Application evaluation of clinical practice guidelines for traditional Chinese medicine: a clinical analysis based on the analytic hierarchy process

Background

Clinical Practice Guidelines (CPGs) play an important role in clinical practice, and they require appropriate evaluation, especially in application. This study explores the application evaluation method of CPGs for Traditional Chinese Medicines (TCM). It uses the Analytic Hierarchy Process (AHP) and clinical cases to evaluate the consistency between CPGs of TCM and clinical practice.

Methods

To evaluate the consistency between CPGs of TCM and clinical cases, a 3-level AHP construction was built. Weightings were calculated by collecting questionnaires according to AHP theory. To test the evaluation system, a retrospective study was performed. The study evaluated the China Association of Chinese Medicine’s Guidelines for Diagnosis and Treatment of Common Internal Diseases in Chinese Medicine Diseases of Modern Medicine (CPGs of DTCID) (ZYYXH/T50–135-2008). A total of 150 cases were involved. The evaluation system was used to assess the consistency between CPGs of DTCID and clinical cases of angina pectoris.

Results

The results showed that the overall consistency between CPGs of DTCID and the 150 cases was 42.32 ± 6.94%, ranging from 35.21 to 63.37%. The overall consistency was not affected by age, gender, type of angina pectoris, condition of percutaneous coronary intervention (PCI), or angina classification as determined by the Canadian Cardiovascular Society. The consistencies of each index were as follows: Diagnosis of TCM, 100%; Diagnosis of Western medicine, 100%; Syndrome classification, 38.25 ± 4.40%; Syndrome key point, 34.17 ± 8.15%; TCM Decoction, 31.08 ± 23.64%; TCM particular treatment, 7.92 ± 19.13%; and Recuperation and prevention, 0. The most frequent syndromes were qi-deficiency, phlegm and blood stasis (n = 124) (82.7%). The overall consistency of qi-deficiency, turbid phlegm and blood stasis was lower than the overall consistency of the group without that syndrome. The difference was statistically significant (P < 0.05). 42 cases (28%) applied the TCM decoction recommended by CPGs of DTCID. Of these, Gualouxiebaibanxia decoction was applied in 34 cases. Wendan decoction, the most frequently used, was applied in 64 cases (42.7%).

Conclusion

This study indicates that the AHP system can perform quantitative evaluation of consistency between TCM CPG and clinical practice. It also found the factors affecting the application of TCM CPGs and might indicate the need for revisions of CPGs.

[Application of analytic hierarchy process in determining the weight coefficients of diagnostic index system for occupational chronic obstructive pulmonary disease]

Objective: To determine the weight coefficients of the diagnostic index system for occupational chronic obstructive pulmonary disease (COPD), and to provide a reference for the determination of diagnostic indices. Methods: The analytic hierarchy process was performed to establish the hierarchical structure of diagnostic indices for occupational COPD, construct a pairwise comparison judgment matrix, and conduct a consistency test on the judgment matrix, in order to determine the weight of each index. Results: The weight coefficients of six first-level indices and 27 second-level indices were determined based on the analytic hierarchy process.All these index weights satisfied the consistency test. Conclusion: The analytic hierarchy process uses expert experience knowledge to set up the index system, then judges the consistency of expert opinions through the consistency test, and effectively combines qualitative analysis with quantitative analysis, which may provide a scientific and feasible idea for establishing the diagnostic index system for COPD caused by occupational irritant chemicals.

Land suitability modeling for newly reclaimed area using GIS-based multi-criteria decision analysis

Selecting the appropriate land use is one of the most important steps toward achieving sustainable development. The main objective of this research is to develop a new method to overcome the contradiction occurring when using the conventional methods to evaluate land suitability for newly reclaimed areas. A spatial model was developed to assess land suitability for wheat in El-Minia Governorate, Egypt, using integration of modeling and geographic information systems-based multi-criteria decision analysis (GIS-MCDA). Land suitability for wheat was performed using two approaches, namely the proposed model (GIS-MCDA) and the parametric method (square root). According to the square root, 75.0% of the study area was classified as not suitable, while the proposed model revealed that 20.5% of the study area was classified as highly suitable and 61.5% as moderately suitable. In order to examine the validity of the proposed model, a comparison was made between the obtained results of both the proposed model and the square root method with the actual yield of the wheat. The correlation coefficient (r) between actual yield and the estimated yield of the square root method was 0.46, while the proposed model gives higher value (r = 0.95), which proves the validity of the proposed model in estimating land suitability for wheat cultivation. The findings of this research revealed that the integration of modeling and GIS-MCDA adopted by the proposed model provides an effective and flexible technique contributing to improve land suitability assessment for wheat in newly reclaimed areas to be more accurate and reliable.

Setting priorities in biodiversity conservation: An exercise with students, recent graduates, and environmental managers in Brazil

Facing a global biodiversity conservation crisis, urgent decisions are needed but prioritization is challenging. We analyzed how students, recent graduates of Biology, Law, and Engineering, and environmental managers in Brazil ranked ten conservation actions. Reduction in habitat loss and in overexploitation, and in situ protection were consensual top priorities. Freshmen students have similar priorities, which change as their courses advance. Biologists, engineers, and lawyers agree about only two priorities, but not in a consensual order. Biologists gave little importance to financial resources; managers much higher, and lower to action plans. Flagship species and ex situ protection were least priorities for all. Prioritization was influenced by educational level and experience and some priorities are counterintuitive. Our study reinforces the need to assess inter-groups differences, so conservationists could anticipate tendencies of single group decisions. Gaps in the conservation-oriented education of potential decision-makers must be filled, so their decisions could be more effective.

A framework for assessing local transmission risk of imported malaria cases

Background

A key issue in achieving and sustaining malaria elimination is the need to prevent local transmission arising from imported cases of malaria. The likelihood of this occurring depends on a range of local factors, and these can be used to allocate resources to contain transmission. Therefore, a risk assessment and management strategy is required to identify risk indexes for malaria transmission when imported cases occur. These risks also need to be quantified and combined to give a weighted risk index score. This can then be used to allocate the resources to each administrative region to prevent transmission according to the degree of risk.

Methods

A list of potential risk indexes were generated from a literature review, expert consultation and panel discussion. These were initially classified into 4 first-level indexes including infection source, transmitting conditions, population vulnerability and control capacity. Each of these was then expanded into more detailed second-level indexes. The Delphi method was then used to obtain expert opinion to review and revise these risk indexes over two consecutive rounds to quantify agreement among experts as to their level of importance. Risk indexes were included in the final Transmission Risk Framework if they achieved a weighted importance score ≥ 4. The Analytic Hierarchy Process was then used to calculate the weight allocated to each of the final risk indexes. This was then used to create an assessment framework that can be used to evaluate local transmission risk in different areas.

Results

Two rounds of Delphi consultation were conducted. Twenty-three experts were used at each round with 100% recovery rate of participant questionnaires. The coordination coefficients (W) for the two rounds of Delphi consultation were 0.341 and 0.423, respectively (P < 0.05). Three first-level indexes and 13 second-level indexes were identified. The Analytic Hierarchy Process was performed to calculate the weight of the indexes. For the first-level indexes, infection source, transmitting conditions, and control capacity, the index weight was 0.5396, 0.2970 and 0.1634 respectively. For the three top second-level indexes, number of imported malaria cases, Anopheles species, and awareness of timely medical visit of patient, the index weight was 0.3382, 0.2475, and 0.1509 respectively.

