Search results for: Maryam Delphi
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 439

Search results for: Maryam Delphi

409 MOOCs (E-Learning) Project Personnel Competency Analysis

Authors: Shang-Hua Wu, Rong-Chi Chang, Horng–Twu Liaw

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Nowadays, competencies of e-learning project personnel are very important in assisting them in offering courses, serving students in an effective way, leveraging advantages, strengthen their relationships with potential students, etc. among e-learning platforms, MOOCs has recently attracted increasing focuses in distance education since it can be conducted for a large numbers of virtual learners. Nonetheless, since MOOCs is a relatively new e-learning platform, top concerns have been paid to what competencies are important for e-learning personnel to consider. Taking this need, this research aimed to carry out an in-depth exploration of competency requirements of MOOCs (e-learning) project personnel in Taiwan vocational schools. Data were collected through thorough literature reviews and discussions and competency analysis was carried out using Delphi technique questionnaires. The results show that that MOOCs (e-learning) project personnel’ professional competency lie in three main dimensions, among which ‘demand analysis competency’ (i.e., containing 10 major competences and 48 subordinate capabilities) is the most important competency, followed by ‘project management competency’ (i.e., comprising 6 major competences and 31 secondary capabilities), and finally ‘digital content production competency’ (i.e., including 12 major competences and 79 secondary capabilities). As such, in Taiwan context with different organizational scales and market sizes, the e-learning competency items and unique experience/ achievements throughout the promotion process obtained in this research will provide useful references for academic institutions in promoting e-learning.

Keywords: competency analysis, Delphi technique questionnaire, e-learning, massive open online courses

Procedia PDF Downloads 285
408 A Model of Empowerment Evaluation of Knowledge Management in Private Banks Using Fuzzy Inference System

Authors: Nazanin Pilevari, Kamyar Mahmoodi

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The purpose of this research is to provide a model based on fuzzy inference system for evaluating empowerment of Knowledge management. The first prototype of the research was developed based on the study of literature. In the next step, experts were provided with these models and after implementing consensus-based reform, the views of Fuzzy Delphi experts and techniques, components and Index research model were finalized. Culture, structure, IT and leadership were considered as dimensions of empowerment. Then, In order to collect and extract data for fuzzy inference system based on knowledge and Experience, the experts were interviewed. The values obtained from designed fuzzy inference system, made review and assessment of the organization's empowerment of Knowledge management possible. After the design and validation of systems to measure indexes ,empowerment of Knowledge management and inputs into fuzzy inference) in the AYANDEH Bank, a questionnaire was used. In the case of this bank, the system output indicates that the status of empowerment of Knowledge management, culture, organizational structure and leadership are at the moderate level and information technology empowerment are relatively high. Based on these results, the status of knowledge management empowerment in AYANDE Bank, was moderate. Eventually, some suggestions for improving the current situation of banks were provided. According to studies of research history, the use of powerful tools in Fuzzy Inference System for assessment of Knowledge management and knowledge management empowerment such an assessment in the field of banking, are the innovation of this Research.

Keywords: knowledge management, knowledge management empowerment, fuzzy inference system, fuzzy Delphi

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407 Development of Chronic Obstructive Pulmonary Disease (COPD) Proforma (E-ICP) to Improve Guideline Adherence in Emergency Department: Modified Delphi Study

Authors: Hancy Issac, Gerben Keijzers, Ian Yang, Clint Moloney, Jackie Lea, Melissa Taylor

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Introduction: Chronic obstructive pulmonary disease guideline non-adherence is associated with a reduction in health-related quality of life in patients (HRQoL). Improving guideline adherence has the potential to mitigate fragmented care thereby sustaining pulmonary function, preventing acute exacerbations, reducing economic health burdens, and enhancing HRQoL. The development of an electronic proforma stemming from expert consensus, including digital guideline resources and direct interdisciplinary referrals is hypothesised to improve guideline adherence and patient outcomes for emergency department (ED) patients with COPD. Aim: The aim of this study was to develop consensus among ED and respiratory staff for the correct composition of a COPD electronic proforma that aids in guideline adherence and management in the ED. Methods: This study adopted a mixed-method design to develop the most important indicators of care in the ED. The study involved three phases: (1) a systematic literature review and qualitative interdisciplinary staff interviews to assess barriers and solutions for guideline adherence and qualitative interdisciplinary staff interviews, (2) a modified Delphi panel to select interventions for the proforma, and (3) a consensus process through three rounds of scoring through a quantitative survey (ED and Respiratory consensus) and qualitative thematic analysis on each indicator. Results: The electronic proforma achieved acceptable and good internal consistency through all iterations from national emergency department and respiratory department interdisciplinary experts. Cronbach’s alpha score for internal consistency (α) in iteration 1 emergency department cohort (EDC) (α = 0.80 [CI = 0.89%]), respiratory department cohort (RDC) (α = 0.95 [CI = 0.98%]). Iteration 2 reported EDC (α = 0.85 [CI = 0.97%]) and RDC (α = 0.86 [CI = 0.97%]). Iteration 3 revealed EDC (α = 0.73 [CI = 0.91%]) and RDC (α = 0.86 [CI = 0.95%]), respectively. Conclusion: Electronic proformas have the potential to facilitate direct referrals from the ED leading to reduced hospital admissions, reduced length of hospital stays, holistic care, improved health care and quality of life and improved interdisciplinary guideline adherence.

Keywords: COPD, electronic proforma, modified delphi study, interdisciplinary, guideline adherence, COPD-X plan

Procedia PDF Downloads 63
406 Understanding the Role of Social Entrepreneurship in Building Mobility of a Service Transportation Models

