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We presented a novel fuzzy multicriteria decision making approach to evaluate and rank organizational resilience factors with respect to user preference orders. Due to vagueness of the decision data, the precise numerical data are inadequate for real-life business situations. Human judgements can be expressed by linguistic expressions which are modeled by fuzzy sets. The complexity of the considered problem calls for analytic methods rather than intuitive decisions. Two fuzzy multi-criteria methods are proposed for solving the treated problem: Fuzzy Analytic Hierarchical Process (FAHP) is applied to determine the relative importance of business processes and the relative importance of organizational resilience factors under each business process, and an extension of the fuzzy Technique for Order Preference by Similarity to Ideal Solution (FTOPSIS) is applied to rank the organizational resilience factors. With respect to complexity and the type of considered management problem, we introduce a modified fuzzy decision matrix. The proposed algorithm has efficiently been applied in the assessment of organizational resilience factors to small and medium enterprises of the process industry.

The simpler oral cavity OAR should be preferred over the mucosal surface OAR for NTCP modelling of severe mucositis. We recommend minimising the volume of mucosa receiving intermediate and high doses, where possible.

Considering the high bleeding risk in patients with ITP and AMI, careful balance between usual anticoagulation and antiplatelet therapy on the one hand, and efforts to raise platelet count on the other hand are needed.

Fully-automated ABS of MSC is suitable for use in radiotherapy dose-response modelling.

BackgroundHormonal manipulation is sometimes recommended in the treatment of metastatic endometrial stromal sarcoma, but there are few data assessing the efficacy of endocrine therapies in this subtype of uterine sarcomas.MethodsWe performed a retrospective electronic medical record review of patients with metastatic ESS treated with a hormonal agent at Royal Marsden Hospital between 1999 and 2011. We assessed progression-free survival (PFS), objective response and toxicity profile among patients with measurable disease.ResultsThirteen patients with metastatic ESS were treated with hormonal therapies. Hormone receptor status (estrogen and progesterone receptors) was assessed in 9 out of 13 patients and in all of them it was moderately to strongly positive. Aromatase inhibitors (AIs) were prescribed as first endocrine line in 11/13 patients and progestins in the remainder, while in 2nd line treatment AIs were prescribed in 7/10 patients, followed by progestins and GnRH analogues. Median PFS for 1stline was 4.0 years (95% CI: 2.4 – 5.5 years) with 5-year progression-free rate of 30.8% (95% CI: 5.7 – 55.9%), both of which reflect the indolent natural history of ESS. Best objective response was partial response (PR) in 6/13 patients (46.2%; 95% CI: 19.2 – 74.9) and clinical benefit rate (defined as complete response + PR + stable disease ≥6 months) was 92.4% (95% CI: 64.0 – 99.8%; 12/13 patients). Median PFS for 2nd line was 3.0 years (95% CI: 2.0 – 4.1 years) with 2-year progression-free rate of 88.9% (95% CI: 68.3 – 100.0).ConclusionsIn this cohort of metastatic ESS patients, 1st line endocrine treatment achieved objective response in 46.2% of them and clinical benefit in 92.4%. Tamoxifen and hormone replacement therapy should not be prescribed in patients with ESS due to their detrimental effects. Until more solid data are available, a reasonable recommendation would be that 1st line treatment with an endocrine treatment, preferably with an AI. Moreover, in view of the positive outcomes of our patients that received 2nd/3rdline endocrine treatments, all available hormonal options should be used in sequence in the management of ESS.

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