Conclusions

An indexed system of transmission risk assessment for imported malaria was established using the Delphi method and the Analytic Hierarchy Process. This was assessed to be an objective and practical tool for assessing transmission risk from imported cases of malaria into China.

Electronic supplementary material

The online version of this article (10.1186/s40249-019-0552-6) contains supplementary material, which is available to authorized users.

A Multicriteria Decision Framework for the Selection of Biomass Separation Equipment

For the first time, a two‐stage decision support framework for equipment selection, applied to biomass separation, is presented. In the first stage, the framework evaluates from a number of equipment based on the process requirements and outputs only those that offer a technically feasible separation. In the second stage, the analytic hierarchy process is applied for performing a multicriteria decision analysis to select amongst the feasible equipment based on separation performance and energy consumption criteria. This approach systematically considers the relative importance of those different alternatives and selection criteria by pairwise comparisons. The output of the framework is an overall ranking of equipment as well as a sensitivity analysis of the results for different weighting of the criteria. These results can be used to equip practitioners in the field of bioseparations with a tool for making more consistent and better‐informed equipment selection decisions.

Community-engaged development of a GIS-based healthfulness index to shape health equity solutions

Addressing health disparities requires both community engagement and an understanding of the social determinants of health. Although elements of the built environment can influence behavior change in public health interventions, such determinants have not been explicitly teased out via participatory mapping. An opportunity exists to integrate community voice in the development of such metrics. To fill this gap and inform the deployment of public health interventions in the Flint (USA) Center for Health Equity Solutions (FCHES), we created a means of assessing spatially-varying community needs and assets in a geographic information system (GIS), what we refer to as a healthfulness index. We engaged community and academic partners in their expert opinions on features of Flint's built environment that may promote or inhibit healthy behaviors via a multiple-criteria decision analysis framework. Experts selected from and ranked 29 variables in 6 categories (including amenities, environment, greenspace, housing, infrastructure, and social issues) using the analytic hierarchy process. The resulting matrices of expert opinions were aggregated and appended as weights for each variable's corresponding map layer. When combined through map algebra, composite scores yield spatially-varying healthfulness indices which signal any neighborhood's relative health promoting qualities (along a 0-100 scale). Results varied substantially across Flint, with the middle belt scoring highest and older neighborhoods in the northeast and north center of the city scoring lowest. Scores were aggregated to 38 Flint neighborhoods; for each of two project-specific indices, these ranged from lows of 38.7 (Hilborn Park) and 41.8 (Columbia Heights) to highs of 52.9 (College Cultural) and 58.0 (University Ave Corridor). We hypothesize that-even when controlling for individual-level factors-we will measure better and more sustained behavior change among participants living in neighborhoods with high healthfulness scores. Future work will examine this hypothesis and determine the importance of such indices in other similar communities.

GALDIT-SUSI a modified method to account for surface water bodies in the assessment of aquifer vulnerability to seawater intrusion

The salinization of coastal aquifers is one of the major environmental issue worldwide. Overexploitation is the most common reason of salinization, since it generates a piezometric inversion, which in turn leads to groundwater flow from the coast towards inland. This also occurs in water bodies connected to the sea like lagoons, rivers, torrents and wetlands. In this study, a modification of the GALDIT method including "SUperficial Seawater Intrusion (SUSI)" is proposed. Six new parameters were added to the classical ones. The analytical hierarchy process and the sensitivity analysis were performed for weights definition and validation of the proposed GALDIT-SUSI method. Two study areas, with different characteristics were chosen for the application of both methods: the coastal area of Epanomi (Greece) and the Po River lowland (Italy). The application of the standard GALDIT in both sites showed a poor discrimination of the vulnerability to seawater intrusion, confining it only in proximity to the coastline. Conversely, GALDIT-SUSI divided the two sites in five classes of vulnerability ranging from very low to very high, stressing the higher vulnerability of lagoons and wetland for Epanomi and lagoons and rivers for the Po River lowland. GALDIT-SUSI is easy to apply and versatile, since it can be adapted to the specific hydrogeological setting of the area of interest. Moreover, GALDIT-SUSI can be further improved to deal with other salinization mechanisms.

Correlation of the oxidative stress indices and Cd exposure using a mathematical model in the earthworm, Eisenia fetida

With the increase in heavy metal pollution, it is of great significance to evaluate the ecological security and early warning of cadmium (Cd) contaminated soil. In this paper, a mathematical model was established for the first time by combining the advantages of the factor analysis method and the analytic hierarchy process, and was used to screen and analyze the ecological indices of oxidative stress in earthworms under Cd exposure. The experiment lasted for 40 days, removing one earthworm every 10 days. The Cd²⁺ concentration gradient was set at 0, 1, 10, 20, 100, 200, 400 and 800 mg kg^-1. The ecological indices measured were total protein (TP), peroxidase (POD), superoxide dismutase (SOD), glutathione peroxidase (GPX), glutathione-S-transferase (GST), catalase (CAT), acetylcholinesterase (AChE) and malondialdehyde (MDA) levels. The results showed that when the earthworm was exposed to Cd²⁺ for 10 days and 30 days, in the head tissues, the key indices to focus on for monitoring were both POD. At 20 days and 40 days, the key indices were both TP. For the tail tissue tests, under Cd exposure for 10 days, the key indicator focused on for monitoring was MDA. After 20 days of exposure, the key monitoring indicator was AChE. At 30 days, it was CAT, and at 40 days, it was TP. This study provides a theoretical basis for the prompt, inexpensive, accurate and scientific early warning of metal contaminated soils and establishes a foundation for application of the screening model for other ecological indicators.

Coastal vulnerability to wave impacts using a multi-criteria index: Santa Catarina (Brazil)

The damage of coastal infrastructure due to wave action has stimulated the need for vulnerability assessments for integrated coastal management. Vulnerability is described as the ability of people living in an area to anticipate, cope with, resist and recover from the impact produced by a coastal hazard. This study aims to develop a multi-criteria index to assess coastal vulnerability to waves. Therefore, we analyze the Santa Catarina State (southern Brazil) coastline vulnerability to the incident wave climate. The applied coastal vulnerability index (CVI) was obtained by integrating the adaptive capacity index (ACI), composed of socioeconomic and locational variables, and the susceptibility index (SI), composed of physical variables. The resulting coastal dynamics from nearshore wave processes were analyzed through numerical models and integrated with other variables in a geographic information system (GIS). The relevance of the variables to the index was obtained by the analytic hierarchy process (AHP). The variables and indices were hierarchized into five vulnerability classes and represented in the administrative sectors defined by the local State Coastal Management Plan. Based on the AHP results, the physical variables were considered more relevant than the socioeconomic and locational variables. In general, the southern portion of the state presented higher susceptibility degrees, a lower income per capita and a lower number of second residences than the northern portion. At the same time, the northern portion presented higher percentages of developed areas, which are predominantly situated along susceptible and vulnerable segments. The numerical modeling of wave propagation has a large impact on the vulnerability as a function of the higher weights assigned to the related variables by experts and the high variability of the significant wave height along the state's coastline. Our results emphasize the importance of the inclusion of physical variables, such as waves, when defining coastal management measures in coastal zones.

