Fuzzy Inf. Eng.

(2012) 2: 195-216
DOI 10.1007/s12543-012-0111-3
ORIGINAL ARTICLE

Mutually Dependent Multi-criteria Decision Making

Doraid Dalalah Mohammad Al-Tahat Khaled Bataineh

Received: 30 April 2011/ Revised: 20 March 2012

Accepted: 15 May 2012
Springer-Verlag Berlin Heidelberg and Fuzzy Information and Engineering Branch of the Operations
Research Society
2012

Abstract In this paper, a model to estimate the weights of mutually dependent criteria, based on cause-eect assessments of a group of professionals, is developed for
problem of multiple criteria decision making (MCDM). Here, both DEMATEL (Decision Making Trial and Evaluation Laboratory) and TOPSIS (Technique for Order
Performance by Similarity to Ideal Solution) models are combined and extended to
handle fuzzy evaluations where the rst is used to set the weights of the interdependent criteria and the second for drawing a decision from a group of professionals who
use linguistic ratings in their evaluation.
The presented model is characterized by the capability to estimate the criteria
weights when the criteria are interrelated. The strict determination of the criteria
weights prior to the assessment process is eliminated as they are computed by the
DEMATEL part. A classical case-study of optimal sore throat treatment in primary
care unit is used to demonstrate the eciency of the proposed model.
Keywords MCDM DEMATEL TOPSIS Decision making

1. Introduction and Literature Review

MCDM is a sub-discipline of operations research which refers to making decisions
in the incidence of multiple and generally conicting criteria. Specically, MCDM
refers to screening, prioritizing and selecting a set of alternatives (also referred to
as candidates or actions) under usually independent and conicting criteria [1,
2]. In practical applications, the criteria weights cannot always be assessed precisely
particularly, when the criteria have some correlation and interdependence.
Doraid Dalalah ()
IE Department, Jordan University of Science and Technology, Jordan
email: doraid@just.edu.jo
Mohammad Al-Tahat
IE Department, Jordan University, Amman, Jordan
Khaled Bataineh
ME Department, Jordan University of Science and Technology, Jordan

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Doraid Dalalah Mohammad Al-Tahat Khaled Bataineh (2012)

Such scenarios may arise in some decision making problems as in clinical diagnosis where the symptoms, the signs as well as the criteria are mutually dependent and
the evaluations are linguistic in their description. Classical MCDM methods cannot
eectively handle such imprecise information, particularly when the individuals do
not have the full right to set their own weights [3].
In this study, to help solve this problem, we present a fuzzy multi-criteria decision making model for interdependent criteria. Here, the criteria weights are determined based on their relation-prominence strength using a modied fuzzy DEMATEL model. Next, a modied fuzzy TOPSIS model is used for the decision making
process. The DEMATEL is extended to include fuzzy ratings and its structural digraphs are modied to estimate the weights of the criteria. The TOPSIS model will
then be used to draw a nal decision by computing the distances from ideal and antiideal solutions.
In brief, the DEMATEL is a methodology which can conrm interdependence
among variables and aid in the development of a visual plan to reect interrelationships between variables. Originated from the Geneva Research Centre of the Battelle
Memorial Institute [4], the DEMATEL aimed at the fragmented and antagonistic phenomena of world societies to search for integrated solutions. It is practical and useful
for visualizing the structure of complicated causal relationships with matrices or digraphs. The matrices or digraphs portray a contextual relation between the elements
of a system, in which a numeral represents the strength of inuence. DEMATEL has
been successfully applied in many elds, for example the authors in [5] analyzed the
obstructive factors of welfare service with the DEMATEL method, and in [6], employed it to design and evaluate software of displaying-screen structure in analyzing
a supervisory control system.
As for TOPSIS, it identies the best alternative by the shortest distance from a
pre-determined positive ideal solution (PIS), and the farthest distance from other predetermined negative ideal solution (NIS). Since its introduction by [7], huge literature
emerged addressing TOPSIS applications, such applications include the evaluation
of quality of services [8], the applications in aggregate production planning [9], inter
company comparison [10], large scale nonlinear programming [11] and facility location selection [12].
The major foreseeable contribution of our proposed model is twofold: First, the
estimation of criteria weights when the criteria are interrelated. Fundamentally, strict
determination of the weights of the criteria may impose a drastic inuence on the
results in traditional models as they have shown high sensitivity to such weights. In
our model, there would not be any need to rmly decide the criteria weights. Second,
the extension to handle fuzzy ratings and linguistic evaluations with respect to fuzzy
ideal and anti-ideal solutions, a matter that may facilitate the judgment process by a
harmonized model of both DEMATEL and TOPSIS.
1.1. MCDM Literature Review
One of the powerful tools for decision making is decision support system (DSS).
While MCDM is one discipline of the decision making eld, it is widely used in conjunction with DSS by a huge number of decision makers in variety of areas such as

Fuzzy Inf. Eng. (2012) 2: 195-216

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disaster management, nancial analysis, risk management, housing evaluation, customer relationship management, etc.
Although MCDM problems are prevalent and common in everyday life, as a discipline, MCDM has a relatively short history of about 30 years [13]. The advancement
in computer technologies was one of the major drives for the development of MCDM
discipline. In one hand, the revolution of information technology and extensive use of
computers have made a huge amount of information available, which makes MCDM
progressively more important and helpful in sustaining business decision making. On
the other hand, the rapid growth of computer technology in recent years has made it
feasible to carry out systematic analysis of complex MCDM approaches.
A good deal of literature exists in MCDM problem [1, 14-18]. Such studies tend
to solve MCDM problems under some predetermined conditions and assumptions,
though some of the methods were criticized as ad hoc and unjustied on theoretical
and/or empirical grounds [19]. Since the seventies, theories and models in MCDM
have continued to grow at a steady state. A number of surveys have been conducted
showing the vitality of the eld and the multitude of methods which have been developed [18, 20].
There are many variations on the theme of MCDM depending on the theoretical basis used for the modeling. In fact, multi-criteria may include both multiple attributes
and multiple objectives which fall under the platform of multiple attribute utility theory (MAUT) and multiple objective linear programming (MOLP), respectively. With
the introduction of MCDM, the rst contributions to truly scientic approach to decision making were made, but the problem was to deal with human preferences which
can hardly reach a momentous degree of consistency or coherence.
Following [18, 20], MCDM methods may be divided into the following major categories: the outranking category, the category/categories of value and utility theory,
the interactive multiple objective programming category and the category of group
decision and negotiation theories.
The rst category depends on the ranking of alternatives. Ranking may be based
on the degree of optimality as in [21], Hamming distance [22], comparison function
[23], fuzzy mean and spread [24], proportion to the ideal and anti-ideal as in TOPSIS,
left and right scores [25], centroid index [26], area measurement [27] and linguistic
ranking methods [28].
A good example of the second family is the analytical hierarchy process [29].
In this family, the relative importance is being assessed for multiple attributes. Other
methods such as fuzzy simple additive weighting [21, 30], fuzzy conjunctive/disjunctive
methods [31], fuzzy outranking methods [32] and maximin methods [33].
The third category includes fuzzy mathematical programming which involves extensive methods such as linear programming [34], exible programming [35], possibilistic programming [36], robust programming [37], possibilistic programming with
fuzzy preference relations [38], possibilistic linear programming with fuzzy goals
[39]. A good survey of the developments in fuzzy programming was presented in
[16, 40, 41].
The fourth category emerges from the growing eld of group decision making and
negotiation, especially from the viewpoints of management science and operations

