Setting a shared development agenda: prioritizing the sustainable development goals in the Dominican Republic with fuzzy-LMAW.

The sustainable development goals (SDGs) were established by the United Nations as an international call to eradicate poverty, safeguard the environment, and guarantee that everyone lives in peace and prosperity by 2030. The SDGs aim to balance growth and sustainability in three dimensions: social, economic and environmental. However, in the post-pandemic era, when resources for public development policies are scarce, nations face the problem of prioritizing which SDGs to pursue. A lack of agreement is one of the determinants of low performance levels of the SDGs, and multicriteria decision analysis tools can help in this task, which is especially relevant in developing countries that are falling behind in achieving the SDGs. To test the feasibility and appropriateness of one of these tools, the Fuzzy Logarithm Methodology of Additive Weights, we apply it to prioritize the SDGs in the Dominican Republic, to see if the priorities established are consistent. Seventeen experts were surveyed, and the main result was that Decent work and economic growth was the most important goal for the country. Our findings, consistent with the literature, show the path to similar applications in other developing countries to enhance performance levels in the achievement of the SDGs.

Suitable municipalities for biomass energy use in Colombia based on a multicriteria analysis from a sustainable development perspective.

Using renewable energies is a global strategy to mitigate the acceleration of global warming generated by industrial processes and is a sustainable way to diversify the energy matrix in all countries. Biomass is a renewable energy source that produces biofuels and generates electricity and heat. The primary purpose of this work is to identify the municipalities in Colombia where agricultural, livestock, and urban residual biomass could be suitable for energy generation in a sustainable and renewable way. To that end, we carried out a Geostatistical Multi-Criteria Decision Methodology using Analytical Hierarchy Processes such as Rank-Sum and Weighted Linear Combination, as well as considering a set of sustainable development indicators applied to official Colombian data. Two scenarios are considered for comparison purposes. The first one is according to expert criteria, and the second one considers The Sustainable Development Goals proposed by the United Nations. Under both proposed scenarios, 127 municipalities were found to be suitable for agricultural-urban residual biomass and 162 for livestock-urban residual biomass for energy generation. One of the main limitations for the use of urban biomass is that municipalities need to have sufficient production potential to fulfill their own energy needs. An additional comparison with previous works to evaluate the performance of the Multi-Criteria Decision Methodologies MCDM is also proposed.

Classification of medicines and materials in hospital inventory management: a multi-criteria analysis.

BACKGROUND: In the hospital environment, to achieve an optimum level of operations and service, it is necessary to develop adequate inventory management system. Stocks can be managed, amongst other ways, through inputs classification, which is generally carried out based on a single criterion, such as monetary value, demand or criticality, which does not fully address the complexity of a hospital's inventory management system. Thus, the present study proposes a multi-criteria decision support model to help classify the stock of medicines and materials, enabling a more effective inventory management system for hospitals. METHODS: Methodologically, the study followed 3 stages: (1) preliminary phase; (2) modelling and choice phase; and (3) finalization phase. Each stage had a set of specific steps that were followed. The first stage identified the actors of the process, objectives, criteria and alternatives, establishing 5 criteria and 48 alternatives; the second stage was the choice and execution of the multi-criteria decision method to solve the problem. It was decided to use the Flexible and Interactive Tradeoff method for the sorting problematic. Finally, in the third stage, the sensitivity analysis for the developed model and the validation of the results with decision makers were carried out. In the study, 48 medicines and materials were included to validate the proposed model; however, the model could be used for more items. RESULTS: From the total of 48 medicines and hospital medical materials selected for the study, the classification of 34 of these alternatives to a single class was obtained through modelling and the other 14 alternatives were destined to two possible classes; moreover, the sensitivity analysis performed showed robust results. The items classified in class W should receive special attention by the stock manager; therefore, they should be monitored weekly. Items classified in class B should be monitored biweekly and finally, items classified in class M, should be monitored monthly. CONCLUSIONS: The classification of medicines and materials developed according to the inventory demands allowed more efficient purchasing decisions, optimizing the stock of materials and medicines at the hospital while optimizing the inventory manager's activities, saving time. Consequently, the proposed model can support the development of other multicriteria models in different hospital scenarios.

