, a further step is made towards structured decision support for sourcing decisions by the development of an initial sourcing criteria framework.

To enhance the quality of software, many software development support tools and software development methodologies have been proposed. However, not all proposed tools and methodologies are widely used in software development. We assume that the evaluation of tools and methodologies by developers is different from the evaluation by researchers, and that this is one of the reasons why the tools and methodologies are not widely used. We analyzed the decision criteria of software developers as applied to the tools and methodologies, to clarify whether the difference exists or not. In behavioral economics, there are theories which assume people have biases, and they do not always act reasonably. In the experiment, we made a questionnaire based on behavioral economics, and collected answers from open source software developers. The results suggest that developers do not always act to maximize expected profit because of the certainty effect and ambiguity aversion. Therefore, we should reconsider the evaluation criteria of tools such as the f-measure or AUC, which mainly focus on the expected profit., SANER 2016 : 2016 IEEE 23rd International Conference on Software Analysis, Evolution, and Reengineering, 14-18 March 2016, Suita, Japan

Newborn metabolic screening is the most widespread application of screening technology and provides the most comprehensive application of genetics in health services, where the Guthrie blood spot cards allow screening for metabolic diseases in close to 100 % of all newborn babies. Despite over 40 years of use and significant benefits to well in excess of 100,000 children worldwide, there is remarkably little consensus in what conditions should be screened for and response to new advances in medicine relating to programme expansion. In this article, the international criteria for newborn metabolic screening are considered, and we propose that these criteria are poorly developed in relation to the baby, its family and society as a whole. Additionally, the ethical issues that should inform the application of screening criteria are often not developed to a level where a consensus might easily be achieved. We also consider that when family interests are factored in to the decision-making process, they have a significant influence in determining the list of diseases in the panel, with countries or states incorporating family and societal values being the most responsive. Based on our analysis, we propose that decision criteria for metabolic screening in the newborn period should be adapted to specifically include parent and family interests, community values, patients' rights, duties of government and healthcare providers, and ethical arguments for action in the face of uncertainty.

Background: Many laboratories use 4 delta check methods: delta difference, delta percent change, rate difference, and rate percent change. However, guidelines regarding decision criteria for selecting delta check methods have not yet been provided. We present new decision criteria for selecting delta check methods for each clinical chemistry test item. Methods: We collected 811,920 and 669,750 paired (present and previous) test results for 27 clinical chemistry test items from inpatients and outpatients, respectively. We devised new decision criteria for the selection of delta check methods based on the ratio of the delta difference to the width of the reference range (DD/RR). Delta check methods based on these criteria were compared with those based on the CV% of the absolute delta difference (ADD) as well as those reported in 2 previous studies. Results: The delta check methods suggested by new decision criteria based on the DD/ RR ratio corresponded well with those based on the CV% of the ADD except for only 2 items each in inpatients and outpatients. Delta check methods based on the DD/RR ratio also corresponded with those suggested in the 2 previous studies, except for 1 and 7 items in inpatients and outpatients, respectively. Conclusions: The DD/RR method appears to yield more feasible and intuitive selection criteria and can easily explain changes in the results by refl ecting both the biological variation of the test item and the clinical characteristics of patients in each laboratory. We suggest this as a measure to determine delta check methods.

Different techniques and tools have been introduced for the analysis of process systems that each has their own capabilities and limitations namely HAZOP and ETBA. One of the process systems which require to be analyzed by these techniques is the chlorination unit of the treatment plants. Due to frequent use of chlorine, an intrinsically hazardous gas, this unit is among the most critical units of a treatment plant. In this study, the safety- related features of the chlorination unit in Tehran treatment plant was investigated employing two methodologies: HAZOP and ETBA and the results from the two techniques were compared. The decision criteria to choose the best methodology was based on six factors (number of identified risks, the cost of eliminating intolerable risks, the number of identified human errors, the identified risk levels, the time and budget required to perform the assessment). Considering the fact that HAZOP and ETBA, each seem to be preferable in accordance with some of these factors, it was difficult to decide on the proffered methodology. In order to determine the best methodology, the AHT (Analytical Hierarchy process) was used. Results from this technique indicated that ETBA is more preferable to serve the purposes of the present study.

In the event of a chemical terrorist attack on a transportation hub, post-event remediation and restoration activities necessary to attain unrestricted facility reuse and re-entry could require hours to multiple days. While restoration timeframes are dependent on numerous variables, a primary controlling factor is the level of pre-planning and decision-making completed prior to chemical terrorist release. What follows is the first of a two-part analysis identifying key considerations, critical information, and decision criteria to facilitate post-attack and post-decontamination consequence management activities. A conceptual site model and human health-based exposure guidelines are developed and reported as an aid to site-specific pre-planning in the current absence of U.S. state or Federal values designated as compound-specific remediation or re-entry concentrations, and to safely expedite facility recovery to full operational status. Chemicals of concern include chemical warfare nerve and vesicant agents and the toxic industrial compounds phosgene, hydrogen cyanide, and cyanogen chloride. This work has been performed as a national case study conducted in partnership with the Los Angeles International Airport and The Bradley International Terminal. All recommended guidelines have been selected for consistency with airport scenario release parameters of a one-time, short-duration, finite airborne release from a single source followed by compound-specific decontamination.

Part 2: Short Papers; International audience; Many books and articles have been written about the importance of business process management. However, in practice, improving business processes remains challenging. Therefore, business process maturity models (BPMMs) have been developed to assist organizations in their search for business process excellence (e.g. CMMI or OMG-BPMM). However, given their importance, a BPMM proliferation exists and practitioners are left without overview. Moreover, BPMMs differ in approach. An organization wishing to start with a BPMM thus risks selecting a model that does not fully fits its needs. The BPMM literature and the general literature on maturity models are mainly restricted to the design perspective. To our knowledge, the user’s perspective is largely neglected. Based on an international Delphi study, this article introduces 14 criteria that (potential) BPMM users must consider to obtain a fit for purpose. The findings will be used to build a decision tool for BPMM selection.

In the event of a chemical terrorist attack on a transportation hub, post-event remediation and restoration activities necessary to attain unrestricted facility re-use and re-entry could require hours to multiple days. While timeframes are dependent on numerous variables, a primary controlling factor is the level of pre-planning and decision-making completed prior to chemical release. What follows is the second of a two-part analysis identifying key considerations, critical information and decision criteria to facilitate post-attack and post-decontamination consequence management activities. Decision criteria analysis presented here provides first-time, open-literature documentation of multi-pathway, health-based remediation exposure guidelines for selected toxic industrial compounds, chemical warfare agents, and agent degradation products for pre-planning application in anticipation of a chemical terrorist attack. Guideline values are provided for inhalation and direct ocular vapor exposure routes as well as percutaneous vapor, surface contact, and ingestion. Target populations include various employees as well as transit passengers. This work has been performed as a national case study conducted in partnership with the Los Angeles International Airport and The Bradley International Terminal. All recommended guidelines have been selected for consistency with airport scenario release parameters of a one-time, short-duration, finite airborne release from a single source followed by compound-specific decontamination.