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Doraid Dalalah Mohammad Al-Tahat Khaled Bataineh (2012)

research. In this family, the decision eectiveness, errors and biases, group think,
evaluation of group processes are all addressed for improving group decision making
[42]. The study in [20] presented a good survey of group decision making methods.
The majority of multi-criteria approaches are based on crisp comparisons of preferences and strict weight values [2]. However, in practical applications, the comparisons may be held using linguistic scales, such as High, Medium and Low
with linguistic weights. Such evaluations cannot be handled using crisp scales, rather,
fuzzy sets may be more powerful in such evaluations. A rich literature exists on fuzzy
MCDM such as the research and surveys was presented in [7, 43-45].
Contrary to conventional MCDM literature studies where the criteria weights are
determined in a strict manner, our model incorporates the strength of DEMATEL
to pull the criteria weights out of the interdependent relations between the criteria
themselves. This way, the weights are computed by utilizing the structural DEMTEL
diagraphs. The calculated weights will be plugged into a modied TOPSIS model to
rank the alternatives using an optimized closeness coecient. Up to our knowledge,
such hybrid model has not been addressed in previous related literature, a certainty
which demonstrates the major contribution in this study.
This paper is organized as follows: The new model is described in Section 2,
presenting the modied DEMATEL, TOPSIS, the membership degree and the implementation procedure. A numerical example of a classical decision making problem
is demonstrated in Section 3 followed by the conclusions in Section 4.
2. The Model
Generally, an MCDM problem is characterized by a) the ratings of each alternative
with respect to each criterion and b) the weights given to each criterion. In this
paper, a hybrid model is proposed that implements a modied DEMATEL-TOPSIS
approach to calculate the weights and process the fuzzy ratings, respectively. Specically, a modied DEMATEL model will be used to estimate the weight of each criterion based on a causal assessment performed by a group of experts. Later, a modied
fuzzy TOPSIS model will be used to process the weights with the corresponding
assessment of each alternative against the dierent criteria. In such an approach,
the model can capture the experts knowledge and preferences precisely, where the
weights do not have to be strictly predetermined prior to the rating process.
Our approach mainly depends on two initial matrices, namely, the direct-relation
fuzzy matrix and the fuzzy decision matrix. Both matrices are evaluated through different assessment processes. The rst assessment process begins with a survey of
the cause-eect relations between the criteria themselves. This method quanties the
total eect of a criterion on the other remaining criteria. In this modied approach,
a group of experts is consulted to provide such assessment. The assessment process is performed by using a fuzzy domain. For instance, one could say criterion a
has a high inuence on criterion b. Similar statements can be drawn using dierent
linguistic variables, particularly, no inuence (No), low inuence (L), moderate inuence (M), high inuence (H) and very high inuence (VH). After the cause-eect
relations among the criteria have been assessed, we can establish the average directrelation fuzzy matrix and proceed to calculate the ultimate criteria weights that will

Fuzzy Inf. Eng. (2012) 2: 195-216

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be plugged into the modied TOPSIS model by which the contrast among the alternatives is calculated. The ratings of alternatives with respect to criteria are measured by
similar linguistic variables, particularly, very poor (VP), poor (P), fair (F), good (G),
and very good (VG). Those ratings symbolize the entries of the initial fuzzy decision
matrix.
The most widely used fuzzy membership function is a triangular fuzzy number
which is based on three values, the lower (), the most possible (m) and the upper
bound (u). In our analysis, a triangular membership function is dened by these three
values, where the most possible value is tied to unity. For instance, a fuzzy set a can
be represented as a = (a , am , au ).
An MCDM problem can be concisely expressed in matrix format as:
C1 C2 Cn

A1 y11 y12 y1n

A2 y21 y22 y2n ,

Y = . . . . .
. . ..
.. .. ..

Am ym1 yn2 ymn

(1)

W = [w1 w2 wn ],
where A1 , A2 , , Am are possible alternatives, C1 , C2 , , Cn are the criteria with
which the alternative performance are measured, yi j is the rating of alternative Ai
with respect to criterion C j , and w j is the weight of criterion C j . In our approach,
a hybrid fuzzy model is established using the DEMATEL and TOPSIS techniques.
A modied fuzzy DEMATEL model will be used to get the criteria weights through
nding the causal diagram of the criteria.
Suppose that a system consists of a set of criteria C = {C1 , C2 , , Cn }, the relations between the criteria factors can be determined through an inuence assessment. The inuence pair-wise comparison scale is partitioned into ve distinct levels
as mentioned previously, that is No, L, M, H and VH. Fig.1 presents the
membership relations between these scales. The initial fuzzy direct-relation matrix Z
is nn matrix that symbolizes the pair-wise inuence between criteria. In this matrix,
zi j denotes the extent to which the criterion Ci inuences criterion C j . Consequently,
the principal diagonal elements zi j of matrix Z are put to be zero [46].

Z (k)

C1
C2
=.
..
Cn

C1 C2 Cn

(k)
0 z(k)

12 z1n
(k)

(k)
z21 0 z2n
. . . . , k = 1, 2, , p,
. . ..
.. ..

(k)
z(k)
z

0
n1 n2

(2)

where zi j = (zi j,l , zi j,m , zi j,u ), k refers to a specic expert among the group and p is
the number of surveyed professionals. To transform the criteria scales into comparable ones, the linear scale transformation is implemented as a normalization. The
normalized direct-relation fuzzy matrix of expert k, denoted as X (k) is thus given by:

Doraid Dalalah Mohammad Al-Tahat Khaled Bataineh (2012)

200

X (k)

(k) (k)
(k)
x11 x12 x1n

(k) (k)

(k)
x21 x22 x2n

= . . . . , k = 1, 2, , p,
. . ..
.. ..

