Are Hazard Assessment Methods in the Assessment of Chemical Alternatives Suitable for REACH?

The assessment of chemical alternatives for hazardous substances is an important prerequisite for avoiding regrettable substitution, and several methods have been developed in the past to perform such a hazard assessment for chemical alternatives. We investigate here whether GreenScreen, Cradle to Cradle, multiple-criteria decision analysis (MCDA), the Pollution Prevention Options Analysis System, the U.S. EPA Safer Choice Standard and Criteria, and the GHS column model 2020 from IFA use similar criteria for the evaluation of substances as Article 57 of the European chemicals regulation, REACH, and how suitable these methods are for assessing per- and polyfluoroalkyl substances. MCDA and GreenScreen were analyzed in detail using two different data sets. The results of the assessments show that none of the investigated hazard assessment methods use the same criteria as described in Article 57 of REACH. It was also not possible to parametrize multi-attribute value theory (MAVT), a commonly used MCDA method, to align with Article 57 of REACH by using the relatively simple objective hierarchy that has been proposed in previous publications. There is therefore an urgent need for a modified/new method that can be used in the future to assess organic substances that are used within the European Economic Area.

Establishment of a value assessment framework for orphan medicinal products in China.

BACKGROUND: This study aimed to establish a suitable value assessment framework for orphan medicinal products in China based on the multi-criteria decision analysis (MCDA) method. METHODS: First, a draft framework of the MCDA criteria was built based on a systematic literature evaluation and the EVIDEM framework tools. Second, stakeholder groups were formed and expert opinions were collected through the brainstorming and expert consultation methods. Third, from the perspective of stakeholders, the five-point weighting method and a two-step percentile distribution method were employed to weigh the quantitative criteria in the framework for orphan drug value evaluation. Meanwhile, from the public perspective, a survey was conducted on a sample of 71 people to obtain the scoring scale of the framework for orphan drugs through a two-step percentile distribution method. Finally, based on the synthetization and comparison of all evidence and methods, we developed the framework criteria and scoring scale for the orphan medicinal products. RESULTS: Combined with the stakeholder selection and suggestions in the stakeholder workshop, the framework criteria for the evaluation were constructed based on China's national conditions, which included 11 quantitative and 8 qualitative criteria. The two-step percentile distribution method was selected as the weighting method. CONCLUSIONS: MCDA is feasible for the value assessment of orphan drugs in China and can be used as a supplementary tool for drug access decisions in medical insurance. It is suggested to further improve the value assessment framework of orphan medicinal products, scientifically evaluate the MCDA framework weighting method, explore a framework system suitable for China's national conditions.

Participatory multi-criteria decision making for optimal siting of multipurpose artificial reservoirs.

Water resources management is a crucial activity due to climate change concerns and increasing water scarcity. The increase of water storage by building new artificial reservoirs is one of the most common solutions to fulfill the community's needs for potable water, energy, irrigation, and prevention of flood risk. The siting of the reservoirs is usually assessed based on topographical and hydrological considerations. However, there are additional crucial factors, often disregarded in common engineering top-down design approaches, that should be considered to determine suitable locations, such as bio-physical, socio-economic, regulatory, and environmental factors, especially where there are competing interests in the use of territory. Involving the communities in the initial stages of the decision-making process is therefore crucial. In this work, we present a methodology, based on multi-criteria decision-making analysis (MCDA), for identifying the optimal locations for new reservoirs while simultaneously addressing all the aforementioned factors through community engagement. The presented method aims at overcoming two major challenges in existing works, i.e., retrieving quantitative information from the participatory approach and going beyond standard hydro-morphological suitability of a dam site. In a first step, an algorithm assesses a large number of sites using a Digital Elevation Model (DEM). Then, MCDA is conducted to rank all potential locations. The selection criteria are defined quantitatively, based on a territorial analysis combined with hydrological modelling. The criteria include: geometric and morphological aspects (reservoir volume, etc.), hydrological indicators (water balance, potential flood mitigation), anthropization (population, infrastructures, etc.), landscape, archaeological heritage, ecology, environmental components and natural hazards. A web-based survey tool based on the pairwise comparison is developed to engage the community in the decision-making process, allowing them to express their perspectives on the relative significance of each criterion. The application of this methodology is demonstrated through a case study in the Pesa river watershed, Italy, showcasing its effectiveness in identifying the most suitable reservoir locations while targeting the highest environmental preservation and community acceptance. The results show that sole engineering criteria might not reflect the sensibility of the community and that variations of the size of the dam can lead to distinct trade-offs between costs and benefits where interference with impact elements occurs.

