Measuring Balance Abilities of Transtibial Amputees Using Multiattribute Utility Theory

Background. Berg Balance Scale (BBS) can be considered the standard for assessment of functional balance but has a noted ceiling effect in active transtibial amputees (TTAs). Development of ceiling-free measures based on quantitative measurement techniques that is suitable for patients in any experience levels, yet sensitive enough to capture improvements in any stage of prosthetic rehabilitation, is needed. Research Question. Does a scoring scheme based on Multiattribute Utility (MAU) theory assess balance abilities of multileveled TTAs comparable to BBS? Methods. A case-control study including 28 participants (8 novice TTAs, 10 experienced TTAs, and 10 healthy controls) was conducted. Guided by MAU theory, a novel balance model was developed and initially validated by Spearman correlation between index-generated scores and expert assigned scores, providing preliminary evidence of validity. Floor/ceiling effects were tested, and between-group comparisons of static/dynamic balance were conducted by paired t -test or Wilcoxon signed-rank test depending on data distribution normality. Results. BBS score was correlated with computed balance index ( r = 0.847 , p < 0.001 ). The BBS score of novice/experienced TTAs was 39/54, and the computed balance index was 38/75. A ceiling effect of BBS (30%) was observed in the experienced TTA group, whereas no ceiling effects were found for the computed index in any combination of TTA groups. Group differences between novice and experienced TTAs were observed in center of pressure (COP) ellipse shift area, COP path length, COP average velocity, gait speed, and cadence (all p < 0.05 ). Significance. Evidence from first stage validation of the proposed MAU balance model indicated that the model performed well. This proposed method can monitor the progress of balance for varied experience-leveled TTAs and provide clinicians with useful information for assessing the rehabilitation training.

Modeling Ethical and Operational Preferences in Automated Driving Systems

Whereas automated driving technology has made tremendous gains in the last decade, significant questions remain regarding its integration into society. Given its revolutionary nature, the use of automated driving systems (ADSs) is accompanied by myriad novel quandaries relating to both operational and ethical concerns that are relevant to numerous stakeholders (e.g., governments, manufacturers, and passengers). When considering any such problem, the ADS’s decision-making calculus is always a central component. This is true for concerns about public perception and trust to others regarding explainability and legal certainty. Therefore, in this manuscript, we set forth a general decision-analytic framework tailorable to multitudinous stakeholders. More specifically, we develop and validate a generic tree of ADS management objectives, explore potential attributes for their measurement, and provide multiattribute utility functions for implementation. Given the contention surrounding numerous ethical concerns in ADS operations, we explore how each of the aforementioned components can be tailored in accordance with the stakeholder’s desired ethical perspective. A simulation environment is developed upon which our framework is tested. Within this environment we illustrate how our approach can be leveraged by stakeholders to make strategic trade-offs regarding ADS behavior and to inform policymaking efforts. In so doing, our framework is demonstrated as a practical, tractable, and transparent means of modeling ADS decision making.

Fundamental Measurement: The Need Fulfilment Quality of Life (N-QOL) Measure

The quality adjusted life year (QALY) has serious problems related to its failure to adhere to measurement theory. If a QALY is to be meaningful, the utility score that translates time spent to an equivalent time spent in so-called perfect health must have ratio properties (i.e., it must support multiplication). Multiattribute utility scores (e.g. those generated by the EQ-5D-5L) fail to meet this standard. The multiattribute instruments produce ordinal scores that lack a true zero and they generate negative values. The manifest deficiencies of multiattribute utility instruments render them unfit, not only as a measure of therapy response but also in generating QALY claims. After 30 years of belief in their use, utilities and QALYs are clearly analytical dead ends. The purpose of this commentary is to demonstrate a coherent way forward in health technology assessment by focusing, not on clinical attributes as surrogates for quality of life, but on measures that are based on a conceptual model describing patient value in terms of need-fulfilment. Building on an extensive, yet often overlooked literature, need-based measures that fit Rasch Measurement Theory criteria are converted from ordinal scores to interval scores to evaluate response to therapy. These measures meet the requirements of single attribute fundamental measurement which is the standard in the physical sciences. It is proposed that a translation from a Rasch interval scale (defined by logits) can be transformed to a bounded ratio scale. Need based Quality of Life (N-QOL) scales bounded by 0 (where no needs are fulfilled) to 1 (where all needs are fulfilled) form such scales. The N-QOL supports the full range of arithmetic operations. Multiattribute utilities and mathematically invalid QALYs can be put to one side as unfortunate historical curiosities in favor of a disease or target population specific N-QOL scale. Such a scale has the required properties to evaluate disease specific response to therapy This can also support N-QOL adjusted life years with a need- fulfillment life year (NALY) metric with ratio properties.

United States Utility Algorithm for the EORTC QLU-C10D, a Multiattribute Utility Instrument Based on a Cancer-Specific Quality-of-Life Instrument

Background The EORTC QLU-C10D is a multiattribute utility measure derived from the cancer-specific quality-of-life questionnaire, the EORTC QLQ-C30. The QLU-C10D contains 10 dimensions (physical, role, social and emotional functioning, pain, fatigue, sleep, appetite, nausea, bowel problems). The objective of this study was to develop a United States value set for the QLU-C10D. Methods A US online panel was quota recruited to achieve a representative sample for sex, age (≥18 y), race, and ethnicity. Respondents undertook a discrete choice experiment, each completing 16 choice-pairs, randomly assigned from a total of 960 choice-pairs. Each pair included 2 QLU-C10D health states and duration. Data were analyzed using conditional logistic regression, parameterized to fit the quality-adjusted life-year framework. Utility weights were calculated as the ratio of each dimension-level coefficient to the coefficient for life expectancy. Results A total of 2480 panel members opted in, 2333 (94%) completed at least 1 choice-pair, and 2273 (92%) completed all choice-pairs. Within dimensions, weights were generally monotonic. Physical functioning, role functioning, and pain were associated with the largest utility weights. Cancer-specific dimensions, such as nausea and bowel problems, were associated with moderate utility decrements, as were general issues such as problems with emotional functioning and social functioning. Sleep problems and fatigue were associated with smaller utility decrements. The value of the worst health state was 0.032, which was slightly greater than 0 (equivalent to being dead). Conclusions This study provides the US-specific value set for the QLU-C10D. These estimated health state scores, based on responses to the EORTC QLQ-C30 questionnaire, can be used to evaluate the cost-utility of oncology treatments.

