Abstract:
Integrated multi-criteria decision frameworks disclosed herein can facilitate making good decisions when faced with a complex choice among several alternatives with different combinations of strengths and weaknesses. Some decision support systems using multi-criteria methods can combine multiple multi-criteria methods in a single adaptable decision support intervention. In some embodiments, the framework can include some or all of the following modules: a decision strategy module; a balance sheet module; an interactive decision dashboard module; an ordinal ranking module; a direct weighting module; and an Analytic Hierarchy Process (AHP) module.

Description:
RELATED APPLICATION 
       [0001]    This application claims the benefit of U.S. Provisional Application No. 61/591,257, entitled “INTEGRATED MULTI-CRITERIA DECISION SUPPORT FRAMEWORK,” filed Jan. 26, 2012, the entirety of which is expressly incorporated herein by reference. 
     
    
     GOVERNMENT LICENSE RIGHTS 
       [0002]    This invention was made with government support under Grant 1K24 RR024198-02 awarded by National Institutes of Health. The Government has certain rights to this invention. 
     
    
     FIELD 
       [0003]    The disclosure relates generally to facilitation of decision making, and, in particular, to making and facilitating the making of medical-treatment decisions. 
       BACKGROUND 
       [0004]    A key challenge in many decision makings is helping decision makers develop meaningful understandings of the differences between alternative resources and management strategies in order to make informed judgments about selection of a proper resource or strategy. 
       SUMMARY 
       [0005]    Interactive decision dashboards may facilitate decision making by reducing the cognitive effort needed to evaluate various options through extensive use of data visualization techniques. The Interactive decision dashboards can present information in a non-linear format that facilitates information search and retrieval tailored to meet individual needs. For example, a physician or patient decision aid formatted as an interactive decision dashboard can be an effective and efficient way to make sense of the information required to make good decisions. 
         [0006]    The integrated multi-criteria decision frameworks disclosed herein can facilitate making good decisions when faced with a complex choice among several alternatives with different combinations of strengths and weaknesses. The decision frameworks can be used to support decisions made by both individuals and groups of people. The decision framework can allow rapid incorporation of new information into the decision making process. 
         [0007]    Some decision support systems using multi-criteria methods rely primarily on a single method. The integrated multi-criteria decision frameworks disclosed herein can combine multiple, e.g., five, multi-criteria methods in a single adaptable decision support intervention. In some embodiments, the framework can include some or all of the following six modules for example: a decision strategy module; a balance sheet module; an interactive decision dashboard module; an ordinal ranking module; a direct weighting module; and an Analytic Hierarchy Process (AHP) module. 
         [0008]    Some systems and methods display queries regarding the significance of criteria to a decision maker, receive responses to those queries, and store data that permit evaluation of an alternative that was not displayed or otherwise made available to the decision maker at the time that the queries were displayed, the responses received, or both. In some embodiments, systems and methods can permit evaluation of whether a new alternative (e.g., a treatment option), based on the stored data, (i) is or may be preferable to a decision maker, (ii) better suited to the needs of a decision maker or other individual (e.g., a patient), (iii) meriting further consideration by a decision maker, or (iv) a combination thereof. Such systems and methods may, in some embodiments, expedite identification of more desirable alternatives after they become available for example. 
         [0009]    The subject technology is illustrated, for example, according to various aspects described below. Various examples of aspects of the subject technology are described as numbered clauses (1, 2, 3, etc.) for convenience. These are provided as examples and do not limit the subject technology. It is noted that any of the dependent clauses may be combined in any combination, and placed into a respective independent clause, e.g., clause 1 or clause 55. The other clauses can be presented in a similar manner. 
         [0010]    1. A system for evaluating patient treatment options, comprising:
       memory,   one or more processors coupled to the memory, the one or more processors configured to execute a plurality of modules including:   an ordinal ranking module configured to display a set of relative-weighting queries regarding the relative importance of at least two criteria to the treatment goal, receive one or more relative-weighting indicator responses to the set of relative-weighting queries, and modify a set of criteria weights based on the relative-weighting indicator responses;   a direct weighting module configured to display a set of direct-weighting queries regarding the individual importance of at least one criterion to the treatment goal, receive one or more direct-weighting indicator responses to the set of direct-weighting queries, and modify the set of criteria weights based on the direct-weighting indicator responses;   an analysis module configured to display a set of analytic queries comparing the at least two criteria, receive one or more analytic indicator responses to the set of analytic queries, and modify the set of criteria weights based on the analytic indicator responses;   wherein at least one of the modules is configured to retrieve data descriptive of a plurality of treatment options at least with respect to the at least two criteria;   wherein at least one of the modules is configured to display a set of criterion-exclusion queries, and receive one or more criterion-exclusion indicator responses to the set of criterion-inclusion queries;   wherein at least one of the modules is configured to calculate, based on at least a portion of the data and the weights, and display a composite score for each treatment option except as indicated by the criterion-exclusion indicator responses; and   wherein at least one of the modules is configured to determine whether at least one response is inconsistent with another received response, and, in response to determining existence of an inconsistency, to perform at least one of: (a) displaying a notice regarding the inconsistency, (b) displaying a resolution query directed to resolution of the inconsistency, (c) identifying at least one objectively incorrect understanding of a user indicated by the inconsistency and displaying information directed to correction of the understanding, or (d) notifying a health care provider of the inconsistency.       
 
         [0020]    2. The system of clause 1, further comprising a balance sheet module configured to display at least a portion of the data in a table according to criteria and treatment options. 
         [0021]    3. The system of clause 1, further comprising a decision dashboard module configured to display a graphical representation of a least a portion of the data. 
         [0022]    4. The system of clause 1, further comprising a decision strategy module configured to receive decision information including the criteria and the treatment options. 
         [0023]    5. The system of clause 1, wherein the analysis module is further configured to provide information related to consistency of analytic indicator responses. 
         [0024]    6. The system of clause 1, further comprising a sensitivity analysis module configured to examine the effects of variation of the weights. 
         [0025]    7. The system of clause 1, wherein the criteria include effectiveness, risk of side effects, and cost of a treatment strategy. 
         [0026]    8. The system of clause 1, wherein at least some of the analytic queries in the set compare only two of the criteria. 
         [0027]    9. The system of clause 1, wherein the analysis module is further configured to display a set of preference queries comparing attributes, relative to one of the at least two criteria, of at least two treatment options, receive one or more preference indicator responses to the set of preference queries, and modify the set of criteria weights based on the preference indicator responses. 
