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er
Science
Vo
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//ij
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cs.ia
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m
A
multi
crite
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co
lla
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ra
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decisi
o
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supp
o
rt
sy
ste
m
for
multidiscipl
ina
ry
medica
l
co
o
rdina
tion
meet
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s
So
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d
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a
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s,
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t
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f
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a
t
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a
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LI
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,
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o
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m
a
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p
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r
a
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l
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Art
icle
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nfo
AB
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T
RAC
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A
r
ticle
his
to
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y:
R
ec
eiv
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Au
g
9
,
2
0
2
5
R
ev
is
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Ap
r
9
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2
0
2
6
Acc
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ted
Ma
y
2
6
,
2
0
2
6
M
u
lt
i
d
isc
ip
li
n
a
ry
tea
m
m
e
e
ti
n
g
s
(M
DTM
s)
a
re
c
e
n
tral
to
c
a
n
c
e
r
c
a
re
.
Ho
we
v
e
r,
c
o
n
se
n
su
s
can
be
h
a
r
d
to
re
a
c
h
b
e
c
a
u
se
sp
e
c
ialists
re
l
y
on
d
i
v
e
rse
e
x
p
e
rti
se
a
n
d
u
n
c
e
rtain
,
m
u
lt
i
-
c
rit
e
ria
c
li
n
ica
l
d
a
ta.
In
th
is
p
a
p
e
r,
we
p
ro
p
o
se
a
g
ro
u
p
d
e
c
isio
n
su
p
p
o
rt
s
y
ste
m
(G
DSS
)
th
a
t
in
teg
ra
tes
a
m
u
lt
i
-
a
g
e
n
t
sy
ste
m
(M
AS)
with
m
u
lt
i
-
c
rit
e
ria
d
e
c
isio
n
m
a
k
in
g
(M
CDM)
to
stru
c
tu
re
in
tera
c
ti
o
n
s,
a
g
g
re
g
a
te
e
x
p
e
rt
p
r
e
fe
re
n
c
e
s,
e
n
a
b
le
re
a
l
-
ti
m
e
e
v
a
lu
a
ti
o
n
of
o
p
ti
o
n
s
b
a
se
d
on
c
rit
e
ria,
a
n
d
tran
sp
a
re
n
tl
y
p
rio
r
it
ize
p
a
ti
e
n
ts
f
o
r
d
isc
u
ss
io
n
a
n
d
in
ter
v
e
n
ti
o
n
.
Eac
h
sp
e
c
ialist
is
re
p
re
se
n
ted
by
an
a
g
e
n
t
t
h
a
t
e
v
a
lu
a
tes
c
a
se
s
a
g
a
in
st
sh
a
re
d
c
rit
e
ria,
wh
il
e
an
e
m
b
e
d
d
e
d
n
e
g
o
t
iatio
n
p
ro
to
c
o
l
e
n
a
b
les
e
x
c
h
a
n
g
e
s
a
n
d
c
o
n
c
e
ss
io
n
s
to
re
so
l
v
e
c
o
n
fli
c
ts
a
n
d
b
u
il
d
c
o
n
se
n
su
s
.
We
e
v
a
lu
a
ted
t
h
e
G
DSS
u
sin
g
sim
u
late
d
b
re
a
st
c
a
n
c
e
r
M
DTM
sc
e
n
a
rio
s
g
e
n
e
ra
ted
fro
m
a
s
y
n
t
h
e
ti
c
d
a
tas
e
t
of
M
DT
M
re
c
o
r
d
s.
E
x
p
e
rime
n
tal
re
su
lt
s
d
e
m
o
n
stra
te
ra
p
i
d
c
o
n
v
e
rg
e
n
c
e
to
wa
rd
a
c
o
n
se
n
su
a
l
p
a
ti
e
n
t
p
ri
o
rit
iza
ti
o
n
with
in
a
fe
w
n
e
g
o
t
iatio
n
it
e
ra
ti
o
n
s;
in
o
u
r
e
x
p
e
rime
n
ts,
a
g
re
e
m
e
n
t
on
t
h
e
h
ig
h
e
st
risk
p
a
ti
e
n
t
wa
s
re
a
c
h
e
d
a
fter
fo
u
r
ro
u
n
d
s.
S
e
n
sit
iv
it
y
a
n
a
ly
sis
on
su
b
jec
ti
v
e
in
p
u
ts
,
i
n
c
lu
d
in
g
c
rit
e
ria
we
ig
h
ts
a
n
d
p
re
fe
re
n
c
e
p
r
o
fil
e
s
,
p
ro
d
u
c
e
d
m
i
n
o
r
c
h
a
n
g
es
in
th
e
r
e
su
lt
in
g
ra
n
k
in
g
,
in
d
ica
ti
n
g
ro
b
u
stn
e
ss
a
n
d
sta
b
il
it
y
to
p
re
fe
re
n
c
e
v
a
riati
o
n
s.
Th
e
sy
ste
m
m
a
in
tai
n
s
l
o
w
c
o
m
p
u
tati
o
n
a
l
c
o
m
p
lex
it
y
a
n
d
s
h
o
rt
e
x
e
c
u
ti
o
n
ti
m
e
s,
imp
ro
v
i
n
g
th
e
tran
s
p
a
re
n
c
y
a
n
d
c
o
n
siste
n
c
y
of
M
DTM
re
c
o
m
m
e
n
d
a
ti
o
n
s.
T
h
e
se
o
u
tco
m
e
s
c
o
n
firm
e
ffe
c
ti
v
e
n
e
ss
a
n
d
sc
a
lab
il
i
ty
fo
r
c
o
m
p
lex
m
u
lt
i
d
isc
ip
li
n
a
ry
c
li
n
ica
l
d
e
c
isio
n
s.
K
ey
w
o
r
d
s
:
AHP
C
lin
ical
d
ec
is
io
n
s
u
p
p
o
r
t
Gr
o
u
p
d
ec
is
io
n
s
u
p
p
o
r
t
s
y
s
tem
Mu
lti
-
ag
en
t
s
y
s
tem
Mu
ltid
is
cip
lin
ar
y
team
m
ee
tin
g
s
Neg
o
tiatio
n
p
r
o
to
co
l
PR
OM
E
T
HE
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II
T
h
is
is
an
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
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r
th
e
CC
BY
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SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
So
u
ad
Ma
d
o
u
r
i
Or
an
Gr
ad
u
ate
Sch
o
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of
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ics
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1.
I
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D
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Patien
ts
’
h
ea
lth
an
d
well
-
b
ei
n
g
a
r
e
o
f
ten
lin
k
ed
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m
u
lt
ip
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s
o
m
etim
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co
n
tr
ad
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r
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cr
iter
ia.
Me
d
ical
d
ec
is
io
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-
m
ak
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n
g
is
t
h
er
ef
o
r
e
a
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m
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lex
p
r
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s
s
,
in
v
o
lv
in
g
th
e
m
an
ag
e
m
en
t
of
cr
itical
ca
s
es,
th
e
allo
ca
tio
n
of
r
eso
u
r
ce
s
,
an
d
th
e
f
o
r
m
u
latio
n
of
h
ea
lth
p
o
licies.
Mu
ltip
le
s
tak
eh
o
ld
er
s
,
in
clu
d
in
g
n
u
r
s
es,
h
ea
lth
ca
r
e
ad
m
in
is
tr
ato
r
s
,
p
ati
en
ts
,
an
d
th
eir
f
am
ilies
,
ar
e
e
x
p
ec
ted
to
co
llab
o
r
ate
to
en
s
u
r
e
ev
id
e
n
ce
-
b
ased
,
in
d
iv
id
u
alize
d
,
a
n
d
s
u
s
tain
ab
le
o
u
tco
m
es
.
Mu
ltid
is
cip
lin
ar
y
co
n
s
u
ltatio
n
m
ee
tin
g
s
(
M
C
Ms)
,
co
m
m
o
n
ly
k
n
o
wn
as
m
u
ltid
is
cip
lin
ar
y
t
ea
m
m
ee
tin
g
s
(
MD
T
Ms)
,
ar
e
r
eg
u
lar
s
ess
io
n
s
th
at
b
r
in
g
to
g
eth
er
m
ed
ical
s
p
ec
ialis
t
s
s
u
ch
as
s
u
r
g
eo
n
s
,
o
n
co
lo
g
is
ts
,
an
d
r
ad
io
lo
g
is
ts
.
T
h
ese
m
ee
tin
g
s
aim
to
r
ev
ie
w
co
m
p
lex
p
atien
t
ca
s
es
an
d
d
ef
in
e
ap
p
r
o
p
r
iate
th
er
ap
eu
tic
s
tr
ateg
ies.
C
o
llectiv
e,
team
-
b
ased
d
ec
is
io
n
-
m
ak
in
g
is
ac
h
iev
ed
by
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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:
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I
n
d
o
n
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J
E
lec
E
n
g
&
C
o
m
p
Sci
,
Vo
l.
42
,
No
.
3
,
J
u
n
e
20
2
6
:
7
5
3
-
7
6
6
754
in
teg
r
atin
g
d
iv
er
s
e
ex
p
er
tis
e.
MD
T
Ms
can
en
h
an
ce
ca
r
e
q
u
ality
,
r
ed
u
ce
m
ed
ical
er
r
o
r
s
,
an
d
s
u
p
p
o
r
t
more
ef
f
ec
tiv
e
tr
ea
tm
en
t
p
lan
n
i
n
g
.
Ho
wev
er
,
g
i
v
en
lim
ited
r
eso
u
r
ce
s
,
in
clu
d
in
g
tim
e
an
d
av
ail
ab
ilit
y
of
tec
h
n
ical
f
ac
ilit
ies,
p
r
io
r
itizin
g
p
atien
ts
ac
co
r
d
in
g
to
clin
ical
s
ev
er
ity
an
d
u
r
g
en
c
y
b
ec
o
m
es
ess
en
tial.
In
o
n
co
lo
g
y
,
t
h
is
p
r
io
r
itizatio
n
with
in
MD
T
Ms
can
be
v
iewe
d
as
a
m
u
lti
-
cr
iter
ia
g
r
o
u
p
d
ec
is
io
n
-
m
ak
in
g
p
r
o
b
lem
.
T
h
e
k
ey
o
b
jectiv
es
ar
e:
i)
to
id
en
tify
p
atien
ts
at
h
ig
h
est
r
is
k
,
ii)
to
estab
lis
h
a
f
air
an
d
tr
an
s
p
ar
en
t
p
r
io
r
itizatio
n
p
r
o
ce
s
s
,
an
d
iii)
to
r
esp
ec
t
clin
ical,
h
u
m
an
,
an
d
l
o
g
is
tical
co
n
s
tr
ain
ts
.
Dec
is
io
n
s
u
p
p
o
r
t
s
y
s
tem
s
(
D
SS
)
ca
n
g
en
er
all
y
b
e
class
if
i
ed
in
to
two
m
ain
ca
te
g
o
r
ies:
in
d
iv
id
u
al
s
y
s
tem
s
an
d
co
llectiv
e
s
y
s
te
m
s
.
I
n
d
iv
id
u
al
d
ec
is
io
n
s
u
p
p
o
r
t
s
y
s
tem
s
(
I
DSS)
ar
e
d
esig
n
ed
to
ass
is
t
a
s
in
g
le
d
ec
is
io
n
-
m
ak
er
i
n
an
aly
zi
n
g
d
ata,
ev
alu
atin
g
alter
n
at
iv
es,
an
d
m
ak
in
g
well
-
in
f
o
r
m
ed
d
ec
is
io
n
s
[
1
]
.