Comprehensive evaluation and scenario simulation for the water resources carrying capacity in Xi'an city, China

The quantity and quality of water resources are of great importance in maintaining urban socio-economic development. Accordingly, substantial research has been conducted on the concept of the water resources carrying capacity (WRCC). In this study, analytic hierarchy process (AHP) and system dynamics (SD) models were combined to construct a multi-criteria evaluation system of the WRCC and a socio-economic/water resources SD model for Xi'an. The developmental trends of the society, economy, water supply/demand, and wastewater discharge were obtained from 2015 to 2020 using five scenarios designed for distinct purposes; these scenarios and trends were comprehensively evaluated using a combination of qualitative and quantitative analyses. The results indicated that the WRCC (0.32 in 2020) in Xi'an will shift from a normal to a poor state if the current social development pattern is maintained; therefore, we conclude that the socio-economic development of Xi'an is unsustainable. However, under a comprehensive scheme, the WRCC index (0.64 in 2020) will increase by 48% compared with the WRCC index under a business-as-usual scenario. Further, some practical suggestions, including the promotion of industrial reforms and the improvement of water-use efficiency and recycling policies, were provided for improving the regional WRCC.

Understanding the adoption and use of point-of-care tests in Dutch general practices using multi-criteria decision analysis

BACKGROUND

The increasing number of available point-of-care (POC) tests challenges clinicians regarding decisions on which tests to use, how to efficiently use them, and how to interpret the results. Although POC tests may offer benefits in terms of low turn-around-time, improved patient's satisfaction, and health outcomes, only few are actually used in clinical practice. Therefore, this study aims to identify which criteria are, in general, important in the decision to implement a POC test, and to determine their weight. Two POC tests available for use in Dutch general practices (i.e. the C-reactive protein (CRP) test and the glycated haemoglobin (HbA_1c) test) serve as case studies. The information obtained from this study can be used to guide POC test development and their introduction in clinical practice.

METHODS

Relevant criteria were identified based on a literature review and semi-structured interviews with twelve experts in the field. Subsequently, the criteria were clustered in four groups (i.e. user, organization, clinical value, and socio-political context) and the relative importance of each criterion was determined by calculating geometric means as implemented in the Analytic Hierarchy Process. Of these twelve experts, ten participated in a facilitated group session, in which their priorities regarding both POC tests (compared to central laboratory testing) were elicited.

RESULTS

Of 20 criteria in four clusters, the test's clinical utility, its technical performance, and risks (associated with the treatment decision based on the test result) were considered most important for using a POC test, with relative weights of 22.2, 12.6 and 8.5%, respectively. Overall, the experts preferred the POC CRP test over its laboratory equivalent, whereas they did not prefer the POC HbA_1c test. This difference was mainly explained by their strong preference for the POC CRP test with regard to the subcriterion 'clinical utility'.

CONCLUSIONS

The list of identified criteria, and the insights in their relative impact on successful implementation of POC tests, may facilitate implementation and use of existing POC tests in clinical practice. In addition, having experts score new POC tests on these criteria, provides developers with specific recommendations on how to increase the probability of successful implementation and use.

Quantified patient preferences for lifestyle intervention programs for diabetes prevention-a protocol for a systematic review

BACKGROUND

The 20-70% participation of diabetes patients in lifestyle interventions (LSI) worldwide seems to be rather sub-optimal, in spite of all intents of such interventions to delay further progress of the disease. Positive effects through LSI are expected in particular for patients who suffer less from diabetes-related limitations or other chronic diseases. Seeing that diabetes prevalence and with it mortality are increasing, LSI have become an inherent part of diabetes treatment standards. Various qualitative studies have been carried out to identify participation barriers for LSI. However, these have not resulted in more detailed knowledge about the relative importance of factors with an inhibiting impact on participation. Since it cannot be assumed that all of the influencing factors have equivalent values, it is necessary to investigate their individual importance with regard to a positive or negative decision about participating. There are no systematic reviews on patient preferences for LSI programs in diabetes prevention. As a result, the main objectives of this systematic review are to (i) identify existing patient preference elicitation studies related to LSI for diabetic patients, (ii) summarize the methods applied and findings, and (iii) appraise the reporting and methodological quality of such studies.

METHODS

We will perform systematic literature searches to identify suitable studies from 14 electronic databases. Retrieved study records will be included based on predefined eligibility criteria as defined in this protocol. We will run abstract and full-text screenings and then extract data from all selected studies by filling in a predefined data extraction spreadsheet. We will undertake a descriptive, narrative synthesis of findings to address the study objectives, since no pooling for quantified preferences is for methodological reasons implementable. We will pay special attention to aspects of methodological quality of preference elicitation by applying established evaluation criteria of the ISPOR and some own developed criteria for different elicitation techniques. All critical stages within the screening, data extraction, and synthesis processes will be conducted by two pairs of authors. This protocol adheres to PRISMA and PRISMA-P standards.

DISCUSSION

The proposed systematic review will provide an overview of the methods used and current practice in the elicitation and quantification of patients' preferences for diabetes prevention lifestyle interventions. Furthermore, the methodological quality of the identified studies will be appraised as well.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018086988.

Multi-criteria decision-making for sustainable metropolitan cities assessment

The recent development of metropolitan cities, especially in Europe, requires an effective integrated management of city services, infrastructure, and communication networks at a metropolitan level. A preliminary step towards a proper organizational and management strategy of the metropolitan city is the analysis, benchmarking and optimization of the metropolitan areas through a set of indicators coherent with the overall sustainability objective of the metropolitan city. This paper proposes the use of the Analytic Hierarchy Process multi-criteria decision making technique for application in the smart metropolitan city context, with the aim of analysing the sustainable development of energy, water and environmental systems, through a set of objective performance indicators. Specifically, the 35 indicators defined for the Sustainable Development of Energy, Water and Environment Systems Index framework are used. The application of the approach to the real case study of four metropolitan areas (Bari, Bitonto, Mola, and Molfetta) in the city of Bari (Italy) shows its usefulness for the local government in benchmarking metropolitan areas and providing decision indications on how to formulate the sustainable development strategy of the metropolitan city. Based on the Analytic Hierarchy Process characteristics, the results highlight that although one specific area (Mola in the considered case) is globally ranked at the first place, it is only ranked first with respect to some dimensions. Such a result has strong implications for the metropolitan city's manager who has the possibility to identify and implement targeted actions, which may be designed ad hoc to improve specific dimensions based on the current state of the city, thus maximizing the efficiency and effectiveness of the actions undertaken for the sustainable development of energy, water and environmental systems of the whole metropolitan city.

Screening indices for cadmium-contaminated soil using earthworm as bioindicator

Artificial soil simulation tests were conducted to study the response of oxidative stress in different parts of Eisenia fetida under cadmium Cd) stress. Factor analysis and analytic hierarchy process were used to establish a comprehensive mathematical model to screen key monitoring indices of the Cd-contaminated soil early warning system. This paper sets the short-term group and the long-term group. The former lasted 10 days, and the latter was 30 days. Gradient solution of 0, 50, 100, 125, 250, and 500 mg kg^-1 Cd²⁺ was used in each test group. The earthworm was cut into two parts from its clitellum to determine oxidative stress indices. Results showed that during the short-term stress, TP (total protein) in the head tissues of the earthworm was the key monitoring index for 3-4 and 8-9 days of Cd stress. In addition, the TP in tail tissues was the key index for 2, 4, 6, and 8-10 days of stress. On the first and second days, the key monitoring indices in the tail tissues were both the CAT (catalase), while in the head, they were CAT and TP, respectively. On the 5th, the 7th, and the 9th days, the focus should be on monitoring POD (peroxidase) in the tail tissues, while in the head tissues, they were POD, CAT, and TP, respectively. In the long-term test after 10 days of Cd stress, the key monitoring index in head tissues was GPX (glutathione peroxidase), and in the tail, it was TP. At 20-30 days, the key monitoring indices were TP in the head and MDA (malondialdehyde) in the tail.