(k) (k)
(k)
xn1 xn2 xnn

(3)

where
(k)

xi j =

z(k)
ij
r(k)

(k) (k) (k)

zi j, zi j,m zi j,u
= (k) , (k) , (k)
r
r
r

and
r

(k)

(k)
= max zi j,u .
1in
j=1

Fig. 1 Fuzzy numbers of the linguistic variables

Similar to the crisp DEMATEL method, it is assumed here that at least one i such
n

(k)
that
z(k)
k = 1, , p, which is usually achieved in practical cases. The
i j,u < r
j=1

average matrix, denoted by X of X (1) , X (2) , , X (p) , thusly can be given as:

and hence

X (1) X (2) X (p)

X =
p

(4)

x11 x12 x1n

x21 x22 . . . x2n

X = . .
.
.. .. ..

xn1 xn2 xnn

(5)

and

p


xi j =

k=1

xi(k)j

(6)

where xi j consists of (xi j, , xi j,m , xi j,u ) and the operator represents element-by-element
addition. The fuzzy matrix X is called the average direct-relation fuzzy matrix. Here,
we implement the arithmetic mean to group the collected data of the experts. This

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201

approach can emphasize the dierences within individuals, which is better than aggregating all the data of the experts right after the initial direct-relation fuzzy matrix
Z (k) is obtained.
After computing the average direct-relation fuzzy matrix, the fuzzy numbers inside this matrix can be split into detached sub-matrices X , Xm and Xu . Hence, any of
the sub-matrices X , Xm or Xu represents the sub-stochastic matrix that results from an
absorbing type Markov chain which is obtained by removing all columns and rows of
the absorbing states [46]. Note that lim (X s )w = O and lim (I + X s + X s2 + + X sk ) =
w

(I X s )1 , s = , m, u, where O is the null matrix and I is the identity matrix. The

total-relation fuzzy matrix T can be acquired by calculating the following term:
X)
1 ,
T = lim (X + X 2 + + X w ) = X(I
w

(7)

that is, T  = X (I X )1 , T m = Xm (I Xm )1 and T u = Xu (I Xu )1 . The set

of equations in (11) includes both inverse and matrix multiplication (i.e., it is not
element by element computation). Accordingly, T will then look like:

t11 t12 t1n

t21 t22 . . . t2n

T = . . . . ,
(8)
.. .. . . ..

tn1 tn2 tnn

where ti j = (ti j, , ti j,m , ti j,u ). The row and column sums of the sub-matrices T  , T m , T u
denoted by D i and R i respectively, can be obtained through the following two formulas:
n

ti j (i = 1, 2, , n),
(9)
D i =
j=1

R i =

n


ti j ( j = 1, 2, , n),

(10)

i=1

where the summation above is held via element-by-element addition. After the def
de f for the list of criteria. Here, the point
fuzzication of D i and R i , we get D de
i and Ri
that splits the triangular fuzzy number into two even areas is considered as the def
fuzzication point. The causal diagram represents the mapping of the pairs of (D de
i
f
de f - R de f ), where the horizontal axis (D de f + R de f ) is called Promi+ R de
i ) and ( Di
i
i
i
f
f
nence and the vertical axis (D de
- R de
i
i ) is called Relation. The prominence axis in
the causal diagram demonstrates how signicant a criterion with regard to the group
of criteria, whereas the relation axis may divide the criteria into the cause and eect
f
f
- R de
groups. When the value (D de
i
i ) is positive, the criterion belongs to the cause
de
f
de
f
group. If the value (D i - R i ) is negative, the criterion belongs to the eect group.
Hence, causal diagrams can visualize the complicated causal relationships between
criteria into a visible structural model and provide valuable insights for problem solving. In this context, we suggest the following expression to measure the relative importance of a criterion which accounts for the interdependence, the cause-eect map
as well as the interrelations between the criteria:

Doraid Dalalah Mohammad Al-Tahat Khaled Bataineh (2012)

202

Wi

f
f 2
de f de f 2 1/2 .
= {(D de
+ R de
i
i ) + ( Di Ri ) }

The weights above have to be normalized so that they sum to unity, which simply
can be held by:
Wi
wi = n
.
(11)

Wi
i=1

Now that the weight values are found, they can be used in the modied fuzzy TOPSIS model. The main concept in the traditional TOPSIS is that the chosen alternative
should have the shortest distance from the PIS and the farthest from the NIS.
In our modied TOPSIS model, we use fuzzy assessments instead of crisp values. Linguistic variables are used to assess the ratings of each alternative with respect to each criterion. According to the notion of TOPSIS, a fuzzy negative ideal
solution (FNIS) and a fuzzy positive ideal solution (FPIS) are dened. Next, the distances from FPIS and FNIS are calculated to all alternatives. Finally, to better portray
the contrast between the ideal alternative and the remaining alternatives, an optimal
membership degree function is established which will eventually determine the ranking order of all alternatives. Higher values of this membership degree indicate that an
alternative is closer to FPIS and farther from FNIS.
Following (1), a fuzzy multi-criteria group decision making problem can be concisely expressed in a fuzzy matrix format as:
C1 C2 Cn
(k) (k)
(k)
A1 y 11 y 12 y 1n
(k) (k)
(k)
A2 y 21
y 22 y 2n

k)
(
y = . . . . . ,
.. . .
. . ..
. .

(k) (k)
Am y y y (k)
mn
m1 n2

(12)

W = [w1 w2 wn ],
where y i j is a linguistic variable represented by triangular fuzzy numbers, y i j =
(yi j, , yi j,m , yi j,u ). Suppose that a decision group of p experts is to conduct the assessment, the average rating of alternatives with respect to each criterion can be calculated
as:
1
y (2)
(p)
(13)
y i j = [y(1)
ij y
i j ],
p ij
where y (k)
i j constitutes
i j is the rating of the kth decision maker. The collection of all y

the aggregated matrix Y. Taking into consideration the weights of each criterion, we
can construct the weighted-normalized fuzzy decision matrix as:
V = [vi j ]mn , i = 1, 2, , m, j = 1, 2, , n,

(14)

where v i j = y i j ()w j , j =1, , n. The elements v i j of the weighted normalized

fuzzy decision matrix are normalized positive triangular fuzzy numbers within the
closed interval [0, 1]. Accordingly, we may characterize the FPIS A and the FNIS
A as:

