Allocating resources for cancer control--resolving multicriteria decision-making using the analytic hierarchy process

When competing programs ought to be financed simultaneously for the same purpose, an allocation problem occurs due to scarce resources, and different perspectives and preferences. Facing the problem needs determining criteria which the decision might be based on. Those criteria form the objectives (the scope) of the different participants, and are relevant for the achievement of the goal, providing a comprehensive resource allocation that bridges and integrates the different perspectives. In case of cancer control primary prevention, secondary prevention, therapy and tertiary prevention, education, basic sciences, and clinical trials form the alternatives. An analytic hierarchy process (AHP) is used for supporting decision-making in the resource allocation problem. AHP is a method for setting priorities, but can only work out the implications of what was declared through the pairwise-ranking process, namely the relative preferences, weighing the criteria and rating the alternatives two by two. In the first analysis the relative weights to criteria were 0.099 for 'distributive justice'; 0.120 for constitutional and human rights; 0.251 for lay opinion; 0.393 for EBM; 0.137 for cost-effectiveness. Ranking the alternatives using 'judgements' resulted in relative preference of 0.238 for therapy, 0.204 for primary prevention, 0.201 for secondary prevention, 0.135 for clinical trials, 0.111 for tertiary prevention, 0.066 for basic sciences and 0.045 for education. In the second analysis the relative importance of "cost-effectiveness" was doubled, thus resulting in 0.234 for therapy, 0.216 for secondary prevention, 0.183 for primary prevention, 0.145 for clinical trials, 0.113 for tertiary prevention, 0.063 for basic sciences and 0.046 for education. Sensitivity analysis has shown that increasing the relative weight of cost-effectiveness up to approximately 0.4 changes the rank of alternatives, and above 0.4 this criterion gives secondary prevention preferences. According to the relative rates computed in both of the models all criteria vote for therapy, but these preferences change at the high level of weights, in case of EBM, 'rights', and cost-effectiveness. Cost-effectiveness prefers secondary prevention to therapy; the criterion of constitutional and human rights and the criterion of evidence-based medicine vote for primary prevention.     

Quantifying and Exploring Strategic Regional Priorities for Managing Natural Capital and Ecosystem Services Given Multiple Stakeholder Perspectives

A ubiquitous problem for community-based regional environmental agencies is to set strategic management priorities among a myriad of issues and multiple stakeholder perspectives. Here, we quantify the strategic management priorities for natural capital and ecosystem services using multicriteria decision analysis (MCDA) in a case study of the South Australian Murray-Darling Basin Natural Resources Management Board (the Board) region. A natural capital and ecosystem services framework was tailored to present decision-makers with a range of potential issues for strategic consideration as goal hierarchies in MCDA. Priorities were elicited from the Board and its four regionally based consultative groups using the Analytical Hierarchy Process and swing weights. Centered log ratio transformed weights were analyzed using multiple pairwise ANOVA comparisons (Dunnett’s T3) and hierarchical cluster analysis. Substantial variation in priorities occurred between decision-makers. Nonetheless, analysis of priorities for assets and services robustly demonstrated that water was the highest priority, followed by land, then biota, with atmosphere the lowest priority. Decision-makers also considered that environmental management should not impact negatively on built or social capital. Few significant differences in priorities were found between decision-maker groups. However, clusters of manager types were found which represent distinct alternative management strategies, notably the prioritization of either intermediate or final ecosystem services. The results have implications for regional environmental decision-making and suggest that embracing variation in perspectives may be a better way forward for multistakeholder MCDA. The study operationalizes natural capital and ecosystem services by providing strategic priorities for targeting management and policy within the context of community-based, regional environmental management.     

Breast cancer as a global health concern

Public health data indicate that the global burden of breast cancer in women, measured by incidence, mortality, and economic costs, is substantial and on the increase. Worldwide, it is estimated that more than one million women are diagnosed with breast cancer every year, and more than 410,000 will die from the disease. In low- and middle-income countries (LMCs), the infrastructure and resources for routine screening mammography are often unavailable. In such lower resource settings, breast cancers are commonly diagnosed at late stages, and women may receive inadequate treatment, pain relief, or palliative care. There have been an increasing number of global health initiatives to address breast cancer including efforts by Susan G. Komen for the Cure^©, the Breast Health Global Initiative (BHGI), the U.S. Centers for Disease Control and Prevention (CDC), the American Cancer Society, the National Cancer Institute (NCI), and ongoing work by leading oncology societies in different parts of the world. To support such initiatives, and to provide a scientific evidence base for health policy and public health decision making, there is a need for further health services research and program evaluations. Cancer registries can be invaluable in ascertaining the magnitude of cancer disease burden and its distribution in these countries. Additional data are needed for various geographic areas to assess resources required, cost-effectiveness, and humane approaches for preventing or controlling breast cancer in low resource settings in developing countries.     