Feasibility of a Hospital Information System for a Military Public Organization in the Light of the Multi-Criteria Analysis.

The healthcare environment presents a large volume of personal and sensitive patient data that needs to be available and secure. Information and communication technology brings a new reality to healthcare, promoting improvements, agility and integration. Regarding high-level and complex decision-making scenarios, the Brazilian Navy (BN), concerning its healthcare field, is seeking to provide better management of its respective processes in its hospital facilities, allowing accurate control of preventive and curative medicine to members who work or have served there in past years. The study addresses the understanding, structure and clarifying variables related to the feasibility of technological updating and installing of a Hospital Information System (HIS) for BN. In this scenario, through interviews and analysis of military organization business processes, criteria and alternatives were established based on multi-criteria methodology as a decision aid. As methodological support for research and data processing, THOR 2 and PROMETHEE-SAPEVO-M1 methods were approached, both based on the scenarios of outranking alternatives based on the preferences established by the stakeholders in the problem. As a result of the methodological implementation, we compare the two implemented methods in this context, exposing the Commercial Software Purchase and Adoption of Free Software, integrated into Customization by the Marine Studies Foundation, as favorable actions to be adopted concerning HIS feasibility. This finding generates a comprehensive discussion regarding the BN perspective and changes in internal development in the military environment, prospecting alignment to the culture of private organizations in Information Technology for healthcare management. In the end, we present some conclusions concerning the study, exploring the main points of the decision-making analysis and for future research.

A Multi-Criteria Approach to Assess the Performance of the Brazilian Unified Health System.

Brazil's Unified Health System (SUS) provides universal free access to health services and is considered a model for the rest of the world. One of the tools used by the Brazilian government to assess this system is the Index of Unified Health System Performance (IDSUS). However, this method has a number of limitations, such as disregarding the opinion of healthcare decision makers. Thus, the aim of the present study was to propose a model based on the R-TOPSIS in order to assess the performance of the SUS. Methodologically, the main steps for proposing multi-criteria models were followed, and to validate the model, a real case study with a set of six cities (alternatives) of the state of São Paulo was used. The results provide a clearer picture of the differences in terms of potential and obtained access, as well as the effectiveness of health services in the cities analyzed. Likewise, the proposal of integrating multiple criteria as well as considering healthcare decision makers proved to be decisive for the results obtained, even in comparison with the other approaches. It was concluded that the proposed method provides a robust and adequate analysis of health systems performance.

A Meta-Analytic Framework for Developing Protocols to Attend Child and Adolescent Victims of Sexual Violence.

Violence against children and adolescents is a global public health problem. In Brazil, there are challenging boundaries for professionals in the protection network in general and for health professionals in particular. Moreover, among other factors, there is the challenge of referral, due to weaknesses in decision making, given the nature of sexual violence and how it is managed by healthcare services. This study aims to propose a Meta-Analytic framework to support the referral of young victims of sexual violence, considering levels of severity, independent of factors such as how protection systems are structured and managed and the local laws in force. We propose a Meta-Analytic approach, developed using the fundamentals of Delphi and DPSIR (Drivers, Pressures, State, Impact, and Response Model of Intervention), from the perspective of Value-Focused Thinking. The Delphi method was structured in two stages: the first stage aimed to identify and classify typical cases of sexual violence; the second stage used the DPSIR model, with the aim of identifying the decision criteria for typical cases that occur in a given municipality. The main outcomes are: (i) the application of the modified Delphi participatory method within the context of local social policies; (ii) the construction of a value tree based on Value-Focused Thinking; and (iii) the identification and systematization of criteria that most interfere with the evaluation of cases of sexual violence, which can be used for multi-criteria decision making.

Qualitative evaluation of pharmaceuticals and metabolites in hospital effluent: Influence of sample preparation technique and outranking by environmental risk using the ELECTRE method.

