Fuzzy Approach for the Decision on Disposable or Returnable Packaging

In modern logistics, companies and packaging engineers have to make decisions to find the optimal sustainable product-packaging system with adequate protection. The decision most often involves a decision option between disposable (single-trip) and reusable (returnable) packaging solutions. In practice, in most cases, this decision is based on historical data and traditions and only considers the packaging material and investment expenses. Although cost is an important factor, it is not the only one needed to find the optimal solution. Several other alternative factors further complicate the situation. Traditional (two-valued) logic is not able to model this problem. This study presents a novel technique to help the decision-making process using the application of fuzzy approach. The authors used three different fuzzy signatures connected by fuzzy rules to model the packaging decisions, which were based on logistics expert opinions. Practical examples are presented concerning both customer packaging (primary packaging) and industrial transport packaging (secondary packaging) as well.

Construction, visualization and application of neutral zone classifiers

When the potential for making accurate classifications with a statistical classifier is limited, a neutral zone classifier can be constructed by adding a no-decision option as a classification outcome. We show how a neutral zone classifier can be constructed from a receiving operating characteristic (ROC) curve. We extend the ROC curve graphic to highlight important performance characteristics of a neutral zone classifier. Additional utility of neutral zone classifiers is illustrated by showing how they can be incorporated into the first stage of a two-stage classification process. At the first stage, a classification is attempted from easily collected or inexpensive features. If the classification falls into the neutral zone, additional relatively more expensive features can be obtained and used to make a definitive classification at the second stage. The methods discussed in the paper are illustrated with an application pertaining to prostate cancer.

Impella 5.0 therapy as a bridge-to-decision option for patients on extracorporeal life support with unclear neurological outcomes

OBJECTIVES Peripheral venoarterial extracorporeal life support (ECLS) for the treatment of cardiogenic shock has shown to improve survival but is associated with complications. However, if the patient cannot be weaned from ECLS, their therapy options are limited. Although durable left ventricular assist device implantation might be an option in such cases, an unclear neurological outcome is often a contraindication. We hypothesize that Impella 5.0 therapy provides sufficient circulatory support while avoiding ECLS-related complications, thereby allowing for an adequate evaluation of a patient’s neurological state and facilitating further treatment options. METHODS We retrospectively reviewed data from 22 ECLS patients (mean age 56.5 ± 10.7 years) with an unclear neurological status who underwent Impella 5.0 implantation between January 2016 and July 2018 in our institution. Neurological status was evaluated on a daily basis using the cerebral performance category score and the modified Rankin scale. RESULTS Sixteen patients (72.7%) were resuscitated before ECLS implantation and 13 patients (59.1%) had acute myocardial infarction. The mean duration on ECLS before Impella 5.0 implantation was 9.3 ± 1.7 days. All patients were successfully weaned from ECLS by Impella 5.0 implantation via the axillary artery. The mean duration on Impella 5.0 was 16.3 ± 4.7 days. In surviving patients, both quantitative measurements of cerebral performance improved after 30 days compared to the baseline (P < 0.01). Six patients (27.3%) were bridged to a durable left ventricular assist device. In 9 patients (40.9%), myocardial function recovered during Impella 5.0 support and the device was successfully explanted. The 30-day survival rate was 68.2%. CONCLUSIONS Impella 5.0 support provides a bridge-to-decision option for patients following ECLS implantation and leads to left ventricular unloading. It allows further evaluation of a patient’s neurological situation and facilitates further therapy. About two-thirds of patients survived with acceptable neurological outcomes.

Health protection planning for extreme weather events and natural disasters

Objective: There is a need to develop cost-effective methods to support public health policy makers plan ahead and make robust decisions on protective measures to safeguard against severe impacts of extreme weather events and natural disasters in the future, given competing demands on the social and healthcare resources, large uncertainty associated with extreme events and their impacts, and the opportunity costs associated with making ineffective decisions.Design: The authors combine a physics-based method known as nonextensive statistical mechanics for modeling the probability distribution of systems or processes exhibiting extreme behavior, with a decision-analytical method known as partitioned multiobjective risk method to determine the optimal decision option when planning for potential extreme events.Results: The method is illustrated using a simple hypothetical example. It is shown that partitioning the exceedance probability distribution of health impact into three ranges (low severity/high exceedance probability, moderate severity/medium exceedance probability, and high severity/low exceedance probability) leads to the correct estimation of the conditional expected impact in each range. Multiobjective optimization is used to determine the optimal decision option based on the perspective of the policy maker.Conclusion: This method constitutes a robust generic framework for the quantification of impacts and supporting decision-making under scenarios of extreme and catastrophic health risks.

