Levels Of Consensus Research Articles

Institutional Change and Legislative Vote Consensus in New Zealand

In this research note, I discuss results from a recent study assessing the impact that New Zealand's electoral and legislative system reforms had on levels of vote consensus achieved in the House of Representatives. Using a new legislative vote data set spanning from 1987 to 2007, I find evidence that the institutional changes fostered an increase in consensual legislative vote outcomes. I also provide a brief theoretical explanation of the developments and address a few issues concerning the measure of consensus used and the interpretation of the data.

Users’ perspectives of key factors to implementing electronic health records in Canada: a Delphi study

BackgroundInteroperable electronic health record (EHR) solutions are currently being implemented in Canada, as in many other countries. Understanding EHR users’ perspectives is key to the success of EHR implementation projects. This Delphi study aimed to assess in the Canadian context the applicability, the importance, and the priority of pre-identified factors from a previous mixed-methods systematic review of international literature.MethodsA three-round Delphi study was held with representatives of 4 Canadian EHR user groups defined as partners of the implementation process who use or are expected to use EHR in their everyday activity. These groups are: non-physician healthcare professionals, health information professionals, managers, and physicians. Four bilingual online questionnaire versions were developed from factors identified by the systematic review. Participants were asked to rate the applicability and the importance of each factor. The main outcome measures were consensus and priority. Consensus was defined a priori as strong (≥ 75%) or moderate (≥ 60-74%) according to user groups’ level of agreement on applicability and importance, partial (≥ 60%) when participants agreed only on applicability or importance, or as no consensus (< 60%). Priority for decision-making was defined as factors with strong consensus with scores of 4 or 5 on a five-point Likert scale for applicability and importance.ResultsThree Delphi rounds were completed by 64 participants. Levels of consensus of 100%, 64%, 64%, and 44% were attained on factors submitted to non-physician healthcare professionals, health information professionals, managers, and physicians, respectively. While agreement between and within user groups varied, key factors were prioritized if they were classified as strong (≥ 75% from questionnaire answers of user groups), for decision-making concerning EHR implementation. The10 factors that were prioritized are perceived usefulness, productivity, motivation, participation of end-users in the implementation strategy, patient and health professional interaction, lack of time and workload, resources availability, management, outcome expectancy, and interoperability.ConclusionsAmongst all factors influencing EHR implementation identified in a previous systematic review, ten were prioritized through this Delphi study. The varying levels of agreement between and within user groups could mean that users’ perspectives of each factor are complex and that each user group has unique professional priorities and roles in the EHR implementation process. As more EHR implementations in Canada are completed it will be possible to corroborate this preliminary result with a larger population of EHR users.

Training teachers to evaluate emerging bilingual students’ biliterate writing

The purpose of this mixed-methods study was to explore and identify issues related to training teachers to use a bilingual writing rubric designed to examine the biliterate writing of emerging bilingual students who are participating in a biliteracy model. Findings indicate the need to provide clarifications on the rubric rating criteria and the need to pay attention to the differences between Spanish and English rhetoric, as teachers had lower levels of consensus when they rated Spanish content. This finding also indicates a need to revise the rubric itself. High levels of consensus were reached when teachers rated spelling and structural elements in both languages. When conducting an analysis of students’ Spanish and English writing, teachers noted students’ ability to transfer writing abilities across languages. This study is significant to the advancement of this biliteracy model and to the education of emerging bilingual students. It is also important to develop a shared vision of what it means to be bilingual and to understand how biliteracy develops using a holistic lens.

Republican Party-Building and Anti-Tax Policies

Our tax politics and policies are startlingly different than a generation ago. We have lost the balanced budget consensus and low levels of politicization tax policy used to receive. While some might point to exogenous economic factors, or ideational ones, the biggest driver of this shift is Republican party-building efforts. Looking at all major tax-cutting bills passed by Congress, the GOP shifts to an anti-tax position in 1978 and experiences remarkably few defections since. This paper uses mixed methods and multiple institutional settings (Congress and the Presidency) to investigate this phenomenon. The Presidential investigation includes party platforms (a critical juncture towards anti-tax policies is observed in 1980) as well as election materials for any credible challenge to this new orthodoxy. In keeping with the conference theme of representation, some NES data is also employed. Interestingly, not only does the impression of wasted taxes skyrocket after the late 1970s, but Republicans in the electorate become more concerned about this notion — but markedly more so when a Democrat holds the White House. Archival investigations also highlight the party-building strategy as it unfolds: the 1964 and 1981 cuts are used as case studies. It appears that the GOP has built a seemingly disparate coalition around a single issue — tax politics.

