Delphi Group Research Articles

Leveraging 13 million responses to the U.S. COVID-19 Trends and Impact Survey to examine vaccine hesitancy, vaccination, and mask wearing, January 2021-February 2022

BackgroundThe urgency of the COVID-19 pandemic called upon the joint efforts from the scientific and private sectors to work together to track vaccine acceptance and prevention behaviors.MethodsOur study utilized individual responses to the Delphi Group at Carnegie Mellon University U.S. COVID-19 Trends and Impact Survey, in partnership with Facebook. We retrieved survey data from January 2021 to February 2022 (n = 13,426,245) to examine contextual and individual-level predictors of COVID-19 vaccine hesitancy, vaccination, and mask wearing in the United States. Adjusted logistic regression models were developed to examine individual and ZIP code predictors of COVID-19 vaccine hesitancy and vaccination status. Given the COVID-19 vaccine was rolled out in phases in the U.S. we conducted analyses stratified by time, January 2021-May 2021 (Time 1) and June 2021-February 2022 (Time 2).ResultsIn January 2021 only 9% of U.S. Facebook respondents reported receiving the COVID-19 vaccine, and 45% were vaccine hesitant. By February 2022, 80% of U.S. Facebook respondents were vaccinated and only 18% were vaccine hesitant. Individuals who were older, held higher educational degrees, worked in white collar jobs, wore a mask most or all the time, and identified as white and Asian had higher COVID-19 vaccination rates and lower vaccine hesitancy across Time 1 and Time 2. Essential workers and blue-collar occupations had lower COVID vaccinations and higher vaccine hesitancy. By Time 2, all adults were eligible for the COVID-19 vaccine, but blacks and multiracial individuals had lower vaccination and higher vaccine hesitancy compared to whites. Those 55 years and older and females had higher odds of wearing masks most or all the time. Protective service, construction, and installation and repair occupations had lower odds of wearing masks. ZIP Code level percentage of the population with a bachelors’ which was associated with mask wearing, higher vaccination, and lower vaccine hesitancy.ConclusionAssociations found in earlier phases of the pandemic were generally found to also be present later in the pandemic, indicating stability in inequities. Additionally, inequities in these important outcomes suggests more work is needed to bridge gaps to ensure that the burden of COVID-19 risk does not disproportionately fall upon subgroups of the population.

Large-scale group Delphi method with heterogeneous decision information and dynamic weights

Managing a large number of participants in the Delphi survey encounters many challenges, such as heterogeneous data, high cost, dynamic quality, and various uncertainties, etc. This paper proposes a novel large-scale group Delphi method with heterogeneous decision information and dynamic weights to address these challenges. Heterogeneous data with various uncertainties, including exact numbers, interval numbers, normal cloud models, linguistic terms, and linguistic expressions, are converted into normal cloud models. Thus, both magnitudes and uncertainties of data can be preserved and propagated throughout the whole calculation process. Furthermore, this study also presents a data preprocessing technique consisting of four steps to discard invalid data and low-quality inputs. Moreover, a novel dynamic weights assignment algorithm is proposed to determine the weights for participants. Afterwards, detailed procedures and formal algorithm are developed. A practical application is presented to demonstrate the effectiveness, applicability, and advantages of the proposed methodology with examples and detailed comparative analysis. The application shows that the decision result becomes more stable and consentaneous. The comparative analysis indicates that the proposed methodology overcomes several challenges. Therefore, the proposed method can provide novel ideas for large-scale group decision making with heterogeneous data and various uncertainties in a dynamically changing decision environment. Eventually, this study contributes to several fields, such as the Delphi technique, group decision making, modeling of uncertainty, and heterogeneous data representation and processing, etc.