Fuzzy Inf. Eng. (2012) 2: 195-216

203

A = (v1 , v 2 , , v n ),
A = (v1 , v 2 , , v n ),

(15)

v j ={maxi (vi j ) if C j C; maxi (vi j ) if C j C},

v j ={maxi (vi j ) if C j C; maxi (vi j ) if C j C},
where C is the set of benet criteria, i.e., more of each criterion is better, and C is
the set of detriment criteria, i.e., less is better. The ideal distance of each alternative
from A and A can be calculated as:
di =
di =

n

j=1
n

j=1

d(vi j , v j ), i = 1, 2, , m,
d(vi j , v j ), i = 1, 2, , m,

(16)

where d(, ) is the distance measure between any two fuzzy numbers. The distance
can be calculated as follows: let a and b be two triangular fuzzy numbers. Using the
vertex method, we can calculate the distance between the two fuzzy numbers as:
= [ 1 ((a b )2 + (am bm )2 + (au bu )2 ))]0.5 .
d(a, b)
3

(17)

Let variable ui denote the global evaluation for alternative Ai in regard to all criteria,
which in turn will provide the ranking order of all alternatives. Now, from the of fuzzy
sets theory point of view, ui interprets the membership degree of alternative Ai with
respect to the notion of optimum to all criteria, i.e., the ideal alternative, while 1-ui
denotes the membership degree to the anti-ideal. In order to better explain the dierence between the ideal alternative with respect to other alternatives, the membership
degree ui can be related as a weight for the fuzzy ideal weight distance. Hence, the
weighted fuzzy ideal weight distance is given by:

and its counter part:

Dgi = ui di ,

(18)

Dbi = (1 ui )di .

(19)

Following the optimality principle presented in [47], the optimal evaluation of the
membership degree ui can be solved by minimizing the square sum of the weighted
fuzzy ideal weight distance Dgi and its counter part Dbi , i.e., the objective function will
have the form:
(20)
min{ f (ui ) = (Dgi )2 + (Dbi )2 }.
According to (18) and (19), we have
f (ui ) = (ui di )2 + (1 ui )2 (di )2 ,
dierentiating
f (ui )
= 0,
dui

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Doraid Dalalah Mohammad Al-Tahat Khaled Bataineh (2012)

we have
ui =

(di )2
.
(di )2 + (di )2

(21)

The expression in (21) represents the overall evaluation of each alternative with
respect to all criteria. The best alternative can be easily identied and the ranking
order of all alternatives can be determined through the membership degree of each
alternative. Equation (21) is comparable in its current form to TOPSIS closeness
coecient. The closeness coecient in TOPSIS is calculated through the distance
to anti-ideal solution divided by the summation of the ideal and anti-ideal solutions
[48].
Noticeably, according to (21), an alternative Ai would be closer to FPIS (A ) and
farther from FNIS (A ) as the membership degree ui approaches 1. In other words,
the membership degree can determine the ranking order of all alternatives and hence
will indicate the best one among a set of given feasible alternatives.
The described hybrid approach can be implemented by following given steps below:
Step 1: Form a committee of p decision-makers, identify the interdependent evaluation criteria and alternatives and acquire the assessments of the group of p experts
to measure the relationship between the criteria C = {C1 ,C2 , , Cn } in terms of linguistic evaluations. Hence, p direct-relation fuzzy matrices Z (1) , Z (2) , , Z (p) will
result, each of which corresponds to a dierent expert.
Step 2: Acquire the decision makers opinions to get the fuzzy ratings y (1) , y (2) , ,
y (p) , where in each matrix an expert will evaluate alternative Ai under criterion C j for
all criteria and alternatives.
Step 3: Acquire the normalized direct-relation fuzzy matrix X (k) , k = 1, , p and
calculate the average matrix X using (4).
Step 4: Compute the total-relation fuzzy matrix T using (7).
f
f
and R de
Step 5: Compute D i and R i then defuzzify to nd D de
i
i .

Step 6: Find the criteria weights using the formula in (11).

Step 7: Compute the aggregated matrix Y from the results of Step 2.
Step 8: Use the results in Step 6 and 7 to construct the weighted normalized fuzzy
decision matrix as in (14).
Step 9: Determine FPIS and FNIS as in (15).
Step 10: Calculate the distance of each alternative from the FPIS and FNIS respectively using (16).
Step 11: Calculate the membership degree ui of each alternative using (21).
Step 12: According to the optimal membership degrees, determine the ranking order
of all alternatives.
3. Numerical Example: Optimal Sore Throat Treatment

Fuzzy Inf. Eng. (2012) 2: 195-216

205

In this numerical example, we will apply the proposed approach to a classical sore
throat optimal treatment problem, a frequent illness for which primary care physicians are consulted [2, 49, 50]. Known as pharyngitis or tonsillitis, a sore throat is an
infection that can be either viral or bacterial which aects the pharynx. Contagious
viral infection (such as cold, u or mononucleosis) are the most common causes for
sore throat, although some bacterial infection may cause serious throat infections
(such as strep, mycoplasma or hemophilus). It is well known in the medical society
that bacterial sore throats react rapidly to antibiotics as compared to viral infections.
Researchers have long attempted to decide how best to treat strep throat, yet it remains a leading cause for physician visits.
The major concern is the extent to which the clinical likelihood of a group. A
streptococcal infection should inuence the decision of clinicians. In this case study,
we will conduct a multi-criteria decision analysis using the proposed model in order
to determine the best treatment of pharyngitis.
The objective of our case study is to recognize the optimal oce management of
patients aged 18 years or older who are suering of a chief complaint of strep throat
(sore throat). There will be four major interdependent criteria which are commonly
implemented for the treatment, particularly: shortening the illness duration, reducing
the antibiotic side eects, optimal antibiotics use and preventing infectious complications. Two sub-criteria are included within the infectious complications, namely, local
complications (peri-tonsillar abscess) and systemic complications (acute rheumatic
fever). The antibiotics side eects are usually divided into minor and major: gastrointestinal distress/anaphylaxis and rash. The best (optimal) antibiotics use is also
divided into avoiding over-treatment to reduce unnecessary antibiotic use as well as
the development of bacterial antibiotic resistance and avoiding under-treatment with
antibiotics to decrease the chance of preventable spread of disease to family and close
contacts. Five diagnostic management strategies are examined in this study, the provided strategies are known to be common in treating sore throat in the medical community, specically:
A1 : No test no rx, meaning no testing and no treatment.
A2 : Rapid strep, here, we obtain a rapid streptococcal antigen test, then we
treat patients whose test results are positive, do not treat patients whose test
results are negative.
A3 : Culture, we conduct a throat culture and treat patients whose test results
are positive, dont treat if negative.
A4 : Rapid strep and culture, we obtain a rapid streptococcal antigen test and
treat patients whose test results are positive, obtain a throat culture on patients
whose test results are found to be negative and treat if the culture result is
positive.
A5 : Empiric rx, with no further diagnostic testing, do treat everyone.
The list of interdependent criteria will thusly be:

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Doraid Dalalah Mohammad Al-Tahat Khaled Bataineh (2012)

C1 : Shorten duration of illness.

