Cancer pain management: recommendations from a Latin-American experts panel.

PubMed

Escobar Alvarez, Yolanda; Agamez Insignares, Claudia; Ahumada Olea, Monica; Barajas, Olga; Calderillo, German; Calvache Guamán, Jenny Cecilia; Caponero, Ricardo; Cavenago Salazar, Benjamín A; Del Giglio, Auro; Pupo Araya, Ana Rocío; Villalobos-Valencia, Ricardo; Yepes Pérez, Andrés; Zumelzu Delgado, Nilda

2017-11-01

Generating a consensus in the Latin-American region on cancer pain management is a current need. Thus a panel of Latin-American experts met in Madrid in March 2017 in order to review the published literature, discuss the best approach for cancer pain classification and evaluation and also make recommendations of pharmacological and nonpharmacological therapies for cancer pain management improvement in Latin-American countries. The result of that meeting is presented in this document. The experts participating were from Costa Rica, Mexico, Chile, Colombia, Peru, Brazil and Ecuador, and the project coordinator was from Spain.

Expert panel report on a study of Splenda in male rats.

PubMed

Brusick, David; Borzelleca, Joseph F; Gallo, Michael; Williams, Gary; Kille, John; Wallace Hayes, A; Xavier Pi-Sunyer, F; Williams, Christine; Burks, Wesley

2009-10-01

A recent study in rats investigated the retail sweetener product, Granulated SPLENDA No Calorie Sweetener (Splenda) (Abou-Donia et al., 2008. Splenda alters gut microflora and increases intestinal P-glycoprotein and cytochrome P-450 in male rats. J. Toxicol. Environ. Health A, 71, 1415-1429), which is composed of (by dry weight) maltodextrin ( approximately 99%) and sucralose ( approximately 1%). The investigators reported that Splenda increased body weight, decreased beneficial intestinal bacteria, and increased the expression of certain cytochrome P450 (CYP450) enzymes and the transporter protein, P-glycoprotein (P-gp), the latter of which was considered evidence that Splenda or sucralose might interfere with the absorption of nutrients and drugs. The investigators indicated that the reported changes were attributable to the sucralose present in the product tested. An Expert Panel conducted a rigorous evaluation of this study. In arriving at its conclusions, the Expert Panel considered the design and conduct of the study, its outcomes and the outcomes reported in other data available publicly. The Expert Panel found that the study was deficient in several critical areas and that its results cannot be interpreted as evidence that either Splenda, or sucralose, produced adverse effects in male rats, including effects on gastrointestinal microflora, body weight, CYP450 and P-gp activity, and nutrient and drug absorption. The study conclusions are not consistent with published literature and not supported by the data presented.

Identification of retention strategies for neurosurgeons in Iran: Results from expert panels.

PubMed

Rafiei, Sima; Abdollahzadeh, Sina; Hashemi, Fariba; Ranjbar, Mohammad

2017-04-04

Background: The key challenge is how to encourage and retain health professionals in their work location. There is a list of policy options for this purpose but applying an appropriate and effective set of strategies requires a country level research. Our study aimed to identify retention strategies for neurosurgeons and examine both the importance and feasibility of the identified strategies using expert panels' point of view. Methods: First of all, a literature review was conducted to identify retention strategies for physicians. Then to gain consensus on the strategies and determine their importance and feasibility an expert panel was organized and a modified Delphi process was used. Results: A total of 40 strategies were identified by the panel classified in seven categories of income and economic factors, professional/job factors, clinical infrastructure, personal/family factors, living condition and welfare, educational factors and career development, governmental regulations and management policies. Conclusion: Based on the study results, three areas of economic incentives, personal and professional factors got the greatest priority in health professional planning for retention purposes.

Elicitation of quantitative data from a heterogeneous expert panel: formal process and application in animal health.

PubMed

Van der Fels-Klerx, Ine H J; Goossens, Louis H J; Saatkamp, Helmut W; Horst, Suzan H S

2002-02-01

This paper presents a protocol for a formal expert judgment process using a heterogeneous expert panel aimed at the quantification of continuous variables. The emphasis is on the process's requirements related to the nature of expertise within the panel, in particular the heterogeneity of both substantive and normative expertise. The process provides the opportunity for interaction among the experts so that they fully understand and agree upon the problem at hand, including qualitative aspects relevant to the variables of interest, prior to the actual quantification task. Individual experts' assessments on the variables of interest, cast in the form of subjective probability density functions, are elicited with a minimal demand for normative expertise. The individual experts' assessments are aggregated into a single probability density function per variable, thereby weighting the experts according to their expertise. Elicitation techniques proposed include the Delphi technique for the qualitative assessment task and the ELI method for the actual quantitative assessment task. Appropriately, the Classical model was used to weight the experts' assessments in order to construct a single distribution per variable. Applying this model, the experts' quality typically was based on their performance on seed variables. An application of the proposed protocol in the broad and multidisciplinary field of animal health is presented. Results of this expert judgment process showed that the proposed protocol in combination with the proposed elicitation and analysis techniques resulted in valid data on the (continuous) variables of interest. In conclusion, the proposed protocol for a formal expert judgment process aimed at the elicitation of quantitative data from a heterogeneous expert panel provided satisfactory results. Hence, this protocol might be useful for expert judgment studies in other broad and/or multidisciplinary fields of interest.

Application of Delphi expert panel in joint venture projects

NASA Astrophysics Data System (ADS)

Adnan, H.; Rosman, M. R.; Rashid, Z. Z. Ahmad; Mohamad Yusuwan, N.; Bakhary, N. A.

2018-02-01

This study was conducted with the aim to identify the application of the Delphi Technique in validating findings obtained from questionnaire surveys and interviews done in- depth on the subject of joint venture projects in Malaysia. The Delphi technique aims to achieve a consensus of opinion amongst expert panellist that were selected on the primary factors in JV projects. To achieve research objectives, a progressive series of questions was designed where a selected panel of expert to confirm and validate the final findings. The rationale, benefits, limitations and recommendations for the use of Delphi were given in this study. From the literature review done, twenty-one factors were identified as critical factors to the making any joint venture project successful. Detail information from contractors were obtained by using the questionnaire survey method and forty-three in-depth interviews were carried out. Trust between partners, mutual understanding, partner selection criteria, agreement of contract, objective compatibility, conflict, and commitment were confirmed by the Delphi panel to be the critical success factors besides another fourteen factors which were found to be the Failure Reduction Criteria. Delphi techniques has proven to successfully assist in recognising the main factors and would be beneficial in supplementing the success of joint venture arrangements application for construction projects in Malaysia.

Expert panel evaluation of health information technology effects on adverse events.

PubMed

Abramson, Erika L; Kern, Lisa M; Brenner, Samantha; Hufstader, Meghan; Patel, Vaishali; Kaushal, Rainu

2014-08-01

Adverse events (AEs) among hospitalized patients occur frequently and result in significant sequelae. Federal policy is incentivizing health information technology (HIT) use, although research demonstrating safety benefits from HIT is mixed. Our objective was to evaluate the potential effects of HIT on reducing 21 different inpatient AEs. Identifying AEs most likely to be reduced by HIT can inform the design of future studies evaluating its effectiveness. We conducted a modified Delphi panel of national experts in HIT and safety. We conducted a focused literature review to inform the experts. Using a novel framework, experts rated each AE as 'definitely reduced by health IT,' 'possibly reduced by health IT' and 'not likely to be reduced by health IT'. From our panel discussion, experts identified six AEs as 'definitely reduced by health IT': (1) adverse drug events (ADEs) associated with digoxin; (2) ADE associated with IV heparin; (3) ADE associated with hypoglycaemic agents; (4) ADE associated with low molecular weight heparin and factor Xa inhibitor; (5) contrast nephropathy associated with catheter angiography; and (6) ADE hospital-acquired antibiotic-associated Clostridium difficile. Understanding the effects of HIT on patient outcomes will be essential to ensuring that the significant federal investment results in anticipated improvements. This study serves as an important early step in helping with the design of future work evaluating level of HIT infrastructure and rates of inpatient AEs. © 2014 John Wiley & Sons, Ltd.

Genotoxicity Expert Panel review: weight of evidence evaluation of the genotoxicity of glyphosate, glyphosate-based formulations, and aminomethylphosphonic acid.

PubMed

Brusick, David; Aardema, Marilyn; Kier, Larry; Kirkland, David; Williams, Gary

2016-09-01

In 2015, the International Agency for Research on Cancer (IARC) published a monograph concluding there was strong evidence for genotoxicity of glyphosate and glyphosate formulations and moderate evidence for genotoxicity of the metabolite aminomethylphosphonic acid (AMPA). These conclusions contradicted earlier extensive reviews supporting the lack of genotoxicity of glyphosate and glyphosate formulations. The IARC Monograph concluded there was strong evidence of induction of oxidative stress by glyphosate, glyphosate formulations, and AMPA. The Expert Panel reviewed the genotoxicity and oxidative stress data considered in the IARC Monograph, together with other available data not considered by IARC. The Expert Panel defined and used a weight of evidence (WoE) approach that included ranking of studies and endpoints by the strength of their linkage to events associated with carcinogenic mechanisms. Importantly, the Expert Panel concluded that there was sufficient information available from a very large number of regulatory genotoxicity studies that should have been considered by IARC. The WoE approach, the inclusion of all relevant regulatory studies, and some differences in interpretation of individual studies led to significantly different conclusions by the Expert Panel compared with the IARC Monograph. The Expert Panel concluded that glyphosate, glyphosate formulations, and AMPA do not pose a genotoxic hazard and the data do not support the IARC Monograph genotoxicity evaluation. With respect to carcinogenicity classification and mechanism, the Expert Panel concluded that evidence relating to an oxidative stress mechanism of carcinogenicity was largely unconvincing and that the data profiles were not consistent with the characteristics of genotoxic carcinogens.

A practical guideline for examining a uterine niche using ultrasonography in non-pregnant women: a modified Delphi method amongst European experts.

PubMed

Jordans, I P M; de Leeuw, R; Stegwee, S I; Amso, N N; Barri-Soldevila, P N; van den Bosch, T; Bourne, T; Brolmann, H A M; Donnez, O; Dueholm, M; Hehenkamp, W J K; Jastrow, N; Jurkovic, D; Mashiach, R; Naji, O; Streuli, I; Timmerman, D; Vd Voet, L F; Huirne, J A F

2018-03-14

To generate a uniform, internationally recognized guideline for detailed uterine niche evaluation by ultrasonography in non-pregnant women using a modified Delphi method amongst international experts. Fifteen international gynecological experts were recruited by their membership of the European niche taskforce group. All experts were physicians with extensive experience in niche evaluation in clinical practice and/or authors of niche studies. Relevant items for niche measurement were determined based on the results of a literature search and recommendations of a focus group. Two online questionnaires were sent to the expert panel and one group meeting was organized. Consensus was predefined as a consensus rate of at least 70%. In total 15 experts participated in this study. Consensus was reached for a total of 42 items on niche evaluation, including definitions, relevance, method of measurement and tips for visualization of the niche. All experts agreed on the proposed guideline for niche evaluation in non-pregnant women as presented in this paper. Consensus between niche experts was achieved on all items regarding ultrasonographic niche measurement. This article is protected by copyright. All rights reserved.

Glyphosate rodent carcinogenicity bioassay expert panel review.

PubMed

Williams, Gary M; Berry, Colin; Burns, Michele; de Camargo, Joao Lauro Viana; Greim, Helmut

2016-09-01

Glyphosate has been rigorously and extensively tested for carcinogenicity by administration to mice (five studies) and to rats (nine studies). Most authorities have concluded that the evidence does not indicate a cancer risk to humans. The International Agency for Research on Cancer (IARC), however, evaluated some of the available data and concluded that glyphosate probably is carcinogenic to humans. The expert panel convened by Intertek assessed the findings used by IARC, as well as the full body of evidence and found the following: (1) the renal neoplastic effects in males of one mouse study are not associated with glyphosate exposure, because they lack statistical significance, strength, consistency, specificity, lack a dose-response pattern, plausibility, and coherence; (2) the strength of association of liver hemangiosarcomas in a different mouse study is absent, lacking consistency, and a dose-response effect and having in high dose males only a significant incidence increase which is within the historical control range; (3) pancreatic islet-cell adenomas (non-significant incidence increase), in two studies of male SD rats did not progress to carcinomas and lacked a dose-response pattern (the highest incidence is in the low dose followed by the high dose); (4) in one of two studies, a non-significant positive trend in the incidence of hepatocellular adenomas in male rats did not lead to progression to carcinomas; (5) in one of two studies, the non-significant positive trend in the incidence of thyroid C-cell adenomas in female rats was not present and there was no progression of adenomas to carcinomas at the end of the study. Application of criteria for causality considerations to the above mentioned tumor types and given the overall weight-of-evidence (WoE), the expert panel concluded that glyphosate is not a carcinogen in laboratory animals.

NTP-CERHR EXPERT PANEL REPORT ON REPRODUCTIVE AND DEVELOPMENTAL TOXICITY OF METHYLPHENIDATE.

EPA Science Inventory

A manuscript describes the results of an expert panel meeting of the NTP Center for the Evaluation of Risks to Human Reproduction (CERHR). The purpose CERHR is to provide timely, unbiased, scientifically sound evaluations of human and experimental evidence for adverse effects on...

Identification of recruitment and retention strategies for rehabilitation professionals in Ontario, Canada: results from expert panels.

PubMed

Tran, Diem; Hall, Linda McGillis; Davis, Aileen; Landry, Michel D; Burnett, Dawn; Berg, Katherine; Jaglal, Susan

2008-12-09

Demand for rehabilitation services is expected to increase due to factors such as an aging population, workforce pressures, rise in chronic and complex multi-system disorders, advances in technology, and changes in interprofessional health service delivery models. However, health human resource (HHR) strategies for Canadian rehabilitation professionals are lagging behind other professional groups such as physicians and nurses. The objectives of this study were: 1) to identify recruitment and retention strategies of rehabilitation professionals including occupational therapists, physical therapists and speech language pathologists from the literature; and 2) to investigate both the importance and feasibility of the identified strategies using expert panels amongst HHR and education experts. A review of the literature was conducted to identify recruitment and retention strategies for rehabilitation professionals. Two expert panels, one on Recruitment and Retention and the other on Education were convened to determine the importance and feasibility of the identified strategies. A modified-delphi process was used to gain consensus and to rate the identified strategies along these two dimensions. A total of 34 strategies were identified by the Recruitment and Retention and Education expert panels as being important and feasible for the development of a HHR plan for recruitment and retention of rehabilitation professionals. Seven were categorized under the Quality of Worklife and Work Environment theme, another seven in Financial Incentives and Marketing, two in Workload and Skill Mix, thirteen in Professional Development and five in Education and Training. Based on the results from the expert panels, the three major areas of focus for HHR planning in the rehabilitation sector should include strategies addressing Quality of Worklife and Work Environment, Financial Incentives and Marketing and Professional Development.

Tamarisk beetle (Diorhabda spp.) in the Colorado River basin: Synthesis of an expert panel forum

USGS Publications Warehouse

Bloodworth, Benjamin R.; Shafroth, Patrick B.; Sher, Anna A.; Manners, Rebecca B.; Bean, Daniel W.; Johnson, Matthew J.; Hinojosa-Huerta, Osvel

2016-01-01

In January 2015, the Tamarisk Coalition convened a panel of experts to discuss and present information on probable ecological trajectories in the face of widespread beetle presence and to consider opportunities for restoration and management of riparian systems in the Colorado River Basin (CRB). An in-depth description of the panel discussion follows. 

Expert panel reviews of research centers: the site visit process.

PubMed

Lawrenz, Frances; Thao, Mao; Johnson, Kelli

2012-08-01

Site visits are used extensively in a variety of settings within the evaluation community. They are especially common in making summative value decisions about the quality and worth of research programs/centers. However, there has been little empirical research and guidance about how to appropriately conduct evaluative site visits of research centers. We review the processes of two site visit examples using an expert panel review: (1) a process to evaluate four university research centers and (2) a process to review a federally sponsored research center. A set of 14 categories describing the expert panel review process was obtained through content analysis and participant observation. Most categories were addressed differently through the two processes highlighting the need for more research about the most effective processes to use within different contexts. Decisions about how to structure site visits appear to depend on the research context, practical considerations, the level at which the review is being conducted and the intended impact of the report. Future research pertaining to the selection of site visitors, the autonomy of the visitors in data collection and report writing, and the amount and type of information provided would be particularly valuable. Copyright © 2012 Elsevier Ltd. All rights reserved.

[ANALYSIS USING AN EXPERT PANEL OF ACTIVITIES AND COMPETENCIES WHICH NURSING CLINICAL PRACTICE TUTORS IN THE COMUNIDAD AUTÓNOMA DE MADRID SHOULD POSSESS].

PubMed

Argüello López, María Teresa; Palmar Santos, Ana María; Sellán Soto, Carmen

2015-01-01

Although practical training has always been important in Nursing, it has reached a new dimension in the European Higher Education Area. This has involved adapting the syllabus, where one of the new features is considering clinical practice as an independent subject and also including the concept of competence as a result of the students' learning. The figure of the tutor becomes one of the key factors and therefore their activities and competencies must be defined. To enumerate and prioritize, by agreement, the main activities and competences by the tutor of clinical practices in the Comunidad Autónoma de Madrid should posses. METHODOLOGY. Quantitative focus, analysis by group of experts between 2010 and 2013. RESULTS. A total of 510 nurses have participated, 17 panels of experts have met and consensus has been reached on 22 competencies and 12 activities. The description of activities and competencies can be extremely useful for selecting, evaluating and developing nursing clinical practice tutors, becoming a baseline and reducing the subjectivity in the development of tutors according to the new demands of the European Higher Education Area.

Economic analysis of complementary, alternative, and integrative medicine: considerations raised by an expert panel.

PubMed

Coulter, Ian D; Herman, Patricia M; Nataraj, Shanthi

2013-07-25

An international panel of experts was convened to examine the challenges faced in conducting economic analyses of Complementary, Alternative and Integrative Medicine (CAIM). A one and a half-day panel of experts was convened in early 2011 to discuss what was needed to bring about robust economic analysis of CAIM. The goals of the expert panel were to review the current state of the science of economic evaluations in health, and to discuss the issues involved in applying these methods to CAIM, recognizing its unique characteristics. The panel proceedings were audiotaped and a thematic analysis was conducted independently by two researchers. The results were then discussed and differences resolved. This manuscript summarizes the discussions held by the panel members on each theme. The panel identified seven major themes regarding economic evaluation that are particularly salient to determining the economics of CAIM: standardization (in order to compare CAIM with conventional therapies, the same basic economic evaluation methods and framework must be used); identifying the question being asked, the audience targeted for the results and whose perspective is being used (e.g., the patient perspective is especially relevant to CAIM because of the high level of self-referral and out-of-pocket payment); the analytic methods to be used (e.g., the importance of treatment description and fidelity); the outcomes to be measured (e.g., it is important to consider a broad range of outcomes, particularly for CAIM therapies, which often treat the whole person rather than a specific symptom or disease); costs (e.g., again because of treating the whole person, the impact of CAIM on overall healthcare costs, rather than only disease-specific costs, should be measured); implementation (e.g., highlighting studies where CAIM allows cost savings may help offset its image as an "add on" cost); and generalizability (e.g., proper reporting can enable study results to be useful beyond the

Identification of recruitment and retention strategies for rehabilitation professionals in Ontario, Canada: results from expert panels

PubMed Central

Tran, Diem; Hall, Linda McGillis; Davis, Aileen; Landry, Michel D; Burnett, Dawn; Berg, Katherine; Jaglal, Susan

2008-01-01

Background Demand for rehabilitation services is expected to increase due to factors such as an aging population, workforce pressures, rise in chronic and complex multi-system disorders, advances in technology, and changes in interprofessional health service delivery models. However, health human resource (HHR) strategies for Canadian rehabilitation professionals are lagging behind other professional groups such as physicians and nurses. The objectives of this study were: 1) to identify recruitment and retention strategies of rehabilitation professionals including occupational therapists, physical therapists and speech language pathologists from the literature; and 2) to investigate both the importance and feasibility of the identified strategies using expert panels amongst HHR and education experts. Methods A review of the literature was conducted to identify recruitment and retention strategies for rehabilitation professionals. Two expert panels, one on Recruitment and Retention and the other on Education were convened to determine the importance and feasibility of the identified strategies. A modified-delphi process was used to gain consensus and to rate the identified strategies along these two dimensions. Results A total of 34 strategies were identified by the Recruitment and Retention and Education expert panels as being important and feasible for the development of a HHR plan for recruitment and retention of rehabilitation professionals. Seven were categorized under the Quality of Worklife and Work Environment theme, another seven in Financial Incentives and Marketing, two in Workload and Skill Mix, thirteen in Professional Development and five in Education and Training. Conclusion Based on the results from the expert panels, the three major areas of focus for HHR planning in the rehabilitation sector should include strategies addressing Quality of Worklife and Work Environment, Financial Incentives and Marketing and Professional Development. PMID:19068134

Expert Opinion Is Necessary: Delphi Panel Methodology Facilitates a Scientific Approach to Consensus.

PubMed

Hohmann, Erik; Brand, Jefferson C; Rossi, Michael J; Lubowitz, James H

2018-02-01

Our current trend and focus on evidence-based medicine is biased in favor of randomized controlled trials, which are ranked highest in the hierarchy of evidence while devaluing expert opinion, which is ranked lowest in the hierarchy. However, randomized controlled trials have weaknesses as well as strengths, and no research method is flawless. Moreover, stringent application of scientific research techniques, such as the Delphi Panel methodology, allows survey of experts in a high quality and scientific manner. Level V evidence (expert opinion) remains a necessary component in the armamentarium used to determine the answer to a clinical question. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

QT Interval Screening in Methadone Maintenance Treatment: Report of a SAMHSA Expert Panel

PubMed Central

Martin, Judith A.; Campbell, Anthony; Killip, Thomas; Kotz, Margaret; Krantz, Mori J.; Kreek, Mary Jeanne; McCarroll, Brian A.; Mehta, Davendra; Payte, J. Thomas; Stimmel, Barry; Taylor, Trusandra; Wilford, Bonnie B.

2014-01-01

In an effort to enhance patient safety in Opioid Treatment Programs (OTPs), the Substance Abuse and Mental Health Services Administration (SAMHSA) convened a multi-disciplinary Expert Panel on the Cardiac Effects of Methadone. Panel members reviewed the literature, regulatory actions, professional guidances, and OTPs’ experiences regarding adverse cardiac events associated with methadone. The Panel concluded that, to the extent possible, every OTP should have a universal Cardiac Risk Management Plan (incorporating clinical assessment, ECG assessment, risk stratification, and prevention of drug interactions) for all patients, and should strongly consider patient-specific risk minimization strategies (such as careful patient monitoring, obtaining ECGs as indicated by a particular patient’s risk profile, and adjusting the methadone dose as needed) for patients with identified risk factors for adverse cardiac events. The Panel also suggested specific modifications to informed consent documents, patient education, staff education, and methadone protocols. PMID:22026519

Expert panels as a reference standard in orthodontic research: An assessment of published methods and reporting.

PubMed

Lempesi, Evangelia; Toulia, Electra; Pandis, Nikolaos

2017-04-01

The aim of this study was to investigate the expert panel methodology applied in orthodontics and its reporting quality. Additionally, the relationship between the reporting quality and a range of variables was explored. PubMed was searched for orthodontic studies in which the final diagnosis or assessment was made by 2 or more experts published up to March 16, 2015. Reporting quality assessment was conducted using an established modified checklist. The relationship between potential predictors and the total score was assessed using univariable linear regression. We identified 237 studies with a mean score of 9.97 (SD, 1.12) out of a maximum of 15. Critical information about panel methodology was missing in all studies. The panel composition differed substantially across studies, ranging from 2 to 646 panel members, with large variations in the expertise represented. Only 17 studies (7.2%) reported sample size calculations to justify the panel size. Panel members were partly blinded in 65 (27.4%) studies. Most studies failed to report which statistic was used to compute intrarater (65.8%) and interrater (66.2%) agreements. Journal type (nonorthodontic: β, 0.23; 95% CI, -0.07 to 0.54 compared with orthodontic), publication year (β, 0; 95% CI, -0.02 to 0.02 for each additional year), number of authors (1-3: β, 0.30; 95% CI, -0.13 to 0.74 compared with at least 6; 4-5: β, 0.18; 95% CI, -0.29 to 0.33 compared with at least 6), and number of centers involved (single: β, 0.20; 95% CI, -0.14 to 0.54 compared with multicenter) were not significant predictors of improved reporting. Studies published in Asia and Australia had significantly lower scores compared with those published in Europe (β, -0.54; 95% CI, -0.92 to -0.17). Formal guidelines on methodology and reporting of studies involving expert panels are required. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Management of rhinosinusitis during pregnancy: systematic review and expert panel recommendations

PubMed Central

Lal, Devyani; Jategaonkar, Ameya A.; Borish, Larry; Chambliss, Linda R.; Gnagi, Sharon H.; Hwang, Peter H.; Rank, Matthew A.; Stankiewicz, James A.; Lund, Valerie J.