Study of Iran–Saudi Arabia Sports Relations

Political tensions and conflicts have been accompanying modern sports for a long time. The objective of this study was to determine the political reasons for not hosting football matches between Iranian and Saudi football teams. To address the research objective, a mixed-method approach was used. First, in the qualitative part, the political reasons for not hosting the matches identified through the content analysis and interviews were reviewed and evaluated by Delphi Group (25 people) in the second and third stages. Secondly, in the qualitative section of the study, the questionnaire was also used to rank the reasons. The research findings showed that tensions between Tehran and Riyadh increased after the Saudi Embassy attack in Tehran and Mashhad (January 2016) and the execution of Sheikh Nimr, a Shia sheikh opposed to the Saudi government. Saudi Arabia has requested that the Asian Champions League matches against Iranian opponents be held on neutral grounds in order to ensure the safety of its players. It is therefore recommended that sports managers and politicians in Iran reduce the political tensions between the two countries. In addition, they need to strive toward creating peace, friendship, and security between the two countries.

Linking of the 'Integration von Menschen mit Behinderungen in die Arbeitswelt' (IMBA) to the 'International Classification of Functioning, Disability and Health' (ICF).

The assessment of work capacity, workable work and the need for a common language is challenging in labour market policy. Being a specific instrument to facilitate Return To Work (RTW), the Integration von Menschen mit Behinderungen in die Arbeitswelt (IMBA) might facilitate the documentation of the individual's work capacity, the job-related workload and the match between these two elements. Since the International Classification of Functioning, Disability and Health (ICF) is worldwide recognized as frame of reference in RTW, this paper presents the linking of IMBA to the ICF, since this is assumed to be beneficial to support RTW. The establishment of the IMBA-ICF linking in order to study 1) the relationship between IMBA and ICF; 2) the content comparison of IMBA with work-related ICF core sets; and 3) the extent to which the linking addresses the challenges in RTW policy. A content comparison of IMBA and ICF was conducted, using a 7- step linking methodology in which the Delphi and Nominal Group Technique are integrated in the implementation of the ICF linking rules. An explorative conversion of the scoring systems of IMBA and ICF was established based on expert opinions. In the main 70 IMBA items, 107 concepts have been identified of which 94 were linked to 87 different ICF categories. Body functions and activities and participation are the most presented ICF components in contrast to the environmental factors. IMBA items regarding occupational safety and work organization are respectively 'not covered' and 'not defined' in ICF. An integration of IMBA and ICF addresses the challenges in RTW policy in the assessment of work capacity, workable work and the need for a common language. In order to do so, extension of ICF terminology regarding 'occupational safety' and 'work organization' is priority. In depth quantitative research is necessary to support the conversion of both scoring systems.

Implementing a combined Delphi and Focus Group qualitative methodology in Nexus research designs-The case of the WEFE Nexus in Apokoronas, Crete.

In recent years, researchers and policymakers have emphasised the importance of understanding the complex relationships between Water, Energy, Food and Ecosystems (WEFE). The primary reason for capturing these complexities is to understand how decisions made in the water, food and energy sectors can affect one another. Crucially, biodiversity and ecosystem services (E) play a mediating role in these relationships by making material and non-material contributions to all other sectors (W, E, F). The Nexus approach has been widely used for capturing these interdependencies and identifying opportunities for increasing efficiency, reducing trade-offs and building synergies for sustainable resource use across the WEFE nodes. One challenge in using this framework is the need to harmonise the technical and managerial dimensions of the WEFE interlinkages with the perceptions and priorities of local populations directly involved in the use and management of resources. This paper presents a methodological framework that seeks to integrate the perspectives of experts, practitioners and local stakeholders on the WEFE Nexus through the combined application of the Delphi and Focus Group methods. In this paper, the municipality of Apokoronas in Crete, Greece has served as the case in point. The combined framework allowed us to explore the Nexus understanding at the local level and was instrumental in the identification of initiatives for more integrated resource management. The triangulation of results captured the differences in priorities between practitioners and the local community at large, but also, more specifically, it pointed to discrepancies within groups and across WEFE sectors. The outcomes of this paper demonstrate that awareness and learning play a central role in Nexus actions to overcome conflicts and perceived inequalities, and to internalise solutions. The inclusion of the ecosystems node in the traditional WEF Nexus encouraged participants to contemplate the pivotal role of ecosystems in supporting the rest of the WEF sectors.

