Levels Of Consensus Research Articles

Identifying priorities for cancer caregiver interventions: protocol for a three-round modified Delphi study

IntroductionCancer is often considered a chronic disease, and most people with cancer have a caregiver, often a family member or friend who provides a significant amount of care during the...

A comparative analysis between two statistical deviation–based consensus measures in Group Decision Making problems

The mean absolute deviation and the standard deviation, two statistical measures commonly used in quantifying variability, may become an interesting tool when defining consensus measures. Two consensus indexes which obtain the level of consensus in some problems of Group Decision Making are introduced in this paper by expanding the aforementioned statistical concepts. A comparative analysis reveals that the levels of consensus derived from these indexes are close to those obtained employing distance functions when a fuzzy preference relations frame is considered, so they turn out to be a useful tool in this context. In addition, these indexes are different from each other and with the distance functions considered. Thus, they are applicable tools in the calculation of consensus in our context and are different from those commonly used.

Andlsquo;Endometrial Cancer: Access Deniedandrsquo; - A Review of the Forgotten Voice of Intellectual and Physical Disability in Gynaecology Oncology in Australia

Introduction: The voice of an intellectually and physically disabled woman is often forgotten when discussing, investigating and managing endometrial cancer in women with disabilities. This case report explores the need to start strategies for collaborative application of resources to optimize a woman’s experience who is living with disabilities and endometrial cancer. Case Description: A 41-year old premenopausal woman with a severe intellectual disability and physically debilitating osteogenesis imperfecta presented with a 2-year history of abnormal uterine bleeding (AUB) and unsuccessful hormonal treatment. After two failed hysteroscopies due to her severe bony-pelvic abnormality, limiting access vaginally; the decision for a hysterectomy was made without a histological diagnosis. An Australian Guardianship Tribunal granted permission for both diagnostic and treatment of her AUB and suspicion of endometrial cancer. The ESMO-ESGO-ESTRO-2014 Consensus current recommendations and levels of evidence in management of endometrial cancer are evaluated in context of the case. Method: Mandatory workup and pathological assessment for diagnosis of endometrial cancer could not be carried out and imaging including: CT scan, transabdominal ultrasound and MRI were relied upon to primarily assess her suspected disease. An abdominal hysterectomy, bilateral salpingectomy and ovarian conservation were performed. The histopathology post-operatively confirmed stage 1A grade 1 endometrioid adenocarcinoma. The time from initial Gynaecology Oncology referral to final histopathology was 9 months. Discussion: This is the first report to explore the limitations and challenges of the literature and application of various current diagnostic modalities, surgical approach and outcomes of endometrial cancer in an intellectually and physically disabled woman in Australia.

Recommendations for services for people living with chronic breathlessness in advanced disease: Results of a transparent expert consultation.

Chronic breathlessness is highly distressing for people with advanced disease and their informal carers, yet health services for this group remain highly heterogeneous. We aimed to generate evidence-based stakeholder-endorsed recommendations for practice, policy and research concerning services for people with advanced disease and chronic breathlessness. We used transparent expert consultation, comprising modified nominal group technique during a stakeholder workshop, and an online consensus survey. Stakeholders, representing multiple specialities and professions, and patient/carers were invited to participate. Thirty-seven participants attended the stakeholder workshop and generated 34 separate recommendations, rated by 74 online survey respondents. Seven recommendations had strong agreement and high levels of consensus. Stakeholders agreed services should be person-centred and flexible, should cut across multiple disciplines and providers and should prioritize breathlessness management in its own right. They advocated for wide geographical coverage and access to expert care, supported through skills-sharing among professionals. They also recommended recognition of informal carers and their role by clinicians and policymakers. Overall, stakeholders' recommendations reflect the need for improved access to person-centred, multi-professional care and support for carers to provide or access breathlessness management interventions. Future research should test the optimal models of care and educational strategies to meet these recommendations.