2018-01-01

Background Management of rhinosinusitis during pregnancy requires special considerations. Objectives 1. Conduct a systematic literature review for acute and chronic rhinosinusitis (CRS) management during pregnancy. 2. Make evidence-based recommendations. Methods The systematic review was conducted using MEDLINE and EMBASE databases and relevant search terms. Title, abstract and full manuscript review were conducted by two authors independently. A multispecialty panel with expertise in management of Rhinological disorders, Allergy-Immunology, and Obstetrics-Gynecology was invited to review the systematic review. Recommendations were sought on use of following for CRS management during pregnancy: oral corticosteroids; antibiotics; leukotrienes; topical corticosteroid spray/irrigations/drops; aspirin desensitization; elective surgery for CRS with polyps prior to planned pregnancy; vaginal birth versus planned Caesarian for skull base erosions/ prior CSF rhinorrhea. Results Eighty-eight manuscripts underwent full review after screening 3052 abstracts. No relevant level 1, 2, or 3 studies were found. Expert panel recommendations for rhinosinusitis management during pregnancy included continuing nasal corticosteroid sprays for CRS maintenance, using pregnancy-safe antibiotics for acute rhinosinusitis and CRS exacerbations, and discontinuing aspirin desensitization for aspirin exacerbated respiratory disease. The manuscript presents detailed recommendations. Conclusions The lack of evidence pertinent to managing rhinosinusitis during pregnancy warrants future trials. Expert recommendations constitute the current best available evidence. PMID:26800862

Management of rhinosinusitis during pregnancy: systematic review and expert panel recommendations.

PubMed

Lal, Devyani; Jategaonkar, Ameya A; Borish, Larry; Chambliss, Linda R; Gnagi, Sharon H; Hwang, Peter H; Rank, Matthew A; Stankiewicz, James A; Lund, Valerie J

2016-06-01

Management of rhinosinusitis during pregnancy requires special considerations. 1. Conduct a systematic literature review for acute and chronic rhinosinusitis (CRS) management during pregnancy. 2. Make evidence-based recommendations. The systematic review was conducted using MEDLINE and EMBASE databases and relevant search terms. Title, abstract and full manuscript review were conducted by two authors independently. A multispecialty panel with expertise in management of Rhinological disorders, Allergy-Immunology, and Obstetrics-Gynecology was invited to review the systematic review. Recommendations were sought on use of following for CRS management during pregnancy: oral corticosteroids; antibiotics; leukotrienes; topical corticosteroid spray/irrigations/drops; aspirin desensitization; elective surgery for CRS with polyps prior to planned pregnancy; vaginal birth versus planned Caesarian for skull base erosions/ prior CSF rhinorrhea. Eighty-eight manuscripts underwent full review after screening 3052 abstracts. No relevant level 1, 2, or 3 studies were found. Expert panel recommendations for rhinosinusitis management during pregnancy included continuing nasal corticosteroid sprays for CRS maintenance, using pregnancy-safe antibiotics for acute rhinosinusitis and CRS exacerbations, and discontinuing aspirin desensitization for aspirin exacerbated respiratory disease. The manuscript presents detailed recommendations. The lack of evidence pertinent to managing rhinosinusitis during pregnancy warrants future trials. Expert recommendations constitute the current best available evidence.

Participation of industry experts in the elaboration of monographs and chapters of the European Pharmacopoeia.

PubMed

Rose, Ulrich

2016-10-10

The European Pharmacopoeia represents an important element in the European regulatory system for medicines. It is elaborated in a co-operation of experts from authorities, academia and industry, assisted by scientific staff from the European Directorate for the Quality of Medicines & HealthCare (EDQM). This article describes the principles of its elaboration with particular focus on the involvement of industry experts. Copyright © 2016 Elsevier B.V. All rights reserved.

What is case management in palliative care? An expert panel study

PubMed Central

2012-01-01

Background Case management is a heterogeneous concept of care that consists of assessment, planning, implementing, coordinating, monitoring, and evaluating the options and services required to meet the client's health and service needs. This paper describes the result of an expert panel procedure to gain insight into the aims and characteristics of case management in palliative care in the Netherlands. Methods A modified version of the RAND®/University of California at Los Angeles (UCLA) appropriateness method was used to formulate and rate a list of aims and characteristics of case management in palliative care. A total of 76 health care professionals, researchers and policy makers were invited to join the expert panel, of which 61% participated in at least one round. Results Nine out of ten aims of case management were met with agreement. The most important areas of disagreement with regard to characteristics of case management were hands-on nursing care by the case manager, target group of case management, performance of other tasks besides case management and accessibility of the case manager. Conclusions Although aims are agreed upon, case management in palliative care shows a high level of variability in implementation choices. Case management should aim at maintaining continuity of care to ensure that patients and those close to them experience care as personalised, coherent and consistent. PMID:22709349

NTP-CERHR EXPERT PANEL REPORT ON THE REPRODUCTIVE AND DEVELOPMENTAL TOXICITY OF AMPHETAMINE AND METHAMPHETAMINE.

EPA Science Inventory

A manuscript describes the results of an expert panel meeting of the NTP Center for the Evaluation of Risks to Human Reproduction (CERHR). The purpose CERHR is to provide timely, unbiased, scientifically sound evaluations of human and experimental evidence for adverse effects ...

77 FR 15753 - Request for Nominations of Experts for a Science Advisory Board Panel To Review EPA's Web-Based...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-16

... Advisory Board Panel To Review EPA's Web-Based Report on the Environment AGENCY: Environmental Protection... nominations of technical experts to form an SAB panel to review the Agency's Web-based Report on the... procedural policies. EPA's Web-based Report on the Environment (ROE) has been developed to provide a...

Expert panel consensus recommendations for home blood pressure monitoring in Asia: the Hope Asia Network.

PubMed

Park, Sungha; Buranakitjaroen, Peera; Chen, Chen-Huan; Chia, Yook-Chin; Divinagracia, Romeo; Hoshide, Satoshi; Shin, Jinho; Siddique, Saulat; Sison, Jorge; Soenarta, Arieska Ann; Sogunuru, Guru Prasad; Tay, Jam Chin; Turana, Yuda; Wang, Ji-Guang; Zhang, Yuqing; Kario, Kazuomi

2018-04-01

Hypertension is the leading cause of mortality throughout Asia. Home blood pressure monitoring has the potential to improve hypertension control and is a useful adjunct to conventional office blood pressure measurements due to its diagnostic accuracy and prognostic value in predicting cardiovascular outcomes. At present, there are no region-specific guidelines addressing the use of home blood pressure monitoring in Asia. Therefore, an expert panel was convened to address the use of home blood pressure monitoring and develop key recommendations to help guide clinical practice throughout the Asia region. The resulting recommendations support the use of home blood pressure monitoring with a validated device as an accurate adjunct for diagnosing hypertension and predicting cardiovascular outcome. Diagnosis and treatment of hypertension should still be guided by conventional office/clinic blood pressure measurements. The expert panel encourages the incorporation of home blood pressure monitoring into local clinical guidelines and offers practical recommendations to ensure continuity of care where a validated home blood pressure device is not available.

Training Future Physicians about Weapons of Mass Destruction: Report of the Expert Panel on Bioterrorism Education for Medical Students.

ERIC Educational Resources Information Center

Association of American Medical Colleges, Washington, DC.

The Association of American Medical Colleges (AAMC) convened a multidisciplinary group of experts to share their insights about the learning objectives and educational experiences that they would recommend for the training of future physicians about bioterrorism. The expert panel broadened the scope of their discussion beyond bioterrorism to…

Interdisciplinary European Guidelines on Metabolic and Bariatric Surgery

PubMed Central

Fried, Martin; Yumuk, Volkan; Oppert, Jean-Michel; Scopinaro, Nicola; Torres, Antonio J.; Weiner, Rudolf; Yashkov, Yuri; Frühbeck, Gema

2013-01-01

In 2012, an outstanding expert panel derived from IFSO-EC (International Federation for the Surgery of Obesity - European Chapter) and EASO (European Association for the Study of Obesity), composed by key representatives of both Societies including past and present presidents together with EASO's OMTF (Obesity Management Task Force) chair, agreed to devote the joint Medico-Surgical Workshop of both institutions to the topic of metabolic surgery as a pre-satellite of the 2013 European Congress on Obesity (ECO) to be held in Liverpool given the extraordinarily advancement made specifically in this field during the past years. It was further agreed to revise and update the 2008 Interdisciplinary European Guidelines on Surgery of Severe Obesity produced in cooperation of both Societies by focusing in particular on the evidence gathered in relation to the effects on diabetes during this lustrum and the subsequent changes that have taken place in patient eligibility criteria. The expert panel composition allowed the coverage of key disciplines in the comprehensive management of obesity and obesity-associated diseases, aimed specifically at updating the clinical guidelines to reflect current knowledge, expertise and evidence-based data on metabolic and bariatric surgery. PMID:24135948

Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults.

PubMed

Hendricks, Katherine A; Wright, Mary E; Shadomy, Sean V; Bradley, John S; Morrow, Meredith G; Pavia, Andy T; Rubinstein, Ethan; Holty, Jon-Erik C; Messonnier, Nancy E; Smith, Theresa L; Pesik, Nicki; Treadwell, Tracee A; Bower, William A

2014-02-01

The Centers for Disease Control and Prevention convened panels of anthrax experts to review and update guidelines for anthrax postexposure prophylaxis and treatment. The panels included civilian and military anthrax experts and clinicians with experience treating anthrax patients. Specialties represented included internal medicine, pediatrics, obstetrics, infectious disease, emergency medicine, critical care, pulmonology, hematology, and nephrology. Panelists discussed recent patients with systemic anthrax; reviews of published, unpublished, and proprietary data regarding antimicrobial drugs and anthrax antitoxins; and critical care measures of potential benefit to patients with anthrax. This article updates antimicrobial postexposure prophylaxis and antimicrobial and antitoxin treatment options and describes potentially beneficial critical care measures for persons with anthrax, including clinical procedures for infected nonpregnant adults. Changes from previous guidelines include an expanded discussion of critical care and clinical procedures and additional antimicrobial choices, including preferred antimicrobial drug treatment for possible anthrax meningitis.

Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults

PubMed Central

Hendricks, Katherine A.; Wright, Mary E.; Shadomy, Sean V.; Bradley, John S.; Morrow, Meredith G.; Pavia, Andy T.; Rubinstein, Ethan; Holty, Jon-Erik C.; Messonnier, Nancy E.; Smith, Theresa L.; Pesik, Nicki; Treadwell, Tracee A.

2014-01-01

The Centers for Disease Control and Prevention convened panels of anthrax experts to review and update guidelines for anthrax postexposure prophylaxis and treatment. The panels included civilian and military anthrax experts and clinicians with experience treating anthrax patients. Specialties represented included internal medicine, pediatrics, obstetrics, infectious disease, emergency medicine, critical care, pulmonology, hematology, and nephrology. Panelists discussed recent patients with systemic anthrax; reviews of published, unpublished, and proprietary data regarding antimicrobial drugs and anthrax antitoxins; and critical care measures of potential benefit to patients with anthrax. This article updates antimicrobial postexposure prophylaxis and antimicrobial and antitoxin treatment options and describes potentially beneficial critical care measures for persons with anthrax, including clinical procedures for infected nonpregnant adults. Changes from previous guidelines include an expanded discussion of critical care and clinical procedures and additional antimicrobial choices, including preferred antimicrobial drug treatment for possible anthrax meningitis. PMID:24447897

Functional recovery in patients with schizophrenia: recommendations from a panel of experts.

PubMed

Lahera, Guillermo; Gálvez, José L; Sánchez, Pedro; Martínez-Roig, Miguel; Pérez-Fuster, J V; García-Portilla, Paz; Herrera, Berta; Roca, Miquel

2018-06-05

The management of schizophrenia is evolving towards a more comprehensive model based on functional recovery. The concept of functional recovery goes beyond clinical remission and encompasses multiple aspects of the patient's life, making it difficult to settle on a definition and to develop reliable assessment criteria. In this consensus process based on a panel of experts in schizophrenia, we aimed to provide useful insights on functional recovery and its involvement in clinical practice and clinical research. After a literature review of functional recovery in schizophrenia, a scientific committee of 8 members prepared a 75-item questionnaire, including 6 sections: (I) the concept of functional recovery (9 items), (II) assessment of functional recovery (23 items), (III) factors influencing functional recovery (16 items), (IV) psychosocial interventions and functional recovery (8 items), (V) pharmacological treatment and functional recovery (14 items), and (VI) the perspective of patients and their relatives on functional recovery (5 items). The questionnaire was sent to a panel of 53 experts, who rated each item on a 9-point Likert scale. Consensus was achieved in a 2-round Delphi dynamics, using the median (interquartile range) scores to consider consensus in either agreement (scores 7-9) or disagreement (scores 1-3). Items not achieving consensus in the first round were sent back to the experts for a second consideration. After the two recursive rounds, consensus was achieved in 64 items (85.3%): 61 items (81.3%) in agreement and 3 (4.0%) in disagreement, all of them from section II (assessment of functional recovery). Items not reaching consensus were related to the concepts of functional recovery (1 item, 1.3%), functional assessment (5 items, 6.7%), factors influencing functional recovery (3 items, 4.0%), and psychosocial interventions (2 items, 5.6%). Despite the lack of a well-defined concept of functional recovery, we identified a trend towards a common

The importance of assessment and management of morning stiffness in Asian patients with rheumatoid arthritis: Recommendations from an expert panel.

PubMed

Mok, Chi Chiu; Cha, Hoon Suk; Hidayat, Rudy; Nguyen, Lan Thi Ngoc; Perez, Emmanuel C; Ramachandran, Raveendran; Tsay, Gregory J; Yoo, Dae Hyun

2016-01-01

In patients with rheumatoid arthritis (RA), morning stiffness is linked more to functional disability and pain than disease activity, as assessed by joint counts and markers of inflammation. As part of the Asia Pacific Morning Stiffness in Rheumatoid Arthritis Expert Panel, a group of eight rheumatologists met to formulate consensus points and develop recommendations for the assessment and management of morning stiffness in RA. On the basis of a systematic literature review and expert opinion, a panel of Asian rheumatologists formulated recommendations for the assessment and medical treatment of RA. The panel agreed upon 10 consensus statements on morning stiffness, its assessment and treatment. Specifically, the panel recommended that morning stiffness, pain and impaired morning function should be routinely assessed in clinical practice. Although there are currently no validated tools for these parameters, they should be assessed as part of the patients' reported outcomes in RA. The panel also agreed on the benefits of low-dose glucocorticoids in RA, particularly for the improvement of morning stiffness. These recommendations serve to guide rheumatologists and other stakeholders on the assessment and management of morning stiffness, and help implement the treat-to-target principle in the management of RA. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

Gold standards and expert panels: a pulmonary nodule case study with challenges and solutions

NASA Astrophysics Data System (ADS)

Miller, Dave P.; O'Shaughnessy, Kathryn F.; Wood, Susan A.; Castellino, Ronald A.

2004-05-01

Comparative evaluations of reader performance using different modalities, e.g. CT with computer-aided detection (CAD) vs. CT without CAD, generally require a "truth" definition based on a gold standard. There are many situations in which a true invariant gold standard is impractical or impossible to obtain. For instance, small pulmonary nodules are generally not assessed by biopsy or resection. In such cases, it is common to use a unanimous consensus or majority agreement from an expert panel as a reference standard for actionability in lieu of the unknown gold standard for disease. Nonetheless, there are three major concerns about expert panel reference standards: (1) actionability is not synonymous with disease (2) it may be possible to obtain different conclusions about which modality is better using different rules (e.g. majority vs. unanimous consensus), and (3) the variability associated with the panelists is not formally captured in the p-values or confidence intervals that are generally produced for estimating the extent to which one modality is superior to the other. A multi-reader-multi-case (MRMC) receiver operating characteristic (ROC) study was performed using 90 cases, 15 readers, and a reference truth based on 3 experienced panelists. The primary analyses were conducted using a reference truth of unanimous consensus regarding actionability (3 out of 3 panelists). To assess the three concerns noted above: (1) additional data from the original radiology reports were compared to the panel (2) the complete analysis was repeated using different definitions of truth, and (3) bootstrap analyses were conducted in which new truth panels were constructed by picking 1, 2, or 3 panelists at random. The definition of the reference truth affected the results for each modality (CT with CAD and CT without CAD) considered by itself, but the effects were similar, so the primary analysis comparing the modalities was robust to the choice of the reference truth.

Curriculum Reform in 3D: A Panel of Experts Discuss the New HPE Curriculum in Australia

ERIC Educational Resources Information Center

Hickey, Chris; Kirk, David; Macdonald, Doune; Penney, Dawn

2014-01-01

This paper was developed at the request of the Organising Committee for the 27th Australian Council for Health, Physical Education and Recreation International Conference, in Melbourne, 2013. Its genesis was as a feature forum, wherein a panel of curriculum experts were bought together to discuss the emergence of the Australian Health and Physical…

Establishment of an International University: Report of the United Nations Panel of Experts and the Director-General's Proposals in This Connexion.

ERIC Educational Resources Information Center

United Nations Educational, Scientific, and Cultural Organization, Paris (France).

This document contains the report and recommendations of the United Nations Panel of Experts on the Establishment of an International University. The panel feels that such a university would be highly beneficial to all nations. The first function of an International University would be to concern itself with problems such as those of coexistence…

Inferring Geographic Coordinates of Origin for Europeans Using Small Panels of Ancestry Informative Markers

PubMed Central

Paschou, Peristera

2010-01-01

Recent large-scale studies of European populations have demonstrated the existence of population genetic structure within Europe and the potential to accurately infer individual ancestry when information from hundreds of thousands of genetic markers is used. In fact, when genomewide genetic variation of European populations is projected down to a two-dimensional Principal Components Analysis plot, a surprising correlation with actual geographic coordinates of self-reported ancestry has been reported. This substructure can hamper the search of susceptibility genes for common complex disorders leading to spurious correlations. The identification of genetic markers that can correct for population stratification becomes therefore of paramount importance. Analyzing 1,200 individuals from 11 populations genotyped for more than 500,000 SNPs (Population Reference Sample), we present a systematic exploration of the extent to which geographic coordinates of origin within Europe can be predicted, with small panels of SNPs. Markers are selected to correlate with the top principal components of the dataset, as we have previously demonstrated. Performing thorough cross-validation experiments we show that it is indeed possible to predict individual ancestry within Europe down to a few hundred kilometers from actual individual origin, using information from carefully selected panels of 500 or 1,000 SNPs. Furthermore, we show that these panels can be used to correctly assign the HapMap Phase 3 European populations to their geographic origin. The SNPs that we propose can prove extremely useful in a variety of different settings, such as stratification correction or genetic ancestry testing, and the study of the history of European populations. PMID:20805874

International Expert Panel Consensus Guidelines for Structure and Delivery of Qigong Exercise for Cancer Care Programming

PubMed Central

Klein, Penelope; Picard, George; Schneider, Roger; Oh, Byeongsang

2017-01-01

Integrative oncology, including Qigong, is a relatively new concept in modern healthcare. Evidence of benefits of Qigong in cancer survivors is emerging. As such, several cancer centers, world-wide, have introduced Qigong as part of integrative medicine within supportive cancer care programming. Qigong exercise programming content and quality varies among institutions due to lack of standard guidelines and, at present, relies solely on the instructor’s skills, knowledge, personal preferences and clinical experience. Development of consensus guidelines recommending the basic structure and delivery of Qigong programming in cancer care can potentiate quality assurance and reduce risk of harm. This applied qualitative research utilized a modified Delphi approach to formulate consensus guidelines. Guidelines were developed through discussions among an international expert panel (N = 13) with representation from Australia, Canada, Ireland, and the United States. Panel communication was predominantly conducted by email and occurred from November 2016 through February 2017. Expert panel work resulted in the generation of a work product: Qigong in Cancer Care Guidelines: A Working Paper including: (a) Consensus Guidelines for structure and delivery of Qigong exercise for Cancer care programming; (b) Consensus guidelines for instructor competence for teaching Qigong exercise for cancer care classes; (c) Screening tool for safe participation in Qigong exercise; (d) Class participant instructions for maintaining safety during Qigong exercise; and (e) Advice from the field. Generation of these resources is the first step in establishing recommendations for ‘best practice’ in the area of Qigong for cancer care programming.

Radiofrequency ablation for hepatic hemangiomas: A consensus from a Chinese panel of experts

PubMed Central

Gao, Jun; Fan, Rui-Fang; Yang, Jia-Yin; Cui, Yan; Ji, Jian-Song; Ma, Kuan-Sheng; Li, Xiao-Long; Zhang, Long; Xu, Chong-Liang; Kong, Xin-Liang; Ke, Shan; Ding, Xue-Mei; Wang, Shao-Hong; Yang, Meng-Meng; Song, Jin-Jin; Zhai, Bo; Nin, Chun-Ming; Guo, Shi-Gang; Xin, Zong-Hai; Lu, Jun; Dong, Yong-Hong; Zhu, Hua-Qiang; Sun, Wen-Bing

2017-01-01

Recent studies have shown that radiofrequency (RF) ablation therapy is a safe, feasible, and effective procedure for hepatic hemangiomas, even huge hepatic hemangiomas. RF ablation has the following advantages in the treatment of hepatic hemangiomas: minimal invasiveness, definite efficacy, high safety, fast recovery, relatively simple operation, and wide applicability. It is necessary to formulate a widely accepted consensus among the experts in China who have extensive expertise and experience in the treatment of hepatic hemangiomas using RF ablation, which is important to standardize the application of RF ablation for the management of hepatic hemangiomas, regarding the selection of patients with suitable indications to receive RF ablation treatment, the technical details of the techniques, therapeutic effect evaluations, management of complications, etc. A final consensus by a Chinese panel of experts who have the expertise of using RF ablation to treat hepatic hemangiomas was reached by means of literature review, comprehensive discussion, and draft approval. PMID:29093616

Conception of an Expert Advisory Board for the European Reference Network for Rare Respiratory Diseases.

PubMed

Walther, Désirée; Steinmann, Olivia; Schaefer, Johanna; Wagner, Thomas O F; Storf, Holger

2018-01-01

Due to low prevalence of rare diseases and lack of expertise, patients suffering rare diseases are challenged with finding experts that are specialized and experienced in treating their conditions and get qualified answers. To address this issue, the approach of an interactive platform was made, which should allow affected patients or physicians the possibility to ask experts their specific questions to gather and improve their knowledge about their condition. This paper introduces the pan-European Internet platform EXABO, an Expert Advisory Board, which is developed within the framework of the European Reference Network for rare respiratory diseases (ERN-LUNG). The purpose of establishing this platform is initially dedicated to rare respiratory diseases in whole Europe, whilst the set-up is however, planned to be a generic tool for additional diseases or groups of diseases. This paper gives an overview of the concept and planning of the EXABO platform and shows how the platform is to be implemented.

An expert assessment on climate change and health - with a European focus on lungs and allergies.

PubMed

Forsberg, Bertil; Bråbäck, Lennart; Keune, Hans; Kobernus, Mike; Krayer von Krauss, Martin; Yang, Aileen; Bartonova, Alena

2012-06-28

For almost 20 years, the Intergovernmental Panel on Climate Change has been assessing the potential health risks associated with climate change; with increasingly convincing evidence that climate change presents existing impacts on human health. In industrialized countries climate change may further affect public health and in particular respiratory health, through existing health stressors, including, anticipated increased number of deaths and acute morbidity due to heat waves; increased frequency of cardiopulmonary events due to higher concentrations of air pollutants; and altered spatial and temporal distribution of allergens and some infectious disease vectors. Additionally exposure to moulds and contaminants from water damaged buildings may increase. We undertook an expert elicitation amongst European researchers engaged in environmental medicine or respiratory health. All experts were actively publishing researchers on lung disease and air pollution, climate and health or a closely related research. We conducted an online questionnaire on proposed causal diagrams and determined levels of confidence that climate change will have an impact on a series of stressors. In a workshop following the online questionnaire, half of the experts further discussed the results and reasons for differences in assessments of the state of knowledge on exposures and health effects. Out of 16 experts, 100% expressed high to very high confidence that climate change would increase the frequency of heat waves. At least half expressed high or very high confidence that climate change would increase levels of pollen (50%), particulate matter (PM2.5) (55%), and ozone (70%). While clarity is needed around the impacts of increased exposures to health impacts of some stressors, including ozone and particulate matter levels, it was noted that definitive knowledge is not a prerequisite for policy action. Information to the public, preventive measures, monitoring and warning systems were among

Appropriate management of special situations in Crohn's disease (upper gastro-intestinal; extra-intestinal manifestations; drug safety during pregnancy and breastfeeding): Results of a multidisciplinary international expert panel-EPACT II.