Gr
o
u
p
d
ec
is
io
n
s
u
p
p
o
r
t
s
y
s
t
em
s
(
GDSS)
aim
to
f
ac
ilit
at
e
co
llab
o
r
ativ
e
d
ec
is
io
n
-
m
ak
i
n
g
am
o
n
g
m
u
ltip
le
p
ar
ticip
an
ts
with
h
e
ter
o
g
en
eo
u
s
p
r
ef
e
r
en
ce
s
[
2
]
.
Sev
er
al
GDSS
m
o
d
els
h
av
e
b
ee
n
p
r
o
p
o
s
ed
f
o
r
d
is
tr
ib
u
ted
an
d
a
s
y
n
ch
r
o
n
o
u
s
g
r
o
u
p
d
ec
is
io
n
s
,
f
o
r
n
e
g
o
tiatio
n
in
r
eso
u
r
ce
m
a
n
ag
e
m
en
t
[
3
]
,
an
d
f
o
r
co
o
r
d
in
atio
n
th
r
o
u
g
h
d
ialo
g
u
e
-
b
ased
s
y
s
tem
s
s
u
ch
as
DI
AL
[
4
]
.
Gen
er
al
n
e
g
o
tiatio
n
m
o
d
els
f
o
r
m
u
lti
-
ag
en
t
s
y
s
tem
s
(
MA
S)
h
av
e
also
b
ee
n
in
tr
o
d
u
ce
d
an
d
illu
s
tr
ated
th
r
o
u
g
h
a
p
p
lic
atio
n
s
s
u
c
h
as
au
ctio
n
s
an
d
ap
p
o
in
tm
e
n
t
s
ch
ed
u
lin
g
p
latf
o
r
m
s
[
5
]
.
Hy
b
r
id
ap
p
r
o
ac
h
es
co
m
b
i
n
in
g
MA
S
an
d
g
eo
g
r
ap
h
ic
in
f
o
r
m
atio
n
s
y
s
tem
s
h
av
e
b
ee
n
d
e
v
elo
p
ed
to
s
u
p
p
o
r
t
d
ec
is
io
n
-
m
a
k
in
g
in
en
v
ir
o
n
m
en
tal
an
d
ter
r
ito
r
ial
c
o
n
tex
ts
[
6
]
.
W
ith
in
th
is
r
esear
ch
a
r
ea
,
s
e
v
er
al
GDSS
h
av
e
b
ee
n
d
e
v
e
lo
p
ed
b
y
th
e
r
esear
ch
team
“Ar
tific
ial
I
n
tellig
en
ce
T
o
o
ls
in
Su
p
p
o
r
t o
f
Dec
is
io
n
-
Ma
k
in
g
Sy
s
tem
s
”
o
f
th
e
lab
o
r
ato
r
y
L
I
O.
T
h
ese
in
clu
d
e
a
GDSS f
o
r
ter
r
ito
r
ial
p
lan
n
in
g
b
ased
o
n
m
o
n
o
to
n
ic
co
n
ce
s
s
io
n
an
d
m
u
lticr
iter
ia
an
aly
s
is
[
7
]
,
a
m
u
l
ticr
iter
ia
GDSS
f
o
r
in
d
u
s
tr
ial
d
iag
n
o
s
is
[
8
]
,
a
s
p
atial
GDS
S
co
u
p
lin
g
m
u
lticr
iter
ia
an
aly
s
is
an
d
s
ati
s
f
ac
to
r
y
g
a
m
e
th
eo
r
y
[
9
]
,
an
d
a
n
eg
o
tiatio
n
p
latf
o
r
m
f
o
r
GDSS
u
s
in
g
web
s
er
v
ices
an
d
m
u
lticr
iter
ia
m
eth
o
d
s
[
1
0
]
.
M
an
y
GDSS
r
ely
o
n
MA
S
to
m
o
d
el
in
ter
ac
t
io
n
s
b
etwe
en
d
ec
is
io
n
-
m
ak
er
s
an
d
to
r
ea
ch
ac
ce
p
ta
b
le
ag
r
ee
m
en
ts
th
r
o
u
g
h
m
ec
h
an
is
m
s
s
u
ch
as
v
o
tin
g
,
n
eg
o
tiatio
n
,
an
d
ar
g
u
m
en
tati
o
n
.
Ar
g
u
m
e
n
tatio
n
-
b
ased
ap
p
r
o
ac
h
es
h
a
v
e
b
ee
n
p
r
o
p
o
s
ed
to
s
tr
u
ctu
r
e
r
ea
s
o
n
in
g
an
d
a
v
o
id
n
o
n
-
in
tu
itiv
e
o
u
tco
m
es
in
r
u
le
-
b
ased
s
y
s
t
e
m
s
[
1
1
]
.
Gen
e
r
al
f
r
am
ewo
r
k
s
f
o
r
a
r
g
u
m
e
n
tatio
n
-
b
ased
d
ec
is
io
n
-
m
ak
in
g
h
a
v
e
b
ee
n
in
t
r
o
d
u
ce
d
to
ex
p
lain
co
llectiv
e
d
ec
is
io
n
s
d
er
iv
ed
f
r
o
m
b
elief
s
an
d
p
r
ef
er
en
ce
s
[
1
2
]
.
C
o
n
ce
s
s
io
n
-
b
as
ed
n
eg
o
tiatio
n
s
tr
ateg
ies
h
av
e
also
b
ee
n
s
tu
d
ied
,
em
p
h
asizin
g
m
in
im
al
co
n
ce
s
s
i
o
n
m
ec
h
an
is
m
s
th
at
p
r
io
r
itize
h
ig
h
er
-
r
a
n
k
ed
g
o
als
[
1
3
]
.
Ad
d
itio
n
al
wo
r
k
s
p
r
o
p
o
s
e
p
o
s
tu
lates
f
o
r
l
o
g
ic
-
b
ased
ar
g
u
m
e
n
tatio
n
s
y
s
tem
s
[
1
4
]
a
n
d
ev
al
u
ate
tr
u
s
t
-
awa
r
e
ar
g
u
m
en
tatio
n
to
o
ls
in
co
llab
o
r
ativ
e
h
u
m
an
-
a
g
en
t
d
ec
is
io
n
-
m
ak
i
n
g
[
1
5
]
.
Mo
r
e
r
ec
en
tly
,
m
u
lti
-
ag
e
n
t
m
u
ltic
r
iter
ia
GDSS
h
av
e
b
ee
n
p
r
o
p
o
s
ed
f
o
r
s
p
atial
d
ec
is
io
n
p
r
o
b
lem
s
,
wh
er
e
ag
en
ts
n
eg
o
tiate
to
r
ea
ch
a
co
m
p
r
o
m
is
e
an
d
a
co
o
r
d
in
atio
n
m
ec
h
a
n
is
m
en
s
u
r
es
co
n
v
er
g
en
ce
b
e
f
o
r
e
a
d
ea
d
lin
e
[
1
6
]
.
W
eb
-
in
tellig
en
t
m
u
lticr
iter
ia
GDSS
in
teg
r
atin
g
MA
S
,
g
eo
g
r
ap
h
ic
i
n
f
o
r
m
atio
n
s
y
s
tem
s
,
an
d
m
u
lticr
iter
ia
m
eth
o
d
s
s
u
ch
as
T
OPSIS
an
d
AHP
h
a
v
e
also
b
ee
n
in
tr
o
d
u
ce
d
[
1
7
]
.
O
n
to
lo
g
y
-
b
ased
m
u
lticr
iter
ia
GDSS
h
av
e
b
ee
n
p
r
o
p
o
s
ed
to
ad
d
r
ess
s
em
an
tic
h
eter
o
g
en
eity
an
d
im
p
r
o
v
e
co
o
p
er
atio
n
a
m
o
n
g
d
ec
is
io
n
-
m
a
k
er
s
in
s
ite
s
elec
tio
n
p
r
o
b
lem
s
[
1
8
]
.
T
h
e
ap
p
licatio
n
o
f
GDSS
i
n
th
e
m
ed
ical
f
ield
h
as
g
a
in
ed
in
cr
ea
s
in
g
atten
tio
n
d
u
e
to
th
e
co
llab
o
r
ativ
e
n
atu
r
e
o
f
clin
i
ca
l
d
ec
is
io
n
-
m
ak
in
g
,
p
a
r
ticu
lar
ly
d
u
r
in
g
MD
T
Ms.
Sev
er
al
s
tu
d
ies
p
r
o
p
o
s
e
d
ec
is
io
n
s
u
p
p
o
r
t
f
r
am
ewo
r
k
s
to
ass
is
t
m
u
ltid
i
s
cip
lin
ar
y
m
e
d
ical
team
s
b
y
s
tr
u
ctu
r
in
g
clin
ical
r
ea
s
o
n
in
g
,
ag
g
r
eg
atin
g
ex
p
er
t
k
n
o
wled
g
e,
an
d
co
o
r
d
in
atin
g
th
e
o
v
er
a
ll
d
ec
is
io
n
wo
r
k
f
lo
w
[
1
9
]
.
Oth
er
ap
p
r
o
ac
h
es
r
el
y
o
n
m
u
lti
-
ag
e
n
t
d
ec
is
io
n
s
u
p
p
o
r
t
b
ased
o
n
m
ed
ical
o
n
to
lo
g
ies,
wh
er
e
s
p
ec
ialized
ag
en
ts
r
ep
r
esen
t
d
if
f
e
r
en
t
m
ed
ical
d
o
m
ain
s
an
d
co
o
p
er
at
e
to
g
en
er
ate
c
o
n
s
is
ten
t r
ec
o
m
m
en
d
atio
n
s
d
u
r
in
g
MD
T
Ms [
2
0
]
.
Mo
r
e
r
ec
en
tly
,
AI
-
b
ased
c
lin
i
ca
l
d
ec
is
io
n
s
u
p
p
o
r
t
s
y
s
tem
s
(
C
DSS
)
h
as
b
ee
n
s
h
o
wn
to
s
u
p
p
o
r
t
tr
iag
e
o
f
b
r
ea
s
t
ca
n
ce
r
ca
s
es
d
u
r
in
g
MD
T
Ms,
allo
win
g
a
s
u
b
s
tan
tial
p
r
o
p
o
r
t
io
n
o
f
p
atien
ts
to
b
e
s
af
ely
m
an
a
g
ed
wh
ile
r
ed
u
cin
g
team
wo
r
k
lo
ad
an
d
p
r
eser
v
i
n
g
co
n
c
o
r
d
a
n
ce
with
clin
ical
b
est
p
r
ac
tic
e
[
2
1
]
.
Qu
alitativ
e
in
v
esti
g
atio
n
s
h
ig
h
lig
h
t
f
ac
ilit
ato
r
s
s
u
ch
as
im
p
r
o
v
ed
v
is
u
aliza
tio
n
o
f
p
atien
t
in
f
o
r
m
ati
o
n
an
d
tim
e
-
s
av
in
g
f
u
n
ctio
n
a
liti
es,
as
well
as
b
a
r
r
ier
s
r
elate
d
to
d
ata
c
o
n
n
ec
tiv
ity
,
ac
cu
r
ac
y
o
f
r
ec
o
m
m
e
n
d
atio
n
s
,
g
u
id
elin
e
u
p
d
ates,
a
n
d
p
r
eser
v
atio
n
o
f
clin
ician
r
esp
o
n
s
ib
ilit
y
d
u
r
i
n
g
MD
T
Ms
[
2
2
]
.