New hybrid EC-PROMETHEE method with multiple iterations of random weight ranges: Step-by-step application in Python.

The decision-making process consists of finding the best solution to an analyzed problem. This search is carried out in the face of countless interactions when analyzing an alternative criterion by criterion, under which weights are assigned that distinguish the degree of importance they have for the decision-makers. The definition of weight for each criterion gives rise to three lines of thought on the subject. There are objective, subjective, and hybrid methods. This discussion concerns the degree to which experts define the criteria weights. Based on this discussion, we developed a hybrid method to integrate the Entropy and CRITIC methods with the PROMETHEE method, called EC-PROMETHEE. The innovation of this method is that the combination of the Entropy and CRITIC methods does not result in a single set of weights. In reality, the weights generated by each method are used to define each criterion's upper and lower limits. The range of weights generated for each criterion is emulated "n" times and builds a set of weights that are applied to the ranking definition process. The model generates "n" rankings, defining a single ranking. In this article, we demonstrate a step-by-step application of a tool developed in Python called EC-PROMETHEE and use it as an example of the problem of choosing rotary-wing airplanes for application in the military police service.➢The method reduces discretion in determining the weights of the criteria;➢The innovation lies in the use of a range of weights for criteria;➢Consistency in defining the final ranking.

Public deliberation on health gain measures.

Researchers and decision-makers use health gain measures to assess the value of health interventions. However, our current understanding of how these measures are understandable and accessible to the community is limited. This study examined a diverse group of stakeholders' attitudes and preferences for 9 commonly used health gain measures. We recruited 20 stakeholders, including patients, caregivers, pharmacists, allied health professionals, and citizens. We conducted 2 in-person deliberative meetings in which participants learned, discussed, deliberated on, and ranked 9 health gain measures. The final ranking conducted after unified deliberation showed the quality-adjusted life year (QALY) as the top-ranked measure, followed by the clinical benefit rating method used by the U.S. Preventive Services Task Force, and multicriteria decision analysis (MCDA). We identified 3 themes during deliberations: the importance of using patient values in population-based health gain measures, examining complementary measures together, and choosing measures that are intuitive and easy to understand. Future policymaking should consider incorporating the QALY, clinical benefit rating, and MCDA into prioritization decisions.

Dichorionic triamniotic triplets after two blastocysts transfer underwent multifetal pregnancy reduction: two case reports and literature review.

BACKGROUND: The increase in the rate of multiple pregnancies in clinical practice is associated with assisted reproductive technology (ART). Given the high risk of dichorionic triamniotic (DCTA) triplet pregnancies, reducing DCTA triplet pregnancies to twin or singleton pregnancies is often beneficial. CASE PRESENTATION: This article reports on two cases of DCTA triplet pregnancies resulting from two blastocyst transfers. Given the high risk of complications such as twin-to-twin transfusion syndrome (TTTS) in monochorionic diamniotic (MCDA) twin pregnancies, patients have a strong desire to preserve the dichorionic diamniotic (DCDA) twins. Multifetal pregnancy reduction (MFPR) was performed in both cases to continue the pregnancy with DCDA twins by reducing one of the MCDA twins. Both of the pregnant women in this report eventually gave birth to healthy twins at 37 weeks. CONCLUSIONS: For infertile couples with multiple pregnancies but with a strong desire to remain the DCDA twins, our report suggests that reducing DCTA triplets to DCDA twin pregnancies may be an option based on clinical operability and assessment of surgical difficulty.

