Progress in the Study of Laboratory Indicators Related to Acute Pancreatitis

Acute pancreatitis (AP) is one of the more common gastrointestinal diseases in clinics and is characterized by rapid progression, many complications, and high mortality. When it develops into severe pancreatitis, its prognosis is poor. Therefore, early assessment of the degree of inflammatory response plays a crucial role in the treatment plan and prognosis of patients. More and more studies have shown that the levels of D-dimer (D-D), angiotensin-2 (Ang-2), phosphate, heparin-binding protein (HBP), retinol-binding protein-4 (RBP4), and osteoblastic protein (OPN) are closely related to the severity of acute pan-creatitis and can be used as effective indicators for early assessment of AP. In this paper, the research progress of the above indicators in assessing the severity of AP is summarized.

Citation distributions and research evaluations:The impossibility of formulating a universal indicator

Purpose:To analyze the diversity of citation distributions to publications in different research topics to investigate the accuracy of size-independent,rank-based indicators.The top percentile-based indicators are the most common indicators of this type,and the evaluations of Japan are the most evident misjudgments.Design/methodology/approach:The distributions of citations to publications from countries and journals in several research topics were analyzed along with the corresponding global publications using histograms with logarithmic binning,double rank plots,and normal probability plots of log-transformed numbers of citations.Findings:Size-independent,top percentile-based indicators are accurate when the global ranks of local publications fit a power law,but deviations in the least cited papers are frequent in countries and occur in all journals with high impact factors.In these cases,a single indicator is misleading.Comparisons of the proportions of uncited papers are the best way to predict these deviations.Research limitations:This study is fundamentally analytical,and its results describe mathematical facts that are self-evident.Practical implications:Respectable institutions,such as the OECD,the European Commission,and the U.S.National Science Board,produce research country rankings and individual evaluations using size-independent percentile indicators that are misleading in many countries.These misleading evaluations should be discontinued because they can cause confusion among research policymakers and lead to incorrect research policies.Originality/value:Studies linking the lower tail of citation distribution,including uncited papers,to percentile research indicators have not been performed previously.The present results demonstrate that studies of this type are necessary to find reliable procedures for research assessments.

Estimating wheat spike-leaf composite indicator(SLI)dynamics by coupling spectral indices and machine learning

The contribution of spike photosynthesis to grain yield(GY)has been overlooked in the accurate spectral prediction of yield.Thus,it’s essential to construct and estimate a yield-related phenotypic trait considering spike photosynthesis.Based on field and spectral reflectance data from 19 wheat cultivars under two nitrogen fertilization conditions in two years,our objectives were to(i)construct a yield-related phenotypic trait(spike–leaf composite indicator,SLI)accounting for the contribution of the spike to photosynthesis,(ii)develop a novel spectral index(enhanced triangle vegetation index,ETVI3)sensitive to SLI,and(iii)establish and evaluate SLI estimation models by integrating spectral indices and machine learning algorithms.The results showed that SLI was sensitive to nitrogen fertilizer and wheat cultivar variation as well as a better predictor of yield than the leaf area index.ETVI3 maintained a strong correlation with SLI throughout the growth stage,whereas the correlations of other spectral indices with SLI were poor after spike emergence.Integrating spectral indices and machine learning algorithms improved the estimation accuracy of SLI,with the most accurate estimates of SLI showing coefficient of determination,root mean square error(RMSE),and relative RMSE values of 0.71,0.047,and 26.93%,respectively.These results provide new insights into the role of fruiting organs for the accurate spectral prediction of GY.This high-throughput SLI estimation approach can be applied for wheat yield prediction at whole growth stages and may be assisted with agronomical practices and variety selection.