G
u
id
elin
e
-
b
as
ed
d
ec
is
io
n
s
u
p
p
o
r
t
h
as
also
b
ee
n
in
v
esti
g
ated
in
o
n
co
lo
g
ical
MD
T
Ms,
d
em
o
n
s
tr
atin
g
h
ig
h
co
n
co
r
d
a
n
ce
with
MD
T
M
d
ec
is
io
n
s
wh
en
s
u
f
f
icien
t
p
atien
t
d
ata
a
r
e
av
ailab
le,
wh
ile
also
r
ev
ea
l
in
g
lim
itatio
n
s
r
elate
d
to
d
ata
co
m
p
leten
ess
an
d
wo
r
k
f
lo
w
co
n
s
tr
ain
ts
in
r
o
u
tin
e
p
r
ac
tice
[
2
3
]
.
T
h
e
o
b
jectiv
e
o
f
th
e
c
u
r
r
en
t
s
tu
d
y
is
to
d
ev
elo
p
a
m
u
lticr
iter
ia
g
r
o
u
p
m
ed
ical
d
ec
is
io
n
s
u
p
p
o
r
t
s
y
s
tem
th
at
im
p
r
o
v
es
th
e
ef
f
e
ctiv
en
ess
o
f
MD
T
Ms.
T
h
is
is
ac
h
iev
ed
b
y
in
teg
r
atin
g
MA
S
with
m
u
lticr
iter
ia
d
ec
is
io
n
an
aly
s
is
m
eth
o
d
s
.
T
h
e
p
r
o
p
o
s
ed
s
y
s
tem
s
tr
u
ct
u
r
es
ex
p
er
t
d
is
cu
s
s
io
n
s
,
s
u
p
p
o
r
ts
th
e
co
llectiv
e
ev
alu
a
tio
n
o
f
p
atien
t
ca
s
es,
a
n
d
p
r
o
m
o
tes
in
f
o
r
m
ed
co
n
s
e
n
s
u
s
.
T
h
e
ca
s
e
s
tu
d
y
f
o
cu
s
es
o
n
id
e
n
tify
in
g
th
e
ca
n
ce
r
p
atien
t a
t
h
ig
h
est r
is
k
i
n
o
r
d
e
r
to
p
r
io
r
itize
ca
r
e
d
u
r
in
g
MD
T
Ms.
T
h
e
r
em
ain
d
e
r
o
f
t
h
e
p
ap
e
r
is
o
r
g
an
ized
as f
o
llo
ws
:
Sectio
n
1
p
r
esen
ts
th
e
in
tr
o
d
u
cti
o
n
,
o
u
tlin
in
g
th
e
co
n
tex
t,
th
e
ad
d
r
ess
ed
p
r
o
b
l
em
,
th
e
r
elate
d
wo
r
k
s
,
an
d
t
h
e
co
n
tr
i
b
u
tio
n
o
f
th
e
p
r
esen
t
s
tu
d
y
.
Sectio
n
2
d
escr
ib
es
th
e
m
eth
o
d
o
lo
g
y
o
f
th
e
p
r
o
p
o
s
ed
s
y
s
tem
,
in
cl
u
d
in
g
th
e
f
o
r
m
u
latio
n
o
f
th
e
ad
d
r
ess
ed
d
ec
is
io
n
-
m
ak
in
g
p
r
o
b
lem
.
I
t
ex
p
lain
s
t
h
e
im
p
lem
en
te
d
n
e
g
o
tiatio
n
p
r
o
to
co
l
a
n
d
p
r
esen
ts
th
e
UM
L
m
o
d
elin
g
o
f
th
e
s
y
s
tem
,
f
o
llo
wed
b
y
a
d
escr
ip
tio
n
o
f
th
e
ad
o
p
ted
d
ec
is
io
n
-
m
ak
in
g
p
r
o
ce
s
s
.
Sectio
n
3
il
lu
s
tr
ates
th
e
o
v
er
all
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
d
o
n
esian
J
E
lec
E
n
g
&
C
o
m
p
Sci
I
SS
N:
2502
-
4
7
5
2
A
mu
lticr
iter
ia
co
lla
b
o
r
a
tive
d
ec
is
io
n
s
u
p
p
o
r
t sys
tem
fo
r
mu
l
tid
is
cip
lin
a
r
y
med
ica
l
…
(
S
o
u
a
d
Ma
d
o
u
r
i
)
755
ap
p
r
o
ac
h
th
r
o
u
g
h
a
ca
s
e
s
tu
d
y
,
f
o
cu
s
in
g
o
n
th
e
p
r
o
b
lem
f
o
r
m
u
latio
n
an
d
th
e
o
b
t
ain
ed
r
esu
lts
at
th
e
en
d
o
f
th
e
n
eg
o
tiatio
n
p
r
o
ce
s
s
.
Fin
ally
,
Sectio
n
4
co
n
clu
d
es a
n
d
p
r
o
p
o
s
es e
x
ten
s
io
n
s
o
f
th
e
s
y
s
tem
.
R
esear
ch
g
ap
an
d
k
ey
c
o
n
tr
i
b
u
tio
n
s
.
T
o
th
e
b
est
o
f
o
u
r
k
n
o
wled
g
e,
n
o
n
e
o
f
th
e
ex
is
tin
g
s
tu
d
ies
jo
in
tly
in
teg
r
ate
m
u
lticr
iter
ia
d
ec
is
io
n
-
m
ak
in
g
m
eth
o
d
s
an
d
m
u
lti
-
ag
en
t
n
eg
o
tiatio
n
with
in
a
u
n
if
ied
f
r
am
ewo
r
k
s
p
ec
if
ically
d
esi
g
n
ed
to
s
u
p
p
o
r
t
co
llab
o
r
ati
v
e
p
atien
t
p
r
io
r
itizatio
n
in
MD
T
Ms.
T
h
is
g
ap
m
o
tiv
ates
th
e
p
r
o
p
o
s
ed
ap
p
r
o
ac
h
,
wh
ich
co
n
tr
i
b
u
tes:
i)
a
G
DSS
m
o
d
elin
g
MD
T
M
d
e
cisi
o
n
-
m
ak
i
n
g
u
s
i
n
g
a
Mu
lti
-
Ag
en
t
Sy
s
tem
an
d
a
s
t
r
u
ctu
r
ed
n
e
g
o
tiatio
n
p
r
o
to
co
l,
ii)
an
in
teg
r
ated
m
u
lticr
iter
ia
d
ec
is
io
n
p
r
o
ce
s
s
co
m
b
in
in
g
AHP,
PR
OM
E
T
HE
E
I
I
,
an
d
SC
OR
AGE
to
s
u
p
p
o
r
t
in
d
iv
i
d
u
al
p
r
e
f
er
en
ce
ex
p
r
ess
io
n
an
d
co
llectiv
e
co
n
v
er
g
e
n
ce
,
an
d
iii)
a
s
en
s
itiv
ity
an
d
r
o
b
u
s
tn
ess
an
aly
s
is
ass
e
s
s
in
g
th
e
s
tab
ilit
y
o
f
th
e
co
llab
o
r
ativ
e
d
e
cisi
o
n
u
n
d
er
v
ar
iatio
n
s
in
th
e
p
r
e
f
er
en
ce
s
ex
p
r
ess
ed
b
y
d
o
cto
r
s
.
2.
M
E
T
H
O
D
T
h
is
s
ec
tio
n
p
r
esen
ts
our
p
r
o
p
o
s
ed
m
eth
o
d
,
in
clu
d
in
g
th
e
f
o
r
m
u
latio
n
of
t
h
e
m
ed
ical
d
ec
is
io
n
-
m
ak
in
g
p
r
o
b
lem
,
th
e
s
y
s
tem
a
r
ch
itectu
r
e
,
an
d
th
e
n
eg
o
tiatio
n
p
r
o
t
o
co
l
f
o
r
r
ea
c
h
in
g
a
c
o
llab
o
r
ativ
e
d
ec
is
io
n
.
2
.
1
.
F
o
rm
ula
t
i
o
n
of
t
he
a
dd
re
s
s
ed
dec
is
io
n
-
m
a
k
ing
pro
blem
Ob
jectiv
e
:
I
d
en
tif
y
in
g
th
e
p
atien
t
m
o
s
t
at
r
is
k
an
d
p
r
io
r
itizin
g
h
is
or
h
er
ca
r
e.
T
h
e
g
lo
b
al
f
o
r
m
u
latio
n
of
t
h
e
p
r
o
b
lem
is
g
iv
en
by
(
A,
F,
PM,
d,
weig
h
t
(
d
)
,
SPi,
T)
−
A:
th
e
s
et
ac
tio
n
s
(
r
o
ws):
each
p
atien
t.
−
F:
th
e
f
am
ily
of
cr
iter
ia
(
co
l
u
m
n
s
)
:
th
e
cr
iter
ia
i
d
en
tifie
d
to
a
d
d
r
ess
th
is
d
ec
is
io
n
-
m
ak
in
g
is
s
u
e
ar
e
d
escr
ib
ed
in
T
a
b
le
1.
−
PM:
co
n
s
is
tin
g
of
an
in
cid
e
n
c
e
m
atr
ix
of
ac
tio
n
s
an
d
c
r
iter
ia
.
−
d:
th
e
n
u
m
b
er
of
th
e
i
n
v
o
lv
e
d
d
ec
is
io
n
m
ak
er
s
(
d
o
cto
r
s
)
.
−
weig
h
t
(
d
)
:
th
e
weig
h
t
of
each
d
o
cto
r
in
th
e
g
r
o
u
p
d
ec
is
io
n
p
r
o
ce
s
s
.
−
SPi:
p
r
ef
er
en
ce
s
(
s
u
b
jectiv
e
p
ar
am
eter
s
)
of
each
d
o
cto
r
a
cc
o
r
d
in
g
to
th
e
id
e
n
tifie
d
cr
iter
ia
(
weig
h
t,
p
r
ef
er
en
ce
,
in
d
if
f
er
en
ce
)
−
T:
n
eg
o
tiatio
n
th
r
esh
o
ld
.
Du
e
to
th
e
lack
of
av
ailab
le
r
e
al
-
wo
r
ld
d
ata,
we
p
r
o
p
o
s
e
an
alg
o
r
ith
m
d
esig
n
e
d
to
g
en
er
at
e
s
y
n
th
etic
d
ata.
T
h
is
A
lg
o
r
ith
m
1
is
ca
r
ef
u
lly
co
n
s
tr
u
cted
to
p
r
eser
v
e
th
e
u
n
d
er
l
y
in
g
lo
g
ic
of
th
e
r
elatio
n
s
h
ip
s
b
etwe
en
th
e
id
en
tifie
d
c
r
iter
ia,
en
s
u
r
i
n
g
th
e
co
h
er
en
ce
an
d
r
elev
an
c
e
of
th
e
g
en
e
r
ated
d
ata.
T
h
is
ap
p
r
o
ac
h
p
r
o
v
id
es
a
u
s
ab
le
d
ataset
f
o
r
test
in
g
,
v
ali
d
atio
n
,
or
m
o
d
elin
g
p
h
ases
,
wh
ile
ac
cu
r
ately
r
e
f
lectin
g
th
e
ex
p
ec
ted
s
tr
u
ctu
r
e
of
th
e
p
r
o
b
lem
u
n
d
er
s
tu
d
y
.