PubMed

Mottet, Christian; Vader, John-Paul; Felley, Christian; Froehlich, Florian; Gonvers, Jean-Jacques; Juillerat, Pascal; Stockbrügger, Reinhold; Angelucci, Erika; Seibold, Frank; Michetti, Pierre; Pittet, Valérie

2009-12-01

High-grade evidence is lacking for most therapeutic decisions in Crohn's disease. Appropriateness criteria were developed for upper gastro-intestinal, extra-intestinal manifestations and drug safety during conception, pregnancy and breastfeeding in patients with Crohn's disease, to assist the physician in clinical decision making. The European Panel on the Appropriateness of Crohn's Disease Therapy (EPACT II), a multidisciplinary international European expert panel, rated clinical scenarios based on evidence from the published literature and panelists' own clinical expertise. Median ratings (on a 9-point scale) were stratified into three categories: appropriate (7-9), uncertain (4-6 with or without disagreement) and inappropriate (1-3). Experts were also asked to rank appropriate medications by priority. Proton pump inhibitors, steroids, azathioprine/6-mercaptopurine and infliximab are appropriate for upper gastro-duodenal Crohn's disease; for stenosis, endoscopic balloon dilation is the first-line therapy, although surgery is also appropriate. Ursodeoxycholic acid is the only appropriate treatment for primary sclerosing cholangitis. Infliximab is appropriate for Pyoderma gangrenosum, ankylosing spondylitis and uveitis, steroids for Pyoderma gangrenosum and ankylosing spondylitis, adalimumab for Pyoderma gangrenosum and ankylosing spondylitis, cyclosporine-A/tacrolimus for Pyoderma gangrenosum. Mesalamine, sulfasalazine, prednisone, azathioprine/6-mercaptopurine, ciprofloxacin, and probiotics, may be administered safely during pregnancy or for patients wishing to conceive, with the exception that male patients considering conception should avoid sulfasalazine. Metronidazol is considered safe in the 2nd and 3rd trimesters whereas infliximab is rated safe in the 1st trimester but uncertain in the 2nd and 3rd trimesters. Methotrexate is always contraindicated at conception, during pregnancy or during breastfeeding, due to its known teratogenicity. Mesalamine

Sequencing an Ashkenazi reference panel supports population-targeted personal genomics and illuminates Jewish and European origins

PubMed Central

Carmi, Shai; Hui, Ken Y.; Kochav, Ethan; Liu, Xinmin; Xue, James; Grady, Fillan; Guha, Saurav; Upadhyay, Kinnari; Ben-Avraham, Dan; Mukherjee, Semanti; Bowen, B. Monica; Thomas, Tinu; Vijai, Joseph; Cruts, Marc; Froyen, Guy; Lambrechts, Diether; Plaisance, Stéphane; Van Broeckhoven, Christine; Van Damme, Philip; Van Marck, Herwig; Barzilai, Nir; Darvasi, Ariel; Offit, Kenneth; Bressman, Susan; Ozelius, Laurie J.; Peter, Inga; Cho, Judy H.; Ostrer, Harry; Atzmon, Gil; Clark, Lorraine N.; Lencz, Todd; Pe’er, Itsik

2014-01-01

The Ashkenazi Jewish (AJ) population is a genetic isolate close to European and Middle Eastern groups, with genetic diversity patterns conducive to disease mapping. Here we report high-depth sequencing of 128 complete genomes of AJ controls. Compared with European samples, our AJ panel has 47% more novel variants per genome and is eightfold more effective at filtering benign variants out of AJ clinical genomes. Our panel improves imputation accuracy for AJ SNP arrays by 28%, and covers at least one haplotype in ≈67% of any AJ genome with long, identical-by-descent segments. Reconstruction of recent AJ history from such segments confirms a recent bottleneck of merely ≈350 individuals. Modelling of ancient histories for AJ and European populations using their joint allele frequency spectrum determines AJ to be an even admixture of European and likely Middle Eastern origins. We date the split between the two ancestral populations to ≈12–25 Kyr, suggesting a predominantly Near Eastern source for the repopulation of Europe after the Last Glacial Maximum. PMID:25203624

Defining the physician's duty to warn: consensus statement of Ontario's Medical Expert Panel on Duty to Inform

PubMed Central

Ferris, L E; Barkun, H; Carlisle, J; Hoffman, B; Katz, C; Silverman, M

1998-01-01

Ontario's Medical Expert Panel on Duty to Inform was formed to consider the duty of Ontario physicians in circumstances where a patient threatens to kill or cause serious bodily harm to a third party. The panel was concerned about the implications of any duty to inform on the integrity of the physician-patient relationship, particularly with respect to confidentiality. The panel agreed that regulations safeguarding the confidentiality of patient information ought to be changed only if there is a critical reason for doing so, but, after deliberation, the panel members concluded that the need to protect the public from serious risk of harm is a paramount concern that should supersede the duty of confidentiality. The recommendations reported here were endorsed in principle by the panelists and the groups they represented (the Royal College of Physicians and Surgeons of Canada, the Canadian Medical Protective Association, the College of Physicians and Surgeons of Ontario, the Ontario College of Family Physicians and the Ontario Medical Association) and are being implemented by the College of Physicians and Surgeons of Ontario. PMID:9629112

Prioritizing Measures of Digital Patient Engagement: A Delphi Expert Panel Study

PubMed Central

2017-01-01

Background Establishing a validated scale of patient engagement through use of information technology (ie, digital patient engagement) is the first step to understanding its role in health and health care quality, outcomes, and efficient implementation by health care providers and systems. Objective The aim of this study was to develop and prioritize measures of digital patient engagement based on patients’ use of the US Department of Veterans Affairs (VA)’s MyHealtheVet (MHV) portal, focusing on the MHV/Blue Button and Secure Messaging functions. Methods We aligned two models from the information systems and organizational behavior literatures to create a theory-based model of digital patient engagement. On the basis of this model, we conducted ten key informant interviews to identify potential measures from existing VA studies and consolidated the measures. We then conducted three rounds of modified Delphi rating by 12 national eHealth experts via Web-based surveys to prioritize the measures. Results All 12 experts completed the study’s three rounds of modified Delphi ratings, resulting in two sets of final candidate measures representing digital patient engagement for Secure Messaging (58 measures) and MHV/Blue Button (71 measures). These measure sets map to Donabedian’s three types of quality measures: (1) antecedents (eg, patient demographics); (2) processes (eg, a novel measure of Web-based care quality); and (3) outcomes (eg, patient engagement). Conclusions This national expert panel study using a modified Delphi technique prioritized candidate measures to assess digital patient engagement through patients’ use of VA’s My HealtheVet portal. The process yielded two robust measures sets prepared for future piloting and validation in surveys among Veterans. PMID:28550008

The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries.

PubMed

Renom-Guiteras, Anna; Meyer, Gabriele; Thürmann, Petra A

2015-07-01

The aim of the study was to develop a European list of potentially inappropriate medications (PIM) for older people, which can be used for the analysis and comparison of prescribing patterns across European countries and for clinical practice. A preliminary PIM list was developed, based on the German PRISCUS list of potentially inappropriate medications and other PIM lists from the USA, Canada and France. Thirty experts on geriatric prescribing from Estonia, Finland, France, the Netherlands, Spain and Sweden participated; eight experts performed a structured expansion of the list, suggesting further medications; twenty-seven experts participated in a two-round Delphi survey assessing the appropriateness of drugs and suggesting dose adjustments and therapeutic alternatives. Finally, twelve experts completed a brief final survey to decide upon issues requiring further consensus. Experts reached a consensus that 282 chemical substances or drug classes from 34 therapeutic groups are PIM for older people; some PIM are restricted to a certain dose or duration of use. The PIM list contains suggestions for dose adjustments and therapeutic alternatives. The European Union (EU)(7)-PIM list is a screening tool, developed with participation of experts from seven European countries, that allows identification and comparison of PIM prescribing patterns for older people across European countries. It can also be used as a guide in clinical practice, although it does not substitute the decision-making process of individualised prescribing for older people. Further research is needed to investigate the feasibility and applicability and, finally, the clinical benefits of the newly developed list.

Comprehensive embryo testing. Experts' opinions regarding future directions: an expert panel study on comprehensive embryo testing.

PubMed

Hens, Kristien; Dondorp, Wybo J; Geraedts, Joep P M; de Wert, Guido M

2013-05-01

What do scientists in the field of preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS) consider to be the future direction of comprehensive embryo testing? Although there are many biological and technical limitations, as well as uncertainties regarding the meaning of genetic variation, comprehensive embryo testing will impact the IVF/PGD practice and a timely ethical reflection is needed. Comprehensive testing using microarrays is currently being introduced in the context of PGD and PGS, and it is to be expected that whole-genome sequencing will also follow. Current ethical and empirical sociological research on embryo testing focuses on PGD as it is practiced now. However, empirical research and systematic reflection regarding the impact of comprehensive techniques for embryo testing is missing. In order to understand the potential of this technology and to be able to adequately foresee its implications, we held an expert panel with seven pioneers in PGD. We conducted an expert panel in October 2011 with seven PGD pioneers from Belgium, The Netherlands, Germany and the UK. Participants expected the use of comprehensive techniques in the context of PGD. However, the introduction of these techniques in embryo testing requires timely ethical reflection as it involves a shift from choosing an embryo without a particular genetic disease (i.e. PGD) or most likely to result in a successful pregnancy (i.e. PGS) to choosing the best embryo based on a much wider set of criteria. Such ethical reflection should take account of current technical and biological limitations and also of current uncertainties with regard to the meaning of genetic variance. However, ethicists should also not be afraid to look into the future. There was a general agreement that embryo testing will be increasingly preceded by comprehensive preconception screening, thus enabling smart combinations of genetic testing. The group was composed of seven participants from

Risk Management Post-Marketing Surveillance for the Abuse of Medications Acting on the Central Nervous System: Expert Panel Report

PubMed Central

Johanson, Chris-Ellyn; Balster, Robert L.; Henningfield, Jack E.; Schuster, Charles R.; Anthony, James C.; Barthwell, Andrea G.; Coleman, John J.; Dart, Richard C.; Gorodetzky, Charles W.; O’Keeffe, Charles; Sellers, Edward M.; Vocci, Frank; Walsh, Sharon L.

2010-01-01

The abuse and diversion of medications is a significant public health problem. This paper is part of a supplemental issue of Drug and Alcohol Dependence focused on the development of risk management plans and post-marketing surveillance related to minimizing this problem. The issue is based on a conference that was held in October, 2008. An Expert Panel was formed to provide a summary of the conclusions and recommendations that emerged from the meeting involving drug abuse experts, regulators and other government agencies, pharmaceutical companies and professional and other non-governmental organizations. This paper provides a written report of this Expert Panel. Eleven conclusions and eleven recommendations emerged concerning the state of the art of this field of research, the regulatory and public health implications and recommendations for future directions. It is concluded that special surveillance tools are needed to detect the emergence of medication abuse in a timely manner and that risk management tools can be implemented to increase the benefit to risk ratio. The scientific basis for both the surveillance and risk management tools is in its infancy, yet progress needs to be made. It is also important that the unintended consequences of increased regulation and the imposition of risk management plans be minimized. PMID:19783383

Prioritizing Measures of Digital Patient Engagement: A Delphi Expert Panel Study.

PubMed

Garvin, Lynn A; Simon, Steven R

2017-05-26

Establishing a validated scale of patient engagement through use of information technology (ie, digital patient engagement) is the first step to understanding its role in health and health care quality, outcomes, and efficient implementation by health care providers and systems. The aim of this study was to develop and prioritize measures of digital patient engagement based on patients' use of the US Department of Veterans Affairs (VA)'s MyHealtheVet (MHV) portal, focusing on the MHV/Blue Button and Secure Messaging functions. We aligned two models from the information systems and organizational behavior literatures to create a theory-based model of digital patient engagement. On the basis of this model, we conducted ten key informant interviews to identify potential measures from existing VA studies and consolidated the measures. We then conducted three rounds of modified Delphi rating by 12 national eHealth experts via Web-based surveys to prioritize the measures. All 12 experts completed the study's three rounds of modified Delphi ratings, resulting in two sets of final candidate measures representing digital patient engagement for Secure Messaging (58 measures) and MHV/Blue Button (71 measures). These measure sets map to Donabedian's three types of quality measures: (1) antecedents (eg, patient demographics); (2) processes (eg, a novel measure of Web-based care quality); and (3) outcomes (eg, patient engagement). This national expert panel study using a modified Delphi technique prioritized candidate measures to assess digital patient engagement through patients' use of VA's My HealtheVet portal. The process yielded two robust measures sets prepared for future piloting and validation in surveys among Veterans. ©Lynn A Garvin, Steven R Simon. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.05.2017.

European Nanotechnology Experts Visit NCL; Harmonize Best Practices for Nanomedicine Collaboration in Europe | FNLCR Staging

Cancer.gov

European nanotechnology experts visited the Nanotechnology Characterization Laboratory (NCL) to observe best practices and methods and to share their own knowledge with NCL scientists as they prepared to launch an NCL-like operation in Europe. The Eu

Exploring experts' views and perspectives on the enhancement of Strategic Environmental Assessment in European small islands

DOE Office of Scientific and Technical Information (OSTI.GOV)

Polido, Alexandra, E-mail: a.polido@campus.fct.unl.pt; João, Elsa, E-mail: elsa.joao@strath.ac.uk; Ramos, Tomás B., E-mail: tabr@fct.unl.pt

Small islands have the attention of the international community because they are territories with unique features, and a pressing need for the enhancement of sustainability. Strategic Environmental Assessment (SEA) has characteristics that may promote the development and improvement of sustainability in these territories: (i) changing the mind-set, and the decision-making and institutional paradigm, (ii) facilitating cooperation and coordination between different stakeholders, and (iii) providing a framework for good governance and community empowerment. The scientific literature suggests that there may be a need for context-specific SEA in these territories. However, SEA studies often do not incorporate local contextual information, including intuitivemore » knowledge and sense of place. Therefore, there is a possible gap between what is found in the literature and what local communities think, including different stakeholders and experts. Hence, the main goal of this research was to gain an insight into the views and perspectives of small islands SEA experts about issues related to SEA in European small islands, including context-specific approaches, as well as the contribution of SEA for sustainability in these territories. To achieve the research aim, exploratory research using a questionnaire-based survey was designed, aimed at experts on SEA in European small islands. Findings showed regional cooperation networks may have a fundamental role when developing SEA-specific approaches in these territories. This is because SEA-specific approaches encourage a joint effort among islands within one region to improve SEA capacity-building, develop and share a baseline information system, and to share and exchange resources, overall. Also, guidelines are preferred among experts over more legal frameworks and regulations. Finally, the research showed that experts view SEA as a way to enhance sustainability in small islands. This study highlights the importance of

EURECCA colorectal: multidisciplinary management: European consensus conference colon & rectum.

PubMed

van de Velde, Cornelis J H; Boelens, Petra G; Borras, Josep M; Coebergh, Jan-Willem; Cervantes, Andres; Blomqvist, Lennart; Beets-Tan, Regina G H; van den Broek, Colette B M; Brown, Gina; Van Cutsem, Eric; Espin, Eloy; Haustermans, Karin; Glimelius, Bengt; Iversen, Lene H; van Krieken, J Han; Marijnen, Corrie A M; Henning, Geoffrey; Gore-Booth, Jola; Meldolesi, Elisa; Mroczkowski, Pawel; Nagtegaal, Iris; Naredi, Peter; Ortiz, Hector; Påhlman, Lars; Quirke, Philip; Rödel, Claus; Roth, Arnaud; Rutten, Harm; Schmoll, Hans J; Smith, Jason J; Tanis, Pieter J; Taylor, Claire; Wibe, Arne; Wiggers, Theo; Gambacorta, Maria A; Aristei, Cynthia; Valentini, Vincenzo

2014-01-01

Care for patients with colon and rectal cancer has improved in the last 20years; however considerable variation still exists in cancer management and outcome between European countries. Large variation is also apparent between national guidelines and patterns of cancer care in Europe. Therefore, EURECCA, which is the acronym of European Registration of Cancer Care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012, the first multidisciplinary consensus conference about cancer of the colon and rectum was held. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries. The expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal Cancer Patient Organisation (EuropaColon), as well as delegates from national registries or audits. Consensus was achieved using the Delphi method. For the Delphi process, multidisciplinary experts were invited to comment and vote three web-based online voting rounds and to lecture on the subjects during the meeting (13th-15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. This manuscript covers all sentences of the consensus document with the result of the voting. The consensus document represents sections on diagnostics, pathology, surgery, medical oncology, radiotherapy, and follow-up where

Education policy implications from the Expert Panel on Electronic Media and Youth Violence.

PubMed

Worthen, Maria R

2007-12-01

The research from the Expert Panel on Electronic Media and Youth Violence makes a compelling case for why educators and education policymakers should care about the effects of media on youth behavior, and the growing phenomenon of Internet bullying and harassment. The ability of the U.S. education system to respond is limited not only by competing instructional priorities but also by the governance structure of the education system itself. The federal role is limited to a proportionally small amount of funding for states and schools, to raising public awareness, and to providing research and data. States can set priorities, make requirements, and direct funding. Districts and schools ultimately have the most control over prevention program selection and setting social and behavioral norms. Key implications of the panel's research for educators and education policymakers include: Internet bullying is correlated with school behavior problems; Internet bullying behavior may peak in middle school; Internet bullying shares common predictors with verbal and, to some extent, physical bullying; Media literacy programs may mitigate the negative effects of electronic media on youth. Specific recommendations based on these conclusions are discussed, and research priorities for the prevention and education fields are identified.

Indonesian dengue burden estimates: review of evidence by an expert panel.

PubMed

Wahyono, T Y M; Nealon, J; Beucher, S; Prayitno, A; Moureau, A; Nawawi, S; Thabrany, H; Nadjib, M

2017-08-01

Routine, passive surveillance systems tend to underestimate the burden of communicable diseases such as dengue. When empirical methods are unavailable, complimentary opinion-based or extrapolative methods have been employed. Here, an expert Delphi panel estimated the proportion of dengue captured by the Indonesian surveillance system, and associated health system parameters. Following presentation of medical and epidemiological data and subsequent discussions, the panel made iterative estimates from which expansion factors (EF), the ratio of total:reported cases, were calculated. Panelists estimated that of all symptomatic Indonesian dengue episodes, 57·8% (95% confidence interval (CI) 46·6-59·8) enter healthcare facilities to seek treatment; 39·3% (95% CI 32·8-42·0) are diagnosed as dengue; and 20·3% (95% CI 16·1-24·3) are subsequently reported in the surveillance system. They estimated most hospitalizations occur in the public sector, while ~55% of ambulatory episodes are seen privately. These estimates gave an overall EF of 5·00; hospitalized EF of 1·66; and ambulatory EF of 34·01 which, when combined with passive surveillance data, equates to an annual average (2006-2015) of 612 005 dengue cases, and 183 297 hospitalizations. These estimates are lower than those published elsewhere, perhaps due to case definitions, local clinical perceptions and treatment-seeking behavior. These findings complement global burden estimates, support health economic analyses, and can be used to inform decision-making.

Risk management and post-marketing surveillance for the abuse of medications acting on the central nervous system: expert panel report.

PubMed

Johanson, Chris-Ellyn; Balster, Robert L; Henningfield, Jack E; Schuster, Charles R; Anthony, James C; Barthwell, Andrea G; Coleman, John J; Dart, Richard C; Gorodetzky, Charles W; O'Keeffe, Charles; Sellers, Edward M; Vocci, Frank; Walsh, Sharon L

2009-12-01

The abuse and diversion of medications is a significant public health problem. This paper is part of a supplemental issue of Drug and Alcohol Dependence focused on the development of risk management plans and post-marketing surveillance related to minimizing this problem. The issue is based on a conference that was held in October 2008. An Expert Panel was formed to provide a summary of the conclusions and recommendations that emerged from the meeting involving drug abuse experts, regulators and other government agencies, pharmaceutical companies and professional and other non-governmental organizations. This paper provides a written report of this Expert Panel. Eleven conclusions and 11 recommendations emerged concerning the state of the art of this field of research, the regulatory and public health implications and recommendations for future directions. It is concluded that special surveillance tools are needed to detect the emergence of medication abuse in a timely manner and that risk management tools can be implemented to increase the benefit to risk ratio. The scientific basis for both the surveillance and risk management tools is in its infancy, yet progress needs to be made. It is also important that the unintended consequences of increased regulation and the imposition of risk management plans be minimized.

Patient engagement with surgical site infection prevention: an expert panel perspective.

PubMed

Tartari, E; Weterings, V; Gastmeier, P; Rodríguez Baño, J; Widmer, A; Kluytmans, J; Voss, A

2017-01-01

Despite remarkable developments in the use of surgical techniques, ergonomic advancements in the operating room, and implementation of bundles, surgical site infections (SSIs) remain a substantial burden, associated with increased morbidity, mortality and healthcare costs. National and international recommendations to prevent SSIs have been published, including recent guidelines by the World Health Organization, but implementation into clinical practice remains an unresolved issue. SSI improvement programs require an integrative approach with measures taken during the pre-, intra- and postoperative care from the numerous stakeholders involved. The current SSI prevention strategies have focused mainly on the role of healthcare workers (HCWs) and procedure related risk factors. The importance and influence of patient participation is becoming an increasingly important concept and advocated as a means to improve patient safety. Novel interventions supporting an active participative role within SSI prevention programs have not been assessed. Empowering patients with information they require to engage in the process of SSI prevention could play a major role for the implementation of recommendations. Based on available scientific evidence, a panel of experts evaluated options for patient involvement in order to provide pragmatic recommendations for pre-, intra- and postoperative activities for the prevention of SSIs. Recommendations were based on existing guidelines and expert opinion. As a result, 9 recommendations for the surgical patient are presented here, including a practice brief in the form of a patient information leaflet. HCWs can use this information to educate patients and allow patient engagement.

Report of the 5th European expert meeting on rotavirus vaccination (EEROVAC).

PubMed

de Hoog, Marieke L A; Vesikari, Timo; Giaquinto, Carlo; Huppertz, Hans-Iko; Martinon-Torres, Federico; Bruijning-Verhagen, Patricia

2018-04-03

The Fifth European Expert Meeting on Rotavirus Vaccination was convened in Utrecht, The Netherlands, in March 2017. The 2-day meeting included invited lectures as well as original oral and poster presentations and brought together experts from 21 countries. Summary findings of the meeting include: Rotavirus vaccination programmes in Europe have resulted in reductions of 60-90% in rotavirus outpatient visits and hospitalizations. Long term trends indicate this impact is sustained over the years. Herd effects, protecting unvaccinated children and neonates too young to be vaccinated have been observed in many European countries. Early evidence now also suggests that rotavirus vaccination may be instrumental in the prevention of celiac disease. Special attention should be given to preterm infants, who may age out of the vaccination window before hospital discharge and to HIV infected children who are at increased risk of severe rotavirus AGE. There is a small but increased risk of IS following rotavirus vaccination and parents should therefore be informed about possible signs and symptoms of IS. New insights in rotavirus genetic susceptibility and interactions with microbiome may open opportunities for interventions to improve protection by vaccination, in particular in LMIC. The development of several novel rotavirus vaccines discussed at the meeting is also promising in this respect.

Exploring the role and function of trial steering committees: results of an expert panel meeting.

PubMed

Harman, Nicola L; Conroy, Elizabeth J; Lewis, Steff C; Murray, Gordon; Norrie, John; Sydes, Matt R; Lane, J Athene; Altman, Douglas G; Baigent, Colin; Bliss, Judith M; Campbell, Marion K; Elbourne, Diana; Evans, Stephen; Sandercock, Peter; Gamble, Carrol

2015-12-30

The independent oversight of clinical trials, which is recommended by the Medical Research Council (MRC) Guidelines for Good Clinical Practice, is typically provided by an independent advisory Data Monitoring Committee (DMC) and an independent executive committee, to whom the DMC makes recommendations. The detailed roles and function of this executive committee, known as the Trial Steering Committee (TSC), have not previously been studied or reviewed since those originally proposed by the MRC in 1998. An expert panel (n = 7) was convened comprising statisticians, clinicians and trial methodologists with prior TSC experience. Twelve questions about the role and responsibilities of the TSC were discussed by the panel at two full-day meetings. Each meeting was transcribed in full and the discussions were summarised. The expert panel reached agreement on the role of the TSC, to which it was accountable, the membership, the definition of independence, and the experience and training needed. The management of ethical issues, difficult/complex situations and issues the TSC should not ask the DMC to make recommendations on were more difficult to discuss without specific examples, but support existed for further work to help share issues and to provide appropriate training for TSC members. Additional topics discussed, which had not been identified by previous work relating to the DMCs but were pertinent to the role of the TSC, included the following: review of data sharing requests, indemnity, lifespan of the TSC, general TSC administration, and the roles of both the Funder and the Sponsor. This paper presents recommendations that will contribute to the revision and update of the MRC TSC terms of reference. Uncertainty remains in some areas due to the absence of real-life examples; future guidance on these issues would benefit from a repository of case studies. Notably, the role of a patient and public involvement (PPI) contributor was not discussed, and further work is

International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT).

PubMed

Torres, Antoni; Niederman, Michael S; Chastre, Jean; Ewig, Santiago; Fernandez-Vandellos, Patricia; Hanberger, Hakan; Kollef, Marin; Li Bassi, Gianluigi; Luna, Carlos M; Martin-Loeches, Ignacio; Paiva, J Artur; Read, Robert C; Rigau, David; Timsit, Jean François; Welte, Tobias; Wunderink, Richard

2017-09-01

The most recent European guidelines and task force reports on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were published almost 10 years ago. Since then, further randomised clinical trials of HAP and VAP have been conducted and new information has become available. Studies of epidemiology, diagnosis, empiric treatment, response to treatment, new antibiotics or new forms of antibiotic administration and disease prevention have changed old paradigms. In addition, important differences between approaches in Europe and the USA have become apparent.The European Respiratory Society launched a project to develop new international guidelines for HAP and VAP. Other European societies, including the European Society of Intensive Care Medicine and the European Society of Clinical Microbiology and Infectious Diseases, were invited to participate and appointed their representatives. The Latin American Thoracic Association was also invited.A total of 15 experts and two methodologists made up the panel. Three experts from the USA were also invited (Michael S. Niederman, Marin Kollef and Richard Wunderink).Applying the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, the panel selected seven PICO (population-intervention-comparison-outcome) questions that generated a series of recommendations for HAP/VAP diagnosis, treatment and prevention. Copyright ©ERS 2017.

Heart Rhythm Monitoring in the Constellation Lunar and Launch/Landing EVA Suit: Recommendations from an Expert Panel

NASA Technical Reports Server (NTRS)

Scheuring, Richard A.; Hamilton, D.; Jones, J. A.; Alexander, D.