Risk Prediction Model for Hypertensive Disorders of Pregnancy Based on Routine Laboratory Indicators and Risk Factors: A Retrospective Analysis

Background: Hypertensive disorder of pregnancy (HDP) is a group of diseases in which pregnancy and elevated blood pressure coexist. There is still a lack of reliable clinical tools to predict the incidence of HDP. The purpose of this study was to establish and validate a nomogram prediction model for assessing the risk of HDP in pregnant women based on laboratory indicators and HDP risk factors. Method: A total of 307 pregnant women who were hospitalized in the obstetrics and gynecology department of our hospital were included in this study, and were randomly divided into a training cohort and validation cohort at a ratio of 7:3. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for the development of HDP on laboratory indicators as well as risk factors for HDP in the training cohort of patients. The results of the multivariate regression model were visualized by forest plots. A nomogram was constructed based on the results of multivariate logistic regression to predict the risk of HDP in pregnant women. The validity of the risk prediction model was evaluated by the area under the receiver operating characteristic curve (AUC), the consistency index (C-index), the calibration curve and the decision curve analysis (DCA). Results: BMI ≥ 25 Kg/m2, total cholesterol in early pregnancy, uric acid and proteinuria in late pregnancy were independent risk factors for HDP. The AUC and C-index of the nomogram constructed by the above four factors were both 0.848. The calibration curve is closely fitted with the ideal diagonal, showing a good consistency between the nomogram prediction and the actual observation of HDP. The DCA has demonstrated the great clinical utility of nomogram. Internal verification proves the reliability of the predicted nomograms. Conclusion: The BTUP nomogram model based on laboratory indicators and risk factors proposed in this study showed good predictive value for the risk assessment of HDP. It is expected to provide evidence for clinical prediction of the risk of HDP in pregnant women.

Evidence-Based Nursing Practice of Reducing Immune-Related Skin Toxicity of Tumor Patients Guided by Sensitive Indicators

Purpose research on nursing sensitive indicators in tumor Patients application effect in immune-related skin toxicity management. Method select our hospital April to June, 202360 cases patients with immune therapy settings as the control group. August-October, 2023 60 cases the patients treated with immune therapy were the experimental group. The control group adopted regular nursing methods, while the experimental group sensitive Indicators, evidence-based give preventive care. The social situation, psychological state, physical function, quality of life score, incidence of skin toxicity caused by immune checkpoint inhibitors, moderate and above of the two groups of patients were compared. Incidence of skin toxicity. Result: experience group SAS score, SDS score higher than the control group, the difference was statistically significant (P < 0.05);The incidence of skin toxic reactions caused by immune checkpoint inhibitors and the incidence of moderate and above skin toxic reactions in the experimental group are lower than those in the control group, and the difference is statistically significant (P < 0.05). Conclusion: sensitive indicator guidance evidence-based preventive care can reduce the degree of immune-related skin toxicity, improve the psychological state and quality of life of tumor patients treated with immune therapy and reduce the incidence of adverse reactions, improve nursing quality and patient satisfaction.

Investigating the causal associations between five anthropometric indicators and nonalcoholic fatty liver disease:Mendelian randomization study

BACKGROUND Although the etiology of nonalcoholic fatty liver disease(NAFLD)has not been thoroughly understood,the emerging roles of anthropometric indicators in assessing and predicting the risk of NAFLD have been highlighted by accumulating evidence.AIM To evaluate the causal relationships between five anthropometric indicators and NAFLD employing Mendelian randomization(MR)design.METHODS The Anthropometric Consortium provided genetic exposure data for five anthropometric indicators,including hip circumference(HC),waist circumference(WC),waist-to-hip ratio(WHR),body mass index(BMI),and body fat percentage(BF).Genetic outcome data for NAFLD were obtained from the United Kingdom Biobank and FinnGen Consortium.Genome-wide significant single nucleotide polymorphisms were chosen as instrumental variables.Univariable MR(UVMR)and multivariable MR(MVMR)designs with analytical approaches,including inverse variance weighted(IVW),MR-Egger,weighted median(WM),and weighted mode methods,were used to assess the causal relationships between anthropometric indicators and NAFLD.RESULTS Causal relationships were revealed by UVMR,indicating that a higher risk of NAFLD was associated with a perunit increase in WC[IVW:odds ratio(OR)=2.67,95%CI:1.42-5.02,P=2.25×10^(−3)],and BF was causally associated with an increased risk of NAFLD(WM:OR=2.23,95%CI:1.07-4.66,P=0.033).The presence of causal effects of WC on the decreased risk of NAFLD was supported by MVMR after adjusting for BMI and smoking.However,no causal association between BF and NAFLD was observed.In addition,other causal relationships of HC,WHR(BMI adjusted),and BMI with the risk of NAFLD were not retained after FDR correction.CONCLUSION This study establishes a causal relationship,indicating that an increase in WC is associated with a higher risk of NAFLD.This demonstrates that a suitable decrease in WC is advantageous for preventing NAFLD.