A participatory multi-criteria decision analysis framework reveals transition potential towards non-grid wastewater management.

Many public environmental decisions are wicked problems due to high complexity and uncertainty. We test a participatory value-based framework based on multi-criteria decision analysis (MCDA) to tackle such problems. Our framework addresses two important gaps identified in reviews of MCDA applications to environmental problems: including stakeholders and treating uncertainty. We applied our framework in two complex real-world cases concerning a paradigm shift in the wastewater sector; the transition from centralized wastewater systems to decentralized non-grid systems. Non-grid systems may solve some problems of centralized systems by reducing costs, increasing flexibility, and addressing growing demands on environmental issues, especially in rural areas. But non-grid systems have rarely been implemented in OECD countries, because it is unclear whether a transition is recommendable, and whether stakeholders would accept this shift. This problem allows addressing several fundamental research questions. As theoretical contribution, we found that stakeholder participation in MCDA is necessary, because different preferences of stakeholders can lead to different best-performing options in the assessments. Compared to the typical integrated assessment (IA) approach that excludes stakeholders' preferences, the MCDA process led to clearer outcomes. Results indicate that including the uncertainty of predicted consequences of options with Monte Carlo simulation helped discriminate between options and identify best-performing options. Challenging the uncertainty of elicited stakeholder preferences with sensitivity analyses, we found that best-performing options were especially sensitive to the MCDA aggregation model. Despite the high uncertainty, it was possible to suggest robust consensus options that would perform reasonably well for all stakeholders. As practical contribution, results indicated that a transition from the centralized to decentralized non-grid systems seems feasible. Most stakeholders assigned highest weights to environmental protection objectives in decision-making workshops. These stakeholder preferences implemented in MCDA led to a generally better assessment of innovative non-grid systems, especially when including urine source separation. Stakeholders perceived the MCDA process as beneficial and found results plausible. We conclude that the proposed participatory value-based framework is rigorous, but still feasible in practice. The framework is certainly transferable to any context and is open to testing and refinement in various applications to wicked decision problems.

The value of the reflective discussion in decision-making using multi-criteria decision analysis (MCDA): an example of determining the value contribution of tabelecleucel for the treatment of the Epstein Barr virus-positive post-transplant lymphoproliferative disease (EBV+ PTLD).

BACKGROUND: The aim of this study was to assess the contribution of the reflective multidisciplinary discussion in determining the value contribution of innovative drugs through the multi-criteria decision analysis (MCDA). This methodology considers all relevant criteria for healthcare decision-making in a global, transparent, and systematic manner and from the perspective of relevant stakeholders. The determination of value contribution of tabelecleucel for the treatment of Epstein-Barr virus-positive post-transplant lymphoproliferative disease (EBV+ PTLD) compared to salvage therapy was used as an example. RESULTS: Tabelecleucel obtained a value contribution score of 0.63 and increased to 0.75 after the reflective discussion. EBV+ PTLD was considered a life-threatening disease (5.0 ± 0.0), with a significant unmet need for an approved treatment (5.0 ± 0.0). Tabelecleucel was perceived as bringing improvements in terms of efficacy (4.2 ± 0.8) and safety (3.8 ± 0.8) compared to the salvage therapy. Most experts considered that the high efficacy and safety results could represent an improvement in the quality of life of patients (2.3 ± 1.2) along with savings in medical costs (2.3 ± 2.0) and non-medical costs (2.7 ± 1.6) compared to the salvage therapy. However, others emphasized the need of more evidence to confirm these improvements and savings over time. Tabelecleucel was regarded as potentially modifying the clinical course of the disease (4.3 ± 0.8) and supported by high-quality evidence (3.2 ± 0.4). All contextual criteria were valued highly positively for tabelecleucel. "Safety/Tolerability" and "Other medical costs" were the criteria that experienced the highest change in the re-test conducted after the reflective discussion. The reflective discussion allowed resolving doubts or misinterpretations of the experts, so the re-test obtained more accurate and consistent results of the value contribution of tabelecleucel. CONCLUSIONS: The study shows that the MCDA methodology is a useful tool for decision-making on innovative treatments for the management of rare diseases. It also highlights the importance of reflective multidisciplinary discussion for its ability to resolve doubts or misinterpretations of experts, subsequently allowing to obtain more consistent and reliable results on the value contribution of the drug, being potentially more positive.