COVID‐19 test positivity by occupation using the Delphi US COVID‐19 trends and impact survey, September–November 2020

BackgroundThe potential for work to be a risk factor for coronavirus disease 2019 (COVID‐19) was recognized early in the pandemic based on the likelihood of work‐related differences in exposures to COVID‐19 in different occupations. Due to intense demands of the pandemic, implementation of recommendations to collect information on occupation in relation to COVID‐19 has been uneven across the United States. The objective of this study was to investigate COVID‐19 test positivity by occupation.MethodsWe analyzed data collected from September 8 to November 30, 2020, by the Delphi Group at Carnegie Mellon University US COVID‐19 Trends and Impact Survey, offered daily to a random sample of US‐based Facebook users aged 18 years or older, who were invited via a banner in their news feed. Our focus was ever testing positive for COVID‐19 in respondents working outside the home for pay in the past 4 weeks.ResultsThe major occupational groups of “Production", "Building and grounds cleaning and maintenance,” “Construction and extraction,” “Healthcare support,” and “Food preparation and serving” had the five highest test positivity percentages (16.7%–14.4%). Highest detailed occupational categories (28.6%–19.1%) were “Massage therapist,” “Food processing worker,” “Bailiff, correctional officer, or jailer,” “Funeral service worker,” “First‐line supervisor of production and operating workers,” and “Nursing assistant or psychiatric aide.” Differences in test positivity by occupation remained after adjustment for age, gender, and pre‐existing medical conditions.ConclusionInformation on differences in test positivity by occupation can aid targeting of messaging for vaccination and testing and mitigation strategies for the current and future respiratory infection epidemics and pandemics. These results, obtained before availability of COVID‐19 vaccines, can form a basis for comparison to evaluate impacts of vaccination and subsequent emergence of viral variants.

Attaining a British consensus on managing idiopathic congenital talipes equinovarus up to walking age.

The aim of this study was to gain an agreement on the management of idiopathic congenital talipes equinovarus (CTEV) up to walking age in order to provide a benchmark for practitioners and guide consistent, high-quality care for children with CTEV. The consensus process followed an established Delphi approach with a predetermined degree of agreement. The process included the following steps: establishing a steering group; steering group meetings, generating statements, and checking them against the literature; a two-round Delphi survey; and final consensus meeting. The steering group members and Delphi survey participants were all British Society of Children's Orthopaedic Surgery (BSCOS) members. Descriptive statistics were used for analysis of the Delphi survey results. The Appraisal of Guidelines for Research & Evaluation checklist was followed for reporting of the results. The BSCOS-selected steering group, the steering group meetings, the Delphi survey, and the final consensus meeting all followed the pre-agreed protocol. A total of 153/243 members voted in round 1 Delphi (63%) and 132 voted in round 2 (86%). Out of 61 statements presented to round 1 Delphi, 43 reached 'consensus in', no statements reached 'consensus out', and 18 reached 'no consensus'. Four statements were deleted and one new statement added following suggestions from round 1. Out of 15 statements presented to round 2, 12 reached 'consensus in', no statements reached 'consensus out', and three reached 'no consensus' and were discussed and included following the final consensus meeting. Two statements were combined for simplicity. The final consensus document includes 57 statements allocated into six successive stages. We have produced a consensus document for the treatment of idiopathic CTEV up to walking age. This will provide a benchmark for standard of care in the UK and will help to reduce geographical variability in treatment and outcomes. Appropriate dissemination and implementation will be key to its success. Cite this article: Bone Joint J2022;104-B(6):758-764.

