Dietary protein intake and health-related outcomes: a methodological protocol for the evidence evaluation and the outline of an evidence to decision framework underlying the evidence-based guideline of the German Nutrition Society

Purpose The present work aimed to delineate (i) a revised protocol according to recent methodological developments in evidence generation, to (ii) describe its interpretation, the assessment of the overall certainty of evidence and to (iii) outline an Evidence to Decision framework for deriving an evidence-based guideline on quantitative and qualitative aspects of dietary protein intake. Methods A methodological protocol to systematically investigate the association between dietary protein intake and several health outcomes and for deriving dietary protein intake recommendations for the primary prevention of various non-communicable diseases in the general adult population was developed. Results The developed methodological protocol relies on umbrella reviews including systematic reviews with or without meta-analyses. Systematic literature searches in three databases will be performed for each health-related outcome. The methodological quality of all selected systematic reviews will be evaluated using a modified version of AMSTAR 2, and the outcome-specific certainty of evidence for systematic reviews with or without meta-analysis will be assessed with NutriGrade. The general outline of the Evidence to Decision framework foresees that recommendations in the derived guideline will be given based on the overall certainty of evidence as well as on additional criteria such as sustainability. Conclusion The methodological protocol permits a systematic evaluation of published systematic reviews on dietary protein intake and its association with selected health-related outcomes. An Evidence to Decision framework will be the basis for the overall conclusions and the resulting recommendations for dietary protein intake.

The native - exotic plant choice in green roof design: using a multicriteria decision framework to foster urban biodiversity

Green roofs are considered key elements of the urban green infrastructure since they offer several environmental benefits, including habitat provision for arthropods. To achieve these benefits and ensure green roof success, an appropriate plant selection is an important step in the design of these infrastructures, especially where green roof technology is emerging like in South American cities. So far, decisions of using native or exotic plant species in green roofs had never been evaluated taking into account the plant potential to foster beneficial arthropods. By applying an integrative multicriteria decision framework that combined the habitat template hypothesis with the potential of plants to attract floral visitors and natural enemies, we obtained a ranked set of candidate native and exotic plant species. Among the best-ranked candidate species, we further compared the performance of six native and six exotic species in 30 experimental green roofs installed in Cordoba city, Argentina. To evaluate plant success, the occurrence and cover of each species were recorded one year after establishment under two management conditions: regular watering and weeding of spontaneous plants, and no management (15 roofs each). All selected species increased their vegetative cover one year after establishment. More interestingly, native plants had an advantage over exotic plant species as they exhibited a significantly higher occurrence and a slightly higher cover with no management than exotics. Native annuals were able to reseed the following season even in the absence of management, thus highlighting the relative importance of lifespan as a useful plant trait for future studies in green roof design. Given that green roofs are one of the possible solutions to ameliorate the negative effects of urban habitat loss on arthropod diversity, the development of an integrative multicriteria decision framework that takes into account the potential of native and exotic plant species for promoting beneficial arthropods would give a new twist in plant selection processes for green roofs.

Modelling approaches for histology-independent cancer drugs to inform NICE appraisals: a systematic review and decision-framework

