Second Round Of Survey Research Articles

Perioperative management of sarcopenia in patients undergoing major surgeries in Singapore: a modified Delphi consensus.

Ageing population is a worldwide phenomenon with correspondingly higher proportion of older patients being treated in the hospital setting. Sarcopenia, which increases with age, has serious negative implications on health, hospitalisation, and overall postoperative recovery. There is no mutual consensus on perioperative management of sarcopenia in surgical patients in Singapore. The purpose of this study is to create greater clarity pertaining to the recognition of sarcopenia, the application of assessment criteria of sarcopenia and perioperative management of surgical patients in Singapore. A modified Delphi consensus consisting of a panel of experts from Singapore forming a multidisciplinary team, including surgeons, geriatricians, anesthesiologists, physiotherapists, and dieticians. Eight recommendations were proposed by the steering committee. Literature search from MEDLINE, Embase, and Scopus for articles up till June 2023 were performed to support recommendation statements. The expert panel voted on agreement to recommendation statements and graded the level of evidence supporting each statement through surveys to achieve consensus, set at 85% a priori. The panellists underwent two rounds of anonymized, independent voting before reaching consensus for all eight statements. After the first round, seven statements reached consensus, including the corresponding grading for level of evidence. The statement which did not achieve consensus was revised with supporting literature and after the second round of survey, all eight statements and level of evidence reached consensus, completing the Delphi process. These eight statements covered themes to (1) encourage the identification of sarcopenia, (2) guide preoperative, and (3) postoperative management of sarcopenia. With the varying approaches in perioperative management, poor understanding of and identification of sarcopenia can result in suboptimal management of sarcopenia in surgical patients. Given the abundance of evidence linking beneficial impact on recovery and postoperative complications with prudent management of sarcopenia, it is imperative and urgent to achieve awareness and consensus.

A clinical consensus guideline for nutrition in infants with congenital diaphragmatic hernia from birth through discharge.

To develop a consensus guideline to meet nutritional challenges faced by infants with congenital diaphragmatic hernia (CDH). The CDH Focus Group utilized a modified Delphi method to develop these clinical consensus guidelines (CCG). Topic leaders drafted recommendations after literature review and group discussion. Each recommendation was sent to focus group members via a REDCap survey tool, and members scored on a Likert scale of 0-100. A score of > 85 with no more than 25% outliers was designated a priori as demonstrating consensus among the group. In the first survey 24/25 recommendations received a median score > 90 and after discussion and second round of surveys all 25 recommendations received a median score of 100. We present a consensus evidence-based framework for managing parenteral and enteral nutrition, somatic growth, gastroesophageal reflux disease, chylothorax, and long-term follow-up of infants with CDH.

Factors influencing choice of treatment for proximal humeral fractures elaborated in a Delphi consensus process

IntroductionHitherto, the decision-making process for treatment of proximal humerus fractures (PHF) remains controversial, with no established or commonly used treatment regimens. Identifying fracture- and patient-related factors that influence treatment decisions is crucial for the development of such treatment algorithms. The objective of this study was to define a Delphi consensus of clinically relevant fracture- and patient-related factors of PHF for clinical application and scientific research.MethodsAn online survey was conducted among an international panel of preselected experienced shoulder surgeons. An evidence-based list of fracture-related and patient-related factors affecting treatment outcome after PHF was generated and reviewed by the members of the committee through online surveys. The proposed factors were revised for definitions, and suggestions from the first round mentioned in the free text were included as possible factors in the second round of surveys. Consensus was defined as having at least a two-thirds majority agreement.ResultsThe Delphi consensus panel consisted of 18 shoulder surgeons who completed 2 rounds of online surveys. There was an agreement of more than two-thirds of the panel for three fracture-related factors affecting treatment decision in the case of PHF: head-split fracture, dislocated tuberosities, and fracture dislocation. Of all patient-related factors, a two-thirds consensus was reached for two factors: age and rotator cuff tear arthropathy.ConclusionThis study successfully conducted a Delphi consensus on factors influencing decision-making in the treatment of proximal humeral fractures. The documented factors will be useful for clinical evaluation and scientific validation in future studies.