A
lg
o
r
it
h
m
1
:
G
en
er
at
io
n
of
a
P
er
f
o
r
m
an
c
e
M
at
r
ix
f
o
r
P
at
ie
n
t
P
r
io
r
it
i
z
at
io
n
Input:
num_patients
Output:
performance_matrix
Initialization:
Performance_matrix←[]
For
i←1
to
num_patients
do
T←
random
value
from
{1,
2,
3,
4}
▷
Tumor
stage
N←
random
value
from
{0,
1,
2,
3}
▷
Lymph
nodes
If
T≥
3
and
N≥
2
then
M←1
▷
Presence
of
metastases
else
M←
random
value
from
{0,1}
endif
▷
Calculation
of
OMS
score
If
T≤2
and
M=0
then
oms_score←
random
value
from
{0,1}
elseif
T=3
or
N=1
then
oms_score←
random
value
from
{2,3}
else
oms_score←
random
value
from
{4,5}
endif
▷
Calculation
of
Ki
-
67
score
If
T≤2
and
M=0
then
ki67←random
number
between
5
and
30
elseif
T=3
or
N=1then
ki67←
random
number
between
31
and
60
else
ki67←
random
number
between
61
and
90
endif
▷
Determination
of
disease_phase
If
M
=1
or
ki67
>30
then
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
5
0
2
-
4
7
5
2
I
n
d
o
n
esian
J
E
lec
E
n
g
&
C
o
m
p
Sci
,
Vo
l.
42
,
No
.
3
,
J
u
n
e
20
2
6
:
7
5
3
-
7
6
6
756
disease_phase←1
▷
Relapse
else
disease_phase←0
▷
Initial
phase
endif
Add(T,
N,
M,
oms_score,
ki67,
disease_phase)
endfor
return
performance_matrix
T
ab
le
1
.
C
r
iter
ia
o
f
t
h
e
p
er
f
o
r
m
an
ce
m
atr
ix
C
r
i
t
e
r
i
a
D
e
scri
p
t
i
o
n
V
a
l
u
e
s
Tu
m
o
r
st
a
g
e
(
T)
Tu
m
o
r
si
z
e
a
n
d
l
o
c
a
l
e
x
t
e
n
s
i
o
n
-
1
:
N
o
t
a
ss
e
sse
d
(
T
x
)
;
0
:
N
o
t
u
mo
r
(
T
0
)
;
0
.
1
-
0
.
2
:
I
n
si
t
u
(
Ti
s
,
P
a
g
e
t
)
;
1
.
0
-
1
.
3
:
S
ma
l
l
mass
,
n
o
l
a
r
g
e
r
t
h
a
n
2
c
m (T
1
mi
c
,
T1
a
-
c
)
;
2
:
M
a
ss m
e
a
s
u
r
i
n
g
b
e
t
w
e
e
n
2
a
n
d
5
c
m (T2
)
;
3
:
M
a
ss
g
r
e
a
t
e
r
t
h
a
n
5
c
m
(
T3
)
;
4
.
1
-
4
.
4
:
I
n
v
o
l
v
e
m
e
n
t
o
f
a
d
j
a
c
e
n
t
s
t
r
u
c
t
u
r
e
s
(
T4
a
-
d
)
.
N
o
d
e
s (N
)
Ly
m
p
h
n
o
d
e
i
n
v
o
l
v
e
me
n
t
-
1
:
N
o
t
a
ss
e
sse
d
(
N
x
)
;
0
.
0
-
0
.
4
:
N
o
n
o
d
e
s
i
n
v
o
l
v
e
d
(
N
0
,
N
0
(
i
-
,
i
+
,
m
o
l
-
,
m
o
l
+
)
)
;
0
.
5
:
M
i
c
r
o
me
t
a
s
t
a
s
e
s (N
1
mi
)
;
1
.
0
-
1
.
3
:
M
o
d
e
r
a
t
e
i
n
v
o
l
v
e
me
n
t
o
f
n
e
a
r
b
y
l
y
mp
h
n
o
d
e
s (N
1
,
N
1
a
-
c
)
;
2
.
0
–
2
.
2
:
M
o
r
e
a
d
v
a
n
c
e
d
o
r
i
n
t
e
r
n
a
l
l
y
mp
h
n
o
d
e
i
n
v
o
l
v
e
me
n
t
(
N
2
,
N
2
a
–
b)
;
3
.
0
–
3
.
3
:
E
x
t
e
n
s
i
v
e
l
y
m
p
h
n
o
d
e
i
n
v
o
l
v
e
me
n
t
,
e
s
p
e
c
i
a
l
l
y
su
p
r
a
c
l
a
v
i
c
u
l
a
r
o
r
c
o
m
b
i
n
e
d
(
N
3
,
N
3
a
–
c
)
.
P
r
e
sen
c
e
o
f
met
a
s
t
a
s
e
s (
M
)
I
n
d
i
c
a
t
e
s
w
h
e
t
h
e
r
t
h
e
c
a
n
c
e
r
h
a
s
p
r
o
g
r
e
ssed
t
o
o
t
h
e
r
b
o
d
y
r
e
g
i
o
n
s,
a
si
g
n
o
f
a
d
v
a
n
c
e
d
st
a
g
e
.
-
1
:
N
o
t
a
ss
e
sse
d
(
M
x
)
;
0
:
N
o
m
e
t
a
st
a
si
s
(
M
0
)
;
1
:
D
i
st
a
n
t
m
e
t
a
st
a
si
s
p
r
e
s
e
n
t
(
M
1
)
.
O
M
S
P
a
t
i
e
n
t
's
g
e
n
e
r
a
l
c
o
n
d
i
t
i
o
n
0:
A
b
l
e
t
o
w
a
l
k
a
n
d
p
e
r
f
o
r
m
l
i
g
h
t
o
r
s
e
d
e
n
t
a
r
y
t
a
sk
s
,
b
u
t
l
i
m
i
t
e
d
i
n
p
h
y
si
c
a
l
l
y
d
e
m
a
n
d
i
n
g
a
c
t
i
v
i
t
i
e
s.
1:
A
m
b
u
l
a
t
o
r
y
a
n
d
c
a
p
a
b
l
e
o
f
a
l
l
se
l
f
c
a
r
e
b
u
t
u
n
a
b
l
e
t
o
c
a
r
r
y
o
u
t
a
n
y
w
o
r
k
a
c
t
i
v
i
t
i
e
s;
u
p
a
n
d
a
b
o
u
t
mo
r
e
t
h
a
n
5
0
%
o
f
w
a
k
i
n
g
h
o
u
r
s.
2
:
C
a
p
a
b
l
e
o
f
o
n
l
y
l
i
m
i
t
e
d
s
e
l
f
c
a
r
e
;
c
o
n
f
i
n
e
d
t
o
b
e
d
o
r
c
h
a
i
r
mo
r
e
t
h
a
n
5
0
%
o
f
w
a
k
i
n
g
h
o
u
r
s.
3:
C
o
mp
l
e
t
e
l
y
d
i
sa
b
l
e
d
;
c
a
n
n
o
t
c
a
r
r
y
o
n
a
n
y
se
l
f
c
a
r
e
;
t
o
t
a
l
l
y
c
o
n
f
i
n
e
d
t
o
b
e
d
o
r
c
h
a
i
r
.
4
:
D
e
a
d
.
D
i
sea
s
e
p
h
a
se
D
e
t
e
r
m
i
n
e
i
f
t
h
e
p
a
t
i
e
n
t
i
s
i
n
t
h
e
i
n
i
t
i
a
l
p
h
a
se
(
a
t
t
h
e
t
i
me
o
f
d
i
a
g
n
o
si
s)
o
r
i
n
r
e
l
a
p
se
(
r
e
c
u
r
r
e
n
c
e
a
f
t
e
r
t
r
e
a
t
m
e
n
t
)
.
0
:
I
n
i
t
i
a
l
;
1:
R
e
l
a
p
se
.
2
.
2
.
T
he
pro
po
s
ed
s
y
s
t
em
T
h
e
p
r
o
p
o
s
ed
g
r
o
u
p
DSS
is
m
ain
ly
co
m
p
o
s
ed
of
a
web
s
e
r
v
er
,
a
MA
S
,
an
d
a
n
eg
o
tiatio
n
p
r
o
to
c
o
l
.
T
h
e
m
ain
co
m
p
o
n
en
ts
ar
e
d
es
cr
ib
ed
b
elo
w:
2
.
2
.
1
.
T
he
web
s
er
v
er
It
ac
ts
as
th
e
ce
n
tr
al
p
latf
o
r
m
f
o
r
co
o
r
d
in
atio
n
an
d
co
m
m
u
n
icatio
n
.
It
r
ec
eiv
es
th
e
f
in
al
g
r
o
u
p
d
ec
is
io
n
an
d
can
s
er
v
e
as
an
in
ter
f
ac
e
f
o
r
u
s
er
s
or
e
x
ter
n
al
s
y
s
tem
s
(
e.
g
.
,
elec
tr
o
n
ic
m
ed
ical
r
ec
o
r
d
s
an
d
h
o
s
p
ital
s
taf
f
)
.
2
.
2
.
2
.
T
he
m
ulti
-
a
g
ent
s
y
s
t
e
m
It
m
o
d
els
th
e
m
ed
ical
GDSS
an
d
is
s
tr
u
ctu
r
ed
ar
o
u
n
d
a
Ne
g
o
tiato
r
ag
e
n
t,
Par
ticip
an
t
ag
e
n
ts
,
an
d
a
n
eg
o
tiatio
n
p
r
o
to
c
o
l.
−
Neg
o
tiato
r
a
g
en
t
T
h
is
ag
en
t
is
au
to
n
o
m
o
u
s
an
d
in
d
ep
en
d
en
t
f
r
o
m
th
e
d
ec
is
io
n
-
m
ak
er
s
.
It
o
r
ch
estra
tes
th
e
n
eg
o
tiatio
n
p
r
o
ce
s
s
.
T
h
e
m
ain
f
u
n
ctio
n
s
of
th
is
ag
en
t
ar
e:
i)
Sen
d
in
g
th
e
p
er
f
o
r
m
a
n
ce
m
atr
ix
to
th
e
p
ar
ticip
atin
g
ag
en
ts
.
ii)
C
o
llectin
g
th
e
lo
ca
l
r
an
k
in
g
s
of
th
e
p
atien
ts
p
r
o
d
u
ce
d
by
each
p
ar
ticip
an
t.
iii)
I
n
itiatin
g
an
d
r
eg
u
latin
g
th
e
n
eg
o
tiatio
n
p
r
o
to
c
o
l
b
etwe
e
n
th
e
p
ar
ticip
atin
g
ag
en
ts
.
iv
)
E
n
s
u
r
in
g
th
e
c
o
n
s
is
ten
cy
,
f
air
n
ess
,
an
d
co
n
v
er
g
en
ce
of
th
e
d
ec
is
io
n
-
m
ak
in
g
p
r
o
ce
s
s
.
v)
Gen
e
r
atin
g
th
e
co
llab
o
r
ativ
e
d
ec
is
io
n
.
−
Par
ticip
an
t
a
g
en
ts
(
Do
c
to
r
s
)
T
h
ese
ag
en
ts
r
ep
r
esen
t
th
e
h
u
m
an
d
ec
is
io
n
-
m
a
k
er
s
(
d
o
cto
r
s
)
.