Time Horizon and Dominance in Dynamic Life Cycle Assessment

Temporal aspects have traditionally not been recognized adequately in life cycle assessment (LCA). The dynamic LCA model recently proposed offers a significant step forward in the dynamic assessment of global warming impacts. The results obtained with dynamic LCA are highly sensitive to the choice of a time horizon. Therefore, decision making between alternative systems can be critical because conclusions are dependent on the specific time horizon. In this article, we develop a decision‐making methodology based on the concept of time dominance. We introduce instantaneous and cumulative time dominance criteria to the dynamic LCA context and argue why the dominance of an alternative should also imply preference. Our approach allows for the rejection of certain alternatives without the determination of a specific time horizon. The number of decision‐relevant alternatives can thereby be reduced and the decision problem facilitated. We demonstrate our methodology by means of a case study of end‐of‐life alternatives for a wooden chair derived from the original authors of dynamic LCA and discuss the implications and limitations of the approach. The methodology based on time dominance criteria is supplementary to the dynamic LCA model, but does not substitute it. The overall value of this article stretches beyond LCA onto more general assessments of global warming, for example, in policy where the choice of a time horizon is equally significant.     

The genetic basis for cancer treatment decisions

Personalized cancer medicine is based on increased knowledge of the cancer mutation repertoire and availability of agents that target?altered genes or pathways. Given advances in cancer genetics, technology, and therapeutics development, the timing is right to develop a clinical trial and research framework to move future clinical decisions from heuristic to evidence-based decisions. Although the challenges of integrating genomic testing into cancer treatment decision making are wide-ranging and complex, there is a scientific and ethical imperative to realize the benefits of personalized cancer medicine, given the overwhelming burden of cancer and the unprecedented opportunities for advancements in outcomes for patients.     

Risk-Cost Trade Off Considerations for Contaminated Sediment Disposal

Delays in dredging and inability to dredge the nation's harbors, due to the presence of contaminated sediments and the lack of environmentally acceptable disposal sites are interfering with shipping activities and hampering trade growth. The United States Government is committed to provide continuing support to the port industry's goals for enhancing economic growth while protecting, conserving and restoring natural resources within coastal aquatic lands. The government's commitment has resulted in the articulation of a national dredging policy in the Action Plan for Improvement of the Dredging Process in the United States. This national challenge calls for a systematic and consistent decision making approach to dredging and disposal including contaminated sediment management. In building an effective decision mak ing framework for costs, risk reduction and potential beneficial uses of the disposal material must be considered in identifying and evaluating environmentally acceptable and cost-effective disposal alternatives. A conceptual framework for applying a risk-cost trade off approach in making decisions regarding contaminated sediment disposal is presented and applied to a hypothetical disposal scenario involving three alternatives: deepwater confined disposal, nearshore fill or capping and, upland disposal. The approach entails the performance of sequential evaluations consisting of risk analysis, estimation of costs, integration of the results into a computational framework for trade-off analysis, and the application of decision analytical tools to build consensus among stakeholders and the general public in selecting a preferred alternative.     

The policy context.

The final article in the series considers the ways in which the methods described previously are used in the formation of policy. When health authorities are making decisions about how to spend their money they have to draw on several sources of information about priorities: diktats from policy makers, opinions of consumers and of the professional bodies involved, and evidence gained from research. They must also consider the various methods of costing and select the right one for their circumstances. Some of these methods are still in the early stages of development, but more are being developed all the time and they have a valuable role in helping decision making throughout the NHS.     

Role of human behavior and the environment in the prevention of cancer

Cancer is one of the main health issues for the French population. The importance of this burden can be measured through mortality and morbidity rates. Because of the still limited success of therapy, prevention should be the main concern. In theory prevention could avoid 50-80% of new cases. Efficiency of prevention depends, on the one hand, on the identification of risk factors and on estimation of their attributable rate and, on the other hand, on the possibility of controlling the exposure to these factors. Because the greatest risk is due to behavioural factors (smoking, alcohol consumption, diet, etc.), suppression of exposure to these factors depends mainly on individual will. But these individual decisions can be supported by an active preventive policy based on health education and on research in the fields of communication and behavioural determinants.     