         [0028]    10. A method for evaluating patient treatment options, comprising:
       a) retrieving data indicative of the attributes of a plurality of treatment options relative to criteria;   b) displaying a set of criterion-exclusion queries and receiving one or more criterion-exclusion indicator responses to the set of criterion-inclusion queries;   c) displaying a set of relative-weighting queries regarding the relative importance of at least two criteria to the treatment goal, receiving one or more relative-weighting indicator responses to the set of relative-weighting queries, and modifying a set of criteria weights based on the relative-weighting indicator responses;   d) displaying a set of direct-weighting queries regarding the individual importance of at least one criterion to the treatment goal, receiving one or more direct-weighting indicator responses to the set of direct-weighting queries, and modifying the set of criteria weights based on the direct-weighting indicator responses;   e) displaying a set of analytic queries comparing the at least two criteria, receiving one or more analytic indicator responses to the set of analytic queries, and modifying the set of criteria weights based on the analytic indicator responses;   f) repeating at least one of steps b, c, d, or e;   g) determining whether at least one response is inconsistent with another received response, and, in response to determining existence of an inconsistency, performing at least one of: (i) displaying a notice regarding the inconsistency, (ii) displaying a resolution query directed to resolution of the inconsistency, (iii) identifying at least one objectively incorrect understanding of a user indicated by the inconsistency and displaying information directed to correction of the understanding, or (iv) notifying a health care provider of the inconsistency; and   h) calculating, based on at least a portion of the data and the weights, and displaying a composite score for each treatment option except those indicated by the criterion-exclusion indicator responses.       
 
         [0037]    11. The method of clause 10, further comprising alphanumerically displaying the data. 
         [0038]    12. The method of clause 10, further comprising graphically displaying at least a portion of the data. 
         [0039]    13. The method of clause 10, further comprising displaying a option-selection query and receiving a selection indicator response to the option-selection query. 
         [0040]    14. A method for evaluating patient treatment options, comprising:
       a) displaying, by a first processor, information regarding (1) a plurality of treatment options and (2) one or more of (i) a set of criterion-exclusion queries, (ii) a set of relative-weighting queries regarding the relative importance of at least two criteria to the treatment goal, (iii) a set of direct-weighting queries regarding the individual importance of at least one criterion to the treatment goal, or (iv) a set of analytic queries comparing at least two criteria;   b) receiving one or more indicator responses to the displayed queries;   c) storing, in a non-transitory machine-readable medium, at least one of (i) the received indicator responses or (ii) a set of criteria weights determined based on the indicator responses;   d) calculating a composite score for an additional treatment option, not comprised by the plurality of treatment options, based on (1) data indicative of attributes of the additional treatment option relative to the at least two criteria, and (2) at least a portion of the stored one of (i) the received indicator responses or (ii) the set of criteria weights; and   e) outputting an indicator of the composite score.       
 
         [0046]    15. The method of Clause 14, wherein the indicator of the composite score comprises an indication of potential preference for the additional treatment option over at least one other treatment option. 
         [0047]    16. The method of Clause 14, wherein the indicator of the composite score comprises an indication of potential preference for the additional treatment option over each of a plurality of treatment options. 
         [0048]    17. The method of Clause 14, wherein the indicator of the composite score comprises an indication that the composite score of the additional treatment option is better than the composite score of at least one other treatment option. 
         [0049]    18. The method of Clause 14, wherein the indicator of the composite score comprises an indication that the composite score of the additional treatment option is better than composite scores of each of a plurality of treatment options. 
         [0050]    19. The method of Clause 14, wherein outputting the indicator of the composite score comprises displaying the composite score. 
         [0051]    20. The method of Clause 14, wherein the displaying of step (e) is performed by the first processor. 
         [0052]    21. The method of Clause 14, wherein the displaying of step (e) is performed by a second processor. 
         [0053]    22. The method of Clause 14, further comprising calculating a composite score for each of the plurality of treatment options based on (1) data indicative of attributes of the plurality of treatment options relative to the at least two criteria, and (2) at least a portion of one of (i) the received indicator responses or (ii) the set of criteria weights; and displaying the composite scores for the plurality of treatment options. 
         [0054]    23. The method of Clause 22, wherein the composite scores for the plurality of treatment options are displayed with the composite score for the additional treatment option. 
         [0055]    24. The method of Clause 22, wherein the composite scores for the plurality of treatment options are calculated based on the stored one of (i) the received indicator responses or (ii) the set of criteria weights. 
         [0056]    25. The method of Clause 14, wherein the additional treatment option was not displayed to a user prior to storing the at least one of (i) the received indicator responses or (ii) the set of criteria weights, wherein the indicator responses were received from the user. 
         [0057]    26. A system for evaluating patient treatment options, comprising:
       memory,   one or more processors coupled to the memory, the one or more processors configured to execute (1) a display module configured to display information regarding a plurality of treatment options and (2) one or more of:
           a) an ordinal ranking module configured to display a set of relative-weighting queries regarding the relative importance of at least two criteria to the treatment goal, receive one or more relative-weighting indicator responses to the set of relative-weighting queries;   b) a direct weighting module configured to display a set of direct-weighting queries regarding the individual importance of at least one criterion to the treatment goal, receive one or more direct-weighting indicator responses to the set of direct-weighting queries; and   c) an analysis module configured to display a set of analytic queries comparing the at least two criteria, receive one or more analytic indicator responses to the set of analytic queries;   
           wherein at least one of the modules is configured to display a set of criterion-exclusion queries, and receive one or more criterion-exclusion indicator responses to the set of criterion-inclusion queries;   wherein at least one of the modules is configured to store, in memory, at least one of received responses and a set of criteria weights determined based on the received indicator responses;   wherein the system further comprises:
           d) a calculation module configured to calculate a composite score for an additional treatment option, not comprised by the plurality of treatment options, based on (1) data indicative of attributes of the additional treatment option relative to the at least two criteria, and (2) at least a portion of the stored one of (i) the received indicator responses or (ii) the set of criteria weights; and   e) an output module configured to output an indicator of the composite score.   
               
 
         [0068]    27. The system of Clause 26, wherein the indicator of the composite score comprises an indication of potential preference for the additional treatment option over at least one other treatment option. 
         [0069]    28. The system of Clause 26, wherein the indicator of the composite score comprises an indication of potential preference for the additional treatment option over each of a plurality of treatment options. 
         [0070]    29. The system of Clause 26, wherein the indicator of the composite score comprises an indication that the composite score of the additional treatment option is better than the composite score of at least one other treatment option. 
         [0071]    30. The system of Clause 26, wherein the indicator of the composite score comprises an indication that the composite score of the additional treatment option is better than composite scores of each of a plurality of treatment options. 