What if we focus on developing commonalities? Results of an international and interdisciplinary Delphi study on transcultural competence

This article seeks to articulate an invitation to rethink the success factors of global cooperation by using a relational approach. It presents the initial results of a 3-stage Delphi study that was conducted in 2020 with a panel of around 50 experts from different countries and disciplines in order to better understand the concept of transcultural competence. The study questions specifically invited the experts to focus on (1) the determinants of people’s perceptions of cultural diversity, (2) the role and creation of commonalities, (3) the competences that support an approach to cultural diversity aiming at commonalities, and (4) the formulation of corresponding conceptual conclusions as a point of departure for further research and practical application.The results suggest that a relational view could be interpreted as a common denominator within the Delphi group. Following such a relational approach, the core aspirations of a revisited concept of transculturality include to consider individuums in their relations, to refer to context-specific events, constructive processes and the connotation of the beyond, which implies the possibility, ability and willingness of creating new commonalities (without excluding the existence of differences). A relational understanding of cultural complexity thus views cultural commonalities and differences not as opposites, but as complementary resources for cooperation. It thereby hints towards a process-perspective of competence, as well as towards the departure from a static concept of identity in favor of the concept of belonging, which is inherently relational.

Long-term proactive management of psoriasis with calcipotriol and betamethasone dipropionate foam: an Italian consensus through a combined nominal group technique and Delphi approach.

Although long-term management of psoriasis is paramount, this approach is challenging in clinical practice. In the recent PSO-LONG trial, a fixed-dose combination of betamethasone dipropionate (BD) and calcipotriol (Cal) foam applied twice a week on non-consecutive days for 52 weeks (proactive treatment) reduced the risk of relapse. However, the role of Cal/BD foam in the long-term management of psoriasis needs further clarifications. The ProActive Management (PAM) program, a nationwide Italian project, aims at reaching a consensus on the role of proactive management of psoriasis. A steering committee generated some statements through the nominal group technique (NGT). The statements were voted by an expert panel in an adapted Delphi voting process. Eighteen statements were proposed, and the majority of them (14/18) reached a consensus during the Delphi voting. The need to provide long-term proactive topical treatment to reduce the risk of relapse for the treatment of challenging diseases sites or in patients where phototherapy or systemic therapies are contraindicated/ineffective was widely recognized. A consensus was reached about the possibility to associate the proactive treatment with systemic and biological therapies, without the need for dose intensification, thus favoring a prolonged remission. Moreover, the proactive treatment was recognized as more effective than weekend therapy in increasing time free from relapses. Approaches to improve adherence, on the other hand, need further investigation. The inclusion in guidelines of a proactive strategy among the effective treatment options will be a fundamental step in the evolution of a mild-moderate psoriasis therapeutic approach.

COVID-19 Phenotypes and Comorbidity: A Data-Driven, Pattern Recognition Approach Using National Representative Data from the United States.

The aim of our study was to determine COVID-19 syndromic phenotypes in a data-driven manner using the survey results based on survey results from Carnegie Mellon University’s Delphi Group. Monthly survey results (>1 million responders per month; 320,326 responders with a certain COVID-19 test status and disease duration <30 days were included in this study) were used sequentially in identifying and validating COVID-19 syndromic phenotypes. Logistic Regression-weighted multiple correspondence analysis (LRW-MCA) was used as a preprocessing procedure, in order to weigh and transform symptoms recorded by the survey to eigenspace coordinates, capturing a total variance of >75%. These scores, along with symptom duration, were subsequently used by the Two Step Clustering algorithm to produce symptom clusters. Post-hoc logistic regression models adjusting for age, gender, and comorbidities and confirmatory linear principal components analyses were used to further explore the data. Model creation, based on August’s 66,165 included responders, was subsequently validated in data from March–December 2020. Five validated COVID-19 syndromes were identified in August: 1. Afebrile (0%), Non-Coughing (0%), Oligosymptomatic (ANCOS); 2. Febrile (100%) Multisymptomatic (FMS); 3. Afebrile (0%) Coughing (100%) Oligosymptomatic (ACOS); 4. Oligosymptomatic with additional self-described symptoms (100%; OSDS); 5. Olfaction/Gustatory Impairment Predominant (100%; OGIP). Our findings indicate that the COVID-19 spectrum may be undetectable when applying current disease definitions focusing on respiratory symptoms alone.

Continuous multidimensional assessment system of medical residents in teaching hospitals.