Research priorities for natural ecosystems in a changing global climate

Climate change poses significant emerging risks to biodiversity, ecosystem function and associated socioecological systems. Adaptation responses must be initiated in parallel with mitigation efforts, but resources are limited. As climate risks are not distributed equally across taxa, ecosystems and processes, strategic prioritization of research that addresses stakeholder‐relevant knowledge gaps will accelerate effective uptake into adaptation policy and management action. After a decade of climate change adaptation research within the Australian National Climate Change Adaptation Research Facility, we synthesize the National Adaptation Research Plans for marine, terrestrial and freshwater ecosystems. We identify the key, globally relevant priorities for ongoing research relevant to informing adaptation policy and environmental management aimed at maximizing the resilience of natural ecosystems to climate change. Informed by both global literature and an extensive stakeholder consultation across all ecosystems, sectors and regions in Australia, involving thousands of participants, we suggest 18 priority research topics based on their significance, urgency, technical and economic feasibility, existing knowledge gaps and potential for cobenefits across multiple sectors. These research priorities provide a unified guide for policymakers, funding organizations and researchers to strategically direct resources, maximize stakeholder uptake of resulting knowledge and minimize the impacts of climate change on natural ecosystems. Given the pace of climate change, it is imperative that we inform and accelerate adaptation progress in all regions around the world.     

An Integrated MCDM Model for Conveyor Equipment Evaluation and Selection in an FMC Based on a Fuzzy AHP and Fuzzy ARAS in the Presence of Vagueness

The conveyor system plays a vital role in improving the performance of flexible manufacturing cells (FMCs). The conveyor selection problem involves the evaluation of a set of potential alternatives based on qualitative and quantitative criteria. This paper presents an integrated multi-criteria decision making (MCDM) model of a fuzzy AHP (analytic hierarchy process) and fuzzy ARAS (additive ratio assessment) for conveyor evaluation and selection. In this model, linguistic terms represented as triangular fuzzy numbers are used to quantify experts’ uncertain assessments of alternatives with respect to the criteria. The fuzzy set is then integrated into the AHP to determine the weights of the criteria. Finally, a fuzzy ARAS is used to calculate the weights of the alternatives. To demonstrate the effectiveness of the proposed model, a case study is performed of a practical example, and the results obtained demonstrate practical potential for the implementation of FMCs.     

Mimotope-hormesis and mortalin/grp75/mthsp70: a new hypothesis on how infectious disease-associated epitope mimicry may explain low cancer burden in developing nations

It is generally observed that countries with heavy infectious burden show lower cancer incidence as compared to more affluent nations. With the emerging paradigm on microbial heat shock proteins (hsps) as molecular link between infections and autoimmune diseases, we posit a new hypothesis, the "mimotope-hormesis", on the immunologic impact of infections on regional cancer prevention. According to this, assaults of infection during early adulthood could fortify the immune system to evoke more potent defenses against late-onset diseases, such as cancer, via autoimmunity. Interestingly, both experimental and clinical data support the beneficial role of autoimmunity in long-term cancer survivors. We illustrate this by a comprehensive in silico mimotope (epitope mimicry) analysis of human infectious pathogens against mortalin (mthsp70/PB74/GRP75), a type of hsp70 protein involved in control of cell proliferation, immortalization and tumorigenesis.     

Economic and Disease Burden of Dengue in Southeast Asia

Background

Dengue poses a substantial economic and disease burden in Southeast Asia (SEA). Quantifying this burden is critical to set policy priorities and disease-control strategies.

Methods and Findings

We estimated the economic and disease burden of dengue in 12 countries in SEA: Bhutan, Brunei, Cambodia, East-Timor, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Viet Nam. We obtained reported cases from multiple sources—surveillance data, World Health Organization (WHO), and published studies—and adjusted for underreporting using expansion factors from previous literature. We obtained unit costs per episode through a systematic literature review, and completed missing data using linear regressions. We excluded costs such as prevention and vector control, and long-term sequelae of dengue. Over the decade of 2001–2010, we obtained an annual average of 2.9 million (m) dengue episodes and 5,906 deaths. The annual economic burden (with 95% certainty levels) was US$950m (US$610m–US$1,384m) or about US$1.65 (US$1.06–US$2.41) per capita. The annual number of disability-adjusted life years (DALYs), based on the original 1994 definition, was 214,000 (120,000–299,000), which is equivalent to 372 (210–520) DALYs per million inhabitants.

Conclusion

Dengue poses a substantial economic and disease burden in SEA with a DALY burden per million inhabitants in the region. This burden is higher than that of 17 other conditions, including Japanese encephalitis, upper respiratory infections, and hepatitis B.     