Future implementation of mobility as a service (MaaS): Results of an international Delphi study

Given the innovative nature of Mobility-as-a-Service (MaaS), various uncertainties are surrounding the possibilities for implementing MaaS. This includes uncertainties about alternative MaaS-system functionalities, about how the implementation of alternative MaaS systems might affect the overall transport system performance and about the preferences of stakeholders regarding alternative MaaS system implementation strategies. This paper contributes to this niche by collecting expert opinions about these uncertainties, using the Delphi method.The expert panel expected a fully-integrated MaaS to start operating in urban areas before 2020 and to expand to rural areas and nationally within the period of 2020–2030. In contrast to the common expectation that MaaS will attract regular car driver from their vehicles, our panel expected youth, current public transport users, and flexible travellers to be early adopters of MaaS. Transport operators are seen as the most important actors and the most preferred MaaS service integrator. Local authorities are expected to have an important role in enabling MaaS. The main objectives for implementing MaaS are to reduce car dependency and to provide a flexible and more customised transport system accessibility to the general public. The implementation of MaaS as a pilot project is considered the most preferred policy in the next phase. These findings largely support earlier reported findings on MaaS implementation.This study report new findings regarding the levels of consensus and how the experts changed their individual opinions in light of the group results on the studied topics. Regarding certain topics, such as the early market, there are higher levels of agreements among the panel with lower proportions of them changing their selections in light of the group results. Whereas in other topics, such as planning for future implementation, the level of agreement are lower with higher proportions of experts changing their selections. These two attributes can be combined to infer how certain the panel is on the topics studied. The study also provides new insights into the possible vulnerabilities and opportunities that can arise in relation to MaaS implementation, the associated levels of importance and uncertainty, and the possible responding actions. The experts also identified potential social issues and challenges in scaling-up the pilot. The findings of this study are of interest to practitioners and researchers in the field of MaaS planning and can be used to initiate a discussion among actors and stakeholders to formulate implementation plans for different MaaS concepts.

Collective decision-making of voters with heterogeneous levels of rationality

This paper studies the collective decision-making processes of voters who have heterogeneous levels of rationality. Specifically, we consider a voting body consisting of both rational and sincere voters. Rational voters vote strategically, correctly using both their private information and the information implicit in other voters’ actions to make decisions; sincere voters vote according to their private information alone. We first characterize the conditions under which the presence of sincere voters increases, reduces, or does not alter the probabilities of making correct collective decisions. We also discuss how the probabilities change when the incidence of sincere voters in the population varies. We then characterize the necessary and sufficient condition under which informational efficiency can be achieved when sincere voters coexist with rational voters. We find that when sincere voters are present, supermajority rules with high consensus levels are not as desirable as they are in rational voting models, as informational efficiency fails under such voting rules.

Multiple Criteria Decision-Making in Heterogeneous Groups of Management Experts

In commercial organizations operations, frequently some dynamic events occur which involve operational, managerial, and valuable information aspects. Then, in order to make a sound decision, the business professional could be supported by a Multi Criteria Decision-Making (MCDM) system for taking an external course of action, as, for instance, forecasting a new market or product, up to an inner decision concerning for instance, the volume of manufacture. Thus, managers need, in a collective manner, to analyze the actual problems, to evaluate various options according to diverse criteria, and finally choose the best solution from a set of various alternatives. Throughout these processes, uncertainty and hesitancy easily arise, when it comes to define and judge criteria or alternatives. Several approaches have been introduced to allow Decision Makers (DMs) to deal with. The Interval Multiplicative Preference Relations (IMPRs) approach is a useful technique and the basis of our proposed methodology to provide reliable consistent and in consensus IMPRs. In this manner, DMs’ choices are implicitly including their uncertainty while maintaining both an acceptable individual consistency, as well as group consensus levels. The present method is based on some recent results and an optimization algorithm to derive reliable consistent and in consensus IMPRs. In order to illustrate our results and compare them with other methodologies, a few examples are addressed and solved.