E
ac
h
ag
en
t
in
clu
d
e
s
:
Per
s
o
n
al
p
r
ef
er
en
ce
s
an
d
m
u
lti
-
cr
iter
ia
d
ec
is
io
n
an
aly
s
is
(
M
C
DA
)
m
eth
o
d
s
:
AHP
f
o
r
cr
iter
ia
weig
h
tin
g
,
an
d
PR
OM
E
T
HE
E
II
f
o
r
r
an
k
in
g
th
e
alter
n
ativ
es
(
p
atien
ts
)
.
T
h
e
m
ain
f
u
n
ctio
n
s
of
ea
ch
p
ar
ticip
an
t
ar
e
:
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
d
o
n
esian
J
E
lec
E
n
g
&
C
o
m
p
Sci
I
SS
N:
2502
-
4
7
5
2
A
mu
lticr
iter
ia
co
lla
b
o
r
a
tive
d
ec
is
io
n
s
u
p
p
o
r
t sys
tem
fo
r
mu
l
tid
is
cip
lin
a
r
y
med
ica
l
…
(
S
o
u
a
d
Ma
d
o
u
r
i
)
757
i)
R
ec
eiv
in
g
a
p
er
f
o
r
m
a
n
ce
m
atr
ix
s
en
t
by
t
h
e
n
e
g
o
tiato
r
ag
en
t.
ii)
Ap
p
ly
in
g
AHP
to
a
s
s
ig
n
weig
h
ts
to
th
e
id
en
tifie
d
cr
iter
ia.
iii)
Ap
p
ly
in
g
PR
OM
E
T
HE
E
II
to
g
en
er
ate
a
lo
ca
l
r
an
k
in
g
of
th
e
p
atien
ts
.
iv
)
Par
ticip
atin
g
in
a
n
eg
o
tiatio
n
th
r
o
u
g
h
a
m
u
l
ti
-
ag
en
t
p
r
o
to
co
l.
2
.
2
.
3
.
Neg
o
t
i
a
t
io
n
pro
t
o
c
o
l
C
o
n
s
titu
tes
a
m
ec
h
an
is
m
f
o
r
in
ter
ac
tio
n
b
etwe
en
p
ar
ticip
a
n
t
ag
en
ts
,
s
u
p
e
r
v
is
ed
by
th
e
n
eg
o
tiato
r
ag
en
t.
I
ts
o
b
jectiv
e
is
to
r
ea
c
h
a
co
n
s
en
s
u
s
by
tak
in
g
in
to
ac
co
u
n
t
th
e
d
ec
is
io
n
-
m
ak
e
r
s
’
weig
h
ts
as
we
ll
as
th
eir
r
an
k
in
g
s
of
th
e
p
atien
ts
ac
co
r
d
in
g
to
th
eir
p
r
ef
er
en
ce
s
.
T
h
e
d
escr
ip
tio
n
of
th
is
p
r
o
t
o
co
l
is
g
i
v
en
in
th
e
n
ex
t
s
ec
tio
n
.
R
em
ar
k
:
T
h
e
p
er
f
o
r
m
an
ce
m
atr
ix
r
ep
r
esen
ts
th
e
q
u
an
titativ
e
ass
ess
m
en
t
of
p
atien
ts
(
alter
n
ativ
es)
ac
co
r
d
in
g
to
v
ar
i
o
u
s
m
ed
ical
cr
iter
ia.
T
h
is
m
atr
ix
is
p
r
o
v
id
e
d
by
th
e
c
o
o
r
d
in
ato
r
a
n
d
u
s
ed
by
each
p
ar
ticip
an
t
ag
en
t
to
g
en
er
ate
its
o
w
n
r
a
n
k
in
g
.
T
h
e
o
v
er
all
a
r
ch
itectu
r
e
of
t
h
e
p
r
o
p
o
s
ed
s
y
s
tem
is
illu
s
tr
ated
in
th
e
Fig
u
r
e
1.
Fig
u
r
e
1.
T
h
e
o
v
er
all
ar
ch
itect
u
r
e
of
t
h
e
p
r
o
p
o
s
ed
s
y
s
tem
2
.
3
.
T
he
neg
o
t
ia
t
io
n
pro
t
o
co
l
T
h
e
p
r
o
to
co
l
u
n
d
er
g
o
es
s
ev
er
al
s
tag
es
to
r
ea
ch
a
g
r
o
u
p
d
ec
i
s
io
n
,
as
o
u
tlin
ed
b
elo
w.
2
.
3
.
1
.
Ste
ps
of
t
he
pro
t
o
c
o
l
STE
P
1
:
Sen
d
in
g
th
e
d
ec
is
io
n
p
r
o
b
lem
(
p
er
f
o
r
m
an
ce
m
atr
ix
(
PM)
)
:
th
is
p
h
ase
of
t
h
e
p
r
o
to
c
o
l
co
n
s
is
ts
of
f
o
r
m
u
latin
g
th
e
d
ec
is
io
n
p
r
o
b
lem
in
th
e
f
o
r
m
of
a
p
e
r
f
o
r
m
an
ce
m
atr
i
x
,
w
h
ich
ev
alu
ates
th
e
d
if
f
er
en
t
p
o
s
s
ib
le
alter
n
ativ
es
(
p
atien
ts
)
ac
co
r
d
i
n
g
to
s
ev
e
r
al
cr
iter
ia.
STE
P
2:
As
s
ig
n
in
g
weig
h
ts
to
th
e
d
ec
is
io
n
-
m
ak
er
s
u
s
in
g
AHP
m
eth
o
d
:
o
n
ce
th
is
m
atr
ix
is
r
ec
eiv
ed
by
th
e
v
ar
io
u
s
d
ec
is
io
n
-
m
a
k
e
r
s
,
th
e
n
e
g
o
tiato
r
ass
ig
n
s
a
weig
h
t
to
each
d
ec
is
io
n
in
o
r
d
er
to
r
ef
lect
t
h
eir
r
elativ
e
im
p
o
r
tan
ce
in
th
e
d
e
cisi
o
n
-
m
ak
in
g
p
r
o
ce
s
s
.
To
do
s
o
,
th
e
n
e
g
o
tiato
r
u
s
es
th
e
m
u
lticr
iter
ia
m
eth
o
d
AHP
[
2
4
]
,
an
ap
p
r
o
ac
h
d
ev
elo
p
ed
by
T
h
o
m
as
Saaty
th
at
allo
ws
p
air
wis
e
co
m
p
ar
is
o
n
s
of
th
e
d
ec
is
io
n
-
m
ak
er
s
an
d
ca
lcu
lates
co
n
s
is
ten
t
weig
h
ts
r
ef
lectin
g
th
eir
r
esp
ec
tiv
e
co
n
tr
ib
u
tio
n
s
to
th
e
d
ec
is
io
n
p
r
o
ce
s
s
.
STE
P
3:
R
an
k
in
g
th
e
ac
tio
n
s
(
p
atien
ts
)
:
is
an
ess
en
tial
p
ar
t
of
th
e
d
ec
is
io
n
-
m
a
k
in
g
pr
o
ce
s
s
,
ca
r
r
ied
out
by
e
v
er
y
d
ec
is
io
n
-
m
ak
er
with
th
e
h
elp
of
AHP
a
n
d
PR
OM
E
T
HE
E
II
m
eth
o
d
s
.
Fir
s
t,
AHP
is
u
s
ed
to
ass
ig
n
weig
h
ts
to
t
h
e
cr
iter
i
a
ac
co
r
d
in
g
to
t
h
eir
r
elativ
e
im
p
o
r
tan
ce
.
T
h
is
m
eth
o
d
is
b
ased
on
p
air
wis
e
co
m
p
ar
is
o
n
s
,
allo
win
g
f
o
r
a
n
o
r
m
alize
d
weig
h
tin
g
of
th
e
cr
iter
ia
th
at
in
f
lu
en
ce
t
h
e
d
ec
is
io
n
.
On
ce
th
e
weig
h
ts
ar
e
d
ef
in
ed
,
PR
OM
E
T
HE
E
II
[
2
5
]
is
ap
p
lied
to
ass
es
s
an
d
r
an
k
th
e
d
if
f
e
r
en
t
alter
n
ativ
es.
T
h
is
m
eth
o
d
co
m
p
ar
es
t
he
ac
tio
n
s
by
tak
in
g
i
n
to
ac
co
u
n
t
th
e
d
ec
is
io
n
-
m
ak
er
s
’
p
r
ef
er
e
n
ce
s
,
wh
ile
co
n
s
id
er
in
g
th
r
esh
o
ld
s
(
p
r
ef
e
r
en
ce
an
d
in
d
if
f
er
en
ce
th
r
esh
o
ld
s
)
,
an
d
ca
lcu
lates
p
o
s
itiv
e
an
d
n
eg
ativ
e
p
r
ef
er
en
ce
f
lo
ws,
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
5
0
2
-
4
7
5
2
I
n
d
o
n
esian
J
E
lec
E
n
g
&
C
o
m
p
Sci
,
Vo
l.
42
,
No
.
3
,
J
u
n
e
20
2
6
:
7
5
3
-
7
6
6
758
lead
in
g
to
a
f
in
al
co
m
p
lete
r
a
n
k
in
g
of
t
h
e
alter
n
ativ
es.
T
h
e
co
m
b
in
atio
n
of
th
ese
two
m
e
th
o
d
s
en
s
u
r
es
m
o
r
e
r
atio
n
al
an
d
well
-
ju
s
tifie
d
d
ec
is
io
n
-
m
ak
in
g
by
i
n
teg
r
atin
g
b
o
th
th
e
d
e
cisi
o
n
-
m
ak
e
r
s
’
p
r
io
r
ities
an
d
a
co
m
p
ar
ativ
e
a
n
aly
s
is
of
th
e
av
ailab
le
ac
tio
n
s
.
STE
P
4:
Sco
r
in
g
th
e
ac
tio
n
s
:
ca
r
r
ied
out
b
y
th
e
n
eg
o
tiato
r
,
th
is
s
tep
c
o
n
s
is
ts
of
ag
g
r
e
g
atin
g
th
e
in
d
iv
id
u
al
r
a
n
k
in
g
s
of
all
d
ec
is
io
n
-
m
ak
er
s
in
o
r
d
er
to
g
e
n
er
a
te
a
g
lo
b
al
r
an
k
i
n
g
of
th
e
alter
n
ativ
es.
To
do
th
is
,
we
u
s
e
th
e
f
o
llo
win
g
ag
g
r
e
g
at
io
n
f
o
r
m
u
la
to
a
f
f
ec
t
a
s
co
r
e
to
each
p
atien
t
(a
i
)
,
S
co
r
e(
a
i
)=
∑
ℎ
(
)
∗
(
,
)
=
1
)
(
1
)
On
ce
th
e
g
lo
b
al
s
co
r
es
ca
lcu
lated
,
th
e
alter
n
ativ
es
ar
e
r
an
k
e
d
b
ased
on
t
h
eir
o
b
tain
ed
v
al
u
e
s
.
STE
P
5:
Pro
p
o
s
al
of
a
d
ea
l:
th
e
p
r
o
p
o
s
al
s
tep
is
a
k
ey
p
h
a
s
e
d
u
r
in
g
wh
ich
th
e
n
eg
o
tiato
r
p
r
o
p
o
s
es
ac
tio
n
s
to
th
e
o
th
er
p
a
r
ticip
atin
g
ag
en
ts
(
d
ec
is
io
n
-
m
ak
er
s
)
o
n
e
by
o
n
e,
ac
co
r
d
in
g
to
th
e
s
co
r
in
g
v
ec
t
o
r
,
o
v
e
r
s
ev
er
al
s
u
cc
ess
iv
e
r
o
u
n
d
s
,
an
d
waits
f
o
r
th
e
r
esp
o
n
s
es
of
th
e
v
ar
io
u
s
d
ec
is
io
n
-
m
a
k
er
s
.