Background and aimsEvaluation of learners is considered as one of the most important principles in education, especially in the clinical fields. Continuous assessment can be used to provide appropriate feedback to students about their strengths and weaknesses. In this regard, this study is aimed to design a system of continuous assessment of medical residents (SCMARs).MethodsThis study was performed using a combination of qualitative methods, including focus group discussion, expert panel, and Delphi technique. The study population consisted of all the stakeholders involved in the evaluation process of medical residents in Imam Reza Hospital Complex (IRHC) in Iran. This study was conducted in three phases, including identification of subthemes and indicators, production of a primary framework for the SCMAR, and agreement on the subthemes of the SCMAR. The nominal group technique was used for generating priority information. Data analysis was performed during the agreement review stage with the Excel software version 2016.ResultsThe finalized SCMAR consisted of 10 main themes and 38 subthemes. The themes included objectives, evaluators, areas, and indicators of evaluation, evaluation periods, evaluation requirements, data collection, data sources, point assignment and data analysis methods, reporting, and feedback dissemination methods. Five areas of evaluation and 11 indicators of evaluation were proposed.ConclusionA comprehensive assessment system that continuously evaluates the performance of Medical Residents can be used as a stimulus to improve the quality of educational processes. The present study was aimed to address this need by designing a framework for such a system.

Developing Key Performance Indicators for Emergency Department of Teaching Hospitals: A Mixed Fuzzy Delphi and Nominal Group Technique Approach.

BackgroundThis article demonstrates combination of the fuzzy Delphi method (FDM) and the nominal group technique (NGT) to consolidate consensus agreement within a panel of experts regarding key performance indicators (KPIs) development for emergency department (ED).MethodsTwenty-four participants for NGT and 10 experts for FDM were randomly chosen from the emergency medicine (EM) department staff list obtained from the human resource department of study centres. A set of item constructs related to KPIs was developed from the NGT session and used for the FDM session in the second phase of the study.ResultsWe found that 16 out of 22 and 11 out of 15 items satisfied the first prerequisite ‘d’ value ≤ 0.2. Ten items (45%) from the service KPI domain and six items (40%) from the academic KPI domain had expert consensus of more than 75%. A total of 16 out of 22 (73%) and 14 out of 15 (93%) fit the criteria of an average fuzzy number (A value) of more than 0.5. Fifteen items that fulfilled the prerequisites were retained for the final KPI draft.ConclusionThe FDM and NGT analyses reached experts’ consensus on the suitability of the pre-selected items in the ED KPIs. The development of the KPI framework is expected to enhance future improvement of EM services and academic activities in all teaching hospitals in the country.

Development of the ASSESS tool: a comprehenSive tool to Support rEporting and critical appraiSal of qualitative, quantitative, and mixed methods implementation reSearch outcomes

BackgroundSeveral tools to improve reporting of implementation studies for evidence-based decision making have been created; however, no tool for critical appraisal of implementation outcomes exists. Researchers, practitioners, and policy makers lack tools to support the concurrent synthesis and critical assessment of outcomes for implementation research. Our objectives were to develop a comprehensive tool to (1) describe studies focused on implementation that use qualitative, quantitative, and/or mixed methodologies and (2) assess risk of bias of implementation outcomes.MethodsA hybrid consensus-building approach combining Delphi Group and Nominal Group techniques (NGT) was modeled after comparative methodologies for developing health research reporting guidelines and critical appraisal tools. First, an online modified NGT occurred among a small expert panel (n = 5), consisting of literature review, item generation, round robin with clarification, application of the tool to various study types, voting, and discussion. This was followed by a larger e-consensus meeting and modified Delphi process with implementers and implementation scientists (n = 32). New elements and elements of various existing tools, frameworks, and taxonomies were combined to produce the ASSESS tool.ResultsThe 24-item tool is applicable to a broad range of study designs employed in implementation science, including qualitative studies, randomized-control trials, non-randomized quantitative studies, and mixed methods studies. Two key features are a section for assessing bias of the implementation outcomes and sections for describing the implementation strategy and intervention implemented. An accompanying explanation and elaboration document that identifies and describes each of the items, explains the rationale, and provides examples of reporting and appraising practice, as well as templates to allow synthesis of extracted data across studies and an instructional video, has been prepared.ConclusionsThe comprehensive, adaptable tool to support both reporting and critical appraisal of implementation science studies including quantitative, qualitative, and mixed methods assessment of intervention and implementation outcomes has been developed. This tool can be applied to a methodologically diverse and growing body of implementation science literature to support reviews or meta-analyses that inform evidence-based decision-making regarding processes and strategies for implementation.