An attitudinal consensus degree to control the feedback mechanism in group decision making with different adjustment cost

This article aims to study the influence of the group attitude on the consensus reaching process in group decision making (GDM). To do that, the attitudinal consensus index (ACI) is defined to aggregate individual consensus levels to form a collective one. This approach allows for the implementation of the group attitude in a continuous state ranging from a pessimistic attitude to an optimistic attitude. Then, ACI is used to build a stop policy to control feedback for consensus, which can be regarded as a generation of the traditional polices: ‘minimum disagreement policy’ and ‘indifferent disagreement policy’. A sensitivity analysis method with visual simulation is proposed to check the adjustment cost and consensus level with different attitudinal parameters. The main conclusion from this analysis is that the bigger the attitudinal parameter implemented is, the bigger the adjustment cost and consensus level are. The visual information facilitates the inconsistent expert keeping a balance between the attitudinal parameter to implement and the adjustment cost and consensus level, which in practice translates into full control of such implementation based on the decision maker’s willingness.

Climate War in the Middle East? Drought, the Syrian Civil War and the State of Climate-Conflict Research

This article reviews existing evidence for a climate-conflict link in Syria and examines how the respective debate reproduces three important shortcomings of climate-conflict research. The potential climate-conflict link for Syria can be conceived of as a four-stage process, with various levels of scientific evidence and consensus existing for each stage: (1) climate change inducing the heavy 2006–2009 drought (plausible, but not proven); (2) massive loss of agricultural livelihoods, significantly attributable to the drought (supported by a majority of studies, but contested); (3) massive rural-to-urban migration triggered by livelihood loss in combination with other factors (supported by a majority of studies, but contested); and (4) migration intensifying existing grievances and facilitating the onset of protests and the subsequent civil war (possible, but little knowledge exists). The debate about the Syrian case reproduces three important shortcomings of climate-conflict research: limited dialogue between different methods, an overstatement of differences, and a lack of theoretical engagement. These shortcomings also have adverse impacts in terms of policy advice.

Foresight of cyber security threat drivers and affecting technologies

PurposeThe cyber security industry emerged rapidly in recent years due to mounting cyber threats and increasing cyber hacking activities. Research on emerging technologies emphasizes the risks and sometimes neglects to address the potential positive contribution to cyber security. The purpose of this study is to conduct a relatively balanced long-term foresight study to elicit major significant threat drivers and to identify emerging technologies that are likely to have a significant impact on defense and attack capabilities in cyber security.Design/methodology/approachThe main instruments used in this study were horizon scanning and an online survey among subject-matter experts that assessed emerging threats and the potential impact of several emerging technologies on cyber defense capabilities and cyber attack capabilities.FindingsAn expert survey shows that cyber resilience, homomorphic encryption and blockchain may be considered as technologies contributing mainly to defense capabilities. On the other hand, Internet of Things, biohacking and human machine interface (HMI) and autonomous technologies add mainly to attack capabilities. In the middle, we find autonomous technologies, quantum computing and artificial intelligence that contribute to defense, as well as to attack capabilities, with roughly similar impact on both.Originality/valueThis study adds to the current research a balanced long-term view and experts’ assessment of negative and positive impacts of emerging technologies, including their time to maturity and consensus levels. Two new Likert scale measures were applied to measure the potential impact of emerging technologies on cyber security, thus enabling the classification of the results into four groups (net positive, net negative, positive-positive and negative-negative).

Identifying Consensus on Coastal Lagoons Ecosystem Services and Conservation Priorities for an Effective Decision Making: A Q Approach

Coastal lagoons ecosystems, while representing benefits for the local populations, have been subjected to high anthropogenic pressures for decades. Hence, conservation measures of these ecosystems are urgently needed and should be combined with their sustainable uses. To address these issues, new research avenues for decision support systems have emphasized the role of the assessment of ecosystem services for establishing conservation priorities by avoiding monetarization approaches. These approaches, because they flatten the various values of nature by projecting them on the single monetary dimension, are often rejected by the stakeholders. We undertake a Q analysis to identify levels of consensus and divergence among stakeholders on the prioritization of ecosystem services provided by two French Mediterranean coastal lagoons areas. The results highlighted that there is a strong consensus among categories of stakeholders in the study sites about the paramount importance of regulation and maintenance services. Three groups of stakeholders, each sharing the same points of view regarding ecosystem services conservation, were identified for each study site. As a non-monetary valuation, Q methodology is very instrumental for the new pluralistic approach of decision support by capturing the values expressed by the stakeholders, without triggering a rejection reflex due to the monetarization.