Study on Temperature Disaster Indicators of Passion Fruit in Southwest Fujian, China

In China, meteorological forecasting relies on meteorological data obtained from regional and national stations. However, there were discrepancies between the data collected from the meteorological station at the passion fruit growing base and the data from regional and national stations. Consequently, the high and low temperature disaster indicators determined by the meteorological station at the passion fruit growing base cannot be applied to meteorological forecasting. To address this issue and facilitate the monitoring and early warning of high and low temperature disasters in passion fruit cultivation in Fujian, China, we used multi-source hourly temperature data (including the data from meteorological observation stations in passion fruit growing bases, the nearest regional stations, and national surface conventional meteorological observation stations) in three cities in southwestern Fujian (Longyan, Sanming, and Zhangzhou) spanning the years 2020 to 2022. By employing comprehensive statistical analysis methods (0.5 interval division and Cumulative frequency), we identified that passion fruit in southwestern Fujian was susceptible to high temperature disasters during the blooming-fruiting period, as well as low temperature disasters during the sprouting period. Consequently, we developed high and low temperature disaster indicators based on data from regional and national stations for different phenological periods of passion fruit in this region.

Influence of reduced-port laparoscopic surgery on perioperative indicators, postoperative recovery, and serum inflammation in patients with colorectal carcinoma

BACKGROUND Conventional five-port laparoscopic surgery,the current standard treatment for colorectal carcinoma(CRC),has many disadvantages.AIM To assess the influence of reduced-port laparoscopic surgery(RPLS)on perioperative indicators,postoperative recovery,and serum inflammation indexes in patients with CRC.METHODS The study included 115 patients with CRC admitted between December 2019 and May 2023,52 of whom underwent conventional five-port laparoscopic surgery(control group)and 63 of whom underwent RPLS(research group).Comparative analyses were performed on the following dimensions:Perioperative indicators[operation time(OT),incision length,intraoperative blood loss(IBL),and rate of conversion to laparotomy],postoperative recovery(first postoperative exhaust,bowel movement and oral food intake,and bowel sound recovery time),serum inflammation indexes[high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)],postoperative complications(anastomotic leakage,incisional infection,bleeding,ileus),and therapeutic efficacy.RESULTS The two groups had comparable OTs and IBL volumes.However,the research group had a smaller incision length;lower rates of conversion to laparotomy and postoperative total complication;and shorter time of first postoperative exhaust,bowel movement,oral food intake,and bowel sound recovery;all of which were significant.Furthermore,hs-CRP,IL-6,and TNF-αlevels in the research group were significantly lower than the baseline and those of the control group,and the total effective rate was higher.CONCLUSION RPLS exhibited significant therapeutic efficacy in CRC,resulting in a shorter incision length and a lower conversion rate to laparotomy,while also promoting postoperative recovery,effectively inhibiting the inflammatory response,and reducing the risk of postoperative complications.

Quality indicators in respiratory therapy

Quality indicators in healthcare refer to measurable and quantifiable parameters used to assess and monitor the performance,effectiveness,and safety of healthcare services.These indicators provide a systematic way to evaluate the quality of care offered,and thereby to identify areas for improvement and to ensure that patient care meets established standards and best practices.Respiratory therapists play a vital role in areas of clinical administration such as infection control practices and quality improvement initiatives.Quality indicators serve as essential metrics for respiratory therapy departments to assess and enhance the overall quality of care.By systematically tracking and analyzing indicators related to infection control,treatment effectiveness,and adherence to protocols,respiratory care practitioners can identify areas to improve and implement evidence-based changes.This article reviewed how to identify,implement,and monitor quality indicators specific to the respiratory therapy departments to set benchmarks and enhance patient outcomes.

