Tele-Ethics in Communication Disorders: Asking the Right Questions, Finding the Right Answers

Purpose: A hypothetical case is used to illustrate legal and ethical issues involving the decision to replace the traditional in-person service delivery model with telepractice in schools beyond the context of the initial COVID-19 health emergency. In this clinical focus article, the reader follows Maria, the lead speech-language pathologist (SLP) in the district, as she determines the feasibility of continuing telepractice in her district now that students and clinicians are returning to schools. First, she considers the support needed to implement this service delivery model within the school setting given the anticipated changes to the rules and regulations governing lawful and ethical provision of telepractice after the health emergency ends. Next, she decides if telepractice is warranted in the district by considering the rationales behind the requests. Faced with balancing school, student, and clinician needs, Maria uses an ethical decision-making model to determine if requests for telepractice, tied to health safety concerns and potentially influenced by implicit bias, reflect legal, ethical, and/or moral issues driven by fear or unconscious discriminatory motives. Conclusions: The health emergency gave SLPs working in schools the unique opportunity to experience the benefits and utility of telepractice. Following the return to schools, continuation of telepractice services will require support and training of SLPs. Many factors must be considered including equivalency of services, technology, and protection of privacy as they relate to the changes to the laws and regulations governing telepractice after the health emergency allowances end. Of primary importance is the selection of telepractice to address student needs, not to avoid specific schools because of their characteristics or location. An ethical decision-making model can be used as a framework to guide service delivery model decisions that balance the needs of the student, the clinician, and the district.

USING A MULTI-CRITERIA DECISION-MAKING MODEL TO EVALUATE AND SELECT AN E-COMMERCE PLATFORM

The COVID-19 pandemic has led to disruptions in consumers' lifestyles and purchases, as well as businesses' online business models. Online platforms are increasingly used for shopping purposes. To evaluate and choose an e-commerce platform requires using many criteria and decision makers. Therefore, the process of evaluating and selecting an e-commerce platform is viewed as a multi-criteria decision-making problem. The objective of this study is to develop a multi-criteria decision-making model to help consumers evaluating the e-commerce platforms. In the proposed model, the ratings of alternatives and the weights of the criteria are evaluated using the linguistic variable. Simulation examples are used to show the effectiveness of the model in practice. Keywords: Fuzzy TOPSIS, E-Commerce Platform, Mcdm, Fuzzy Sets.

Proximal hamstring tendon avulsions: comparable clinical outcomes of operative and non-operative treatment at 1-year follow-up using a shared decision-making model

ObjectiveTo prospectively evaluate 1-year clinical and radiological outcomes after operative and non-operative treatment of proximal hamstring tendon avulsions.MethodsPatients with an MRI-confirmed proximal hamstring tendon avulsion were included. Operative or non-operative treatment was selected by a shared decision-making process. The primary outcome was the Perth Hamstring Assessment Tool (PHAT) score. Secondary outcome scores were Proximal Hamstring Injury Questionnaire, EQ-5D-3L, Tegner Activity Scale, return to sports, hamstring flexibility, isometric hamstring strength and MRI findings including proximal continuity.ResultsTwenty-six operative and 33 non-operative patients with a median age of 51 (IQR: 37–57) and 49 (IQR: 45–56) years were included. Median time between injury and initial visit was 12 (IQR 6–19) days for operative and 21 (IQR 12–48) days for non-operative patients (p=0.004). Baseline PHAT scores were significantly lower in the operative group (32±16 vs 45±17, p=0.003). There was no difference in mean PHAT score between groups at 1 year follow-up (80±19 vs 80±17, p=0.97). Mean PHAT score improved by 47 (95% CI 39 to 55, p<0.001) after operative and 34 (95% CI 27 to 41, p<0.001) after non-operative treatment. There were no relevant differences in secondary clinical outcome measures. Proximal continuity on MRI was present in 20 (95%, 1 recurrence) operative and 14 (52%, no recurrences) non-operative patients (p=0.008).ConclusionIn a shared decision-making model of care, both operative and non-operative treatment of proximal hamstring tendon avulsions resulted in comparable clinical outcome at 1-year follow-up. Operative patients had lower pretreatment PHAT scores but improved substantially to reach comparable PHAT scores as non-operative patients. We recommend using this shared decision model of care until evidence-based indications in favour of either treatment option are available from high-level clinical trials.

Supply Chain Networking Models Under Fuzzy Uncertainty

In decision-making model, the techniques of numerical analysis have been widely adopted. It is rare for someone to solve a linear program by hand — except perhaps in a class-room. Large-scale simulations would be all but impossible without the aid of a computer. For many people, numerical techniques have superseded analytic techniques as a tool for solving mathematical problems. This paper proposed Generalized LUExponential Trapezoidal Fuzzy Number and their ranking based on numerical integration. In this ranking method, the values are calculated with left and right spreads at some 𝜶 −level of generalized LU-exponential trapezoidal fuzzy numbers and Weddle‘s rule for numerical integration. To illustrate the proposed methods, a fuzzy four dimensional transportation problem (FDTP) is proposed and solved. This ranking approach is very simple and useful for the real life inequality based decision making problems.