         [0072]    31. The system of Clause 26, wherein the output module is configured to display the composite score. 
         [0073]    32. The system of Clause 26, wherein the calculation module is further configured to calculate a composite score for each of the plurality of treatment options based on (1) data indicative of attributes of the plurality of treatment options relative to the at least two criteria, and (2) at least a portion of one of (i) the received indicator responses or (ii) the set of criteria weights; and displaying the composite scores for the plurality of treatment options. 
         [0074]    33. The system of Clause 32, wherein the output module is configured to display the composite scores for the plurality of treatment options with the composite score for the additional treatment option. 
         [0075]    34. The system of Clause 32, wherein the calculation module is further configured to calculate the composite scores for the plurality of treatment options based on the stored one of (i) the received indicator responses or (ii) the set of criteria weights. 
         [0076]    35. A non-transitory machine-readable medium encoded with instructions executable by a processing system to perform a method for evaluating patient treatment options, comprising:
       a) retrieving data indicative of the performance of a plurality of treatment options relative to criteria descriptive of the treatment options;   b) displaying a set of criterion-exclusion queries and receiving one or more criterion-exclusion indicator responses to the set of criterion-inclusion queries;   c) displaying a set of relative-weighting queries regarding the relative importance of at least two criteria to the treatment goal, receiving one or more relative-weighting indicator responses to the set of relative-weighting queries, and modifying a set of criteria weights based on the relative-weighting indicator responses;   d) displaying a set of direct-weighting queries regarding the individual importance of at least one criterion to the treatment goal, receiving one or more direct-weighting indicator responses to the set of direct-weighting queries, and modifying the set of criteria weights based on the direct-weighting indicator responses;   e) displaying a set of analytic queries comparing the at least two criteria, receiving one or more analytic indicator responses to the set of analytic queries, and modifying the set of criteria weights based on the analytic indicator responses;   f) repeating at least one of steps b, c, d, or e; and   g) calculating, based on at least a portion of the data and the weights, and displaying a composite score for each treatment option except those indicated by the criterion-exclusion indicator responses.       
 
         [0084]    36. The machine-readable medium of clause 35, wherein the instructions further comprise code for alphanumerically displaying the data. 
         [0085]    37. The machine-readable medium of clause 35, wherein the instructions further comprise code for graphically displaying at least a portion of the data. 
         [0086]    38. The machine-readable medium of clause 35, wherein the instructions further comprise code for displaying a option-selection query and receiving a selection indicator response to the option-selection query. 
         [0087]    39. A computing machine comprising the machine-readable medium of clause 35. 
         [0088]    Additional features and advantages of the subject technology will be set forth in the description below, and in part will be apparent from the description, or may be learned by practice of the subject technology. The advantages of the subject technology will be realized and attained by the structure particularly pointed out in the written description and claims hereof as well as the appended drawings. 
         [0089]    It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory and are intended to provide further explanation of the subject technology as claimed. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0090]    The accompanying drawings, which are included to provide further understanding of the subject technology and are incorporated in and constitute a part of this specification, illustrate aspects of the subject technology and together with the description serve to explain the principles of the subject technology. 
           [0091]      FIG. 1A  is a diagram illustrating interaction between modules of a decision support framework, according to some embodiments. 
           [0092]      FIG. 1B  illustrates an exemplifying step-wise method for decision making according to some embodiments. 
           [0093]      FIG. 2  is a schematic diagram illustrating an integrated multi-criteria decision system, according to some embodiments. 
           [0094]      FIG. 3  is a simplified example of table generated by a balance sheet module, such as shown in  FIG. 2 , according to some embodiments. 
           [0095]      FIG. 4  is an example of an interactive decision dashboard, in accordance with various embodiments of the subject technology. 
           [0096]      FIG. 5  is an example of a user interface generated by a ranking module, such as shown in  FIG. 2 , in accordance with various embodiments of the subject technology. 
           [0097]      FIG. 6  is an example of a user interface generated by a direct weighing module, such as shown in  FIG. 2 , in accordance with various embodiments of the subject technology. 
           [0098]      FIG. 7  is a table of information related to several medications. 
           [0099]      FIG. 8  is a table summarizing characteristics of a study sample. 
           [0100]      FIGS. 9A-B  are a table of results of a quantitative dashboard evaluation. 
           [0101]      FIG. 10  is a diagram illustrating ratings shown in tables  9 A-B. 
           [0102]      FIG. 11  is a conceptual block diagram illustrating an example of a system, in accordance with various embodiments of the subject technology. 
           [0103]      FIG. 12  illustrates a simplified diagram of a system, in accordance with various embodiments of the subject technology. 
       
    
    
     DETAILED DESCRIPTION 
       [0104]    In the following detailed description, numerous specific details are set forth to provide a full understanding of the subject technology. It will be apparent, however, to one ordinarily skilled in the art that the subject technology may be practiced without some of these specific details. In other instances, well-known structures and techniques have not been shown in detail so as not to obscure the subject technology. 
         [0105]    A phrase such as “an aspect” does not imply that such aspect is essential to the subject technology or that such aspect applies to all configurations of the subject technology. A disclosure relating to an aspect may apply to all configurations, or one or more configurations. An aspect may provide one or more examples of the disclosure. A phrase such as “an aspect” may refer to one or more aspects and vice versa. A phrase such as “an embodiment” does not imply that such embodiment is essential to the subject technology or that such embodiment applies to all configurations of the subject technology. A disclosure relating to an embodiment may apply to all embodiments, or one or more embodiments. An embodiment may provide one or more examples of the disclosure. A phrase such “an embodiment” may refer to one or more embodiments and vice versa. A phrase such as “a configuration” does not imply that such configuration is essential to the subject technology or that such configuration applies to all configurations of the subject technology. A disclosure relating to a configuration may apply to all configurations, or one or more configurations. A configuration may provide one or more examples of the disclosure. A phrase such as “a configuration” may refer to one or more configurations and vice versa. 
         [0106]      FIG. 1A  is a diagram illustrating interaction between modules of a decision support framework  100 , according to some embodiments. As illustrated in  FIG. 1 , the framework can comprise a decision strategy module  102 , a balance sheet module  104 , a dashboard module  106 , an ordinal ranking module  108 , a direct weighting module  110 , and an APH module  112 . In some embodiments, the integrated multi-criteria decision support framework can use an explicit, step-wise method for decision making Although the method can be step-wise, the framework can permit selective, arbitrary movement among modules in some embodiment. For example, the framework can respond to received responses to move or return to a selected step (or module). 