Development of a community-based model for respiratory care services

BackgroundChronic respiratory diseases are a major cause of mortality and morbidity, and represent a high chronic disease burden, which is expected to rise between now and 2020. Care for chronic diseases is increasingly located in community settings for reasons of efficiency and patient preference, though what services should be offered and where is contested. Our aim was to identify the key characteristics of a community-based service for chronic respiratory disease to help inform NHS commissioning decisions.MethodsWe used the Delphi method of consensus development. We derived components from Wagner’s Chronic Care Model (CCM), an evidence-based, multi-dimensional framework for improving chronic illness care. We used the linked Assessment of Chronic Illness Care to derive standards for each component.We established a purposeful panel of experts to form the Delphi group. This was multidisciplinary and included national and international experts in the field, as well as local health professionals involved in the delivery of respiratory services. Consensus was defined in terms of medians and means. Participants were able to propose new components in round one.ResultsTwenty-one experts were invited to participate, and 18 agreed to take part (85.7% response). Sixteen responded to the first round (88.9%), 14 to the second round (77.8%) and 13 to the third round (72.2%). The panel rated twelve of the original fifteen components of the CCM to be a high priority for community-based respiratory care model, with varying levels of consensus. Where consensus was achieved, there was agreement that the component should be delivered to an advanced standard. Four additional components were identified, all of which would be categorised as part of delivery system design.ConclusionsThis consensus development process confirmed the validity of the CCM as a basis for a community-based respiratory care service and identified a small number of additional components. Our approach has the potential to be applied to service redesign for other chronic conditions.

Quality indicators for in‐hospital management of exacerbation of chronic obstructive pulmonary disease: results of an international Delphi study

To report a Delphi study that was conducted to select process and outcome indicators that are relevant to study quality of care and impact of care pathways for patients hospitalized with exacerbation of chronic obstructive pulmonary disease. Management of patients hospitalized with exacerbation of chronic obstructive pulmonary disease is suboptimal and outcomes are poor. To evaluate the impact of care pathways properly, relevant indicators need to be selected. Delphi study. The study was conducted over 4 months in 2008, with 35 experts out of 15 countries, including 19 medical doctors, 8 nurses and 8 physiotherapists. Participants were asked to rate, for 72 process and 21 outcome indicators, the relevance for follow-up in care pathways for in-hospital management of exacerbation of chronic obstructive pulmonary disease. Consensus (agreement by at least 75% of the participants) that an indicator is relevant for follow-up was sought in two rounds. Consensus was reached for 26 of 72 process indicators (36·1%) and 10 of 21 outcome indicators (47·6%). Highest consensus levels were found for the process indicators regarding oxygen therapy (100%), pulmonary rehabilitation (100%) and patient education (94·5-88·6%) and for the outcome indicators concerning understanding of therapy (91·4-85·7%) and self-management (88·6-88·2%). The selected indicators appear to be sensitive for improvement. Therefore, researchers and clinicians that want to study and improve the care for patients hospitalized with exacerbation of chronic obstructive pulmonary disease should primarily focus on these indicators.

Diagnostic reframing of intractable environmental problems: Case of a contested multiparty public land-use conflict

Intractable conflicts are omnipresent in environmental management. These conflicts do not necessarily resist resolution but need to be fundamentally transformed in order to reach agreement. Reframing, a process that allows disputants to create new alternative understandings of the problem, is one way of transforming these conflicts. Cognitive and interactional reframing are the two major approaches to conflict transformation. These approaches have some drawbacks. Cognitive reframing does not guarantee commensurate consideration of all disputants' views about the problem. Interactional reframing is prone to inter-disputant influences that interfere with presenting the problems as accurately as they exist in disputants' minds. Inadequate consideration of other disputants' views and inter-disputant influences often lead to inaccurate problem identification and definition. This in turn leads to solving the wrong problem, enabling intractability to persist. Proper problem identification and definition requires commensurate consideration of all sides of the conflict while minimizing inter-disputant influences. From a problem diagnosis perspective, we show how Q methodology is used to reframe environmental problems, rendering them more tractable to analysis while minimizing the influence of who disputants are talking with, and without ignoring the perspectives of other disputants. Using a case of contentious All-Terrain Vehicle (ATV) use in a state-administered public land, conflicting parties reframed the problem by prioritizing issues, outlining areas and levels of consensus and disagreement, and revealing inherent unrecognized and/or unspoken agendas. The reframing process surprisingly revealed several areas of common ground in disputants' diagnosis of the problem, including lack of emphasis on environmental protection and uncoordinated management factions. Emergent frames were misaligned on some issues, such as the behaviors of ATV riders and the role of management, including political and economic influences on decision making. We discuss how the reframing process enhances tractability of multiparty environmental problems. We point to some limitations of Q methodology as a tool for the diagnostic reframing of such problems.