Effects of cumulative COVID-19 cases on mental health: Evidence from multi-country survey.

Depression and anxiety were both ranked among the top 25 leading causes of global burden of diseases in 2019 prior to the coronavirus disease 2019 (COVID-19) pandemic. The pandemic affected, and in many cases threatened, the health and lives of millions of people across the globe and within the first year, global prevalence of anxiety and depression increased by 25% with the greatest influx in places highly affected by COVID-19. To explore the psychological impact of the pandemic and resultant restrictions in different countries using an opportunistic sample and online questionnaire in different phases of the pandemic. A repeated, cross-sectional online international survey of adults, 16 years and above, was carried out in 10 countries (United Kingdom, India, Canada, Bangladesh, Ukraine, Hong Kong, Pakistan, Egypt, Bahrain, Saudi Arabia). The online questionnaire was based on published approaches to understand the psychological impact of COVID-19 and the resultant restrictions. Five standardised measures were included to explore levels of depression [patient health questionnaire (PHQ-9)], anxiety [generalized anxiety disorder (GAD) assessment], impact of trauma [the impact of events scale-revised (IES-R)], loneliness (a brief loneliness scale), and social support (The Multi-dimensional Scale of Perceived Social support). There were two rounds of the online survey in 10 countries with 42866 participants in Round 1 and 92260 in Round 2. The largest number of participants recruited from the United Kingdom (112985 overall). The majority of participants reported receiving no support from mental health services throughout the pandemic. This study found that the daily cumulative COVID-19 cases had a statistically significant effect on PHQ-9, GAD-7, and IES-R scores. These scores significantly increased in the second round of surveys with the ordinary least squares regression results with regression discontinuity design specification (to control lockdown effects) confirming these results. The study findings imply that participants' mental health worsened with high cumulative COVID-19 cases. Whist we are still living through the impact of COVID-19, this paper focuses on its impact on mental health, discusses the possible consequences and future implications. This study revealed that daily cumulative COVID-19 cases have a significant impact on depression, anxiety, and trauma. Increasing cumulative cases influenced and impacted education, employment, socialization and finances, to name but a few. Building a database of global evidence will allow for future planning of pandemics, particularly the impact on mental health of populations considering the cultural differences.

Compilation and evaluation of gastrointestinal endoscopy satisfaction scale.

Gastrointestinal endoscopy plays an important role in the diagnosis and treatment of gastrointestinal diseases. The satisfaction degree of gastrointestinal endoscopy can directly affect the patient's compliance and further impact the treating effect. At present, there is no scale to evaluate the satisfaction degree of gastrointestinal endoscopy in China. This study aims to develop a satisfaction scale of gastrointestinal endoscopy suitable for national conditions and to evaluate its reliability and validity, which provides a tool for clinic to evaluate patients' satisfaction with gastrointestinal endoscopy. The original gastrointestinal endoscopy satisfaction scale was compiled by literature review, consulting senior endoscopists and experts. Through the first round of survey about 120 patients, the original scale was analyzed and modified according to the results to get the gastrointestinal endoscopy satisfaction scale (formal scale). The formal scale was used to conduct the second round of survey about 200 patients. The reliability and validity of the scale were analyzed and evaluated according to the survey results. The reliability of the original scale was good but the validity was poor. The formal scale had 2 dimensions and 10 items, the Cronbach's alpha and split-half reliability were 0.889 and 0.823. The structure validity index χ2/df was 2.513, root mean square error of approximation (RMSEA) was 0.094, goodness of fit index (GFI) was 0.914, adjusted goodness of fit index (AGFI) was 0.861, comparative fit index (CFI) was 0.946, normed fit index (NFI) was 0.915. The aggregate validity was general, the discriminative validity was good, and the direct score of patients was strongly correlated with the total score of the scale. The gastrointestinal endoscopy satisfaction scale has good reliability and validity, which can be used as a tool to evaluate patients' satisfaction with gastrointestinal endoscopy in China.

