OBJECTIVES: The anti-vaccination movement is prevalent in today's media with claims which continue to create feelings of fear and trepidation in the minds of many parents. The C.A.S.E. Approach (Corroboration, About Me, Science, Explain/Advise) is a method ofcommunication to be used in formulating meaningful, rapid responses to parents hesitant to vaccinating their children. This DNP project assessed the effects of a C.A.S.E. Approach learning module on family nurse practitioner (FNP) students' perceived levels of knowledge and self-efficacy regarding vaccination discussion with vaccine hesitant parents (VHPs). METHODS: This DNP project used a pretest-posttest design to measure the effects of the C.A.S.E. Approach training intervention on both knowledge and self-efficacy levels of FNP students. Fourteen students participated in this study. Each took the 20-question pretest C.A.S.E. Approach Questionnaire, then participated in the C.A.S.E. Approach learning module,and finished by repeating the questionnaire as a posttest following the intervention. The questionnaire was designed using four-item Likert questions scored 1 (strongly disagree) to 4(strongly agree), wherein higher scores reflected better understanding and self-efficacy in the C.A.S.E. Approach. Students were recruited via an online classroom format within a nursing course offered at the University of Arizona: Nursing 612, Introduction to Pediatrics. All testing and module information was accessed online and questionnaire responses were stored at Qualtrics.com, also online. RESULTS: Students' posttest scores following the intervention of the C.A.S.E. Approach learning module were significantly higher than pretest scores. Perceived knowledge (p< 0.001)of the C.A.S.E. Approach increased more significantly than did perceived self-efficacy (p =0.001) of the C.A.S.E. Approach following the module. Mean test scores increased on average 14.29 points in perceived knowledge of the C.A.S.E. Approach following the module, and 7.93 points for perceived self-efficacy following the module. CONCLUSION: Key findings included an observed increase in participating students' perceived knowledge regarding the C.A.S.E. Approach as well as an observed increase inparticipating students' perceived self-efficacy in using the C.A.S.E. Approach. There was strong statistical evidence (p≤0.05) to suggest the learning module increased student knowledge andself-efficacy regarding vaccine discussion.

BACKGROUND: The widespread use of vaccines led to significant decline in multiple potentially fatal infectious diseases. Recently, there has been an increase in vaccine hesitancy. Measles and pertussis outbreaks throughout the United States have put a spotlight on this urgent healthcare issue. Motivational interviewing is a counseling tactic that is gaining popularity and is being studied for its efficacy in preventative medicine and psychological disorders. It aims to inspire people to make behavioral changes through collaborative relationships with their provider by understanding how current actions do not translate into their health goals. LITERATURE REVIEW FINDINGS: Vaccine hesitancy is growing. Communities with decreased immunization rates are associated with a higher risk of disease outbreak. Increasing rates of undervaccinated children are likely due to increases in non-medical exemptions. Many parents, regardless of their vaccine hesitancy status, are concerned about vaccine safety. Vaccine hesitant parents refuse vaccines due to philosophical and religious beliefs, conspiracy theories, and safety concerns. Parents feel that providers do not adequately address their concern. Providers report not having the training to discredit parental concerns. The majority of parents describe their child’s pediatrician as their most trusted source of vaccine information. Parents who receive vaccine information from a provider are more likely to comply with the recommended childhood vaccine schedule. The most efficient way to discuss vaccines with parents has yet to be determined. PROPOSED PROJECT: This is a proposed QI research project for the Pediatric Clinic at Boston Medical Center. Providers would be trained in motivational interviewing during several sessions that included lectures and small group practice sessions with systematic feedback. During the intervention, parents who refuse vaccines for their child, aged 0-6 years old, will receive motivational interviewing from the provider. The proportion of the vaccine hesitant parents who accept the offered vaccine after will be analyzed. The pre and post intervention vaccination rates for the entire clinic will also be assessed. Data collection will be preformed through retrospective chart review. The project aims to increase provider confidence on vaccine counseling, educate providers on reasons for hesitancy, and improve compliance with the CDC recommended vaccine schedule. CONCLUSION: While most Americans continue to vaccinate their children according to the CDC’s recommended schedule, constant vigilance is required to maintain high immunization rates to protect our communities. Motivational interviewing is goal-oriented to alter a specific behavior and would allow providers to engage in an open, persuasive dialogue about parental vaccine concerns.