2008-01-01

Currently there are several physiological monitoring requirements for Extravehicular Activity (EVA) in the Human-Systems Interface Requirements (HSIR) document, including continuous heart rhythm monitoring. However, it is not known whether heart rhythm monitoring in the lunar surface space suit is a necessary capability for lunar surface operations or in launch/landing suit the event of a cabin depressurization enroute to or from the moon. Methods: Current US astronaut corps demographic information was provided to an expert panel of cardiovascular medicine experts, including specialists in electrophysiology, exercise physiology, interventional cardiology and arrhythmia. This information included averages for male/female age, body mass index (BMI), blood pressure, cholesterol, inflammatory markers, echocardiogram, ranges for coronary artery calcium (CAC) scores for long duration astronauts, and ranges for heart rate (HR) and metabolic (MET) rates obtained during microgravity and lunar EVA. Results: The panel determined that no uncontrolled hazard was likely to occur in the suit during lunar surface or contingency microgravity ops that would require ECG monitoring in the highly screened US astronaut population. However having the capability for rhythm monitoring inside the vehicle (IVA) was considered critical to manage an astronaut in distress. Discussion: Heart rate (HR) monitoring alone allows effective monitoring of astronaut health and function. Consequently, electrocardiographic (ECG) monitoring capability as a clinical tool is not essential in the lunar or launch/landing space suit. However, the panel considered that rhythm monitoring could be useful in certain clinical situations, it was not considered required for safe operations. Also, lunar vehicles should be required to have ECG monitoring capability with a minimum of 5-lead ECG (derived 12- lead) for IVA medical assessments.

Leveraging geospatial data, technology, and methods for improving the health of communities: priorities and strategies from an expert panel convened by the CDC.

PubMed

Elmore, Kim; Flanagan, Barry; Jones, Nicholas F; Heitgerd, Janet L

2010-04-01

In 2008, CDC convened an expert panel to gather input on the use of geospatial science in surveillance, research and program activities focused on CDC's Healthy Communities Goal. The panel suggested six priorities: spatially enable and strengthen public health surveillance infrastructure; develop metrics for geospatial categorization of community health and health inequity; evaluate the feasibility and validity of standard metrics of community health and health inequities; support and develop GIScience and geospatial analysis; provide geospatial capacity building, training and education; and, engage non-traditional partners. Following the meeting, the strategies and action items suggested by the expert panel were reviewed by a CDC subcommittee to determine priorities relative to ongoing CDC geospatial activities, recognizing that many activities may need to occur either in parallel, or occur multiple times across phases. Phase A of the action items centers on developing leadership support. Phase B focuses on developing internal and external capacity in both physical (e.g., software and hardware) and intellectual infrastructure. Phase C of the action items plan concerns the development and integration of geospatial methods. In summary, the panel members provided critical input to the development of CDC's strategic thinking on integrating geospatial methods and research issues across program efforts in support of its Healthy Communities Goal.

Levosimendan beyond inotropy and acute heart failure: Evidence of pleiotropic effects on the heart and other organs: An expert panel position paper.

PubMed

Farmakis, Dimitrios; Alvarez, Julian; Gal, Tuvia Ben; Brito, Dulce; Fedele, Francesco; Fonseca, Candida; Gordon, Anthony C; Gotsman, Israel; Grossini, Elena; Guarracino, Fabio; Harjola, Veli-Pekka; Hellman, Yaron; Heunks, Leo; Ivancan, Visnja; Karavidas, Apostolos; Kivikko, Matti; Lomivorotov, Vladimir; Longrois, Dan; Masip, Josep; Metra, Marco; Morelli, Andrea; Nikolaou, Maria; Papp, Zoltán; Parkhomenko, Alexander; Poelzl, Gerhard; Pollesello, Piero; Ravn, Hanne Berg; Rex, Steffen; Riha, Hynek; Ricksten, Sven-Erik; Schwinger, Robert H G; Vrtovec, Bojan; Yilmaz, M Birhan; Zielinska, Marzenna; Parissis, John

2016-11-01

Levosimendan is a positive inotrope with vasodilating properties (inodilator) indicated for decompensated heart failure (HF) patients with low cardiac output. Accumulated evidence supports several pleiotropic effects of levosimendan beyond inotropy, the heart and decompensated HF. Those effects are not readily explained by cardiac function enhancement and seem to be related to additional properties of the drug such as anti-inflammatory, anti-oxidative and anti-apoptotic ones. Mechanistic and proof-of-concept studies are still required to clarify the underlying mechanisms involved, while properly designed clinical trials are warranted to translate preclinical or early-phase clinical data into more robust clinical evidence. The present position paper, derived by a panel of 35 experts in the field of cardiology, cardiac anesthesiology, intensive care medicine, cardiac physiology, and cardiovascular pharmacology from 22 European countries, compiles the existing evidence on the pleiotropic effects of levosimendan, identifies potential novel areas of clinical application and defines the corresponding gaps in evidence and the required research efforts to address those gaps. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Creating a roadmap for delivering gender-sensitive comprehensive care for women Veterans: results of a national expert panel.

PubMed

deKleijn, Miriam; Lagro-Janssen, Antoine L M; Canelo, Ismelda; Yano, Elizabeth M

2015-04-01

Women Veterans are a significant minority of users of the VA healthcare system, limiting provider and staff experience meeting their needs in environments historically designed for men. The VA is nonetheless committed to ensuring that women Veterans have access to comprehensive care in environments sensitive to their needs. We sought to determine what aspects of care need to be tailored to the needs of women Veterans in order for the VA to deliver gender-sensitive comprehensive care. Modified Delphi expert panel process. Eleven clinicians and social scientists with expertise in women's health, primary care, and mental health. Importance of tailoring over 100 discrete aspects of care derived from the Institute of Medicine's definition of comprehensive care and literature-based domains of sex-sensitive care on a 5-point scale. Panelists rated over half of the aspects of care as very-to-extremely important (median score 4+) to tailor to the needs of women Veterans. The panel arrived at 14 priority recommendations that broadly encompassed the importance of (1) the design/delivery of services sensitive to trauma histories, (2) adapting to women's preferences and information needs, and (3) sex awareness and cultural transformation in every facet of VA operations. We used expert panel methods to arrive at consensus on top priority recommendations for improving delivery of sex-sensitive comprehensive care in VA settings. Accomplishment of their breadth will require national, regional, and local strategic action and multilevel stakeholder engagement, and will support VA's national efforts at improving customer service for all Veterans.

The Report of the Expert Panel on the Sustainable Management of Groundwater in Canada: The Council of Canadian Academies

NASA Astrophysics Data System (ADS)

Bruce, J. P.

2009-05-01

The Expert Panel on Groundwater was established in response to a request from the Minister of Natural Resources Canada, asking the Council of Canadian Academies to assess what is needed to achieve sustainable management of Canada's groundwater resources, from a science perspective. To this end, the Council of Canadian Academies assembled an interdisciplinary panel of experts who interpreted science, in the context of this assessment, to include natural and social sciences as well as local, provincial, and federal governance. The panel's report, released on May 11th 2009, noted that nearly 10 million Canadians rely on groundwater for household purposes, in addition to uses for agriculture and industry. Both media and public have expressed many recent concerns about water supplies and their quality. The concept of groundwater sustainability developed by the panel encompasses five interrelated goals: three that involve primarily the physical sciences and engineering, and two that are essentially socio-economic in nature. These goals are as follows: i. Protection of groundwater supplies from depletion ii. Protection of groundwater quality from contamination iii. Protection of ecosystem viability iv. Achievement of economic and social well-being v. Application of good governance The achievement of groundwater sustainability requires a careful analysis and balancing of the five goals; a comprehensive sustainability framework for groundwater has not yet been implemented in Canada. Adoption by federal, provincial and local jurisdictions of such a framework, based on the goals outlined above, would be invaluable in guiding efforts to improve the understanding and management of groundwater. To contextualize the components of the sustainability framework, the panel examined a series of case studies that typify examples along a spectrum, from near-sustainable, to situations that are fail to meet the outlined criteria. The panel identified the fragmentation of water management

Identification and management of comorbidity in psoriatic arthritis: evidence- and expert-based recommendations from a multidisciplinary panel from Spain.

PubMed

Torre-Alonso, Juan Carlos; Carmona, Loreto; Moreno, Mireia; Galíndez, Eva; Babío, Jesús; Zarco, Pedro; Linares, Luis; Collantes-Estevez, Eduardo; Barrial, Manuel Fernández; Hermosa, Juan Carlos; Coto, Pablo; Suárez, Carmen; Almodóvar, Raquel; Luelmo, Jesús; Castañeda, Santos; Gratacós, Jordi

2017-08-01

The objective is to establish recommendations, based on evidence and expert opinion, for the identification and management of comorbidities in patients with psoriatic arthritis (PsA). The following techniques were applied: discussion group, systematic review, and Delphi survey for agreement. A panel of professionals from four specialties defined the users, the sections of the document, possible recommendations, and what systematic reviews should be performed. A second discussion was held with the results of the systematic reviews. Recommendations were formulated in the second meeting and voted online from 1 (total disagreement) to 10 (total agreement). Agreement was considered if at least 70% voted ≥7. The level of evidence and grade of recommendation were assigned using the Oxford Centre for Evidence-Based Medicine guidance. The full document was critically appraised by the experts, and the project was supervised at all times by a methodologist. In a final step, the document was reviewed and commented by a patient and a health management specialist. Fourteen recommendations were produced, together with a checklist to facilitate the implementation. The items with the largest support from evidence were those related to cardiovascular disease and risk factors. The panel recommends paying special attention to obesity, smoking, and alcohol consumption, as they are all modifiable factors with an impact on treatment response or complications of PsA. Psychological and organizational aspects were also deemed important. We herein suggest practical recommendations for the management of comorbidities in PsA based on evidence and expert opinion.

A consensus on liquid biopsy from the 2016 Chinese Lung Cancer Summit expert panel.

PubMed

Wu, Yi-Long; Wang, Chang-Li; Sun, Yan; Liao, Mei-Lin; Guan, Zhong-Zhen; Yang, Zhi-Min; Zhou, Qing-Hua; Lu, Shun; Cheng, Ying; Liu, Xiao-Qing; Zhang, Xu-Chao; Zhou, Caicun; Wang, Jie; Zhou, Qing; Song, Yong; Han, Bao-Hui; Ma, Zhi-Yong; Yang, Fan; Wang, Qun; Chuai, Shao-Kun; Shao, Yang; He, Wei; Zhu, Guanshan; Xiong, Lei; Wang, Jian-Jun; Chen, Ke-Neng; Zhang, Li; Mao, Wei-Min; Ma, Sheng-Lin; Feng, Ji-Feng; Yang, Xue-Ning; Xu, Lin; Chen, Gang; Zhao, Jian; Song, Qi-Bin; Shen-Tu, Yang; Qiao, Gui-Bin; Yu, Ding; Yu, Shi-Ying; Hu, Yi; Chen, Ming; Chen, Gong-Yan; Fan, Yun; Zhang, He-Long; Liang, Jun; Zhu, Guang-Ying; Cui, Jiu-Wei; Yang, Jin-Ji; Zhao, Qiong; Zhao, Ming-Fang; Lu, You; Chang, Jian-Hua; Li, Jun-Ling; Yang, Yue; Hu, Jie; Gu, Chun-Dong; Zhang, Yi-Chen; Zhong, Wen-Zhao

2017-01-01

The diagnosis and treatment of lung cancer have evolved into the era of precision medicine. Liquid biopsy, a minimally invasive approach, has emerged as a promising practice in genetic profiling and monitoring of lung cancer. Translating liquid biopsy from bench to bedside has encountered various challenges, including technique selection, protocol standardisation, data analysis and cost management. Regarding these challenges, the 2016 Chinese Lung Cancer Summit expert panel organised a trilateral forum involving oncologists, clinicians, clinical researchers, and industrial expertise on the 13th Chinese Lung Cancer Summit to formally discuss these controversies. Six consensuses were reached to guide the use of liquid biopsy and perform precision medicine in both clinic and research.

Health Economics of Dengue: A Systematic Literature Review and Expert Panel's Assessment

PubMed Central

Beatty, Mark E.; Beutels, Philippe; Meltzer, Martin I.; Shepard, Donald S.; Hombach, Joachim; Hutubessy, Raymond; Dessis, Damien; Coudeville, Laurent; Dervaux, Benoit; Wichmann, Ole; Margolis, Harold S.; Kuritsky, Joel N.

2011-01-01

Dengue vaccines are currently in development and policymakers need appropriate economic studies to determine their potential financial and public health impact. We searched five databases (PubMed, EMBASE, LILAC, EconLit, and WHOLIS) to identify health economics studies of dengue. Forty-three manuscripts were identified that provided primary data: 32 report economic burden of dengue and nine are comparative economic analyses assessing various interventions. The remaining two were a willingness-to-pay study and a policymaker survey. An expert panel reviewed the existing dengue economic literature and recommended future research to fill information gaps. Although dengue is an important vector-borne disease, the economic literature is relatively sparse and results have often been conflicting because of use of inconsistent assumptions. Health economic research specific to dengue is urgently needed to ensure informed decision making on the various options for controlling and preventing this disease. PMID:21363989

Evaluation of holistic sexuality education: A European expert group consensus agreement.

PubMed

Ketting, Evert; Friele, Minou; Michielsen, Kristien

2016-01-01

Holistic sexuality education (HSE) is a new concept in sexuality education (SE). Since it differs from other types of SE in a number of important respects, strategies developed for the evaluation of the latter are not necessarily applicable to HSE. In this paper the authors provide a basis for discussion on how to evaluate HSE. First, the international literature on evaluation of SE in general was reviewed in terms of its applicability to HSE. Second, the European Expert Group on Sexuality Education extensively discussed the requirements of its evaluation and suggested appropriate indicators and methods for evaluating HSE. The European experience in SE is scarcely represented in the general evaluation literature. The majority of the literature focuses on impact and neglects programme and implementation evaluations. Furthermore, the current literature demonstrates that evaluation criteria predominantly focus on the public health impact, while there is not yet a consensus on sexual well-being criteria and aspects of positive sexuality, which are crucial parts of HSE. Finally, experimental designs are still considered the gold standard, yet several of the conditions for their use are not fulfilled in HSE. Realising that a new evaluation framework for HSE is needed, the European expert group initiated its development and agreed upon a number of indicators that provide a starting point for further discussion. Aside from the health impact, the quality of SE programmes and their implementation also deserve attention and should be evaluated. To be applicable to HSE, the evaluation criteria need to cover more than the typical public health aspects. Since they do not register long-term and multi-component characteristics, evaluation methods such as randomised controlled trials are not sufficiently suitable for HSE. The evaluation design should rely on a number of different information sources from mixed methods that are complemented and triangulated to build a plausible case

Assessment of avionics technology in European aerospace organizations

NASA Technical Reports Server (NTRS)

Martinec, D. A.; Baumbick, Robert; Hitt, Ellis; Leondes, Cornelius; Mayton, Monica; Schwind, Joseph; Traybar, Joseph

1992-01-01

This report provides a summary of the observations and recommendations made by a technical panel formed by the National Aeronautics and Space Administration (NASA). The panel, comprising prominent experts in the avionics field, was tasked to visit various organizations in Europe to assess the level of technology planned for use in manufactured civil avionics in the future. The primary purpose of the study was to assess avionics systems planned for implementation or already employed on civil aircraft and to evaluate future research, development, and engineering (RD&E) programs, address avionic systems and aircraft programs. The ultimate goal is to ensure that the technology addressed by NASa programs is commensurate with the needs of the aerospace industry at an international level. The panel focused on specific technologies, including guidance and control systems, advanced cockpit displays, sensors and data networks, and fly-by-wire/fly-by-light systems. However, discussions the panel had with the European organizations were not limited to these topics.

Advancing Research on Endocrine Disrupting Chemicals in Breast Cancer: Expert Panel Recommendations

PubMed Central

Teitelbaum, Susan L.; Belpoggi, Fiorella; Reinlib, Les

2015-01-01

Breast cancer incidence continues to increase in the US and Europe, a reflection of the growing influence of environment factors that interact with personal genetics. The US Environmental Protection Agency estimates that over 85,000 endocrine disrupting chemicals are among the common daily exposures that could affect the risk of disease. The daunting tasks of identifying, characterizing, and elucidating the mechanisms of endocrine disrupting chemicals in breast cancer need to be addressed to produce a comprehensive model that will facilitate preventive strategies and public policy. An expert panel met to describe and bring attention to needs linking common environmental exposures, critical windows of exposure, and optimal times of assessment in investigating breast cancer risk. The group included investigators with extensive experience in the use of rodent models and in leading population studies and produced a set of recommendations for effective approaches to gaining insights into the environmental origins of breast cancer across the lifespan. PMID:25549947

An expert panel approach to assessing potential effects of bull trout reintroduction on federally listed salmonids in the Clackamas River, Oregon

Treesearch

Bruce G. Marcot; Chris S. Allen; Steve Morey; Dan Shively; Rollie White

2012-01-01

The bull trout Salvelinus confluentus is an apex predator in native fish communities in the western USA and is listed as threatened under the U.S. Endangered Species Act (ESA). Restoration of this species has raised concerns over its potential predatory impacts on native fish fauna. We held a five-person expert panel to help determine potential...

The healthy food environment policy index: findings of an expert panel in New Zealand.

PubMed

Vandevijvere, Stefanie; Dominick, Clare; Devi, Anandita; Swinburn, Boyd

2015-05-01

To assess government actions to improve the healthiness of food environments in New Zealand, based on the healthy food environment policy index. A panel of 52 public health experts rated the extent of government implementation against international best practice for 42 indicators of food environment policy and infrastructure support. Their ratings were informed by documented evidence, validated by government officials and international benchmarks. There was a high level of implementation for some indicators: providing ingredient lists and nutrient declarations and regulating health claims on packaged foods; transparency in policy development; monitoring prevalence of noncommunicable diseases and monitoring risk factors for noncommunicable diseases. There was very little, if any implementation of the following indicators: restrictions on unhealthy food marketing to children; fiscal and food retail policies and protection of national food environments within trade agreements. Interrater reliability was 0.78 (95% confidence interval, CI: 0.76-0.79). Based on the implementation gaps, the experts recommended 34 actions, and prioritized seven of these. The healthy food environment policy index provides a useful set of indicators that can focus attention on where government action is needed. It is anticipated that this policy index will increase accountability of governments, stimulate government action and support civil society advocacy efforts.

Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care.

PubMed

Radbruch, Lukas; Leget, Carlo; Bahr, Patrick; Müller-Busch, Christof; Ellershaw, John; de Conno, Franco; Vanden Berghe, Paul

2016-02-01

In recognition of the ongoing discussion on euthanasia and physician-assisted suicide, the Board of Directors of the European Association for Palliative Care commissioned this white paper from the palliative care perspective. This white paper aims to provide an ethical framework for palliative care professionals on euthanasia and physician-assisted suicide. It also aims to provide an overview on the available evidence as well as a discourse of ethical principles related to these issues. Starting from a 2003 European Association for Palliative Care position paper, 21 statements were drafted and submitted to a five-round Delphi process A panel with 17 experts commented on the paper in round 1. Board members of national palliative care or hospice associations that are collective members of European Association for Palliative Care were invited to an online survey in rounds 2 and 3. The expert panel and the European Association for Palliative Care board members participated in rounds 4 and 5. This final version was adopted as an official position paper of the European Association for Palliative Care in April 2015. Main topics of the white paper are concepts and definitions of palliative care, its values and philosophy, euthanasia and physician-assisted suicide, key issues on the patient and the organizational level. The consensus process confirmed the 2003 European Association for Palliative Care white paper and its position on the relationship between palliative care and euthanasia and physician-assisted suicide. The European Association for Palliative Care feels that it is important to contribute to informed public debates on these issues. Complete consensus seems to be unachievable due to incompatible normative frameworks that clash. © The Author(s) 2015.

Viral hemorrhagic septicemia virus (VHSV IVb) risk factors and association measures derived by expert panel

USGS Publications Warehouse

,

2010-01-01

Viral hemorrhagic septicemia virus (VHSV) is an OIE-listed pathogen of fish, recently expanding in known host and geographic range in North America. Through a group process designed for subjective probability assessment, an international panel of fish health experts identified and weighted risk factors perceived important to the emergence and spread of the viral genotype, VHSV IVb, within and from the Great Lakes region of the US and Canada. Identified factors included the presence of known VHSV-susceptible species, water temperatures conducive for disease, hydrologic connectivity and proximity to known VHSV-positive areas, untested shipments of live or frozen fish from known positive regions, insufficient regulatory infrastructure for fish health oversight, and uncontrolled exposure to fomites associated with boat and equipment or fish wastes from known VHSV-positive areas. Results provide qualitative insights for use in VHSV surveillance and risk-management planning, and quantitative estimates of contextual risk for use in a Bayesian model combining multiple evidence streams for joint probability assessment of disease freedom status. Consistency checks suggest that the compiled factors positively reflect expert judgment of watershed risk for acquiring VHSV IVb. External validation is recommended as the availability of empirical data permits.

Rare cancers in children - The EXPeRT Initiative: a report from the European Cooperative Study Group on Pediatric Rare Tumors.

PubMed

Bisogno, G; Ferrari, A; Bien, E; Brecht, I B; Brennan, B; Cecchetto, G; Godzinski, J; Orbach, D; Reguerre, Y; Stachowicz-Stencel, T; Schneider, D T

2012-10-01

The low incidence and the heterogeneity of very rare tumors (VRTs) demand for international cooperation. In 2008, EXPeRT (European Cooperative Study Group for Pediatric Rare Tumors) was founded by national groups from Italy, France, United Kingdom, Poland and Germany. The first aims of EXPeRT were to agree on a uniform definition of VRTs and to develop the currently most relevant scientific questions. Current initiatives include international data exchange, retrospective and prospective studies of specific entities, and the development of harmonized and internationally recognized guidelines. Moreover, EXPeRT established a network for expert consultation to assist in clinical decision in VRTs. © Georg Thieme Verlag KG Stuttgart · New York.

Heart Rhythm Monitoring in the Constellation Lunar and Launch/Landing EVA Suit: Recommendations from an Expert Panel

NASA Technical Reports Server (NTRS)

Scheuring, Richard A.; Hamilton, Doug; Jones, Jeffrey A.; Alexander, David

2009-01-01

There are currently several physiological monitoring requirements for EVA in the Human-Systems Interface Requirements (HSIR) document. There are questions as to whether the capability to monitor heart rhythm in the lunar surface space suit is a necessary capability for lunar surface operations. Similarly, there are questions as to whether the capability to monitor heart rhythm during a cabin depressurization scenario in the launch/landing space suit is necessary. This presentation seeks to inform space medicine personnel of recommendations made by an expert panel of cardiovascular medicine specialists regarding in-suit ECG heart rhythm monitoring requirements during lunar surface operations. After a review of demographic information and clinical cases and panel discussion, the panel recommended that ECG monitoring capability as a clinical tool was not essential in the lunar space suit; ECG monitoring was not essential in the launch/landing space suit for contingency scenarios; the current hear rate monitoring capability requirement for both launch/landing and lunar space suits should be maintained; lunar vehicles should be required to have ECG monitoring capability with a minimum of 5-lead ECG for IVA medical assessments; and, exercise stress testing for astronaut selection and retention should be changed from the current 85% maximum heart rate limit to maximal, exhaustive 'symptom-limited' testing to maximize diagnostic utility as a screening tool for evaluating the functional capacity of astronauts and their cardiovascular health.

Evaluation of a Performance-Based Expert Elicitation: WHO Global Attribution of Foodborne Diseases.

PubMed

Aspinall, W P; Cooke, R M; Havelaar, A H; Hoffmann, S; Hald, T

2016-01-01

For many societally important science-based decisions, data are inadequate, unreliable or non-existent, and expert advice is sought. In such cases, procedures for eliciting structured expert judgments (SEJ) are increasingly used. This raises questions regarding validity and reproducibility. This paper presents new findings from a large-scale international SEJ study intended to estimate the global burden of foodborne disease on behalf of WHO. The study involved 72 experts distributed over 134 expert panels, with panels comprising thirteen experts on average. Elicitations were conducted in five languages. Performance-based weighted solutions for target questions of interest were formed for each panel. These weights were based on individual expert's statistical accuracy and informativeness, determined using between ten and fifteen calibration variables from the experts' field with known values. Equal weights combinations were also calculated. The main conclusions on expert performance are: (1) SEJ does provide a science-based method for attribution of the global burden of foodborne diseases; (2) equal weighting of experts per panel increased statistical accuracy to acceptable levels, but at the cost of informativeness; (3) performance-based weighting increased informativeness, while retaining accuracy; (4) due to study constraints individual experts' accuracies were generally lower than in other SEJ studies, and (5) there was a negative correlation between experts' informativeness and statistical accuracy which attenuated as accuracy improved, revealing that the least accurate experts drive the negative correlation. It is shown, however, that performance-based weighting has the ability to yield statistically accurate and informative combinations of experts' judgments, thereby offsetting this contrary influence. The present findings suggest that application of SEJ on a large scale is feasible, and motivate the development of enhanced training and tools for remote

Improving Health Outcomes for Patients with Depression: A Population Health Imperative. Report on an Expert Panel Meeting

PubMed Central

Skoufalos, Alexis; Medalia, Alice; Fendrick, A. Mark

2016-01-01

Improving Health Outcomes for Patients with Depression: A Population Health Imperative. Report on an Expert Panel Meeting Janice L. Clarke, RN, Alexis Skoufalos, EdD, Alice Medalia, PhD, and A. Mark Fendrick, MD Editorial: A Call to Action: David B. Nash, MD, MBA   S-2 Overview: Depression and the Population Health Imperative   S-3 Promoting Awareness of the Issues and Opportunities for Improvement   S-5 Cognitive Dysfunction in Affective Disorders   S-5 Critical Role of Employers in Improving Health Outcomes for Employees with Depression   S-6 Closing the Behavioral Health Professional and Process Gaps   S-6 Achieving the Triple Aim for Patients with Depressive Disorders   S-6 Improving the Experience of Care for Patients with Depression   S-6 Improving Quality of Care and Health Outcomes for Patients with Depression   S-7 Changing the Cost of Care Discussion from How Much to How Well   S-8 Panel Insights and Recommendations   S-9 Conclusion   S-10 PMID:27636743

Improved inter-observer agreement of an expert review panel in an oncology treatment trial--Insights from a structured interventional process.