The HOME Core outcome set for clinical trials of atopic dermatitis

Core outcome sets are critically important outcomes that should be measured in clinical trials. Their absence in atopic dermatitis is a form of research waste and impedes combining evidence to inform patient care. Here, we articulate the rationale for core outcome sets in atopic dermatitis and review the work of the international Harmonising Outcome Measures for Eczema group from its inception in Munich, 2010. We describe core domain determination (what should be measured), to instrument selection (how domains should be measured), culminating in the complete core outcome measurement set in Tokyo, 2019. Using a "road map," Harmonising Outcome Measures for Eczema includes diverse research methods including Delphi and nominal group techniques informed by systematic reviews of properties of candidate instruments. The 4 domains and recommended instruments for including in all clinical trials of atopic dermatitis are patient symptoms, measured by Patient-Oriented Eczema Measure and peak Numerical Rating Scale 11 for itch intensity over 24 hours, clinical signs measured using the Eczema Area and Severity Index, quality of life measured by the Dermatology Life Quality Index series for adults, children, and infants, and long-term control measured by either Recap of atopic eczema or Atopic Dermatitis Control Tool.

Introduction to methodology for the development of an integrative medical service model

BackgroundThe purpose of this article was to present a valid and reliable theoretical framework and method for the development of an integrated medical service model for the four major diseases. MethodsMethodologies for each process were presented based on three theoretical frameworks. The three theories were the double diamond process model, the Donabedian model, and the International Classification of Functioning, Disability, and Health model. Based on this, in the process of problem finding, a literature review, service user questionnaire, and interview methods were applied. For problem definition and solution, expert focus group interview and expert Delphi methods were applied. The subjects of the study were mainly selected from experts for each disease and users of medical services. For literature review, systematic literature review and subject range literature review were conducted, and for analysis, a meta-analysis was carried out. In the case of focus group interview and Delphi, the validity and reliability of domain derivation and sub-items were analyzed by applying the qualitative analysis method. ResultsTo develop an integrative medical service model, a theoretical framework and a systematic methodology were needed, and case studies were performed to prove its validity and reliability. This showed that the development of a medical service model needs to follow a scientific procedure. ConclusionsBy introducing methodological approaches and procedures for the development of an integrated medical service model for the four major diseases, the researchers provided basic information on model development.

Methodological quality assessment criteria for the evaluation of laboratory-based studies included in systematic reviews within the specialty of Endodontology: A development protocol.

High-quality systematic reviews in the field of Dentistry provide the most definitive overarching evidence for clinicians, guideline developers and healthcare policy makers to judge the foreseeable risks, anticipated benefits, and potential harms of dental treatment. In the process of carrying out a systematic review, it is essential that authors appraise the methodological quality of the primary studies they include, because studies which follow poor methodology will have a potentially serious negative impact on the overall strength of the evidence and the recommendations that can be drawn. In Endodontology, systematic reviews of laboratory studies have used quality assessment criteria developed subjectively by the individual authors as there are no comprehensive, well-structured, and universally accepted criteria that can be applied objectively and universally to individual studies included in reviews. Unfortunately, these subjective criteria are likely to be inaccurately defined, unreliably applied, inadequately analysed, unreasonably biased, defective, and non-repeatable. The aim of the present paper is to outline the process to be followed in the development of comprehensive methodological quality assessment criteria to be used when evaluating laboratory studies, that is research not conducted in vivo on humans or animals, included in systematic reviews within Endodontology. The development of new methodological quality assessment criteria for appraising the laboratory-based studies included in systematic reviews within Endodontology will follow a three-stage process. First, a steering committee will be formed by the project leaders to develop a preliminary list of assessment criteria by modifying and adapting those already available, but with the addition of several new items relevant for Endodontology. The initial draft assessment criteria will be reviewed and refined by a Delphi Group (n=40) for their relevance and inclusion using a nine-point Likert scale. Second, the agreed items will then be discussed in an online or face-to-face meeting by a group of experts (n=10) to further refine the assessment criteria. Third, based on the feedback received from the online/face-to-face meeting, the steering committee will revise the quality assessment criteria and subsequently a group of authors will be selected to pilot the new system. Based on the feedback collected, the criteria may be revised further before being approved by the steering committee. The assessment criteria will be published in relevant journals, presented at national and international congresses/meetings, and will be freely available on a dedicated website. The steering committee will update the assessment criteria periodically based on feedback received from end-users.

