State-of-the-Art dynamischer Methoden zur multikriteriellen Entscheidungsunterstützung

Die Methoden der multikriteriellen Entscheidungsunterstützung (MCDA) bieten die Möglichkeit eine Vielzahl an Kriterien unterschiedlicher Natur im Zuge der Entscheidungsfindung simultan einzubeziehen. Bestimmte Entscheidungen, insbesondere im strategischen Bereich, zeichnen sich zudem durch eine hohe Komplexität aus, da die zugrundeliegenden Annahmen sowie die Auswirkungen der Entscheidung mit Unsicherheiten behaftet sind. Das Ziel dieser Arbeit war es, durch ein strukturiertes Literaturreview herauszustellen, welche Ansätze zur Erfassung einer solchen dynamischen Entscheidungskomponente es bislang gibt. Zur Identifikation relevanter Literatur wurden themenrelevante, wissenschaftliche Verlage wie ELSEVIER, sowie die EBSCO Datenbank genutzt. Auch Dissertationen, Konferenzberichte sowie vorherige Reviewartikel wurden inkludiert. Insgesamt wurden 60 Zeitschriftenartikel aus 31 verschiedenen Zeitschriften, 6 Konferenz-Paper, 11 Buchquellen und eine Dissertation gefunden. Die Literatur wurde anschließend nach dem zugrundeliegenden Verständnis der dynamischen Komponente, sowie deren methodischer Erfassung klassifiziert. Hierbei offenbarten sich drei Gruppen von Ansätzen Dynamik in die MCDA zu integrieren: (1) Szenario-basierte Ansätze, (2) Eine Kombination von MCDA mit Lebenszyklusmodellen (LCA), sowie (3) die direkte Einbeziehung von Dynamik in der Problemformulierung über mehrere Datensätze (DMCDA). Ein kritischer Vergleich dieser zeigt eine fortgeschrittene Entwicklung mit vielen Anwendungsbeispielen im Forschungsstrang der Szenario-basierten Ansätze. Eine Kombination von MCDA mit LCA kommt vor allem in Nachhaltigkeitsfragen und bei der Beurteilung von Energietechnologien zum Einsatz. Das Gebiet der DMCDA-Ansätze erweist sich als vergleichsweise jüngerer Forschungsstrang mit Ansatzpunkten für zukünftige Forschungsvorhaben. Die Methoden der multikriteriellen Entscheidungsunterstützung (MCDA) bieten die Möglichkeit eine Vielzahl an Kriterien unterschiedlicher Natur im Zuge der Entscheidungsfindung simultan einzubeziehen. Bestimmte Entscheidungen, insbesondere im strategischen Bereich, zeichnen sich zudem durch eine hohe Komplexität aus, da die zugrundeliegenden Annahmen sowie die Auswirkungen der Entscheidung mit Unsicherheiten behaftet sind. Das Ziel dieser Arbeit war es, durch ein strukturiertes Literaturreview herauszustellen, welche Ansätze zur Erfassung einer solchen dynamischen Entscheidungskomponente es bislang gibt. Zur Identifikation relevanter Literatur wurden themenrelevante, wissenschaftliche Verlage wie ELSEVIER, sowie die EBSCO Datenbank genutzt. Auch Dissertationen, Konferenzberichte sowie vorherige Reviewartikel wurden inkludiert. Insgesamt wurden 60 Zeitschriftenartikel aus 31 verschiedenen Zeitschriften, 6 Konferenz-Paper, 11 Buchquellen und eine Dissertation gefunden. Die Literatur wurde anschließend nach dem zugrundeliegenden Verständnis der dynamischen Komponente, sowie deren methodischer Erfassung klassifiziert. Hierbei offenbarten sich drei Gruppen von Ansätzen Dynamik in die MCDA zu integrieren: (1) Szenario-basierte Ansätze, (2) Eine Kombination von MCDA mit Lebenszyklusmodellen (LCA), sowie (3) die direkte Einbeziehung von Dynamik in der Problemformulierung über mehrere Datensätze (DMCDA). Ein kritischer Vergleich dieser zeigt eine fortgeschrittene Entwicklung mit vielen Anwendungsbeispielen im Forschungsstrang der Szenario-basierten Ansätze. Eine Kombination von MCDA mit LCA kommt vor allem in Nachhaltigkeitsfragen und bei der Beurteilung von Energietechnologien zum Einsatz. Das Gebiet der DMCDA-Ansätze erweist sich als vergleichsweise jüngerer Forschungsstrang mit Ansatzpunkten für zukünftige Forschungsvorhaben.  Keywords: Multikriterielle Entscheidungsunterstützung, DMCDA, uncertainty, dynamic decision making, MAD