In consensus we trust? Persuasive effects of scientific consensus communication.

Scholars have recently suggested that communicating levels of scientific consensus (e.g. the percentage of scientists who agree about human-caused climate change) can shift public opinion toward the dominant scientific opinion. Initial research suggested that consensus communication effectively reduces public skepticism. However, other research failed to find a persuasive effect for those with conflicting prior beliefs. This study enters this contested space by experimentally testing how different levels of consensus shape perceptions of scientific certainty. We further examine how perceptions of certainty influence personal agreement and policy support. Findings indicate that communicating higher levels of consensus increases perceptions of scientific certainty, which is associated with greater personal agreement and policy support for non-political issues. We find some suggestive evidence that this mediated effect is moderated by participants' overall trust in science, such that those with low trust in science fail to perceive higher agreement as indicative of greater scientific certainty.

Colonoscopy quality requisites for selecting surveillance intervals: A World Endoscopy Organization Delphi Recommendation.

Different post-polypectomy guidelines underscore the need for high-quality baseline colonoscopy before appropriate surveillance recommendations can be made. Standards for colonoscopy practice have been advocated by gastrointestinal societies. Our aims were to define standards for the procedural practice of colonoscopy in this particular setting of surveillance and to generate a colonoscopy procedural quality checklist that could be implemented in clinical practice. This study was based on the Delphi process methodology. The baseline questionnaire included 12 domains and 56 individual statements. A total of three rounds were carried out between September 2015 and March 2016 until consensus or lack of consensus was reached. In total, consensus was reached on 27 statements in nine domains. High levels of agreement and consensus were reached that: (i) colonoscopy should be considered complete only if the whole cecum has been inspected, including the ileocecal valve and the appendiceal orifice (agreement score 4.63; degree of consensus 82%); (ii) quality of the bowel preparation should always be reported (agreement score 4.9, degree of consensus 94%); and (iii) it is preferable to use a segmental validated scale (agreement score 4.36, degree of consensus 86%). Consensus was also reached regarding multiple statements related to documentation of polyps and their resection. Finally, a colonoscopy quality checklist was drafted. Consensus on different statements regarding quality of colonoscopy has been reached. Based on this consensus, we propose a colonoscopy quality checklist that would be helpful for post-polypectomy surveillance recommendations.

The role of within-class consensus on mastery goal structures in predicting socio-emotional outcomes.

BackgroundWithin‐class consensus on mastery goal structures describes the extent to which students agree in their perceptions of mastery goal structures. Research on (work) teams suggests that higher levels of consensus within a group indicate a well‐functioning social environment and are thus positively related to beneficial socio‐emotional outcomes. However, the potential of within‐class consensus to predict socio‐emotional outcomes has not yet been explored in research on mastery goal structures.AimsThis study aimed to test whether within‐class consensus on the three mastery goal structures dimensions of task, autonomy, and recognition/evaluation has predictive power for socio‐emotional outcomes in terms of classroom climate, negative classmate reactions to errors, and cooperative learning.SampleA total of 1,455 Austrian secondary school students (65.70% female) in 157 classrooms participated in this study.MethodsStudents responded to items measuring their perceptions of mastery goal structures, classroom climate, error climate, and cooperative learning. Items assessing mastery goal structures, error climate, and cooperative learning referred to the subject of mathematics and items assessing classroom climate referred to positive classmate relations without focusing on a subject.ResultsResults from multilevel structural equation models revealed that within‐class consensus on all mastery goal structures dimensions predicted a less negative error climate. Additionally, consensus regarding task and autonomy predicted more frequent use of cooperative learning strategies, and consensus regarding task predicted a more positive classroom climate.ConclusionsOur findings show that higher levels of within‐class consensus on mastery goal structures enhance beneficial socio‐emotional outcomes. Moreover, the results emphasize the value of expanding the scope of educational research to the study of within‐class consensus.

