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EVOKE： A VALUE-DRIVEN CONCEPT SELECTION METHOD FOR EARLY SYSTEM DESIGN

Journal of Systems Science and Systems Engineering 2018年第1期27卷 46-77页

作者： marco bertoni Alessandro bertoni Ola Isaksson GKN Aerospace Sweden AB Trollhättan Sweden

The development of new technologically advanced products requires the contribution from a range of skills and disciplines, which are often difficult to fred within a single company or organization. Requirements establishment practices in Systems Engineering （SE）, while ensuring coordination of activities and tasks across the supply network, fall short when it comes to facilitate knowledge sharing and negotiation during early system design. Empirical observations show that when system-level requirements are not available or not mature enough, engineers dealing with the development of long lead-time sub-systems tend to target local optima, rather than opening up the design space. This phenomenon causes design teams to generate solutions that do not embody the best possible configuration for the overall system. The aim of this paper is to show how methodologies for value-driven design may address this issue, facilitating early stage design iterations and the resolution of early stage design trade-offs. The paper describes how such methodologies may help gathering and dispatching relevant knowledge about the ＇design intent＇ of a system to the cross-functional engineering teams, so to facilitate a more concurrent process for requirement elicitation in SE. The paper also describes EVOKE （Early Value Oriented design exploration with KnowledgE maturity）, a concept selection method that allows benchmarking design options at sub-system level on the base of value-related information communicated by the system integrators. The use of EVOKE is exemplified in an industrial case study related to the design of an aero-engine component. EVOKE＇s ability to raise awareness on the value contribution of early stage design concepts in the SE process has been further verified with industrial practitioners in ad-hoc design episodes.

关键词： Requirements elicitation concept selection systems engineering value-driven design,decision-making knowledge maturity

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Endotics system vs colonoscopy for the detection of polyps

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World Journal of Gastroenterology 2010年第43期16卷 5452-5456页

作者： Emanuele Tumino Rodolfo Sacco marco Bertini Michele bertoni Giuseppe Parisi Alfonso Capria Operative Unit of Gastroenterology and Metabolic Diseases Department of Gastroenterology Pisa University Hospital Institute of Internal Medicine University of Foggia

AIM: To compare the endotics system (ES), a set of new medical equipment for diagnostic colonoscopy, with video-colonoscopy in the detection of polyps. METHODS: Patients with clinical or familial risk of colonic polyps/carcinomas were eligible for this study. After a standard colonic cleaning, detection of polyps by the ES and by video-colonoscopy was performed in each patient on the same day. In each single patient, the assessment of the presence of polyps was performed by two independent endoscopists, who were randomly assigned to evaluate, in a blind fashion, the presence of polyps either by ES or by standard colonoscopy. The frequency of successful procedures (i.e. reaching to the cecum), the time for endoscopy, and the need for sedation were recorded. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the ES were also calculated. RESULTS: A total of 71 patients (40 men, mean age51.9 ± 12.0 years) were enrolled. The cecum was reached in 81.6% of ES examinations and in 94.3% of colonoscopies (P = 0.03). The average time of endoscopy was 45.1 ± 18.5 and 23.7 ± 7.2 min for the ES and traditional colonoscopy, respectively (P < 0.0001). No patient required sedation during ES examination, compared with 19.7% of patients undergoing colonoscopy (P < 0.0001). The sensitivity and specificity of ES for detecting polyps were 93.3% (95% CI: 68-98) and 100% (95% CI: 76.8-100), respectively. PPV was 100% (95% CI: 76.8-100) and NPV was 97.7% (95% CI: 88-99.9). CONCLUSION: The ES allows the visualization of the entire colonic mucosa in most patients, with good sensitivity/specificity for the detection of lesions and without requiring sedation.

