While sustainability of transport projects is of increasing importance, the concept of sustainability can be understood in many different ways by the stakeholders that are involved in or affected by mobility projects. In this paper, we compare the outcomes of the assessment of sustainability of projects through a multi-criteria analysis (MCA) and the appraisal of stakeholder preferences through the multi-actor multi-criteria analysis (MAMCA). Evaluating projects with both tools and comparing the outcomes can provide insight into the stakeholder support of sustainable solutions and the sustainability of alternatives preferred by stakeholders. The sustainability of projects is assessed through 16 criteria grouped under the three pillars of sustainability. They were selected by in-depth review of 16 case studies of mobility projects, 18 transport evaluation schemes and the ranking of potential criteria by 214 stakeholders in North-West Europe. These criteria were weighted by 93 representatives of decision makers in the mobility domain. Stakeholder preferences were appraised through the criteria identified for each stakeholder group. We illustrate the framework by evaluating alternative solutions to improve cycling connections between the towns of Tilburg and Waalwijk in the Netherlands. The results of the comparison show that stakeholder preferences are biased towards one or two of the sustainability pillars (economy, environment, society) in three ways: through the selection of the criteria by the stakeholders, the weights of each criterion by each stakeholder group and differences in the final ranking of alternatives between the stakeholder groups and the MCA.
MULTIFILE
Background: A patient decision aid (PtDA) can support shared decision making (SDM) in preference-sensitive care, with more than one clinically applicable treatment option. The development of a PtDA is a complex process, involving several steps, such as designing, developing and testing the draft with all the stakeholders, known as alpha testing. This is followed by testing in ‘real life’ situations, known as beta testing, and then finalising the definite version. Our aim was developing and alpha testing a PtDA for primary treatment of early stage breast cancer, ensuring that the tool is considered relevant, valid and feasible by patients and professionals. Methods: Our qualitative descriptive study applied various methods including face-to-face think-aloud interviews, a focus group and semi-structured telephone interviews. The study population consisted of breast cancer patients facing the choice between breast-conserving therapy with or without preceding neo-adjuvant chemotherapy and mastectomy, and professionals involved in breast cancer care in dedicated multidisciplinary breast cancer teams. Results: A PtDA was developed in four iterative test rounds, taking nearly 2 years, involving 26 patients and 26 professionals. While the research group initially opted for simplicity for the sake of implementation, the clinicians objected that the complexity of the decision could not be ignored. Other topics of concern were the conflicting views of professionals and patients regarding side effects, the amount of information and how to present it. Conclusion: The development was an extensive process, because the professionals rejected the simplifications proposed by the research group. This resulted in the development of a completely new draft PtDA, which took double the expected time and resources. The final version of the PtDA appeared to be well-appreciated by professionals and patients, although its acceptability will only be proven in actual practice (beta testing)
ion of verb agreement by hearing learners of a sign language. During a 2-year period, 14 novel learners of Sign Language of the Netherlands (NGT) with a spoken language background performed an elicitation task 15 times. Seven deaf native signers and NGT teachers performed the same task to serve as a benchmark group. The results obtained show that for some learners, the verb agreement system of NGT was difficult to master, despite numerous examples in the input. As compared to the benchmark group, learners tended to omit agreement markers on verbs that could be modified, did not always correctly use established locations associated with discourse referents, and made characteristic errors with respect to properties that are important in the expression of agreement (movement and orientation). The outcomes of the study are of value to practitioners in the field, as they are informative with regard to the nature of the learning process during the first stages of learning a sign language.