PubMed

Nestle, Ursula; Rischke, Hans Christian; Eschmann, Susanne Martina; Holl, Gabriele; Tosch, Marco; Miederer, Matthias; Plotkin, Michail; Essler, Markus; Puskas, Cornelia; Schimek-Jasch, Tanja; Duncker-Rohr, Viola; Rühl, Friederike; Leifert, Anja; Mix, Michael; Grosu, Anca-Ligia; König, Jochem; Vach, Werner

2015-11-01

Oncologic imaging is a key for successful cancer treatment. While the quality assurance (QA) of image acquisition protocols has already been focussed, QA of reading and reporting offers still room for improvement. The latter was addressed in the context of a prospective multicentre trial on fluoro-deoxyglucose (FDG)-positron-emission tomography (PET)/CT-based chemoradiotherapy for locally advanced non-small cell lung cancer (NSCLC). An expert panel was prospectively installed performing blinded reviews of mediastinal NSCLC involvement in FDG-PET/CT. Due to a high initial reporting inter-observer disagreement, the independent data monitoring committee (IDMC) triggered an interventional harmonisation process, which overall involved 11 experts uttering 6855 blinded diagnostic statements. After assessing the baseline inter-observer agreement (IOA) of a blinded re-review (phase 1), a discussion process led to improved reading criteria (phase 2). Those underwent a validation study (phase 3) and were then implemented into the study routine. After 2 months (phase 4) and 1 year (phase 5), the IOA was reassessed. The initial overall IOA was moderate (kappa 0.52 CT; 0.53 PET). After improvement of reading criteria, the kappa values improved substantially (kappa 0.61 CT; 0.66 PET), which was retained until the late reassessment (kappa 0.71 CT; 0.67 PET). Subjective uncertainty was highly predictive for low IOA. The IOA of an expert panel was significantly improved by a structured interventional harmonisation process which could be a model for future clinical trials. Furthermore, the low IOA in reporting nodal involvement in NSCLC may bear consequences for individual patient care. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cognitive and Physical Demands of Activities of Daily Living in Older Adults: Validation of Expert Panel Ratings.

PubMed

Fong, Tamara G; Gleason, Lauren J; Wong, Bonnie; Habtemariam, Daniel; Jones, Richard N; Schmitt, Eva M; de Rooij, Sophia E; Saczynski, Jane S; Gross, Alden L; Bean, Jonathan F; Brown, Cynthia J; Fick, Donna M; Gruber-Baldini, Ann L; O'Connor, Margaret; Tabloski, Patrica A; Marcantonio, Edward R; Inouye, Sharon K

2015-07-01

Difficulties with performance of functional activities may result from cognitive and/or physical impairments. To date, there has not been a clear delineation of the physical and cognitive demands of activities of daily living. To quantify the relative physical and cognitive demands required to complete typical functional activities in older adults. Expert panel survey. Web-based platform. Eleven experts from 8 academic medical centers and 300 community-dwelling elderly adults age 70 and older scheduled for elective noncardiac surgery from 2 academic medical centers. Sum scores of expert ratings were calculated and then validated against objective data collected from a prospective longitudinal study. Correlation between expert ratings and objective neuropsychologic tests (memory, language, complex attention) and physical measures (gait speed and grip strength) for performance-based tasks. Managing money, self-administering medications, using the telephone, and preparing meals were rated as requiring significantly more cognitive demand, whereas walking and transferring, moderately strenuous activities, and climbing stairs were assessed as more physically demanding. Largely cognitive activities correlated with objective neuropsychologic performance (r = 0.13-0.23, P < .05) and largely physical activities correlated with physical performance (r = 0.15-0.46, P < .05). Quantifying the degree of cognitive and/or physical demand for completing a specific task adds an additional dimension to standard measures of functional assessment. This additional information may significantly influence decisions about rehabilitation, postacute care needs, treatment plans, and caregiver education. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

European Nanotechnology Experts Visit NCL; Harmonize Best Practices for Nanomedicine Collaboration in Europe | Frederick National Laboratory for Cancer Research

Cancer.gov

European nanotechnology experts visited the Nanotechnology Characterization Laboratory (NCL) to observe best practices and methods and to share their own knowledge with NCL scientists as they prepared to launch an NCL-like operation in Europe. The Eu

PRIORITIES FOR HEALTH ECONOMIC METHODOLOGICAL RESEARCH: RESULTS OF AN EXPERT CONSULTATION.

PubMed

Tordrup, David; Chouaid, Christos; Cuijpers, Pim; Dab, William; van Dongen, Johanna Maria; Espin, Jaime; Jönsson, Bengt; Léonard, Christian; McDaid, David; McKee, Martin; Miguel, José Pereira; Patel, Anita; Reginster, Jean-Yves; Ricciardi, Walter; Rutten-van Molken, Maureen; Rupel, Valentina Prevolnik; Sach, Tracey; Sassi, Franco; Waugh, Norman; Bertollini, Roberto

2017-01-01

The importance of economic evaluation in decision making is growing with increasing budgetary pressures on health systems. Diverse economic evidence is available for a range of interventions across national contexts within Europe, but little attention has been given to identifying evidence gaps that, if filled, could contribute to more efficient allocation of resources. One objective of the Research Agenda for Health Economic Evaluation project is to determine the most important methodological evidence gaps for the ten highest burden conditions in the European Union (EU), and to suggest ways of filling these gaps. The highest burden conditions in the EU by Disability Adjusted Life Years were determined using the Global Burden of Disease study. Clinical interventions were identified for each condition based on published guidelines, and economic evaluations indexed in MEDLINE were mapped to each intervention. A panel of public health and health economics experts discussed the evidence during a workshop and identified evidence gaps. The literature analysis contributed to identifying cross-cutting methodological and technical issues, which were considered by the expert panel to derive methodological research priorities. The panel suggests a research agenda for health economics which incorporates the use of real-world evidence in the assessment of new and existing interventions; increased understanding of cost-effectiveness according to patient characteristics beyond the "-omics" approach to inform both investment and disinvestment decisions; methods for assessment of complex interventions; improved cross-talk between economic evaluations from health and other sectors; early health technology assessment; and standardized, transferable approaches to economic modeling.

Evaluation of a Performance-Based Expert Elicitation: WHO Global Attribution of Foodborne Diseases

PubMed Central

Aspinall, W. P.; Cooke, R. M.; Havelaar, A. H.; Hoffmann, S.; Hald, T.

2016-01-01

For many societally important science-based decisions, data are inadequate, unreliable or non-existent, and expert advice is sought. In such cases, procedures for eliciting structured expert judgments (SEJ) are increasingly used. This raises questions regarding validity and reproducibility. This paper presents new findings from a large-scale international SEJ study intended to estimate the global burden of foodborne disease on behalf of WHO. The study involved 72 experts distributed over 134 expert panels, with panels comprising thirteen experts on average. Elicitations were conducted in five languages. Performance-based weighted solutions for target questions of interest were formed for each panel. These weights were based on individual expert’s statistical accuracy and informativeness, determined using between ten and fifteen calibration variables from the experts' field with known values. Equal weights combinations were also calculated. The main conclusions on expert performance are: (1) SEJ does provide a science-based method for attribution of the global burden of foodborne diseases; (2) equal weighting of experts per panel increased statistical accuracy to acceptable levels, but at the cost of informativeness; (3) performance-based weighting increased informativeness, while retaining accuracy; (4) due to study constraints individual experts’ accuracies were generally lower than in other SEJ studies, and (5) there was a negative correlation between experts' informativeness and statistical accuracy which attenuated as accuracy improved, revealing that the least accurate experts drive the negative correlation. It is shown, however, that performance-based weighting has the ability to yield statistically accurate and informative combinations of experts' judgments, thereby offsetting this contrary influence. The present findings suggest that application of SEJ on a large scale is feasible, and motivate the development of enhanced training and tools for remote

40 CFR 766.28 - Expert review of protocols.

Code of Federal Regulations, 2013 CFR

2013-07-01

... CONTROL ACT DIBENZO-PARA-DIOXINS/DIBENZOFURANS Specific Chemical Testing/Reporting Requirements § 766.28 Expert review of protocols. EPA will gather a panel of experts in analysis of chemical matrices for HDDs... 40 Protection of Environment 32 2013-07-01 2013-07-01 false Expert review of protocols. 766.28...

40 CFR 766.28 - Expert review of protocols.

Code of Federal Regulations, 2014 CFR

2014-07-01

... CONTROL ACT DIBENZO-PARA-DIOXINS/DIBENZOFURANS Specific Chemical Testing/Reporting Requirements § 766.28 Expert review of protocols. EPA will gather a panel of experts in analysis of chemical matrices for HDDs... 40 Protection of Environment 31 2014-07-01 2014-07-01 false Expert review of protocols. 766.28...

40 CFR 766.28 - Expert review of protocols.

Code of Federal Regulations, 2011 CFR

2011-07-01

... CONTROL ACT DIBENZO-PARA-DIOXINS/DIBENZOFURANS Specific Chemical Testing/Reporting Requirements § 766.28 Expert review of protocols. EPA will gather a panel of experts in analysis of chemical matrices for HDDs... 40 Protection of Environment 31 2011-07-01 2011-07-01 false Expert review of protocols. 766.28...

40 CFR 766.28 - Expert review of protocols.

Code of Federal Regulations, 2012 CFR

2012-07-01

... CONTROL ACT DIBENZO-PARA-DIOXINS/DIBENZOFURANS Specific Chemical Testing/Reporting Requirements § 766.28 Expert review of protocols. EPA will gather a panel of experts in analysis of chemical matrices for HDDs... 40 Protection of Environment 32 2012-07-01 2012-07-01 false Expert review of protocols. 766.28...

Expert perspectives on Western European prison health services: do ageing prisoners receive equivalent care?

PubMed

Bretschneider, Wiebke; Elger, Bernice Simone

2014-09-01

Health care in prison and particularly the health care of older prisoners are increasingly important topics due to the growth of the ageing prisoner population. The aim of this paper is to gain insight into the approaches used in the provision of equivalent health care to ageing prisoners and to confront the intuitive definition of equivalent care and the practical and ethical challenges that have been experienced by individuals working in this field. Forty interviews took place with experts working in the prison setting from three Western European countries to discover their views on prison health care. Experts indicated that the provision of equivalent care in prison is difficult mostly due to four factors: variability of care in different prisons, gatekeeper systems, lack of personnel, and delays in providing access. This lack of equivalence can be fixed by allocating adequate budgets and developing standards for health care in prison.

Etiologies of Chronic Cough in Pediatric Cohorts: CHEST Guideline and Expert Panel Report.

PubMed

Chang, Anne B; Oppenheimer, John J; Weinberger, Miles; Grant, Cameron C; Rubin, Bruce K; Irwin, Richard S

2017-09-01

There is no published systematic review on the etiologies of chronic cough or the relationship between OSA and chronic cough in children aged ≤ 14 years. We thus undertook a systematic review based on key questions (KQs) using the Population, Intervention, Comparison, Outcome format. The KQs follow: Among children with chronic (> 4 weeks) cough (KQ 1) are the common etiologies different from those in adults? (KQ 2) Are the common etiologies age or setting dependent, or both? (KQ 3) Is OSA a cause of chronic cough in children? We used the CHEST Expert Cough Panel's protocol and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development, and Evaluation framework. Data from the systematic reviews in conjunction with patients' values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain consensus. Combining KQs 1 and 2, we found moderate-level evidence from 10 prospective studies that the etiologies of cough in children are different from those in adults and are setting dependent. Data from three studies found that common etiologies of cough in young children were different from those in older children. However, data relating sleep abnormalities to chronic cough in children were found only in case studies. There is moderate-quality evidence that common etiologies of chronic cough in children are different from those in adults and are dependent on age and setting. As there are few data relating OSA and chronic cough in children, the panel suggested that these children should be managed in accordance with pediatric sleep guidelines. Copyright © 2017. Published by Elsevier Inc.

[European Portuguese EARS test battery adaptation].

PubMed

Alves, Marisa; Ramos, Daniela; Oliveira, Graça; Alves, Helena; Anderson, Ilona; Magalhães, Isabel; Martins, Jorge H; Simões, Margarida; Ferreira, Raquel; Fonseca, Rita; Andrade, Susana; Silva, Luís; Ribeiro, Carlos; Ferreira, Pedro Lopes

2014-01-01

The use of adequate assessment tools in health care is crucial for the management of care. The lack of specific tools in Portugal for assessing the performance of children who use cochlear implants motivated the translation and adaptation of the EARS (Evaluation of Auditory Responses to Speech) test battery into European Portuguese. This test battery is today one of the most commonly used by (re)habilitation teams of deaf children who use cochlear implants worldwide. The goal to be achieved with the validation of EARS was to provide (re)habilitation teams an instrument that enables: (i) monitoring the progress of individual (re)habilitation, (ii) managing a (re)habilitation program according to objective results, comparable between different (re)habilitation teams, (iii) obtaining data that can be compared with the results of international teams, and (iv) improving engagement and motivation of the family and other professionals from local teams. For the test battery translation and adaptation process, the adopted procedures were the following: (i) translation of the English version into European Portuguese by a professional translator, (ii) revision of the translation performed by an expert panel, including doctors, speech-language pathologists and audiologists, (iii) adaptation of the test stimuli by the team's speechlanguage pathologist, and (iv) further review by the expert panel. For each of the tests that belong to the EARS battery, the introduced adaptations and adjustments are presented, combining the characteristics and objectives of the original tests with the linguistic and cultural specificities of the Portuguese population. The difficulties that have been encountered during the translation and adaptation process and the adopted solutions are discussed. Comparisons are made with other versions of the EARS battery. We defend that the translation and the adaptation process followed for the EARS test battery into European Portuguese was correctly conducted

An Experts Survey on Sustainability Across Twenty-Seven Extensive European Systems of Grassland Management

NASA Astrophysics Data System (ADS)

Caballero, Rafael; Gil, Ángel; Fernández-Santos, Xavier

2008-08-01

European Large Scale Grazing Systems (LSGS) are at a crossroad with environmental, agronomic, and social factors interacting on their future viability. This research assesses the current environmental and socio-economic status of a wide range of European LSGS according to an agreed subset of sustainability criteria and indicators, which have been recognized by corresponding experts and privileged observers on their respective case-study system. A survey questionnaire was drafted containing five main criteria (pastoral use, environmental, economic, social, and market and development), with four conceptual-scored variables (indicators) within each criterion. Descriptive, analytical and clustering statistical techniques helped to draw a synthesis of the main result and to standardize sustainability variables across different biogeographical regions and management situations. The results show large multicollinearity among the 20 variables proposed. This dependence was revealed by the reduction to six main factor-components, which accounted for about 73% of the total variance in responses. Aggregation of point-score indicators across criteria to obtain a sustainability index can be of less policy relevance than responses to specific criteria or indicators. Affinity between case-study systems, as judged by collaborative-expert responses, was not related to biogeographical location, operating livestock sector, or population density in their areas. The results show larger weaknesses and constraints in the economic and social criteria than in the pastoral and environmental criteria, and the large heterogeneity of responses appears in the social criterion.

[Consensus statement on the clinical management of non-AIDS defining malignancies. GeSIDA expert panel].

PubMed

Santos, Jesús; Valencia, Eulalia

2014-10-01

This consensus document has been prepared by a panel of experts appointed by GeSIDA. This paper reviews the recommendations on the most important non-AIDS defining malignancies that can affect patients living with AIDS. Lung cancer, hepatocellular carcinoma, anal carcinoma and other less frequent malignancies such as breast, prostate, vagina or colon cancers are reviewed. The aim of the recommendations is to make clinicians who attend to this patients aware of how to prevent, diagnose and treat this diseases. The recommendations for the use of antiretroviral therapy when the patient develops a malignancy are also presented. In support of the recommendations we have used the modified criteria of the Infectious Diseases Society of America. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Science Advisory Panel Meeting on PBPK Modeling Postponed

EPA Pesticide Factsheets

EPA is postponing the Federal Insecticide, Fungicide, and Rodenticide Act Scientific Advisory Panel (SAP) meeting scheduled for October 24-27, 2017 due to the unavailability of experts for the peer review panel.

FIFRA Scientific Advisory Panel

EPA Pesticide Factsheets

Experts on the Federal Insecticide, Fungicide, and Rodenticide Act Scientific Advisory Panel provide independent scientific advice to the EPA on a wide range of health and safety issues related to pesticides.

Patient/Family Education for Newly Diagnosed Pediatric Oncology Patients: Consensus Recommendations from a Children’s Oncology Group Expert Panel

PubMed Central

Landier, Wendy; Ahern, JoAnn; Barakat, Lamia P.; Bhatia, Smita; Bingen, Kristin M.; Bondurant, Patricia G.; Cohn, Susan L.; Dobrozsi, Sarah K.; Haugen, Maureen; Herring, Ruth Anne; Hooke, Mary C.; Martin, Melissa; Murphy, Kathryn; Newman, Amy R.; Rodgers, Cheryl C.; Ruccione, Kathleen S.; Sullivan, Jeneane; Weiss, Marianne; Withycombe, Janice; Yasui, Lise; Hockenberry, Marilyn

2016-01-01

There is a paucity of data to support evidence-based practices in the provision of patient/family education in the context of a new childhood cancer diagnosis. Since the majority of children with cancer are treated on pediatric oncology clinical trials, lack of effective patient/family education has the potential to negatively affect both patient and clinical trial outcomes. The Children’s Oncology Group Nursing Discipline convened an interprofessional expert panel from within and beyond pediatric oncology to review available and emerging evidence and develop expert consensus recommendations regarding harmonization of patient/family education practices for newly diagnosed pediatric oncology patients across institutions. Five broad principles, with associated recommendations, were identified by the panel, including recognition that (1) in pediatric oncology, patient/family education is family-centered; (2) a diagnosis of childhood cancer is overwhelming and the family needs time to process the diagnosis and develop a plan for managing ongoing life demands before they can successfully learn to care for the child; (3) patient/family education should be an interprofessional endeavor with 3 key areas of focus: (a) diagnosis/treatment, (b) psychosocial coping, and (c) care of the child; (4) patient/family education should occur across the continuum of care; and (5) a supportive environment is necessary to optimize learning. Dissemination and implementation of these recommendations will set the stage for future studies that aim to develop evidence to inform best practices, and ultimately to establish the standard of care for effective patient/family education in pediatric oncology. PMID:27385664

Executive summary and conclusions from the European Hydration Institute Expert Conference on human hydration, health, and performance.

PubMed

Benton, D; Braun, H; Cobo, J C; Edmonds, C; Elmadfa, I; El-Sharkawy, A; Feehally, J; Gellert, R; Holdsworth, J; Kapsokefalou, M; Kenney, W L; Leiper, J B; Macdonald, I A; Maffeis, C; Maughan, R J; Shirreffs, S M; Toth-Heyn, P; Watson, P

2015-09-01

On April 7-8, 2014, the European Hydration Institute hosted a small group of experts at Castle Combe Manor House, United Kingdom, to discuss a range of issues related to human hydration, health, and performance. The meeting included 18 recognized experts who brought a wealth of experience and knowledge to the topics under review. Eight selected topics were addressed, with the key issues being briefly presented before an in-depth discussion. Presented here is the executive summary and conclusions from this meeting. © The Author(s) 2015. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

The response of an expert panel to Nutritional armor for the warfighter: can omega-3 fatty acids enhance stress resilience, wellness, and military performance?

PubMed

Coulter, Ian D

2014-11-01

Recommendations of an Expert Panel on 5 central questions addressed during the workshop. The Panel reviewed available scientific literature, workshop presentations, and comments from workshop guests. The Panel unanimously agreed that a military Daily Recommended Intake for long-chain omega-3 fatty acids (FAs) should be established within the context of lowering current intakes of omega-6 FAs. The Panelists also felt that there was sufficient evidence to support increasing omega-3 intake to receive cardiovascular, immunological, and surgical benefits. In addition, research indicates that preloading with omega-3 FAs before combat exposure may be beneficial. Evidence for reduction of depressive symptoms and suicide prevention was felt to be strong. Insufficient data were available to evaluate post-traumatic stress disorder and impulsive aggression. Benefits for traumatic brain injury were promising. Adverse side effects were deemed negligible. The Panel concluded that based on studies analyzing omega-3 and omega-6 FA balance, it would be unethical to not attempt elevating the omega-3 status among U.S. military personnel. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Multi-criteria decision analysis for health technology assessment in Canada: insights from an expert panel discussion.

PubMed

Diaby, Vakaramoko; Goeree, Ron; Hoch, Jeffrey; Siebert, Uwe

2015-02-01

Multi-criteria decision analysis (MCDA), a decision-making tool, has received increasing attention in recent years, notably in the healthcare field. For Canada, it is unclear whether and how MCDA should be incorporated into the existing health technology assessment (HTA) decision-making process. To facilitate debate on improving HTA decision-making in Canada, a workshop was held in conjunction with the 8th World Congress on Health Economics of the International Health Economics Association in Toronto, Canada in July 2011. The objective of the workshop was to discuss the potential benefits and challenges related to the use of MCDA for HTA decision-making in Canada. This paper summarizes and discusses the recommendations of an expert panel convened at the workshop to discuss opportunities and concerns with reference to the implementation of MCDA in Canada.

Similarities and differences of systematic consensus on disaster mental health services between Japanese and European experts.

PubMed

Fukasawa, Maiko; Suzuki, Yuriko; Nakajima, Satomi; Narisawa, Tomomi; Kim, Yoshiharu

2013-04-01

We recently developed new disaster mental health guidelines in Japan through the Delphi process, a method for building consensus among experts, using as a reference the guidelines developed by The European Network for Traumatic Stress (TENTS) in Europe. We included in our survey 30 items used in the TENTS survey, 20 of which achieved positive consensus in that survey. Here we report on the extent of agreement of 95 Japanese experts on each of these 30 items and examine the reasons for disagreements with the TENTS survey results based on the comments obtained from the participants of our survey. Of the 20 items, 12 also gained consensus in our survey and 1 additional item achieved consensus that did not achieve it in the TENTS survey. Items that did not gain consensus in our survey, but did in the TENTS survey, were recommendations for close collaboration with the media, screening volunteers for their suitability, and withholding formal screening of the affected population. The need for specialist care for specific populations was endorsed in our survey, but not in the TENTS survey. Overall, the opinion of Japanese experts was congruent with that of Western experts, but some guideline amendments would be beneficial. Copyright © 2013 International Society for Traumatic Stress Studies.

Expert Panel Recommendations for the Identification and Management of Hyperkalemia and Role of Patiromer in Patients with Chronic Kidney Disease and Heart Failure.

PubMed

Rafique, Zubaid; Weir, Matthew R; Onuigbo, Macaulay; Pitt, Bertram; Lafayette, Richard; Butler, Javed; Lopes, Maria; Farnum, Carolyn; Peacock, W Frank

2017-04-01

Virtual panel meetings were conducted among 7 physicians, all of whom are independent experts, including 3 nephrologists, 2 cardiologists, and 2 emergency medicine physicians (the panel). The panel met with the purpose of discussing the current treatment landscape, treatment challenges, economic impact, and gaps in care for patients with hyperkalemia that is associated with heart failure and chronic kidney disease. The stated goal of the panel discussion was to develop practical solutions in the identification and management of hyperkalemia in this patient population. The panel noted that hyperkalemia is a serious condition that can lead to life-threatening complications, yet the treatment paradigm for hyperkalemia has remained without major advances for approximately 50 years, until the approval of patiromer. A number of issues still exist in the management of this patient population, including the lack of uniform treatment guidelines and consensus regarding the approach to treatment. As part of its effort, the panel developed an algorithm, the Proposed Diagnostic Algorithm for Hyperkalemia Treatment in the Acute Care Setting/Chronic Care. The panel agreed that patiromer appears to be a viable option for the management of hyperkalemia in patients with chronic kidney disease and/or heart failure and in patients who experience chronic hyperkalemia. This panel discussion was funded by Relypsa and facilitated by Magellan Rx Management. Rafique is a principal investigator for Relypsa and serves as a consultant for Instrumentation Laboratory, Magellan Health, Relypsa, and ZS-Pharma. Butler serves as consultant for Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, CardioCell, Janssen, Merck, Novartis, Relypsa, and ZS-Pharma. Lopes and Farnum are employed by Magellan Rx Management. Rafique designed the management protocol for this panel discussion and contributed to the writing and editing of this report document. The other authors report no conflicting interests. Relypsa

The Social Cognition Psychometric Evaluation Study: Results of the Expert Survey and RAND Panel

PubMed Central

Pinkham, Amy E.; Penn, David L.; Green, Michael F.; Buck, Benjamin; Healey, Kristin; Harvey, Philip D.