关键词： Colonoscopy Diagnosis Endotics system Polyps Sedation

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Assessment of clinical and radiological response to sorafenib in hepatocellular carcinoma patients

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World Journal of Hepatology 2015年第1期7卷 33-39页

作者： Rodolfo Sacco Valeria Mismas Antonio Romano marco Bertini Michele bertoni Graziana Federici Salvatore Metrangolo Giuseppe Parisi Emanuele Tumino Giampaolo Bresci Luca Giacomelli Sara Marceglia Irene Bargellini Dipartimento di Gastroenterologia-UO Gastroenterologia e Malattie del Ricambio Azienda Ospedaliero Universitaria Pisana56124 PisaItaly Dipartimento di Elettronica Informazione e BioingegneriaPolitecnico di Milano20100 MilanItaly Dipartimento di Radiologia-Azienda Ospedaliero Universitaria Pisana 56124 PisaItaly

Sorafenib is an effective anti-angiogenic treatment forhepatocellular carcinoma(HCC). The assessment of tumor progression in patients treated with sorafenib is crucial to help identify potentially-resistant patients,avoiding unnecessary toxicities. Traditional methods to assess tumor progression are based on variations in tumor size and provide unreliable results in patients treated with sorafenib. New methods to assess tumor progression such as the modified Response Evaluation Criteria in Solid Tumors or European Association for the Study of Liver criteria are based on imaging to measure the vascularization and tumor volume(viable or necrotic). These however fail especially when the tumor response results in irregular development of necrotic tissue. Newer assessment techniques focus on the evaluation of tumor volume,density or perfusion. Perfusion computed tomography and Dynamic ContrastEnhanced-UltraS ound can measure the vascularization of HCC lesions and help predict tumor response to antiangiogenic therapies. Mean Transit Time is a possible predictive biomarker to measure tumor response. Volumetric techniques are reliable,reproducible and time-efficient and can help measure minimal changes in viable tumor or necrotic tissue,allowing the prompt identification of non-responders. Volume ratio may be a reproducible biomarker for tumor response. Larger trials are needed to confirm the use of these techniques in the prediction of response to sorafenib.

关键词： Hepatocellular carcinoma Sorafenib ResponseEvaluation Criteria in Solid Tumors Perfusioncomputed tomography Dynamic Contrast-Enhanced-UltraSound Volumetric assessment

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Clinical impact of selective transarterial chemoembolization on hepatocellular carcinoma:A cohort study

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World Journal of Gastroenterology 2009年第15期15卷 1843-1848页

作者： Rodolfo Sacco marco Bertini Pasquale Petruzzi Michele bertoni Irene Bargellini Giampaolo Bresci Graziana Federici Luigi Gambardella Salvatore Metrangolo Giuseppe Parisi Antonio Romano Antonio Scaramuzzino Emanuele Tumino Alessandro Silvestri Emanuele Altomare Claudio Vignali Alfonso Capria Gastroenterology Department Pisa University Hospital Institute of Interna Medicine University of Foggia Department of Diagnostic and Interventional Radiology Pisa University Hospital

AIM： To prospectively long term clinical impact evaluate the short and of selective transarterial chemoembolization （TACE） on fiver function in patients with hepatocellular carcinoma （HCC）. To assess side effects in relation to treatments. To analyze the overall survival and HCC progression free survival probability. METHODS： One hundred and seventeen cirrhotic patients with HCC were enrolled. Baseline liver function included Child-Pugh score and serum levels of alanine- aminotransferase （ALT）, prothrombin time （PT） and bilirubin. According to Cancer Liver Italian Program （CLIP） and Barcelona Clinic Liver Cancer （BCLC） staging systems, 71 patients were eligible for TACE; 32 had previously received treatment for HCC. No significant differences in liver function were observed between previously treated and not treated patients. TACE was performed by selective catheterization of the arteries nourishing the lesions. While hospitalized, patients underwent clinical, hematologic and ultrasonographic assessments. One month after TACE a CT scan was performed to assess tumor response. A second TACE was performed ＂on demand＂ Liver function tests were checked in all patients every four months. RESULTS： After first TACE, the mean Child-Pugh score increased from a mean baseline 5.62 ±1.12 to 6.11 ±1.57 at discharge time （P 〈 0.0001）, decreasing after four months to 5.81 ± 0.73 （not significant）. ALT, PT and bilirubin significantly （P 〈 0.0001） increased 24 h after TACE and progressively decreased until discharge. After the second TACE, variations in Child-Pugh score, ALT, PT and bilirubin were comparable to that described after the first TACE. No major complications were observed. The mean follow-up was 14.7 ＋ 6.3 mo （median： 16 mo）. Only one patient died. No other patient experienced important long term worsening of clinical status. The overall survival probability at twenty-four months was 98.18% with a correspondent HCC progression free survival probability of 69%. CONCLUSION：

关键词： Hepatocellular carcinoma Transarterialchemoembolization Liver function Liver cirrhosis Child-Pugh score

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