Changing course: Relocating commercial tanker lanes significantly reduces threat of chronic oiling for a top marine predator

A goal for conservation biologists is to show that policies enacted on behalf of an imperiled species results in direct benefits for it. In Argentina, tens of thousands of Magellanic penguins (Spheniscus magellanicus) were estimated to have died from chronic oil pollution each year through the early 1980s. From 1982 to 1990, surveys at sites along approximately 900 km of Chubut Province coastline found that >60 % of penguin carcasses had evidence of oiling in some years. In response to these findings, as well as pressure from non-governmental organizations and the public, provincial and federal authorities in Chubut moved the commercial tanker lanes 20 nautical miles farther offshore in 1997 and required oil tankers to have double hulls. During a second round of surveys in 2001, using most of the same sites as the first survey period, the number of dead and oiled penguins dropped effectively to zero. A policy change not only led to fewer oiled penguins, but also likely increased the survival of adult Magellanic penguins near some of their most significant breeding colonies in Argentina.

Reducing Nighttime Interruptions and Improving Sleep for Hospitalized Patients by Restructuring Nighttime Clinical Workflow.

Nighttime sleep disruptions negatively impact the experience of hospitalized patients. To determine the impact of adopting a sleep-promoting nighttime clinical workflow for hospitalized patients on nocturnal disruptions and sleep. Survey-based pre- and post-intervention cross-sectional study using convenience samples. Hospitalized veterans on a 23-bed general medical ward at a tertiary Veterans Administration Hospital. Baseline sleep surveys (N=149) identified two major sources of interruptions: blood pressure checks at 4 am for telemetry patients and subcutaneous (SQ) heparin injections between 4:30 and 6 am for venous thromboembolism prophylaxis. Clinical workflow was restructured to eliminate these disruptions: moving 4 am blood pressure checks to 6 am and providing daily SQ enoxaparin at 9 am as an alternative to Q 8-h SQ heparin, which had prompted an injection between 4:30 and 6 am. The impact of these changes was assessed in a second round of surveys (N=99). Frequency and sources for nighttime sleep disruptions; percentage of patients reporting longer time to fall asleep, more interruptions, and worse sleep quality (vs. home) before and after restructuring nighttime clinical workflow. After restructuring nighttime clinical workflow, medication administration as a source of nighttime disruption decreased from 40% (59/149) to 4% (4/99) (p<0.001). Blood pressure checks as a source of disruption decreased from 56% (84/149) to 42% (42/99) (p=0.033). Fewer patients reported taking longer to fall asleep in the hospital vs. home (39% pre-intervention vs. 25% post-intervention, p=0.021). Similarly, fewer patients experienced waking up more frequently in the hospital vs. home (46% pre-intervention vs. 32% post-intervention, p=0.036). Fewer patients reported sleeping worse in the hospital (44% pre-intervention vs. 39% post-intervention), though this trend was not statistically significant (p=0.54). Nighttime disruptions in hospitalized patients frequently interfere with sleep. Restructuring of the clinical workflow significantly reduced disruptions and improved sleep.

The correlation between lifestyle health behaviors, coping style, and mental health during the COVID-19 pandemic among college students: Two rounds of a web-based study.