Optimization Management of Industrial Organizations Based on Performance Indicators

This paper proposes an intelligent management system (IMS) to help managers in their delicate and tedious task of exploiting the plethora of data (indicators) contained in management dashboards. This system is based on intelligent agents, ontologies and data mining. It is implemented by PASSI (Process for Agent Societies Specification and Implementation) methods for agent design and implementation, the Methodology for Knowledge Modeling and Hot-Winters for data prediction. Intelligent agents not only track indicators but also store the knowledge of managers within the company. Ontologies are used to manage the representation and presentation aspects of knowledge. Data mining makes it possible to: make the most of all available data;model the industrial process of data selection, exploration and modeling;and transform behaviors into predictive indicators. An instance of the IMS named SYGISS, currently in operation within a large brewery organization, allows us to observe very interesting results: the extraction of indicators is done in less than 5 minutes whereas manual extraction used to take 14 days;the generation of dashboards is instantaneous whereas it used to take 12 hours;the interpretation of indicators is instantaneous whereas it used to take a day;forecasts are possible and are done in less than 5 minutes whereas they did not exist with the old management. These important contributions help to optimize the management of this organization.

Development and Application of Integrated Indicators for Assessing Healthcare Waste Management Systems in Kenyan Hospitals

Healthcare waste management (HCWM) is an important aspect of healthcare delivery globally because of its hazardous and infectious components that have potential for adverse health and environmental impacts. The paper introduces a set of indicators for assessing HCWM systems in hospitals. These indicators are: HCWM policies and standard operating procedures, management and oversight, logistics and budget support, training and occupational health and safety, and treatment, disposal and waste treatment equipment housing. By plotting a mark on a continuum which is defined as good and poor on the extremes and is connected with all other marks in a spoke arrangement, it’s possible to describe a baseline for HCWM in any specific hospital. This baseline can be used to improve awareness of the actors and policy-makers, compare the same hospital at a different point in time, to compare observations by different evaluators and to track improvements. Results suggest that in Kenya, the application of such indicators is useful for evaluating which priorities should be addressed to improve outcomes in HCWM systems. Systematic sampling technique was used to identify and collect data by use of observational checklist, interviews, visual verification and review of documents and a HCWM assessment tool. The objective is to suggest an integrated management tool as a method to identify prevailing problems with a HCWM system. The method can be replicated in other contexts worldwide, with a focus on the developing world. The integrated indicators focus on management of HCW and not its potential impact on human health and environment, an area recognized to be critical for future research.

Comparative Study of Evaluation Indicators for Learning Cities and the Implications

With the development of society,more and more cities are participating in the initiative to build learning cities.Constructing an evaluation indicator system for learning cities to monitor the progress and promote their growth has become increasingly important.This paper analyzes the preliminary framework of the UNESCO Global Learning City Index and R3L+Quality Framework.The comparison is made from the aspects of design philosophy,criteria of indicator,and the cycle of evaluation process.The findings suggest that the construction of an evaluation indicator system should be focused more on the diversity of learning city development,the construction of an evaluation process cycle,and the significance of building cooperative networks.

Contribution of the MERISE-Type Conceptual Data Model to the Construction of Monitoring and Evaluation Indicators of the Effectiveness of Training in Relation to the Needs of the Labor Market in the Republic of Congo

This study proposes the use of the MERISE conceptual data model to create indicators for monitoring and evaluating the effectiveness of vocational training in the Republic of Congo. The importance of MERISE for structuring and analyzing data is underlined, as it enables the measurement of the adequacy between training and the needs of the labor market. The innovation of the study lies in the adaptation of the MERISE model to the local context, the development of innovative indicators, and the integration of a participatory approach including all relevant stakeholders. Contextual adaptation and local innovation: The study suggests adapting MERISE to the specific context of the Republic of Congo, considering the local particularities of the labor market. Development of innovative indicators and new measurement tools: It proposes creating indicators to assess skills matching and employer satisfaction, which are crucial for evaluating the effectiveness of vocational training. Participatory approach and inclusion of stakeholders: The study emphasizes actively involving training centers, employers, and recruitment agencies in the evaluation process. This participatory approach ensures that the perspectives of all stakeholders are considered, leading to more relevant and practical outcomes. Using the MERISE model allows for: • Rigorous data structuring, organization, and standardization: Clearly defining entities and relationships facilitates data organization and standardization, crucial for effective data analysis. • Facilitation of monitoring, analysis, and relevant indicators: Developing both quantitative and qualitative indicators helps measure the effectiveness of training in relation to the labor market, allowing for a comprehensive evaluation. • Improved communication and common language: By providing a common language for different stakeholders, MERISE enhances communication and collaboration, ensuring that all parties have a shared understanding. The study’s approach and contribution to existing research lie in: • Structured theoretical and practical framework and holistic approach: The study offers a structured framework for data collection and analysis, covering both quantitative and qualitative aspects, thus providing a comprehensive view of the training system. • Reproducible methodology and international comparison: The proposed methodology can be replicated in other contexts, facilitating international comparison and the adoption of best practices. • Extension of knowledge and new perspective: By integrating a participatory approach and developing indicators adapted to local needs, the study extends existing research and offers new perspectives on vocational training evaluation.