Authors: Liam Fassam, Pouria Liravi, Jacquie Bridgman

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Introduction: The way we travel is rapidly changing, car ownership and use are declining among young people and those residents in urban areas. Also, the increasing role and popularity of sharing economy companies like Uber highlight a movement towards consuming transportation solutions as a service [Mobility of a Service]. This research looks to bridge the knowledge gap that exists between city mobility, smart cities, sharing economy and social entrepreneurship business models. Understanding of this subject is crucial for smart city design, as access to affordable transport has been identified as a contributing factor to social isolation leading to issues around health and wellbeing. Methodology: To explore the current fit vis-a-vis transportation business models and social impact this research undertook a comparative analysis between a systematic literature review and a Delphi study. The systematic literature review was undertaken to gain an appreciation of the current academic thinking on ‘social entrepreneurship and smart city mobility’. The second phase of the research initiated a Delphi study across a group of 22 participants to review future opinion on ‘how social entrepreneurship can assist city mobility sharing models?’. The Delphi delivered an initial 220 results, which once cross-checked for duplication resulted in 130. These 130 answers were sent back to participants to score importance against a 5-point LIKERT scale, enabling a top 10 listing of areas for shared user transports in society to be gleaned. One further round (4) identified no change in the coefficient of variant thus no further rounds were required. Findings: Initial results of the literature review returned 1,021 journals using the search criteria ‘social entrepreneurship and smart city mobility’. Filtering allied to ‘peer review’, ‘date’, ‘region’ and ‘Chartered associated of business school’ ranking proffered a resultant journal list of 75. Of these, 58 focused on smart city design, 9 on social enterprise in cityscapes, 6 relating to smart city network design and 3 on social impact, with no journals purporting the need for social entrepreneurship to be allied to city mobility. The future inclusion factors from the Delphi expert panel indicated that smart cities needed to include shared economy models in their strategies. Furthermore, social isolation born by costs of infrastructure needed addressing through holistic A-political social enterprise models, and a better understanding of social benefit measurement is needed. Conclusion: In investigating the collaboration between key public transportation stakeholders, a theoretical model of social enterprise transportation models that positively impact upon the smart city needs of reduced transport poverty and social isolation was formed. As such, the research has identified how a revised business model of Mobility of a Service allied to a social entrepreneurship can deliver impactful measured social benefits associated to smart city design existent research.

Keywords: social enterprise, collaborative transportation, new models of ownership, transport social impact

Procedia PDF Downloads 143
405 A Study of the Establishment of the Evaluation Index System for Tourist Attraction Disaster Resilience

Authors: Chung-Hung Tsai, Ya-Ping Li

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Tourism industry is highly depended on the natural environment and climate. Compared to other industries, it is more susceptible to environment and climate. Taiwan belongs to a sea island country and located in the subtropical monsoon zone. The events of climate variability, frequency of typhoons and rainfalls raged are caused regularly serious disaster. In traditional disaster assessment, it usually focuses on the disaster damage and risk assessment, which is short of the features from different industries to understand the impact of the restoring force in post-disaster resilience and the main factors that constitute resilience. The object of this study is based on disaster recovery experience of tourism area and to understand the main factors affecting the tourist area of disaster resilience. The combinations of literature review and interviews with experts are prepared an early indicator system of the disaster resilience. Then, it is screened through a Fuzzy Delphi Method and Analytic Network Process for weight analysis. Finally, this study will establish the tourism disaster resilience evaluation index system considering the Taiwan's tourism industry characteristics. We hope that be able to enhance disaster resilience after tourist areas and increases the sustainability of industrial development. It is expected to provide government departments the tourism industry as the future owner of the assets in extreme climates responses.

Keywords: resilience, Fuzzy Delphi Method, Analytic Network Process, industrial development

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404 A Study of the Planning and Designing of the Built Environment under the Green Transit-Oriented Development

Authors: Wann-Ming Wey

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In recent years, the problems of global climate change and natural disasters have induced the concerns and attentions of environmental sustainability issues for the public. Aside from the environmental planning efforts done for human environment, Transit-Oriented Development (TOD) has been widely used as one of the future solutions for the sustainable city development. In order to be more consistent with the urban sustainable development, the development of the built environment planning based on the concept of Green TOD which combines both TOD and Green Urbanism is adapted here. The connotation of the urban development under the green TOD including the design toward environment protect, the maximum enhancement resources and the efficiency of energy use, use technology to construct green buildings and protected areas, natural ecosystems and communities linked, etc. Green TOD is not only to provide the solution to urban traffic problems, but to direct more sustainable and greener consideration for future urban development planning and design. In this study, we use both the TOD and Green Urbanism concepts to proceed to the study of the built environment planning and design. Fuzzy Delphi Technique (FDT) is utilized to screen suitable criteria of the green TOD. Furthermore, Fuzzy Analytic Network Process (FANP) and Quality Function Deployment (QFD) were then developed to evaluate the criteria and prioritize the alternatives. The study results can be regarded as the future guidelines of the built environment planning and designing under green TOD development in Taiwan.

Keywords: green TOD, built environment, fuzzy delphi technique, quality function deployment, fuzzy analytic network process

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403 The Effect of Six Weeks Aerobic Training and Taxol Consumption on Interleukin 8 and Plasminogen Activator Inhibitor-1 on Mice with Cervical Cancer

Authors: Alireza Barari, Maryam Firoozi, Maryam Ebrahimzadeh, Romina Roohan Ardeshiri, Maryam Kamarloeei

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Background: The The purpose of this study was to evaluate the effect of six-week aerobic training and taxol consumption on interleukin 8 and Plasminogen Activator Inhibitor-1 (PAI-1) in mice with cervical cancer. Material and method: In this experimental study, 40 female C57 mice, eight weeks old, were randomly divided into 4 groups: cancer, cancer-taxol complement, cancer-training and cancer-training - taxol complement with 10 mice in each group. The implantation of cancerous tumors was performed under the skin of the upper pelvis. The training group completed the endurance training protocol, which included 3 sessions per week, 50 minutes per session, at a speed of 14-18 m/s for six weeks. A dose of 60 mg/ kg/day, a pure extract of Taxol was injected peritoneal Data were analyzed by t-test, One-way ANOVA and post hoc Bonferron's at the significant level P<0. 05. Results: The results showed that there was a significant difference between mean values of interleukin-8 (P < 0.05, F = 12.25) and the plasminogen activator inhibitor-1 (P < 0.05, P=0.10737) in four groups. A significance level of less than 0.05 in Tukey test for both variables also showed a significant difference between the "control" group and the complementary "exercise" group. Namely, six weeks of aerobic training, along with taxol, have a significant effect on the level of plasminogen activator inhibitor-1 and interleukin-8 mice with cervical cancer. Conclusion: Considering the effect of training on these variables, this type of exercise can be used as a complementary therapeutic approach along with other therapies for cervical cancer.

Keywords: cervical cancer, taxol, endurance training, interleukin 8, plasminogen activator inhibitor-1

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402 Learning-Oriented School Education: Indicator Construction and Taiwan's Implementation Performance

Authors: Meiju Chen, Chaoyu Guo, Chia Wei Tang

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The present study's purpose is twofold: first, to construct indicators for learning-oriented school education and, second, to conduct a survey to examine how learning-oriented education has been implemented in junior high schools after the launch of the 12-year compulsory curriculum. For indicator system construction, we compiled relevant literature to develop a preliminary indicator list model and then conducted two rounds of a questionnaire survey to gain comprehensive feedback from experts to finalize our indicator model. In the survey's first round, 12 experts were invited to evaluate the indicators' appropriateness. Based on the experts' consensus, we determined our final indicator list and used it to develop the Fuzzy Delphi questionnaire to finalize the indicator system and each indicator's relative value. For the fact-finding survey, we collected 454 valid samples to examine how the concept of learning-oriented education is adopted and implemented in the junior high school context. We also used this data in our importance-performance analysis to explore the strengths and weaknesses of school education in Taiwan. The results suggest that the indicator system for learning-oriented school education must consist of seven dimensions and 34 indicators. Among the seven dimensions, 'student learning' and 'curriculum planning and implementation' are the most important yet underperforming dimensions that need immediate improvement. We anticipate that the indicator system will be a useful tool for other countries' evaluation of schools' performance in learning-oriented education.