During the last months of 2019, worldwide attention has focused on a pandemic of COVID-19, and the pandemic spread rapidly, becoming a public health emergency of international concern. The Chinese government has quickly taken quarantine measures and the drastic measures incurred to curtail it, which could have harmful consequences for everyone's behavior and mental health. This study aimed to investigate the correlation of influencing factors and mental health symptoms among Chinese college students according to two rounds of surveys during the COVID-19 pandemic. This study was divided into two stages of cross-sectional investigation. In February 2020 and May 2020, two cross-sectional surveys were conducted on college students in the above areas by means of cluster sampling. From February 4 to February 12, 2020, 14,789 college students completed the first round of online study from 16 cities and universities in 21 in China, excluding participants who completed the questionnaire, and finally included 11,787 college students. After 3 months, we also conducted a large-scale questionnaire survey based on the first study area to observe the behavioral changes and psychological symptoms of college students within 3 months. Using the convenience sampling method, a survey on the cognitive and psychological status of COVID-19 among college students was conducted in 21 universities in 16 regions in May 2020. The regions among the two surveys are divided into Wuhan (District 1), neighboring Hubei (District 2), first-tier cities, namely, Beijing, Shanghai and Guangzhou (District 3), and other provinces (District 4). (1) In the first survey, the average age of the participants was 20.51 ± 1.88 years. One-third of the college students were male. In total, 25.9 and 17.8% of college students reported depression and anxiety symptoms, respectively. College students, who reported higher ST, lower PA, higher soda beverage and tea beverage intake, have Chinese herbal medicine and vitamin drinking, and decreased frequency of diet had higher depression and anxiety symptoms. Moreover, infection risk, perceived resistance to COVID-19, concerns about physical symptoms, family/friends directly/indirectly contacted with confirmed cases, and seeking psychological counseling had significant associations with anxiety and depression symptoms. (2) In the second round of surveys, 6803 males (41.7%) and 9502 females (58.3%) had a mean age of 20.58 ± 1.81 years. The prevalence of depressive symptoms and anxiety symptoms during COVID-19 was 30.7 and 23.9%, respectively. (3) In both surveys, college students who reported having higher ST, lower PA, higher soda beverage and tea beverage intake, Chinese herbal medicine and vitamin drinking, and decreased frequency of diet also had higher depression and anxiety symptoms. Coping styles with COVID-19 partially mediate the association between some related lifestyle behaviors and anxiety and depression. The results of the conditional process model analysis support our hypothesis that lifestyle behaviors, and coping styles are both predictors of anxiety and depression symptoms, with both direct and indirect effects moderated by gender level. In logistic regression analysis, the correlation of depression and anxiety in the second rounds of the survey was higher than that in the first survey. In two surveys, there was a correlation between lifestyle health behaviors and coping style, gender and mental health. Our findings demonstrated that the prevalence of anxiety and depression in the two rounds of surveys was different, and the prevalence in the second round was higher than that in the first round, as well as that in the two rounds of surveys. All survey identified that unhealthy lifestyle behaviors were positively associated with depression and anxiety symptoms. Compared with the emerged city of risk areas, other pandemic regions have a lower risk of mental health problems. The survey findings complement each other. Lifestyle health behaviors and coping style alleviated mental health symptoms. COVID-19-related social stressors were positively associated with mental health symptoms. The study also suggests that at the beginning of the pandemic, the effective management of college students' mental health problems, corresponding coping measures and maintaining a good lifestyle play a key role in the prevention and control of other cities. Understanding the college students' lifestyle behaviors during COVID-19 lockdown will help public health authorities reshape future policies on their nutritional recommendations, in preparation for future pandemics.

Coaching Leadership and Employees' Deviant Innovation Behavior: Mediation and Chain Mediation of Interactional Justice and Organizational Identification.

Previous studies are based on social exchange theory to explore the influence of leadership style on employees' deviant innovation behavior. However, deviant innovation is risky, not supported by the organization, and is expected to benefit the long-term development of the organization. The key to the problem lies in how to guide employees to think and solve problems from the perspective of the organization, instead of just relying on material or spiritual exchange and return. Therefore, the purpose of this study was to analyze the relationship between coaching leadership, interactional justice, organizational identification and employees' deviant innovation from the perspective of changing cognition. This work surveyed employees in 26 Chinese enterprises in more than 10 regions. Questionnaires were distributed to 450 employees, the first round of survey mainly investigated demographic information of employees and coaching leadership style of supervisors, and the second round of survey mainly investigated employees' organizational identification, interactional justice, and deviant innovation behavior. By tracking and matching, 340 valid questionnaires were finally obtained. Spss 22.0 was used to describe all the study variables; Mplus 7.0 is used to carry out a confirmatory factor analysis and a multi-path regression model. According to self-categorization theory, the results demonstrated that coaching leadership can directly or indirectly promote employees' deviant innovation behavior through the dual-path intermediary and chain intermediary of interactional fairness and organizational identification. Under the open situation created by coaching leadership, coaching leaders will interact and communicate sincerely with employees, and employees' cognition will change. The original "I" of employees will be transformed into "big self" with organizational membership, which will guide employees to show behaviors beneficial to the organization. Therefore, interactional justice and organizational identification can play a key role of the influence of coaching leadership on employees' deviant innovation behavior.