COVID-19 Pandemic and Vitiligo: Changing Paradigms.

Dear editor, The COVID-19 pandemic has now grown to colossal proportions, affecting nearly 233 million cases, with 4.7 million deaths (WHO dashboard 1-10-2021). How vitiligo management has changed during the pandemic has not been explored.[12] A cross-sectional Google form (Google LLC) based questionnaire was developed by a group of 4 consultants of our institutional pigmentary clinic (later updated by Delphi group of 15 members) [Annexure 1] and disseminated, via email to a few national and international experts who had five or more years in managing vitiligo and had been the first or corresponding authors of articles published on the same. Totally 103 participants responded to the survey. Most worked in private clinics (35; 33.9%), followed by university hospitals (30; 29.1%), public hospitals (21; 20.4%), and corporate hospitals’ centers of excellence (17; 16.5%). All questions were answered by the participants. The approximate number of both stable (80.2 ± 26.4/month to 10.4 ± 8.6/month, P < 0.05) and unstable vitiligo cases (60.4 ± 32.8/month to 7.5 ± 7.2/month, P < 0.05) seen by study participants decreased during the lockdown [Figure 1]. A gross decrease in number of face-to-face consultations during the lockdown (74.7% to 13.5%; P < 0.05) was noted [Figure 1].Figure 1: Consultation trends by physiciansThose who presented during the pandemic phase predominantly had unstable disease and nearly 10% presented with an unstable disease for the first time during the pandemic. There was a gross reduction in the usage of almost all scoring systems [Table 1].Table 1: Use of scoring systemsThirty-five percent of respondents had been posted in care of COVID-19 patients, of them 14 (40%) agreed that these assignments had negatively impacted the care of their vitiligo patients due to unavailability and less time. A few (1.9%) of the participants had vitiligo patients who were COVID-19 positive [Table 2].Table 2: Characterization of the vitiligo patients with COVID-19 positiveThe majority of participants (65; 63.1%) felt pandemic had a negative impact on the quality of life of vitiligo patients (VITIQoL and by physician perception). Twenty participants (19.4%) advocated switch over from previous systemic treatment to topical therapies, and disfavored the use of systemic immunosuppressants, phototherapy, and immunomodulators [Table 3].Table 3: Comparison of the initiation of systemic immunosuppressants and immunomodulators during the COVID-19 lockdownFor patients affected with COVID-19, 60 (58.25%) wished to continue only oral mini pulse with dexamethasone at the same dose, whereas 70 (67.9%) felt that the dose of agents like oral cyclosporine, azathioprine, and mycophenolate mofetil should be reduced by 25%–50%. The majority (78; 75.7%) felt that phototherapy can be continued at the same dose and frequency, if feasible. There was hesitation in the initiation of systemic immunosuppressive therapy. The highest level of safety so far appears to be with low dose mini pulse of dexamethasone and with apremilast. The risk is moderate with methotrexate, and high with mycophenolate mofetil and JAK inhibitors.[2] Xu et al.[3] had found that delay in initiation of systemic immunosuppressants was the most significant risk factor for recurrence of vitiligo during the pandemic. Now even though there is a lesser number of cases, the unstable cases constitute a higher proportion. We had observed a trend of hesitancy in the initiation of immunosuppression. Steps need to be taken by the vitiligo task force to regularize the role of adequate immunosuppressive treatment, especially in patients with unstable vitiligo. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Development of Nursing Informatics Competencies Evaluation Index System of Clinical Nurses.