Robust Real-time Query Processing with QStream

Processing data streams with Quality-of-Service (QoS) guarantees is an emerging area in existing streaming applications. Although it is possible to negotiate the result quality and to reserve the required processing resources in advance, it remains a challenge to adapt the DSMS to data stream characteristics which are not known in advance or are difficult to obtain. Within this paper we present the second generation of our QStream DSMS which addresses the above challenge by using a real-time capable operating system environment for resource reservation and by applying an adaptation mechanism if the data stream characteristics change spontaneously

Clinical Applications for Cardiovascular Magnetic Resonance Imaging at 3 Tesla

Cardiovascular magnetic resonance (CMR) imaging has evolved rapidly and is now accepted as a powerful diagnostic tool with significant clinical and research applications. Clinical 3 Tesla (3 T) scanners are increasingly available and offer improved diagnostic capabilities compared to 1.5 T scanners for perfusion, viability, and coronary imaging. Although technical challenges remain for cardiac imaging at higher field strengths such as balanced steady state free precession (bSSFP) cine imaging, the majority of cardiac applications are feasible at 3 T with comparable or superior image quality to that of 1.5 T. This review will focus on the benefits and limitations of 3 T CMR for common clinical applications and examine areas in development for potential clinical use

Clinical and radiological outcome 1-year after cervical total disc replacement using the Signus ROTAIO - Prosthesis.

INTRODUCTION The instantaneous center of rotation (iCOR) of a motion segment has been shown to correlate with its total range of motion (ROM). Importantly, a correlation of the correct placement of cervical total disc replacement (cTDR) to preserve a physiological iCOR has been previously identified. However, changes of these parameters and the corresponding clinical relevance have hardly been analyzed. This study assesses the radiological and clinical correlation of iCOR and ROM following cTDR. MATERIALS/METHODS A retrospective multi-center observational study was conducted and radiological as well as clinical parameters were evaluated preoperatively and 1 year after cTDR with an unconstrained device. Radiographic parameters including flexion/extension X-rays (flex/ex), ROM, iCOR and the implant position in anterior-posterior direction (IP ap), as well as corresponding clinical parameters [(Neck Disability Index (NDI) and the visual analogue scale (VAS)] were assessed. RESULTS 57 index segments of 53 patients treated with cTDR were analyzed. Pre- and post-operative ROM showed no significant changes (8.0° vs. 10.9°; p > 0.05). Significant correlations between iCOR and IP (Pearson's R: 0.6; p < 0.01) as well as between ROM and IP ap (Pearson's R: - 0.3; p = 0.04) were identified. NDI and VAS improved significantly (p < 0.01). A significant correlation between NDI and IP ap after 12 months (Pearson's R: - 0.39; p < 0.01) was found. CONCLUSION Implantation of the tested prosthesis maintains the ROM and results in a physiological iCOR. The exact position of the device correlates with the clinical outcome and emphasize the importance of implant design and precise implant positioning

Prospective Multicenter Trial of Cervical Arthroplasty with the ROTAIO® Cervical Disc Prosthesis.