When Words Speak Louder: The Effect of Verb Abstraction on Inferences from Interpersonal Events

When confronted with subject-verb-object descriptions of interpersonal events people seem to make stronger causal attributions to the object and stronger personality inferences about the subject from descriptions with abstract rather than concrete verbs. We examined two explanations for this apparent contradiction: (1) verb abstraction affects causal attributions and personality inferences in opposite directions, and (2) verb abstraction affects both causality and personality inferences about the subject and the object in a parallel yet curvilinear manner. Studies 1, 2, and 3 refuted the first hypothesis and supported the second. Study 4 showed that the curvilinear relationship between verb abstraction and subject/object inferences does not occur because the verb types suggest differential personal control by the subject and the object. Instead, it occurs because different verb types suggest different levels of consensus and distinctiveness (Studies 5 and 6). Subject inferences revealed a negativity effec...

Reliability and Consensus of Experienced Wine Judges: Expertise Within and Between?

AbstractThis paper considers the levels of reliability and consensus of wine quality judgments found in studies of experienced wine judges. Both reliability, which concerns the similarity of repeat judgments of a particular wine by the same judge, and consensus, which concerns the similarity of judgments of a particular wine across judges, are necessary requirements for expertise in wine judging. Reliability and consensus levels found in wine judging are compared to those documented by a large body of research in six other fields: medicine, clinical psychology, business, auditing, personnel management, and meteorology. In all fields, including wine judging, reliability is greater than consensus. Both reliability and consensus are, on average, substantially lower in wine judging than in other fields, although tremendous variability exists across judges in every field. Overall, little support is found for the idea that experienced wine judges should be regarded as experts. (JEL Classification: C91)

Consensus formation in science modeled by aggregated bibliographic coupling

The level of consensus in science has traditionally been measured by a number of different methods. The variety is important as each method measures different aspects of science and consensus. Citation analytical studies have previously measured the level of consensus using the scientific journal as their unit of analysis. To produce a more fine grained citation analysis one needs to study consensus formation on an even more detailed level – i.e. the scientific document or article. To do so, we have developed a new technique that measures consensus by aggregated bibliographic couplings (ABC) between documents. The advantages of the ABC-technique are demonstrated in a study of two selected disciplines in which the levels of consensus are measured using the proposed technique.

Cultural similarities and differences in medical professionalism: a multi‐region study

Over the last two decades, many medical educators have sought to define professionalism. Initial attempts to do so were focused on defining professionalism in a manner that allowed for universal agreement. This quest was later transformed into an effort to 'understand professionalism' as many researchers realised that professionalism is a social construct and is culture-sensitive. The determination of cultural differences in the understanding of professionalism, however, has been subject to very little research, possibly because of the practical difficulties of doing so. In this multi-region study, we illustrate the universal and culture-specific aspects of medical professionalism as it is perceived by medical practitioners. Forty-six professional attributes were identified by reviewing the literature. A total of 584 medical practitioners, representing the UK, Europe, North America and Asia, participated in a survey in which they indicated the importance of each of these attributes. We determined the 'essentialness' of each attribute in different geographic regions using the content validity index, supplemented with kappa statistics. With acceptable levels of consensus, all regional groups identified 29 attributes as 'essential', thereby indicating the universality of these professional attributes, and six attributes as non-essential. The essentialness of the rest varied by regional group. This study has helped to identify regional similarities and dissimilarities in understandings of professionalism, most of which can be explained by cultural differences in line with the theories of cultural dimensions and cultural value. However, certain dissonances among regions may well be attributable to socio-economic factors. Some of the responses appear to be counter-cultural and demonstrate practitioners' keenness to overcome cultural barriers in order to provide better patient care.