Investigation of suitable land use potential for industrial sites: the case of Kemalpaşa

Kemalpaşa district (İzmir/Turkey), a significant area in terms of its natural and cultural characteristics alongside with its agricultural production, was selected as the specific site for the study at hand as its natural resources were endangered as a result of unplanned industrial settlement and development in the area. Therefore, the aim of the study was to ascertain the most suitable industrial sites for the area by taking natural factors into consideration, while excluding the economic ones. Within the scope of the study, a total of 13 criteria were set including wildlife development areas, protected areas, forest lands, olive groves, pastures, agricultural lands, water surfaces, streams, land capability areas, distance to residential areas, transportation (distance to roads), slopes, and erosion. Seventeen maps were created based on these 13 criteria and were used to select the suitable sites. The inquiries were conducted through the weighted linear combination technique and the analytic hierarchy process method utilizing the geographical information system software ArcGIS 10.2.1. The land use of Kemalpaşa is classified under five classes indicating different suitability values for industrial use and evaluating the land from "not suitable" (0) to "most suitable" (4). The results of the study revealed that 98.64% of Kemalpaşa district was "not suitable" (0) for industrial land use. The results further indicated that only 0.50% of the district was "suitable" (3) for industrial use, while 0.86% was found to be "most suitable" (4) to that end. Three alternative sites designated by the study and current industrial sites were evaluated based on protection criteria and planning proposals were suggested.

The Heidelberg VR Score: development and validation of a composite score for laparoscopic virtual reality training

INTRODUCTION

Virtual reality (VR-)trainers are well integrated in laparoscopic surgical training. However, objective feedback is often provided in the form of single parameters, e.g., time or number of movements, making comparisons and evaluation of trainees' overall performance difficult. Therefore, a new standard for reporting outcome data is highly needed. The aim of this study was to create a weighted, expert-based composite score, to offer simple and direct evaluation of laparoscopic performance on common VR-trainers.

MATERIALS AND METHODS

An integrated analytic hierarchy process-Delphi survey was conducted with 14 international experts to achieve a consensus on the importance of different skill categories and parameters in evaluation of laparoscopic performance. A scoring algorithm was established to allow comparability between tasks and VR-trainers. A weighted composite score was calculated for basic skills tasks and peg transfer on the LapMentor™ II and III and validated for both VR-trainers.

RESULTS

Five major skill categories (time, efficiency, safety, dexterity, and outcome) were identified and weighted in two Delphi rounds. Safety, with a weight of 67%, was determined the most important category, followed by efficiency with 17%. The LapMentor™-specific score was validated using 15 (14) novices and 9 experts; the score was able to differentiate between both groups for basic skills tasks and peg transfer (LapMentor™ II: Exp: 86.5 ± 12.7, Nov. 52.8 ± 18.3; p < 0.001; LapMentor™ III: Exp: 80.8 ± 7.1, Nov: 50.6 ± 16.9; p < 0.001).

CONCLUSION

An effective and simple performance measurement was established to propose a new standard in analyzing and reporting VR outcome data-the Heidelberg virtual reality (VR) score. The scoring algorithm and the consensus results on the importance of different skill aspects in laparoscopic surgery are universally applicable and can be transferred to any simulator or task. By incorporating specific expert baseline data for the respective task, comparability between tasks, studies, and simulators can be achieved.

Zoning for eco-geological environment before mining in Yushenfu mining area, northern Shaanxi, China

Zoning for the eco-geological environment (EGE) aims to protect and improve the regional ecological environment. It is the basis for evaluating the ecological characteristics of a mining area prior to mining activities and has the purpose of implementing water-preserved mining according to zoning type. In this study, four EGE types were proposed following field investigation in the Yushenfu mining area: oasis type with phreatic water and bottomland in desert (OTPWBD), oasis type with surface water and valley river (OTSWVR), loess gully type with surface runoff (LGTSR), and regional deep groundwater enrichment type (RDGET). Nine EGE evaluation indices were selected: rainfall, evaporation capacity, Luohe formation thickness, surface elevation, Sara Wusu aquifer water abundance, surface lithology, topography, slope, and normalized difference vegetation index (NDVI). Remote sensing technology and geographic information systems were first used to generate the evaluation index thematic maps. Then, the weight of each evaluation index was determined based on an analytic hierarchy process (AHP). Third, the index weight was used to form an improved weighted fuzzy C s clustering algorithm, and EGE zones were assigned using the MATLAB computing platform. For comparison, the AHP was also adopted for EGE zoning and a map of zoning differences was obtained. Finally, EGE field surveys of typical mines were carried out, which verified that EGE zoning using fuzzy clustering was accurate and reasonable.

Development and validation of an environmental fragility index (EFI) for the neotropical savannah biome

Augmented production and transport of fine sediments resulting from increased human activities are major threats to freshwater ecosystems, including reservoirs and their ecosystem services. To support large scale assessment of the likelihood of soil erosion and reservoir sedimentation, we developed and validated an environmental fragility index (EFI) for the Brazilian neotropical savannah. The EFI was derived from measured geoclimatic controls on sediment production (rainfall, variation of elevation and slope, geology) and anthropogenic pressures (natural cover, road density, distance from roads and urban centers) in 111 catchments upstream of four large hydroelectric reservoirs. We evaluated the effectiveness of the EFI by regressing it against a relative bed stability index (LRBS) that assesses the degree to which stream sites draining into the reservoirs are affected by excess fine sediments. We developed the EFI on 111 of these sites and validated our model on the remaining 37 independent sites. We also compared the effectiveness of the EFI in predicting LRBS with that of a multiple linear regression model (via best-subset procedure) using 7 independent variables. The EFI was significantly correlated with the LRBS, with regression R2 values of 0.32 and 0.40, respectively, in development and validation sites. Although the EFI and multiple regression explained similar amounts of variability (R2 = 0.32 vs 0.36), the EFI had a higher F-ratio (51.6 vs 8.5) and better AICc value (333 vs 338). Because the sites were randomly selected and well-distributed across geoclimatic controlling factors, we were able to calculate spatially-explicit EFI values for all hydrologic units within the study area (~38,500 km2). This model-based inference showed that over 65% of those units had high or extreme fragility. This methodology has great potential for application in the management, recovery, and preservation of hydroelectric reservoirs and streams in tropical river basins.

Innovative Distribution Priorities for the Medical Devices Industry in the Fourth Industrial Revolution

Purpose

This study aimed to set priorities for improving the medical device distribution structure and to suggest an innovative improvement plan for the distribution structure using the analytic hierarchy process (AHP) method, focusing on stakeholders in the medical device industry.

Methods

This study conducted a survey with 35 specialists using the AHP method, which is a multiple-criteria decisionmaking methodology, in order to set priorities for improvement plans to address the problems faced by the medical device distribution structure.