Pterosaur dietary hypotheses: a review of ideas and approaches.

ABSTRACTPterosaurs are an extinct group of Mesozoic flying reptiles, whose fossil record extends from approximately 210 to 66 million years ago. They were integral components of continental and marginal marine ecosystems, yet their diets remain poorly constrained. Numerous dietary hypotheses have been proposed for different pterosaur groups, including insectivory, piscivory, carnivory, durophagy, herbivory/frugivory, filter‐feeding and generalism. These hypotheses, and subsequent interpretations of pterosaur diet, are supported by qualitative (content fossils, associations, ichnology, comparative anatomy) and/or quantitative (functional morphology, stable isotope analysis) evidence. Pterosaur dietary interpretations are scattered throughout the literature with little attention paid to the supporting evidence. Reaching a robustly supported consensus on pterosaur diets is important for understanding their dietary evolution, and their roles in Mesozoic ecosystems. A comprehensive examination of the pterosaur literature identified 314 dietary interpretations (dietary statement plus supporting evidence) from 126 published studies. Multiple alternative diets have been hypothesised for most principal taxonomic pterosaur groups. Some groups exhibit a high degree of consensus, supported by multiple lines of evidence, while others exhibit less consensus. Qualitative evidence supports 87.3% of dietary interpretations, with comparative anatomy most common (62.1% of total). More speciose groups of pterosaur tend to have a greater range of hypothesised diets. Consideration of dietary interpretations within alternative phylogenetic contexts reveals high levels of consensus between equivalent monofenestratan groups, and lower levels of consensus between equivalent non‐monofenestratan groups. Evaluating the possible non‐biological controls on apparent patterns of dietary diversity reveals that numbers of dietary interpretations through time exhibit no correlation with patterns of publication (number of peer‐reviewed publications through time). 73.8% of dietary interpretations were published in the 21st century. Overall, consensus interpretations of pterosaur diets are better accounted for by non‐biological signals, such as the impact of the respective quality of the fossil record of different pterosaur groups on research levels. That many interpretations are based on qualitative, often untestable lines of evidence adds significant noise to the data. More experiment‐led pterosaur dietary research, with greater consideration of pterosaurs as organisms with independent evolutionary histories, will lead to more robust conclusions drawn from repeatable results. This will allow greater understanding of pterosaur dietary diversity, disparity and evolution and facilitate reconstructions of Mesozoic ecosystems.

Revision of Quality Indicators for the Endoscopy Quality Improvement Program of the National Cancer Screening Program in Korea.

Gastroscopy and colonoscopy are widely used for the early diagnosis of stomach and colorectal cancer. The present revision integrates recent data regarding previous quality indicators and novel indicators suggested for gastroscopy and colonoscopy procedures for the National Cancer Screening Program in Korea. The new indicators, developed by the Quality Improvement Committee of the Korean Society for Gastrointestinal Endoscopy, vary in the level of supporting evidence, and most are based solely on expert opinion. Updated indicators validated by clinical research were prioritized, but were chosen by expert consensus when such studies were absent. The resultant quality indicators were graded according to the levels of consensus and recommendations. The updated indicators will provide a relevant guideline for high-quality endoscopy. The future direction of quality indicator development should include relevant outcome measures and an evidence-based approach to support proposed performance targets.

Global Expertise of Financial Analysts

We describe the challenges of forecasting earnings in a globally interconnected marketplace, and we document inefficient use of information regarding foreign country exposures and expected country GDP growth at the consensus and individual forecast levels. A country’s proximity to the US, importance to the firm, and visibility, as well as availability of more precise information about foreign country exposures, contribute to consensus forecast efficiency. We identify a dimension of individual analyst global expertise — similarity in exposure between the firm and the rest of the firms in the analyst portfolio — and show that it contributes to forecast efficiency, accuracy, and informativeness and that it helps the analyst achieve the coveted all-star rank, suggesting that globalization not only poses a challenge but also creates an opportunity for research providers and analysts to distinguish themselves.

Essential Content for Discharge Instructions in Pediatric Emergency Care: A Delphi Study.