The Internal Coherence of Breast Cancer Patients Is Associated with the Decision-Making for Chemotherapy and Viscum album L. Treatment

Objective. In the present observational study, the influence of internal coherence on shared decision-making for chemotherapy (CTX) and Viscum album L. extracts (VA) treatment in breast cancer patients was evaluated. Methods. Breast cancer patients with a guideline-oriented advice from the tumor board for CTX were included in the study. At first diagnosis (T0) and 6 months later (T1), a questionnaire, the internal coherence scale (ICS), was administered and evaluated. Prior to analysis, patients were classified retrospectively depending on their treatment decision. Results. 64 primary nonmetastasized breast cancer patients (median age 54.8 years, IQR: 46.3-65.3) were analyzed in this study. At T0, adjusted multivariable linear regression analyses revealed significant low ICS scores in patients rejecting CTX, especially in the ICS subscale “thermo coherence” (p = 0.006). The decision for add-on VA-therapy was associated with low scores for the ICS subscale “inner resilience coherence”, in particular low for the item “courage”. At T1, in the CTX+VA-group the thermo coherence increased significantly (p(d) < 0.01), while in contrast, in the CTX-only group the thermo coherence decreased significantly (p(d) = 0.02). Conclusion. Add-on VA-applications in CTX treatment support the thermo coherence of breast cancer patients, revealing a decision option to encourage patients to undergo CTX in combination with additional VA-treatments.

Reciprocity Among Preschoolers in Relation to Resource Allocation Toward Siblings, Friends, and Strangers

Children at age 6 years differentially treat kin, friends, and strangers in resource allocation games by being more altruistic toward kin. However, it is unknown how previous allocation experience as a recipient influences the potential kinship effect in subsequent resource allocations. The present study investigated how 4- to 6-year-old children allocated resources between themselves and a sibling, a friend, or a stranger in three allocation tasks after the recipient had previously shared or nonshared with the participant. Results showed that, when a share would induce cost on the self, 6-year-old children were likely to share with a sibling whether the sibling had previously shared or not, but they would share only with friends or strangers who had previously shared. When a share would induce no cost, participants across ages were likely to share with a recipient who had previously shared. When the decision option was between sharing equally and sharing altruistically, participants would allow the recipient to have more only when the recipient was a sibling or friend who had previously allocated altruistically. These findings suggest that kin altruism in resource allocation emerges at around 6 years of age and that reciprocity partly overrides and partly reinforces kin altruism.

An uncertainty-based comprehensive decision support system for site-specific crop management

This paper presents a framework for the implementation of a decision support system that considers spatial, temporal and managerial factors in assessing the potential impact of crop amendments on the cost of a given production scenario. The proposed system includes a database and a numeric simulation model. The database is linked to previously recorded crop responses for a given agricultural input under different conditions while the numeric simulation model determines the probability of different levels of profit for each decision option. This system then determines the optimal uniform rate of application of an amendment to maximize profits, or to define the range of such rates for a case of variable rate application. Uncertainty-based treatment of each model input allows for a balance between the potential results of under-application or over-application.

Collective animal decisions: preference conflict and decision accuracy

Social animals frequently share decisions that involve uncertainty and conflict. It has been suggested that conflict can enhance decision accuracy. In order to judge the practical relevance of such a suggestion, it is necessary to explore how general such findings are. Using a model, I examine whether conflicts between animals in a group with respect to preferences for avoiding false positives versus avoiding false negatives could, in principle, enhance the accuracy of collective decisions. I found that decision accuracy nearly always peaked when there was maximum conflict in groups in which individuals had different preferences. However, groups with no preferences were usually even more accurate. Furthermore, a relatively slight skew towards more animals with a preference for avoiding false negatives decreased the rate of expected false negatives versus false positives considerably (and vice versa), while resulting in only a small loss of decision accuracy. I conclude that in ecological situations in which decision accuracy is crucial for fitness and survival, animals cannot ‘afford’ preferences with respect to avoiding false positives versus false negatives. When decision accuracy is less crucial, animals might have such preferences. A slight skew in the number of animals with different preferences will result in the group avoiding that type of error more that the majority of group members prefers to avoid. The model also indicated that knowing the average success rate (‘base rate’) of a decision option can be very misleading, and that animals should ignore such base rates unless further information is available.