         [0107]      FIG. 1B  illustrates an exemplifying step-wise approach  200 . A step  202  can include explicitly defining the goal, the alternatives, and/or the factors that will be used as criteria to evaluate how well the alternatives meet the goal. A step  204  can include gathering and summarizing information about how well the alternatives fulfill each decision criterion. A step  206  can include converting the information about the alternatives into formal ratings that compare the alternatives on each decision criterion and, if there is no single dominant alternative, determining the priorities of the decision criteria relative to the goal. In a step  208 , the alternative ratings and criteria priorities can be combined to create a measure of how well the alternatives can be expected to fulfill the goal. A step  210  can include a sensitivity analysis. Step  210  can include varying the parameters used for the initial analysis to explore the impact on the results of changes in the original judgments and assumptions. Step  212  can include either making a decision or continuing the decision making by gathering additional information and/or changing the structure of the original decision model. If the latter option is chosen, one or more of the steps are repeated until a final decision is made. Any combination of some or all of the foregoing steps is contemplated. 
         [0108]      FIG. 2  is a schematic diagram illustrating an integrated multi-criteria decision system  120 , according to some embodiments. The integrated multi-criteria decision system can include the decision strategy module  102 , the balance sheet module  104 , the decision dashboard module  106 , the ranking module  108 , the direct weighting module  110 , the APH module  112 , memory  114 , one or more processors  116 , and a display  118 . 
         [0109]    The decision strategy module  102  is optional and can be configured to help the decision makers define the decision goal, the alternatives to be considered, and/or the criteria that will be used to compare the alternatives relative to the goal. 
         [0110]    Once the decision parameters are defined (either through use of the decision strategy module or some other means), in the next step decision parameters can be summarized along with the information available. This can be accomplished in the balance sheet module  104 . The result can be a balance sheet table with one column for every decision criterion and one row for every alternative, as illustrated in  FIG. 3  for example. A database  122  can provide summaries of current data regarding outcomes expected for different alternatives categorized based on common decision criteria. In the context of evaluating medical treatment options, decision criteria can include, for example, effectiveness, risk of side effects, and cost. These links can be maintained throughout the entire framework. In some aspects the database can be an online database accessible via a network, such the Internet, a local area network (LAN), a wide area network (WAN), a metropolitan area network (MAN), or the like, or a combination thereof 
         [0111]    As illustrated in  FIG. 1A , after reviewing the balance sheet table, a decision maker can decide to make a decision, redefine the decision parameters, or continue to explore the decision by moving on to any other module in the multi-criteria decision system. The decision dashboard module  106  can present the decision-related information contained in the balance sheet table graphically, using the display module, and can allow the decision makers to interactively explore the data. After reviewing the dashboard, the decision makers can decide to make a decision, refine the decision parameters by adding or deleting alternatives and/or criteria, retrace previous steps, or continue to explore the decision by moving on to the next step in the framework, the ranking module (e.g., ordinal ranking module), or any other module in the framework. 
         [0112]    The ordinal ranking module  108  can engage the user in analyzing the decision by rank ordering the priorities of the criteria relative to the goal of the decision and the alternatives relative to the criteria. The latter step can be taken if the ranks of the alternatives relative to a criterion cannot be determined objectively. These ordinal rankings can then be combined to create a numeric score indicating how well the alternatives can be expected to meet the goal based on the input provided by the user. If desired, sensitivity analyses can be performed to determine the effects of changing the initial set of rankings At this point, the decision makers can decide to make a decision, refine the decision parameters by adding or deleting alternatives and/or criteria, retrace previous steps, or continue to explore the decision by moving on to the either the next step in the framework, direct weighting module, or any other module in the system. 
         [0113]    In the direct weighting module  110 , users can directly assess the priorities assigned to decision criteria and the evaluations of the alternatives relative to the criteria. Because the decision maker(s) can assign all weights used in the analysis, this step may involve judgments regarding both the criteria and the alternatives. Once the weights are determined they can be combined to generate the overall score indicating the alternatives&#39; priorities relative to the goal based on the input provided by the user. If desired, sensitivity analyses can then be performed to examine the effects of changing the initial set of weights. At this point, the decision makers can decide to make a decision, refine the decision parameters by adding or deleting alternatives and/or criteria, retrace previous steps, or continue to explore the decision by moving on to the AHP module. 
         [0114]    The AHP module  112  can engage the user in a full multi-criteria analysis of the decision using the AHP, a well-known and widely used multi-criteria method. The AHP can extend the sophistication of the analysis beyond simple direct weighting by: a) deriving weights through a series of pairwise comparisons among the elements being compared, b) providing information about the consistency of the pairwise judgments in the analysis, and c) providing a thorough theoretical background for the weighting and score-generating process. Once the weights are determined, they can be combined to generate the overall score indicating the alternatives&#39; priorities relative to the goal based on the input provided by the user. If desired, sensitivity analyses can then be performed. Further details of this process are provided below. At this point, the decision makers can decide to make a decision, retrace previous steps, or continue to explore the decision in some other way. 
         [0115]    One or more of the decision strategy module  102 , the balance sheet module  104 , the dashboard module  106 , the ordinal ranking module  108 , the direct weighting module  110 , the APH module  112 , or another module (not shown) can be configured to determine whether at least one response is inconsistent with another received response, such as a response received by another module. For example, the direct weighting module  110  can be configured to evaluate whether responses to directed weighting queries are inconsistent with responses received by the ordinal ranking module  108  to a set of ordinal ranking queries to determine whether the response are congruent. As another example, the APH module  112  can be configured to compare the responses receive by the ordinal ranking module  108 , the direct weighting module  110 , or both are congruent with each other and/or with responses to pairwise comparisons. In response to determining existence of an inconsistency among analyzed responses, the module(s) can perform at least one of: (a) displaying a notice regarding the inconsistency, (b) displaying a resolution query directed to resolution of the inconsistency, (c) identifying at least one objectively incorrect understanding of a user indicated by the inconsistency and displaying information directed to correction of the understanding, or (d) notifying a health care provider of the inconsistency. 
         [0116]    A notification of the inconsistency can be provided to a decision maker, person supporting the decision maker, or other interested individual. For example, the notification can be provided a patient, a family member of a patient, a physician, or other health care worker. The notification can prompt the notified individual to take remedial action. 
         [0117]    Upon detection of an incongruence, one or more queries can be presented such that responses to those quires resolves the incongruence. Inconsistency-resolution queries can be presented before, after, or together with a notification of the incongruence. For example, a individual, e.g., system user, can be notified that Response A conflicts with Response B and requested to revise one of the Response A and Response B. As another example, an individual can be presented with a query that has not been presented to the individual in the same session and that resolves a conflict between prior responses. 