C2 : Prevent infectious complications, local (Peri-tonsillar abscess).
C3 : Prevent infectious complications, systemic (Rheumatic fever).
C4 : Avoid medication side eects: rash and gastrointestinal distress (minor).
C5 : Avoid medication side eects: anaphylaxis (major).
C6 : Prudent antibiotic use, avoid over-treatment.
C7 : Prudent antibiotic use, avoid under-treatment.
Fig.2 shows the interdependence of the criteria. For instance, we all know that
the use of antibiotics may aect the illness duration, the illness duration has an eect
on the infectious complications (systemic or local). Medication side eects may be
related to over-treatments and so on. Such complicated interdependence may lead to
confusion in the decision making process. It is not clear which criterion should have
the highest weight from the perspectives of the decision maker. Our presented model
will address such decision making problem.

Fig. 2 Criteria sample interdependence

The criteria assessment against the alternatives was held using the linguistic variables mentioned before, where Table 2 shows the surveyed ratings.
Using the cause-eect relationship matrix given in Table 1, we can calculate the
average fuzzy matrix X and the total relation fuzzy matrix T . The resulting matrices
are given in Table 3 and 4.
Correspondingly, from the above table we can calculate D i and R i as seen in Table
5 and 6.
Now using Table 5 and 6, we can simply calculate the prominence and the relation
terms for each alternative as illustrated in Table 7. The causal diagram which relates
the prominence to the relation is depicted in Fig.3.
Each alternative can now be weighted using (11), the corresponding weights are
shown in Table 7.

Fuzzy Inf. Eng. (2012) 2: 195-216

207

Table 1: Initial direct-relation fuzzy matrices, where e1 , e2 and e3 constitute the set
of three experts.
C1

C3

C2

C5

C4

C6

C7

e1 e2 e3 e1 e2 e3 e1 e2 e3 e1 e2 e3 e1 e2 e3 e1 e2 e3 e1 e2 e3
C1 0

M L NO L M L M L M M M M NO NO NO M M M
0

C2 H H H

C3 L M H H L M

M M M M M M M M L M M M NO NO NO
0

0 NO NO L M M M M L M L M NO

C4 M M M H H H M M M

H H H M M M M M L

C5 H H H VH VH VH H H H H H H

0 NO NO NO H H H

C6 M M M M M M M M M H H H H H H

M M M
0

C7 NO NO NO M M M H H H M M M M M M M M M

Table 2: Criteria versus alternatives assessment.

A1

A3

A2

A5

A4

e1

e2

e3

e1

e2

e3

e1

e2

e3

e1

e2

e3

e1

e2

C1

VP

VP

VP

G VG

C2

C3

VG G

VG G VG

C4

G VG

VP

VP VP VP

C5 VG G

VP VP

C6

C7 VP VP

VG

VP VP

VP VP
F

e3

VG VG

The causal diagram in Fig.3 shows that criterion 1 through 3 fall in the category of
eect, i.e., they can be inuenced by the remaining criteria factors. As a mater of fact,
shortening duration of illness, preventing local and systemic infectious complications
(Peri-tonsillar abscess and Rheumatic fever) denitely fall in the category of symptoms rather than causes. Clearly, the assessment model shows that medication side
eects are one of the most important factors in treating sore throat followed by the lo-

Doraid Dalalah Mohammad Al-Tahat Khaled Bataineh (2012)

208

Table 3: The average matrix X.

C1

C2

C3

C4

C5

C6

C7

C1

0.00 0.00 0.00 0.02 0.05 0.10 0.02 0.06 0.11 0.03 0.08 0.13 0.05 0.10 0.14 0.00 0.00 0.05 0.05 0.10 0.14

C2

0.10 0.14 0.19 0.00 0.00 0.00 0.05 0.10 0.14 0.05 0.10 0.14 0.03 0.08 0.13 0.05 0.10 0.14 0.00 0.00 0.05

C3

0.05 0.10 0.14 0.05 0.10 0.14 0.00 0.00 0.00 0.00 0.02 0.06 0.05 0.10 0.14 0.03 0.08 0.13 0.02 0.05 0.10

C4

0.05 0.10 0.14 0.10 0.14 0.19 0.05 0.10 0.14 0.00 0.00 0.00 0.10 0.14 0.19 0.05 0.10 0.14 0.03 0.08 0.13

C5

0.10 0.14 0.19 0.14 0.19 0.19 0.10 0.14 0.19 0.10 0.14 0.19 0.00 0.00 0.00 0.00 0.00 0.05 0.10 0.14 0.19

C6

0.05 0.10 0.14 0.05 0.10 0.14 0.05 0.10 0.14 0.10 0.14 0.19 0.10 0.14 0.19 0.00 0.00 0.00 0.05 0.10 0.14

C7

0.00 0.00 0.05 0.05 0.10 0.14 0.10 0.14 0.19 0.05 0.10 0.14 0.05 0.10 0.14 0.05 0.10 0.14 0.00 0.00 0.00

Table 4: The total relation fuzzy matrixT .

C1

C2

C3

C4

C5

C6

C7

C1

0.01 0.08 0.53 0.03 0.14 0.64 0.03 0.15 0.66 0.04 0.15 0.63 0.06 0.17 0.68 0.01 0.05 0.58 0.06 0.15 0.58

C2

0.11 0.23 0.78 0.02 0.11 0.63 0.06 0.19 0.76 0.06 0.18 0.72 0.05 0.18 0.76 0.05 0.15 0.58 0.02 0.09 0.58

C3

0.06 0.18 0.69 0.06 0.18 0.70 0.01 0.09 0.59 0.02 0.10 0.61 0.06 0.18 0.71 0.04 0.13 0.57 0.03 0.11 0.57

C4

0.08 0.22 0.85 0.12 0.28 0.91 0.08 0.23 0.88 0.03 0.13 0.70 0.12 0.27 0.92 0.06 0.17 0.73 0.05 0.18 0.73

C5

0.13 0.27 0.90 0.17 0.33 0.93 0.13 0.28 0.94 0.12 0.26 0.88 0.04 0.15 0.78 0.02 0.10 0.80 0.11 0.23 0.80