The presence of pharmaceuticals and metabolites in effluents has become a serious environmental problem, so it is essential to be able to monitor these microcontaminants using qualitative approaches, as well as to assess the potential environmental risks that such compounds may present. Therefore, in this study, suspect screening analysis was performed of 2030 pharmaceuticals and metabolites in hospital effluent samples, applying different sample preparation techniques. Additionally, a pioneering association of (Q)SAR assessment of identified contaminants with the ELECTRE multi-criteria decision analysis technique made it possible to prioritize analytes according to their environmental risk, in order to enable their inclusion in environmental monitoring programs. The results showed that the most advantageous alternative sample preparation technique consisted of cleanup (100 mg of silica/alumina sorbent) + dispersive liquid-liquid microextraction (7.5 of aqueous matrix, 325 µL of chloroform (extracting solvent), and 500 µL of acetonitrile as dispersing solvent). This procedure resulted in the identification of 70 pharmaceuticals and metabolites in the composite sample tested. The suspect screening analysis found a total of 105 microcontaminants, 28 of them being "confirmed compounds" and 77 being "suspect compounds". Of the compounds identified, 87% were pharmaceuticals and 13% were metabolites. The compounds identified were subsequently evaluated using different open access software packages, considering eight endpoints: mobility, persistence, estrogen receptor binding, wastewater treatment plant total removal, biodegradability, PBT (persistent, bioaccumulation and toxic), mutagenicity, and carcinogenicity. The (Q)SAR prediction results were used as input data for the ELECTRE outranking method. Categorization of the identified compounds by ELECTRE resulted in the kernel (priority compounds) and a further 19 groups. ELECTRE sensitivity evaluation indicated that for all the cases, the kernel and the following two groups coincided. The categorization provided by the ELECTRE method constitutes a highly intuitive decision and choice tool, which can assist in the selection of compounds if subsequent quantitative analysis is to be carried out.

A Decision Support Tool For Water Pollution and Eutrophication Prevention In Groundwater-dependent Shallow Lakes From Periurban Areas Based On The DPSIR Framework.

The deterioration of water quality worldwide is a serious environmental problem. Water managers still need operational tools to assess water issues and to inform water planning and decision-making. The aim of this article is to propose a 3-step methodological framework for assessing water pollution problems by combining a conceptual modeling tool (DPSIR) with the development of a quantitative model (Multi-Criteria Decision Model). This contribution provides a practical and flexible evaluation tool for conducting an integrated assessment of eutrophication and agrochemicals delivered to groundwater-dependent shallow lakes. It lays out action guidelines for decision-making environmental managers within the context of intermediate cities in developing countries. Forty-one indicators were identified to characterize the D-P-S-I compartments and for the multi-criteria model conceptualization. In this work, response options analysis consisted of evaluating and choosing water management instruments via a decision support tool. Two lake watersheds located in the peri-urban of two middle-size cities, in Argentina, were chosen to illustrate this methodological approach. The ensuing results allowed establishing a ranking of areas to prioritize, identifying a criteria and sub-criteria to focus on in order to set out action guidelines to minimize water pollution and eutrophication. These action guidelines are urgently needed in emerging countries, where financial, human resources and infrastructure are limited. The scarcity of such causes important implications regarding policy solutions for environmental issues. The implemented decision support tool in both lake watersheds provided a common basis for the understanding of the ongoing water pollution problems and a quantitative ranking (i.e., decision scores) for defining specific actions (responses) for human-induced stresses on such natural systems.

Healthcare waste management assessment: Challenges for hospitals in COVID-19 pandemic times.

With the spread of the new Coronavirus, there was an increase in the generation of contaminated waste. Thus, healthcare waste management (HCWM) became even a greater challenge in hospitals due to Coronavirus easily spread. In this context, it was necessary to create tools that could aid healthcare facilities in evaluating their HCWM. Therefore, the objective of this article was to elaborate a support tool that helps in identifying the shortcomings of hospitals' HCWM. For this purpose, the Health Service Waste Management Index was developed based on the selection of indicators in the area. The index was applied to six hospitals in the state of Minas Gerais, Brazil. Its application meet the purpose of this research, since the results in the form of an index objectively summarize the reality of the HCWM in healthcare facilities. From the six hospitals investigated, four were classified as highly efficient. However, even though most of them were well evaluated, they still have difficulties with properly training their employees, which can be even a worse problem during a pandemic, when every precaution is extremely important to reduce the spread of the disease. Therefore, beyond this article contribution related to sustainability by demanding the hospitals to check which points of HCWM should be improved, it also adds academically by developing a tool with indicators that evaluate operational, human, economic and environmental factors in an innovative way.