T
h
is
p
r
o
ce
s
s
all
o
ws
th
e
p
r
o
p
o
s
als
to
be
p
r
o
g
r
ess
iv
ely
ad
ju
s
ted
b
ased
on
th
e
f
ee
d
b
ac
k
r
ec
eiv
e
d
.
STE
P
6:
E
v
alu
atio
n
of
r
esp
o
n
s
es:
it
tak
es
p
lace
af
ter
r
ec
eiv
in
g
th
e
r
esp
o
n
s
es
f
r
o
m
th
e
v
ar
io
u
s
d
ec
is
io
n
-
m
ak
er
s
.
At
th
is
s
tag
e,
th
e
n
eg
o
tiato
r
an
aly
ze
s
t
h
e
f
ee
d
b
ac
k
by
co
u
n
tin
g
t
h
e
n
u
m
b
er
of
ac
ce
p
ta
n
ce
s
an
d
r
ejec
tio
n
s
.
If
th
e
n
u
m
b
er
of
ac
ce
p
tan
ce
s
ex
ce
e
d
s
a
p
r
ed
ef
in
ed
th
r
esh
o
ld
of
n
eg
o
tiatio
n
,
th
e
co
llab
o
r
ativ
e
d
ec
is
io
n
is
v
alid
ated
a
n
d
ad
o
p
ted
.
C
o
n
v
er
s
ely
,
if
th
is
th
r
e
s
h
o
ld
is
not
r
ea
ch
ed
,
th
e
d
ec
is
io
n
-
m
ak
er
s
m
u
s
t
b
eg
in
a
n
ew
r
o
u
n
d
of
n
eg
o
tiatio
n
.
T
h
is
p
r
o
ce
s
s
allo
ws
p
r
o
p
o
s
als
to
be
r
ef
in
e
d
a
n
d
p
r
o
g
r
ess
iv
ely
lead
s
to
a
co
n
s
en
s
u
s
th
at
is
s
atis
f
ac
to
r
y
f
o
r
all
p
ar
ties
in
v
o
l
v
ed
.
STE
P
7:
C
o
llab
o
r
ativ
e:
th
e
co
o
r
d
in
ato
r
s
en
d
s
th
e
f
in
al
co
lla
b
o
r
ativ
e
(
g
r
o
u
p
)
d
ec
is
io
n
to
t
h
e
v
ar
io
u
s
d
ec
is
io
n
-
m
ak
er
s
.
T
h
is
d
ec
is
io
n
s
tep
r
e
p
r
esen
ts
th
e
f
in
al
p
h
ase
of
th
e
n
e
g
o
tiatio
n
p
r
o
ce
s
s
.
On
ce
a
co
n
s
en
s
u
s
h
as
b
ee
n
r
ea
ch
e
d
d
u
r
i
n
g
th
e
p
r
ev
io
u
s
r
o
u
n
d
s
,
th
e
in
itiato
r
of
th
e
n
eg
o
tiatio
n
f
o
r
m
alize
s
th
e
f
in
al
d
ec
is
io
n
.
It
is
th
en
co
m
m
u
n
icate
d
to
th
e
d
if
f
er
en
t
d
ec
is
io
n
-
m
ak
er
s
in
v
o
lv
ed
so
th
at
it
ca
n
be
v
alid
ated
an
d
im
p
lem
en
ted
.
T
h
is
s
tep
m
ar
k
s
th
e
co
n
clu
s
io
n
of
th
e
p
r
o
ce
s
s
,
e
n
s
u
r
in
g
th
at
all
s
tak
eh
o
l
d
er
s
h
a
v
e
a
clea
r
an
d
s
h
ar
e
d
u
n
d
er
s
tan
d
i
n
g
of
th
e
d
ec
is
io
n
th
at
h
as
b
ee
n
ad
o
p
ted
.
2
.
3
.
2
.
UM
L
m
o
delin
g
of
t
he
pro
po
s
ed
s
y
s
t
em
Dec
is
io
n
-
m
ak
er
s
co
m
m
u
n
icat
e
an
d
n
eg
o
tiate
by
s
en
d
i
n
g
m
ess
ag
es.
We
d
is
tin
g
u
is
h
two
ty
p
es
of
m
ess
ag
es:
th
o
s
e
ex
clu
s
iv
ely
u
s
ed
by
th
e
n
eg
o
tiato
r
an
d
th
o
s
e
ex
clu
s
iv
ely
u
s
ed
by
ea
c
h
d
e
cisi
o
n
-
m
ak
er
.
T
h
e
d
if
f
er
en
t
m
ess
ag
es
ex
ch
a
n
g
ed
in
th
e
p
r
o
to
co
l
ar
e
d
escr
ib
ed
in
th
e
T
ab
les
2
a
n
d
3.
T
ab
le
2.
T
h
e
m
ess
ag
es
u
s
ed
by
th
e
n
e
g
o
tiato
r
ag
e
n
t
F
o
r
mu
l
a
t
e
(
P
M
)
F
o
r
mu
l
a
t
i
o
n
of
t
h
e
d
e
c
i
si
o
n
a
l
p
r
o
b
l
e
m
a
n
d
se
n
d
i
n
g
of
t
h
e
p
e
r
f
o
r
m
a
n
c
e
ma
t
r
i
x
to
t
h
e
p
a
r
t
i
c
i
p
a
n
t
a
g
e
n
t
s
(
D
o
c
t
o
r
s)
.
W
e
i
g
h
t
_
D
M
(
)
A
ssi
g
n
i
n
g
a
w
e
i
g
h
t
to
e
a
c
h
d
e
c
i
s
i
o
n
-
mak
e
r
u
s
i
n
g
t
h
e
AHP
met
h
o
d
.
R
e
q
u
e
st
(
R
a
n
k
)
A
sk
i
n
g
p
a
r
t
i
c
i
p
a
n
t
s
to
r
a
n
k
t
h
e
a
c
t
i
o
n
s
u
s
i
n
g
t
h
e
P
R
O
M
E
TH
EE
II
met
h
o
d
.
P
r
o
p
o
se
_
d
e
a
l
()
P
r
o
p
o
sa
l
of
a
d
e
a
l
(
a
c
t
i
o
n
)
b
a
se
d
on
t
h
e
s
c
o
r
i
n
g
v
e
c
t
o
r
c
r
e
a
t
e
d
by
t
h
e
n
e
g
o
t
i
a
t
o
r
a
n
d
c
o
n
si
d
e
r
i
n
g
t
h
e
d
i
f
f
e
r
e
n
t
r
a
n
k
i
n
g
s
of
t
h
e
d
e
c
i
s
i
o
n
-
m
a
k
e
r
s.
C
o
n
f
i
r
m
(
C
o
l
d
e
c
i
si
o
n
)
S
u
c
c
e
ss
of
t
h
e
n
e
g
o
t
i
a
t
i
o
n
a
n
d
s
e
n
d
i
n
g
t
h
e
c
o
l
l
a
b
o
r
a
t
i
v
e
d
e
c
i
s
i
o
n
to
a
l
l
p
a
r
t
i
c
i
p
a
n
t
s
(
d
o
c
t
o
r
s)
F
a
i
l
u
r
e
_
N
e
g
o
t
(
)
A
l
l
p
r
o
p
o
sa
l
s
ma
d
e
,
b
u
t
f
a
i
l
u
r
e
of
t
h
e
p
a
r
t
i
c
i
p
a
n
t
s'
n
e
g
o
t
i
a
t
i
o
n
T
ab
le
3.
T
h
e
m
ess
ag
es
u
s
ed
by
each
p
a
r
ticip
an
t
ag
e
n
t
T
h
e
UM
L
s
eq
u
en
ce
m
o
d
el
ass
o
ciate
d
with
th
e
p
r
o
p
o
s
ed
s
y
s
tem
an
d
th
e
ad
o
p
te
d
d
ec
is
io
n
m
ak
in
g
p
r
o
ce
s
s
ar
e
illu
s
tr
ated
,
r
esp
ec
t
iv
ely
,
in
Fig
u
r
e
2
an
d
Fig
u
r
e
3.
−
W
e
co
n
d
u
cted
a
s
en
s
itiv
ity
an
d
r
o
b
u
s
tn
ess
an
aly
s
is
o
f
th
e
p
r
o
p
o
s
ed
p
r
o
to
co
l to
ass
ess
it
s
s
t
ab
ilit
y
in
th
e
f
ac
e
o
f
v
a
r
iatio
n
s
in
d
ec
is
io
n
-
m
ak
er
s
’
p
r
ef
er
e
n
ce
s
.
T
o
d
o
th
is
,
we
s
lig
h
tly
m
o
d
if
ied
th
e
p
r
ef
e
r
en
ce
s
ex
p
r
ess
ed
b
y
th
e
d
o
cto
r
s
an
d
r
ep
ea
ted
th
e
d
ec
is
i
on
-
m
ak
i
n
g
p
r
o
ce
s
s
s
ev
er
al
tim
es.
T
h
is
ap
p
r
o
ac
h
allo
wed
u
s
t
o
o
b
s
er
v
e
h
o
w
th
ese
ch
an
g
es
c
o
u
ld
af
f
ec
t
th
e
o
u
tco
m
e
o
f
th
e
co
llab
o
r
ativ
e
d
ec
is
io
n
.
T
h
e
an
aly
s
is
f
o
cu
s
ed
o
n
b
o
th
s
en
s
itiv
ity
to
in
itial
co
n
d
itio
n
s
an
d
r
o
b
u
s
tn
ess
to
h
eter
o
g
e
n
eo
u
s
p
r
ef
er
e
n
ce
s
.
A
c
c
u
s
e
_
F
o
r
m
u
l
a
t
e
(
P
M
)
A
c
k
n
o
w
l
e
d
g
m
e
n
t
of
r
e
c
e
i
p
t
of
t
h
e
p
e
r
f
o
r
man
c
e
ma
t
r
i
x
P
r
e
f
(
w
,
p
,
q
)
Ex
p
r
e
ssi
o
n
of
s
u
b
j
e
c
t
i
v
e
p
a
r
a
m
e
t
e
r
s
(
A
ssi
g
n
i
n
g
w
e
i
g
h
t
s
to
c
r
i
t
e
r
i
a
u
si
n
g
A
H
P
(
w
)
,
man
u
a
l
e
n
t
r
y
of
p
r
e
f
e
r
e
n
c
e
a
n
d
i
n
d
i
f
f
e
r
e
n
c
e
t
h
r
e
s
h
o
l
d
s
p
a
n
d
q)
S
e
n
d
_
R
a
n
k
()
S
e
n
d
i
n
g
t
h
e
r
a
n
k
i
n
g
s
of
a
c
t
i
o
n
s
p
e
r
f
o
r
m
e
d
u
s
i
n
g
t
h
e
M
u
l
t
i
c
r
i
t
e
r
i
a
a
n
a
l
y
si
s
m
e
t
h
o
d
P
R
O
M
E
TH
EE
II
A
c
c
e
p
t
(
d
e
a
l
)
A
c
c
e
p
t
t
h
e
p
r
o
p
o
sa
l
R
e
f
u
s
e
(
d
e
a
l
)
R
e
j
e
c
t
t
h
e
p
r
o
p
o
s
a
l
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
d
o
n
esian
J
E
lec
E
n
g
&
C
o
m
p
Sci
I
SS
N:
2502
-
4
7
5
2
A
mu
lticr
iter
ia
co
lla
b
o
r
a
tive
d
ec
is
io
n
s
u
p
p
o
r
t sys
tem
fo
r
mu
l
tid
is
cip
lin
a
r
y
med
ica
l
…
(
S
o
u
a
d
Ma
d
o
u
r
i
)
759
T
h
e
r
esu
lts
p
r
o
v
id
e
v
alu
a
b
le
in
s
ig
h
ts
in
to
t
h
e
s
y
s
tem
’
s
a
b
ilit
y
to
m
ai
n
tain
co
n
s
is
ten
t
an
d
r
eliab
le
d
ec
is
io
n
s
d
esp
ite
u
n
ce
r
tain
ty
o
r
v
ar
ia
b
ilit
y
in
in
d
iv
i
d
u
al
ex
p
er
t o
p
in
io
n
s
.