Extraction and imaging of indicator elements for non-destructive,in-situ,fast identification of adverse geology in tunnels

The lag in quantitative methods and detection techniques for geologic information has resulted in time-consuming and human-experienced geologic analysis in tunnels.Geochemical indicators of rocks can be used to identify adverse geology and to explain the intrinsic causes of damage to normal rocks.This study proposes a method to identify adverse geology by extracting and imaging the indicator elements.The mapping relationship between rock components and geologic bodies is quickly determined by indicator element extraction based on factor analysis,and then the data are gridded for image output.The location and size of the target adverse geology are visually identified through the distribution images of the indicator elements,thus reducing data dimensions and analysis time.A non-destructive,in-situ and fast element detection technique in tunnels was adopted to speed up the process of geology identification.The accuracy of the detection was validated by comparing field and laboratory test results.This study further confirms and refines the previous research,and the results provide references for geological,mining and underground projects.

Mitochondrial targeting sequence of magnetoreceptor MagR:More than just targeting

Iron-sulfur clusters(ISC)are essential cofactors for proteins involved in various biological processes,such as electron transport,biosynthetic reactions,DNA repair,and gene expression regulation.ISC assembly protein IscA1(or MagR)is found within the mitochondria of most eukaryotes.Magnetoreceptor(MagR)is a highly conserved A-type iron and iron-sulfur cluster-binding protein,characterized by two distinct types of iron-sulfur clusters,[2Fe-2S]and[3Fe-4S],each conferring unique magnetic properties.MagR forms a rod-like polymer structure in complex with photoreceptive cryptochrome(Cry)and serves as a putative magnetoreceptor for retrieving geomagnetic information in animal navigation.Although the N-terminal sequences of MagR vary among species,their specific function remains unknown.In the present study,we found that the N-terminal sequences of pigeon MagR,previously thought to serve as a mitochondrial targeting signal(MTS),were not cleaved following mitochondrial entry but instead modulated the efficiency with which iron-sulfur clusters and irons are bound.Moreover,the N-terminal region of MagR was required for the formation of a stable MagR/Cry complex.Thus,the N-terminal sequences in pigeon MagR fulfil more important functional roles than just mitochondrial targeting.These results further extend our understanding of the function of MagR and provide new insights into the origin of magnetoreception from an evolutionary perspective.

Classification and technical target of water electrolysis for hydrogen production

Continuous efforts are underway to reduce carbon emissions worldwide in response to global climate change.Water electrolysis technology,in conjunction with renewable energy,is considered the most feasible hydrogen production technology based on the viable possibility of large-scale hydrogen production and the zero-carbon-emission nature of the process.However,for hydrogen produced via water electrolysis systems to be utilized in various fields in practice,the unit cost of hydrogen production must be reduced to$1/kg H_(2).To achieve this unit cost,technical targets for water electrolysis have been suggested regarding components in the system.In this paper,the types of water electrolysis systems and the limitations of water electrolysis system components are explained.We suggest guideline with recent trend for achieving this technical target and insights for the potential utilization of water electrolysis technology.

Targeted regeneration and upcycling of spent graphite by defect‐driven tin nucleation