Performance Appraisal of Select Nations in Mitigation of COVID-19 Pandemic using Entropy based TOPSIS Method / Avaliação de desempenho de nações selecionadas na mitigação de pandemia de COVID-19 usando método TOPSIS baseado em entropia

Abstract The present study was an effort to assess the mitigation interventions carried out, so far, by the nations to fight the pandemic COVID-19. The novelty of the study was that it had considered the issue of pandemic mitigation strategy as a decision making problem. The performances of the twenty nations were to be ranked. The problem considered in the study was essentially a Multi-Criteria Decision Analysis (MCDA) problem. The available alternatives were the 20 countries and the 8 traits were the criteria. The Technique of Order Preference Similarity to the Ideal Solution (TOPSIS) was used in the present study. The study used Entropy method for assignment of weights to all the criteria. The performance score obtained in respect of the countries considered in the study and the corresponding ranks indicated the relative performances of the countries in their efforts to mitigate the COVID-19 pandemic. The results show that New Zealand is the best performing country and India is the worst one. Brazil ranked 17th, while the rank of UK was 15. The performance of the USA stood at 18th position.

Resumo O presente estudo foi um esforço para avaliar as intervenções de mitigação realizadas, até o momento, pelas nações para combater a pandemia COVID-19. A novidade do estudo é que considerou a questão da estratégia de mitigação da pandemia como um problema de tomada de decisão. As performances das vinte nações deveriam ser classificadas. O problema considerado no estudo era essencialmente um problema de Análise de Decisão Multi-Critério (MCDA). As alternativas disponíveis eram os 20 países e as 8 características eram os critérios. A Técnica de Similaridade de Preferência de Pedido com a Solução Ideal (TOPSIS) foi utilizada no presente estudo. O estudo utilizou o método da Entropia para atribuição de pesos a todos os critérios. A pontuação de desempenho obtida em relação aos países considerados no estudo e as classificações correspondentes indicaram os desempenhos relativos dos países em seus esforços para mitigar a pandemia COVID-19. Os resultados mostram que a Nova Zelândia é o país com melhor desempenho e a Índia o pior. O Brasil ficou em 17º, enquanto o Reino Unido ficou em 15. O desempenho dos EUA ficou na 18ª posição.

Sanitary landfill site selection using multi-criteria decision analysis and analytical hierarchy process: A case study in Azuay province, Ecuador.

Despite environmental regulations in Ecuador, particularly in the Province of Azuay, the solid waste final disposal management is still a socio-environmental problem, worsened by weak governance processes. The province has three sanitary landfills with almost expired service lives. The site selection was based on circumstantial reasons, which makes landfills more likely to cause environmental pollution and, therefore, have negative implications for public health. The largest landfill serves Cuenca and also leases service to other small cities. The remaining two are small and, accordingly, have limited technology and fewer resources. In this context, the main aim of this study is to evaluate the terrain of the province to find the most suitable area for landfill siting. A multi-criteria decision analysis, integrated with a geographical information system and analytical hierarchy process methodology, was conducted. Fourteen factors and seven constraints were simultaneously analysed, divided into technical, environmental, social, and economic categories; 15 of these criteria were from the Ecuadorian Unified Text of the Secondary Legislation of the Environmental Ministry. According to the results, 76.17% of the territory is not suitable for landfill implementation, and the unrestricted area represents the remaining 23.83%. The highest landfill suitability index (70-81%) is located in the south of the province in Santa Isabel, Oña, and Nabón cantons, which are dry and clay-rich areas.

Methodological proposal for the allocation of water quality monitoring stations using strategic decision analysis.