Keywords: learning-oriented education, school education, fuzzy Delphi method, importance-performance analysis

Procedia PDF Downloads 143
401 Modified Fuzzy Delphi Method to Incorporate Healthcare Stakeholders’ Perspectives in Selecting Quality Improvement Projects’ Criteria

Authors: Alia Aldarmaki, Ahmad Elshennawy

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There is a global shift in healthcare systems’ emphasizing engaging different stakeholders in selecting quality improvement initiatives and incorporating their preferences to improve the healthcare efficiency and outcomes. Although experts bring scientific knowledge based on the scientific model and their personal experience, other stakeholders can bring new insights and information into the decision-making process. This study attempts to explore the impact of incorporating different stakeholders’ preference in identifying the most significant criteria that should be considered in healthcare for electing the improvement projects. A Framework based on a modified Fuzzy Delphi Method (FDM) was built. In addition to, the subject matter experts, doctors/physicians, nurses, administrators, and managers groups contribute to the selection process. The research identifies potential criteria for evaluating projects in healthcare, then utilizes FDM to capture expertise knowledge. The first round in FDM is intended to validate the identified list of criteria from experts; which includes collecting additional criteria from experts that the literature might have overlooked. When an acceptable level of consensus has been reached, a second round is conducted to obtain experts’ and other related stakeholders’ opinions on the appropriate weight of each criterion’s importance using linguistic variables. FDM analyses eliminate or retain the criteria to produce a final list of the critical criteria to select improvement projects in healthcare. Finally, reliability and validity were investigated using Cronbach’s alpha and factor analysis, respectively. Two case studies were carried out in a public hospital in the United Arab Emirates to test the framework. Both cases demonstrate that even though there were common criteria between the experts and the stakeholders, still stakeholders’ perceptions bring additional critical criteria into the evaluation process, which can impact the outcomes. Experts selected criteria related to strategical and managerial aspects, while the other participants preferred criteria related to social aspects such as health and safety and patients’ satisfaction. The health and safety criterion had the highest important weight in both cases. The analysis showed that Cronbach’s alpha value is 0.977 and all criteria have factor loading greater than 0.3. In conclusion, the inclusion of stakeholders’ perspectives is intended to enhance stakeholders’ engagement, improve transparency throughout the decision process, and take robust decisions.

Keywords: Fuzzy Delphi Method, fuzzy number, healthcare, stakeholders

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400 Analysis on the Importance and Direction of Change in Residential Environment of Apartment with the Change of Population Structure

Authors: Jo, Eui Chang, Shin, Heekang, Mun, A. Young , Kim, Hong Kyu

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Regarding change on population and family structure in Korea after the 1980s, there has been a rapid change of low fertility, graying and increase of single household that cannot be found in any other parts of the world. With the result of total population residence by the National Statistical Office, Korea will hold 52,160,065 people in 2030 and reduction is predicted and from 2025 people above the age of 65 will take 20% of the total population, which means the entry of a super aging society. Also, average number in a family will be 2.71 in 2015 and decrease to 2.33 in 2035. On the other hand, proportion of single and two person household will be 53.7% in 2015 and it will increase up to 68.4% in 2035. Old population will increase greatly, single and two person household will take 2/3 of the total households. Delphi research was processed in 3 steps on 40 professionals about the importance and changing factors of residential environment of apartment followed by the change of population structure. For interior plan, space variety, variability, safety, convenient installation, eco-friendly installation, and IT installation were important factors for construction plan, plan on aged and single households, convenient installation, safety installation, eco-friendly installation for subdivision plan, education/child care facility, parks/gymnasium facility, community facility, and accessibility of transportation were predicted as important factors.

Keywords: change of population structure, super-graying, change of residential environment of apartment, single household, interior plan, construction plan, subdivision plan, Delphi research

Procedia PDF Downloads 439
399 A Study on Factors Affecting (Building Information Modelling) BIM Implementation in European Renovation Projects

Authors: Fatemeh Daneshvartarigh

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New technologies and applications have radically altered construction techniques in recent years. In order to anticipate how the building will act, perform, and appear, these technologies encompass a wide range of visualization, simulation, and analytic tools. These new technologies and applications have a considerable impact on completing construction projects in today's (architecture, engineering and construction)AEC industries. The rate of changes in BIM-related topics is different worldwide, and it depends on many factors, e.g., the national policies of each country. Therefore, there is a need for comprehensive research focused on a specific area with common characteristics. Therefore, one of the necessary measures to increase the use of this new approach is to examine the challenges and obstacles facing it. In this research, based on the Delphi method, at first, the background and related literature are reviewed. Then, using the knowledge obtained from the literature, a primary questionnaire is generated and filled by experts who are selected using snowball sampling. It covered the experts' attitudes towards implementing BIM in renovation projects and their view of the benefits and obstacles in this regard. By analyzing the primary questionnaire, the second group of experts is selected among the participants to be interviewed. The results are analyzed using Theme analysis. Six themes, including Management support, staff resistance, client willingness, Cost of software and implementation, the difficulty of implementation, and other reasons, are obtained. Then a final questionnaire is generated from the themes and filled by the same group of experts. The result is analyzed by the Fuzzy Delphi method, showing the exact ranking of the obtained themes. The final results show that management support, staff resistance, and client willingness are the most critical barrier to BIM usage in renovation projects.

Keywords: building information modeling, BIM, BIM implementation, BIM barriers, BIM in renovation

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398 Identification and Classification of Stakeholders in the Transition to 3D Cadastre

Authors: Qiaowen Lin

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The 3D cadastre is an inevitable choice to meet the needs of real cadastral management. Nowadays, more attention is given to the technical aspects of 3D cadastre, resulting in the imbalance within this field. To fulfill this research gap, the stakeholder, which has been regarded as the determining factor in cadastral change has been studied. Delphi method, Michael rating, and stakeholder mapping are used to identify and classify the stakeholders in 3D cadastre. It is concluded that the project managers should pay more attention to the interesting appeal of the key stakeholders and different coping strategies should be adopted to facilitate the transition to 3D cadastre.