Consumer research priorities for pediatric anesthesia and perioperative medicine.

Consumer-driven research is increasingly being prioritized. Our aim was to partner with consumers to identify the top 10 research priorities for pediatric anesthesia and perioperative medicine. The ACORN (Anesthesia Consumer Research Network) was formed to collaborate with children and families across Australia. A prospective online survey was developed to generate research ideas from consumers. The survey was developed in Qualtrics, a survey research platform. Consumers were invited to participate through poster advertising, social media posts, via consumer networks at participating hospitals and in addition 35 national consumer/patient representative organizations were approached. We also conducted a similar idea generating survey for clinicians through email invitation and via Twitter. A second round of surveys was conducted to prioritize the long list of research questions and a shortlist of priorities developed. A single consensus meeting was held, and a final consensus list of top 10 priorities emerged. A total of 281 research ideas were submitted between 356 consumers in the idea generating survey and from four consumer/patient representative groups. Seventy-five clinicians responded to the clinician idea generation survey. This was consolidated into 20 research ideas/themes for the second survey for each group. 566 responses were received to the consumer prioritization top 10 survey and 525 responses to the clinician survey. The consensus meeting produced the final 10 consumer research priorities. This study has given Australian consumers the opportunity to shape the anesthesia and perioperative medicine research agenda for pediatric patients both nationally and internationally.

Perceived Overqualification as a Determinant of Proactive Behavior and Career Success: The Need for Achievement as a Moderator

Recent studies show the importance of overqualification for the career success of professionals. Drawing on relative deprivation and person-environment fit theory and with a focus on career success perspective, we examined the effect of perceived overqualification on career success via proactive behaviour and relative deprivation, and how the need for achievement moderates the relationship between perceived overqualification and proactive behaviour and relative deprivation. The study collected data in three waves using time lagged design from the top universities of Lahore and Faisalabad, Pakistan. In the first set of surveys, 456 questionnaires were returned, yielding an 85.23 percent response rate. Three hundred eighty-two questionnaires were returned in the second round of surveys, yielding an 83.77 percent response rate. In the third round of surveys, 318 questionnaires were received, accounting for 83.25 percent of the total. so a total of 318 questionnaires were selected for analysis. The study found that perceived overqualification was found to have a positive relationship with career success. Proactive behaviour and relative deprivation mediate between overqualification and career success. Moreover, the findings suggest that a high need for achievement strengthens the positive relationship between perceived overqualifications and proactive behaviour, whereas a high need for achievement weakens the relation between perceived overqualification and relative deprivation. These findings show that employees high on need for achievement will show more proactive behaviour with overqualification and low relative deprivation. The findings suggest many theoretical as well as practical implications for managers to reduce overqualification perceptions of employees in an organizational context. The managerial implications are also discussed in the end.

Which are the limiting factors in lung tissue sampling and diagnostic accuracy for a new Interventional Pulmonology Unit? From expert consensus-based evidence to results of a new-born Unit.

