Construction of capital procurement decision making model to optimize supplier selection using Fuzzy Delphi and AHP-DEMATEL

Purpose – Supplier selection for capital procurement is a major strategic decision for any automobile company. The decision determines the success of the company and must be taken systematically with the utmost transparency. Therefore, the aim of this study is the construction of capital procurement decision making models to optimize supplier selection in the Indian automobile industry. Design/methodology/approach – To achieve the stated objective, a combined approach of fuzzy theory and AHP-DEMATEL is applied. Evaluation parameters are identified through an extensive literature review and criteria validation has been introduced through a Fuzzy Delphi method by using fuzzy linguistic scales to handle the vagueness of information. AHP is employed to find the priority weight of criteria although an inter-relationship map among criteria is not possible through AHP alone since it considers all criteria as independent. To overcome this, DEMATEL is used to establish cause-effect relationships among criteria. Findings – The results show that the total cost of ownership is the first weighted criterion in supplier selection for capital procurement, followed by manufacturing flexibility and maintainability, then conformity with requirement. The cause-effect model shows that supplier profile, total cost of ownership, service support and conformity with requirement are in the cause group and are considered to be the most critical factors in selecting the supplier. Originality/value – The study’s outcome can help the automobile industry to optimize their selection process in selecting their suppliers for capital procurement; the proposed model can provide guidelines and direction in this regard.N

Do Socio-Economic Factors Play a Role in Delayed Presentation of Complicated Chronic Otitis Media (Squamous)?

Introduction The influence of Socioeconomic (SE) status on delayed reporting and consequent complications in cases of Chronic Otitis Media-squamous (COMS) has been investigated. Materials and Methods This prospective observational study included 34 patients with complicated COMS who presented to Otolaryngology Department at a tertiary care teaching hospital between December 2012 and December 2016. The patients were classified into 5 classes namely upper, upper middle, lower middle, upper lower, and lower based on a standardised real-time Kuppuswamy’s SE status scale (KS) taking an average of consumer price indices for Industrial workers over 4 years (Jan ‘12 to Dec ‘16) as 267 and calculating their incomes. Level of education and occupation of the head of the family were the other components of KS which was calculated for each presenting patient. Results Of the 34 patients, 15 were males (44%) and 19 females (56%) with their ages ranging from 18 months to 61 years (Mean-24.1 years, SD-17.3). 15 of the 34 patients (44.1%) were in the Upper-lower SE class as per KS Scale, 13 were in lower-middle class (38.23%), 5 were in Upper-middle class ( 14.70%) and 1 patient belonged to Upper class (2.9%).  Though the literacy levels are integral to KS Scale a differential analysis showed 23 of the 34 patients/guardians had education level poorer or equal to Intermediate high school (67.64%). The time gap between onset of symptoms of COMS and presentation with complications of COMS ranged from 9 months to 8 years with a mean time gap of 3.48 years (SD-2.01). There were 24 Extra-cranial complications and 21 Intra-cranial complications with 10 patients having more than one complications. There was a strong inverse correlation between Time gap and composite KS (-0.51). A differential analysis showed that Time gap most strongly correlated with Education level of the head of the family (-0.615), followed by total family income (-0.403) and occupation of the head of the family (-0.329).  Conclusion There is a strong association between the SE status of the family and the occurrence of complications in COMS that is otherwise highly amenable to successful management. Level of education, nature of employment and family income that constitute KS scale have significant inverse correlation with delayed reporting and consequent complications of COMS. Level of Education is the greatest influence on the time gap

Do Socio-Economic Factors Play a Role in Delayed Presentation of Complicated Chronic Otitis Media (Squamous)?

Introduction The influence of Socioeconomic (SE) status on delayed reporting and consequent complications in cases of Chronic Otitis Media-squamous (COMS) has been investigated. Materials and Methods This prospective observational study included 34 patients with complicated COMS who presented to Otolaryngology Department at a tertiary care teaching hospital between December 2012 and December 2016. The patients were classified into 5 classes namely upper, upper middle, lower middle, upper lower, and lower based on a standardised real-time Kuppuswamy’s SE status scale (KS) taking an average of consumer price indices for Industrial workers over 4 years (Jan ‘12 to Dec ‘16) as 267 and calculating their incomes. Level of education and occupation of the head of the family were the other components of KS which was calculated for each presenting patient. Results Of the 34 patients, 15 were males (44%) and 19 females (56%) with their ages ranging from 18 months to 61 years (Mean-24.1 years, SD-17.3). 15 of the 34 patients (44.1%) were in the Upper-lower SE class as per KS Scale, 13 were in lower-middle class (38.23%), 5 were in Upper-middle class ( 14.70%) and 1 patient belonged to Upper class (2.9%).  Though the literacy levels are integral to KS Scale a differential analysis showed 23 of the 34 patients/guardians had education level poorer or equal to Intermediate high school (67.64%). The time gap between onset of symptoms of COMS and presentation with complications of COMS ranged from 9 months to 8 years with a mean time gap of 3.48 years (SD-2.01). There were 24 Extra-cranial complications and 21 Intra-cranial complications with 10 patients having more than one complications. There was a strong inverse correlation between Time gap and composite KS (-0.51). A differential analysis showed that Time gap most strongly correlated with Education level of the head of the family (-0.615), followed by total family income (-0.403) and occupation of the head of the family (-0.329).  Conclusion There is a strong association between the SE status of the family and the occurrence of complications in COMS that is otherwise highly amenable to successful management. Level of education, nature of employment and family income that constitute KS scale have significant inverse correlation with delayed reporting and consequent complications of COMS. Level of Education is the greatest influence on the time gap

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Noise Induced Hearing Loss with Tinnitus: Does TRT Help?

Introduction To determine if hearing augmentation and tinnitus retraining therapy (TRT) helps in cases of Tinnitus with Noise induced hearing loss (NIHL) and does degree of hearing loss, severity or duration of tinnitus affect recovery  Materials and Methods A prospective study was done on 100 patients of NIHL with tinnitus from Jan 14-Jul 15. Degree of hearing loss was assessed. Tinnitus severity was scored on Tinnitus handicap inventory (THI) scale as Slight, Mild, Moderate, severe or catastrophic and patients were subjected to TRT. Patients scored after 1 year of TRT. A relation between tinnitus severity, duration and degree of hearing loss on recovery from tinnitus was analysed. Result 62 of the 100 patients improved following TRT. Discussion In 100 patients THI scores improved from a mean of 63.12 (SD-21.12) to 38.16 (SD-18.21). Mean difference between pre and post-intervention THI scores was 24.96 (SD-17.97). Improvement was significant in severe or profound hearing loss (P<.001). Tinnitus severity was slight, mild, moderate, severe or catastrophic on THI. Following TRT, 82.35% with Catastrophic, 70.96% with severe, 52.63% with moderate, 20% with mild tinnitus improved. 1 patient with slight tinnitus did not improve. Based on duration of tinnitus three groups made; 0-6 months, 6-12 months and >12 months. All groups showed improvement. Reduction in Post-TRT THI was significant but did not show any difference among groups. Conclusion TRT helps in tinnitus with NIHL particularly if hearing loss is severe. Severe or catastrophic tinnitus patients experience greater improvement. Duration of tinnitus has no impact