Keywords: stakeholders, three dimension, cadastre, transtion

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397 A Proposed Inclusive Motor Skill Intervention Programme for Pre-schoolers in Low Resources Areas in Preparation of School Readiness

Authors: J. Van der Walt, N. A. Plastow, M. Unger

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Gross and fine motor skill difficulties among children affect their ability to learn and progress in school. Research indicates that children in low socio-economic areas are at a higher risk of motor skill difficulties, while therapy resources are limited. The Hopscotch motor skill programme is a well-researched accessible in-school intervention developed by occupational and physiotherapists through complex intervention development. The development stage of the complex intervention development model firstly included a prevalence study in a low-resourced area in the West Coast of South Africa, indicating a high prevalence with significant motor skill difficulties among pre-school children at 14.5% with fine motor skill difficulties at 24.6%. A scoping review identifies motor skill interventions for pre-school children and a proposed a framework of fundamental concepts to consider when developing a motor skill intervention. a Delphi-study considered the framework and encouraged collaboration between therapists and educators to make the programme accessible, resource and cost effective, specifically geared towards a rural, low resourced area. The results from the Delphi study, together with the proposed framework from the scoping review was used to develop the Hopscotch programme, adopting a task-shifting approach. The eight-week small-group programme is facilitated by teachers with the support of therapists. The programme aims to improve the motor skills of pre-school aged children with motor skill difficulties to promote academic readiness through obstacle courses, ball skill games and fine motor games and crafts. A randomised controlled trial is planned as a next stage to determine the preliminary effect of the programme on the motor and early academic skills of pre-school children.

Keywords: accesible learning, motor skill intervention, school readiness, task shifting

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396 A Perspective on Teaching Mathematical Concepts to Freshman Economics Students Using 3D-Visualisations

Authors: Muhammad Saqib Manzoor, Camille Dickson-Deane, Prashan Karunaratne

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Cobb-Douglas production (utility) function is a fundamental function widely used in economics teaching and research. The key reason is the function's characteristics to describe the actual production using inputs like labour and capital. The characteristics of the function like returns to scale, marginal, and diminishing marginal productivities are covered in the introductory units in both microeconomics and macroeconomics with a 2-dimensional static visualisation of the function. However, less insight is provided regarding three-dimensional surface, changes in the curvature properties due to returns to scale, the linkage of the short-run production function with its long-run counterpart and marginal productivities, the level curves, and the constraint optimisation. Since (freshman) learners have diverse prior knowledge and cognitive skills, the existing “one size fits all” approach is not very helpful. The aim of this study is to bridge this gap by introducing technological intervention with interactive animations of the three-dimensional surface and sequential unveiling of the characteristics mentioned above using Python software. A small classroom intervention has helped students enhance their analytical and visualisation skills towards active and authentic learning of this topic. However, to authenticate the strength of our approach, a quasi-Delphi study will be conducted to ask domain-specific experts, “What value to the learning process in economics is there using a 2-dimensional static visualisation compared to using a 3-dimensional dynamic visualisation?’ Here three perspectives of the intervention were reviewed by a panel comprising of novice students, experienced students, novice instructors, and experienced instructors in an effort to determine the learnings from each type of visualisations within a specific domain of knowledge. The value of this approach is key to suggesting different pedagogical methods which can enhance learning outcomes.

Keywords: cobb-douglas production function, quasi-Delphi method, effective teaching and learning, 3D-visualisations

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395 Contributions of Women to the Development of Hausa Literature as an Effective Means of Public Enlightenment: The Case of a 19th Century Female Scholar Maryam Bint Uthman Ibn Foduye

Authors: Balbasatu Ibrahim

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In the 19th century, Hausaland an Islamic revolution known as the Sokoto Jihad took place that led to the establishment of the Sokoto Caliphate in 1804 under the leadership of the famous Sheik Uthman Bn Fodiye. Before the Jihad movement in Hausaland (now Northern Nigeria), women were left in ignorance and were used and dumped like old kitchen utensils. The sheik and his followers did their best to actualising women’s right to education by using their female family members as role models who were highly educated and renowned scholars. After the Jihad with the establishment of an Islamic state, the women scholars initiated different strategies to teach the generality of the women. The most efficient strategy was the ‘Yantaru Movement founded by Nana Asma’u the daughter of Sheikh Uthman Bn Fodiye in collaboration with her sisters around 1840. The ‘Yantaru movement is a women’s educational movement aimed at enlightening women in rural and urban areas. The move helped in massively mobilizing women for education. In addition to town pupils, women from villages and throughout the nooks and crannies of metropolitan Sokoto participated in the movement in the search for knowledge. Thus, the birth of the ‘Yantaru system of women’s education. The ‘Yantaru operates the three-tier system at village, town and the metropolitan capital of Sokoto. ‘Yantaru functions include imparting knowledge to elderly women and young girls. Step down enlightenment program on returning home. The most effective medium of communication in the ‘Yantaru movement was through poetry where scholars composed educational poems which were memorized by the ‘Yantaru, who on return recite it to fellow women at home. Through this system, many women were educated. This paper translated and examines one of such educative poems written by the second leader of the ‘Yantaru Movement Maryam Bn Uthman Bn Fodiye in 1855.

Keywords: English, Hausa language, public enlightenment, Maryam Bint Uthman Ibn Foduye

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394 A Preliminary Report of HBV Full Genome Sequencing Derived from Iranian Intravenous Drug Users

Authors: Maryam Vaezjalali, Koroush Rahimian, Maryam Asli, Tahmineh Kandelouei, Foad Davoodbeglou, Amir H. Kashi

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Objectives: The present study was conducted to assess the HBV molecular profiles including genotypes, subgenotypes, subtypes & mutations in hepatitis B genes. Materials/Patients and Methods: This study was conducted on 229 intravenous drug users who referred to three Drop- in-Centers and a hospital in Tehran. HBV DNA was extracted from HBsAg positive serum samples and amplified by Nested PCR. HBV genotype, subgenotypes, subtype and genes mutation were determined by direct sequencing. Phylogenetic tree was constructed using neighbor- joining (NJ) method. Statistical analyses were carried out by SPSS 20. Results: HBV DNA was found in 3 HBsAg positive cases. Phylogenetic tree of derived HBV DNAs showed the existence of genotype D (subgenotype D1, subtype ayw2). Also immune escape mutations were determined in S gene. Conclusion: There were a few variations and genotypes and subtypes among infected intravenous drug users. This study showed the predominance of genotype D among intravenous drug users. Our study concurs with other reports from Iran, that all showing currently only genotype D is the only detectable genotype in Iran.