2014-01-01

Background: In schizophrenia, social cognition is strongly linked to functional outcome and is increasingly seen as a viable treatment target. The goal of the Social Cognition Psychometric Evaluation (SCOPE) study is to identify and improve the best existing measures of social cognition so they can be suitably applied in large-scale treatment studies. Initial phases of this project sought to (1) develop consensus on critical domains of social cognition and (2) identify the best existing measures of social cognition for use in treatment studies. Methods: Experts in social cognition were invited to nominate key domains of social cognition and the best measures of those domains. Nominations for measures were reduced according to set criteria, and all available psychometric information about these measures was summarized and provided to RAND panelists. Panelists rated the quality of each measure on multiple criteria, and diverging ratings were discussed at the in-person meeting to obtain consensus. Results: Expert surveys identified 4 core domains of social cognition—emotion processing, social perception, theory of mind/mental state attribution, and attributional style/bias. Using RAND panel consensus ratings, the following measures were selected for further evaluation: Ambiguous Intentions Hostility Questionnaire, Bell Lysaker Emotion Recognition Task, Penn Emotion Recognition Test, Relationships Across Domains, Reading the Mind in the Eyes Test, The Awareness of Social Inferences Test, Hinting Task, and Trustworthiness Task. Discussion: While it was possible to establish consensus, only a limited amount of psychometric information is currently available for the candidate measures, which underscores the need for well-validated and standardized measures in this area. PMID:23728248

76 FR 30939 - Science Advisory Board Staff Office; Request for Nominations of Experts for SAB Libby Amphibole...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-27

... Nominations of Experts for SAB Libby Amphibole Asbestos Review Panel AGENCY: Environmental Protection Agency... nominations of technical experts to serve on an Asbestos expert panel under the auspices of the SAB to conduct a peer review of EPA's Draft Toxicological Review of Libby Amphibole Asbestos. DATES: Nominations...

Statin-associated muscle symptoms: impact on statin therapy-European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management.

PubMed

Stroes, Erik S; Thompson, Paul D; Corsini, Alberto; Vladutiu, Georgirene D; Raal, Frederick J; Ray, Kausik K; Roden, Michael; Stein, Evan; Tokgözoğlu, Lale; Nordestgaard, Børge G; Bruckert, Eric; De Backer, Guy; Krauss, Ronald M; Laufs, Ulrich; Santos, Raul D; Hegele, Robert A; Hovingh, G Kees; Leiter, Lawrence A; Mach, Francois; März, Winfried; Newman, Connie B; Wiklund, Olov; Jacobson, Terry A; Catapano, Alberico L; Chapman, M John; Ginsberg, Henry N

2015-05-01

Statin-associated muscle symptoms (SAMS) are one of the principal reasons for statin non-adherence and/or discontinuation, contributing to adverse cardiovascular outcomes. This European Atherosclerosis Society (EAS) Consensus Panel overviews current understanding of the pathophysiology of statin-associated myopathy, and provides guidance for diagnosis and management of SAMS. Statin-associated myopathy, with significant elevation of serum creatine kinase (CK), is a rare but serious side effect of statins, affecting 1 per 1000 to 1 per 10 000 people on standard statin doses. Statin-associated muscle symptoms cover a broader range of clinical presentations, usually with normal or minimally elevated CK levels, with a prevalence of 7-29% in registries and observational studies. Preclinical studies show that statins decrease mitochondrial function, attenuate energy production, and alter muscle protein degradation, thereby providing a potential link between statins and muscle symptoms; controlled mechanistic and genetic studies in humans are necessary to further understanding. The Panel proposes to identify SAMS by symptoms typical of statin myalgia (i.e. muscle pain or aching) and their temporal association with discontinuation and response to repetitive statin re-challenge. In people with SAMS, the Panel recommends the use of a maximally tolerated statin dose combined with non-statin lipid-lowering therapies to attain recommended low-density lipoprotein cholesterol targets. The Panel recommends a structured work-up to identify individuals with clinically relevant SAMS generally to at least three different statins, so that they can be offered therapeutic regimens to satisfactorily address their cardiovascular risk. Further research into the underlying pathophysiological mechanisms may offer future therapeutic potential. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

Developing an expert panel process to refine health outcome definitions in observational data.

PubMed

Fox, Brent I; Hollingsworth, Joshua C; Gray, Michael D; Hollingsworth, Michael L; Gao, Juan; Hansen, Richard A

2013-10-01

Drug safety surveillance using observational data requires valid adverse event, or health outcome of interest (HOI) measurement. The objectives of this study were to develop a method to review HOI definitions in claims databases using (1) web-based digital tools to present de-identified patient data, (2) a systematic expert panel review process, and (3) a data collection process enabling analysis of concepts-of-interest that influence panelists' determination of HOI. De-identified patient data were presented via an interactive web-based dashboard to enable case review and determine if specific HOIs were present or absent. Criteria for determining HOIs and their severity were provided to each panelist. Using a modified Delphi method, six panelist pairs independently reviewed approximately 200 cases across each of three HOIs (acute liver injury, acute kidney injury, and acute myocardial infarction) such that panelist pairs independently reviewed the same cases. Panelists completed an assessment within the dashboard for each case that included their assessment of the presence or absence of the HOI, HOI severity (if present), and data contributing to their decision. Discrepancies within panelist pairs were resolved during a consensus process. Dashboard development was iterative, focusing on data presentation and recording panelists' assessments. Panelists reported quickly learning how to use the dashboard. The assessment module was used consistently. The dashboard was reliable, enabling an efficient review process for panelists. Modifications were made to the dashboard and review process when necessary to facilitate case review. Our methods should be applied to other health outcomes of interest to further refine the dashboard and case review process. The expert review process was effective and was supported by the web-based dashboard. Our methods for case review and classification can be applied to future methods for case identification in observational data sources

Recommendations for the clinical evaluation of agents for treatment of osteoporosis: consensus of an expert panel representing the American Society for Bone and Mineral Research (ASBMR), the International Society for Clinical Densitometry (ISCD), and the National Osteoporosis Foundation (NOF).

PubMed

Silverman, Stuart L; Cummings, Steven R; Watts, Nelson B

2008-01-01

A panel of experts representing ASBMR, NOF, and ISCD reviewed evidence and reached consensus that regulatory approval of treatments for osteoporosis should be based on trials with fracture endpoints, lasting 18-24 mo, and extending treatment to 5 yr; other indications could be approved based on BMD and turnover markers. In response to an FDA request for clinical trial guidance in osteoporosis, an expert panel was convened with representatives from the American Society of Bone and Mineral Research, the International Society of Clinical Densitometry, and the National Osteoporosis Foundation. The panel used a validated evidence-based expert panel process (the Rand Appropriateness Method) to address issues of trial duration, trial design, use of intermediate endpoints as outcomes, and use of placebo-controlled trials in high-risk patients. The panel concluded that placebo-controlled trials with fracture endpoints are appropriate and, with informed consent, are ethical for registration of new compounds. Trials may be 18-24 mo in duration for efficacy, assuming longer duration to 5 yr for safety and demonstration of sustained fracture reduction. Once fracture efficacy has been established for a particular agent, intermediate endpoints (e.g., BMD and bone turnover markers) may be used as outcomes for new indications other than corticosteroid-induced osteoporosis.

Alemtuzumab Use in Clinical Practice: Recommendations from European Multiple Sclerosis Experts.

PubMed

Berger, Thomas; Elovaara, Irina; Fredrikson, Sten; McGuigan, Chris; Moiola, Lucia; Myhr, Kjell-Morten; Oreja-Guevara, Celia; Stoliarov, Igor; Zettl, Uwe K

2017-01-01

Alemtuzumab (Lemtrada™) is a humanized monoclonal antibody approved in more than 50 countries. Within the European Union, alemtuzumab is indicated for the treatment of adult patients with relapsing-remitting multiple sclerosis (RRMS) with active disease defined by clinical or imaging features; in the USA, the indication states that alemtuzumab should generally be reserved for the treatment of patients with relapsing forms of multiple sclerosis who have had an inadequate response to two or more disease-modifying therapies (DMTs). In clinical trials, alemtuzumab demonstrated efficacy in treatment-naïve patients with active RRMS and those relapsing on prior DMTs, with a consistent and manageable safety and tolerability profile. The European Union indication provides physicians with significant flexibility regarding treatment decisions, affording the opportunity for individualized treatment. Thus, alemtuzumab may be an appropriate treatment choice across a broad range of patients with RRMS, including, for example, treatment-naïve patients with active disease, patients with highly active disease, or for patients relapsing on prior DMTs. There are several practicalities to consider when using alemtuzumab, including the unique dosing regimen, administered via intravenous infusion on 5 consecutive days at baseline and on 3 consecutive days 12 months later, and as-needed retreatment (3 consecutive days at least 12 months after the last course) in cases of disease recurrence. Additionally, routine monthly monitoring is required for up to 48 months after the last infusion to promptly identify potentially serious autoimmune adverse events. Given these considerations, it is beneficial to gain insight into how alemtuzumab is being used in the real-world clinical setting. Here, we report recommendations from European multiple sclerosis experts regarding best practices for alemtuzumab treatment, including management of adverse events and compliance with ongoing safety

Eligibility for renal denervation: experience at 11 European expert centers.

PubMed

Persu, Alexandre; Jin, Yu; Baelen, Marie; Vink, Eva; Verloop, Willemien L; Schmidt, Bernhard; Blicher, Marie K; Severino, Francesca; Wuerzner, Grégoire; Taylor, Alison; Pechère-Bertschi, Antoinette; Jokhaji, Fadi; Fadl Elmula, Fadl Elmula M; Rosa, Jan; Czarnecka, Danuta; Ehret, Georg; Kahan, Thomas; Renkin, Jean; Widimsky, Jiři; Jacobs, Lotte; Spiering, Wilko; Burnier, Michel; Mark, Patrick B; Menne, Jan; Olsen, Michael H; Blankestijn, Peter J; Kjeldsen, Sverre; Bots, Michiel L; Staessen, Jan A

2014-06-01

Based on the SYMPLICITY studies and CE (Conformité Européenne) certification, renal denervation is currently applied as a novel treatment of resistant hypertension in Europe. However, information on the proportion of patients with resistant hypertension qualifying for renal denervation after a thorough work-up and treatment adjustment remains scarce. The aim of this study was to investigate the proportion of patients eligible for renal denervation and the reasons for noneligibility at 11 expert centers participating in the European Network COordinating Research on renal Denervation in treatment-resistant hypertension (ENCOReD). The analysis included 731 patients. Age averaged 61.6 years, office blood pressure at screening was 177/96 mm Hg, and the number of blood pressure-lowering drugs taken was 4.1. Specialists referred 75.6% of patients. The proportion of patients eligible for renal denervation according to the SYMPLICITY HTN-2 criteria and each center's criteria was 42.5% (95% confidence interval, 38.0%-47.0%) and 39.7% (36.2%-43.2%), respectively. The main reasons of noneligibility were normalization of blood pressure after treatment adjustment (46.9%), unsuitable renal arterial anatomy (17.0%), and previously undetected secondary causes of hypertension (11.1%). In conclusion, after careful screening and treatment adjustment at hypertension expert centers, only ≈40% of patients referred for renal denervation, mostly by specialists, were eligible for the procedure. The most frequent cause of ineligibility (approximately half of cases) was blood pressure normalization after treatment adjustment by a hypertension specialist. Our findings highlight that hypertension centers with a record in clinical experience and research should remain the gatekeepers before renal denervation is considered.

European Network of Bipolar Research Expert Centre (ENBREC): a network to foster research and promote innovative care.

PubMed

Henry, Chantal; Andreassen, Ole A; Barbato, Angelo; Demotes-Mainard, Jacques; Goodwin, Guy; Leboyer, Marion; Vieta, Eduard; Nolen, Willem A; Kessing, Lars Vedel; Scott, Jan; Bauer, Michael

2013-01-01

Bipolar disorders rank as one of the most disabling illnesses in working age adults worldwide. Despite this, the quality of care offered to patients with this disorder is suboptimal, largely due to limitations in our understanding of the pathology. Improving this scenario requires the development of a critical mass of expertise and multicentre collaborative projects. Within the framework of the European FP7 programme, we developed a European Network of Bipolar Research Expert Centres (ENBREC) designed specifically to facilitate EU-wide studies. ENBREC provides an integrated support structure facilitating research on disease mechanisms and clinical outcomes across six European countries (France, Germany, Italy, Norway, Spain and the UK). The centres are adopting a standardised clinical assessment that explores multiple aspects of bipolar disorder through a structured evaluation designed to inform clinical decision-making as well as being applicable to research. Reliable, established measures have been prioritised, and instruments have been translated and validated when necessary. An electronic healthcare record and monitoring system (e-ENBREC©) has been developed to collate the data. Protocols to conduct multicentre clinical observational studies and joint studies on cognitive function, biomarkers, genetics, and neuroimaging are in progress; a pilot study has been completed on strategies for routine implementation of psycho-education. The network demonstrates 'proof of principle' that expert centres across Europe can collaborate on a wide range of basic science and clinical programmes using shared protocols. This paper is to describe the network and how it aims to improve the quality and effectiveness of research in a neglected priority area.

European union standards for tuberculosis care.

PubMed

Migliori, G B; Zellweger, J P; Abubakar, I; Ibraim, E; Caminero, J A; De Vries, G; D'Ambrosio, L; Centis, R; Sotgiu, G; Menegale, O; Kliiman, K; Aksamit, T; Cirillo, D M; Danilovits, M; Dara, M; Dheda, K; Dinh-Xuan, A T; Kluge, H; Lange, C; Leimane, V; Loddenkemper, R; Nicod, L P; Raviglione, M C; Spanevello, A; Thomsen, V Ø; Villar, M; Wanlin, M; Wedzicha, J A; Zumla, A; Blasi, F; Huitric, E; Sandgren, A; Manissero, D

2012-04-01

The European Centre for Disease Prevention and Control (ECDC) and the European Respiratory Society (ERS) jointly developed European Union Standards for Tuberculosis Care (ESTC) aimed at providing European Union (EU)-tailored standards for the diagnosis, treatment and prevention of tuberculosis (TB). The International Standards for TB Care (ISTC) were developed in the global context and are not always adapted to the EU setting and practices. The majority of EU countries have the resources and capacity to implement higher standards to further secure quality TB diagnosis, treatment and prevention. On this basis, the ESTC were developed as standards specifically tailored to the EU setting. A panel of 30 international experts, led by a writing group and the ERS and ECDC, identified and developed the 21 ESTC in the areas of diagnosis, treatment, HIV and comorbid conditions, and public health and prevention. The ISTCs formed the basis for the 21 standards, upon which additional EU adaptations and supplements were developed. These patient-centred standards are targeted to clinicians and public health workers, providing an easy-to-use resource, guiding through all required activities to ensure optimal diagnosis, treatment and prevention of TB. These will support EU health programmes to identify and develop optimal procedures for TB care, control and elimination.

European Union Standards for Tuberculosis Care

PubMed Central

Migliori, G.B.; Zellweger, J.P.; Abubakar, I.; Ibraim, E.; Caminero, J.A.; De Vries, G.; D'Ambrosio, L.; Centis, R.; Sotgiu, G.; Menegale, O.; Kliiman, K.; Aksamit, T.; Cirillo, D.M.; Danilovits, M.; Dara, M.; Dheda, K.; Dinh-Xuan, A.T.; Kluge, H.; Lange, C.; Leimane, V.; Loddenkemper, R.; Nicod, L.P.; Raviglione, M.C.; Spanevello, A.; Thomsen, V.Ø.; Villar, M.; Wanlin, M.; Wedzicha, J.A.; Zumla, A.; Blasi, F.; Huitric, E.; Sandgren, A.; Manissero, D.

2012-01-01

The European Centre for Disease Prevention and Control (ECDC) and the European Respiratory Society (ERS) jointly developed European Union Standards for Tuberculosis Care (ESTC) aimed at providing European Union (EU)-tailored standards for the diagnosis, treatment and prevention of tuberculosis (TB). The International Standards for TB Care (ISTC) were developed in the global context and are not always adapted to the EU setting and practices. The majority of EU countries have the resources and capacity to implement higher standards to further secure quality TB diagnosis, treatment and prevention. On this basis, the ESTC were developed as standards specifically tailored to the EU setting. A panel of 30 international experts, led by a writing group and the ERS and ECDC, identified and developed the 21 ESTC in the areas of diagnosis, treatment, HIV and comorbid conditions, and public health and prevention. The ISTCs formed the basis for the 21 standards, upon which additional EU adaptations and supplements were developed. These patient-centred standards are targeted to clinicians and public health workers, providing an easy-to-use resource, guiding through all required activities to ensure optimal diagnosis, treatment and prevention of TB. These will support EU health programmes to identify and develop optimal procedures for TB care, control and elimination. PMID:22467723

Are the psychosocial aspects of weapons of mass destruction incidents addressed in the Federal Response Plan: summary of an expert panel.

PubMed

Becker, S M

2001-12-01

Within the domestic preparedness community, there is a growing recognition of the importance of psychosocial issues in weapons of mass destruction (WMD) incidents. Whereas social and behavioral issues were only infrequently considered just a few years ago, they are now coming to be seen as central to consequence management efforts. As a result, discussions in the domestic preparedness community are beginning to consider the extent to which psychosocial effects are addressed in the Federal Response Plan and the degree to which additional preparedness and response steps may be needed. To grapple with this crucial issue, an expert panel was brought together at the International Conference on the Operational Impact of Psychological Casualties from Weapons of Mass Destruction. The panel brought together a wide range of specialists from federal agencies, the armed services, and the academic community. This article summarizes the views and assessments of the panelists as well as their policy recommendations for enhancing preparedness.

A Genomewide Admixture Mapping Panel for Hispanic/Latino Populations

PubMed Central

Mao, Xianyun ; Bigham, Abigail W. ; Mei, Rui ; Gutierrez, Gerardo ; Weiss, Ken M. ; Brutsaert, Tom D. ; Leon-Velarde, Fabiola ; Moore, Lorna G. ; Vargas, Enrique ; McKeigue, Paul M. ; Shriver, Mark D. ; Parra, Esteban J. 

2007-01-01

Admixture mapping (AM) is a promising method for the identification of genetic risk factors for complex traits and diseases showing prevalence differences among populations. Efficient application of this method requires the use of a genomewide panel of ancestry-informative markers (AIMs) to infer the population of origin of chromosomal regions in admixed individuals. Genomewide AM panels with markers showing high frequency differences between West African and European populations are already available for disease-gene discovery in African Americans. However, no such a map is yet available for Hispanic/Latino populations, which are the result of two-way admixture between Native American and European populations or of three-way admixture of Native American, European, and West African populations. Here, we report a genomewide AM panel with 2,120 AIMs showing high frequency differences between Native American and European populations. The average intermarker genetic distance is ∼1.7 cM. The panel was identified by genotyping, with the Affymetrix GeneChip Human Mapping 500K array, a population sample with European ancestry, a Mesoamerican sample comprising Maya and Nahua from Mexico, and a South American sample comprising Aymara/Quechua from Bolivia and Quechua from Peru. The main criteria for marker selection were both high information content for Native American/European ancestry (measured as the standardized variance of the allele frequencies, also known as “f value”) and small frequency differences between the Mesoamerican and South American samples. This genomewide AM panel will make it possible to apply AM approaches in many admixed populations throughout the Americas. PMID:17503334

Validation of consensus panel diagnosis in dementia.

PubMed

Gabel, Matthew J; Foster, Norman L; Heidebrink, Judith L; Higdon, Roger; Aizenstein, Howard J; Arnold, Steven E; Barbas, Nancy R; Boeve, Bradley F; Burke, James R; Clark, Christopher M; Dekosky, Steven T; Farlow, Martin R; Jagust, William J; Kawas, Claudia H; Koeppe, Robert A; Leverenz, James B; Lipton, Anne M; Peskind, Elaine R; Turner, R Scott; Womack, Kyle B; Zamrini, Edward Y

2010-12-01

The clinical diagnosis of dementing diseases largely depends on the subjective interpretation of patient symptoms. Consensus panels are frequently used in research to determine diagnoses when definitive pathologic findings are unavailable. Nevertheless, research on group decision making indicates that many factors can adversely affect panel performance. To determine conditions that improve consensus panel diagnosis. Comparison of neuropathologic diagnoses with individual and consensus panel diagnoses based on clinical scenarios only, fludeoxyglucose F 18 positron emission tomography images only, and scenarios plus images. Expert and trainee individual and consensus panel deliberations using a modified Delphi method in a pilot research study of the diagnostic utility of fludeoxyglucose F 18 positron emission tomography. Forty-five patients with pathologically confirmed Alzheimer disease or frontotemporal dementia. Statistical measures of diagnostic accuracy, agreement, and confidence for individual raters and panelists before and after consensus deliberations. The consensus protocol using trainees and experts surpassed the accuracy of individual expert diagnoses when clinical information elicited diverse judgments. In these situations, consensus was 3.5 times more likely to produce positive rather than negative changes in the accuracy and diagnostic certainty of individual panelists. A rule that forced group consensus was at least as accurate as majority and unanimity rules. Using a modified Delphi protocol to arrive at a consensus diagnosis is a reasonable substitute for pathologic information. This protocol improves diagnostic accuracy and certainty when panelist judgments differ and is easily adapted to other research and clinical settings while avoiding the potential pitfalls of group decision making.

Guidelines for locoregional therapy in primary breast cancer in developing countries: The results of an expert panel at the 8th Annual Women's Cancer Initiative – Tata Memorial Hospital (WCI-TMH) Conference

PubMed Central

Munshi, Anusheel; Gupta, Sudeep; Anderson, Benjamin; Yarnold, John; Parmar, Vani; Jalali, Rakesh; Sharma, Suresh Chander; Desai, Sangeeta; Thakur, Meenakshi; Baijal, Gunjan; Sarin, Rajiv; Mittra, Indraneel; Ghosh, Jaya; Badwe, Rajendra

2012-01-01

Background: Limited guidelines exist for breast cancer management in developing countries. In this context, the Women's Cancer Initiative - Tata Memorial Hospital (WCI-TMH) organised its 8th Annual Conference to update guidelines in breast cancer. Materials and Methods: Appropriately formulated guideline questions on each topic and subtopic in the surgical, radiation and systemic management of primary breast cancer were developed by the scientific committee and shared with the guest faculty of the Conference. Majority of the questions had multiple choice answers. The opinion of the audience, comprising academic and community oncologists, was electronically cumulated, followed by focussed presentations by eminent national and international experts on each topic. The guidelines were finally developed through an expert panel that voted on each guideline question after all talks had been delivered and audience opinion elicited. Separate panels were constituted for locoregional and systemic therapy in primary breast cancer. Results: Based on the voting results of the expert panel, guidelines for locoregional therapy of breast cancer have been formulated. Voting patterns for each question are reported. Conclusions: The updated guidelines on locoregional management of primary breast cancer in the context of developing countries are presented in this article. These recommendations have been designed to allow centers in the developing world to improve the quality of care for breast cancer patients. PMID:22988354

Management of Acute Diarrheal Illness During Deployment: A Deployment Health Guideline and Expert Panel Report.

PubMed

Riddle, Mark S; Martin, Gregory J; Murray, Clinton K; Burgess, Timothy H; Connor, Patrick; Mancuso, James D; Schnaubelt, Elizabeth R; Ballard, Timothy P; Fraser, Jamie; Tribble, David R

2017-09-01

Acute diarrheal illness during deployment causes significant morbidity and loss of duty days. Effective and timely treatment is needed to reduce individual, unit, and health system performance impacts. This critical appraisal of the literature, as part of the development of expert consensus guidelines, asked several key questions related to self-care and healthcare-seeking behavior, antibiotics for self-treatment of travelers' diarrhea, what antibiotics/regimens should be considered for treatment of acute watery diarrhea and febrile diarrhea and/or dysentery, and when and what laboratory diagnostics should be used to support management of deployment-related travelers' diarrhea. Studies of acute diarrhea management in military and other travelers were assessed for relevance and quality. On the basis of this critical appraisal, guideline recommendations were developed and graded by the Expert Panel using good standards in clinical guideline development methodology. New definitions for defining the severity of diarrhea during deployment were established. A total of 13 graded recommendations on the topics of prophylaxis, therapy and diagnosis, and follow-up were developed. In addition, four non-graded consensus-based statements were adopted. Successful management of acute diarrheal illness during deployment requires action at the provider, population, and commander levels. Strong evidence supports that single-dose antimicrobial therapy is effective in most cases of moderate to severe acute diarrheal illness during deployment. Further studies are needed to address gaps in available knowledge regarding optimal therapies for treatment, prevention, and laboratory testing of acute diarrheal illness. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Handling and reporting of orchidectomy specimens with testicular cancer: areas of consensus and variation among 25 experts and 225 European pathologists.

PubMed

Berney, Daniel M; Algaba, Ferran; Amin, Mahul; Delahunt, Brett; Compérat, Eva; Epstein, Jonathan I; Humphrey, Peter; Idrees, Mohammed; Lopez-Beltran, Antonio; Magi-Galluzzi, Cristina; Mikuz, Gregor; Montironi, Rodolfo; Oliva, Esther; Srigley, John; Reuter, Victor E; Trpkov, Kiril; Ulbright, Thomas M; Varma, Murali; Verrill, Clare; Young, Robert H; Zhou, Ming; Egevad, Lars

2015-09-01

The handling and reporting of testicular tumours is difficult due to their rarity. A survey developed by the European Network of Uro-Pathology (ENUP) and sent to its members and experts to assess the evaluation of testicular germ cell tumours. Twenty-five experts and 225 ENUP members replied. Areas of disagreement included immaturity in teratomas, reported by 32% of experts but 68% of ENUP. Although the presence of rete testis invasion was reported widely, the distinction between pagetoid and stromal invasion was made by 96% of experts but only 63% of ENUP. Immunohistochemistry was used in more than 50% of cases by 68% of ENUP and 12% of experts. Staging revealed the greatest areas of disagreement. Invasion of the tunica vaginalis without vascular invasion was interpreted as T1 by 52% of experts and 67% of ENUP, but T2 by the remainder. Tumour invading the hilar adipose tissue adjacent to the epididymis without vascular invasion was interpreted as T1: 40% of experts, 43% of ENUP; T2: 36% of experts, 30% of ENUP; and T3: 24% of experts, 27% of ENUP. There is remarkable consensus in many areas of testicular pathology. Significant areas of disagreement included staging and reporting of histological types, both of which have the potential to impact on therapy. © 2015 John Wiley & Sons Ltd.