−
R
eg
ar
d
in
g
co
n
v
er
g
en
ce
,
n
eg
o
tiatio
n
m
ay
f
ail
if
all
o
p
tio
n
s
(
p
atien
ts
)
h
av
e
b
ee
n
p
r
o
p
o
s
ed
b
u
t
n
o
co
n
s
en
s
u
s
is
r
ea
ch
ed
.
T
h
is
ca
n
b
e
ex
p
lain
ed
b
y
th
e
f
ac
t
th
at
th
e
p
r
o
to
co
l
r
elies
m
o
r
e
o
n
m
ed
iatio
n
th
a
n
o
n
co
n
ce
s
s
io
n
.
Fig
u
r
e
2.
T
h
e
UM
L
s
eq
u
en
ce
d
iag
r
am
Fig
u
r
e
3.
T
h
e
d
ec
is
io
n
-
m
ak
in
g
p
r
o
ce
s
s
3.
RE
SU
L
T
S
AND
D
I
SCU
SS
I
O
N
In
th
is
s
ec
tio
n
,
we
p
r
esen
t
th
e
r
esu
lts
o
b
tain
ed
by
s
im
u
latin
g
a
d
ec
is
io
n
-
m
ak
in
g
s
ce
n
ar
io
with
in
th
e
f
r
am
ewo
r
k
of
a
MD
T
M
in
o
n
co
lo
g
y
.
In
o
r
d
er
to
ex
p
e
r
im
en
t
th
e
p
r
o
p
o
s
ed
GDSS,
th
e
d
ata
s
u
p
p
o
r
tin
g
th
is
s
tu
d
y
ar
e
f
r
ee
ly
ac
ce
s
s
ib
le
on
th
e
o
f
f
icial
p
o
r
tal
d
ata.
g
o
u
v
.
f
r
.
T
h
ey
ar
e
co
m
p
iled
u
n
d
e
r
th
e
title
'
Sy
n
th
etic
r
ec
o
r
d
s
of
MCM
s
(
R
C
P)'
an
d
can
be
v
iewe
d
at
th
e
f
o
llo
win
g
[
2
6
]
.
Alth
o
u
g
h
th
ese
ar
e
s
y
n
th
etic
d
ata,
th
e
y
h
av
e
b
ee
n
d
ev
el
o
p
ed
to
ac
cu
r
ately
r
ef
lect
th
e
s
tr
u
ctu
r
e,
ch
allen
g
es,
an
d
u
n
d
er
l
y
in
g
lo
g
i
c
of
MCMs
in
th
e
m
ed
ical
f
ield
.
Fig
u
r
e
4
illu
s
tr
ates
th
e
lo
ad
in
g
of
th
e
p
er
f
o
r
m
an
ce
m
atr
ix
(
PM)
by
th
e
n
eg
o
tiato
r
.
Fig
u
r
e
5
p
r
esen
ts
th
e
in
v
o
lv
e
d
d
ec
is
io
n
-
m
ak
er
s
an
d
th
eir
ass
o
ciate
d
weig
h
ts
,
as
d
er
iv
ed
f
r
o
m
th
e
AHP
m
eth
o
d
.
Fiv
e
d
ec
is
io
n
-
m
ak
e
r
s
ar
e
i
n
v
o
lv
e
d
in
th
is
ca
s
e
s
tu
d
y
,
n
am
el
y
:
th
e
s
u
r
g
eo
n
,
o
n
co
lo
g
is
t,
r
ad
io
th
er
a
p
is
t,
is
o
to
p
is
t,
an
d
r
ad
io
lo
g
is
t.
T
h
e
co
o
r
d
in
ato
r
s
e
n
d
s
th
e
p
er
f
o
r
m
an
ce
m
atr
ix
to
th
e
f
iv
e
d
ec
is
io
n
-
m
ak
er
s
.
Af
ter
r
ec
eiv
in
g
th
e
p
er
f
o
r
m
a
n
ce
m
atr
ix
,
ea
c
h
d
ec
i
s
io
n
-
ma
k
er
s
ets
th
eir
p
r
ef
er
en
ce
an
d
in
d
if
f
er
en
ce
th
r
esh
o
ld
s
,
ca
lcu
lates
th
e
cr
i
ter
ia
weig
h
ts
u
s
in
g
th
e
AHP
m
eth
o
d
,
an
d
p
er
f
o
r
m
s
th
e
r
an
k
in
g
u
s
in
g
th
e
PR
OM
E
T
HE
E
I
I
m
eth
o
d
.
T
h
e
r
an
k
in
g
s
p
er
f
o
r
m
ed
by
th
e
f
i
v
e
d
ec
is
io
n
-
m
a
k
er
s
ar
e
s
en
t
to
th
e
co
o
r
d
in
ato
r
,
as
s
h
o
wn
in
th
e
Fig
u
r
e
6.
Fig
u
r
e
4.
L
o
ad
in
g
th
e
PM
(
n
e
g
o
tiato
r
)
Fig
u
r
e
5.
Dec
is
io
n
-
m
a
k
er
lis
t
(
n
eg
o
tiato
r
)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
5
0
2
-
4
7
5
2
I
n
d
o
n
esian
J
E
lec
E
n
g
&
C
o
m
p
Sci
,
Vo
l.
42
,
No
.
3
,
J
u
n
e
20
2
6
:
7
5
3
-
7
6
6
760
Fig
u
r
e
6.
Neg
o
tiato
r
:
lis
t
of
all
r
ec
eiv
ed
r
a
n
k
in
g
s
3
.
1
.
Neg
o
t
ia
t
i
o
n
pro
ce
s
s
a
nd
co
ns
ens
u
s
bu
ild
i
ng
T
h
e
n
eg
o
tiato
r
p
er
f
o
r
m
s
th
e
s
co
r
in
g
by
tak
i
n
g
in
to
ac
co
u
n
t
th
e
r
ec
eiv
ed
r
a
n
k
in
g
s
as
well
as
th
e
d
ec
is
io
n
-
m
ak
er
s
'
weig
h
ts
,
as
s
h
o
wn
in
Fig
u
r
e
7.
T
h
e
n
,
it
p
r
o
p
o
s
es
p
atien
t
119
an
d
wai
ts
f
o
r
th
e
d
ec
is
io
n
-
m
ak
er
s
'
r
esp
o
n
s
es
(
s
ee
Fig
u
r
e
8
)
.
C
o
n
s
en
s
u
s
was
not
r
ea
ch
ed
a
f
ter
th
r
ee
iter
atio
n
s
.
T
h
e
co
n
s
en
s
u
s
p
r
o
ce
s
s
was
ca
r
r
ied
o
u
t
in
s
ev
er
al
s
tep
s
.
At
f
ir
s
t,
th
e
n
eg
o
tiato
r
p
r
o
p
o
s
ed
p
atien
ts
one
by
o
n
e
b
ased
on
t
h
eir
ag
g
r
eg
ate
s
co
r
es
(
s
ee
Fig
u
r
e
9
)
,
r
ec
eiv
in
g
ac
ce
p
ta
n
ce
or
r
ejec
tio
n
r
esp
o
n
s
es
f
r
o
m
all
d
o
cto
r
s
ac
co
r
d
in
g
to
th
eir
in
d
iv
i
d
u
al
r
an
k
in
g
s
.
If
th
e
n
u
m
b
er
of
ac
ce
p
tan
ce
s
d
id
n
o
t
r
ea
ch
th
e
n
e
g
o
tiatio
n
th
r
es
h
o
ld
,
t
h
e
p
r
o
p
o
s
als
wer
e
r
ef
i
n
ed
in
s
u
b
s
eq
u
en
t
iter
atio
n
s
in
o
r
d
er
to
r
ec
o
n
cile
d
iv
er
g
e
n
t
p
r
ef
er
en
ce
s
with
o
u
t
im
p
o
s
in
g
c
o
n
ce
s
s
io
n
s
.
Fin
ally
,
p
atien
t
120
was
ac
ce
p
ted
by
all
d
ec
is
io
n
-
m
ak
e
r
s
at
iter
atio
n
4
(
s
ee
Fig
u
r
e
1
0
)
,
an
d
t
h
e
c
o
llectiv
e
d
ec
is
io
n
was
co
m
m
u
n
icate
d
to
all
p
ar
ticip
an
ts
.
Acc
ep
tan
ce
was
in
f
lu
en
ce
d
by
th
e
A
HP
-
b
ased
weig
h
ts
of
each
d
ec
is
io
n
-
m
ak
er
,
th
e
in
d
iv
id
u
al
p
atien
t
r
a
n
k
in
g
s
d
eter
m
in
ed
by
PR
OM
E
T
HE
E
II,
t
h
e
n
e
g
o
tiatio
n
th
r
esh
o
ld
,
an
d
co
m
p
r
o
m
is
es
am
o
n
g
t
h
e
d
o
ct
o
r
s
’
p
r
e
f
er
en
ce
s
.
Fig
u
r
e
7
.
Sco
r
i
n
g
v
ec
t
o
r
an
d
it
er
atio
n
1
(
n
eg
o
tiato
r
)
Fig
u
r
e
8
.
Dec
is
io
n
-
m
a
k
er
s
’
r
e
s
p
o
n
s
es
(
n
eg
o
tiato
r
)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
d
o
n
esian
J
E
lec
E
n
g
&
C
o
m
p
Sci
I
SS
N:
2502
-
4
7
5
2
A
mu
lticr
iter
ia
co
lla
b
o
r
a
tive
d
ec
is
io
n
s
u
p
p
o
r
t sys
tem
fo
r
mu
l
tid
is
cip
lin
a
r
y
med
ica
l
…
(
S
o
u
a
d
Ma
d
o
u
r
i
)
761
Fig
u
r
e
9
.
Sco
r
i
n
g
v
ec
t
o
r
an
d
it
er
atio
n
4
(
n
eg
o
tiato
r
)
Fig
u
r
e
10
.
Dec
is
io
n
-
m
ak
er
s
’
r
esp
o
n
s
es
(
n
eg
o
tiato
r
)
T
h
e
n
e
g
o
tiatio
n
h
is
to
r
y
is
r
e
co
r
d
ed
in
a
lo
g
,
as
illu
s
tr
ated
in
Fig
u
r
e
11.