Keywords: drug users, genotype, HBV, phylogenetic tree

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393 The Development of Learning Outcomes and Learning Management Process of Basic Education along Thailand, Laos, and Cambodia Common Border for the ASEAN Community Preparation

Authors: Ladda Silanoi

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One of the main purposes in establishment of ASEAN Community is educational development. All countries in ASEAN shall then prepare for plans and strategies for country development. Therefore, Thailand set up the policy concerning educational management for all educational institutions to understand about ASEAN Community. However, some educational institutions lack of precision in determining the curriculums of ASEAN Community, especially schools in rural areas, for example, schools along the common border with Laos, and Cambodia. One of the effective methods to promote the precision in ASEAN Community is to design additional learning courses. The important process of additional learning courses design is to provide learning outcomes of ASEAN Community for course syllabus determination. Therefore, the researcher is interested in developing teachers in the schools of common border with Laos, and Cambodia to provide learning outcomes and learning process. This research has the objective of developing the learning outcomes and learning process management of basic education along Thailand, Laos, and Cambodia Common Border for the ASEAN Community Preparation. Research methodology consists of 2 steps. Step 1: Delphi Technique was used to provide guidelines in development of learning outcomes and learning process. Step 2: Action Research procedures was employed to study the result of additional learning courses design. Result of the study: By using Delphi technique, consensus is expected to be achieved, from 50 experts in the study within 3 times of the survey. The last survey found that experts’ opinions were compatible on every item (inter-quartile range = 0) leading to the arrangement of training courses in step of Action Research. The result from the workshop found that teachers in schools of Srisaket and Bueng Kan provinces could be able to provide learning outcomes of all courses.

Keywords: learning outcome and learning process, basic education, ASEAN Community preparation, Thailand Laos and Cambodia common border

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392 Exploring Socio-Economic Barriers of Green Entrepreneurship in Iran and Their Interactions Using Interpretive Structural Modeling

Authors: Younis Jabarzadeh, Rahim Sarvari, Negar Ahmadi Alghalandis

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Entrepreneurship at both individual and organizational level is one of the most driving forces in economic development and leads to growth and competition, job generation and social development. Especially in developing countries, the role of entrepreneurship in economic and social prosperity is more emphasized. But the effect of global economic development on the environment is undeniable, especially in negative ways, and there is a need to rethink current business models and the way entrepreneurs act to introduce new businesses to address and embed environmental issues in order to achieve sustainable development. In this paper, green or sustainable entrepreneurship is addressed in Iran to identify challenges and barriers entrepreneurs in the economic and social sectors face in developing green business solutions. Sustainable or green entrepreneurship has been gaining interest among scholars in recent years and addressing its challenges and barriers need much more attention to fill the gap in the literature and facilitate the way those entrepreneurs are pursuing. This research comprised of two main phases: qualitative and quantitative. At qualitative phase, after a thorough literature review, fuzzy Delphi method is utilized to verify those challenges and barriers by gathering a panel of experts and surveying them. In this phase, several other contextually related factors were added to the list of identified barriers and challenges mentioned in the literature. Then, at the quantitative phase, Interpretive Structural Modeling is applied to construct a network of interactions among those barriers identified at the previous phase. Again, a panel of subject matter experts comprised of academic and industry experts was surveyed. The results of this study can be used by policymakers in both the public and industry sector, to introduce more systematic solutions to eliminate those barriers and help entrepreneurs overcome challenges of sustainable entrepreneurship. It also contributes to the literature as the first research in this type which deals with the barriers of sustainable entrepreneurship and explores their interaction.

Keywords: green entrepreneurship, barriers, fuzzy Delphi method, interpretive structural modeling

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391 A Multi Criteria Approach for Prioritization of Low Volume Rural Roads for Maintenance and Improvement

Authors: L. V. S. S. Phaneendra Bolem, S. Shankar

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Low Volume Rural Roads (LVRRs) constitute an integral component of the road system in all countries. These encompass all aspects of the social and economic development of rural communities. It is known that on a worldwide basis the number of low traffic roads far exceeds the length of high volume roads. Across India, 90% of the roads are LVRRs, and they often form the most important link in terms of providing access to educational, medical, recreational and commercial activities in local and regional areas. In the recent past, Government of India (GoI), with the initiation of the ambitious programme namely 'Pradhan Mantri Gram Sadak Yojana' (PMGSY) gave greater importance to LVRRs realizing their role in economic development of rural communities. The vast expansion of the road network has brought connectivity to the rural areas of the country. Further, it is noticed that due to increasing axle loads and lack of timely maintenance, is accelerated the process of deterioration of LVRRs. In addition to this due to limited budget for maintenance of these roads systematic and scientific approach in utilizing the available resources has been necessitated. This would enable better prioritization and ranking for the maintenance and make ‘all-weather roads’. Taking this into account the present study has adopted a multi-criteria approach. The multi-criteria approach includes parameters such as social, economic, environmental and pavement condition as the main criterion and some sub-criteria to find the best suitable parameters and their weight. For this purpose the expert’s opinion survey was carried out using Delphi Technique (DT) considering Likert scale, pairwise comparison and ranking methods and entire data was analyzed. Finally, this study developed the maintenance criterion considering the socio-economic, environmental and pavement condition parameters for effective maintenance of low volume roads based on the engineering judgment.

Keywords: Delphi technique, experts opinion survey, low volume rural road maintenance, multi criteria analysis

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390 The Effect of Endurance Training and Taxol Consumption on Cyclooxygenase-2 and Prostaglandin E2 Levels in the Liver Tissue of Mice with Cervical Cancer

Authors: Alireza Barari, Maryam Firozi-Niyaki, Maryam Kamarlouei

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Background: Herbs have a strong anti-cancer effect. Also, exercise is one of several lifestyle factors known to lower the risk of developing cancer. The aim of this study was to investigate the effect of endurance training and taxol on cyclooxygenase-2 and prostaglandin E2 in the liver tissue of mice with cervical cancer. Materials and Methods: In this experimental study, 35 female C57 mice were randomly divided into 5 groups (n=7 in each group): control (healthy), control (cancer), complement (cancer), training-supplementary (cancer) and training (cancer). The implantation of cancerous tumors was performed under the skin of the upper pelvis. The training group completed the endurance training protocol, which included 3 sessions per week, 50 minutes per session, at a speed of 14-18 m/s for six weeks. A dose of 60 mg/kg/day of pure taxol was injected intra peritoneally. The dependent variables of this study were measured 24 hours after the last training session by ELISA. Results: The results showed that the use of taxol and endurance training reduced the levels of cyclooxygenase-2 and prostaglandin E2 in the liver tissues of C57 mice with cervical cancer. Conclusion: Induction of the cancerous tissue in mice with cervical cancer increases the levels of cyclooxygenase-2 and prostaglandin E2 and endurance training along with taxol may reduce these levels.