For lack of effective and reliable assessment tools of nursing informatics competencies (NIC), we used literature research method, nominal group technology (NGT) and delphi technique to construct an evaluation index system of NIC for clinical nurses, which can provide reference for establishing a training system of talents of nursing informatics.

IMPROVEMENT OF PEDAGOGICAL COMPETENCE OF TEACHERS THROUGH THE METHOD OF MONITORING AND EVALUATION AT SDN SIDOTOPO WETAN I/255 SURABAYA ACADEMIC YEAR 2021/2022

AbstractThe school principal has a very important role in a school. A good school is dependent to its school principal. If the principal is able to organize the whole components in the school to achieve the goals set in the beginning. The school principal must have a vision for the future and follow the changes that occur in the globalization era.In this action research, the monitoring and evaluation method is considered as the most appropriate one in applying managerial supervision to the school principal, compared to the other methods such as Focus Group Discussion (FGD), Workshop, and Delphi. As an advantage, researchers can directly monitor and contact with the conditions and developments in the field.The School Action Research (SAR) was conducted at SDN Sidotopo Wetan I/255 Surabaya. Research was scheduled from September 2021 to October 2021. The subject of research was the Teachers in SDN Sidotopo Wetan I/255 Surabaya. The number of Respondents were as many as 13 people.From the results, the implementation of a Method of Monitoring and Evaluation can Improve the pedagogical Competence of teachers at SDN Sidotopo Wetan I/255 Surabaya within Academic Year 2021/2022. The result of pedagogical competence improvement of teachers through the Method of Monitoring and Evaluation at SDN Sidotopo Wetan I/255 Surabaya Academic Year 2021/2022 is excellent. In cycle 2, the ability of teachers increased significantly compared to the earlier phase. In cycle 1, the average ability grew from 75 % to 86 % in cycle 2 after some improvement was being conducted in the cycle. Several weaknesses in cycle 1 included specifically aspect number 4 (the improvement activities for students); so, teachers were encouraged to conduct remedial activities for students with lower scores

Epidemic tracking and forecasting: Lessons learned from a tumultuous year

Epidemic forecasting has garnered increasing interest in the last decade, nurtured and scaffolded by various forecasting challenges organized by groups within the US federal government, including the Centers for Disease Control and Prevention (CDC) (1⇓–3), Office of Science and Technology Policy (OSTP) (4), and Defense Advanced Research Projects Agency (DARPA) (5), and elsewhere (6, 7). In 2017, after several years of experimentation with flu forecasting in academic groups, the CDC decided to incorporate influenza forecasting into its normal operations, including weekly public communications (8) and briefing to higher-ups. To provide more reliable infrastructure and support for its forecasting needs, the CDC in 2019 designated two national Centers of Excellence for Influenza Forecasting, one at the University of Massachusetts at Amherst (https://reichlab.io/people) and one at Carnegie Mellon University (https://delphi.cmu.edu/about/center-of-excellence/). Not unrelatedly, the last decade has also seen a rise in the importance of digital surveillance streams in public health, with improving epidemic tracking and forecasting models being a key application of these data. Digital streams, such as search and social media trends, have constituted a large part of the focus (9⇓⇓⇓⇓–14); however, even more broadly, data from auxiliary streams that operate outside of traditional public health reporting, such as online surveys, medical devices, or electronic medical records (EMRs), have received considerable attention as well (15⇓⇓⇓⇓⇓⇓⇓⇓⇓–25). The Carnegie Mellon Delphi group, which the two of us colead, has worked in both of these emerging disciplines—epidemic forecasting and building relevant auxiliary signals to aid such forecasting models—since 2012. In 2020, as the pandemic broke out, we struggled like many other groups to find ways to contribute to the national efforts to respond to the pandemic. We ended up shifting our … [↵][1]1To whom correspondence may be addressed. Email: ryantibs{at}cmu.edu. [1]: #xref-corresp-1-1