T
h
e
n
,
th
e
c
o
llab
o
r
ativ
e
d
ec
is
io
n
is
s
en
t
to
all
d
ec
is
io
n
-
m
ak
er
s
.
Fig
u
r
e
12
s
h
o
ws
th
e
r
ec
ep
tio
n
of
th
e
d
ec
is
io
n
(
t
h
e
p
atien
t
with
th
e
h
ig
h
est
p
r
io
r
ity
f
o
r
h
o
s
p
italiza
tio
n
)
by
th
e
s
u
r
g
e
o
n
.
In
o
r
d
er
to
ass
ess
th
e
r
o
b
u
s
tn
ess
of
th
e
p
r
o
p
o
s
ed
co
llab
o
r
ativ
e
d
ec
is
io
n
-
m
a
k
in
g
a
p
p
r
o
ac
h
,
we
co
n
d
u
cte
d
a
th
o
r
o
u
g
h
s
en
s
itiv
ity
an
aly
s
is
.
T
h
is
an
aly
s
is
aim
ed
to
ex
am
in
e
th
e
im
p
a
ct
of
v
ar
i
atio
n
s
in
d
if
f
er
en
t
s
u
b
jectiv
e
p
ar
am
eter
s
on
t
h
e
o
b
tain
ed
r
esu
lts
,
in
o
r
d
er
to
v
er
if
y
th
e
s
tab
ilit
y
a
n
d
r
elia
b
ilit
y
of
th
e
d
ec
is
io
n
-
m
ak
in
g
m
o
d
el.
T
h
e
r
esu
lts
wer
e
v
er
y
co
n
v
in
cin
g
:
s
m
all
ch
an
g
es
in
th
e
p
ar
am
ete
r
s
o
n
ly
led
to
s
lig
h
t
v
ar
iatio
n
s
in
th
e
r
esp
ec
tiv
e
r
a
n
k
in
g
s
of
th
e
d
ec
is
io
n
-
m
ak
er
s
(
d
o
cto
r
s
)
.
T
h
e
r
ef
o
r
e
,
we
ca
n
co
n
clu
d
e
th
at
th
e
p
r
o
p
o
s
ed
ap
p
r
o
ac
h
d
em
o
n
s
tr
ates
a
s
atis
f
ac
to
r
ily
r
o
b
u
s
t
p
er
f
o
r
m
an
ce
.
3
.
2
.
Q
ua
ntit
a
t
iv
e
e
v
a
lua
t
io
n
a
nd
s
y
s
t
em
perf
o
rma
nce
T
h
e
s
y
s
tem
was
q
u
an
titativ
ely
ev
alu
ated
in
ter
m
s
of
d
e
cisi
o
n
q
u
ality
,
co
n
v
er
g
e
n
ce
tim
e,
an
d
co
m
p
u
tatio
n
al
p
er
f
o
r
m
a
n
ce
.
T
h
e
lev
el
of
ag
r
ee
m
en
t
am
o
n
g
d
ec
is
io
n
-
m
ak
e
r
s
s
ig
n
if
ica
n
tly
im
p
r
o
v
e
d
af
te
r
n
eg
o
tiatio
n
,
with
Ken
d
all’
s
co
ef
f
icien
t
of
co
n
co
r
d
an
ce
i
n
cr
ea
s
in
g
f
r
o
m
0
.
6
1
to
0
.
8
4
,
in
d
icatin
g
s
tr
o
n
g
co
n
s
en
s
u
s
.
R
o
b
u
s
tn
ess
an
aly
s
is
s
h
o
wed
h
ig
h
s
tab
ilit
y
,
with
a
9
2
%
d
ec
is
io
n
s
tab
ilit
y
r
ate
u
n
d
er
v
ar
iatio
n
s
in
d
o
cto
r
s
’
p
r
ef
e
r
en
ce
s
.
T
h
e
n
eg
o
tiatio
n
p
r
o
to
co
l
co
n
v
er
g
e
d
e
f
f
icien
tly
,
r
eq
u
ir
i
n
g
an
a
v
er
a
g
e
of
3
.
6
iter
atio
n
s
an
d
less
th
an
30
s
ec
onds
to
r
ea
ch
a
co
llectiv
e
d
ec
is
io
n
.
Fro
m
a
co
m
p
u
tatio
n
al
p
er
s
p
ec
tiv
e,
th
e
s
y
s
tem
d
em
o
n
s
tr
ated
g
o
o
d
s
ca
lab
ilit
y
an
d
lo
w
ex
ec
u
tio
n
tim
e,
r
em
ain
in
g
b
elo
w
1
.
5
s
ec
o
n
d
s
f
o
r
20
p
atien
ts
an
d
5
s
ec
o
n
d
s
f
o
r
lar
g
er
s
ce
n
ar
io
s
.
Ov
er
all,
th
e
r
esu
lts
co
n
f
ir
m
th
at
th
e
p
r
o
p
o
s
ed
s
y
s
tem
is
ac
cu
r
ate,
r
o
b
u
s
t,
an
d
s
u
itab
le
f
o
r
r
ea
l
-
tim
e
m
u
ltid
i
s
cip
lin
ar
y
m
ed
ical
d
ec
is
io
n
-
m
ak
in
g
.
T
h
e
c
o
m
p
u
tatio
n
al
p
er
f
o
r
m
an
ce
of
th
e
p
r
o
p
o
s
ed
s
y
s
tem
was
ev
alu
ated
ac
co
r
d
i
n
g
to
t
h
e
p
r
o
b
lem
s
iz
e.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
5
0
2
-
4
7
5
2
I
n
d
o
n
esian
J
E
lec
E
n
g
&
C
o
m
p
Sci
,
Vo
l.
42
,
No
.
3
,
J
u
n
e
20
2
6
:
7
5
3
-
7
6
6
762
T
h
e
alg
o
r
ith
m
ic
co
m
p
lex
ity
of
each
c
o
m
p
o
n
en
t
is
as
f
o
llo
ws:
i)
AHP:
O(
n
²)
f
o
r
cr
iter
ia
weig
h
tin
g
.
ii)
PR
O
ME
T
HE
E
II:
O(
m
²)
f
o
r
p
atien
t
r
an
k
in
g
.
iii)
Ag
g
r
e
g
atio
n
an
d
n
e
g
o
tiatio
n
:
O(
m
×
d
)
.
W
h
er
e
:
n
=
n
u
m
b
er
of
cr
iter
ia;
m
=
n
u
m
b
er
of
p
atien
ts
(
ac
tio
n
s
)
;
d
=
n
u
m
b
er
of
d
ec
is
io
n
-
m
ak
e
r
s
.
T
h
e
o
b
s
er
v
ed
e
x
ec
u
tio
n
tim
es
wer
e
as
f
o
llo
ws:
i)
10
p
atien
ts
/
5
d
o
cto
r
s
:
<
0
.
5
s
ec
o
n
d
s
.
ii)
20
p
atien
ts
/
5
d
o
cto
r
s
:
≈
1
.
2
s
ec
o
n
d
s
.
iii)
50
p
atien
ts
/
7
d
o
cto
r
s
:
≈
4
.
5
s
ec
o
n
d
s
.
Me
m
o
r
y
u
s
ag
e
r
e
m
ain
ed
b
elo
w
200
MB
in
all
s
ce
n
ar
i
o
s
.
T
h
ese
r
esu
lts
in
d
icate
th
at
t
h
e
s
y
s
tem
is
ef
f
icien
t,
s
ca
lab
le,
an
d
well
s
u
ited
to
th
e
ty
p
ical
s
ize
of
clin
ical
m
u
ltid
is
cip
lin
ar
y
m
ee
tin
g
s
.
Fo
r
clar
ity
an
d
ea
s
e
of
an
al
y
s
is
,
th
e
m
ain
r
esu
lts
of
th
e
ca
s
e
s
tu
d
y
an
d
th
e
co
n
s
en
s
u
s
-
b
u
ild
i
n
g
p
r
o
ce
s
s
a
r
e
s
u
m
m
ar
ized
in
T
ab
le
4
.
T
h
e
r
esu
lts
of
th
is
s
tu
d
y
ar
e
p
ar
ticu
lar
ly
r
elev
an
t
f
o
r
h
ea
lt
h
ca
r
e
p
r
o
f
ess
io
n
als
in
v
o
lv
ed
in
MD
T
Ms,
as
well
as
f
o
r
r
esear
ch
er
s
in
DSS
an
d
m
ed
ical
ar
tific
ial
i
n
tellig
en
ce
.
T
h
e
p
r
o
p
o
s
ed
ap
p
r
o
ac
h
ad
d
r
ess
e
s
a
ce
n
tr
al
ch
allen
g
e
in
m
o
d
er
n
c
lin
ical
p
r
ac
tice,
n
am
ely
co
lla
b
o
r
ativ
e
d
ec
is
io
n
-
m
ak
in
g
in
c
o
m
p
lex
,
u
n
ce
r
tain
,
an
d
m
u
lticr
iter
ia
c
o
n
tex
ts
.
By
in
teg
r
atin
g
MA
S,
m
u
lticr
iter
ia
d
ec
is
io
n
-
m
ak
i
n
g
m
e
th
o
d
s
(
AHP
an
d
PR
OM
E
T
HE
E
II),
an
d
a
s
tr
u
ctu
r
ed
n
e
g
o
tiatio
n
p
r
o
to
co
l,
th
e
s
y
s
tem
f
o
r
m
alize
s
h
eter
o
g
en
eo
u
s
m
ed
ical
p
r
ef
er
en
ce
s
,
r
e
d
u
ce
s
d
ec
is
io
n
co
n
f
licts
an
d
am
b
ig
u
ity
d
u
r
in
g
g
r
o
u
p
d
is
cu
s
s
io
n
s
,
an
d
en
h
a
n
ce
s
th
e
tr
an
s
p
ar
en
cy
,
t
r
ac
ea
b
ilit
y
,
an
d
ju
s
tific
atio
n
of
co
llectiv
e
m
e
d
ical
d
ec
is
io
n
s
.
Mo
r
eo
v
er
,
it
en
ab
les
a
f
aster
an
d
more
r
eliab
le
id
en
tific
atio
n
of
h
ig
h
-
r
is
k
p
atien
ts
,
th
er
eb
y
o
p
tim
izin
g
ca
r
e
p
r
io
r
itizatio
n
.
Sen
s
itiv
ity
an
d
r
o
b
u
s
tn
ess
an
aly
s
es
f
u
r
t
h
er
i
n
d
icate
th
at
th
e
o
b
tain
e
d
d
ec
is
io
n
s
r
em
ain
s
tab
le
d
esp
ite
v
ar
iatio
n
s
in
e
x
p
er
t
p
r
ef
er
en
ce
s
,
r
ein
f
o
r
cin
g
th
e
r
eliab
ilit
y
of
t
h
e
p
r
o
p
o
s
ed
s
y
s
tem
in
r
ea
l
-
wo
r
ld
cli
n
ical
en
v
ir
o
n
m
e
n
ts
ch
ar
ac
ter
ized
by
u
n
ce
r
tain
ty
a
n
d
tim
e
p
r
ess
u
r
e.
Fig
u
r
e
11.
Neg
o
tiato
r
:
n
eg
o
tia
tio
n
lo
g
Fig
u
r
e
12.
Dec
is
io
n
-
m
ak
er
s
u
r
g
eo
n
:
r
ec
e
p
tio
n
of
th
e
c
o
llab
o
r
ativ
e
d
ec
is
io
n
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