Prospective Optimization with Limited Resources

The future is uncertain because some forthcoming events are unpredictable and also because our ability to foresee the myriad consequences of our own actions is limited. Here we studied how humans select actions under such extrinsic and intrinsic uncertainty, in view of an exponentially expanding number of prospects on a branching multivalued visual stimulus. A triangular grid of disks of different sizes scrolled down a touchscreen at a variable speed. The larger disks represented larger rewards. The task was to maximize the cumulative reward by touching one disk at a time in a rapid sequence, forming an upward path across the grid, while every step along the path constrained the part of the grid accessible in the future. This task captured some of the complexity of natural behavior in the risky and dynamic world, where ongoing decisions alter the landscape of future rewards. By comparing human behavior with behavior of ideal actors, we identified the strategies used by humans in terms of how far into the future they looked (their "depth of computation") and how often they attempted to incorporate new information about the future rewards (their "recalculation period"). We found that, for a given task difficulty, humans traded off their depth of computation for the recalculation period. The form of this tradeoff was consistent with a complete, brute-force exploration of all possible paths up to a resource-limited finite depth. A step-by-step analysis of the human behavior revealed that participants took into account very fine distinctions between the future rewards and that they abstained from some simple heuristics in assessment of the alternative paths, such as seeking only the largest disks or avoiding the smaller disks. The participants preferred to reduce their depth of computation or increase the recalculation period rather than sacrifice the precision of computation.ope

Review of precision cancer medicine: Evolution of the treatment paradigm.

In recent years, biotechnological breakthroughs have led to identification of complex and unique biologic features associated with carcinogenesis. Tumor and cell-free DNA profiling, immune markers, and proteomic and RNA analyses are used to identify these characteristics for optimization of anticancer therapy in individual patients. Consequently, clinical trials have evolved, shifting from tumor type-centered to gene-directed, histology-agnostic, with innovative adaptive design tailored to biomarker profiling with the goal to improve treatment outcomes. A plethora of precision medicine trials have been conducted. The majority of these trials demonstrated that matched therapy is associated with superior outcomes compared to non-matched therapy across tumor types and in specific cancers. To improve the implementation of precision medicine, this approach should be used early in the course of the disease, and patients should have complete tumor profiling and access to effective matched therapy. To overcome the complexity of tumor biology, clinical trials with combinations of gene-targeted therapy with immune-targeted approaches (e.g., checkpoint blockade, personalized vaccines and/or chimeric antigen receptor T-cells), hormonal therapy, chemotherapy and/or novel agents should be considered. These studies should target dynamic changes in tumor biologic abnormalities, eliminating minimal residual disease, and eradicating significant subclones that confer resistance to treatment. Mining and expansion of real-world data, facilitated by the use of advanced computer data processing capabilities, may contribute to validation of information to predict new applications for medicines. In this review, we summarize the clinical trials and discuss challenges and opportunities to accelerate the implementation of precision oncology

Implementing a perioperative efficiency initiative for orthopedic surgery instrumentation at an academic center: A comparative before-and-after study.

Optimizing surgical instrumentation may contribute to value-based care, particularly in commonly performed procedures. We report our experience in implementing a perioperative efficiency program in 2 types of orthopedic surgery (primary total-knee arthroplasty, TKA, and total-hip arthroplasty, THA).A comparative before-and-after study with 2 participating surgeons, each performing both THA and TKA, was conducted. Our objective was to evaluate the effect of surgical tray optimization on operating and processing time, cost, and waste associated with preparation, delivery, and staging of sterile surgical instruments. The study was designed as a prospective quality improvement initiative with pre- and postimplementation operational measures and a provider satisfaction survey.A total of 96 procedures (38 preimplementation and 58 postimplementation) were assessed using time-stamped performance endpoints. The number and weight of trays and instruments processed were reduced substantially after the optimization intervention, particularly for TKA. Setup time was reduced by 23% (6 minutes, P = .01) for TKA procedures but did not differ for THA. The number of survey respondents was small, but satisfaction was high overall among personnel involved in implementation.Optimizing instrumentation trays for orthopedic procedures yielded reduction in processing time and cost. Future research should evaluate patient outcomes and incremental/additive impact on institutional quality measures

A STOCHASTIC SIMULATION-BASED HYBRID INTERVAL FUZZY PROGRAMMING APPROACH FOR OPTIMIZING THE TREATMENT OF RECOVERED OILY WATER

In this paper, a stochastic simulation-based hybrid interval fuzzy programming (SHIFP) approach is developed to aid the decision-making process by solving fuzzy linear optimization problems. Fuzzy set theory, probability theory, and interval analysis are integrated to take into account the effect of imprecise information, subjective judgment, and variable environmental conditions. A case study related to oily water treatment during offshore oil spill clean-up operations is conducted to demonstrate the applicability of the proposed approach. The results suggest that producing a random sequence of triangular fuzzy numbers in a given interval is equivalent to a normal distribution when using the centroid defuzzification method. It also shows that the defuzzified optimal solutions follow the normal distribution and range from 3,000-3,700 tons, given the budget constraint (CAD 110,000-150,000). The normality seems to be able to propagate throughout the optimization process, yet this interesting finding deserves more in-depth study and needs more rigorous mathematical proof to validate its applicability and feasibility. In addition, the optimal decision variables can be categorized into several groups with different probability such that decision makers can wisely allocate limited resources with higher confidence in a short period of time. This study is expected to advise the industries and authorities on how to distribute resources and maximize the treatment efficiency of oily water in a short period of time, particularly in the context of harsh environments

Why foresight? The impact of resource consumption and technology on the ability to foresee the future

In this article we attempt at providing evolution of the resource consumption (RC) which meets the needs of a modern society. In analyzing the impact of resources consumption and technologies to meets the needs, over the possibility of anticipating the future is necessary to establish patterns based on past information. On the those information, we can say that RC evolution between the ? and ? moments follows a logistic curve. Based on the graphic representation of the RC evolution, we can identify four different phases, with specific characteristics. Each phase will be the basis for building a pattern of RC evolution. For each of the four patterns we analytically present the risks of performing an exercise of future’s anticipation. The analysis indicates that currently, the forecasts lose representativeness and becomes less important compared with the foresight. The foresight, through its features, answers much better the needs to anticipate the future evolution of the society, compared to the forecast. Foresight exercises are offensive compared to the defensive nature of forecast exercises. The foresight exercise specialist is not just a spectator to the evolution of the phenomenon, as in the forecast’s case, but is involved in making and implementing decisions. Foresight exercises, although not able to generate accurate projections of the future, will help to correlate the current technologies with the future needs of societyresource consumption, technology, foresight, possibility of anticipating the future