         [0118]    In some embodiments, one or more of the decision strategy module  102 , the balance sheet module  104 , the dashboard module  106 , the ordinal ranking module  108 , the direct weighting module  110 , the APH module  112 , or another module (not shown) can be configured to store, in a non-transitory computer-readable medium, data indicative of at least one of (i) responses received by that module, other modules, or both, and (ii) a set of criteria weights determined based on the received responses. The data can be transmitted over a network to be stored in non-transitory computer-readable medium at a remote location. 
         [0119]    A calculation module can be configured to calculate a composite score for an additional alternative, e.g., treatment option, not presented to a user during a session when the responses were received, based on (1) data indicative of attributes of the additional alternative, and (2) at least a portion of the stored data. An output module can be configured to output an indicator of the composite score. The calculation module, the output module, or both can operate remotely, in time, space or both, from the decision strategy module  102 , the balance sheet module  104 , the dashboard module  106 , the ordinal ranking module  108 , the direct weighting module  110 , and/the APH module  112 . 
         [0120]    In some embodiments, the indicator of the composite score can be used to determine whether to present the decision maker with information regarding the additional alternative. In some embodiments, the indicator of the composite score can comprise an indication of a potential preference for the additional alternative (e.g., treatment option) over at least one other alternative (e.g., treatment option). In some embodiments, the indicator of the composite score can comprise an indication of potential preference for the additional alternative over all of the alternative that were presented or available to the decision maker during the session when the responses were received and stored. In some embodiments, the indicator of the composite score can comprise an indication that the composite score of the additional alternative is better than the composite score of at least one other alternative. In some embodiments, the indicator of the composite score can comprise an indication that the composite score of the additional alternative is better than composite scores of all of the alternative that were presented or available to the decision maker during the session when the responses were received and stored. In some embodiments, the output module can be configured to display the composite score. 
         [0121]    The calculation module can be configured in some embodiments to calculate a composite score for the alternatives presented or available to the user at the time responses were received based on (1) data indicative of attributes of the plurality of alternatives relative to the at least two criteria, and (2) at least a portion of one of (i) the received indicator responses or (ii) the set of criteria weights. The data indicative of the alternatives&#39; attributes can be the same what was used as the basis of the user&#39;s responses to the decision strategy module  102 , the balance sheet module  104 , the dashboard module  106 , the ordinal ranking module  108 , the direct weighting module  110 , and/the APH module  112 . In some embodiments, the data can be different that what was used at that time. For example, at the time of calculating composite scores after a session when responses were received, the merits of a particular alternative may have changed. For example, the cost of a particular alternative may increase or decrease over time. 
         [0122]    The integrated multi-criteria decision system can be implemented on a client device or a server. By way of illustration and not limitation, a client device can represent a computer, a mobile phone, a laptop computer, a thin client device, a personal digital assistant (PDA), a portable computing device, or a suitable device with a processor. In one example, a client device can be a Smartphone (e.g., iPhone, Android phone, Blackberry, etc.). In one example, a client device can be mobile. In another example, a client device can be stationary. According to one aspect of the disclosure, a client device can be a device having at least a processor and memory, where the total amount of memory of the client device could be less than the total amount of memory in a server. In one example, a client device does not have a hard disk. In one aspect, a client device has a display smaller than a display supported by a server. In one aspect, a client device can include one or more client devices. 
         [0123]    In some embodiments, a server can represent a computer, a laptop computer, a computing device, a virtual machine (e.g., VMware® Virtual Machine), a desktop session (e.g., Microsoft Terminal Server), a published application (e.g., Microsoft Terminal Server) or a suitable device with a processor. In some embodiments, a server can be stationary. In some embodiments, a server can be mobile. In certain configurations, a server can be any device that can represent a client device. In some embodiments, a server can include one or more servers. 
         [0124]      FIG. 3  is a simplified example of a table  300  generated by a balance sheet module  104 , such as shown in  FIG. 2 , according to some embodiments. The balance sheet table can be automatically generated by the balance sheet module. The balance sheet table includes a number of columns each representing a criteria (e.g., criteria A, B, C and D) defined by a user (e.g., a decision maker). Also defined by the user are a number of alternatives (e.g., alternatives 1, 2, and 3). The cells in the table can contain information that describes the performance of each alternative relative to a criterion. For example, the cell denoted Al can contain information about how well alternative 1 performs on Criterion A. 
         [0125]      FIG. 4  is an example of an interactive decision dashboard  400 , according to some embodiments. The decision dashboard module  106  can support decision making by presenting the information that is used in making the choice in a structured format (steps  202  and  204  of the multi-criteria decision making framework of  FIG. 1B ). Decision dashboards can differ from balance sheets in the way the information is presented. As illustrated in  FIG. 4 , the dashboard  400  can present information graphically using formats designed to enhance understanding of the differences that exist among the decision options. Interactive dashboards provide users with the ability to actively explore the information being presented by obtaining additional information about the alternatives and modifying the information displayed. Although  FIG. 4  illustrates an implementation of a dashboard  400  via a browser, the dashboard can be implemented in other ways in some embodiments. For example, the dashboard, and/or other aspects of the subject technology (e.g., of the framework  100  or system  120  for example) can be implemented using a dedicated application running on specific or general use hardware. In some embodiments, the subject technology can be implemented via a mobile device such as a phone or tablet computer, for example. 
         [0126]    In some embodiments, the dashboard  400  can illustrate differences between treatment options for treating a disease such as a pain related to osteoarthritis of the knee. Information about the relative abilities of the alternatives relative to each decision criterion can be shown in separate panels. In the example dashboard shown in  FIG. 4 , five panels  402 ,  404 ,  406 ,  408 ,  410  are shown that summarize the relative performance of the treatment alternatives with regard to each of the included drug (medication) information categories. In four of the panels  402 ,  404 ,  406 ,  408 , relative performances are shown graphically. As illustrated in  FIG. 4 , graphical representations can comprise bar graphs with a bar indicating how well a particular alternative performs relative to the criterion of a particular panel. Other graphical representations can be used in some embodiments. 
         [0127]    Buttons  412  for obtaining additional category-specific information can be included within some or all of the panels, as illustrated in  FIG. 4  for each of four panels  402 ,  404 ,  406 ,  408 , but not for the panel  410  that corresponds to the administration category. In response to inputs received in response to selection of a button  412 , the dashboard module  106  can display more information about the alternatives relative to the criterion of the panel corresponding to the selected button  412 . 
