Delphi Results Research Articles

Criteria for Critical Care Infants and Children: PICU Admission, Discharge, and Triage Practice Statement and Levels of Care Guidance.

To update the American Academy of Pediatrics and Society of Critical Care Medicine's 2004 Guidelines and levels of care for PICU. A task force was appointed by the American College of Critical Care Medicine to follow a standardized and systematic review of the literature using an evidence-based approach. The 2004 Admission, Discharge and Triage Guidelines served as the starting point, and searches in Medline (Ovid), Embase (Ovid), and PubMed resulted in 329 articles published from 2004 to 2016. Only 21 pediatric studies evaluating outcomes related to pediatric level of care, specialized PICU, patient volume, or personnel. Of these, 13 studies were large retrospective registry data analyses, six small single-center studies, and two multicenter survey analyses. Limited high-quality evidence was found, and therefore, a modified Delphi process was used. Liaisons from the American Academy of Pediatrics were included in the panel representing critical care, surgical, and hospital medicine expertise for the development of this practice guidance. The title was amended to "practice statement" and "guidance" because Grading of Recommendations, Assessment, Development, and Evaluation methodology was not possible in this administrative work and to align with requirements put forth by the American Academy of Pediatrics. The panel consisted of two groups: a voting group and a writing group. The panel used an iterative collaborative approach to formulate statements on the basis of the literature review and common practice of the pediatric critical care bedside experts and administrators on the task force. Statements were then formulated and presented via an online anonymous voting tool to a voting group using a three-cycle interactive forecasting Delphi method. With each cycle of voting, statements were refined on the basis of votes received and on comments. Voting was conducted between the months of January 2017 and March 2017. The consensus was deemed achieved once 80% or higher scores from the voting group were recorded on any given statement or where there was consensus upon review of comments provided by voters. The Voting Panel was required to vote in all three forecasting events for the final evaluation of the data and inclusion in this work. The writing panel developed admission recommendations by level of care on the basis of voting results. The panel voted on 30 statements, five of which were multicomponent statements addressing characteristics specific to PICU level of care including team structure, technology, education and training, academic pursuits, and indications for transfer to tertiary or quaternary PICU. Of the remaining 25 statements, 17 reached consensus cutoff score. Following a review of the Delphi results and consensus, the recommendations were written. This practice statement and level of care guidance manuscript addresses important specifications for each PICU level of care, including the team structure and resources, technology and equipment, education and training, quality metrics, admission and discharge criteria, and indications for transfer to a higher level of care. The sparse high-quality evidence led the panel to use a modified Delphi process to seek expert opinion to develop consensus-based recommendations where gaps in the evidence exist. Despite this limitation, the members of the Task Force believe that these recommendations will provide guidance to practitioners in making informed decisions regarding pediatric admission or transfer to the appropriate level of care to achieve best outcomes.

Consensus on priorities in maternal education: results of Delphi and nominal group technique approaches

BackgroundMaternal education is wide-ranging and covers many areas from pregnancy to the immediate postpartum period and childrearing. However, for it to be effective, more resources need to be assigned to key topics. The goal of this study was to identify and prioritize the most important issues in maternal education, so that specific objectives could subsequently be set and learning outcomes evaluated.MethodsWe drew up a comprehensive list of topics addressed in existing maternal education programs, based on a systematic review of information obtained from the Internet and the experience of the research team. The topics were presented to a multidisciplinary panel whose members were asked to rate them from 1 to 9, and consensus of opinion was reached using a two-round Delphi survey, with consensus defined beforehand as 80% agreement among panelists in awarding a score of 7, 8 or 9. The most highly-rated topics were then discussed and again prioritized by a multidisciplinary team of healthcare and non-healthcare experts, using a nominal group technique.ResultsInitially, 650 topics were identified and grouped into 80 categories which were then prioritized by 54 healthcare and non-healthcare experts using a Delphi survey with a study participation rate of around 20%. 63 topics were considered very important, so criteria were restricted and only the 24 highest-scoring selected (95% of agreement on scores ≥7 or 80% of agreement on scores ≥8). Using the nominal group technique, a group of 12 experts identified the following priorities: initiation and establishment of breastfeeding, development of a birth plan, identification of problems and self-care postpartum, nutrition and a healthy lifestyle, options for pain management in labor and birth and characteristics of a normal newborn/looking after a newborn baby.ConclusionThis study, with a Delphi study and the Consensus among Experts: the nominal group technique, has succeeded in identifying priority topics in maternal education. We need to assess women’s needs in relation to these topics, design an intervention to respond to these needs and evaluate its effectiveness.