Use of questionnaires and an expert panel to judge the environmental consequences of chemical spills for the development of an environment-accident index.

PubMed

Andersson, Asa Scott; Stjernström, Olof; Fängmark, Ingrid

2005-05-01

Assessing the environmental consequences of a chemical accident is a complex task. To date, the methods used to evaluate the environmental effects of an acute release of a chemical have often been based on measurements of chemical and physical variables deemed to be important, such as the concentration of the chemical. However, a broader strategy is needed to predict the environmental consequences of potential accidents during the planning process. An Environment-Accident Index (EAI), a simple tool based on such a strategy, has been developed to facilitate the consideration of a multitude of influential variables. The objectives of this study were to evaluate whether questionnaire-based expert panel's judgements could provide useful data on the environmental consequences of chemical spills, and an effective basis for further development of the EAI. As expected, the judgements did not agree perfectly, but they do give rough indications of the environmental effects, and highlight consistent trends that should be useful inputs for planning, prevention and decontamination processes. The different accidents were also judged to have caused everything from minor to very major effects in the environment, implying that a wide range of accident scenarios were represented in the material and covered by the EAI. Therefore, questionnaires and expert panel judgements can be used to collect useful data for estimating the likely environmental consequences of chemical accidents and for further development of the EAI.

Impact of the 2014 expert panel recommendations for management of high blood pressure on contemporary cardiovascular practice: insights from the NCDR PINNACLE registry.

PubMed

Borden, William B; Maddox, Thomas M; Tang, Fengming; Rumsfeld, John S; Oetgen, William J; Mullen, J Brendan; Spinler, Sarah A; Peterson, Eric D; Masoudi, Frederick A

2014-12-02

Since 2003, the Seventh Report of the Joint National Committee (JNC-7) has been the predominant guideline for blood pressure management. A 2014 expert panel recommended increasing the blood pressure targets for patients age 60 years and older, as well as those with diabetes or chronic kidney disease. The purpose of this study was to examine the effect of the 2014 expert panel blood pressure management recommendations on patients managed in U.S. ambulatory cardiovascular practices. Using the National Cardiovascular Data Registry PINNACLE Registry, we assessed the proportion of patients who met the 2003 and 2014 panel recommendations, highlighting the populations of patients for whom the blood pressure goals changed. Of 1,185,253 patients in the study cohort, 706,859 (59.6%) achieved the 2003 JNC-7 goals. Using the 2014 recommendations, 880,378 (74.3%) patients were at goal. Among the 173,519 (14.6%) for whom goal achievement changed, 40,323 (23.2%) had a prior stroke or transient ischemic attack, and 112,174 (64.6%) had coronary artery disease. In addition, the average Framingham risk score in this group was 8.5 ± 3.2%, and the 10-year ASCVD risk score was 28.0 ± 19.5%. Among U.S. ambulatory cardiology patients with hypertension, nearly 1 in 7 who did not meet JNC-7 recommendations would now meet the 2014 treatment goals. If the new recommendations are implemented in clinical practice, blood pressure target achievement and cardiovascular events will need careful monitoring, because many patients for whom the target blood pressure is now more permissive are at high cardiovascular risk. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Panel 5: Microbiology and Immunology Panel

PubMed Central

Murphy, Timothy F.; Chonmaitree, Tasnee; Barenkamp, Stephen; Kyd, Jennelle; Nokso-Koivisto, Johanna; Patel, Janak A.; Heikkinen, Terho; Yamanaka, Noboru; Ogra, Pearay; Swords, W. Edward; Sih, Tania; Pettigrew, Melinda M.

2014-01-01

Objective The objective is to perform a comprehensive review of the literature from January 2007 through June 2011 on the virology, bacteriology, and immunology related to otitis media. Data Sources PubMed database of the National Library of Medicine. Review Methods Three subpanels with co-chairs comprising experts in the virology, bacteriology, and immunology of otitis media were formed. Each of the panels reviewed the literature in their respective fields and wrote draft reviews. The reviews were shared with all panel members, and a second draft was created. The entire panel met at the 10th International Symposium on Recent Advances in Otitis Media in June 2011 and discussed the review and refined the content further. A final draft was created, circulated, and approved by the panel. Conclusion Excellent progress has been made in the past 4 years in advancing an understanding of the microbiology and immunology of otitis media. Advances include laboratory-based basic studies, cell-based assays, work in animal models, and clinical studies. Implications for Practice The advances of the past 4 years formed the basis of a series of short-term and long-term research goals in an effort to guide the field. Accomplishing these goals will provide opportunities for the development of novel interventions, including new ways to better treat and prevent otitis media. PMID:23536533

Curricula for Media Literacy Education According to International Experts

ERIC Educational Resources Information Center

Fedorov, Alexander; Levitskaya, Anastasia; Camarero, Emma

2016-01-01

The article analyzes the results of the international experts' survey regarding the curriculum of media literacy education, which was administrated by the authors in September-October 2015. The expert panel includes specialists actively involved in the real process of media literacy education in schools, universities and other educational…

The view of European experts regarding health economics for medical nutrition in disease-related malnutrition.

PubMed

Freijer, K; Lenoir-Wijnkoop, I; Russell, C A; Koopmanschap, M A; Kruizenga, H M; Lhachimi, S K; Norman, K; Nuijten, M J C; Schols, J M G A

2015-05-01

Health-care systems are currently facing tremendous budget constraints resulting in growing pressure on decision makers and health-care providers to obtain the maximum possible health benefits of the resources available. Choices have to be made, and health economics can help in allocating limited health-care resources among unlimited wants and needs. Attempts to achieve cost reductions often focus on severe pathologies and chronic diseases as they commonly represent high health-care expenditures. In this context, awareness of the considerable financial burden caused by disease-related malnutrition (DRM) is lacking. Possibilities of reducing costs by optimising the management of DRM through medical nutrition will mostly not even be taken into account. During a European expert meeting, the total evaluation of medical nutrition was viewed and discussed. The aim of this meeting was to gain an experts' outline of the key issues relating to the health economic assessment of the use of medical nutrition. This article provides a summary of the observations per discussed item and describes the next steps suggested.

Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the Expert Panel.

PubMed

Black, Robert E; Taylor, Carl E; Arole, Shobha; Bang, Abhay; Bhutta, Zulfiqar A; Chowdhury, A Mushtaque R; Kirkwood, Betty R; Kureshy, Nazo; Lanata, Claudio F; Phillips, James F; Taylor, Mary; Victora, Cesar G; Zhu, Zonghan; Perry, Henry B

2017-06-01

The contributions that community-based primary health care (CBPHC) and engaging with communities as valued partners can make to the improvement of maternal, neonatal and child health (MNCH) is not widely appreciated. This unfortunate reality is one of the reasons why so few priority countries failed to achieve the health-related Millennium Development Goals by 2015. This article provides a summary of a series of articles about the effectiveness of CBPHC in improving MNCH and offers recommendations from an Expert Panel for strengthening CBPHC that were formulated in 2008 and have been updated on the basis of more recent evidence. An Expert Panel convened to guide the review of the effectiveness of community-based primary health care (CBPHC). The Expert Panel met in 2008 in New York City with senior UNICEF staff. In 2016, following the completion of the review, the Panel considered the review's findings and made recommendations. The review consisted of an analysis of 661 unique reports, including 583 peer-reviewed journal articles, 12 books/monographs, 4 book chapters, and 72 reports from the gray literature. The analysis consisted of 700 assessments since 39 were analyzed twice (once for an assessment of improvements in neonatal and/or child health and once for an assessment in maternal health). The Expert Panel recommends that CBPHC should be a priority for strengthening health systems, accelerating progress in achieving universal health coverage, and ending preventable child and maternal deaths. The Panel also recommends that expenditures for CBPHC be monitored against expenditures for primary health care facilities and hospitals and reflect the importance of CBPHC for averting mortality. Governments, government health programs, and NGOs should develop health systems that respect and value communities as full partners and work collaboratively with them in building and strengthening CBPHC programs - through engagement with planning, implementation (including the

A new way to ask the experts: Rating radioactive waste risks

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kerr, R.A.

1996-11-08

The possible risks of a proposed nuclear waste repository at Yucca Mountain include the dozen or more young volcanos near by. Now some earth scientists have a new approach to evaluating hazards accounting for uncertainty at every step - `expert elicitation.` This pulls together a panel of experts, carefully assesses the uncertainties of each of their views then mathematically combines their risk estimates along with the accompanying uncertainties. The article goes on to describe just such a panel which considered seismic hazards to Yucca Mountain, how they came to their conclusions, the arguments about the conclusions, and the future ofmore » expert elicitation in evaluating the risks of nuclear waste disposal.« less

A combined reference panel from the 1000 Genomes and UK10K projects improved rare variant imputation in European and Chinese samples

PubMed Central

Chou, Wen-Chi; Zheng, Hou-Feng; Cheng, Chia-Ho; Yan, Han; Wang, Li; Han, Fang; Richards, J. Brent; Karasik, David; Kiel, Douglas P.; Hsu, Yi-Hsiang

2016-01-01

Imputation using the 1000 Genomes haplotype reference panel has been widely adapted to estimate genotypes in genome wide association studies. To evaluate imputation quality with a relatively larger reference panel and a reference panel composed of different ethnic populations, we conducted imputations in the Framingham Heart Study and the North Chinese Study using a combined reference panel from the 1000 Genomes (N = 1,092) and UK10K (N = 3,781) projects. For rare variants with 0.01% < MAF ≤ 0.5%, imputation in the Framingham Heart Study with the combined reference panel increased well-imputed genotypes (with imputation quality score ≥0.4) from 62.9% to 76.1% when compared to imputation with the 1000 Genomes. For the North Chinese samples, imputation of rare variants with 0.01% < MAF ≤ 0.5% with the combined reference panel increased well-imputed genotypes by from 49.8% to 61.8%. The predominant European ancestry of the UK10K and the combined reference panels may explain why there was less of an increase in imputation success in the North Chinese samples. Our results underscore the importance and potential of larger reference panels to impute rare variants, while recognizing that increasing ethnic specific variants in reference panels may result in better imputation for genotypes in some ethnic groups. PMID:28004816

Wood-based panels : supply, trade and consumption

Treesearch

Henry Spelter

2000-01-01

Preliminary figures of wood-based panels consumption in Europe show a small increase in 1999 to 52.1 million m3 a new record level. However, according to the European Panel Federation (EPF), real consumption taking into account particle board stock changes, was higher due to the recovery of markets in the second half of 1999. Particle board is the main panel in Europe...

Final report of the Cosmetic Ingredient Review Expert Panel amended safety assessment of Calendula officinalis-derived cosmetic ingredients.

PubMed

Andersen, F Alan; Bergfeld, Wilma F; Belsito, Donald V; Hill, Ronald A; Klaassen, Curtis D; Liebler, Daniel C; Marks, James G; Shank, Ronald C; Slaga, Thomas J; Snyder, Paul W

2010-01-01

Calendula officinalis extract, C officinalis flower, C officinalis flower extract, C officinalis flower oil, and C officinalis seed oil are cosmetic ingredients derived from C officinalis. These ingredients may contain minerals, carbohydrates, lipids, phenolic acids, flavonoids, tannins, coumarins, sterols and steroids, monoterpenes, sesquiterpenes, triterpenes, tocopherols, quinones, amino acids, and resins. These ingredients were not significantly toxic in single-dose oral studies using animals. The absence of reproductive/developmental toxicity was inferred from repeat-dose studies of coriander oil, with a similar composition. Overall, these ingredients were not genotoxic. They also were not irritating, sensitizing, or photosensitizing in animal or clinical tests but may be mild ocular irritants. The Cosmetic Ingredient Review (CIR) Expert Panel concluded that these ingredients are safe for use in cosmetics in the practices of use and concentration given in this amended safety assessment.

Expert Panel Recommendations for Hanford Double-Shell Tank Life Extension

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stewart, Charles W; Bush, Spencer H; Berman, Herbert Stanton

2001-06-29

Expert workshops were held in Richland in May 2001 to review the Hanford Double-Shell Tank Integrity Project and make recommendations to extend the life of Hanford's double-shell waste tanks. The workshop scope was limited to corrosion of the primary tank liner, and the main areas for review were waste chemistry control, tank inspection, and corrosion monitoring. Participants were corrosion experts from Hanford, Savannah River Site, Brookhaven National Lab., Pacific Northwest National Lab., and several consultants. This report describes the current state of the three areas of the program, the final recommendations of the workshop, and the rationale for their selection.

European Thyroid Association Guidelines regarding Thyroid Nodule Molecular Fine-Needle Aspiration Cytology Diagnostics.

PubMed

Paschke, Ralf; Cantara, Silvia; Crescenzi, Anna; Jarzab, Barbara; Musholt, Thomas J; Sobrinho Simoes, Manuel

2017-07-01

Molecular fine-needle aspiration (FNA) cytology diagnostics has the potential to address the inherent limitation of FNA cytology which is an indeterminate (atypia of undetermined significance/follicular lesion of undetermined significance follicular neoplasm) cytology. Because of the emerging role of molecular FNA cytology diagnostics, the European Thyroid Association convened a panel of international experts to review methodological aspects, indications, results, and limitations of molecular FNA cytology diagnostics. The panel reviewed the evidence for the diagnostic value of mutation panel assessment (including at least BRAF , NRAS , HRAS , KRAS , PAX8/PPARG , RET/PTC ) of targeted next generation sequencing and of a microarray gene expression classifier (GEC) test in the diagnostic assessment of an indeterminate cytology thyroid nodule. Moreover, possible surgical consequences of molecular FNA diagnostic results of thyroid nodules and the evidence that analysis of a molecular FNA diagnostic panel of somatic mutations or a microarray GEC test can alter the follow-up were reviewed. Molecular tests may help clinicians to drive patient care and the surgical decision if the analysis is performed in specialized laboratories. These molecular tests require standardization of performance characteristics and appropriate calibration as well as analytic validation before clinical interpretation.

European Thyroid Association Guidelines regarding Thyroid Nodule Molecular Fine-Needle Aspiration Cytology Diagnostics

PubMed Central

Paschke, Ralf; Cantara, Silvia; Crescenzi, Anna; Jarzab, Barbara; Musholt, Thomas J.; Sobrinho Simoes, Manuel

2017-01-01

Molecular fine-needle aspiration (FNA) cytology diagnostics has the potential to address the inherent limitation of FNA cytology which is an indeterminate (atypia of undetermined significance/follicular lesion of undetermined significance follicular neoplasm) cytology. Because of the emerging role of molecular FNA cytology diagnostics, the European Thyroid Association convened a panel of international experts to review methodological aspects, indications, results, and limitations of molecular FNA cytology diagnostics. The panel reviewed the evidence for the diagnostic value of mutation panel assessment (including at least BRAF, NRAS, HRAS, KRAS, PAX8/PPARG, RET/PTC) of targeted next generation sequencing and of a microarray gene expression classifier (GEC) test in the diagnostic assessment of an indeterminate cytology thyroid nodule. Moreover, possible surgical consequences of molecular FNA diagnostic results of thyroid nodules and the evidence that analysis of a molecular FNA diagnostic panel of somatic mutations or a microarray GEC test can alter the follow-up were reviewed. Molecular tests may help clinicians to drive patient care and the surgical decision if the analysis is performed in specialized laboratories. These molecular tests require standardization of performance characteristics and appropriate calibration as well as analytic validation before clinical interpretation. PMID:28785538

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the Expert Panel

PubMed Central

Black, Robert E; Taylor, Carl E; Arole, Shobha; Bang, Abhay; Bhutta, Zulfiqar A; Chowdhury, A Mushtaque R; Kirkwood, Betty R; Kureshy, Nazo; Lanata, Claudio F; Phillips, James F; Taylor, Mary; Victora, Cesar G; Zhu, Zonghan; Perry, Henry B

2017-01-01

Background The contributions that community–based primary health care (CBPHC) and engaging with communities as valued partners can make to the improvement of maternal, neonatal and child health (MNCH) is not widely appreciated. This unfortunate reality is one of the reasons why so few priority countries failed to achieve the health–related Millennium Development Goals by 2015. This article provides a summary of a series of articles about the effectiveness of CBPHC in improving MNCH and offers recommendations from an Expert Panel for strengthening CBPHC that were formulated in 2008 and have been updated on the basis of more recent evidence. Methods An Expert Panel convened to guide the review of the effectiveness of community–based primary health care (CBPHC). The Expert Panel met in 2008 in New York City with senior UNICEF staff. In 2016, following the completion of the review, the Panel considered the review’s findings and made recommendations. The review consisted of an analysis of 661 unique reports, including 583 peer–reviewed journal articles, 12 books/monographs, 4 book chapters, and 72 reports from the gray literature. The analysis consisted of 700 assessments since 39 were analyzed twice (once for an assessment of improvements in neonatal and/or child health and once for an assessment in maternal health). Results The Expert Panel recommends that CBPHC should be a priority for strengthening health systems, accelerating progress in achieving universal health coverage, and ending preventable child and maternal deaths. The Panel also recommends that expenditures for CBPHC be monitored against expenditures for primary health care facilities and hospitals and reflect the importance of CBPHC for averting mortality. Governments, government health programs, and NGOs should develop health systems that respect and value communities as full partners and work collaboratively with them in building and strengthening CBPHC programs – through engagement with

Future directions for postdoctoral training in cancer prevention: insights from a panel of experts.

PubMed

Nelson, David E; Faupel-Badger, Jessica; Phillips, Siobhan; Belcher, Britni; Chang, Shine; Abrams, David B; Kramer, Barnett S; White, Mary C; O'Malley, Michael; Varanasi, Arti P; Fabian, Carol J; Wiest, Jonathan S; Colditz, Graham A; Hall, Kara; Shields, Peter G; Weitzel, Jeffrey N

2014-04-01

Cancer prevention postdoctoral fellowships have existed since the 1970s. The National Cancer Institute facilitated a meeting by a panel of experts in April 2013 to consider four important topics for future directions for cancer prevention postdoctoral training programs: (i) future research needs; (ii) underrepresented disciplines; (iii) curriculum; and (iv) career preparation. Panelists proffered several areas needing more research or emphasis, ranging from computational science to culture. Health care providers, along with persons from nontraditional disciplines in scientific training programs such as engineers and lawyers, were among those recognized as being underrepresented in training programs. Curriculum suggestions were that fellows receive training in topics such as leadership and human relations, in addition to learning the principles of epidemiology, cancer biologic mechanisms, and behavioral science. For career preparation, there was a clear recognition of the diversity of employment options available besides academic positions, and that program leaders should do more to help fellows identify and prepare for different career paths. The major topics and strategies covered at this meeting can help form the basis for cancer prevention training program leaders to consider modifications or new directions, and keep them updated with the changing scientific and employment climate for doctoral degree recipients and postdoctoral fellows.

Future Directions for Postdoctoral Training in Cancer Prevention: Insights from a Panel of Experts

PubMed Central

Nelson, David E.; Faupel-Badger, Jessica; Phillips, Siobhan; Belcher, Britni; Chang, Shine; Abrams, David B.; Kramer, Barnett S.; White, Mary C.; O’Malley, Michael; Varanasi, Arti P.; Fabian, Carol J.; Wiest, Jonathan S.; Colditz, Graham A.; Hall, Kara; Shields, Peter G.; Weitzel, Jeffrey N.

2014-01-01

Cancer prevention postdoctoral fellowships have existed since the 1970s. The National Cancer Institute facilitated a meeting by a panel of experts in April 2013 to consider four important topics for future directions for cancer prevention postdoctoral training programs: 1) future research needs; 2) underrepresented disciplines; 3) curriculum; and 4) career preparation. Panelists proffered several areas needing more research or emphasis, ranging from computational science to culture. Health care providers, along with persons from non-traditional disciplines such as engineers and lawyers, were among disciplines recognized as being underrepresented in training programs. Curriculum suggestions were that fellows receive training in topics such as leadership and human relations, in addition to learning the principles of epidemiology, cancer biological mechanisms, and behavioral science. For career preparation, there was a clear recognition of the diversity of employment options available besides academic positions, and that program leaders should do more to help fellows identify and prepare for different career paths. The major topics and strategies covered at this meeting can help form the basis for cancer prevention training program leaders to consider modifications or new directions, and keep them current with the changing scientific and employment climate for doctoral degree recipients and postdoctoral fellows. PMID:24604827

Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: CHEST Guideline and Expert Panel Report.

PubMed

Wahidi, Momen M; Herth, Felix; Yasufuku, Kazuhiro; Shepherd, Ray Wesley; Yarmus, Lonny; Chawla, Mohit; Lamb, Carla; Casey, Kenneth R; Patel, Sheena; Silvestri, Gerard A; Feller-Kopman, David J

2016-03-01

Endobronchial ultrasound (EBUS) was introduced in the last decade, enabling real-time guidance of transbronchial needle aspiration (TBNA) of mediastinal and hilar structures and parabronchial lung masses. The many publications produced about EBUS-TBNA have led to a better understanding of the performance characteristics of this procedure. The goal of this document was to examine the current literature on the technical aspects of EBUS-TBNA as they relate to patient, technology, and proceduralist factors to provide evidence-based and expert guidance to clinicians. Rigorous methodology has been applied to provide a trustworthy evidence-based guideline and expert panel report. A group of approved panelists developed key clinical questions by using the PICO (population, intervention, comparator, and outcome) format that addressed specific topics on the technical aspects of EBUS-TBNA. MEDLINE (via PubMed) and the Cochrane Library were systematically searched for relevant literature, which was supplemented by manual searches. References were screened for inclusion, and well-recognized document evaluation tools were used to assess the quality of included studies, to extract meaningful data, and to grade the level of evidence to support each recommendation or suggestion. Our systematic review and critical analysis of the literature on 15 PICO questions related to the technical aspects of EBUS-TBNA resulted in 12 statements: 7 evidence-based graded recommendations and 5 ungraded consensus-based statements. Three questions did not have sufficient evidence to generate a statement. Evidence on the technical aspects of EBUS-TBNA varies in strength but is satisfactory in certain areas to guide clinicians on the best conditions to perform EBUS-guided tissue sampling. Additional research is needed to enhance our knowledge regarding the optimal performance of this effective procedure. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights

World Health Organization Estimates of the Relative Contributions of Food to the Burden of Disease Due to Selected Foodborne Hazards: A Structured Expert Elicitation

PubMed Central

Hald, Tine; Aspinall, Willy; Devleesschauwer, Brecht; Cooke, Roger; Corrigan, Tim; Havelaar, Arie H.; Gibb, Herman J.; Torgerson, Paul R.; Kirk, Martyn D.; Angulo, Fred J.; Lake, Robin J.; Speybroeck, Niko; Hoffmann, Sandra

2016-01-01

providing estimates for one or more subregions, depending on their experience in the region. The size of the 19 hazard-specific panels ranged from 6 to 15 persons with several experts serving on more than one panel. Pathogens with animal reservoirs (e.g. non-typhoidal Salmonella spp. and Toxoplasma gondii) were in general assessed by the experts to have a higher proportion of illnesses attributable to food than pathogens with mainly a human reservoir, where human-to-human transmission (e.g. Shigella spp. and Norovirus) or waterborne transmission (e.g. Salmonella Typhi and Vibrio cholerae) were judged to dominate. For many pathogens, the foodborne route was assessed relatively more important in developed subregions than in developing subregions. The main exposure routes for lead varied across subregions, with the foodborne route being assessed most important only in two subregions of the European region. Conclusions For the first time, we present worldwide estimates of the proportion of specific diseases attributable to food and other major transmission routes. These findings are essential for global burden of FBD estimates. While gaps exist, we believe the estimates presented here are the best current source of guidance to support decision makers when allocating resources for control and intervention, and for future research initiatives. PMID:26784029

World Health Organization Estimates of the Relative Contributions of Food to the Burden of Disease Due to Selected Foodborne Hazards: A Structured Expert Elicitation.

PubMed

Hald, Tine; Aspinall, Willy; Devleesschauwer, Brecht; Cooke, Roger; Corrigan, Tim; Havelaar, Arie H; Gibb, Herman J; Torgerson, Paul R; Kirk, Martyn D; Angulo, Fred J; Lake, Robin J; Speybroeck, Niko; Hoffmann, Sandra

2016-01-01

, depending on their experience in the region. The size of the 19 hazard-specific panels ranged from 6 to 15 persons with several experts serving on more than one panel. Pathogens with animal reservoirs (e.g. non-typhoidal Salmonella spp. and Toxoplasma gondii) were in general assessed by the experts to have a higher proportion of illnesses attributable to food than pathogens with mainly a human reservoir, where human-to-human transmission (e.g. Shigella spp. and Norovirus) or waterborne transmission (e.g. Salmonella Typhi and Vibrio cholerae) were judged to dominate. For many pathogens, the foodborne route was assessed relatively more important in developed subregions than in developing subregions. The main exposure routes for lead varied across subregions, with the foodborne route being assessed most important only in two subregions of the European region. For the first time, we present worldwide estimates of the proportion of specific diseases attributable to food and other major transmission routes. These findings are essential for global burden of FBD estimates. While gaps exist, we believe the estimates presented here are the best current source of guidance to support decision makers when allocating resources for control and intervention, and for future research initiatives.