In order to fill a gap in the monitoring of water quality in Brazil, the objective of this study was to propose a methodology to support the allocation of water quality monitoring stations in river basins. To achieve this goal, eight criteria were selected and weighted according to their degree of importance. It was taken into account the opinion of water resources management experts. In addition, a decision support system was designed so that the methodology could be used in the allocation of water quality monitoring stations by researchers and management bodies of water resources, to be fully implemented in geographic information system environment. In order to demonstrate the potential of the proposed methodology, which can be used in places that have or not existing monitoring networks, it has been applied in the Minas Gerais portion of the Doce river basin. Because the area already has a monitoring network with 65 stations in operation under the responsibility of the Minas Gerais Water Management Institute (IGAM), an expansion of the network was suggested and a simulation of a scenario was performed considering that the study area did not have an established network. The results of the analyses consisted of maps of suitability, indicating the locations with greater and lesser suitability for the establishment of the stations. With the application of the methodology, seven new sites were proposed so that the study area had the density recommended by the National Water Agency (ANA), and it was verified that the Caratinga River Water Resources Management Unit (UGRH5 Caratinga) has the most deficiency of stations among the six units evaluated in the Minas Gerais portion of the Doce river basin. In the simulated scenario considering the non-existence of a network, the adequacy map obtained was compared with the existing monitoring network and it was possible to classify the stations according to the purpose for which they were established, such as monitoring environments under anthropic activities or establishing benchmarks for the water bodies. Overall, the proposed methodology proved itself robust, and although the results were specific to one basin, the criteria and decision support system used are fully applicable to other areas of study.

International experiences in multicriteria decision analysis (MCDA) for evaluating orphan drugs: a scoping review.

Introduction: Orphan diseases are low-prevalence conditions with chronically debilitating or life-threatening consequences. Their treatments are generally called orphan drugs (OD). Health-technology assessment processes have traditionally considered cost-effectiveness analysis (CEA), when making reimbursement and pricing decisions for health-care plans. Valuing OD with standard CEA raises important issues due to uncertain evidence, inability to meet cost-effectiveness thresholds for reimbursement and high budget impact, among others. Multi-criteria decision analysis (MCDA) allows to overcome these issues and improve the technical and ethical quality of decisions regarding prioritization, coverage, and reimbursement of OD. Areas covered: A scoping review was conducted in order to characterize MCDA frameworks for assessing OD and implementation experiences. We reviewed electronic databases (Medline, Embase, Cochrane Library, EBSCO, CINAHL, EconLit, Web of Science, LILACS, Google Scholar) key journals (Orphanet Journal of Rare Diseases and Value in Health) and organization repositories. Expert opinion: The theoretical framework for MCDA considers areas related to characteristics of orphan diseases and their technologies' clinical and economic impact. Participation processes are critical in incorporating societal values in weighting different dimensions and constructing decision rules. Local implementation pilots considering different stakeholders are necessary in order to pinpoint specific barriers and opportunities.

Quantitative Assessment of Life Cycle Sustainability (QUALICS): Framework and its application to assess electrokinetic remediation.

In recent years, the broader environmental impacts of remediation that arise from different remediation activities has drawn attention of practitioners, remediation design professionals and academicians to evaluate the net environmental benefit of environmental remediation projects. The main objective of this paper is to describe the Quantitative Assessment of Life Cycle Sustainability (QUALICS) framework, a new tool developed to strengthen decision-making in the selection of sustainable remedial technologies for the clean-up of contaminated sites. The proposed framework is a combination of two multi-criteria evaluation methods namely, the Integrated Value Model for Sustainable Assessment (MIVES) and Analytic Hierarchy Process (AHP). The QUALICS uses a multi-criteria assessment framework to support decision-making in remediation projects. A description of the methodology adopted for sustainability assessment of alternative remedial strategies using QUALICS framework is presented in this study. In addition, a case study is discussed to demonstrate the application of the QUALICS framework for the sustainability assessment of different remediation options for clean-up of a contaminated site. The case study involves sustainability assessment of different remediation options namely, electrokinetic remediation (EKR), excavation/disposal, and phytoremediation for remediation of a contaminated site. A sensitivity analysis was also performed for the EKR option by varying different parameters including electrode materials, energy source, electrolyte used, to analyze their influence on the sustainability of the alternative remedial options. The proposed framework can also be applied to any project in general to quantify and compare the sustainability indices of each of the alternative options considered and thereby identify the most sustainable option.

Multi-criteria decision model for assessing groundwater pollution risk in the urban-rural interface of Mar del Plata City (Argentina).