Providing a framework for assessment of the access to medicine.

Improving access to effective and safe medicines is one of the major goals of all health systems. To achieve this goal, assessment is a fundamental phase of national medicine programs for access improvement. Collecting and compiling applicable indicators and impart a comprehensive framework for assessing access to medicine, are the aims of this study. To investigate the published materials on access to medicines framework or indicators, a literature review with a systematic search was conducted using PubMed/ Medline, Scopus, and Google Scholar databases. The results were completed with a general search of documents in Iran Food and Drug Administration (IRFDA). Two independent researchers reviewed all the articles and documents. Thereafter the related indicators were extracted. In focused group discussion of academics and IRFDA experts, duplicate entries or ineffectual concepts were cleaned from the preliminary indicators. In the next step, Delphi questionnaire was sent to the 17 experts that work in academia, Social Security Insurance, IRFDA, Ministry of Health and Iran Pharmacist Association. The results of Delphi technique were finalized in an expert panel. One hundred and thirty one indicators were found in systematic search. After primary extraction of related indicators, 77 indicators were sent to the 17 experts in a Delphi form. The results of Delphi were finalized in a specialized-working group and 67 indicators were accepted in 5 categories including physical availability and geographical accessibility (19 indicators), affordability (23 indicators), human resources (4 indicators), quality and safety (5 indicators), information and rational use (16 indicators). The indicators that inclusively assess the full access to medicine in the concept of rational use have been categorized into five categories in this study. To determine the access to medicine status in each country further local surveys are necessary for all several indicators in each category. Graphical abstract The graphical abstract of accomplished steps.

The Essential Elements of Adolescent-friendly Care in School-based Health Centers: A Mixed Methods Study of the Perspectives of Nurse Practitioners and Adolescents

PurposeIn this study we identified the essential elements of adolescent-friendly care in school-based health centers (SBHCs) from the perspectives of the nurse practitioners (NPs) providing care to adolescents and the adolescents, as the consumers of these services. Design and methodsComplex adaptive systems provided the philosophical and theoretical foundation for this study. An explanatory sequential mixed methods study was conducted. A Delphi technique (strand one) was conducted with an expert panel of NPs (N = 21) to identify the essential elements of adolescent-friendly care in SBHCs. The second strand, a focus group study with adolescents (N = 30), elaborated on the Delphi results. Data from the two strands were then mixed. ResultsThis study generated expert opinion regarding the essential elements of adolescent-friendly health care in SBHCs. After four Delphi rounds, consensus was reached on 98-items (49% of the original 200; consensus level of 0.75). The results clustered into 6 essential elements: Confidentiality/Privacy (n = 8; 8.2%), Accessibility, (n = 15; 15.3%), Clinician/Staff (n = 51; 52%), SBHC Clinical Services (n = 12; 12.2%), SBHC Environment (n = 4; 4.1%), and Relationship between the School and SBHC (n = 8; 8.2%). The adolescent focus groups confirmed the essential elements identified in the Delphi and added two overarching themes: Comfortable and Trusted Relationship. ConclusionsThese findings contribute to a greater understanding of essential characteristics needed in adolescent friendly care. Practice implicationsSBHCs, as an important community resource for addressing the health care needs of adolescents, should incorporate these characteristics.

Core competencies for academic leaders in Iran University of Medical Sciences.