Keywords: cervical cancer, taxol, endurance training, cyclooxygenase-2, prostaglandin E2

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389 Top Skills That Build Cultures at Organizations

Authors: Priyanka Botny Srinath, Alessandro Suglia, Mel McKendrick

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Background: Organizational cultural studies integrate sociology and anthropology, portraying man as a creator of symbols, languages, beliefs, and ideologies -essentially, a creator and manager of meaning. In our research, we leverage analytical measures to discern whether an organization embodies a singular culture or a myriad of subcultures. Fast-forward to 2023, our research thesis focuses on digitally measuring culture, coining it as the "Work Culture Quotient." This entails conceptually mapping common experiential patterns to provide executives insights into the digital organization journey, aiding in understanding their current position and identifying future steps. Objectives: Finding the new age skills that help in defining the culture; understand the implications of post-COVID effects; derive a digital framework for measuring skillsets. Method: We conducted two comprehensive Delphi studies to distill essential insights. Delphi 1: Through a thematic analysis of interviews with 20 high-level leaders representing companies across diverse regions -India, Japan, the US, Canada, Morocco, and Uganda- we identified 20 key skills critical for cultivating a robust organizational culture. The skills are -influence, self-confidence, optimism, empathy, leadership, collaboration and cooperation, developing others, commitment, innovativeness, leveraging diversity, change management, team capabilities, self-control, digital communication, emotional awareness, team bonding, communication, problem solving, adaptability, and trustworthiness. Delphi 2: Subject matter experts were asked to complete a questionnaire derived from the thematic analysis in stage 1 to formalise themes and draw consensus amongst experts on the most important workplace skills. Results: The thematic analysis resulted in 20 workplace employee skills being identified. These skills were all included in the Delphi round 2 questionnaire. From the outputs, we analysed the data using R Studio for arriving at agreement and consensus, we also used sum of squares method to compare various agreements to extract various themes with a threshold of 80% agreements. This yielded three themes at over 80% agreement (leadership, collaboration and cooperation, communication) and three further themes at over 60% agreement (commitment, empathy, trustworthiness). From this, we selected five questionnaires to be included in the primary data collection phase, and these will be paired with the digital footprints to provide a workplace culture quotient. Implications: The findings from these studies bear profound implications for decision-makers, revolutionizing their comprehension of organizational culture. Tackling the challenge of mapping the digital organization journey involves innovative methodologies that probe not only external landscapes but also internal cultural dynamics. This holistic approach furnishes decision-makers with a nuanced understanding of their organizational culture and visualizes pivotal skills for employee growth. This clarity enables informed choices resonating with the organization's unique cultural fabric. Anticipated outcomes transcend mere individual cultural measurements, aligning with organizational goals to unveil a comprehensive view of culture, exposing artifacts and depth. Armed with this profound understanding, decision-makers gain tangible evidence for informed decision-making, strategically leveraging cultural strengths to cultivate an environment conducive to growth, innovation, and enduring success, ultimately leading to measurable outcomes.

Keywords: leadership, cooperation, collaboration, teamwork, work culture

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388 Advancing Healthcare Excellence in China: Crafting a Strategic Operational Evaluation Index System for Chinese Hospital Departments amid Payment Reform Initiatives

Authors: Jing Jiang, Yuguang Gao, Yang Yu

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Facing increasingly challenging insurance payment pressures, the Chinese healthcare system is undergoing significant transformations, akin to the implementation of DRG payment models by the United States' Medicare. Consequently, there is a pressing need for Chinese hospitals to establish optimizations in departmental operations tailored to the ongoing healthcare payment reforms. This abstract delineates the meticulous construction of a scientifically rigorous and comprehensive index system at the departmental level in China strategically aligned with the evolving landscape of healthcare payment reforms. Methodologically, it integrates key process areas and maturity assessment theories, synthesizing relevant literature and industry standards to construct a robust framework and indicator pool. Employing the Delphi method, consultations with 21 experts were conducted, revealing a collective demonstration of high enthusiasm, authority, and coordination in designing the index system. The resulting model comprises four primary indicators -technical capabilities, cost-effectiveness, operational efficiency, and disciplinary potential- supported by 14 secondary indicators and 23 tertiary indicators with varied coefficient adjustment for department types (platform or surgical). The application of this evaluation system in a Chinese hospital within the northeastern region yielded results aligning seamlessly with the actual operational scenario. In conclusion, the index system comprehensively considers the integrity and effectiveness of structural, process, and outcome indicators and stands as a comprehensive reflection of the collective expertise of the engaged experts, manifesting in a model designed to elevate the operational management of hospital departments. Its strategic alignment with healthcare payment reforms holds practical significance in guiding departmental development positioning, brand cultivation, and talent development.

Keywords: Chinese healthcare system, Delphi method, departmental management, evaluation indicators, hospital operations, weight coefficients

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387 Women Retelling the Iranian Revolution: A Comparative Study of Novelists Maryam Madjidi and Negar Djavadi

Authors: Alessandro Giardino

Abstract:

The Iranian Revolution has been the object of numberless historical and semi-fictional accounts, often providing a monolithic perspective on the events, due to the westerner positioning of those recounting them. Against this tradition, two contemporary French-Iranian novels "Disoriental" (2016) by Negar Djavadi and "Marx and The Doll" (2017) by Maryam Madjidi have offered readers a female-oriented and interestingly layered representation of the Iranian Revolution, hence addressing the responsibilities and misconceptions of Western countries. Furthermore, these two women writers have shed light on the disenchantment of the Iranian intellectual class vis-à-vis the foundation of the Islamic Republic, by particularly focusing on the deterioration of women’s rights, as well as the repression of political, ethnical, religious and sexual minorities. By a psycholinguistic and semasiological analysis of the two novels by Djavadi and Madjidi, this essay will focus on alternative accounts of the revolution in order to reflect upon the role of intersectional literature to the understanding of history. More specifically, as both women, refugees, and bi-cultural writers, Djavadi and Madjidi unearthed moments and figures of the revolution which had disappeared from the prevalent narrative. In doing so, however, these two writers resorted to entirely opposite styles of writing that, it will be argued, stem from different types of female resistance. In defining these two approaches as a "narrative resistance" and a "photographic resistance," the essay will elucidate the dependence of these writers’ language on generational and psychological factors, but it will also stir a reflection on their different communicative strategies.