A gestão eficaz dos processos que envolvem os fornecedores tem grande influência na melhoria do desempenho organizacional, sendo, portanto, fundamental para desenvolver capacidades das operações de produção que podem gerar vantagem competitiva, tais como qualidade, preço e tempo de entrega. A gestão de fornecedores inclui as atividades de qualificação, seleção, avaliação e desenvolvimento de fornecedores, além da alocação de pedido quando múltiplas fontes de fornecimento são selecionadas. A qualificação é um processo importante para assegurar que os fornecedores atendam requisitos mínimos de desempenho e, idealmente, deve ser realizada com métodos não compensatórios de categorização das alternativas. Entretanto, na literatura há poucos estudos que abordam a qualificação de fornecedores. Dentre aqueles que abordam, a maioria utiliza técnicas multicritério que são compensatórias e de ordenação. Outros aspectos importantes da gestão de fornecedores é a possível presença vários tomadores de decisão, caracterizando um processo de tomada de decisão em grupo, além da subjetividade de alguns critérios que gera incerteza nos julgamentos e hesitação. Ao se considerar essas questões na gestão de fornecedores, nenhuma pesquisa na literatura apresenta uma abordagem que contemple todos as características simultaneamente. Além disso, poucas pesquisas abordam os processos da gestão de fornecedores sob uma perspectiva integrada. Com vista a estas lacunas, esta pesquisa tem por objetivo a proposição de dois modelos de decisão que consideram os processos de qualificação, seleção e avaliação de fornecedores, em um cenário de tomada de decisão em grupo, considerando a incerteza e hesitação. Os modelos propostos têm por finalidade elicitar as preferências, agregar os julgamentos e categorizar os fornecedores. O primeiro modelo utiliza a representação linguística Triangular Hesitant Fuzzy Sets, para lidar com a hesitação nos julgamentos dos tomadores de decisão, além da técnica ELECTRE TRI para a categorização dos fornecedores. O segundo modelo se baseia na aplicação representação linguística Intuitionistic Fuzzy Sets para modelar a hesitação na parametrização das variáveis linguísticas e no ELECTRE TRI para a categorização. A elicitação é realizada com o uso do Fuzzy Delphi combinado com operadores de agregação do Triangular Hesitant Fuzzy Sets e Intuitionistic Fuzzy Sets. Os modelos de decisão foram detalhados e implementados no Matlab©. Após a proposição dos métodos, dois casos ilustrativos, obtidos a partir da coleta em campo, foram apresentados para analisar o desempenho dos modelos. Os casos ilustrativos mostraram resultados de categorização consistentes, especialmente para o procedimento pessimista do ELECTRE TRI. Testes com a hesitação nos julgamentos dos tomadores de decisão evidenciaram a importância da modelagem da hesitação, pois ela tem o potencial de alterar a categorização das alternativas. Testes com os parâmetros do ELECTRE TRI, confirmaram o efeito não compensatório da técnica e que a variação do nível de corte tem o potencial de tornar a categorização mais flexível. Assim, esta tese apresenta uma revisão de literatura sobre os processos de gestão de fornecedores e sobre tomada de decisão multicritério e em grupo, a proposição de métodos de apoio à tomada de decisão, casos ilustrativos para ilustrar o modelo, análises de sensibilidade dos métodos, além das conclusões e propostas para trabalhos futuros. / Effective management of the processes that involving suppliers has a major influence on improving organizational performance and is therefore fundamental to develop production operations capabilities that can generate competitive advantage, such as quality, price and delivery time. Supplier management includes qualification, selection, evaluation and development of suppliers, as well as allocation of orders when multiple sources of supply are selected. Qualification is an important process to ensure that suppliers meet minimum performance requirements and ideally must be performed with non-compensatory methods of categorization. However, in the literature there are few studies that consider the process of supplier qualification. Among the studies that consider the qualification, most use multicriteria techniques that are compensatory and for ranking. Other important aspects of supplier management are the possible presence of several decision makers, characterizing a process of group decision making, as well as the subjectivity of some criteria that generates uncertainty in judgments and hesitation. When considering these issues in supplier management, none of the studies found in the literature presents an approach that contemplates all features simultaneously. In addition, few researches deal with supplier management processes from an integrated perspective. In view of these gaps, this research aims to propose two decision models that consider the processes of qualification, selection and evaluation of suppliers, in a scenario of group decision making, considering the uncertainty and hesitation. The proposed models have the purpose the elicitation of the preferences, the aggregation of the judgments and the categorization of the suppliers. The first model uses the linguistic representation Triangular Hesitant Fuzzy Sets, to deal with the hesitation in the judgments of the decision makers, in addition to the ELECTRE TRI technique for the categorization of the suppliers. The second model is based on the application of the linguistic representation Intuitionistic Fuzzy Sets to model the hesitation in the parameterization of the linguistic variables and in the ELECTRE TRI for categorization. Elicitation is performed with the use of Fuzzy Delphi combined with aggregation operators of the Triangular Hesitant Fuzzy Sets and Intuitionistic Fuzzy Sets. The decision models were detailed and implemented in Matlab©. Two illustrative cases, obtained from the field collection, were presented to analyze the performance of the models. The illustrative cases showed consistent categorization results, especially for the pessimistic procedure of ELECTRE TRI. Tests with hesitation in the judgments of decision makers highlighted the importance of modeling hesitation, since it has the potential to change the categorization of alternatives. Tests with the ELECTRE TRI parameters confirmed the non-compensatory effect of the technique and that the variation of the cut level has the potential to make categorization more flexible. Thus, this thesis presents a review of the literature on supplier management processes and on multicriteria and group decision making, the proposition of methods to support decision making, illustrative cases to illustrate the model, method sensitivity analyzes, besides the conclusions and proposals for future works.