STUDY DESIGN Clinical observational study. OBJECTIVE The ROTAIO® cervical disc prosthesis is a novel unconstrained implant with a variable center of rotation aiming at physiological motion. The objective of this multicenter prospective trial was to evaluate clinical outcome and complications within 2 years. MATERIAL AND METHODS 120 patients (72 females and 48 males with median age of 43.0 years [23-60 yrs] underwent ACDA (ROTAIO®, SIGNUS Medical, Alzenau, Germany) and were prospectively followed for 24 months. Preoperative complaints were mainly associated with radiculopathy (n = 104) or myelopathy (n=16). There were 108 monosegmental and 12 bisegmental procedures including 6 hybrid constructs. Clinical outcome was evaluated at 3, 12 and 24 months in 100%, 96% and 77% of the cohort by VAS, NDI, WL-26, Patient`s Satisfaction Index (PSI), SF-36, Nurick Score, mJOA, Composite Success Rate, complications, patient`s overall satisfaction and analgesics use. RESULTS Highly significant clinical improvements were observed according to NDI and VAS (P < .0001 (arm); P < .001 (neck); P = .002 (head)) at all time points. Analgetic use could be reduced in 87.1 to 95.2%. Doctor`s visits have been reduced in 93.8% after 24 months. Patient`s overall satisfaction was high with 78.4 to 83.5% of patients. The composite success rate was 77.5% after 12 months and 76.9% after 24 months. There were no major complications in this series. Slight subsidence of the prosthesis was observed in 2 patients and 3 patients demonstrated fusion after 24 months. 2 patients developed symptomatic foraminal stenosis, so that implant removal and fusion was performed resulting in a revision rate of 1.7% in 2 years. CONCLUSION The ROTAIO® cervical disc prosthesis is a safe and efficient treatment option for symptomatic degenerative disc disease demonstrating highly significant clinical improvement and high patient`s overall satisfaction with very low revision rates at 2 years

Prospective Multicenter Trial of Cervical Arthroplasty With the ROTAIO® Cervical Disc Prosthesis

Objective Anterior Cervical Discectomy and Arthroplasty (ACDA) is an established treatment for degenerative cervical disc disease and seems to be an alternative to fusion in minimizing the risk of Adjacent Segment Disease (ASD). The ROTAIO® cervical disc prosthesis is a novel unconstrained implant with a variable center of rotation aiming at physiological motion. The objective of this multicenter prospective trial was to evaluate clinical outcome and complications within 2 years. Material and Methods 120 patients (72 females and 48 males with a median age of 43.0 years; range: 23 to 60 years) underwent ACDA (ROTAIO®, SIGNUS Medical, Alzenau, Germany) and were prospectively followed for 24 months. Preoperative complaints were mainly associated with radiculopathy (n=104) or myelopathy (n=16). There were 108 monosegmental and 12 bisegmental procedures including 6 hybrid constructs. Clinical outcome was evaluated at 3, 12 and 24 months by the Visual Analogue Scale (VAS) for head, neck and arm pain, the Neck Disability Index (NDI), the Work Limitation Questionnaire (WL-26), the Patient`s Satisfaction Index (PSI) and a Quality of Life Questionnaire (SF-36). The Nurick Score, the Modified Japanese Orthopaedic Association Score (mJOA) plus a Composite Success Rate have been additionally applied. Finally, complications, the patient`s overall satisfaction and the amount of analgesics were assessed. Results Highly significant clinical improvements were observed according to NDI and VAS (p<0.0001 (arm); p<0.001 (neck); p=0.002 (head)) at all postoperative time points. Analgetic medication could be reduced after 3 months in 91.3%, after 12 months in 87.1% and after 24 months in 95.2% of patients. Doctor`s visits for cervical spine problems have been reduced in 93.8% after 24 months. Patient`s overall satisfaction was high after 3, 12 and 24 months with 83.5%, 78.4% and 79.1% of patients, while 4.1%, 6.8% and 7.0% respectively were not satisfied. The composite success rate was 77.5% after 12 months and 76.9% after 24 months. There were no major complications in this series. Slight subsidence of the prosthesis was observed in 2 patients and 3 patients demonstrated fusion after 24 months. 2 patients developed symptomatic foraminal stenosis, so that implant removal and fusion was performed. Conclusion The ROTAIO® cervical disc prosthesis is a safe and efficient treatment option for symptomatic degenerative disc disease demonstrating excellent clinical results at 2 years. Outcome proves to be stable over time with very low revision rates