Alignment of port policy to the context of the Physical Internet.

The Physical Internet (PI) is a paradigm-changing and technology-driven vision, which is expected to significantly impact the development of the freight transport and logistics (FTL) system of today. However, the development of the FTL system towards the PI creates much uncertainty for its current stakeholders. Ports are one of those stakeholders that are expected to be profoundly affected by these developments. However, research that focuses on port policy, under the uncertain developments towards the PI, is still lacking. By providing port authorities with insights and recommendations on robust policy areas, we address this void in literature. We conduct a scenario analysis in combination with multi-criteria decision analysis (MCDA) to determine the importance of port performance indicators and policy areas in different scenarios. The most significant, uncertain, and orthogonal factors for the development of the PI are technological development and institutional development. We find that for a proper alignment with the PI vision, in three out of four scenarios, ports should prioritize the implementation of digital solutions and standards, as opposed to an infrastructure focused policy.

Assessment of bioenergy plant locations using a GIS-MCDA approach based on spatio-temporal stability maps of agricultural and livestock byproducts: A case study.

Addressing the global challenge of energy sustainability and global directives on farming emissions, the United Nations, the European Union, and China have led with strict targets for clean energy, renewable share growth, and carbon neutrality, highlighting a commitment to collective sustainability. This work is situated within the ambit of the Sustainable Development Goals (SDGs), advocating for a transition towards renewable energy sources. With substantial and accessible bioenergy resources, notably in Hubei Province, China, biogas technology has emerged as an emission-cutting solution. This research, focused on the Jianghan Plain, employs an integrated approach combining spatial analyses with machine learning tools to evaluate crop yield stability over two decades, with the aim of maximising the biogas yield from agricultural byproducts, i.e., crop straw and livestock manure. Using Multi-Criteria Decision Analysis (MCDA), which is informed by grey-based DEMATEL, 9 constraints and 13 environmental, social, and economic criteria were assessed to identify optimal sites for biogas facilities. The findings underscore the significant bioenergy potential of agricultural byproducts from the plain of 6.3 × 1012 kJ/year at an 11.4 kJ/m2 density. Stability analyses revealed consistent biomass availability, with rice in Gongan and Shayang and wheat in Jiangling being the primary contributors. Through the MCDA, 45-66 optimal biogas plants were identified across 4 critical counties (Zhongxiang, Shangyang, Jingshan, and Yichen), balancing the energy supply and demand under various stable scenarios. Furthermore, this study demonstrated the criticality of moderate biomass stability for stakeholder consensus and identified areas of high stability essential for energy demand fulfilment. Theoretically, this study offers a practical model for bioenergy resource exploitation that aligns with global sustainability and carbon neutrality goals to address the urgent need for renewable energy solutions amidst the global energy crisis. Practically, this study sets a precedent for policy and planning in environmental, agricultural, and renewable sectors, signifying a step forwards in achieving environmental sustainability and an energy-efficient future.

Application of geospatial technology on land suitability analysis for wheat and maize farming: In a case of Guder sub-watershed North West Oromia, Ethiopia.