A gestão eficaz dos processos que envolvem os fornecedores tem grande influência na melhoria do desempenho organizacional, sendo, portanto, fundamental para desenvolver capacidades das operações de produção que podem gerar vantagem competitiva, tais como qualidade, preço e tempo de entrega. A gestão de fornecedores inclui as atividades de qualificação, seleção, avaliação e desenvolvimento de fornecedores, além da alocação de pedido quando múltiplas fontes de fornecimento são selecionadas. A qualificação é um processo importante para assegurar que os fornecedores atendam requisitos mínimos de desempenho e, idealmente, deve ser realizada com métodos não compensatórios de categorização das alternativas. Entretanto, na literatura há poucos estudos que abordam a qualificação de fornecedores. Dentre aqueles que abordam, a maioria utiliza técnicas multicritério que são compensatórias e de ordenação. Outros aspectos importantes da gestão de fornecedores é a possível presença vários tomadores de decisão, caracterizando um processo de tomada de decisão em grupo, além da subjetividade de alguns critérios que gera incerteza nos julgamentos e hesitação. Ao se considerar essas questões na gestão de fornecedores, nenhuma pesquisa na literatura apresenta uma abordagem que contemple todos as características simultaneamente. Além disso, poucas pesquisas abordam os processos da gestão de fornecedores sob uma perspectiva integrada. Com vista a estas lacunas, esta pesquisa tem por objetivo a proposição de dois modelos de decisão que consideram os processos de qualificação, seleção e avaliação de fornecedores, em um cenário de tomada de decisão em grupo, considerando a incerteza e hesitação. Os modelos propostos têm por finalidade elicitar as preferências, agregar os julgamentos e categorizar os fornecedores. O primeiro modelo utiliza a representação linguística Triangular Hesitant Fuzzy Sets, para lidar com a hesitação nos julgamentos dos tomadores de decisão, além da técnica ELECTRE TRI para a categorização dos fornecedores. O segundo modelo se baseia na aplicação representação linguística Intuitionistic Fuzzy Sets para modelar a hesitação na parametrização das variáveis linguísticas e no ELECTRE TRI para a categorização. A elicitação é realizada com o uso do Fuzzy Delphi combinado com operadores de agregação do Triangular Hesitant Fuzzy Sets e Intuitionistic Fuzzy Sets. Os modelos de decisão foram detalhados e implementados no Matlab©. Após a proposição dos métodos, dois casos ilustrativos, obtidos a partir da coleta em campo, foram apresentados para analisar o desempenho dos modelos. Os casos ilustrativos mostraram resultados de categorização consistentes, especialmente para o procedimento pessimista do ELECTRE TRI. Testes com a hesitação nos julgamentos dos tomadores de decisão evidenciaram a importância da modelagem da hesitação, pois ela tem o potencial de alterar a categorização das alternativas. Testes com os parâmetros do ELECTRE TRI, confirmaram o efeito não compensatório da técnica e que a variação do nível de corte tem o potencial de tornar a categorização mais flexível. Assim, esta tese apresenta uma revisão de literatura sobre os processos de gestão de fornecedores e sobre tomada de decisão multicritério e em grupo, a proposição de métodos de apoio à tomada de decisão, casos ilustrativos para ilustrar o modelo, análises de sensibilidade dos métodos, além das conclusões e propostas para trabalhos futuros. / Effective management of the processes that involving suppliers has a major influence on improving organizational performance and is therefore fundamental to develop production operations capabilities that can generate competitive advantage, such as quality, price and delivery time. Supplier management includes qualification, selection, evaluation and development of suppliers, as well as allocation of orders when multiple sources of supply are selected. Qualification is an important process to ensure that suppliers meet minimum performance requirements and ideally must be performed with non-compensatory methods of categorization. However, in the literature there are few studies that consider the process of supplier qualification. Among the studies that consider the qualification, most use multicriteria techniques that are compensatory and for ranking. Other important aspects of supplier management are the possible presence of several decision makers, characterizing a process of group decision making, as well as the subjectivity of some criteria that generates uncertainty in judgments and hesitation. When