IntroductionIntegrated educational, health, and medical services necessitate the development of high-competent academic leaders in medical universities of Iran. Most organizations attempt to limit the total number of competencies to a rational number and consider the most important competencies. Therefore, the purpose of this study was to determine core competencies which can be improved through development programs for the academic leaders in Iran University of Medical Sciences.MethodsThis study was conducted in two phases. The first phase was the critical review based on Carnwell and Daly’s approach. The search time was from 2000 to 2017. The searches were conducted in PubMed, Emerald, ERIC, ProQuest, Web of Science, Scopus, SID, and nor gram. The second phase was modified Delphi in three rounds. The purposive sampling was used to employ appropriate participants.ResultAccording to the critical review results, competencies were categorized in two groups, including 62 personal competencies and 19 functional competencies. Also, according to modified Delphi results, 19 competencies, including 12 personal competencies and 7 functional competencies were selected as trainable core competencies.ConclusionIn order to design a development program for academic leaders in the integrated educational system in Iran University of Medical Sciences, both personal and functional competencies need to be considered together.

Development and Validation of a Pain Competence Assessment Tool (PCAT) Based on the IASP Core Competencies for Pain Management

ABSTRACTSeveral interprofessional education programs have been developed to enhance primary care providers’ (PCPs) competency in pain management. This project aims to develop a valid and reliable competency-based assessment tool, suitable for all professions, to evaluate the impact of these programs.To develop a new pain competence assessment tool (PCAT), six clinical vignettes were created. Each vignette is followed by questions addressing one or more competencies derived from the core pain competencies developed by Fishman et al. in 2013. Experts in pain management representing different professions were asked to review and rate the appropriateness of the PCAT questions to confirm face validity through a modified Delphi study. The selected PCAT questions were mapped against the core competencies to ensure content validity. A pilot sample of PCPs was then asked to answer the PCAT through a cognitive interview study to assess feasibility. Currently, the PCAT was sent to a large sample of PCPs to assess its reliability through a cross-sectional study. The PCAT was also sent to healthcare prelicensure students to test for construct validity.Based on the Delphi results, nineteen questions were rated as appropriate confirming its face and content validity. The PCAT also showed adequate feasibility based on the cognitive interview study. Psychometric testing is still in process.Future implementation of a valid and reliable tool is necessary to reduce measurement error and produce results with high degree of credibility.Introduction/Aim: Several interprofessional education programs have been developed to enhance primary care providers’ (PCPs) competency in pain management. This project aims to develop a valid and reliable competency-based assessment tool, suitable for all professions, to evaluate the impact of these programs.Methods: To develop a new pain competence assessment tool (PCAT), six clinical vignettes were created. Each vignette is followed by questions addressing one or more competencies derived from the core pain competencies developed by Fishman et al. in 2013. Experts in pain management representing different professions were asked to review and rate the appropriateness of the PCAT questions to confirm face validity through a modified Delphi study. The selected PCAT questions were mapped against the core competencies to ensure content validity. A pilot sample of PCPs was then asked to answer the PCAT through a cognitive interview study to assess feasibility. Currently, the PCAT was sent to a large sample of PCPs to assess its reliability through a cross-sectional study. The PCAT was also sent to healthcare prelicensure students to test for construct validity.Results: Based on the Delphi results, nineteen questions were rated as appropriate confirming its face and content validity. The PCAT also showed adequate feasibility based on the cognitive interview study. Psychometric testing is still in process.Discussion/Conclusions: Future implementation of a valid and reliable tool is necessary to reduce measurement error and produce results with high degree of credibility.

Unlocking the drivers of big data analytics value in firms

Although big data analytics (BDA) is considered the next “frontier” in data science by creating potential business opportunities, the way to extract those opportunities is unclear. This paper aims to understand the antecedents of BDA value at a firm level. The authors performed a study using a mixed methodology approach. First, by carrying out a Delphi study to explore and rank the antecedents affecting the creation of BDA value. Based on the Delphi results, we propose an empirically validated model supported by a survey conducted on 175 European firms to explain the antecedents of BDA sustained value. The results show that the proposed model explains 62% of BDA sustained value at the firm level, where the most critical contributor is BDA use. We provide directions for managers to support their decisions on BDA strategy definition and refinement. For academics, we extend BDA value literature and outline some potential research opportunities.