         [0128]    Buttons  414 , shown in  FIG. 4  at the bottom left of the display, can be used to prioritize the importance of each drug information category in making a treatment choice. A set of buttons  414  with each button representing a different priority can be provided for each criterion. As illustrated in  FIG. 4  for example, a selected priority level for a criterion can be displayed in a corresponding panel  402 ,  404 ,  406 ,  408 . 
         [0129]    Buttons  416 , shown in  FIG. 4  at the bottom right of the display, can be used to determine which alternatives (e.g., drugs in  FIG. 4 ) are included in the display. Some panels, such as panel  410 , can indicates text descriptions, for example regarding various administration options. Buttons  416  can be displayed as check boxes. In response to inputs received in response to selection of a button  416 , the dashboard module  106  can hide or display information about the corresponding alternative. One or more buttons  416  can be provided for each criterion. For example, one button  416  can toggle display of an alternative or separate buttons  416  can be provide to select display or omission of a criterion. 
         [0130]      FIG. 5  is an example of a user interface  500  generated by the ranking module  108 , such as shown in  FIG. 2 , according to some embodiments. The user interface can receive user inputs via a number of selection options  502 . For example, the queries can request that a user input via radio buttons the criterion that the user considers most important, second most important, etc. The ranking module  108  presents queries requesting users to rank order the criteria in terms of their importance in meeting the decision goal and the alternatives relative to their abilities to fulfill each of the decision criteria. These rank order judgments can then be converted into numeric scores  504  that, when combined, can create a measure of how well the alternatives can be expected to meet the goal based on the input provided by the user. Although the embodiment illustrated in  FIG. 6  indicates that the “first step in exploring your options is to rank order the difference among the treatment options based on how important they are to you in making your decision,” such a step is not the first in some embodiments that include it, and such a step can be omitted in some embodiments. 
         [0131]      FIG. 6  is an example of a user interface  600  generated by the direct weighting module  110 , such as shown in  FIG. 2 , according to some embodiments. The direct weighting module of  FIG. 2  can ask user(s) (e.g., decision maker(s)) to directly assess the priorities assigned to decision criteria and the evaluations of the alternatives relative to the criteria. Because the decision maker(s) can assign all weights used in the analysis, this step may involve rank order judgments regarding both the criteria and the alternatives, The user interface can show graphs representing an overall score  602 , a summary of option evaluations  604 , and sliders  606  to receive user inputs. The graphs  602 ,  604  summarize the results of the analysis. User input can be received via a series of sliders  606  used to adjust the weights. The sliders can adjust the weights of the major decision criteria and sub-criteria included in a decision making scenario. For example, in a disease treatment scenario, the user input can include, importance related to treatment, importance of minimizing risk of side effects, importance of out-of-pocket treatment and so on. The user input can also include inputs regarding effectiveness is controlling symptoms of the disease or risks of serious side effects. 
         [0132]      FIG. 7  shows a table  700  of information related to several drugs, such as generated by a balance sheet module  104  in some embodiments. The drugs shown in  FIG. 7  can correspond to the options shown in the decision dashboard of  FIG. 4 , in some embodiments. Table  700  can summarize the treatment-related information included in the dashboard of  FIG. 4 . To avoid respondent bias due to past treatment experiences or name recognition, the options on the dashboard can be identified using arbitrary letters rather than, for example, the actual drug names, where the decision making is related to selection of a drug for treating a disease. Note that the data indicate that two options, e.g., non-steroidal anti-inflammatory (NSAID) drugs plus misoprostol and non-steroidal anti-inflammatory drugs and proton pump inhibitors (PPIs), can be considered inferior choices because other treatment options are available that are better with respect to every medication characteristic being considered. [ 0040 ] A study was conducted to quantitatively evaluate a dashboard according to an embodiment.  FIG. 8  shows a table  800  summarizing characteristics of participants in the study. The majority of participants were white women with at least an Associate&#39;s degree and good to excellent literacy and numeracy skills. They were recruited in almost equal proportions from office and departmental staff, patient volunteers, and clinical trial website respondents. 
         [0133]      FIGS. 9A-B  is a table illustrating results of a quantitative dashboard evolution. The responses incorporated in  FIGS. 9A and 9B  show consistently positive answers for questions concerning mechanical and cognitive ease of use, decision aiding effectiveness, and effectiveness in reducing decisional conflict by providing needed information, clarifying values, and easing uncertainty. There seems to be no evidence of adverse emotional consequences. 
         [0134]      FIG. 10  is a diagram illustrating ratings shown in the tables of  FIGS. 9A-B , according to some embodiments. The diagram summarizes the ratings and evaluation results shown in  FIGS. 9A-B . The vertical axis indicates the average rating and the horizontal axis shows abbreviations representing categories presented in  FIGS. 9A and 9B . The abbreviations include: Mech=mechanical ease of use scale (4 items); Cog=cognitive ease of use scale (7 items); Emo=emotional ease of use scale (3 items); DAE=decision aiding effectiveness scale (7 items); DCSI=decisional conflict scale, informed sub-scale; DCSV=decisional conflict scale, values sub-scale; DCSU=decisional conflict scale, uncertainty sub-scale. 
         [0135]    Some embodiments can be implemented in a system including a server and a client device. When a client device and a server are remote with respect to each other, a client device may connect to a server over a network, for example, via a modem connection, a LAN connection including the Ethernet or a broadband WAN connection including DSL, Cable, T1, T3, Fiber Optics, Wi-Fi, or a mobile network connection including GSM, GPRS, 3G, WiMax or other network connection. A network can be a LAN network, a WAN network, a wireless network, the Internet, an intranet or other network. A network may include one or more routers for routing data between client devices and/or servers. A remote device (e.g., client device, server) on a network may be addressed by a corresponding network address, such as, but not limited to, an Internet protocol (IP) address, an Internet name, a Windows Internet name service (WINS) name, a domain name or other system name. These illustrate some examples as to how one device may be remote to another device. But the subject technology is not limited to these examples. 
         [0136]      FIG. 11  is a conceptual block diagram illustrating an example of a system, in accordance with various embodiments of the subject technology. A system  1101  may be, for example, a client device (e.g., client device  102 ) or a server (e.g., server  106 ). The system  1101  may include a processing system  1102 . The processing system  1102  is capable of communication with a receiver  1106  and a transmitter  1109  through a bus  1104  or other structures or devices. It should be understood that communication means other than busses can be utilized with the disclosed configurations. The processing system  1102  can generate audio, video, multimedia, and/or other types of data to be provided to the transmitter  1109  for communication. In addition, audio, video, multimedia, and/or other types of data can be received at the receiver  1106 , and processed by the processing system  1102 . 