Results

The AHP analysis showed that supply stability was the most important factor, followed by greater transparency, efficiency, smart supply, and cost reduction.

Conclusions

It is necessary to establish a stable supply system and manage crises through supply stability, as well as to provide opportunities for fair trade through greater transparency. As steps towards those goals, we propose establishing a unique device identification system, an information disclosure system, online distribution, and a group purchasing organization system in Korea.

Post-surgery length of stay using multi-criteria decision-making tool

Purpose Length of stay (LOS) in hospital after surgery varies for each patient depending on surgeon's decision that considers criticality of the surgery, patient's conditions before and after surgery, expected time to recovery and experience of the surgeon involved. Decision on patients' LOS at hospital post-surgery affects overall healthcare performance as it affects both cost and quality of care. The purpose of this paper is to develop a model for deriving the most appropriate LOS after surgical interventions. Design/methodology/approach The study adopts an action research involving multiple stakeholders (surgeon, patients/patients' relatives, hospital management and other medics). First, a conceptual model is developed using literature and experts' opinion. Second, the model is applied in three surgical interventions in a public hospital in Malta to demonstrate the effectiveness of the model. Third, the policy alternatives developed are compared to a selection of current international standards for each surgical intervention. The proposed model analyses three LOS threshold policies for three procedures using efficiency and responsiveness criteria. The entire analysis is carried out using 325 randomly selected patient files along with structured interactions with more than 50 stakeholders (surgeon, patients/patients' relatives, hospital management and other medics). A multiple criteria decision-making method is deployed for model building and data analysis. The method involves combining the analytic hierarchy process (AHP) for verbal subjective judgements on prioritizing the four predictors of surgical LOS-medical, financial, social and risk, with pairwise comparisons of the sub-criteria under each criterion in line with the concerned interventions-the objective data of which are obtained from the patients' files. Findings The proposed model was successfully applied to decide on the best policy alternative for LOS for the three interventions. The best policy alternatives compared well to current international benchmarks. Research limitations/implications The proposed method needs to be tested for other interventions across various healthcare settings. Practical implications Multi-criteria decision-making tools enable resource optimization and overall improvement of patient care through the application of a scientific management technique that involves all relevant stakeholders while utilizing both subjective judgements as well as objective data. Originality/value Traditionally, the duration of post-surgery LOS is mainly based on the surgeons' clinical but also arbitrary decisions, with, as a result, having insufficiently explicable variations in LOS amongst peers for similar interventions. According to the authors' knowledge, this is the first attempt to derive post-surgery LOS using the AHP, a multiple criteria decision-making method.

How to weight patient-relevant treatment goals for assessing treatment benefit in psoriasis: preference elicitation methods vs. rating scales

In psoriasis, several patient-relevant treatment goals must be met to be able to consider a treatment beneficial. To assess treatment benefit, the validated questionnaire Patient Benefit Index (PBI) can be used. Its global score summarizes the degree of patient-relevant treatment goals achieved after treatment, weighted by their individual importance on rating scales. These treatment goals have empirically been assigned to five dimensions. While the weighting procedure of the PBI provides information about the importance patients attach to treatment goals on a rating scale from 0 to 4, methods of preference elicitation provide information on how patients would trade off certain treatment goals against each other. However, since the treatment goals defined in the PBI often overlap conceptually, the dimensions of the PBI might be more suitable for exploration in preference elicitation methods. We used an analytic hierarchy process (AHP) and a discrete choice experiment (DCE) to generate preference-based importance weights for the PBI dimensions, and compared these weights to those derived from the rating scales. We were further interested in the effect of importance weights on the calculation of the PBI score. A total of 120 patients with psoriasis completed a questionnaire at baseline, including AHP, DCE and the rating scales, and at follow-up, regarding the attainment of treatment goals, to calculate the PBI score. In contrast to the results derived from the average rating scores, use of AHP and DCE resulted in both similar importance weights and rankings of dimensions. Presumably, patients rated treatment goals differently than the respective dimension they belong to. However, the differently calculated importance weights led to similar values of the PBI score. Our findings nevertheless provide clear evidence that, regardless of the method used, the importance of treatment goals differs between psoriasis patients, and this should be reflected in treatment decisions.

Assessment of groundwater vulnerability by applying the modified DRASTIC model in Beihai City, China

This study assesses vulnerability of groundwater to pollution in Beihai City, China, as a support of groundwater resource protection. The assessment result not only objectively reflects potential possibility of groundwater to contamination but also provides scientific basis for the planning and utilization of groundwater resources. This study optimizes the parameters consisting of natural factors and human factors upon the DRASTIC model and modifies the ratings of these parameters, based on the local environmental conditions for the study area. And a weight of each parameter is assigned by the analytic hierarchy process (AHP) to reduce the subjectivity of humans to vulnerability assessment. The resulting scientific ratings and weights of modified DRASTIC model (AHP-DRASTLE model) contribute to obtain the more realistic assessment of vulnerability of groundwater to contaminant. The comparison analysis validates the accuracy and rationality of the AHP-DRASTLE model and shows it suits the particularity of the study area. The new assessment method (AHP-DRASTLE model) can provide a guide for other scholars to assess the vulnerability of groundwater to contamination. The final vulnerability map for the AHP-DRASTLE model shows four classes: highest (2%), high (29%), low (55%), and lowest (14%). The vulnerability map serves as a guide for decision makers on groundwater resource protection and land use planning at the regional scale and that it is adapted to a specific area.

Site suitability evaluation of an old operating landfill using AHP and GIS techniques and integrated hydrogeological and geophysical surveys

Because of the outdated methods of common landfill selection, it is imperative to reevaluate the usage suitability. To assess the suitability of the existing waste landfill in Zanjan, Iran, we have used a combination of the analytical hierarchy process (AHP) and GIS techniques, along with fieldwork surveys. Four major criteria and 12 subcriteria were considered, and the AHP was applied to assign the relative importance weights of criteria and subcriteria to each other. Finally, a landfill suitability map was generated and ranked based on the final suitability scores. The results show that the unsuitable areas are around Zanjan, in the middle parts of the plain. By contrast, the most suitable areas are uncultivated areas, located mostly in the west, north, and south. The results also indicate that the present landfill is a highly suitable site. After desk studies, geoelectrical surveys and infiltration measurements were conducted to make the final decision. Double-ring permeability tests confirm the landfill is an acceptable site. The electrical sounding shows that the leachate plume has a width of about ~ 450 m, spreads to a depth of about ~ 55 m, and migrates towards the northeast. Considering the groundwater depth, dry climate, and a low infiltration rate of the landfill soils, it can be concluded that leachate plumes will not contaminate groundwater within this decade. The proposed method can be implemented to reevaluate the suitability of any old operating reservoir such as oil reservoirs, petrol filling stations, heavy industrial tanks, and landfills, containing liquid hazardous materials.

Optimal siting of solid waste-to-value-added facilities through a GIS-based assessment

Siting a solid waste conversion facility requires an assessment of solid waste availability as well as ensuring compliance with environmental, social, and economic factors. The main idea behind this study was to develop a methodology to locate suitable locations for waste conversion facilities considering waste availability as well as environmental and social constraints. A geographic information system (GIS) spatial analysis was used to identify the most suitable areas and to screen out unsuitable lands. The analytic hierarchy process (AHP) was used for a multi-criteria evaluation of relative preferences of different environmental and social factors. A case study was conducted for Alberta, a western province in Canada, by performing a province-wide waste availability assessment. The total available waste considered in this study was 4,077,514tonnes/year for 19 census divisions collected from 79 landfills. Finally, a location-allocation analysis was performed to determine suitable locations for 10 waste conversion facilities across the province.