considering these issues in supplier management, none of the studies found in the literature presents an approach that contemplates all features simultaneously. In addition, few researches deal with supplier management processes from an integrated perspective. In view of these gaps, this research aims to propose two decision models that consider the processes of qualification, selection and evaluation of suppliers, in a scenario of group decision making, considering the uncertainty and hesitation. The proposed models have the purpose the elicitation of the preferences, the aggregation of the judgments and the categorization of the suppliers. The first model uses the linguistic representation Triangular Hesitant Fuzzy Sets, to deal with the hesitation in the judgments of the decision makers, in addition to the ELECTRE TRI technique for the categorization of the suppliers. The second model is based on the application of the linguistic representation Intuitionistic Fuzzy Sets to model the hesitation in the parameterization of the linguistic variables and in the ELECTRE TRI for categorization. Elicitation is performed with the use of Fuzzy Delphi combined with aggregation operators of the Triangular Hesitant Fuzzy Sets and Intuitionistic Fuzzy Sets. The decision models were detailed and implemented in Matlab©. Two illustrative cases, obtained from the field collection, were presented to analyze the performance of the models. The illustrative cases showed consistent categorization results, especially for the pessimistic procedure of ELECTRE TRI. Tests with hesitation in the judgments of decision makers highlighted the importance of modeling hesitation, since it has the potential to change the categorization of alternatives. Tests with the ELECTRE TRI parameters confirmed the non-compensatory effect of the technique and that the variation of the cut level has the potential to make categorization more flexible. Thus, this thesis presents a review of the literature on supplier management processes and on multicriteria and group decision making, the proposition of methods to support decision making, illustrative cases to illustrate the model, method sensitivity analyzes, besides the conclusions and proposals for future works.

As we all know the classical set theory has a deep-rooted influence in the traditional mathematics. According to the two-valued logic, an element can belong to a set or cannot. In the former case, the element’s membership degree will be assigned to one, whereas in the latter case it takes the zero value. With other words, a feeling of imprecision or fuzziness in the two-valued logic does not exist. With the rapid development of science and technology, more and more scientists have gradually come to realize the vital importance of the multi-valued logic. Thus, in 1965, Professor Lotfi A. Zadeh from Berkeley University put forward the concept of a fuzzy set. In less than 60 years, people became more and more familiar with fuzzy set theory. The theory of fuzzy sets has been turned to be a favor applied to many fields. The study aims to apply some classical and extensional methods of fuzzy set theory in life expectancy and treatment prognoses for cancer patients. The research is based on real-life problems encountered in clinical works by physicians. From the introductory items of the fuzzy set theory to the medical applications, a collection of detailed analysis of fuzzy set theory and its extensions are presented in the thesis. Concretely speaking, the Mamdani fuzzy control systems and the Sugeno controller have been applied to predict the survival length of gastric cancer patients. In order to keep the gastric cancer patients, already examined, away from the unnecessary suffering from surgical operation, the fuzzy c-means clustering analysis has been adopted to investigate the possibilities for operation contra to nonoperation. Furthermore, the approach of point set approximation has been adopted to estimate the operation possibilities against to nonoperation for an arbitrary gastric cancer patient. In addition, in the domain of multi-expert decision-making, the probabilistic model, the model of 2-tuple linguistic representations and the hesitant fuzzy linguistic term sets (HFLTS) have been utilized to select the most consensual treatment scheme(s) for two separate prostate cancer patients. The obtained results have supplied the physicians with reliable and helpful information. Therefore, the research work can be seen as the mathematical complements to the physicians’ queries.