Keywords: Iranian revolution, French-Iranian, intersectionality, literature, women writers

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386 Synthesis and Cytotoxic Activity of New Quinazolinone-Based Compounds against Human Breast Cancer Cell Line MCF-7

Authors: Maryam Zahedifard, Fadhil Lafta Faraj, Maryam Hajrezaie, Nazia Abdul Majid, Mahmood Ameen Abdulla, Hapipah Mohd Ali

Abstract:

In the current study, we prepared two new quinazoline schiff bases through condensation reaction of 2-aminobenzhydrazide with 5-bromosalicylaldehyde and 3-methoxy-5-bromosalicylaldehyde. The chemical structures of both newly synthesized compounds (1 and 2) were confirmed by FT-IR and X-ray crystallography studies. The cytotoxic effect of compounds was investigated against MCF-7 human breast cancer cells. MTT results showed that (1) and (2) decreased the viability of MCF-7 cells in a time-dependent manner, exhibiting an IC50 value of 3.23 ± 0.28 µg/mL and 3.41 ± 0.34 µg/mL, respectively, after a 72-hours treatment period. In contrast, they did not show significant anti-proliferative effect towards MCF-10A normal breast cells and WRL-68 normal liver cells. We found a perturbation in mitochondrial membrane potential and increased cytochrome c release from the mitochondria to the cytosol, suggesting an activation of apoptosis by compounds, which was confirmed by activation of the initiator caspase-9 and the executioner caspases-3/7. (1) was also able to trigger extrinsic pathway via activation of caspase-8 and inhibition of NF-κB translocation. The acute toxicity test showed no toxicity effect of the compounds in rats. Our results showed that the selected synthesized compounds are highly potent to induce apoptosis in MCF-7 cells via either intrinsic or extrinsic mitochondrial pathway.

Keywords: Quinazoline Schiff base, apoptosis, MCF-7 human breast cancer cell line, caspase, NF-κB translocation

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385 Development of Generally Applicable Intravenous to Oral Antibiotic Switch Therapy Criteria

Authors: H. Akhloufi, M. Hulscher, J. M. Prins, I. H. Van Der Sijs, D. Melles, A. Verbon

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Background: A timely switch from intravenous to oral antibiotic therapy has many advantages, such as reduced incidence of IV-line related infections, a decreased hospital length of stay and less workload for healthcare professionals with equivalent patient safety. Additionally, numerous studies have demonstrated significant decreases in costs of a timely intravenous to oral antibiotic therapy switch, while maintaining efficacy and safety. However, a considerable variation in iv to oral antibiotic switch therapy criteria has been described in literature. Here, we report the development of a set of iv to oral switch criteria that are generally applicable in all hospitals. Material/methods: A RAND-modified Delphi procedure, which was composed of 3 rounds, was used. This Delphi procedure is a widely used structured process to develop consensus using multiple rounds of questionnaires within a qualified panel of selected experts. The international expert panel was multidisciplinary and composed out of clinical microbiologists, infectious disease consultants and clinical pharmacists. This panel of 19 experts appraised 6 major intravenous to oral antibiotic switch therapy criteria and operationalized these criteria using 41 measurable conditions extracted from the literature. The procedure to select a concise set of iv to oral switch criteria included 2 questionnaire rounds and a face-to-face meeting. Results: The procedure resulted in the selection of 16 measurable conditions, which operationalize 6 major intravenous to oral antibiotic switch therapy criteria. The following 6 major switch therapy criteria were selected: (1) Vital signs should be good or improving when bad. (2) Signs and symptoms related to the infection have to be resolved or improved. (3) The gastrointestinal tract has to be intact and functioning. (4) The oral route should not be compromised. (5) Absence of contra-indicated infections. (6) An oral variant of the antibiotic with good bioavailability has to exist. Conclusions: This systematic stepwise method which combined evidence and expert opinion resulted in a feasible set of 6 major intravenous to oral antibiotic switch therapy criteria operationalized by 16 measurable conditions. This set of early antibiotic iv to oral switch criteria can be used in daily practice in all adult hospital patients. Future use in audits and as rules in computer assisted decision support systems will lead to improvement of antimicrobial steward ship programs.

Keywords: antibiotic resistance, antibiotic stewardship, intravenous to oral, switch therapy

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384 Chemopreventive Efficacy Of Cdcl2(C14H21N3O2) in Rat Colon Carcinogenesis Model Using Aberrant Crypt Foci (ACF) as Endpoint Marker

Authors: Maryam Hajrezaie, Mahmood Ameen Abdulla, Nazia AbdulMajid, Maryam Zahedifard

Abstract:

Colon cancer is one of the most prevalent cancers in the world. Cancer chemoprevention is defined as the use of natural or synthetic compounds capable of inducing biological mechanisms necessary to preserve genomic fidelity. New schiff based compounds are reported to exhibit a wide spectrum of biological activities of therapeutic importance. To evaluate inhibitory properties of CdCl2(C14H21N3O2) complex on colonic aberrant crypt foci, five groups of 7-week-old male rats were used. Control group was fed with 10% Tween 20 once a day, cancer control group was intra-peritoneally injected with 15 mg/kg Azoxymethan, drug control group was injected with 15 mg/kg azoxymethan and 5-Flourouracil, experimental groups were fed with 2.5 and 5 mg/kg CdCl2(C14H21N3O2) compound each once a day. Administration of compound were found to be effectively chemoprotective. Andrographolide suppressed total colonic ACF formation up to 72% to 74%, respectively, when compared with control group. The results also showed a significant increase in glutathione peroxidase, superoxide dismutase, catalase activities and a decrease in malondialdehyde level. Immunohistochemical staining demonstrated down-regulation of PCNA protein. According to the Western blot comparison analysis, COX-2 and Bcl2 is up-regulated whilst the Bax is down-regulated. according to these data, this compound plays promising chemoprotective activity, in a model of AOM-induced in ACF.

Keywords: chemopreventive, Schiff based compound, aberrant crypt foci (ACF), immunohistochemical staining

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383 Geographical Location and the Global Airline Industry: A Delphi Study into the Future of Home Base Requirements

Authors: Darren J. Ellis

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This paper investigates the key industry-level consequences and future prospects for the global airline industry of the requirement for airlines to have a home base. This industry context results in geographical location playing a central role in determining how and where international airlines can operate, and the extent to which their international networks can develop. Data from a five stage mixed-methods Delphi study into the global airline industry’s likely future trajectory conducted in 2013 and 2014 are utilized to better understand the likelihood and consequences of home base requirements changing in future. Expert views and forecasts were collected to gauge core industry trends over a ten year timeframe. Attempts to change or bypass this industry requirement have not been successful to date outside of the European single air market. Europe remains the only prominent exception to the general rule in this regard. Most of the industry is founded on air space sovereignty, the nationality rule, and the bilateral system of traffic rights. Europe’s exceptionalism has seen it evolve into a single air market with characteristics similar to a nation-state, rather than to become a force for wider industry change and regional multilateralism. Europe has indeed become a key actor in global aviation, but Europe seems to now be part of the industry’s status quo, not a vehicle for substantially wider multilateralism around the world. The findings from this research indicate that the bilateral system is not viewed by most study experts as disappearing or substantially weakening in the foreseeable future. However, regional multilateralism was also viewed as progressively taking hold in the industry in future, demonstrating that for most industry experts the two are not seen as mutually exclusive but rather as being able to co-exist with each other. This reality ensures that geographical location will continue to play an important role in the global airline industry in future and that, home base requirements will not disappear any time soon either. Even moves in some aviation jurisdictions to dilute nationality requirements for airlines, and instead replace ownership and control restrictions with principal place of business tests, do not ultimately free airlines from their home base. Likewise, an expansion of what constitutes home base to include a regional grouping of countries – again, a currently uncommon reality in global aviation – does not fundamentally weaken the continued relevance of geographical location to the global industry’s future growth and development realities and prospects.