Consensus-based standards for best supportive care in clinical trials in advanced cancer

Best supportive care is poorly defined in clinical trials, and a standard framework for delivery of such care is needed, using best available evidence and allowing replication of studies. We convened a panel of 36 experts to develop consensus statements via the Delphi method. The first round included open-ended questions; subsequent rounds sought to develop consensus-based standards. Consensus was assessed by use of a 5-point Likert agreement scale; more than 70% of panellists had to give a score of 5 to meet a-priori levels of consensus. The panel identified four key domains of best supportive care in clinical trials: multidisciplinary care; supportive care documentation; symptom assessment; and symptom management. Consensus was reached on 11 statements within these four domains. For example, 24 (96%) panellists recommended that the intervals between symptom assessments should be identical for control and experimental groups. Availability of resources was cited as a challenge to implementation of best supportive care standards.

Populism vs. Elitism: Social Consensus and Social Status as Bases of Attitude Certainty

ABSTRACT This study examined the effects of social consensus and social status on attitude certainty that is conceptualized multi-dimensionally as perceived clarity and correctness of one's attitude. In a mock opinion exchange about a social issue, participants were either supported (high consensus) or opposed (low consensus) by most of the confederates. They were informed that their opinion (high status) or their opponents' opinion (low status) had the alleged psychological significance indicative of future success. Post-experimental attitude clarity was significantly greater when attitudinal position was associated with high rather than low status. Attitude correctness was interactively affected by social status and social consensus. Supporting the compensatory effect hypothesis, attitude correctness was comparable across the levels of social consensus as long as they were associated with high status, and across the levels of social status as long as they were associated with high social consensus.

IDENTIFICAÇÃO DE FATORES DE ESTRESSE LABORAL EM PROFISSIONAIS DE ENFERMAGEM

Durante as últimas décadas, o interesse pelo estudo do estresse vem crescendo, bem como os fatores psicossociais relacionados com o trabalho. É comum estudar o tema estresse em unidades específicas, porém frequentemente se encontram situações de estresse em Unidades Médicas. O objetivo desse estudo foi identificar e classificar fatores laborais estressantes que afetam os profissionais de enfermagem em Unidades Hospitalares. Estudo qualitativo, descritivo-analítico, prospectivo segundo a metodologia Delphi, na Espanha – Hospital Geral. Universitário de Alicante e Hospital Geral. de Elda. Participaram 30 profissionais de enfermagem das unidades. Foram identificados, nas quatro etapas do processo, diferentes fatores de estresse nos profissionais, elevando-se progressivamente os níveis de consenso. A conclusão a que se chegou foi a de que os fatores com maior consenso e maior pontuação no grupo podem ser usados como feramenta na gestão clínica de unidade hospitalar, a fim de melhorar a qualidade de vida laboral dos trabalhadores e buscar a excelência na linha gestora.

Japanese Guideline for the Management of Hyperuricemia and Gout: Second Edition

Gout is a urate deposition disease caused by persistent hyperuricemia. Because gout patients present with a variety of clinical symptoms, it is necessary to have a guideline for the standard management and care of gout and hyperuricemia. The Japanese Society of Gout and Nucleic Acid Metabolism, a scientific society committed to study nucleic acid metabolism and related diseases, established the first edition of the “Guideline for the Management of Hyperuricemia and Gout” in 2002, and published the revised version in January 2010. This second edition is not only evidence based on a search of systemic literature, but also includes consensus levels by a Delphi exercise to determine the strength of the recommendations. A draft version of this guideline was reviewed by internal and external reviewers as well as a patient. In this guideline, key messages from each chapter are listed as statements together with the evidence level, consensus level, and strength of the recommendation. In this proceeding, several selected chapters on the clinical management of gout and hyperuricemia are described. We hope this guideline is appropriately used for the standard management and care of patients with hyperuricemia and gout in daily practice.