An engineering approach to modelling, decision support and control for sustainable systems

Engineering research and development contributes to the advance of sustainable agriculture both through innovative methods to manage and control processes, and through quantitative understanding of the operation of practical agricultural systems using decision models. This paper describes how an engineering approach, drawing on mathematical models of systems and processes, contributes new methods that support decision making at all levels from strategy and planning to tactics and real-time control. The ability to describe the system or process by a simple and robust mathematical model is critical, and the outputs range from guidance to policy makers on strategic decisions relating to land use, through intelligent decision support to farmers and on to real-time engineering control of specific processes. Precision in decision making leads to decreased use of inputs, less environmental emissions and enhanced profitability-all essential to sustainable systems.     

How Well Are Malaria Maps Used to Design and Finance Malaria Control in Africa?

Introduction

Rational decision making on malaria control depends on an understanding of the epidemiological risks and control measures. National Malaria Control Programmes across Africa have access to a range of state-of-the-art malaria risk mapping products that might serve their decision-making needs. The use of cartography in planning malaria control has never been methodically reviewed.

Materials and Methods

An audit of the risk maps used by NMCPs in 47 malaria endemic countries in Africa was undertaken by examining the most recent national malaria strategies, monitoring and evaluation plans, malaria programme reviews and applications submitted to the Global Fund. The types of maps presented and how they have been used to define priorities for investment and control was investigated.

Results

91% of endemic countries in Africa have defined malaria risk at sub-national levels using at least one risk map. The range of risk maps varies from maps based on suitability of climate for transmission; predicted malaria seasons and temperature/altitude limitations, to representations of clinical data and modelled parasite prevalence. The choice of maps is influenced by the source of the information. Maps developed using national data through in-country research partnerships have greater utility than more readily accessible web-based options developed without inputs from national control programmes. Although almost all countries have stratification maps, only a few use them to guide decisions on the selection of interventions allocation of resources for malaria control.

Conclusion

The way information on the epidemiology of malaria is presented and used needs to be addressed to ensure evidence-based added value in planning control. The science on modelled impact of interventions must be integrated into new mapping products to allow a translation of risk into rational decision making for malaria control. As overseas and domestic funding diminishes, strategic planning will be necessary to guide appropriate financing for malaria control.     

National ocean institutions: Research needs

Abstract

U.S. ocean institutions and decision‐making processes merit careful study and attention. Given the economic and strategic importance of the oceans to the United States, such research would be valuable if it contributed to a more effective ocean policy process and an improved policy product. Moreover, findings with regard to the ocean policy process could be relevant to other high‐technology, transnational policy areas. Four aspects of ocean institutions and policy making merit priority attention: (1) current institutions and processes compared with alternative modes of organization and process; (2) the premises on which the present policy process is based; (3) the generation and utilization of policy‐relevant data; and (4) the operation of U.S. ocean institutions transnationally.     

Procedures and tools for generating and selecting alternatives in LCA

Life Cycle Assessments (LCAs) frequently do not contribute to sustainable development because product alternatives with a truly low environmental burden are not included in the assessment. As a result, environmentally-friendly alternatives are not uncovered, although much effort has been put into collecting inventory data and making an impact assessment. Part of this problem is caused by the defensive use of LCAs. Companies eager to show that their product is not too bad for the environment prefer to compare their product with alternatives that are not very promising in an environmental sense. To (mis)use LCAs in this way is quite easy, because the LCA methodology and handbooks provide few guidelines and little advice on how to generate and select adequate alternatives. An analysis of the problems related to the alternatives is given using insights drawn from the field of policy analysis — a field in which methodological rules for the generation of alternatives in policy studies have been developed — ecodesign and the LCA discipline, and measures to reduce the problems are developed. Explicating the different steps in the determination of alternatives in the goal and scope formulation stage of an LCA process, and the development of a toolbox for this activity, would certainly improve the quality of the selection of alternatives. Furthermore, involving stakeholders and a group of experts in the generation and selection process will increase the variety and relevance of alternatives, and the social support for alternatives.     

System boundaries according to decision scope a concept of focal zones

Applying a “whole system model” in Life Cycle Assessment results in LCA being a tool for the best possible representation of the physical context of an analysed product. An implementation of LCA in decision making, however, has to consider the demands of the decision-maker; information of a kind that can be implemented in decision making has to be generated. Consequently, the system model has to reflect the operational context of the actor to a larger extent, the connection between the goal and scope definition and the actual system model underlying the assessment has to be stressed further. For this we introduce the concept of focal zones assisting in the derivation of the system model from the goal of the actor. This is done via the preferences, priorities and constraints of the actor. The resulting system model is consequently individually tailored to the decision at hand, resulting in the generation and documentation of environmental information that is clearly related to that decision.     