The aim of this study was to identify the 5 most essential discharge instruction content elements that should be communicated to all caregivers of children who present to the emergency department (ED) with asthma, vomiting/diarrhea, abdominal pain, fever, minor head injury, or bronchiolitis. A discharge information content list was developed for each illness presentation following a review of the literature. Using a modified Delphi technique, 6 lists were distributed to a panel of experts from EDs across Canada using a secure online survey tool with the goal of achieving the 5 most essential discharge instruction elements. A total of 37 emergency clinicians completed all 4 rounds of the Delphi. Consensus for the final 30 content items ranged from 51.4% to 100%. Items pertaining to diarrhea/vomiting, abdominal pain, fever, and bronchiolitis obtained relatively high levels of consensus for all top 5 items. The majority of items (n = 19 [63.3%]) that reached consensus across the illness presentations were associated with instructions intended to educate caregivers on instances when they should return to the ED department. Findings from this study provide a better understanding of what should be communicated to caregivers of children who present to the ED with a number of different illness presentations. Results from this study suggest that health care providers agree on the importance of providing information to caregivers regarding when to return to the ED with their child. Reaching consensus among all experts in this study provides insight into the difficulty of standardizing discharge communication in the absence of widely accepted guidelines.

Mixed strategy to allocate resources with air pollution treatment in China: based on the analytic network process and large-group decision-making method.

The resource allocation of air pollution treatment in China is a complex problem, since many alternatives are available and many criteria influence mutually. A number of stakeholders participate in this issue holding different opinions because of the benefits they value. So a method is needed, based on the analytic network process (ANP) and large-group decision-making (LGDM), to rank the alternatives considering interdependent criteria and stakeholders' opinions. In this method, the criteria related to air pollution treatment are examined by experts. Then, the network structure of the problem is constructed based on the relationships between the criteria. Further, every participant in each group provide comparison matrices by judging the importance between criteria according to dominance, regarding a certain criteria (or goal), and the geometric average comparison matrix of each group is obtained. The decision weight of each group is derived by combining the subjective weight and the objective weight, in which the subjective weight is provided by organizers, while the objective weight is determined by considering the consensus levels of groups. The final comparison matrices are obtained by the geometric average of comparison matrices and the decision weights. Next, the resource allocation is made according to the priorities of the alternatives using the super decision software. Finally, an example is given to illustrate the use of the proposed method.

Differences in opinions of occupational physicians on the required competencies by field of practice: results of an international Delphi study

BackgroundThe activities and work demands of medical professionals, including occupational physicians (OPs), fall into three categories: clinical, academic, and administrative. Work demands of an OP consist of these three categories and additional specialty specific roles and competencies. Research on the core competencies and skills required for OPs have identified high levels of consensus amongst OPs internationally, however these opinions have not been examined between areas of practice specific groups. Furthermore, it has been identified that to a large extent academics are often the group who define the skills required of OPs. The aim of this study is to compare the opinions of OPs grouped by field of practice on the common core competencies required for occupational health (OH) practice using results from an international survey.MethodsAn international modified Delphi study conducted among OPs, completed in two rounds (Rating-Round 1; Ranking-Round 2) using developed questionnaires based on the specialist training syllabus of a number of countries and expert discussions. Respondents were categorised as Physician, Manager/Physician, and Academic/Physician, based on self-reported job titles and place of work.ResultsThere was good agreement between the Physician and Manager/Physician groups, with the Academic/Physician group deviating the most. The top three and bottom three principle domains (PDs) were in good agreement across all groups. The top three were clinically based and would be considered core OH activities. The PDs with considerable intergroup variance were Environmental Issues Related to Work Practice and Communication Skills, categories which may reflect direct relevance and relative importance to the job tasks of respective groups.ConclusionThis study demonstrated general agreement between the three occupational groups. Academic/Physician opinions deviate the most, while good agreement is depicted between the Physician and Manager/Physician groups. The findings of this study can help identify potential gaps in training requirements for OPs and be used as a stepping stone to developing training programmes that are reflective of practice and tailored for those predominantly undertaking these specific roles.