Cereal crops like wheat and maize are crucial to providing food security in rural areas of Ethiopia. However, due to population growth, agricultural practices for these cereal crops have been expanded to vulnerable areas, and increasing land degradation. Geospatial technologies are essential for decision-making to reduce land degradation and ensure sustainable agriculture activities. In the Guder sub-watershed, Oromia regional state of Ethiopia, where land degradation has been a persistent issue, agricultural suitability study is crucial. This study is focused on the Guder sub-watershed, which aimed to analyze the land suitability based on ten controlling parameters, including elevation, slope, soil texture, soil depth, soil PH, soil drainage, proximity to the road, temperature, rainfall and land use/land cover, for the two most significant cereal crops (wheat and maize). All of these factors were weighted in accordance with the relative importance of each component for the appropriateness of wheat and maize land suitability using MCDA and AHP method, based on the recommendations of numerous writers and expert opinions. The findings of the study showed that 6 %, 50.58 %, 23.26 %, and 20.26 % of the total study area were highly, moderately, marginally and not suitable for wheat cultivation, respectively, whereas 5.1 %, 57.3 %, 17.3 %, and 20.3 % of the study area were highly, moderately, marginally and not suitable for cultivating maize crop respectively. This result support decision makers to develop land use planning thereby improve productivity and minimize land degradation.

Unraveling urban hydro-environmental response to climate change and MCDA-based area prioritization in a data-scarce developing city.

Climate change leads to more frequent and intense heavy rainfall events, posing significant challenges for urban stormwater management, particularly in rapidly urbanizing cities of developing countries with constrained infrastructure. However, the quantitative assessment of urban stormwater, encompassing both its volume and quality, in these regions is impeded due to the scarcity of observational data and resulting limited understanding of drainage system dynamics. This study aims to elucidate the present and projected states of urban flooding, with a specific emphasis on fecal and organic contamination caused by combined sewer overflow (CSO). Leveraging a hydrological model incorporating physical and biochemical processes validated against invaluable observational data, we undertake simulations to estimate discharge, flood volume, and concentrations of suspended solids (SS), Escherichia coli (E. coli), and chemical oxygen demand (COD) within the drainage channel network of Phnom Penh City, Cambodia. Alterations in flood volumes, and pollutant concentrations and loads in overflow under two representative concentration pathways (RCPs 4.5 and 8.5) for extreme rainfall events are projected. Furthermore, we employ a multi-criteria decision analysis (MCDA) framework to evaluate flood risk, incorporating diverse indicators encompassing physical, social, and ecological dimensions. Our results demonstrate the exacerbating effects of climate change on flood volumes, expansion of flooded areas, prolonged durations of inundation, elevated vulnerability index, and heightened susceptibility to pollutant contamination under both scenarios, underscoring increased risks of flooding and fecal contamination. Spatial analysis identifies specific zones exhibiting heightened vulnerability to flooding and climate change, suggesting priority zones for investment in flood mitigation measures. These findings provide crucial insights for urban planning and stormwater management in regions with limited drainage infrastructure, offering essential guidance for decision-making in locales facing similar challenges.

Mapping flood susceptibility with PROMETHEE multi-criteria analysis method.

On a global scale, flooding is the most devastating natural hazard with an increasingly negative impact on humans. It is necessary to accurately detect flood-prone areas. This research introduces and evaluates the Preference Ranking Organization METHod for Enrichment Evaluation (PROMETHEE) integrated with GIS in the field of flood susceptibility in comparison with two conventional multi-criteria decision analysis (MCDA) methods: analytical hierarchy process (AHP) and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS). The Spercheios river basin in Greece, which is a highly susceptible area, was selected as a case study. The application of these approaches and the completion of the study requires the creation of a geospatial database consisting of eight flood conditioning factors (elevation, slope, NDVI, TWI, geology, LULC, distance to river network, rainfall) and a flood inventory of flood (564 sites) and non-flood locations for validation. The weighting of the factors is based on the AHP method. The output values were imported into GIS and interpolated to map the flood susceptibility zones. The models were evaluated by area under the curve (AUC) and the statistical metrics of accuracy, root mean squared error (RMSE), and frequency ratio (FR). The PROMETHEE model is proven to be the most efficient with AUC = 97.21%. Statistical metrics confirm the superiority of PROMETHEE with 87.54% accuracy and 0.12 RMSE. The output maps revealed that the regions most prone to flooding are arable land in lowland areas with low gradients and quaternary formations. Very high susceptible zone covers approximately 15.00-19.50% of the total area and have the greatest FR values. The susceptibility maps need to be considered in the preparation of a flood risk management plan and utilized as a tool to mitigate the adverse impacts of floods.