Factors influencing decision making for healthcare services outsourcing: A review and Delphi study.

Background: Outsourcing is considered as one of the tools for organizational development and promotion of productivity by managers. In recent years, outsourcing of healthcare services has become significant. The aim of this study was to identify the most important factors influencing the decision making of outsourcing healthcare services. Methods: This study is a combined study. First, the literature was examined to identify the factors influencing decision making for outsourcing. Then, with the aim of consensus on the most important factors affecting the decision making of outsourcing in health services, the panel of experts and Delphi technique were used. Sampling was purposeful. Results: In the selected articles, a total of 180 factors were extracted. The members of the panel of experts from these 180 factors selected 29 sub-factors in the form of six main factors: strategy, quality, management, technology, performance feature, and economy, as the most important factors affecting the outsourcing of services. Finally, the results of Delphi showed that 22 sub-factors were more important in outsourcing decision making at healthcare services. Conclusion: The study showed that the decision making to outsource health services is a complex and multi-criteria decision. Therefore, when deciding to outsource healthcare services, attention should be paid to various factors, such as strategy, quality, management, technology, and economics.

Selecting Core Outcomes for Randomised Effectiveness trials In Type 2 Diabetes (SCORE-IT): study protocol for the development of a core outcome set

BackgroundType 2 diabetes is characterised by abnormal glucose metabolism, and treatment is aimed at normalising glycaemia. Outcomes measured in clinical trials should be meaningful to patients, health care professionals and researchers, yet there is heterogeneity in the outcomes used across trials of glucose-lowering interventions. This inconsistency affects the ability to compare findings and may mean that the results have little importance to health care professionals and the patients for whom they care. The SCORE-IT study aims to develop a core outcome set (COS) for use in all trials of glucose-lowering interventions for people with type 2 diabetes.Methods/designThis study will involve three key stages in the development of a COS: (1) A list of outcomes will be identified from multiple sources, specifically registered clinical trials, online patient resources, the qualitative literature and landmark studies identified by a Study Steering Committee. (2) The list of outcomes will be scored by multiple stakeholder groups in a two-round online international Delphi survey. (3) The results of the online Delphi will be summarised and discussed at a face-to-face consensus meeting with representation from all stakeholder groups.DiscussionThe SCORE-IT study aims to develop an internationally relevant set of core outcomes for use in future trials of glucose-lowering interventions for type 2 diabetes. The use of a COS will improve the consistency of outcomes, allowing results of studies to be compared and combined and for new effective treatments to made available more quickly.Trial registrationThe COS study, of which this is a part, is registered in the Core Outcome Measures in Effectiveness Trials (COMET) database, http://www.comet-initiative.org/studies/details/956. Registered January 2017.

국민건강보험공단의 건강증진사업 개선 방향

Objectives: The purpose of this study was to set up the direction of health promotion program of NHIS through the survey related to experts. Methods: Data collected from 166 managers through self-administered questionaries using intranet from July 17 to 19 in 2017. Also, first delphi survey was done to 37 experts and second delphi survey was done to 28 respondents from July 20 to August 18 in 2017. Results: The results of the survey on the importance of health promotion programs by managers were as follows: 1) Health 100-years old sports class; 2) Screening Follow-up management(metabolic syndrome) improvement; 3) Chronic diseases support service improvement. The results of the expert delphi of operational suitable programs by NHIS were as follows: Prevention system by population characteristics, Incidence management after screening, Chronic diseases education program operation by level. The core topics in NHIS by managers were physical activity and the core topics by experts were Smoking cessation. Expert said consideration while NHIS operating health care programs was Establishment of cooperation system with public health center and medical care institution. Conclusions: Based on legal foothold and opinion of stake holders, new direction of health care program of Korea National Health Insurance Corporation have successfully emerged.