In developing countries, conflict between the objectives of environmental policies and those focused on economic development, a low availability of human resources and infrastructure, and the lack of continuity and incentives, contribute to the inability to successfully implement environmental policies. Moreover, in these countries, population growth in the peri-urban areas has resulted in serious water pressures, poor water management, and severe non-point source pollution. The aim of this paper is to implement a procedure of aquifer pollution risk assessment for identifying priority areas in an urban-rural interface based on multi-criteria decision tools. In this sense, a multi-criteria decision model was designed, in terms of environmental and socio-economic criteria and sub-criteria relevant to water resource management, by using the software Criterium Decision Plus 4.0. This model was applied to the northwestern peri-urban area of Mar del Plata City, Argentina, which is embedded in the second most important fruit-horticultural belt of the country. Here, groundwater is the only source of water supply. The proposed decision model allowed establishing a ranking of priority areas for defining action guidelines in order to minimize the risk of pollution of the aquifer. Aquifer pollution hazard criterion mainly contributes to alternatives classified as very high priority whilst in the case of low and very low priority classes, social vulnerability criterion mostly influences the final results. The first alternatives will require an intervention in a short-term time horizon, and the last ones must be monitored in order to avoid their shift to a worse environmental condition.

HTA and MCDA solely or combined? The case of priority-setting in Colombia.

BACKGROUND: All healthcare systems face problems of justice and efficiency related to setting priorities for allocating limited financial resources. Therefore, explicit decision-making in healthcare depicted as a continuum from evidence generation to deliberation and communication of the decision made, needs to be transparent and fair. Nevertheless, priority-setting in many parts of the world remains being implicit and ad-hoc process. Health Technology Assessment (HTA) and Multi-Criteria Decision Analysis (MCDA) have emerged as policy tools to assist informed decision-making. Both, MCDA and HTA have pros and cons. MAIN BODY: Colombia experienced an important institutional transformation after the establishment of the Health Technology Assessment Institute in 2012. This paper briefly presents the current challenges of the Colombian health system, the general features of the new health sector reform, the main characteristics of HTA in Colombia and the potential benefits and caveats of incorporating MCDA approaches into the decision-making process. CONCLUSION: Structured and objective consideration of the factors that are both measurable and value-based in an open and transparent manner may be feasible through combining HTA and MCDA in contexts like Colombia. Further testing and validation of HTA and MCDA solely or combined in LMICs are needed to advance these approaches into healthcare decision-making worldwide.

Multi-criteria decision analysis and spatial statistic: an approach to determining human vulnerability to vector transmission of Trypanosoma cruzi

BACKGROUND Chagas disease (CD), caused by the protozoan Trypanosoma cruzi, is a neglected human disease. It is endemic to the Americas and is estimated to have an economic impact, including lost productivity and disability, of 7 billion dollars per year on average. OBJECTIVES To assess vulnerability to vector-borne transmission of T. cruzi in domiciliary environments within an area undergoing domiciliary vector interruption of T. cruzi in Colombia. METHODS Multi-criteria decision analysis [preference ranking method for enrichment evaluation (PROMETHEE) and geometrical analysis for interactive assistance (GAIA) methods] and spatial statistics were performed on data from a socio-environmental questionnaire and an entomological survey. In the construction of multi-criteria descriptors, decision-making processes and indicators of five determinants of the CD vector pathway were summarily defined, including: (1) house indicator (HI); (2) triatominae indicator (TI); (3) host/reservoir indicator (Ho/RoI); (4) ecotope indicator (EI); and (5) socio-cultural indicator (S-CI). FINDINGS Determination of vulnerability to CD is mostly influenced by TI, with 44.96% of the total weight in the model, while the lowest contribution was from S-CI, with 7.15%. The five indicators comprise 17 indices, and include 78 of the original 104 priority criteria and variables. The PROMETHEE and GAIA methods proved very efficient for prioritisation and quantitative categorisation of socio-environmental determinants and for better determining which criteria should be considered for interrupting the man-T. cruzi-vector relationship in endemic areas of the Americas. Through the analysis of spatial autocorrelation it is clear that there is a spatial dependence in establishing categories of vulnerability, therefore, the effect of neighbors' setting (border areas) on local values should be incorporated into disease management for establishing programs of surveillance and control of CD via vector. CONCLUSIONS The study model proposed here is flexible and can be adapted to various eco-epidemiological profiles and is suitable for focusing anti-T. cruzi serological surveillance programs in vulnerable human populations.