Multi-criteria evaluation of hydro-geological and anthropogenic parameters for the groundwater vulnerability assessment

Groundwater contamination assessment is a challenging task due to inherent complex dynamisms associated with the groundwater. DRASTIC is a very widely used rapid regional tool for the assessment of vulnerability of groundwater to contamination. DRASTIC has many lacunas in the form of subjectivities associated with weights and ratings of its hydro-geological parameters, and, therefore, the accuracy of the DRASTIC-based vulnerability map is questioned. The present study demonstrates the optimisation of the DRASTIC parameters along with a scientific consideration to the anthropogenic factors causing groundwater contamination. The resulting scientific consistent weights and ratings to DRASTIC parameters assist in the development of a very precise groundwater vulnerability map highlighting different zones of different gravity of contamination. One of the most important aspects of this study is that we have considered the impact of vadose zone in a very comprehensive manner by considering every sub-surface layer from the earth surface to the occurrence of groundwater. The study area for our experiment is Fatehgarh Sahib district of Punjab which is facing several groundwater issues.

Evaluation of infectious diseases and clinical microbiology specialists' preferences for hand hygiene: analysis using the multi-attribute utility theory and the analytic hierarchy process methods

BACKGROUND

Hand hygiene is one of the most effective attempts to control nosocomial infections, and it is an important measure to avoid the transmission of pathogens. However, the compliance of healthcare workers (HCWs) with hand washing is still poor worldwide. Herein, we aimed to determine the best hand hygiene preference of the infectious diseases and clinical microbiology (IDCM) specialists to prevent transmission of microorganisms from one patient to another.

METHODS

Expert opinions regarding the criteria that influence the best hand hygiene preference were collected through a questionnaire via face-to-face interviews. Afterwards, these opinions were examined with two widely used multi-criteria decision analysis (MCDA) methods, the Multi-Attribute Utility Theory (MAUT) and the Analytic Hierarchy Process (AHP).

RESULTS

A total of 15 IDCM specialist opinions were collected from diverse private and public hospitals located in İzmir, Turkey. The mean age of the participants was 49.73 ± 8.46, and the mean experience year of the participants in their fields was 17.67 ± 11.98. The findings that we obtained through two distinct decision making methods, the MAUT and the AHP, suggest that alcohol-based antiseptic solution (ABAS) has the highest utility (0.86) and priority (0.69) among the experts' choices.

CONCLUSION

In conclusion, the MAUT and the AHP, decision models developed here indicate that rubbing the hands with ABAS is the most favorable choice for IDCM specialists to prevent nosocomial infection.

An AHP-based evaluation method for teacher training workshop on information and communication technology

The emergence of information and communication technology (ICT) has created opportunities for enhancing the learning process at different educational levels. However, its potential benefits can only be fully realized if teachers are properly trained to utilize such tools. The rapid evolution of ICT also necessitates rigorous assessment of training programs by participants. Thus, this study proposes an evaluation framework based on the Analytic Hierarchy Process (AHP) to systematically evaluate such workshops designed for teachers. The evaluation model is decomposed hierarchically into four main criteria namely: (1) workshop design, (2) quality of content of the workshop, (3) quality of delivery of the content of the workshop, and the (4) relevance of the workshop. These criteria are further disaggregated into 24 sub-indicators to measure the effectiveness of the workshop as perceived by the participants based on their own expectations. This framework is applied to a case study of ICT workshops done in the Philippines. In this case, relevance of the workshop is found to be the most important main criterion identified by the participants, particularly on the new ICT knowledge that promotes teachers' professional growth and development. The workshop evaluation index (WEI) is also proposed as a metric to support decision-making by providing a mechanism for benchmarking performance, tracking improvement over time, and developing strategies for the design and improvement of training programs or workshops on ICT for teachers.

Evolvement rules of basin flood risk under low-carbon mode. Part II: risk assessment of flood disaster under different land use patterns in the Haihe basin

Land use pattern contains a large amount of information about the flood hazard-formative environments, which is the most sensitive factor in hazard-formative environments. In this paper, based on the land use pattern in 2008 (the base year) and in 2020 (the planning year), the comparative analysis of flood disaster risk changes in Haihe basin were studied by the spatial analysis function of ARCGIS and the analytic hierarchy process (AHP). The results showed the flood disaster risk in Haihe basin had an obvious zonality in the space, among which low risk was located in the northwest regions, and high risk was located in the southeast regions. Flood disaster risk in planning year was lower than in the base year. The risk value of 2020 in the mountain decreases from 0.445 to 0.430, while the risk value of the plain increases from 0.562 to 0.564. For the plain, high-risk area in 2020 is increased by 13.2%, which is the biggest change in risk grades. For the mountain, low-risk area and low risk area in 2020 are increased, and the low-risk area is the biggest increase, up to 37.7%. Meanwhile, high-risk area, high risk area, and medium risk area all tend to decrease, and the high-risk area is the biggest decrease, up to 32.6%. Overall, land use planning pattern under low-carbon mode is conducive to the Haihe basin flood control. The research can provide scientific foundations for basin land use planning and flood disaster risk management.

[Evaluation of upper limb load intensity based on biomechanical methods]

Objective: To establish a model for evaluating the upper limb load intensity of workers based on biomechanical methods, and to verify its effectiveness. Methods: 15 male volunteers participated in lifting test of 3 kinds of external force load in March 2015. Volunteers' operating postures, forces, and subjective load intensities were collected. The biomechanical models of lifting operation were established with the input of operating postures and forces, and to output joint torque of shoulder, elbow and wrist. The simulation results were normalized by the maximum torque of each joint, and the relative joint torque was obtained. Then the upper limb load intensity evaluation model, which related with relative joint torque of shoulder, elbow and wrist, was established based on analytic hierarchy process. In order to validate the validity of the model, the assessment results of the model and the subjective load intensities of the volunteers were contrasted. Results: The weight of shoulder joint (0.56) was larger than the weights of elbow and wrist (0.27 and 0.17) in the influence factors of the upper limb load. Pearson correlation analysis showed that the upper limb load intensities of the model were significantly correlated with the subjective load intensities of volunteers (r=0.863, P<0.05) . There was no significant difference between the two groups (t=0.105, P>0.05) . Conclusion: The evaluation model of the upper limb load intensity based on biomechanical methods could be used for predicting and evaluating the upper limb load intensities of workers.

Emission inventory and provincial distribution of short-chain chlorinated paraffins in China

Chlorinated paraffins (CPs) are used as flame retardants, plasticizers, and metalworking fluids, which have varying contents of toxic short-chain chlorinated paraffins (SCCPs). Based on the study of several relevant production and consumption sectors, this paper classifies the consumption of CPs among sectors and provides an emission inventory and the provincial emission distribution of SCCPs in China in 2010-2014 based on the consumption patterns and emission factors of each sector. The total emissions of SCCPs in China in 2014 were 3083.88tons, with emissions to the atmosphere and water accounting for 894.81tons and 2189.07tons, respectively. The largest emission source was from metalworking fluids, with total emissions of 2459.12tons, of which 756.65tons went to the atmosphere and 1702.47tons to water. Our results show that SCCP emissions were mainly concentrated in the eastern, more developed regions and that Jiangsu Province was the biggest producer in China, with total emissions of 1853.06tons, of which 562.61tons were to the atmosphere and 1290.46tons to water.