BackgroundThere is a gap of knowledge about the factors that may determine the quality and the accuracy of diagnostic bronchoscopic procedures when setting up a new Interventional Pulmonology Unit. As little evidence-based medicine is available on this matter, an online consensus opinion of experts was gathered and compared with real-life data coming from a new Interventional Pulmonology (IP) Unit.MethodsA survey was emailed to the heads of all Italian IP Units to investigate the factors influencing the success of the diagnostic yield of a new IP Unit. The survey consisted of 24 items grouped by topic; the level of agreement ranged from 1 (no influence) to 7 (strong influence). After responses were collected, we submitted the data on the accuracy of the endoscopic procedures performed during the first two years of our new IP Unit to the attention of the participants for a second round of survey; the level of consistency between the first and second round of responses was assessed.ResultsAfter having been shown the results of the first two years of activity of our Unit, in the second round of the survey the responders indicated the personal skills of the Interventional Pulmonologist, the availability of echoendoscopic technology and the expertise in evaluating cytological samples as the factors able to positively influence the performance of a newly established IP Unit. Neither the role of dedicated nursing assistance, the availability of a rapid on-site evaluation, nor the presence of anesthesiology assistance were considered to be limiting factors for the final accuracy results.ConclusionsA consensus of opinion of a group of expert interventional pulmonologists highlighted the factors that may be responsible for the diagnostic success of a newly established Italian IP Unit. These factors are mainly three: personal skills of the interventional pulmonologist, the availability of echoendoscopic technology, and the expertise in reading cytological samples.

The main issue working with migrant construction labor: a case study in Thailand

PurposeThe purpose of this paper is to study and prioritize the problems impacted on construction work together migrant laborers, by using the Delphi technique. The case study is construction work in Bangkok and metropolitan zones, Thailand.Design/methodology/approachThe framework of the perceived issues caused by working with migrant construction labors especially migrant construction laborers from neighboring countries were identified from literature reviews. The issue list was sent to 162 experts seeking for their opinions. Subsequently, a questionnaire was created from 58 items of suitable issue lists according to expert's opinions. The questionnaires were then submitted to 147 respondents from construction contractor companies. Their responses were calculated and prioritized by means of the Delphi techniqueFindingsThe polling data showed its constancy on the second round of survey. There were 34 out of 58 items passed consensus criteria. The issue “Foreman obtained incompetent or inadequate trained migrant labors when relocate them from/to other site or job” ranked 1st in priority ranking with the average score of 4.56. Subproblems were appropriately prioritized according to their mean scores.Practical implicationsThe results of this research were expected to facilitate construction operators in making appropriate decisions and primary solution concerning main issue factors in working with migrant labors, in order to help even more increasing competition efficiency in Thai construction industries.Originality/valueThe research provides a list of main issue occurred in the case study. These outcomes are also expected to provide important information for other case studies on the issue working with migrant construction labor.

The impact of COVID-19 on small and medium-sized enterprises (SMEs): Evidence from two-wave phone surveys in China

This paper examines the short-term and mid-term impact of COVID-19 restrictions on SMEs, based on two waves of phone interviews with a previously surveyed large SME sample in China. The outbreak of COVID-19 and the resultant lockdowns took a heavy toll on SMEs. Afflicted by problems of logistics blocks, labor shortages, and drops in demand, 80% of SMEs were temporarily closed at the time of the first wave of interviews in February 2020. After reining in COVID-19, authorities largely eased lockdown restrictions in April. Consequently, most SMEs had reopened by the time of the second round of surveys in May. However, many firms, particularly export firms, were running at partial capacity, primarily due to inadequate demand. Moreover, around 19% of incorporated enterprises and 25% of self-employed businesses had permanently closed between the two waves of surveys.

Public health crisis in the refugee community: little change in social determinants of health preserve health disparities.

Structural inequities and lack of resources put vulnerable refugee communities at great risk. Refugees flee their country of origin to escape persecution and flee from war, famine and torture. Resettled refugee communities become particularly vulnerable during times of crisis due to limited English proficiency and poor social determinants of health (SDOH), which create barriers to attaining and sustaining health and wellbeing for themselves and their families. The purpose of this case study was to evaluate SDOH among a refugee community in the Southeastern United States. We surveyed the community twice during a 1-year period to assess various elements of SDOH. Among a primarily African and Southeast Asian refugee community, 76% reported difficulty paying for food, housing and healthcare during the first round of surveys. During the second round of surveys at the beginning of the Coronavirus pandemic, 70% reported lost income; 58% indicated concern about paying bills. There was little change during the 12-month study period, showing that SDOH are an enduring measure of poor health and wellbeing for this vulnerable refugee community.