Combined therapy with ibrutinib and bortezomib followed by ibrutinib maintenance in relapsed or refractory mantle cell lymphoma and high-risk features: a phase 1/2 trial of the European MCL network (SAKK 36/13).

BACKGROUND The Bruton's tyrosine kinase inhibitor ibrutinib and the proteasome inhibitor bortezomib have single-agent activity, non-overlapping toxicities, and regulatory approval in mantle cell lymphoma (MCL). In vitro, their combination provides synergistic cytotoxicity. In this investigator-initiated phase 1/2 trial, we established the recommended phase 2 dose of ibrutinib in combination with bortezomib, and assessed its efficacy in patients with relapsed or refractory MCL. METHODS In this phase 1/2 study open in 15 sites in Switzerland, Germany and Italy, patients with relapsed or refractory MCL after ≤2 lines of chemotherapy and both ibrutinib-naïve and bortezomib-naïve received six cycles of ibrutinibb and bortezomib, followed by ibrutinib maintenance. For the phase 1 study, a standard 3 + 3 dose escalation design was used to determine the recommended phase 2 dose of ibrutinib in combination with bortezomib. The primary endpoint in phase 1 was the dose limiting toxicities in cycle 1. The phase 2 study was an open-label, single-arm trial with a Simon's two-stage min-max design, with a primary endpoint of overall response rate (ORR) assessed by CT/MRI. This study was registered with ClinicalTrials.gov, NCT02356458. FINDINGS Between August 2015 and September 2016, nine patients were treated in the phase 1 study, and 49 patients were treated between November 2016 and March 2020 in the phase 2 of the trial. The ORR was 81.8% (90% CI 71.1, 89.8%, CR(u) 21.8%) which increased with continued ibrutinib (median 10.6 months) to 87.3%, (CR(u) 41.8%). 75.6% of patients had at least one high-risk feature (Ki-67 > 30%, blastoid or pleomorphic variant, p53 overexpression, TP53 mutations and/or deletions). In these patients, ibrutinib and bortezomib were also effective with an ORR of 74%, increasing to 82% during maintenance. With a median follow-up of 25.4 months, the median duration of response was 22.7, and the median PFS was 18.6 months. PFS reached 30.8 and 32.9 months for patients with a CR or Cru, respectively. INTERPRETATION The combination of ibrutinib and bortezomib shows durable efficacy in patients with relapsed or refractory MCL, also in the presence of high-risk features. FUNDING SAKK (Hubacher Fund), Swiss State Secretariat for Education, Research and Innovation, Swiss Cancer Research Foundation, and Janssen

Geographical and temporal distribution of SARS-CoV-2 clades in the WHO European Region, January to June 2020

We show the distribution of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) genetic clades over time and between countries and outline potential genomic surveillance objectives. We applied three genomic nomenclature systems to all sequence data from the World Health Organization European Region available until 10 July 2020. We highlight the importance of real-time sequencing and data dissemination in a pandemic situation, compare the nomenclatures and lay a foundation for future European genomic surveillance of SARS-CoV-2

Robust Real-time Query Processing with QStream

Processing data streams with Quality-of-Service (QoS) guarantees is an emerging area in existing streaming applications. Although it is possible to negotiate the result quality and to reserve the required processing resources in advance, it remains a challenge to adapt the DSMS to data stream characteristics which are not known in advance or are difficult to obtain. Within this paper we present the second generation of our QStream DSMS which addresses the above challenge by using a real-time capable operating system environment for resource reservation and by applying an adaptation mechanism if the data stream characteristics change spontaneously