The Essential Elements of Adolescent-Friendly Care in School-Based Health Centers: A Mixed Methods Study of the Perspectives of Nurse Practitioners and Adolescents

Abstract Purpose In this study we identified the essential elements of adolescent-friendly care in school-based health centers (SBHCs) from the perspectives of the nurse practitioners (NPs) providing care to adolescents and the adolescents, as the consumers of these services. Design and methods Complex adaptive systems provided the philosophical and theoretical foundation for this study. An explanatory sequential mixed methods study was conducted. A Delphi technique (strand one) was conducted with an expert panel of NPs (N = 21) to identify the essential elements of adolescent-friendly care in SBHCs. The second strand, a focus group study with adolescents (N = 30), elaborated on the Delphi results. Data from the two strands were then mixed. Results This study generated expert opinion regarding the essential elements of adolescent-friendly health care in SBHCs. After four Delphi rounds, consensus was reached on 98-items (49% of the original 200; consensus level of 0.75). The results clustered into 6 essential elements: Confidentiality/Privacy (n = 8; 8.2%), Accessibility, (n = 15; 15.3%), Clinician/Staff (n = 51; 52%), SBHC Clinical Services (n = 12; 12.2%), SBHC Environment (n = 4; 4.1%), and Relationship between the School and SBHC (n = 8; 8.2%). The adolescent focus groups confirmed the essential elements identified in the Delphi and added two overarching themes: Comfortable and Trusted Relationship. Conclusions These findings contribute to a greater understanding of essential characteristics needed in adolescent friendly care. Practice implications SBHCs, as an important community resource for addressing the health care needs of adolescents, should incorporate these characteristics.

Plan Ceibal 2020: future scenarios for technology and education\u2014the case of the Uruguayan public education system

In the present work, a set of future studies were implemented in order to answer the following question: What will the future scenarios be within the next 5 years regarding new technologies in the public education sector in Uruguay? For this purpose, two panels (consisting of 20 participants internal to the programme and 25 international experts external to the programme) were set up to conduct a Delphi study. In addition, a historical analysis of the use of Internet resources at schools (traffic and users connected to the network) was developed. This section of the study brought us the following findings: Primary and middle public school centres have experienced an exponential growth in Internet use as measured by traffic downloads and uploads, as well as by connections. Traffic doubled every 1.5 years, and connections had doubled roughly every year in the period from 2011 to 2015.The study integrated the Delphi results and the analysis of Internet use as a method for prospective scenario planning, based on which four main possible educational and technological scenarios for 2020 were identified. This approach allowed us to define the possible technological future for the national education and technology policy.We found that the key challenges were not technological, but social and cultural factors. Some of the challenges to be explored are (1) How can we understand the role(s) of teachers better?, (2) can we rethink how technology is being used, adopted and adapted in learning environments?, and (3) what systemic changes are needed to respond these possible scenarios better through policy development? The findings suggest that problems and challenges presented by new technological innovations in education are not solved by more technology.Finally, we consider an approach such as this could work as a framework to help develop public education and technology policies in other countries with middle to high incomes that have strong orientations toward public education, including much of Europe.

Competency model for dentists in China: Results of a Delphi study.

ObjectiveWith the increasing awareness of the importance of oral health, patients have an increasing need for integrated care from dentists. In China, the dentistry examination consists of two parts: a practical skills examination and a comprehensive medical examination; to date, no assessment methods that are based on specialized dentistry competencies, unlike the United States, Canada, and other countries, have been established. Therefore, the purpose of this study was to construct a competency model for dentists in China in order to guide the development, admission, training and assessment of dentists.MethodsUsing a literature review, focus group interviews and in-depth personal interviews, a dentist competency index was developed with an expert consultation questionnaire. A panel of 20 specialist experts was chosen from ten national medical universities to carry out two rounds of Delphi expert analysis, using the boundary value method to filter the indicators and the Analytic Hierarchy Process to calculate the weights of the primary indicators.ResultsTwo rounds of Delphi results showed that the expert authority, enthusiasm, and coordination coefficients were high. Constructs of the competency model that included seven primary indicators and 62 secondary indicators determined the weight of each index. The seven primary indicators included the following: clinical skills and medical services, disease prevention and health promotion, interpersonal communication skills, core values and professionalism, medical knowledge and lifelong learning ability, teamwork ability and scientific research ability.ConclusionIn conclusion, the use of the Delphi method to construct an initial model of Chinese physician competency is scientific and feasible. The initial competency model conforms to the characteristics and quality requirements of dentists in China and has a strong scientific basis. The dentist competency model should be used in the National Dental Licensing Examination in China.