Linking ecosystem characteristics to final ecosystem services for public policy

Governments worldwide are recognising ecosystem services as an approach to address sustainability challenges. Decision‐makers need credible and legitimate measurements of ecosystem services to evaluate decisions for trade‐offs to make wise choices. Managers lack these measurements because of a data gap linking ecosystem characteristics to final ecosystem services. The dominant method to address the data gap is benefit transfer using ecological data from one location to estimate ecosystem services at other locations with similar land cover. However, benefit transfer is only valid once the data gap is adequately resolved. Disciplinary frames separating ecology from economics and policy have resulted in confusion on concepts and methods preventing progress on the data gap. In this study, we present a 10‐step approach to unify concepts, methods and data from the disparate disciplines to offer guidance on overcoming the data gap. We suggest: (1) estimate ecosystem characteristics using biophysical models, (2) identify final ecosystem services using endpoints and (3) connect them using ecological production functions to quantify biophysical trade‐offs. The guidance is strategic for public policy because analysts need to be: (1) realistic when setting priorities, (2) attentive to timelines to acquire relevant data, given resources and (3) responsive to the needs of decision‐makers.     

关于物种濒危等级标准之探讨--对IUCN物种濒危等级的思考

为了保存地球上的生物多样性,我们需要根据物种的种群数量与分布、种群数量波动与分布区下降速率来评定濒危物种的濒危等级,并针对物种的濒危等级提出具体的保护措施。1994年11月,IUCN第40次理事会会议正式通过了经过修订的Mace-Lande物种濒危等级标准作为IUCN物种濒危等级标准。IUCN濒危物种红色名录虽然不是国际法和国家法律,但是对于政府间组织、非政府组织的保护决策以及各国的自然法律法规的制定有着深远的影响,在保护生物学理论研究中也发挥了一定作用。我们在研究制定中国水生野生生物濒危等级标准时发现,如果直接应用IUCN物种濒危等级标准评定水生野生生物濒危等级将存在一些问题。如：(1)如何区别对待那些本来就数量稀少、分布区狭窄的物种和那些由于人类活动而导致其种群数量与生境面积急剧下降的物种?(2)不同的动物类群能否应用同一濒危标准尺度?(3)如何区别对待物种边缘分布区和核心分布区的种群数量与密度的差异?(4)如何处理种群的局部灭绝、局部濒危?(5)一些濒危物种在野生环境中濒危,但是这些物种可以人工繁殖,如何处理可以人工繁殖的濒危物种?(6)如果没有种群与栖息地的精确历史资料和统计数据,怎样应用物种的濒危标准评估其濒危等级?在实践中,我们针对这些问题提出了解决方案。考虑与国际流行的IUCN物种濒危等级标准接轨,我们提出来一个由“无危”、“值得关注”、“受胁”、“濒危”和“灭绝”等5个级构成的濒危等级系统,其中“值得关注”、“受胁”、“濒危”又分为“一般”与“高度”两个亚等级。我们提出应区分“生态濒危物种”、“进化濒危物种”;对于不同生物类群,应区分物种的生活史对策,制定不同生活史物种的濒危标准。对于r-对策物种,引入“经济灭绝”这一等级,将这一等级对应于“受胁”等级,以解决缺少物种数量的统计数据和历史数据这一难题;区别对待特有物种,将其濒危等级提升一等;引进集合种群(metapopulation)概念,将集合种群的局域种群(local population)作为“个体”对待。     

Understanding Acceptable Level of Risk: Incorporating the Economic Cost of Under-Managing Invasive Species

Management of nonindigenous species includes prevention, early detection and rapid response and control. Early detection and rapid response depend on prioritizing and monitoring sites at risk for arrival or secondary spread of nonindigenous species. Such monitoring efforts require sufficient biosecurity budgets to be effective and meet management or policy directives for reduced risk of introduction. Such consideration of risk reduction is rarely considered, however. Here, we review the concepts of acceptable level of risk (ALOR) and associated costs with respect to nonindigenous species and present a framework for aligning risk reduction priorities with available biosecurity resources. We conclude that available biosecurity resources may be insufficient to attain stated and desired risk reduction. This outcome highlights the need to consider policy and management directives when beginning a biosecurity program to determine the feasibility of risk reduction goals, given available resources.