Integrating fuzzy-AHP and GIS for solid waste disposal site selection in Kenitra province, NW Morocco.

Selecting an optimal solid waste disposal site is one of the decisive waste management issues because unsuitable sites cause serious environmental and public health problems. In Kenitra province, northwest Morocco, sustainable disposal sites have become a major challenge due to rapid urbanization and population growth. In addition, the existing disposal sites are traditional and inappropriate. The objective of this study is to suggest potential suitable disposal sites using fuzzy logic and analytical hierarchy process (fuzzy-AHP) method integrated with geographic information system (GIS) techniques. For this purpose, thirteen factors affecting the selection process were involved. The results showed that 5% of the studied area is considered extremely suitable and scattered in the central-eastern parts, while 9% is considered almost unsuitable and distributed in the northern and southern parts. Thereafter, these results were validated using the area under the curve (AUC) of the receiver operating characteristics (ROC). The AUC found was 57.1%, which is a moderate prediction's accuracy because the existing sites used in the validation's process were randomly selected. These results can assist relevant authorities and stakeholders for setting new solid waste disposal sites in Kenitra province.

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.

Value contribution of blood-based neurofilament light chain as a biomarker in multiple sclerosis using multi-criteria decision analysis.

Introduction: Multiple sclerosis (MS) is a chronic autoimmune demyelinating disease that represents a leading cause of non-traumatic disability among young and middle-aged adults. MS is characterized by neurodegeneration caused by axonal injury. Current clinical and radiological markers often lack the sensitivity and specificity required to detect inflammatory activity and neurodegeneration, highlighting the need for better approaches. After neuronal injury, neurofilament light chains (NfL) are released into the cerebrospinal fluid, and eventually into blood. Thus, blood-based NfL could be used as a potential biomarker for inflammatory activity, neurodegeneration, and treatment response in MS. The objective of this study was to determine the value contribution of blood-based NfL as a biomarker in MS in Spain using the Multi-Criteria Decision Analysis (MCDA) methodology. Materials and methods: A literature review was performed, and the results were synthesized in the evidence matrix following the criteria included in the MCDA framework. The study was conducted by a multidisciplinary group of six experts. Participants were trained in MCDA and scored the evidence matrix. Results were analyzed and discussed in a group meeting through reflective MCDA discussion methodology. Results: MS was considered a severe condition as it is associated with significant disability. There are unmet needs in MS as a disease, but also in terms of biomarkers since no blood biomarker is available in clinical practice to determine disease activity, prognostic assessment, and response to treatment. The results of the present study suggest that quantification of blood-based NfL may represent a safe option to determine inflammation, neurodegeneration, and response to treatments in clinical practice, as well as to complement data to improve the sensitivity of the diagnosis. Participants considered that blood-based NfL could result in a lower use of expensive tests such as magnetic resonance imaging scans and could provide cost-savings by avoiding ineffective treatments. Lower indirect costs could also be expected due to a lower impact of disability consequences. Overall, blood-based NfL measurement is supported by high-quality evidence. Conclusion: Based on MCDA methodology and the experience of a multidisciplinary group of six stakeholders, blood-based NfL measurement might represent a high-value-option for the management of MS in Spain.

Determining value in the treatment of activated PI3Kδ syndrome in Spain: a multicriteria decision analysis from the perspective of key stakeholders.

Introduction: Activated phosphoinositide 3-kinase (PI3K)δ syndrome (APDS) is an ultra-rare inborn error of immunity (IEI) combining immunodeficiency and immune dysregulation. This study determined what represents value in APDS in Spain from a multidisciplinary perspective applying multicriteria decision analysis (MCDA) methodology. Methods: A multidisciplinary committee of nine experts scored the evidence matrix. A specific framework for orphan drug evaluation in Spain and the weights assigned by a panel of 98 evaluators and decision-makers was used. Re-evaluation of scores was performed. Results: APDS is considered a very severe disease with important unmet needs, including misdiagnosis and diagnostic delay. Current management is limited to treatment of symptoms with off-label use of therapies supported by limited evidence. Therapeutic benefit is partial, resulting in limited disease control. Haematopoietic stem cell transplantation (HSCT), the only potential curative alternative, is restricted to a reduced patient population and without evidence of long-term efficacy or safety. All options present a limited safety profile. Data on patients' quality of life are lacking. APDS is associated with high pharmacological, medical and indirect costs. Conclusions: APDS is considered a severe disease, with limited understanding by key stakeholders of how treatment success is assessed in clinical practice, the serious impact that has on patients and the associated high economic burden. This study brings to light how MCDA methodology could represent a useful tool to complement current clinical and decision-making methods used by APDS experts and evaluators.