Diagnosis and management of pemphigus: Recommendations of an international panel of experts

Several European countries recently developed international diagnostic and management guidelines for pemphigus, which have been instrumental in the standardization of pemphigus management. We now present results from a subsequent Delphi consensus to broaden the generalizability of the recommendations. A preliminary survey, based on the European Dermatology Forum and the European Academy of Dermatology and Venereology guidelines, was sent to a panel of international experts to determine the level of consensus. The results were discussed at the International Bullous Diseases Consensus Group in March 2016 during the annual American Academy of Dermatology conference. Following the meeting, a second survey was sent to more experts to achieve greater international consensus. The 39 experts participated in the first round of the Delphi survey, and 54 experts from 21 countries completed the second round. The number of statements in the survey was reduced from 175 topics in Delphi I to 24 topics in Delphi II on the basis of Delphi results and meeting discussion. Each recommendation represents the majority opinion and therefore may not reflect all possible treatment options available. We present here the recommendations resulting from this Delphi process. This international consensus includes intravenous CD20 inhibitors as a first-line therapy option for moderate-to-severe pemphigus.

Identifying Core Concepts of Cybersecurity: Results of Two Delphi Processes

This paper presents and analyzes results of two Delphi processes that polled cybersecurity experts to rate cybersecurity topics based on importance, difficulty, and timelessness. These ratings can be used to identify core concepts–cross-cutting ideas that connect knowledge in the discipline. The first Delphi process identified core concepts that should be learned in any first course on cybersecurity. The second identified core concepts that any cybersecurity professional should know upon graduating from college. Despite the rapidly growing demand for cybersecurity professionals, it is not clear what defines foundational cybersecurity knowledge. Initial data from the Delphi processes lay a foundation for defining the core concepts of the field and, consequently, provide a common starting point to accelerate the development of rigorous cybersecurity education practices. These results provide a foundation for developing evidence-based educational cybersecurity assessment tools that will identify and measure effective methods for teaching cybersecurity. The Delphi results can also be used to inform the development of curricula, learning exercises, and other educational materials and policies.

COSUMO: study protocol for the development of a core outcome set for efficacy and effectiveness trials in posterior segment-involving uveitis

BackgroundUveitis, a group of disorders characterised by intraocular inflammation, causes 10–15% of total blindness in the developed world. The most sight-threatening uveitis affects the posterior segment of the eye (posterior-segment involving uveitis (PSIU)). Numerous different outcomes have been used in clinical trials evaluating alternative treatments for uveitis, limiting inter-trial comparison and aggregation of data. We aim to develop a core outcome set (COS) that would provide a standardised set of outcomes to be measured and reported in all effectiveness trials for PSIU.MethodsA three-phase design will be used informed by recommendations from the Core Outcome Measures in Effectiveness Trials (COMET) initiative. Phase 1: a comprehensive list of outcomes will be identified through both a systematic review of effectiveness trials of PSIU and qualitative research with stakeholders. The qualitative study will comprise focus groups with patients and their carers in parallel with one-to-one telephone interviews with health professionals and policy-makers. In the focus groups, patients will be grouped according to whether or not their uveitis is complicated by the sight-threatening condition uveitic macular oedema (UMO) since it is hypothesised that the presence of UMO may significantly impact on patient experience of PSIU. Phase 2: Delphi methodology will be used to reduce the range of potential outcomes for the core set. Up to three Delphi rounds will be used through an online survey. Participants will be asked to rate the importance of each outcome on a 9-point Likert scale where 9 is most important. Phase 3: a consensus meeting will be held with key stakeholders to discuss the Delphi results and ratify the final outcomes to be included in the COS.DiscussionThe development of an agreed COS for PSIU would help ensure that outcomes which matter to key stakeholders are captured and reported in a consistent way. A COS for PSIU would allow greater comparison and aggregation of data across trials for the better evaluation of established and emerging therapies through evidence synthesis and meta-analysis to inform clinical guidelines and health policy.Trial registrationCOMET. http://comet-initiative.org/studies/details/640. August 2015.