Scale Development for measuring the level of Happiness of Uni3versity Students (HUS)

The purpose of this study is to find the factors that impact university students'' happiness and makes tangible the tools to quantify such factors. In order to do this, we first conducted group interview to identify key words and using this we created a 1st round of questionnaires. Next we performed factor analysis on the results collected to separate different happiness factors, and conducted a second round of survey to finalize the items/questions in the scale. As a result, we found that the five lower level factors include goal achievement, thankfulness, relationship, positivity, and forgiveness. This study contribution can be summarized as the following. We have to a way to measure students'' happiness which can be utilized in university policies and it can also be used to present solutions to our emerging students adaptability problem.

Family planning counseling and its associations with modern contraceptive use, initiation, and continuation in rural Uttar Pradesh, India

BackgroundWe examine the association between the quality of family planning (FP) counseling received in past 24 months, and current modern contraceptive use, initiation, and continuation, among a sample of women in rural Uttar Pradesh, India.MethodsThis study included data from a longitudinal study with two rounds of representative household survey (2014 and 2016), with currently married women of age 15–49 years; the analysis excluded women who were already using a permanent method of contraceptive during the first round of survey and who reported discontinuation because they wanted to be pregnant (N = 1398). We measured quality of FP counseling using four items on whether women were informed of advantages and disadvantages of different methods, were told of method(s) that are appropriate for them, whether their questions were answered, and whether they perceived the counseling to be helpful. Positive responses to every item was categorized as higher quality counseling, vs lower quality counseling for positive response to less than four items. Outcome variables included modern contraceptive use during the second round of survey, and a variable categorizing women based on their contraceptive use behavior during the two rounds: continued-users, new-users, discontinued-users, and non-users.ResultsAround 22% had received any FP counseling; only 4% received higher-quality counseling. Those who received lower-quality FP counseling had 2.42x the odds of reporting current use of any modern contraceptive method (95% CI: 1.56–3.76), and those who received higher quality FP counseling at 4.14x the odds of reporting modern contraceptive use (95% CI: 1.72–9.99), as compared to women reporting no FP counseling. Women receiving higher-quality counseling also had higher likelihood of continued use (ARRR 5.93; 95% CI: 1.97–17.83), as well as new use or initiation (ARRR: 4.2; 95% CI: 1.44–12.35) of modern contraceptives. Receipt of lower-quality counseling also showed statistically significant associations with continued and new use of modern contraceptives, but the effect sizes were smaller than those for higher-quality counseling.ConclusionsFindings suggest the value of FP counseling. With a patient-centered approach to counseling, continued use of modern contraceptives can be supported among married women of reproductive age. Unfortunately, FP counseling, particularly higher-quality FP counseling remains rare.

Circling the Reality of Public Institutions: An e-Delphi Study of Information, Culture, and Community Stakeholders Voicing the Way Forward in Detroit, Michigan