A multi-criteria approach to identify favorable areas for goat production systems in Veracruz, México

This research identifies favorable areas for goat production systems in the state of Veracruz, Mexico. Through the use of the analytic hierarchy process, layers of biophysical and soil information were combined to generate a model of favorability. Model validation was performed by calculating the area under the curve, the true skill statistic, and a qualitative comparison with census records. The results showed the existence of regions with high (4494.3 km²) and moderate (2985.8 km²) favorability, and these areas correspond to 6.25 and 4.15%, respectively, of the state territory and are located in the regions of Sierra de Huayacocotla, Perote, and Orizaba. These regions are characterized as mountainous and having predominantly temperate-wet or cold climates, and having montane mesophilic forests, containing pine, fir, and desert scrub. The reliability of the distribution model was supported by the area under the curve value (0.96), the true skill statistic (0.86), and consistency with census records.

A cloud model-based approach for water quality assessment

Water quality assessment entails essentially a multi-criteria decision-making process accounting for qualitative and quantitative uncertainties and their transformation. Considering uncertainties of randomness and fuzziness in water quality evaluation, a cloud model-based assessment approach is proposed. The cognitive cloud model, derived from information science, can realize the transformation between qualitative concept and quantitative data, based on probability and statistics and fuzzy set theory. When applying the cloud model to practical assessment, three technical issues are considered before the development of a complete cloud model-based approach: (1) bilateral boundary formula with nonlinear boundary regression for parameter estimation, (2) hybrid entropy-analytic hierarchy process technique for calculation of weights, and (3) mean of repeated simulations for determining the degree of final certainty. The cloud model-based approach is tested by evaluating the eutrophication status of 12 typical lakes and reservoirs in China and comparing with other four methods, which are Scoring Index method, Variable Fuzzy Sets method, Hybrid Fuzzy and Optimal model, and Neural Networks method. The proposed approach yields information concerning membership for each water quality status which leads to the final status. The approach is found to be representative of other alternative methods and accurate.

Integrating expert knowledge in a GIS to optimize siting decisions for small-scale healthy food retail interventions

BACKGROUND

The availability of healthy foods in a neighborhood remains a key determinant of diet and diet-related disease in disadvantaged communities. Innovative solutions to the 'food desert' problem include the deployment of mobile markets and healthy corner store initiatives. Such initiatives, however, do not always capitalize on the principles guiding retail development and the possibilities of GIS-based data. Simultaneously, community partners are not always engaged effectively in the planning for such interventions, which limits acceptability and suitability of such work.

METHODS

This paper highlights the results of a participatory mapping exercise to optimize the siting of a planned healthy food retail intervention in Flint, Michigan. Potential sites are chosen by engaging experts in a three-stage mapping process that includes the analytic hierarchy process and point allocation of five key variables (including food access, socioeconomic distress, population density, access to transit, and proximity to neighborhood centers), as well as direct mapping of suitable sites.

RESULTS

Results suggest a discrete set of areas-primarily in the northwestern quadrant of the city-where small-scale healthy food retail interventions might be most strategically located. Areas with the most consistent overlap between directly mapped sites and very high levels of suitability align well with neighborhoods which are distant from existing grocery stores.

CONCLUSIONS

As a community-based strategy, this increases the opportunity for effectively improving neighborhood access to healthy foods by optimizing the potential sites for healthy food interventions. Community partners have already been active in using these results in project planning for just such an intervention.

Site selection for installing plasma incinerator reactor using the GIS in Rudsar county, Iran

Nowadays, the urban waste disposal and the proper location for doing so is considered as one of the most important urban service issues, which has the potential of causing environmental hazards for the citizens, if not done properly. One of the newest methods of waste burial is using plasma incinerator reactors. Using the advanced technology of plasma reactors in waste disposal has been the subject of study for a considerable number of researchers in the last few years. Moreover, insignificant emissions of environmental pollutants and high efficiency in these reactors have led to a high incentive for using them in the area of urban services. Therefore, finding the proper location for the plasma incinerator reactor in order to minimize environmental hazards is considered as a very important issue. In the present study, different parts of this reactor and its working procedure are presented at first. Then, quantitative and qualitative criteria effective on locating plasma incinerator reactor are presented, and these criteria are given proper weights using analytic hierarchy process (AHP) multi-criteria decision making method. Next, the data were collected for the studying area, and then, weighting, analysis, and presentation of geospatial data were performed using the geographic information system (GIS). Finally, the output map for installing location of the plasma incinerator reactor was developed in three classes of good, average, and bad.

Information preferences for the evaluation of coastal development impacts on ecosystem services: A multi-criteria assessment in the Australian context

Ecosystem based management requires the integration of various types of assessment indicators. Understanding stakeholders' information preferences is important, in selecting those indicators that best support management and policy. Both the preferences of decision-makers and the general public may matter, in democratic participatory management institutions. This paper presents a multi-criteria analysis aimed at quantifying the relative importance to these groups of economic, ecological and socio-economic indicators usually considered when managing ecosystem services in a coastal development context. The Analytic Hierarchy Process (AHP) is applied within two nationwide surveys in Australia, and preferences of both the general public and decision-makers for these indicators are elicited and compared. Results show that, on average across both groups, the priority in assessing a generic coastal development project is for the ecological assessment of its impacts on marine biodiversity. Ecological assessment indicators are globally preferred to both economic and socio-economic indicators regardless of the nature of the impacts studied. These results are observed for a significantly larger proportion of decision-maker than general public respondents, questioning the extent to which the general public's preferences are well reflected in decision-making processes.

Analytic hierarchy process as module for productivity evaluation and decision-making of the operation theater

The analytic hierarchy process (AHP) is a theory of measurement through pairwise comparisons and relies on the judgments of experts to derive priority scales, these scales that measure intangibles in relative terms. The aim of the article was to develop a model for productivity measurement of the operation theater (OT), which could be applied as a model for quality improvement and decision-making. AHP is used in this article to evolve such a model. The steps consist of identifying the critical success factors for measuring the productivity of OT, identifying subfactors that inflauence the critical factors, comparing the pairwise, deriving their relative importance and ratings, and calculating the cumulative effect according to the attributes in OT. The cumulative productivitycan be calculated by the end and can be compared Ideal productivity to measure the productive of OT in percentage fraction. Hence, the productivity could be calculated. Hence, AHP is a very useful model to measure the productivity in OT.