Technology roadmapping: A methodological proposition to refine Delphi results

This study outlines a methodology to refine Delphi results as part of the process to design a technology roadmap. The objectives of this paper are: (a) present a methodology to design a TRM using Delphi associated with other techniques (morphological analysis, decision matrix, interviews, and prioritization analysis), and (b) demonstrate and discuss the application of proposed TRM methodology to define alternative materials aiming to reduce the weight of structural shock absorbers. The field research consisted of a case study approach in the Brazilian subsidiary of an Italian auto parts MNC combined with action research methodology. The main contributions of this paper are: a) The proposition of a methodology to refine Delphi results as part of the process to design a technology roadmap (TRM), including a decision matrix, interviews with external experts, and a prioritization analysis and b) The action research provided good quality results as well as an opportunity to test the methodology in a company environment during eight months; this is not common to find in the literature.

Potential measures for the pre-detection of terrorism

Events worldwide make clear that the threat of terrorism is growing, and would-be terrorists may be developing new strategies and new tools that will enable them to develop massively destructive weapons. Yet, at the same time, new measures are becoming available that could improve chances for early identification of planned terrorist acts. A previous study conducted by the authors of this paper suggested that pre-detection is feasible and in many cases, likely to be effective. These hints led to the present study and a subsequent NATO workshop [3] intended to evaluate and extend a list of possible pre-detection measures and their downside risks. The present paper presents and assesses results of a Real-Time Delphi (RTD) study that was conducted to collect judgments from an expert panel on the potential effectiveness, likelihood of use and other attributes of 19 pre-detection measures derived from the literature and most importantly, their possible societal consequences. The results show that pre-detection is possible especially if some pre-detection measures are applied in parallel. While many attacks can be avoided, it is unlikely that 100% protection will ever be achieved; thus, intelligence gathering remains important and essential and resiliency and preparedness will always be necessary. The study further sheds light on possible collateral damage that could result from the inappropriate application of pre-detection measures, principally compromise or loss of civil rights. Unless we are careful in implementing these and other such measures, we could lose what we are trying to protect.

Expected long-term labour market resilience and the European Union’s perceived role — results of an online Policy Delphi

The 2008 crisis highlighted how fragile the labour markets of the European Union’s member states were, while it also directed attention to the eventual further deepening of integration as a potential solution. Nevertheless, employment and labour market policy competences are still on the national level with relatively low EU intervention. In a recent study, we explored the role of the EU in facilitating potential policy solutions with regards to labour market resilience until 2030. The study focused on labour market experts’ opinion, coming from different European countries; and took form of an online Policy Delphi Survey combined with backcasting to predict the importance and feasibility of policies concerning future challenges. The most important policies considered to be best suited to deal with the main challenges of the labour market in the EU until 2030 are education, investment in human and social capital and improvement of social policies and protection, including migration policy. The research revealed a systematic gap between the importance and feasibility of relevant solutions.

Analyzing the barriers to humanitarian supply chain management: A case study of the Tehran Red Crescent Societies

Billions of people are affected by worldwide natural and man-made disasters each year. There is considerable evidence that the number of disasters is increasing, but there is still relatively little-published work aimed at improving the understanding of the different barriers of the humanitarian supply chain (HSC) and finding suitable solutions for dealing with them. The aim of this paper is to provide a comprehensive review of HSC barriers in the context of a case study of the Tehran Red Crescent Societies. An integrated approach using Fuzzy Delphi and the Best-Worst method (BWM) has been used for analyzing the barriers. Based on the literature and interviews with experts, 28 barriers of the humanitarian supply chain were identified. According to the Fuzzy Delphi result, 22 barriers were assessed that subsequently classified into 9 categories. After that, the BWM method calculated the importance of each barrier. The findings showed that Cultural, Managerial, and Educational barriers are the important barriers. This research provides useful guidelines for policy makers so that they can benefit from the results to optimize their solutions.