The recycling of spent batteries has become increasingly important owing to their wide applications,abundant raw material supply,and sustainable development.Compared with the degraded cathode,spent anode graphite often has a relatively intact structure with few defects after long cycling.Yet,most spent graphite is simply burned or discarded due to its limited value and inferior performance on using conventional recycling methods that are complex,have low efficiency,and fail in performance restoration.Herein,we propose a fast,efficient,and“intelligent”strategy to regenerate and upcycle spent graphite based on defect‐driven targeted remediation.Using Sn as a nanoscale healant,we used rapid heating(~50 ms)to enable dynamic Sn droplets to automatically nucleate around the surface defects on the graphite upon cooling owing to strong binding to the defects(~5.84 eV/atom),thus simultaneously achieving Sn dispersion and graphite remediation.As a result,the regenerated graphite showed enhanced capacity and cycle stability(458.9 mAh g^(−1) at 0.2 A g^(−1) after 100 cycles),superior to those of commercial graphite.Benefiting from the self‐adaption of Sn dispersion,spent graphite with different degrees of defects can be regenerated to similar structures and performance.EverBatt analysis indicates that targeted regeneration and upcycling have significantly lower energy consumption(~99%reduction)and near‐zero CO_(2) emission,and yield much higher profit than hydrometallurgy,which opens a new avenue for direct upcycling of spend graphite in an efficient,green,and profitable manner for sustainable battery manufacture.

Mitophagy in intracerebral hemorrhage:a new target for therapeutic intervention

Intracerebral hemorrhage is a life-threatening condition with a high fatality rate and severe sequelae.However,there is currently no treatment available for intracerebral hemorrhage,unlike for other stroke subtypes.Recent studies have indicated that mitochondrial dysfunction and mitophagy likely relate to the pathophysiology of intracerebral hemorrhage.Mitophagy,or selective autophagy of mitochondria,is an essential pathway to preserve mitochondrial homeostasis by clearing up damaged mitochondria.Mitophagy markedly contributes to the reduction of secondary brain injury caused by mitochondrial dysfunction after intracerebral hemorrhage.This review provides an overview of the mitochondrial dysfunction that occurs after intracerebral hemorrhage and the underlying mechanisms regarding how mitophagy regulates it,and discusses the new direction of therapeutic strategies targeting mitophagy for intracerebral hemorrhage,aiming to determine the close connection between mitophagy and intracerebral hemorrhage and identify new therapies to modulate mitophagy after intracerebral hemorrhage.In conclusion,although only a small number of drugs modulating mitophagy in intracerebral hemorrhage have been found thus far,most of which are in the preclinical stage and require further investigation,mitophagy is still a very valid and promising therapeutic target for intracerebral hemorrhage in the long run.

Establishing Standardized Nursing Quality Sensitive Indicators

This is a pilot research project was prepared to assess the impact of implementing essential standardized nursing quality sensitive indicators in monitoring, evaluating, and controlling the nursing services and activities which implemented in daily nursing care works with the patients in a health institute, aiming for emphasizing the concept of “nursing quality sensitive indicators” which is valuable to elaborate nursing care performance, and for continuous upgrading of daily nursing care, which hopefully will result in more beneficial outcomes, and lesser negative or undesirable outcomes in all aspects of nursing care, and consequently the health care process, particularly regarding patient safety, patient satisfaction and nursing performance improvement. This pilot research project for the essential standardized nursing quality sensitive indicators was applied in intensive care unit (ICU) department in Qurayyat general hospital, and resulted in excellent improvement of all outcomes correlated with the essential standardized nursing quality sensitive indicators. These essential standardized nursing quality sensitive indicators are hopefully be accepted and accredited by the higher health authorities as standardized nursing quality sensitive indicators in health institutes.

Indicator Selection for Quality Measurement in Maternal Neonatal and Child Health Services: Application of Random Forest Classifier

Quality of Maternal, Neonatal and Child (MNCH) care is an important aspect in ensuring healthy outcomes and survival of mothers and children. To maintain quality in health services provided, organizations and other stakeholders in maternal and child health recommend regular quality measurement. Quality indicators are the key components in the quality measurement process. However, the literature shows neither an indicator selection process nor a set of quality indicators for quality measurement that is universally accepted. The lack of a universally accepted quality indicator selection process and set of quality indicators results in the establishment of a variety of quality indicator selection processes and several sets of quality indicators whenever the need for quality measurement arises. This adds extra processes that render quality measurement process. This study, therefore, aims to establish a set of quality indicators from a broad set of quality indicators recommended by the World Health Organization (WHO). The study deployed a machine learning technique, specifically a random forest classifier to select important indicators for quality measurement. Twenty-nine indicators were identified as important features and among those, eight indicators namely maternal mortality ratio, still-birth rate, delivery at a health facility, deliveries assisted by skilled attendants, proportional breach delivery, normal delivery rate, born before arrival rate and antenatal care visit coverage were identified to be the most important indicators for quality measurement.