An integrated fuzzy sustainable supplier evaluation and selection framework for green supply chains in reverse logistics.

Green supply chain management considers the environmental effects of all activities related to the supply chain, from obtaining raw materials to the final delivery of finished goods. Selecting the right supplier is a critical decision in green supply chain management. We propose a fuzzy green supplier selection model for sustainable supply chains in reverse logistics. We define a novel hierarchical fuzzy best-worst method (HFBWM) to determine the importance weights of the green criteria and sub-criteria selected. The fuzzy extension of Shannon's entropy, a more complex evaluation method, is also used to determine the criteria weights, providing a reference comparison benchmark. Several hybrid models integrating both weighting techniques with fuzzy versions of complex proportional assessment (COPRAS), multi-objective optimization by ratio analysis plus the full multiplicative form (MULTIMOORA), and the technique for order of preference by similarity to ideal solution (TOPSIS) are designed to rank the suppliers based on their ability to recycle in reverse logistics. We aggregate these methods' ranking results through a consensus ranking model and illustrate the capacity of relatively simple methods such as fuzzy COPRAS and fuzzy MOORA to provide robust rankings highly correlated with those delivered by more complex techniques such as fuzzy MULTIMOORA. We also find that the ranking results obtained by these hybrid models are more consistent when HFBWM determines the weights. A case study in the asphalt manufacturing industry is presented to demonstrate the proposed methods' applicability and efficacy.

Inter- and intra-examiner agreement of three classification systems of gingival recession.

Background: Several classifications have been proposed for gingival recession defects. Correct diagnosis of the type of gingival recession is necessary for proper treatment planning and assessment of the prognosis. Considering the existing uncertainty regarding the reliability of different classification systems available for gingival recession and their shortcomings, this study sought to assess the reproducibility and reliability of accuracy of three available classifications (Cairo, Mahajan and Miller's classification systems) for gingival recession. Methods: This descriptive study was conducted on 32 patients presenting to the Department of Periodontics, who were selected using convenience sampling. The screening process entailed two sessions and those with a minimum of one site of gingival recession disclosing the cementoenamel junction (CEJ) of the tooth with no adjacent tooth loss at the site of recession were enrolled. Each patient was separately evaluated by three calibrated examiners twice with a minimum of one-week interval. Grading of the gingival recession defects was determined using the Cairo, Mahajan and Miller's classification systems for gingival recession. The gradings of each examiner were separately recorded by a blinded examiner. A total of 120 single recession defects were examined and data were analyzed using intra-class correlation coefficient (ICC) and Spearman's test. Level of agreement was evaluated according to Landis and Koch. Results: The results showed that the reliability of all the three methods was almost perfect (P<0.05), and no significant difference was noted in reliability of the Cairo, Mahajan and Miller's classifications for gingival recession (P=0.7). Conclusion: Based on the results of the study, the highest intra- and inter-observer agreement in the use of the three classifications belonged to the Cairo classification; however, all the three classifications showed high reliability.

The effect of endotracheal tube cuff pressure control on postextubation throat pain in orthognathic surgeries: a randomized double-blind controlled clinical trial.

Pain in the throat after extubation is one of the most common complaints after maxillofacial operations under general anaesthesia. We have evaluated the amount of pain after extubation when we controlled the pressure in the endotracheal cuff during operation by analysing the records of 43 patients who had maxillofacial operations under general anaesthesia. In the study group (n=20) the cuff pressure of the endotracheal tube was adjusted using a pressure gauge at the beginning of intubation and every hour during operation. In the control group (n=23), an experienced anaesthetist adjusted the pressure only at the beginning of the operation by palpating the pilot balloon. Throat pain was evaluated 1, 6, and 24h postoperatively on a visual analogue scale (VAS), and the pain scores in the control and study groups postoperatively was 5.3 (1.1) compared with 3.9 (1.5) (p=0.002); 4.5 (1.3) compared with 3.1 (1.5) (p=0.002); and 1.9 (1.1) compared with 1.6 (1.2) (p=0.4), respectively. The differences between the two groups at 1h and 6h postoperatively were significant, but that at 24h was not. Control of the cuff pressure of the endotracheal tube with a gauge at the beginning of the operation, and adjustment of the pressure during operation, can reduce postoperative complications such as throat pain.