C6

0.08 0.22 0.86 0.09 0.24 0.89 0.08 0.23 0.89 0.12 0.26 0.88 0.12 0.27 0.94 0.02 0.08 0.76 0.07 0.20 0.76

C7

0.02 0.12 0.69 0.07 0.21 0.79 0.11 0.24 0.83 0.06 0.19 0.74 0.07 0.20 0.80 0.06 0.16 0.55 0.01 0.08 0.55

cal infectious complications (peri-tonsillar abscess). This ranking of weights is based

on the assessment process that has been conducted through the group of experts.
is shown in Table 8, while the weighted norThe over all rating of all expert (Y)
malized decision fuzzy matrix V is shown in Table 9.
According to the table above, we can nd ideal and anti-ideal solutions using (15)
as shown in Table 10. In our case study, all the criteria fall in the detriment (negative)
group.
The distance of each alternative Ai (i =1,2, ,m) from A and A can be calculated using (16) as shown in Table 11 and 12.
Using the last row entry in Table 11 and 12, we can now employ (21) to nd the
ranking of all treatment options for this particular case study. Table 13 presents the
nal score (ui ) of each alternative.
The scores of the ve alternatives show that: to culture every one, who visits
the primary care unit, will be the most reasonable option taking in consideration

Fuzzy Inf. Eng. (2012) 2: 195-216

209

f
Table 5: The fuzzy number D i and its defuzzied term D de
i .

f
D de
i

D i

i
1 0.2402

0.8834

4.162

1.63

2 0.3811

1.1392

4.8314

1.97

3 0.2788

0.9767

4.4055

1.75

4 0.5345

1.4627

5.6575

2.38

5 0.7183

1.6264

5.8586

2.56

6 0.563

1.5088

5.7754

2.44

7 0.4169

1.2097

5.0073

2.05

f
Table 6: The fuzzy number R i and its defuzzied term R de
i .

f
R de
i

R i

i
1 0.49

1.32

5.2911

2.20671

2 0.57

1.5

5.4811

2.35409

3 0.5

1.41

5.5448

2.317

4 0.45

1.26

5.1552

2.12984

5 0.51

1.43

5.589

2.3404

6 0.26

0.84

4.048

1.5813

7 0.35

1.04

4.5885

1.84395

the relative interdependence among the criteria and experts judgment. Our results
highlight the outcomes of [2, 49] where the culture option is the best among the
others. The next preferred option is to obtain a rapid streptococcal antigen test and
treat patients who test positive, obtain a throat culture on patients who test negative
and treat if the culture is positive, (rapid strep and culture). No-test No-treatment as
well as empiric treatment, both achieve almost similar scores, though, they are the
least preferred options. Although the literature studies in [49, 50] state that A2 and A5

Doraid Dalalah Mohammad Al-Tahat Khaled Bataineh (2012)

210

Fig. 3 Alternatives prominence vs. relation

Table 7: Alternatives prominence, relation and weights.

i

f
+
D de
i

f
R de
i

D de
i

f
R de
i

Wi

wi

3.83

-0.58

3.88 0.130

4.32

-0.39

4.34 0.146

4.06

-0.57

4.10 0.138

4.51

0.25

4.52 0.152

4.90

0.22

4.91 0.165

4.02

0.86

4.11 0.138

3.90

0.21

3.90 0.131

are almost the same in rank, it was not the case in our model. Our model conforms to
the literature results in the rank of A3 , A4 and A5 and presents a better contrast for the
remaining alternatives.
Although it is pointed by the baseline analysis in [49, 50] that there is no superior patient management course of action as it would be dicult to mark a denitive
treatment, however, the presented model tends to spot the best management among
the available ones.
Remarks: From the presented case study, we notice that not only our model could
present more insights to the alternatives and conform to the found literature results,
but it also presented higher rank contrasts in which equal alternatives in [49, 50] are

Fuzzy Inf. Eng. (2012) 2: 195-216

211

Table 8: The matrix of the aggregated opinions Y.

i

A1

A2

A3

A4

A5

0.00 0.17 0.42 0.50 0.75 1.00 0.00 0.08 0.33 0.33 0.58 0.83 0.58 0.83 1.00

0.25 0.50 0.75 0.25 0.50 0.75 0.33 0.58 0.83 0.42 0.67 0.92 0.50 0.75 0.92

0.00 0.25 0.50 0.42 0.67 0.92 0.42 0.67 0.92 0.50 0.75 0.92 0.67 0.92 1.00

0.50 0.75 0.92 0.17 0.42 0.67 0.08 0.33 0.58 0.08 0.25 0.50 0.00 0.00 0.25

0.50 0.75 0.92 0.00 0.25 0.50 0.08 0.33 0.58 0.00 0.08 0.33 0.00 0.08 0.33

0.50 0.75 1.00 0.08 0.33 0.58 0.25 0.50 0.75 0.17 0.42 0.67 0.08 0.17 0.42

0.00 0.08 0.33 0.25 0.50 0.75 0.17 0.42 0.67 0.25 0.50 0.75 0.58 0.83 0.92

Table 9: The weighted normalized decision fuzzy matrix V.

i

A1

A2

A3

A4

A5

0.00 0.02 0.05 0.07 0.10 0.13 0.00 0.01 0.04 0.04 0.08 0.11 0.08 0.11 0.13

0.03 0.07 0.10 0.03 0.07 0.10 0.04 0.08 0.11 0.05 0.09 0.12 0.07 0.10 0.12

0.00 0.03 0.07 0.05 0.09 0.12 0.05 0.09 0.12 0.07 0.10 0.12 0.09 0.12 0.13

0.07 0.10 0.12 0.02 0.05 0.09 0.01 0.04 0.08 0.01 0.03 0.07 0.00 0.00 0.03

0.07 0.10 0.12 0.00 0.03 0.07 0.01 0.04 0.08 0.00 0.01 0.04 0.00 0.01 0.04

0.07 0.10 0.13 0.01 0.04 0.08 0.03 0.07 0.10 0.02 0.05 0.09 0.01 0.02 0.05

0.00 0.01 0.04 0.03 0.07 0.10 0.02 0.05 0.09 0.03 0.07 0.10 0.08 0.11 0.12

found to have dierent ranks.