         [0137]    The processing system  1102  may include a processor for executing instructions and may further include a machine-readable medium  1119 , such as a volatile or non-volatile memory, for storing data and/or instructions for software programs. The instructions, which may be stored in a machine-readable medium  1110  and/or  1119 , may be executed by the processing system  1102  to control and manage access to the various networks, as well as provide other communication and processing functions. The instructions may also include instructions executed by the processing system  1102  for various user interface devices, such as a display  1112  and a keypad  1114 . The processing system  1102  may include an input port  1122  and an output port  1124 . Each of the input port  1122  and the output port  1124  may include one or more ports. The input port  1122  and the output port  1124  may be the same port (e.g., a bi-directional port) or may be different ports. 
         [0138]    The processing system  1102  may be implemented using software, hardware, or a combination of both. By way of example, the processing system  1102  may be implemented with one or more processors. A processor may be a general-purpose microprocessor, a microcontroller, a Digital Signal Processor (DSP), an Application Specific Integrated Circuit (ASIC), a Field Programmable Gate Array (FPGA), a Programmable Logic Device (PLD), a controller, a state machine, gated logic, discrete hardware components, or any other suitable device that can perform calculations or other manipulations of information. 
         [0139]    A machine-readable medium can be one or more machine-readable media. Software shall be construed broadly to mean instructions, data, or any combination thereof, whether referred to as software, firmware, middleware, microcode, hardware description language, or otherwise. Instructions may include code (e.g., in source code format, binary code format, executable code format, or any other suitable format of code). 
         [0140]    Machine-readable media (e.g.,  1119 ) may include storage integrated into a processing system, such as might be the case with an ASIC. Machine-readable media (e.g.,  1110 ) may also include storage external to a processing system, such as a Random Access Memory (RAM), a flash memory, a Read Only Memory (ROM), a Programmable Read-Only Memory (PROM), an Erasable PROM (EPROM), registers, a hard disk, a removable disk, a CD-ROM, a DVD, or any other suitable storage device. Those skilled in the art will recognize how best to implement the described functionality for the processing system  1102 . According to one aspect of the disclosure, a machine-readable medium is a computer-readable medium encoded or stored with instructions and is a computing element, which defines structural and functional interrelationships between the instructions and the rest of the system, which permit the instructions&#39; functionality to be realized. In one aspect, a machine-readable medium is a non-transitory machine-readable medium, a machine-readable storage medium, or a non-transitory machine-readable storage medium. In one aspect, a computer-readable medium is a non-transitory computer-readable medium, a computer-readable storage medium, or a non-transitory computer-readable storage medium. Instructions may be executable, for example, by a client device or server or by a processing system of a client device or server. Instructions can be, for example, a computer program including code. 
         [0141]    An interface  1116  may be any type of interface and may reside between any of the components shown in  FIG. 11 . An interface  1116  may also be, for example, an interface to the outside world (e.g., an Internet network interface). A transceiver block  1107  may represent one or more transceivers, and each transceiver may include a receiver  1106  and a transmitter  1109 . A functionality implemented in a processing system  1102  may be implemented in a portion of a receiver  1106 , a portion of a transmitter  1109 , a portion of a machine-readable medium  1110 , a portion of a display  1112 , a portion of a keypad  1114 , or a portion of an interface  1116 , and vice versa. 
         [0142]      FIG. 12  illustrates a simplified diagram of a system  1200 , in accordance with various embodiments of the subject technology. The system  1200  may include one ore more remote client devices  1202  (e.g., client devices  1202   a,    1202   b,    1202   c,  and  1202   d ) in communication with a server computing device  1206  (server) via a network  1204 . In some embodiments, the server  1206  is configured to run applications that may be accessed and controlled at the client devices  1202 . For example, a user at a client device  1202  may use a web browser to access and control an application running on the server  1206  over the network  1204 . In some embodiments, the server  1206  is configured to allow remote sessions (e.g., remote desktop sessions) wherein users can access applications and files on the server  1206  by logging onto the server  1206  from a client device  1202 . Such a connection may be established using any of several well-known techniques such as the Remote Desktop Protocol (RDP) on a Windows-based server. 
         [0143]    By way of illustration and not limitation, in one aspect of the disclosure, stated from a perspective of a server side (treating a server as a local device and treating a client device as a remote device), a server application is executed (or runs) at a server  1206 . While a remote client device  1202  may receive and display a view of the server application on a display local to the remote client device  1202 , the remote client device  1202  does not execute (or run) the server application at the remote client device  1202 . Stated in another way from a perspective of the client side (treating a server as remote device and treating a client device as a local device), a remote application is executed (or runs) at a remote server  1206 . 
         [0144]    By way of illustration and not limitation, a client device  1202  can represent a computer, a mobile phone, a laptop computer, a thin client device, a personal digital assistant (PDA), a portable computing device, or a suitable device with a processor. In one example, a client device  1202  is a smartphone (e.g., iPhone, Android phone, Blackberry, etc.). In certain configurations, a client device  1202  can represent an audio player, a game console, a camera, a camcorder, an audio device, a video device, a multimedia device, or a device capable of supporting a connection to a remote server. In one example, a client device  1202  can be mobile. In another example, a client device  1202  can be stationary. According to one aspect of the disclosure, a client device  1202  may be a device having at least a processor and memory, where the total amount of memory of the client device  1202  could be less than the total amount of memory in a server  1206 . In one example, a client device  1202  does not have a hard disk. In one aspect, a client device  1202  has a display smaller than a display supported by a server  1206 . In one aspect, a client device may include one or more client devices. 
         [0145]    In some embodiments, a server  1206  may represent a computer, a laptop computer, a computing device, a virtual machine (e.g., VMware® Virtual Machine), a desktop session (e.g., Microsoft Terminal Server), a published application (e.g., Microsoft Terminal Server) or a suitable device with a processor. In some embodiments, a server  1206  can be stationary. In some embodiments, a server  1206  can be mobile. In certain configurations, a server  1206  may be any device that can represent a client device. In some embodiments, a server  1206  may include one or more servers. 
         [0146]    In one example, a first device is remote to a second device when the first device is not directly connected to the second device. In one example, a first remote device may be connected to a second device over a communication network such as a Local Area Network (LAN), a Wide Area Network (WAN), and/or other network. 