Keywords: airline industry, air space sovereignty, geographical location, home base

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382 Toward Particular Series with (k,h)-Jacobsthal Sequence

Authors: Seyyd Hossein Jafari-Petroudi, Maryam Pirouz

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This note is devoted to (k; h)-Jacobsthal sequence as a general term of particular series. More formulas for nth term and sum of the first n terms of series that their general terms are (k; h)-Jacobsthal sequence and (k; h)-Jacobsthal-Petroudi sequence are derived. Finally other properties of these sequences are represented.

Keywords: (k, h)-Jacobsthal sequence, (k, h)-Jacobsthal Petroudisequence, recursive relation, sum

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381 Multiple Strategies in Prevention of Metabolic Syndrome Result from Vitamin D Deficiency in Children

Authors: Maryam Ghavam Sadri, Maryam Shahrooz

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Background: Nowadays the prevalence of metabolic syndrome (Mets) has taken on a growing trend. Studies have shown the relationship between vitamin D deficiency (VDD) status and Mets in children. Also studies have recorded that exerting strategies for vitamin D status improvement can help prevent Mets in children. This study investigated multiple strategies of prevention of Mets resulting from VDD in children. Methods: This review study has been done by using keywords related to the topic and 54 articles were found (2000-2015) that 25 were selected according to the indicators of Mets, supplementation and fortification of foods with vitamin D and attention to children environment and life style. Results: Studies have suggested the correlation between serum levels of vitamin D with waist circumference (p < 0.0001), systolic blood pressure (p=0.01), HOMA-IR (p=0.001) and HDL cholesterol (p < 0.0001). An inverse correlation between serum 25 (OH) D and HOMA-IR (p = 0.006) and insulin (P = 0.002) has been proved in overweight group. Higher HOMASDS and triglycerides found in vitamin D deficient obese children compared to control group without VDD (p=0.04). After supplementation with vitamin D, serum TG concentration decreases significantly (p=0.04), and improves insulin resistance (p=0.02). The prevalence of VDD is associated with time of watching TV (P < 0.01), hours of physical activity per week (P = 0.01), skipping breakfast (P < 0.001) soda intake (P < 0.001), and milk intake per day (P < 0.01). Conclusion: According to the beneficial role of vitamin D in prevention of Mets and proven relationship between serum levels of vitamin D and Mets indicators, we can prevent childhood Mets through the application of appropriate strategies such as supplementation and food fortification with vitamin D and positive changes in children life style with especial attention to physical activity in exposure of sunlight and their environment condition.

Keywords: children, metabolic syndrome, prevention strategies, vitamin D

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380 Development of a Core Set of Clinical Indicators to Measure Quality of Care for Thyroid Cancer: A Modified-Delphi Approach

Authors: Liane J. Ioannou, Jonathan Serpell, Cino Bendinelli, David Walters, Jenny Gough, Dean Lisewski, Win Meyer-Rochow, Julie Miller, Duncan Topliss, Bill Fleming, Stephen Farrell, Andrew Kiu, James Kollias, Mark Sywak, Adam Aniss, Linda Fenton, Danielle Ghusn, Simon Harper, Aleksandra Popadich, Kate Stringer, David Watters, Susannah Ahern

Abstract:

BACKGROUND: There are significant variations in the management, treatment and outcomes of thyroid cancer, particularly in the role of: diagnostic investigation and pre-treatment scanning; optimal extent of surgery (total or hemi-thyroidectomy); use of active surveillance for small low-risk cancers; central lymph node dissections (therapeutic or prophylactic); outcomes following surgery (e.g. recurrent laryngeal nerve palsy, hypocalcaemia, hypoparathyroidism); post-surgical hormone, calcium and vitamin D therapy; and provision and dosage of radioactive iodine treatment. A proven strategy to reduce variations in the outcome and to improve survival is to measure and compare it using high-quality clinical registry data. Clinical registries provide the most effective means of collecting high-quality data and are a tool for quality improvement. Where they have been introduced at a state or national level, registries have become one of the most clinically valued tools for quality improvement. To benchmark clinical care, clinical quality registries require systematic measurement at predefined intervals and the capacity to report back information to participating clinical units. OBJECTIVE: The aim of this study was to develop a core set clinical indicators that enable measurement and reporting of quality of care for patients with thyroid cancer. We hypothesise that measuring clinical quality indicators, developed to identify differences in quality of care across sites, will reduce variation and improve patient outcomes and survival, thereby lessening costs and healthcare burden to the Australian community. METHOD: Preparatory work and scoping was conducted to identify existing high quality, clinical guidelines and best practice for thyroid cancer both nationally and internationally, as well as relevant literature. A bi-national panel was invited to participate in a modified Delphi process. Panelists were asked to rate each proposed indicator on a Likert scale of 1–9 in a three-round iterative process. RESULTS: A total of 236 potential quality indicators were identified. One hundred and ninety-two indicators were removed to reflect the data capture by the Australian and New Zealand Thyroid Cancer Registry (ANZTCR) (from diagnosis to 90-days post-surgery). The remaining 44 indicators were presented to the panelists for voting. A further 21 indicators were later added by the panelists bringing the total potential quality indicators to 65. Of these, 21 were considered the most important and feasible indicators to measure quality of care in thyroid cancer, of which 12 were recommended for inclusion in the final set. The consensus indicator set spans the spectrum of care, including: preoperative; surgery; surgical complications; staging and post-surgical treatment planning; and post-surgical treatment. CONCLUSIONS: This study provides a core set of quality indicators to measure quality of care in thyroid cancer. This indicator set can be applied as a tool for internal quality improvement, comparative quality reporting, public reporting and research. Inclusion of these quality indicators into monitoring databases such as clinical quality registries will enable opportunities for benchmarking and feedback on best practice care to clinicians involved in the management of thyroid cancer.

Keywords: clinical registry, Delphi survey, quality indicators, quality of care

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