Wastewater management decision-making: A literature review and synthesis.

Wastewater management decision-making is complicated because of: (1) a complex regulatory structure, (2) the wide variety of conflicting expectations by stakeholders external and internal to the responsible utility, and (2) constrains including regulatory requirements, available technologies and practices, and customer willingness to pay. This review synthesizes the results from over 200 papers published since 2000 and presents a decision-making structure and process which is (1) science and fact-based, (2) reflects sustainability, (3) clear and transparent, (4) inclusive, (5) produces an objective-oriented decision, (6) scalable, (7) repeatable, and (8) efficient. Tools supporting the decision-making process are reviewed, including Multi-Criteria Decision Analysis (MCDA), Data Envelopment Analysis (DEA), Analytic Hierarchy Process (AHP), process modeling, economic assessments, Life Cycle Assessment (LCA), and Social Life Cycle Assessment (SLCA). Ultimately it was determined that engagement of decision-makers and relevant stakeholders to assess their values and preferences, coupled with supporting data and analyses, is necessary to reach a decision that, critically, has the support needed for it to be implemented. The results demonstrate that an understanding of the components of the decision process, coupled with an orderly process, enables good wastewater management decision-making. PRACTITIONER POINTS: A decision-making structure and process leading to the selection of implementable solutions is presented. The process possesses the following attributes: (1) science and fact-based, (2) reflect sustainability, (3) clear and transparent, (4) inclusive, (5) produce an objective-oriented decision, (6) scalable, (7) repeatable, and (8) efficient An extensive summary and analysis of tools supporting the decision process are provided, including Multi-Criteria Decision Analysis (MCDA), Data Envelopment Analysis (DEA), Analytic Hierarchy Process (AHP), process modeling, economic assessments, Life Cycle Assessment (LCA), and Social Life Cycle Assessment (SLCA). The critical role of internal and external stakeholders and differentiating their involvement relative to decision-makers is emphasized.

Multi-criteria decision analysis: technique for order of preference by similarity to ideal solution for selecting greener analytical method in the determination of mifepristone in environmental water samples.

This work proposes the use of multi-criteria decision analysis (MCDA) to select a more environmentally friendly analytical procedure. TOPSIS, which stands for Technique for Order of Preference by Similarity to Ideal Solution, is an example of a MCDA method that may be used to rank or select best alternative based on various criteria. Thirteen analytical procedures were used in this study as TOPSIS input choices for mifepristone determination in water samples. The input data, which consisted of these choices, was described using assessment criteria based on 12 principles of green analytical chemistry (GAC). Based on the objective mean weighting (MW), the weights for each criterion were assigned equally. The most preferred analytical method according to the ranking was solid phase extraction with micellar electrokinetic chromatography (SPE-MEKC), while solid phase extraction combined with ultra-high performance liquid chromatography tandem mass spectrometry (SPE-UHPLC-MS/MS) was ranked last. TOPSIS ranking results were also compared to the green metrics NEMI, Eco-Scale, GAPI, AGREE, and AGREEprep that were used to assess the greenness of thirteen analytical methods for mifepristone determination. The results demonstrated that only the AGREE metric tool correlated with TOPSIS; however, there was no correlation with other metric tools. The analysis results suggest that TOPSIS is a very useful tool for ranking or selecting the analytical procedure in terms of its greenness and that it can be easily integrated with other green metrics tools for method greenness assessment.