Terrorism and Political Science

This article shows empirically, theoretically and statistically that domestic (or ‘home-grown’) terrorism in Western Europe occurs more frequently in countries with majoritarian political systems (typically first-past-the-post electoral systems and single-party governments) than in countries with consensus political systems (typically countries with PR electoral systems and coalition governments). Based on a survey of all domestic terrorist incidents in Western Europe from 1985 to 2010, the article shows strong negative correlations between consensus institutions and levels of terrorism; that is, the more disproportional the political system is, the higher the levels of terrorism are likely to be. Thus domestic terrorism tends to occur when minorities are excluded from the decision-making process on matters they find important. These findings indicate that constitutional engineering provides a more promising model of counterterrorism than the prevailing orthodoxy.

Personality assessment and behavioral prediction at first impression

Research has demonstrated high levels of consensus and self-other agreement for extraversion and conscientiousness. However, the mechanisms whereby these assessments contribute to accuracy in behavioral predictions remain unclear. In this study, two judges rated targets on Big Five personality factors, and predicted their compliance to offer help in response to a fabricated emergency. Whereas one judge interacted directly with the target, the other judge only observed the interaction. There was consensus and self-other agreement on conscientiousness for both judges. Critically, self-reported conscientiousness fully mediated the effect of judged conscientiousness on compliance to offer help, regardless of the nature of the judge–target interaction. These results demonstrate a mechanism whereby judged personality can predict a specific behavioral outcome in initially unacquainted persons.

Predictors of relationship adjustment among couples coping with a high risk of developing breast/ovarian cancer

This study investigated the association between supportive and collaborative processes and dyadic adjustment in 94 women at increased risk of breast/ovarian cancer and their partners. Participants were recruited through two familial cancer clinics. They completed mailed, self-report questionnaires that included measures of psychological distress, dyadic adjustment (consensus, cohesion and satisfaction) and couple predictor variables (perceived support and team approach). Most couples reported average-to-high levels of consensus, cohesion and satisfaction, with a small proportion of couples (6.4%) reporting scores that reached clinically significant levels of dyadic distress. Greater perceived support was associated with better dyadic consensus and satisfaction, and dyadic cohesion and satisfaction were higher among couples who reported greater use of a team approach. General distress did not moderate the association between dyadic coping and relationship quality. There were no significant relationships between intra-couple congruence on support or team approach, and dyadic adjustment. Most couples had a functional relationship in the face of the current health stressor, although a subgroup may be at elevated risk of negative psychological consequences, including further relationship strain. The results highlight that dyadic coping strategies are important factors involved in the quality of couples’ relationship following genetic counselling for breast/ovarian cancer risk.

Building consensus about eHealth in Slovene primary health care: Delphi study

BackgroundSlovenia's national eHealth strategy aims to develop an efficient, flexible and modern health care informatics framework that would be comparable to the most successful EU countries. To achieve this goal, the gap between availability and usage of information and communication technology by primary care physicians needs to be reduced.As recent efforts show, consensus on information and communication technology purpose and usage in primary care needs to be established before any national information and communication technology solutions are developed.The aim of this study was to identify the most appropriate measures in implementation of Slovene national eHealth strategy and to suggest an appropriate model for success by using the three round Delphi study.MethodsAn e-mail based, three-round Delphi study was undertaken to achieve consensus from a selected sample of nationally recognized experts from the fields of primary health care and medical informatics. The aim of this study was to identify the most appropriate measures and key obstacles in implementation of eHealth in Slovene primary health care by using the Delphi study.ResultsHigh levels of consensus on the majority of suggested measures were achieved among all study participants, as well as between the subgroups of experts from primary health care and medical informatics. All aims of the three-round Delphi study on eHealth implementation in Slovenian primary health care were achieved.ConclusionsThe three round decision Delphi process has proven to be effective for developing outcomes, ranking key priorities in primary care eHealth development, and achieving consensus among the most influential experts in that field. This consensus is an important contribution to future national eHealth strategies in the field of primary health care.

Using Nominal Group Technique to Develop a Consensus Derived Model for Peer Review of Teaching Across a Multi-school Faculty

This paper describes the development of a peer review of teaching model for the Faculty of Health at the University of Newcastle, Australia. The process involved using the nominal group technique to engage Faculty academic staff to consider seven key decision points that informed the development of the peer review of teaching model. Use of the consensus based nominal group technique established collegial discussion and networking among participants, and has expanded the discussion within the Faculty about peer review of teaching. Although the academics come from a diverse multi-school and multi-program Faculty, there was high levels of consensus on the structure and process of the developed peer review of teaching model.