         [0147]    When a client device  1202  and a server  1206  are remote with respect to each other, a client device  1202  may connect to a server  1206  over a network  1204 , for example, via a modem connection, a LAN connection including the Ethernet or a broadband WAN connection including DSL, Cable, T1, T3, Fiber Optics, Wi-Fi, or a mobile network connection including GSM, GPRS, 3G, WiMax or other network connection. A network  1204  can be a LAN network, a WAN network, a wireless network, the Internet, an intranet or other network. A network  1204  may include one or more routers for routing data between client devices and/or servers. A remote device (e.g., client device, server) on a network may be addressed by a corresponding network address, such as, but not limited to, an Internet protocol (IP) address, an Internet name, a Windows Internet name service (WINS) name, a domain name or other system name. These illustrate some examples as to how one device may be remote to another device. But the subject technology is not limited to these examples. 
         [0148]    According to certain embodiments of the subject technology, the terms “server” and “remote server” are generally used synonymously in relation to a client device, and the word “remote” may indicate that a server is in communication with other device(s), for example, over a network connection(s). 
         [0149]    According to certain embodiments of the subject technology, the terms “client device” and “remote client device” are generally used synonymously in relation to a server, and the word “remote” may indicate that a client device is in communication with a server(s), for example, over a network connection(s). 
         [0150]    In some embodiments, a “client device” may be sometimes referred to as a client or vice versa. Similarly, a “server” may be sometimes referred to as a server device or vice versa. 
         [0151]    In some embodiments, the terms “local” and “remote” are relative terms, and a client device may be referred to as a local client device or a remote client device, depending on whether a client device is described from a client side or from a server side, respectively. Similarly, a server may be referred to as a local server or a remote server, depending on whether a server is described from a server side or from a client side, respectively. Furthermore, an application running on a server may be referred to as a local application, if described from a server side, and may be referred to as a remote application, if described from a client side. 
         [0152]    In some embodiments, devices placed on a client side (e.g., devices connected directly to a client device(s) or to one another using wires or wirelessly) may be referred to as local devices with respect to a client device and remote devices with respect to a server. Similarly, devices placed on a server side (e.g., devices connected directly to a server(s) or to one another using wires or wirelessly) may be referred to as local devices with respect to a server and remote devices with respect to a client device. 
         [0153]    As used herein, the word “module” refers to logic embodied in hardware or firmware, or to a collection of software instructions, possibly having entry and exit points, written in a programming language, such as, for example C++. A software module may be compiled and linked into an executable program, installed in a dynamic link library, or may be written in an interpretive language such as BASIC. It will be appreciated that software modules may be callable from other modules or from themselves, and/or may be invoked in response to detected events or interrupts. Software instructions may be embedded in firmware, such as an EPROM or EEPROM. It will be further appreciated that hardware modules may be comprised of connected logic units, such as gates and flip-flops, and/or may be comprised of programmable units, such as programmable gate arrays or processors. The modules described herein are preferably implemented as software modules, but may be represented in hardware or firmware. 
         [0154]    It is contemplated that the modules may be integrated into a fewer number of modules. One module may also be separated into multiple modules. The described modules may be implemented as hardware, software, firmware or any combination thereof. Additionally, the described modules may reside at different locations connected through a wired or wireless network, or the Internet. 
         [0155]    In general, it will be appreciated that the processors can include, by way of example, computers, program logic, or other substrate configurations representing data and instructions, which operate as described herein. In other embodiments, the processors can include controller circuitry, processor circuitry, processors, general purpose single-chip or multi-chip microprocessors, digital signal processors, embedded microprocessors, microcontrollers and the like. 
         [0156]    Furthermore, it will be appreciated that in one embodiment, the program logic may advantageously be implemented as one or more components. The components may advantageously be configured to execute on one or more processors. The components include, but are not limited to, software or hardware components, modules such as software modules, object-oriented software components, class components and task components, processes methods, functions, attributes, procedures, subroutines, segments of program code, drivers, firmware, microcode, circuitry, data, databases, data structures, tables, arrays, and variables. 
         [0157]    The foregoing description is provided to enable a person skilled in the art to practice the various configurations described herein. While the subject technology has been particularly described with reference to the various figures and configurations, it should be understood that these are for illustration purposes only and should not be taken as limiting the scope of the subject technology. 
         [0158]    There may be many other ways to implement the subject technology. Various functions and elements described herein may be partitioned differently from those shown without departing from the scope of the subject technology. Various modifications to these configurations will be readily apparent to those skilled in the art, and generic principles defined herein may be applied to other configurations. Thus, many changes and modifications may be made to the subject technology, by one having ordinary skill in the art, without departing from the scope of the subject technology. 
         [0159]    It is understood that the specific order or hierarchy of steps in the processes disclosed is an illustration of exemplary approaches. Based upon design preferences, it is understood that the specific order or hierarchy of steps in the processes may be rearranged. Some of the steps may be performed simultaneously. The accompanying method claims present elements of the various steps in a sample order, and are not meant to be limited to the specific order or hierarchy presented. 
         [0160]    Terms such as “top,” “bottom,” “front,” “rear” and the like as used in this disclosure should be understood as referring to an arbitrary frame of reference, rather than to the ordinary gravitational frame of reference. Thus, a top surface, a bottom surface, a front surface, and a rear surface may extend upwardly, downwardly, diagonally, or horizontally in a gravitational frame of reference. 
         [0161]    Furthermore, to the extent that the term “include,” “have,” or the like is used in the description or the claims, such term is intended to be inclusive in a manner similar to the term “comprise” as “comprise” is interpreted when employed as a transitional word in a claim. 
         [0162]    The word “exemplary” is used herein to mean “serving as an example, instance, or illustration.” Any embodiment described herein as “exemplary” is not necessarily to be construed as preferred or advantageous over other embodiments. 
         [0163]    A reference to an element in the singular is not intended to mean “one and only one” unless specifically stated, but rather “one or more.” Pronouns in the masculine (e.g., his) include the feminine and neuter gender (e.g., her and its) and vice versa. The term “some” refers to one or more. Underlined and/or italicized headings and subheadings are used for convenience only, do not limit the subject technology, and are not referred to in connection with the interpretation of the description of the subject technology. All structural and functional equivalents to the elements of the various configurations described throughout this disclosure that are known or later come to be known to those of ordinary skill in the art are expressly incorporated herein by reference and intended to be encompassed by the subject technology. Moreover, nothing disclosed herein is intended to be dedicated to the public regardless of whether such disclosure is explicitly recited in the above description. 
         [0164]    While certain aspects and embodiments of the invention have been described, these have been presented by way of example only, and are not intended to limit the scope of the invention. Indeed, the novel methods and systems described herein may be embodied in a variety of other forms without departing from the spirit thereof. The accompanying claims and their equivalents are intended to cover such forms or modifications as would fall within the scope and spirit of the invention.