Moreover, although the group of experts dont have to provide any criteria weights,
indirectly, the model can compute the weights out of the interrelations between the
criteria themselves. However, the interrelations cannot just be resolved by any person,
they have to be determined by the experts as they will result in the relative signicance
of the criteria. Such approach will eliminate the bias towards certain criteria due to
individual preferences. Our presented model is most useful for the cases where an
individual is not completely free to impose his own preferences, instead, the criteria
interrelations are the most responsible for stating their relative importance. Such a
decision model can suite medical diagnosis systems where the physicians have to
decide which action plan to take for the best treatment or in the situations when
the criteria importance is not necessarily related personal aspects as much as to the

Doraid Dalalah Mohammad Al-Tahat Khaled Bataineh (2012)

212

Table 10: The ideal and anti-ideal solutions, i.e., A and A .

v j

j
1
2
3
4
5
6
7

0.000
0.033
0.000
0.000
0.000
0.011
0.000

v j

0.011
0.065
0.033
0.000
0.011
0.022
0.011

0.043
0.098
0.065
0.033
0.043
0.054
0.043

0.076
0.065
0.087
0.065
0.065
0.065
0.076

0.109
0.098
0.119
0.098
0.098
0.098
0.109

0.130
0.119
0.130
0.119
0.119
0.130
0.119

Table 11: Distance from FPIS.

d(vi j , v j )
A1

A2

A3

A4

A5

C1

0.000

0.000

0.011

0.022

0.029

C2

0.000

0.054

0.054

0.062

0.080

C3

0.084

0.046

0.036

0.027

0.000

C4

0.077

0.018

0.027

0.000

0.000

C5

0.070

0.018

0.038

0.027

0.000

C6

0.000

0.048

0.038

0.048

0.084

C7

0.000

0.000

0.000

0.000

0.000

di

0.230

0.184

0.204

0.186

0.194

interrelation structure.
Not only the weights-which now can be imputed out of the interrelations-come
into sight of this study contributions, the combination of DEMATEL and TOPSIS altogether as well as extending them to manage fuzzy information is another part which
could improve the contrast in the nal ratings. In addition, data pooling across the
experts is accomplished via fuzzy evaluations where the calculated averages remain
in the fuzzy domain. With the denition of fuzzy ideal and fuzzy anti-ideal alternatives, the fuzzy weight distances could be calculated using a geometrical distance

Fuzzy Inf. Eng. (2012) 2: 195-216

213

Table 12: Distance from FNIS.

d(vi j , v j )
A1

A2

A3

A4

A5

C1

0.080

0.009

0.087

0.029

0.000

C2

0.029

0.029

0.019

0.009

0.000

C3

0.080

0.027

0.027

0.019

0.000

C4

0.000

0.040

0.051

0.058

0.084

C5

0.000

0.062

0.051

0.077

0.077

C6

0.000

0.054

0.033

0.043

0.070

C7

0.084

0.038

0.048

0.038

0.000

di

0.273

0.259

0.316

0.273

0.230

Table 13: Final rank of each alternative treatment option.

A1
ui

A2

A3

A4

A5

0.585 0.665 0.706 0.682 0.586

measure. Such notation helped in the robustness of the defuzzication as the decision
deployment is held in the fuzzy domain.
4. Conclusion
In this paper, a fuzzy DEMATEL-TOPSIS model has been proposed. The model
aids in estimating the weights of mutually dependent criteria based on cause-eect
assessments of a group of professionals. In this model, both DEMATEL and TOPSIS
have been extended to handle fuzzy evaluations where the rst is used to set the
weights of the interdependent criteria and the second is used to draw a decision from
a group of professionals who use linguistic rating in their evaluations.
With the proposed methodology, the complex interactions between the criteria can
be transformed into a visible structural model and then translated into criteria weights.
The calculated weights of the modied DEMATEL model are plugged into a modied
fuzzy TOPSIS model to help draw a decision. We modied the procedures in both
DEMATEL and TOPSIS techniques in which a decision maker can use linguistic

214

Doraid Dalalah Mohammad Al-Tahat Khaled Bataineh (2012)

variables to handle the vagueness and uncertainty in the judgments and the criteria
interdependence. In the modied TOPSIS, an optimality function is introduced to
calculate the optimal membership degree of an alternative to both FPIS and FNIS.
The farther the degree of membership from the FNIS and the closer to the FPIS the
more favored the alternative. A classical numerical example was given to nd the
optimal treatment of sore throat in a typical primary care unit. The demonstrated
example has shown better results that are almost identical to the literature with a
improved insights and rank contrasts.
The major contributions of the presented model are mainly as follows: rst, the
estimation of criteria weights when the criteria are interrelated in which traditional
MCDM may fail or mislead the decision maker. Second, the prevention of having to
strictly determine the criteria weights in case of mutual interdependence. Third, the
extension of both DEMATEL and TOPSIS to handle the fuzzy ratings and linguistic
evaluations of a group of experts. Finally, the introduction of miscellaneous aggregating procedures and distance measures to harmonize the two approaches to t our
hybrid model.
Acknowlegements
I would like to thank the editor and the anonymous reviewers of the International
Journal of Fuzzy Information and Engineering for their valuable comments to help
improve the quality of this paper.
References
1. Hwang C L, Yoon K (1981) Multiple attributes decision making methods and application. SpringerVerlag, Berlin Heidelberg
2. Doraid Dalalah, Sami Magableh (2008) Diagnosis and management of strep throat: remote multicriteria fuzzy reasoning approach. Telemedicine and Ehealth Journal 14(7): 656-665
3. Chen S JHwang C L (1992) Fuzzy multiple attribute decision making methods and applications.
Springer-Verlag, Berlin Heidelberg
4. Fontela E, Gabus A (1976) The DEMATEL observer, DEMATEL 1976 report. Switzerland, Geneva,
Battelle Geneva Research Center
5. Yamazaki M, Ishibe K, Yamashita S (1997) An analysis of obstructive factors to welfare service using
DEMATEL method. Reports of the Faculty of Engineering, Yamanashi University 48: 25-30
6. Hori S, Shimizu Y (1999) Designing methods of human interface for supervisory control systems.
Control Engineering Practice 7(11): 1413-1419
7. Hwang C L, Yoon K (1981) Multiple attributes decision making methods and applications. Springer,
Berlin Heidelberg
8. Tsuar S H, Chang T Y, Yen C H (2002) The evaluation of airline service quality by fuzzy MCDM.
Tourism Management 23: 107-115
9. Wang R C, Liang T F (2004) Application of fuzzy multi-objective linear programming to aggregate
production planning. Computers and Industrial Engineering 46: 17-41
10. Deng H, Yeh C H, Willis R J (2000) Inter-company comparison using modied TOPSIS with objective weights. Computers and Operations Research 27: 963-973
11. Abo-Sinha M A, Amer A H (2005) Extensions of TOPSIS for multi-objective large-scale nonlinear
programming problems. Appl. Math. Comput. 162: 243-256
12. Chu T C (2002) Facility location selection using fuzzy TOPSIS under group decisions. International
Journal of Uncertainty, Fuzziness and Knowledge-Based Systems 10(6): 687-701
13. Xu D L, Yang J B (2001) Introduction to multi-criteria decision making and the evidential reasoning approach. Working Paper Series No. 0106, Manchester School of Management, University of