Fuzzy Analytic Hierarchy Process-based Chinese Resident Best Fitness Behavior Method Research

With explosive development in Chinese economy and science and technology, people's pursuit of health becomes more and more intense, therefore Chinese resident sports fitness activities have been rapidly developed. However, different fitness events popularity degrees and effects on body energy consumption are different, so bases on this, the paper researches on fitness behaviors and gets Chinese residents sports fitness behaviors exercise guide, which provides guidance for propelling to national fitness plan's implementation and improving Chinese resident fitness scientization. The paper starts from the perspective of energy consumption, it mainly adopts experience method, determines Chinese resident favorite sports fitness event energy consumption through observing all kinds of fitness behaviors energy consumption, and applies fuzzy analytic hierarchy process to make evaluation on bicycle riding, shadowboxing practicing, swimming, rope skipping, jogging, running, aerobics these seven fitness events. By calculating fuzzy rate model's membership and comparing their sizes, it gets fitness behaviors that are more helpful for resident health, more effective and popular. Finally, it gets conclusions that swimming is a best exercise mode and its membership is the highest. Besides, the memberships of running, rope skipping and shadowboxing practicing are also relative higher. It should go in for bodybuilding by synthesizing above several kinds of fitness events according to different physical conditions; different living conditions so that can better achieve the purpose of fitness exercises.

Quality evaluation of yellow peach chips prepared by explosion puffing drying

Nineteen evaluation indicators in 15 yellow peach chips prepared by explosion puffing drying were analyzed, including color, rehydration ratio, texture, and so on. The analysis methods of principle component analysis (PCA), analytic hierarchy process (AHP), K-means cluster (KC) and Discriminate analysis (DA) were used to analyze the comprehensive quality of the yellow peach chips. The dispersed coefficient of variation of the 19 evaluation indicators varied from 3.58 to 852.89 %, suggesting significant differences among yellow peach cultivars. The characteristic evaluation indicators, namely, reducing sugar content, out-put ratio, water content, a value and L value were analyzed by PCA, and their weights 0.0429, 0.1140, 0.4816, 1.1807 and 0.1807 were obtained by AHP. The levels in 15 cultivars effectively were classified by discrimination functions which obtained by KC and DA. The results suggested that three levels of comprehensive quality for yellow peach chips were divided, and the highest synthesis scores was observed in "senggelin" (11.1037), while the lowest synthesis value was found in "goldbaby" (-3.7600).

Development and validation of a convenient formula evaluating the value and applicability of medical literature in clinical practice

OBJECTIVE

Evidence-based medicine offers explicit methods to evaluate the evidence grades of literature. However, evidence grades do not meet all the practical needs of physicians. This study is aimed to develop a convenient method for evaluating the clinical value of medical literature from the perspective of the clinician.

METHODS

A literature applicability equation was formulated through the Delphi method and the analytic hierarchy process. A consistency check was used to ascertain the efficacy of the formula. Three senior clinicians assessed 30 articles based on their clinical experiences and subjective opinions, while one independent researcher performed independent assessments of the applicability of 30 articles using the evaluation formula.

RESULTS

The literature applicability equation was Y = 3.93X1 + 11.78X2 + 14.83X3 + 44.53X4 + 24.93X5, where Y = literature applicability, X1 = years since publication, X2 = target question covered or not, X3 = sample size, X4 = study type, and X5 = journal quality. Consistency index (CI) values for the first-level indicator ("literature applicability") and the second-level indicators ("pertinence and timeliness" and "quality of results") were 0.0325, 0.0012, and 0.0001, respectively. The weights used to calculate the matrix indicators had satisfactory accordance (random coincidence coefficient = 0.056). A consistency check for the efficacy of the formula revealed kappa = 0.749 and P < .001. Conclusion : The developed and validated literature applicability evaluation formula may be a useful and convenient tool for identifying clinically valuable medical literature.

Can composite performance measures predict survival of patients with colorectal cancer?

AIM: To assess the relationship between long-term colorectal patient survival and methods of calculating composite performance scores.

METHODS: The Taiwan Cancer Database was used to identify patients who underwent bowel resection for colorectal adenocarcinoma between 2003 and 2004. Patients were assigned to one of three cohorts based on tumor staging: cohort 1, colon cancer stage < III; cohort 2, colon cancer stage III; cohort 3, rectal cancer. A composite performance score (CPS) was calculated for each patient using five different aggregating methods, including all-or-none, 70% standard, equal weight, analytic hierarchy process (AHP), and principal component analysis (PCA) algorithms. The relationships between CPS and five-year overall, disease-free, and disease-specific survivals were evaluated by a Cox proportional hazards model. A goodness-of-fit analysis for all five methods was performed using Akaike’s information criterion.

RESULTS: A total of 3272 colorectal cancer patients (cohort 1, 1164; cohort 2, 790; cohort 3, 1318 patients) with a mean age of 65 years were enrolled in the study. Bivariate correlation analysis showed that CPS values from the equal weight method were highly correlated with those from the AHP method in all cohorts (all P < 0.05). Multivariate Cox hazards analysis showed that CPS values derived from equal weight and AHP methods were significantly associated with five-year survivals of patients in cohorts 1 and 2 (all P < 0.05). In these cohorts, higher CPS values suggested a higher probability of five-year survival. However, CPS values derived from the all-or-none method did not show any significant process-outcome relationship in any cohort. Goodness-of-fit analyses showed that CPS values derived from the PCA method were the best fit to the Cox proportional hazards model, whereas the values from the all-or-none model showed the poorest fit.

CONCLUSION: CPS values may highlight process-outcome relationships for patients with colorectal cancer in addition to evaluating quality of care performance.

Using analytic hierarchy process to identify the nurses with high stress-coping capability: model and application

BACKGROUND

Nurses have long been relied as the major labor force in hospitals. Featured with complicated and highly labor-intensive job requirement, multiple pressures from different sources was inevitable. Success in identifying stresses and accordingly coping with such stresses is important for job performance of nurses, and service quality of a hospital. Purpose of this research is to identify the determinants of nurses' capabilities.

METHODS

A modified Analytic Hierarchy Process (AHP) was adopted. Overall, 105 nurses from several randomly selected hospitals in southern Taiwan were investigated to generate factors. Ten experienced practitioners were included as the expert in the AHP to produce weights of each criterion. Six nurses from two regional hospitals were then selected to test the model.

RESULTS

Four factors are then identified as the second level of hierarchy. The study result shows that the family factor is the most important factor, and followed by the personal attributes. Top three sub-criteria that attribute to the nurse's stress-coping capability are children's education, good career plan, and healthy family. The practical simulation provided evidence for the usefulness of this model.

CONCLUSION

The study suggested including these key determinants into the practice of human-resource management, and restructuring the hospital's organization, creating an employee-support system as well as a family-friendly working climate. The research provided evidence that supports the usefulness of AHP in identifying the key factors that help stabilizing a nursing team.

Safety risk assessment using analytic hierarchy process (AHP) during planning and budgeting of construction projects

INTRODUCTION

The inherent and unique risks on construction projects quite often present key challenges to contractors. Health and safety risks are among the most significant risks in construction projects since the construction industry is characterized by a relatively high injury and death rate compared to other industries. In construction project management, safety risk assessment is an important step toward identifying potential hazards and evaluating the risks associated with the hazards. Adequate prioritization of safety risks during risk assessment is crucial for planning, budgeting, and management of safety related risks.

METHOD

In this paper, a safety risk assessment framework is presented based on the theory of cost of safety (COS) model and the analytic hierarchy process (AHP). The main contribution of the proposed framework is that it presents a robust method for prioritization of safety risks in construction projects to create a rational budget and to set realistic goals without compromising safety.

THE IMPACT TO THE INDUSTRY

The framework provides a decision tool for the decision makers to determine the adequate accident/injury prevention investments while considering the funding limits. The proposed safety risk framework is illustrated using a real-life construction project and the advantages and limitations of the framework are discussed.