Control Sequence Ranking for Critical System Based on Health of Equipment Thanks to Choquet Integral

This paper presents a ranking method of operating sequences based on the actual condition of complex systems. This objective is achieved using the health checkup concept and the multiattribute utility theory. Our contribution is the proposal of sequences ranking process using data and experts’ judgments. The ranking results in a decision-making element; it allows experts to have an objective and concise overall ranking to be used for decision making. A case study is presented based on an experimental platform; it allows us to compare two aggregation operators: the weighted mean and the Choquet integral.

Nonadditive Multiattribute Utility Functions for Portfolio Decision Analysis

Axiomatic Foundations for Nonadditive Multiattribute Portfolio Utility Functions

Using Value-Focused Thinking and Multicriteria Decision Making to Evaluate Energy Transition Alternatives

The future transformation of the energy system is a contentious topic, involving a variety of conflicting opinions and interests. In order to structure and evaluate these opinions, we develop a decision-making process with professional stakeholders and energy experts. The aim of this process is to develop a common objective system for the energy transition and to evaluate four possible energy transition alternatives for Germany until 2030. We apply value-focused thinking to define and structure the objectives of the stakeholders and use multiattribute utility theory to evaluate the preferences of the stakeholders toward these objectives. The results show that 8 out of 11 stakeholders prefer the energy transition alternative with the highest climate protection ambitions. Only 3 stakeholders favor the pan-European alternative, where Germany’s power system is further integrated into the European energy system.

Utility-Based Multicriteria Model for Screening Patients under the COVID-19 Pandemic

In this paper, a utility-based multicriteria model is proposed to support the physicians to deal with an important medical decision—the screening decision problem—given the squeeze put on resources due to the COVID-19 pandemic. Since the COVID-19 emerged, the number of patients with an acute respiratory failure has increased in the health units. This chaotic situation has led to a deficiency in health resources. Thus, this study, using the concepts of the multiattribute utility theory (MAUT), puts forward a mathematical model to aid physicians in the screening decision problem. The model is used to generate which of the three alternatives is the best one for where patients with suspected COVID-19 should be treated, namely, an intensive care unit (ICU), a hospital ward, or at home in isolation. Also, a decision information system, called SIDTriagem, is constructed and illustrated to operate the mathematical model proposed.

Utility Function Derived Off-Road Vehicle Path Planning

Optimal navigation of ground vehicles in an off-road setting is a challenging task. One must accurately model the properties of the terrain and reconcile it with vehicle capabilities, while simultaneously addressing mission requirements. An important part of navigation is path planning, the selection of the route a vehicle takes between the start and end points. It is often seen that, given the starting and end points for a vehicle, the optimal path that the vehicle should take varies considerably with the mission requirements. While most commonly used algorithms use a local cost function, mission requirements are typically defined over the entire run of the vehicle. Utility theoretic methods provide a normative tool to model tradeoffs over attributes (mission requirements) that the operator cares about. It is critical therefore, that preferences embedded in the utility function influence the local cost functions used. In this paper, we provide a framework for a feedback-based method to update the parameters of the local cost-function. We do so by using a geodesic-based method for path planning given the terrain inputs, followed by a physics-based simulation of a vehicle to evaluate the attributes. These attributes are then combined into a multiattribute utility function. An optimization-based approach is used to find the parameters of the cost function that maximizes this multiattribute utility. We present our approach on a vehicle navigation example over a terrain acquired from United States Geological Survey data.

Modelo de avaliação da sustentabilidade de ciclovias urbanas aplicado à capital brasileira

Este artigo propôs um modelo quantitativo usando Dimensões, Características e Indicadores de Sustentabilidade para avaliar a sustentabilidade das ciclovias. O modelo foi aplicado como um estudo de caso a duas ciclovias reais na capital brasileira, Brasília. O processo de seleção de indicadores de sustentabilidade empregou o método Delphi com 9 especialistas seniores da área de transporte e, originalmente, foram identificados 650 indicadores. Estes foram convertidos para fornecer 28 indicadores consolidados. Utilizou-se o método Função Multiatributo Aditiva (Multiattribute Utility Theory) para estabelecer uma hierarquia de dimensões, características e indicadores. Outros nove especialistas definiram níveis de importância e atribuíram pesos a Dimensões, Características e Indicadores. No total, 40 pesos foram atribuídos aos três níveis hierárquicos e o peso final de cada nível foi considerado a média aritmética dos pesos indicados pelos 9 especialistas. Os pesos dos indicadores foram multiplicados pelos pesos de suas respectivas Características e Dimensões, resultando em uma equação para o Índice de Sustentabilidade na forma de uma combinação linear dos pesos com os indicadores. Os usuários das ciclovias analisadas foram entrevistados e atribuíram pontuações a cada um dos indicadores. A partir dessas pontuações, foi possível calcular o indicador de sustentabilidade de cada ciclovia. A ciclovia 2 obteve uma melhor avaliação em relação a ciclovia 1 em todos os cenários de ponderação analisados.