Fuzzy Inf. Eng. (2012) 2: 195-216

215

Manchester Institute and Technology ISBN: 1-86115-111-X

14. Robert Fuller, Peter Majlender (2003) On weighted possibilistic mean and variance of fuzzy numbers.
Fuzzy Sets and Systems 136: 363-374
15. Carlsson C, Robert Fuller, Markku Heikkila, Peter Majlender (2007) A fuzzy approach to R&D
project portfolio selection. International Journal of Approximate Reasoning 44: 93-105
16. Carlsson C, Fuller R (1994) Interdependence in fuzzy multiple objective programming. Fuzzy Sets
and Systems 65: 19-29
17. Carlsson C, Fuller R (1995) Multiple criteria decision making. The case for interdependence. Computers & Operations Research 22(3): 251-260
18. Carlsson C, Robert Fuller (1996) Fuzzy multiple criteria decision making: Recent developments.
Fuzzy Sets and Systems 78: 139-153
19. Stewart TJ (1992) A critical survey on the status of multiple criteria decision making theory and
practice. OMEGA International Journal of Management Science 20(5-6): 569-586
20. Umm-e-Habiba (2009) A survey on multicriteria decision making approaches. International Conference on Emerging Technologies (ICET 2009) Islamabad 321-325
21. Kwakernaak H (1979) An algorithm for rating multiple-aspect alternatives using fuzzy sets. Automatica 15: 615-616
22. Buckley J J, Chanas S (1989) A fast method of ranking alternatives using fuzzy numbers. Fuzzy Sets
and Systems 30: 337-339
23. Dubois D, Prade H (1983) Ranking fuzzy numbers in the setting of possibility theory. Information
Sciences 30(3): 183-224
24. Lee E S, Li, R J (1988) Comparison of fuzzy numbers based on the probability measure of fuzzy
events. Computers and Mathematics with Applications 15(10): 887-896
25. Chen S J, Hwang C L (1992) Fuzzy multiple attribute decision making: Methods and applications,
Springer-Verlag, New York
26. Yager R R (1981) A procedure for ordering fuzzy subsets of the unit interval. Information Sciences
24(2): 141-161
27. Yager R (1978) Fuzzy decision making including unequal objectives. Fuzzy Sets and Systems 1:
87-95
28. Bonissone P (1982) A fuzzy sets based linguistic approach: theory and applications, in approximate
reasoning in decision analysis. North-Holland Publishing Company 329-339
29. Saaty T L (1988) The analytic hierarchy process. University of Pittsburgh: Pittsburgh
30. Chang Y M, McInnis B (1980) An algorithm for multiple attribute, multiple alternative decision
problem based on fuzzy sets with application to medical diagnosis. IEEE Transactions on System,
Man, and Cybernetics SMC-10(10): 645-650
31. Dubois D, Prade H (1988) Possibility theory: an approach to the computerized processing of uncertainty. Plenum Press, New York
32. Takeda (1982) Interactive identication of fuzzy outranking relations in a multi-criteria decision problem. Fuzzy Information and Decision Processes 301-307
33. Bellman R, Zadeh L A (1970) Decision making in a fuzzy environment. Manag. Sci. 17: 141-164
34. Tomas Gal, Thomas Hanne (2006) Nonessential objectives within network approaches for MCDM.
European Journal of Operational Research 168(2): 584-592
35. Fuller R, Zimmermann H J (1993) Fuzzy reasoning for solving fuzzy mathematical programming
problems. Fuzzy Sets and Systems 60: 121-133
36. Tanaka H, Uejima S, Asai K (1982) Fuzzy linear model fuzzy linear regression model. IEEE trans.
System, Man and Cybernetics 12: 903-907
37. Negoita C V (1981) The current interest in fuzzy optimization. Fuzzy Sets and Systems 6: 261-269
38. Orlovsky S A (1978) Decision making with a fuzzy preference relation. Fuzzy Sets and Systems
1(3): 155-167
39. Inuiguchi M , Ichihashi H (1990) Relative modalities and their use in possibilistic linear programming. Fuzzy Sets and Systems 35: 303-323
40. Inuiguchi M, Ichihashi H, Tanaka H (1990) Fuzzy programming: a survey of recent developments.
Stochastic Versus Fuzzy Approaches to Multi objective Mathematical Programming under Uncer-

216

Doraid Dalalah Mohammad Al-Tahat Khaled Bataineh (2012)

tainty. Kluwer Academic Publishers, Dordrecht 45-68

41. Ricardo C Silva, Carlos Cruz, Jose L Verdegay, Akebo Yamakami (2010) A survey of fuzzy convex
programming models. Studies in Fuzziness and Soft Computing 254: 127-143
42. Wang J G, Stanley Zoints (2008) Negotiating wisely: considerations based on MCDM/MAUT. European Journal of Operational Research 191-205
43. Doraid Dalalah, Omar Bataineh (2008) A fuzzy logic approach to the selection of the best silicon
crystal slicing technology. Expert Systems with Applications 36(2): 3712-3719
44. Doraid Dalalah, Mohammed Hayajneh, Farhan Batieha (2011) A fuzzy multi-criteria decision making model for supplier selection. Expert Systems Appl. 38(7): 8384-8391
45. Saghaan S, Reza Hejazi S (2005) Multi-criteria group decision making using a modied fuzzy
TOPSIS procedure. IEEE Processing of the 2005 Int. conf. on comp. intelligence for modeling,
control and automation CIMCA05: 215-221
46. Lin C J, Wu W W (2008) A causal analytical method for group decision-making under fuzzy environment. Expert Syst. Appl. 34(1): 205-213
47. Fu G (2008) A fuzzy optimization method for multicriteria decision-making, An application to reservoir ood control operation. Expert Systems Appl. 34(1): 145-149
48. Chen C T (2000) Extension of the TOPSIS for group decision-making under fuzzy environment.
Fuzzy Sets and Systems 114: 1-9
49. Singh S, James G D, Centor R M (2006) Optimal management of adults with pharyngitis-a multicriteria decision analysis. BMC Medical Informatics & Decision Making 6: 14
50. McIsaac W J, Kellner J D, Aufricht P, Vanjaka A, Low D E (2004) Empirical validation of guidelines
for the management of pharyngitis in children and adults. JAMA 291(13): 1587-1595