AbstractInformation, culture, and memory centers are increasingly anchored to urban redevelopment projects within historically marginalized communities challenged by contemporary social and economic disparity. This paper situated libraries, archives, and museums within a sociocultural context to examine the role of cultural heritage institutions in gentrification. Librarians, archivists, curators, and community advocates in Detroit, Michigan shared their viewpoints and experiences of gentrification. Using a modified Delphi process, respondents explored the need for policy, service delivery, and programming assessment in a city of color at-risk to gentrification-induced displacement.This mixed research study was implemented using a concurrent triangulation design. A three-round e-Delphi survey (round one: n = 32; round two: n = 31; round three: n = 30) was conducted from May 2017 to August 2017. A panel of experts was selected composed of information, culture, and community workers who practiced: (a) at an anchor institution; (b) in a neighborhood undergoing gentrification; or (c) with community members seeking to stay put in transitioning neighborhoods. Qualitative and quantitative data were analyzed using inductive analysis and descriptive statistics. A nonparametric statistical test, Kendall’s Coefficient of Concordance (W), measured the extent of agreement among the e-Delphi panelists’ rankings of issues and recommendations (identified by the panel members) regarding the role of cultural heritage institutions in gentrification and displacement.Thirty panel members (93%) in the first round of the survey indicated that it was important for cultural heritage institutions to assess if revitalization partnerships contributed to gentrification-induced displacement. The panel generated 25 propositions in the second round of survey, which they ranked in the third and final round of the survey. Kendall’s W for the rank ordering of the five most important issues (W = 0.008; X2 = 15.815; df = 6; p = 0.015) and ten most important recommendations (W = 0.050; X2 = 24.467; df = 17; p = 0.085) indicated a very weak level of agreement. The implication of this finding suggested a need for further exploration. This study adds to the global investigation on the role of cultural heritage institutions in gentrification and displacement and contributes to an emerging body of knowledge in cultural heritage informatics in the U.S.

The MISDEF2 algorithm: an updated algorithm for patient selection in minimally invasive deformity surgery.

Minimally invasive surgery (MIS) can be used as an alternative or adjunct to traditional open techniques for the treatment of patients with adult spinal deformity. Recent advances in MIS techniques, including advanced anterior approaches, have increased the range of candidates for MIS deformity surgery. The minimally invasive spinal deformity surgery (MISDEF2) algorithm was created to provide an updated framework for decision-making when considering MIS techniques in correction of adult spinal deformity. A modified algorithm was developed that incorporates a patient's preoperative radiographic parameters and leads to one of 4 general plans ranging from basic to advanced MIS techniques to open deformity surgery with osteotomies. The authors surveyed 14 fellowship-trained spine surgeons experienced with spinal deformity surgery to validate the algorithm using a set of 24 cases to establish interobserver reliability. They then re-surveyed the same surgeons 2 months later with the same cases presented in a different sequence to establish intraobserver reliability. Responses were collected and analyzed. Correlation values were determined using SPSS software. Over a 3-month period, 14 fellowship-trained deformity surgeons completed the surveys. Responses for MISDEF2 algorithm case review demonstrated an interobserver kappa of 0.85 for the first round of surveys and an interobserver kappa of 0.82 for the second round of surveys, consistent with substantial agreement. In at least 7 cases, there was perfect agreement between the reviewing surgeons. The mean intraobserver kappa for the 2 surveys was 0.8. The MISDEF2 algorithm was found to have substantial inter- and intraobserver agreement. The MISDEF2 algorithm incorporates recent advances in MIS surgery. The use of the MISDEF2 algorithm provides reliable guidance for surgeons who are considering either an MIS or an open approach for the treatment of patients with adult spinal deformity.

Impact of Attitude Towards Human Resource Accounting on Performance of Undergraduate Students’ Education – Evidence From Private University Students in Kurdistan Region – Iraq

The current research was undertaken to find the impact of attitude towards Human Resource Accounting on performance of undergraduate student’s education. The research was carried out as a pilot study on accounting department’s students who are pursuing their 3rd year and final year of their under graduation in a private university which is located in Kurdistan Region – Iraq. The total number of students in accounting department was 125 where 59 students responded to the questionnaire distributed. Researchers used Delphi technique where respondents are given chance to choose their responses in the first round randomly. All results of each item of the survey were shown to the respondents in the second round and requested to re-confirm their responses and provided freedom to change their responses. Researchers found few differences from first round to the second round of survey with the same respondents. Researchers constructed a basic model to understand the impact of predicted variable and predictor variables. The predictor variable for current research is attitude towards Human Resource Accounting and Predicted variable is performance of undergraduate students’ education. The null hypothesis got rejected in the study. The research gap was identified by the researchers as literature was completely focused on reporting, measuring and evaluating the human values but overlooked the attitude part related to human resource accounting. Current research helps the educational institutions to understand the value of human resource accounting and implication of it to achieve high level of productivity among student community