Background The first histology-independent marketing authorisation in Europe was granted in 2019. This was the first time that a cancer treatment was approved based on a common biomarker rather than the location in the body at which the tumour originated. This research aims to explore the implications for National Institute for Health and Care Excellence appraisals. Methods Targeted reviews were undertaken to determine the type of evidence that is likely to be available at the point of marketing authorisation and the analyses required to support National Institute for Health and Care Excellence appraisals. Several challenges were identified concerning the design and conduct of trials for histology-independent products, the greater levels of heterogeneity within the licensed population and the use of surrogate end points. We identified approaches to address these challenges by reviewing key statistical literature that focuses on the design and analysis of histology-independent trials and by undertaking a systematic review to evaluate the use of response end points as surrogate outcomes for survival end points. We developed a decision framework to help to inform approval and research policies for histology-independent products. The framework explored the uncertainties and risks associated with different approval policies, including the role of further data collection, pricing schemes and stratified decision-making. Results We found that the potential for heterogeneity in treatment effects, across tumour types or other characteristics, is likely to be a central issue for National Institute for Health and Care Excellence appraisals. Bayesian hierarchical methods may serve as a useful vehicle to assess the level of heterogeneity across tumours and to estimate the pooled treatment effects for each tumour, which can inform whether or not the assumption of homogeneity is reasonable. Our review suggests that response end points may not be reliable surrogates for survival end points. However, a surrogate-based modelling approach, which captures all relevant uncertainty, may be preferable to the use of immature survival data. Several additional sources of heterogeneity were identified as presenting potential challenges to National Institute for Health and Care Excellence appraisal, including the cost of testing, baseline risk, quality of life and routine management costs. We concluded that a range of alternative approaches will be required to address different sources of heterogeneity to support National Institute for Health and Care Excellence appraisals. An exemplar case study was developed to illustrate the nature of the assessments that may be required. Conclusions Adequately designed and analysed basket studies that assess the homogeneity of outcomes and allow borrowing of information across baskets, where appropriate, are recommended. Where there is evidence of heterogeneity in treatment effects and estimates of cost-effectiveness, consideration should be given to optimised recommendations. Routine presentation of the scale of the consequences of heterogeneity and decision uncertainty may provide an important additional approach to the assessments specified in the current National Institute for Health and Care Excellence methods guide. Further research Further exploration of Bayesian hierarchical methods could help to inform decision-makers on whether or not there is sufficient evidence of homogeneity to support pooled analyses. Further research is also required to determine the appropriate basis for apportioning genomic testing costs where there are multiple targets and to address the challenges of uncontrolled Phase II studies, including the role and use of surrogate end points. Funding This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment; Vol. 25, No. 76. See the NIHR Journals Library website for further project information.

A Conceptual Framework for Bounded Rationality in Bank Officers’ Credit Decision for SME Lending in Malaysia

Based on the Bounded Rational Theory, ideally, bank credit officers would be influenced by both rational (fundamental factors) and irrational (behavioural factors) in their credit assessment and decision making process. Emphasizing on the irrational decision making perspective, behavioural factors distort the credit decision making process in the banking industry. Despite such evidence, the psychology perspectives in bank lending practice has been given little attention in research and neglected in practice and policy perspectives. This conceptual research investigated the role of irrationality in bank lending decision making. The research design involved three stages. The research started with conceptualization of the bounded rational credit decision framework. This was designed based on review of three theories and related empirical evidence. In the second stage, constructs and their measurement items were sourced from prior work. Thereafter, a questionnaire was developed. In the third stage, the validity of the questionnaire was tested using expert validation, pre-test and pilot-test involving 30 credit officers working in business banking division of a Malaysian bank. Findings from the pilot study confirmed the validity of the questionnaire as an instrument that can be used for future empirical test. This bounded rational credit decision framework can guide further empirical analysis on the role of behavioural factors in lending decision making. The framework provides new insights that are valuable in enhancing the SMEs lending theory, practice, and policy. Keywords: behavioural finance, bounded rational theory, business banking, credit decision, small and medium-sized enterprises (SMEs)

A Decision Framework for Solar PV Panels Supply Chain in Context of Sustainable Supplier Selection and Order Allocation

Sustainable supplier selection and order allocation (SSSOA) is paramount to sustainable supply chain management. It is a complex multi-dimensional decision-making process augmented with the triple bottom line of sustainability. This research presents a multi-phase decision framework to address a SSSOA problem for the multi-echelon renewable energy equipment (Solar PV Panels) supply chain. The framework comprises of fuzzy Multi-Criteria Decision-Making techniques augmented with fuzzy multi-objective mixed-integer non-linear programming mathematical model. The various economic, environmental, and social objectives were optimized for a multi-period, multi-modal transportation network of the supply chain. The results show that among the various sustainable criteria selected in this study, product cost, environmental management system, and health and safety rights of employees are the most important for decision-makers. The results of the mathematical model highlighted the impact of multimodal transportation on overall cost, time, and environmental impact for all periods. An analysis of results revealed that transfer cost and customer clearance cost contribute significantly towards overall cost. Furthermore, defect rate was also observed to play a critical role in supplier selection and order allocation.