Advancing Symptom Science Through Symptom Cluster Research: Expert Panel Proceedings and Recommendations

PubMed Central

Miaskowski, Christine; Barsevick, Andrea; Berger, Ann; Casagrande, Rocco; Grady, Patricia A.; Jacobsen, Paul; Kutner, Jean; Patrick, Donald; Zimmerman, Lani; Xiao, Canhua; Matocha, Martha; Marden, Sue

2017-01-01

An overview of proceedings, findings, and recommendations from the workshop on “Advancing Symptom Science Through Symptom Cluster Research” sponsored by the National Institute of Nursing Research (NINR) and the Office of Rare Diseases Research, National Center for Advancing Translational Sciences, is presented. This workshop engaged an expert panel in an evidenced-based discussion regarding the state of the science of symptom clusters in chronic conditions including cancer and other rare diseases. An interdisciplinary working group from the extramural research community representing nursing, medicine, oncology, psychology, and bioinformatics was convened at the National Institutes of Health. Based on expertise, members were divided into teams to address key areas: defining characteristics of symptom clusters, priority symptom clusters and underlying mechanisms, measurement issues, targeted interventions, and new analytic strategies. For each area, the evidence was synthesized, limitations and gaps identified, and recommendations for future research delineated. The majority of findings in each area were from studies of oncology patients. However, increasing evidence suggests that symptom clusters occur in patients with other chronic conditions (eg, pulmonary, cardiac, and end-stage renal disease). Nonetheless, symptom cluster research is extremely limited and scientists are just beginning to understand how to investigate symptom clusters by developing frameworks and new methods and approaches. With a focus on personalized care, an understanding of individual susceptibility to symptoms and whether a “driving” symptom exists that triggers other symptoms in the cluster is needed. Also, research aimed at identifying the mechanisms that underlie symptom clusters is essential to developing targeted interventions. PMID:28119347

Diagnosis and management of acute myeloid leukemia in children and adolescents: recommendations from an international expert panel.

PubMed

Creutzig, Ursula; van den Heuvel-Eibrink, Marry M; Gibson, Brenda; Dworzak, Michael N; Adachi, Souichi; de Bont, Eveline; Harbott, Jochen; Hasle, Henrik; Johnston, Donna; Kinoshita, Akitoshi; Lehrnbecher, Thomas; Leverger, Guy; Mejstrikova, Ester; Meshinchi, Soheil; Pession, Andrea; Raimondi, Susana C; Sung, Lillian; Stary, Jan; Zwaan, Christian M; Kaspers, Gertjan J L; Reinhardt, Dirk

2012-10-18

Despite major improvements in outcome over the past decades, acute myeloid leukemia (AML) remains a life-threatening malignancy in children, with current survival rates of ∼70%. State-of-the-art recommendations in adult AML have recently been published in this journal by Döhner et al. The primary goal of an international expert panel of the International BFM Study Group AML Committee was to set standards for the management, diagnosis, response assessment, and treatment in childhood AML. This paper aims to discuss differences between childhood and adult AML, and to highlight recommendations that are specific to children. The particular relevance of new diagnostic and prognostic molecular markers in pediatric AML is presented. The general management of pediatric AML, the management of specific pediatric AML cohorts (such as infants) or subtypes of the disease occurring in children (such as Down syndrome related AML), as well as new therapeutic approaches, and the role of supportive care are discussed.

Expert consensus contouring guidelines for IMRT in esophageal and gastroesophageal junction cancer

PubMed Central

Wu, Abraham J.; Bosch, Walter R.; Chang, Daniel T.; Hong, Theodore S.; Jabbour, Salma K.; Kleinberg, Lawrence R.; Mamon, Harvey J.; Thomas, Charles R.; Goodman, Karyn A.

2015-01-01

Purpose/Objective(s) Current guidelines for esophageal cancer contouring are derived from traditional two-dimensional fields based on bony landmarks, and do not provide sufficient anatomical detail to ensure consistent contouring for more conformal radiotherapy techniques such as intensity-modulated radiation therapy (IMRT). Therefore, we convened an expert panel with the specific aim to derive contouring guidelines and generate an atlas for the clinical target volume (CTV) in esophageal or gastroesophageal junction (GEJ) cancer. Methods and Materials Eight expert academically-based gastrointestinal radiation oncologists participated. Three sample cases were chosen: a GEJ cancer, a distal esophageal cancer, and a mid-upper esophageal cancer. Uniform CT simulation datasets and an accompanying diagnostic PET-CT were distributed to each expert, and he/she was instructed to generate gross tumor volume (GTV) and CTV contours for each case. All contours were aggregated and subjected to quantitative analysis to assess the degree of concordance between experts and generate draft consensus contours. The panel then refined these contours to generate the contouring atlas. Results Kappa statistics indicated substantial agreement between panelists for each of the three test cases. A consensus CTV atlas was generated for the three test cases, each representing common anatomic presentations of esophageal cancer. The panel agreed on guidelines and principles to facilitate the generalizability of the atlas to individual cases. Conclusions This expert panel successfully reached agreement on contouring guidelines for esophageal and GEJ IMRT and generated a reference CTV atlas. This atlas will serve as a reference for IMRT contours for clinical practice and prospective trial design. Subsequent patterns of failure analyses of clinical datasets utilizing these guidelines may require modification in the future. PMID:26104943

Patient engagement in the process of planning and designing outpatient care improvements at the Veterans Administration Health-care System: findings from an online expert panel.

PubMed

Khodyakov, Dmitry; Stockdale, Susan E; Smith, Nina; Booth, Marika; Altman, Lisa; Rubenstein, Lisa V

2017-02-01

There is a strong interest in the Veterans Administration (VA) Health-care System in promoting patient engagement to improve patient care. We solicited expert opinion using an online expert panel system with a modified Delphi structure called ExpertLens ™ . Experts reviewed, rated and discussed eight scenarios, representing four patient engagement roles in designing and improving VA outpatient care (consultant, implementation advisor, equal stakeholder and lead stakeholder) and two VA levels (local and regional). Rating criteria included desirability, feasibility, patient ability, physician/staff acceptance and impact on patient-centredness and care quality. Data were analysed using the RAND/UCLA Appropriateness Method for determining consensus. Experts rated consulting with patients at the local level as the most desirable and feasible patient engagement approach. Engagement at the local level was considered more desirable than engagement at the regional level. Being an equal stakeholder at the local level received the highest ratings on the patient-centredness and health-care quality criteria. Our findings illustrate expert opinion about different approaches to patient engagement and highlight the benefits and challenges posed by each. Although experts rated local consultations with patients on an as-needed basis as most desirable and feasible, they rated being an equal stakeholder at the local level as having the highest potential impact on patient-centredness and care quality. This result highlights a perceived discrepancy between what is most desirable and what is potentially most effective, but suggests that routine local engagement of patients as equal stakeholders may be a desirable first step for promoting high-quality, patient-centred care. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Male reproductive disorders, diseases, and costs of exposure to endocrine-disrupting chemicals in the European Union.

PubMed

Hauser, Russ; Skakkebaek, Niels E; Hass, Ulla; Toppari, Jorma; Juul, Anders; Andersson, Anna Maria; Kortenkamp, Andreas; Heindel, Jerrold J; Trasande, Leonardo

2015-04-01

Increasing evidence suggests that endocrine-disrupting chemicals (EDCs) contribute to male reproductive diseases and disorders. To estimate the incidence/prevalence of selected male reproductive disorders/diseases and associated economic costs that can be reasonably attributed to specific EDC exposures in the European Union (EU). An expert panel evaluated evidence for probability of causation using the Intergovernmental Panel on Climate Change weight-of-evidence characterization. Exposure-response relationships and reference levels were evaluated, and biomarker data were organized from carefully identified studies from the peer-reviewed literature to represent European exposure and approximate burden of disease as it occurred in 2010. The cost-of-illness estimation utilized multiple peer-reviewed sources. The expert panel identified low epidemiological and strong toxicological evidence for male infertility attributable to phthalate exposure, with a 40-69% probability of causing 618,000 additional assisted reproductive technology procedures, costing €4.71 billion annually. Low epidemiological and strong toxicological evidence was also identified for cryptorchidism due to prenatal polybrominated diphenyl ether exposure, resulting in a 40-69% probability that 4615 cases result, at a cost of €130 million (sensitivity analysis, €117-130 million). A much more modest (0-19%) probability of causation in testicular cancer by polybrominated diphenyl ethers was identified due to very low epidemiological and weak toxicological evidence, with 6830 potential cases annually and costs of €848 million annually (sensitivity analysis, €313-848 million). The panel assigned 40-69% probability of lower T concentrations in 55- to 64-year-old men due to phthalate exposure, with 24 800 associated deaths annually and lost economic productivity of €7.96 billion. EDCs may contribute substantially to male reproductive disorders and diseases, with nearly €15 billion annual

Expert study to select indicators of the occurrence of emerging mycotoxin hazards.

PubMed

Kandhai, M C; Booij, C J H; Van der Fels-Klerx, H J

2011-01-01

This article describes a Delphi-based expert judgment study aimed at the selection of indicators to identify the occurrence of emerging mycotoxin hazards related to Fusarium spp. in wheat supply chains. A panel of 29 experts from 12 European countries followed a holistic approach to evaluate the most important indicators for different chain stages (growth, transport and storage, and processing) and their relative importance. After three e-mailing rounds, the experts reached consensus on the most important indicators for each of the three stages: wheat growth, transport and storage, and processing. For wheat growth, these indicators include: relative humidity/rainfall, crop rotation, temperature, tillage practice, water activity of the kernels, and crop variety/cultivar. For the transport and storage stage, they include water activity in the kernels, relative humidity, ventilation, temperature, storage capacity, and logistics. For wheat processing, indicators include quality data, fraction of the cereal used, water activity in the kernels, quality management and traceability systems, and carryover of contamination. The indicators selected in this study can be used in an identification system for the occurrence of emerging mycotoxin hazards in wheat supply chains. Such a system can be used by risk managers within governmental (related) organizations and/or the food and feed industry in order to react proactively to the occurrence of these emerging mycotoxins. © 2010 Society for Risk Analysis.

Engaging expert communities in development of content of Russia’s regional geoportals (case study: “River basins in European Russia” geoportal)

NASA Astrophysics Data System (ADS)

Ermolaeva, P.

2018-01-01

The purpose of this study is to attract expert communities’ intellectual resources to the process of developing a geoportal entitled "River Basins in European Russia". The results of a survey of experts (n=100) have shown that more than half of respondents had used a variety of geoportals’ data in their professional life. Data on digital relief models, streamflows and landscape maps are of greatest interest. In order to obtain a comprehensive social and ecological analysis of the territory, experts have expressed interest in placing data on population in the basins and its density, the volume of used natural resources, and recreational zones on the designed geoportal. In practical sense, our study can be viewed as a fruitful ground for the development of upward vertical communication (from citizens to the government) and partially horizontal communication among citizens via their engagement in the environmental decision-making process.

Expert Groups in the Building of European Public Policy

ERIC Educational Resources Information Center

Robert, Cecile

2012-01-01

When it comes to building European public action, expertise is ubiquitous and polymorphic. This article intends to study the ways expertise is being used in the European Commission and the logics underlying its use. The massive use of expertise also has consequences for the practices and identities of actors with whom European institutions…

Validating Measures of Real-World Outcome: The Results of the VALERO Expert Survey and RAND Panel

PubMed Central

Leifker, Feea R.; Patterson, Thomas L.; Heaton, Robert K.; Harvey, Philip D.

2011-01-01

Background: People with schizophrenia demonstrate considerable discrepancy between self-reported functioning and informant reports. It is not clear whether these discrepancies originate from the instruments used or from the perspectives of different informants. The goal of the Validation of Everyday Real-World Outcomes (VALERO) Study is to enhance the measurement of real-world (RW) outcomes in the social, residential, and vocational domains through selection of optimal scales and informants using a multistep process similar to the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative. Methods: Forty-eight experts provided their opinion regarding the best scales measuring RW outcomes. Fifty-nine measures were nominated. The investigators selected the 11 scales that were the most highly nominated, had the most published validity data, and best represented the domains of interest. Information was provided to other experts who served as RAND panelists. Panelists rated each measure for its suitability across multiple a priori domains. Discrepant ratings were discussed until consensus was reached. Results: Following the RAND Panel, the 2 scales that scored highest across the various criteria for each of the classes of scales (hybrid, social functioning, and everyday living skills) were selected for use in the first substudy of VALERO. The scales selected were the Quality-of-Life Scale, Specific Levels of Functioning Scale, Social Behavior Schedule, Social Functioning Scale, Independent Living Skills Schedule, and Life Skills Profile. Discussion: The results show that although there are significant limitations with current scales used for the assessment of RW outcome in schizophrenia, a consensus is possible. Further, several existing instruments were rated as useful for measuring social, residential, and vocational outcomes. PMID:19525354

Guidance for contact tracing of cases of Lassa fever, Ebola or Marburg haemorrhagic fever on an airplane: results of a European expert consultation.

PubMed

Gilsdorf, Andreas; Morgan, Dilys; Leitmeyer, Katrin

2012-11-21

Travel from countries where viral haemorrhagic fevers (VHF) are endemic has increased significantly over the past decades. In several reported VHF events on airplanes, passenger trace back was initiated but the scale of the trace back differed considerably. The absence of guidance documents to help the decision on necessity and scale of the trace back contributed to this variation.This article outlines the recommendations of an expert panel on Lassa fever, Ebola and Marburg haemorrhagic fever to the wider scientific community in order to advise the relevant stakeholders in the decision and scale of a possible passenger trace back. The evidence was collected through review of published literature and through the views of an expert panel. The guidance was agreed by consensus. Only a few events of VHF cases during air travel are reported in literature, with no documented infection in followed up contacts, so that no evidence of transmission of VHF during air travel exists to date. Based on this and the expert opinion, it was recommended that passenger trace back was undertaken only if: the index case had symptoms during the flight; the flight was within 21 days after detection of the event; and for Lassa fever if exposure of body fluid has been reported. The trace back should only be done after confirmation of the index case. Passengers and crew with direct contact, seat neighbours (+/- 1 seat), crew and cleaning personal of the section of the index case should be included in the trace back. No evidence has been found for the transmission of VHF in airplanes. This information should be taken into account, when a trace back decision has to be taken, because such a measure produces an enormous work load. The procedure suggested by the expert group can guide decisions made in future events, where a patient with suspected VHF infection travelled on a plane. However, the actual decision on start and scale of a trace back always lies in the hands of the responsible people

A review of the carcinogenic potential of glyphosate by four independent expert panels and comparison to the IARC assessment.

PubMed

Williams, Gary M; Aardema, Marilyn; Acquavella, John; Berry, Sir Colin; Brusick, David; Burns, Michele M; de Camargo, Joao Lauro Viana; Garabrant, David; Greim, Helmut A; Kier, Larry D; Kirkland, David J; Marsh, Gary; Solomon, Keith R; Sorahan, Tom; Roberts, Ashley; Weed, Douglas L

2016-09-01

The International Agency for Research on Cancer (IARC) published a monograph in 2015 concluding that glyphosate is "probably carcinogenic to humans" (Group 2A) based on limited evidence in humans and sufficient evidence in experimental animals. It was also concluded that there was strong evidence of genotoxicity and oxidative stress. Four Expert Panels have been convened for the purpose of conducting a detailed critique of the evidence in light of IARC's assessment and to review all relevant information pertaining to glyphosate exposure, animal carcinogenicity, genotoxicity, and epidemiologic studies. Two of the Panels (animal bioassay and genetic toxicology) also provided a critique of the IARC position with respect to conclusions made in these areas. The incidences of neoplasms in the animal bioassays were found not to be associated with glyphosate exposure on the basis that they lacked statistical strength, were inconsistent across studies, lacked dose-response relationships, were not associated with preneoplasia, and/or were not plausible from a mechanistic perspective. The overall weight of evidence from the genetic toxicology data supports a conclusion that glyphosate (including GBFs and AMPA) does not pose a genotoxic hazard and therefore, should not be considered support for the classification of glyphosate as a genotoxic carcinogen. The assessment of the epidemiological data found that the data do not support a causal relationship between glyphosate exposure and non-Hodgkin's lymphoma while the data were judged to be too sparse to assess a potential relationship between glyphosate exposure and multiple myeloma. As a result, following the review of the totality of the evidence, the Panels concluded that the data do not support IARC's conclusion that glyphosate is a "probable human carcinogen" and, consistent with previous regulatory assessments, further concluded that glyphosate is unlikely to pose a carcinogenic risk to humans.

Maintaining success, reducing treatment burden, focusing on survivorship: highlights from the third European consensus conference on diagnosis and treatment of germ-cell cancer.

PubMed

Beyer, J; Albers, P; Altena, R; Aparicio, J; Bokemeyer, C; Busch, J; Cathomas, R; Cavallin-Stahl, E; Clarke, N W; Claßen, J; Cohn-Cedermark, G; Dahl, A A; Daugaard, G; De Giorgi, U; De Santis, M; De Wit, M; De Wit, R; Dieckmann, K P; Fenner, M; Fizazi, K; Flechon, A; Fossa, S D; Germá Lluch, J R; Gietema, J A; Gillessen, S; Giwercman, A; Hartmann, J T; Heidenreich, A; Hentrich, M; Honecker, F; Horwich, A; Huddart, R A; Kliesch, S; Kollmannsberger, C; Krege, S; Laguna, M P; Looijenga, L H J; Lorch, A; Lotz, J P; Mayer, F; Necchi, A; Nicolai, N; Nuver, J; Oechsle, K; Oldenburg, J; Oosterhuis, J W; Powles, T; Rajpert-De Meyts, E; Rick, O; Rosti, G; Salvioni, R; Schrader, M; Schweyer, S; Sedlmayer, F; Sohaib, A; Souchon, R; Tandstad, T; Winter, C; Wittekind, C

2013-04-01

In November 2011, the Third European Consensus Conference on Diagnosis and Treatment of Germ-Cell Cancer (GCC) was held in Berlin, Germany. This third conference followed similar meetings in 2003 (Essen, Germany) and 2006 (Amsterdam, The Netherlands) [Schmoll H-J, Souchon R, Krege S et al. European consensus on diagnosis and treatment of germ-cell cancer: a report of the European Germ-Cell Cancer Consensus Group (EGCCCG). Ann Oncol 2004; 15: 1377-1399; Krege S, Beyer J, Souchon R et al. European consensus conference on diagnosis and treatment of germ-cell cancer: a report of the second meeting of the European Germ-Cell Cancer Consensus group (EGCCCG): part I. Eur Urol 2008; 53: 478-496; Krege S, Beyer J, Souchon R et al. European consensus conference on diagnosis and treatment of germ-cell cancer: a report of the second meeting of the European Germ-Cell Cancer Consensus group (EGCCCG): part II. Eur Urol 2008; 53: 497-513]. A panel of 56 of 60 invited GCC experts from all across Europe discussed all aspects on diagnosis and treatment of GCC, with a particular focus on acute and late toxic effects as well as on survivorship issues. The panel consisted of oncologists, urologic surgeons, radiooncologists, pathologists and basic scientists, who are all actively involved in care of GCC patients. Panelists were chosen based on the publication activity in recent years. Before the meeting, panelists were asked to review the literature published since 2006 in 20 major areas concerning all aspects of diagnosis, treatment and follow-up of GCC patients, and to prepare an updated version of the previous recommendations to be discussed at the conference. In addition, ∼50 E-vote questions were drafted and presented at the conference to address the most controversial areas for a poll of expert opinions. Here, we present the main recommendations and controversies of this meeting. The votes of the panelists are added as online supplements.

Indicators for evaluating European population health: a Delphi selection process.

PubMed

Freitas, Ângela; Santana, Paula; Oliveira, Mónica D; Almendra, Ricardo; Bana E Costa, João C; Bana E Costa, Carlos A

2018-04-27

Indicators are essential instruments for monitoring and evaluating population health. The selection of a multidimensional set of indicators should not only reflect the scientific evidence on health outcomes and health determinants, but also the views of health experts and stakeholders. The aim of this study is to describe the Delphi selection process designed to promote agreement on indicators considered relevant to evaluate population health at the European regional level. Indicators were selected in a Delphi survey conducted using a web-platform designed to implement and monitor participatory processes. It involved a panel of 51 experts and 30 stakeholders from different areas of knowledge and geographies. In three consecutive rounds the panel indicated their level of agreement or disagreement with indicator's relevance for evaluating population health in Europe. Inferential statistics were applied to draw conclusions on observed level of agreement (Scott's Pi interrater reliability coefficient) and opinion change (McNemar Chi-square test). Multivariate analysis of variance was conducted to check if the field of expertise influenced the panellist responses (Wilk's Lambda test). The panel participated extensively in the study (overall response rate: 80%). Eighty indicators reached group agreement for selection in the areas of: economic and social environment (12); demographic change (5); lifestyle and health behaviours (8); physical environment (6); built environment (12); healthcare services (11) and health outcomes (26). Higher convergence of group opinion towards agreement on the relevance of indicators was seen for lifestyle and health behaviours, healthcare services, and health outcomes. The panellists' field of expertise influenced responses: statistically significant differences were found for economic and social environment (p < 0.05 in round 1 and 2), physical environment (p < 0.01 in round 1) and health outcomes (p < 0.01 in round 3). The

Boosted protease inhibitor monotherapy in HIV-infected adults: outputs from a pan-European expert panel meeting

PubMed Central

2013-01-01

While the introduction of combination highly active antiretroviral therapy (HAART) regimens represents an important advance in the management of human immunodeficiency virus (HIV)-infected patients, tolerability can be an issue and the use of several different agents may produce problems. The switch of combination HAART to ritonavir-boosted protease inhibitor (PI) monotherapy may offer the opportunity to maintain antiviral efficacy while reducing treatment complexity and the risks of toxicity. Current European AIDS Clinical Society (EACS) guidelines recognise ritonavir-boosted PI monotherapy with twice-daily lopinavir/ritonavir or once-daily darunavir/ritonavir as a possible option in patients who have intolerance to nucleoside reverse transcriptase inhibitors, or for treatment simplification. Clinical trials data for PI boosted monotherapy are encouraging, showing substantial efficacy in the majority of patients; however, further data are required before this approach can be recommended as a routine treatment. Available data indicate that the most suitable candidates for the use of boosted PI monotherapy are long-term virologically suppressed patients who have demonstrated good adherence to antiretroviral therapy, who do not have chronic hepatitis B, have no history of treatment failure on PIs and are able to tolerate low-dose ritonavir. PMID:23347595

Expert opinion on best practice guidelines and competency framework for visual screening in children.

PubMed

Lança, Carla

2013-09-01

Screening programs to detect visual abnormalities in children vary among countries. The aim of this study is to describe experts' perception of best practice guidelines and competency framework for visual screening in children. A qualitative focus group technique was applied during the Portuguese national orthoptic congress to obtain the perception of an expert panel of 5 orthoptists and 2 ophthalmologists with experience in visual screening for children (mean age 53.43 years, SD ± 9.40). The panel received in advance a script with the description of three tuning competencies dimensions (instrumental, systemic, and interpersonal) for visual screening. The session was recorded in video and audio. Qualitative data were analyzed using a categorical technique. According to experts' views, six tests (35.29%) have to be included in a visual screening: distance visual acuity test, cover test, bi-prism or 4/6(Δ) prism, fusion, ocular movements, and refraction. Screening should be performed according to the child age before and after 3 years of age (17.65%). The expert panel highlighted the influence of the professional experience in the application of a screening protocol (23.53%). They also showed concern about the false negatives control (23.53%). Instrumental competencies were the most cited (54.09%), followed by interpersonal (29.51%) and systemic (16.4%). Orthoptists should have professional experience before starting to apply a screening protocol. False negative results are a concern that has to be more thoroughly investigated. The proposed framework focuses on core competencies highlighted by the expert panel. Competencies programs could be important do develop better screening programs.

Perspectives of policy and political decision makers on access to formal dementia care: expert interviews in eight European countries.

PubMed

Broda, Anja; Bieber, Anja; Meyer, Gabriele; Hopper, Louise; Joyce, Rachael; Irving, Kate; Zanetti, Orazio; Portolani, Elisa; Kerpershoek, Liselot; Verhey, Frans; Vugt, Marjolein de; Wolfs, Claire; Eriksen, Siren; Røsvik, Janne; Marques, Maria J; Gonçalves-Pereira, Manuel; Sjölund, Britt-Marie; Woods, Bob; Jelley, Hannah; Orrell, Martin; Stephan, Astrid

2017-08-03

As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers. Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4-7 experts (total N = 38). The interview guide addressed the topics "Complexity and Continuity of Care", "Formal Services", and "Public Awareness". Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries. The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness. Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations.

An expert consortium review of the EC-commissioned report "alternative (Non-Animal) methods for cosmetics testing: current status and future prospects - 2010".

PubMed

Hartung, Thomas; Blaauboer, Bas J; Bosgra, Sieto; Carney, Edward; Coenen, Joachim; Conolly, Rory B; Corsini, Emanuela; Green, Sidney; Faustman, Elaine M; Gaspari, Anthony; Hayashi, Makoto; Wallace Hayes, A; Hengstler, Jan G; Knudsen, Lisbeth E; Knudsen, Thomas B; McKim, James M; Pfaller, Walter; Roggen, Erwin L

2011-01-01

The European cosmetics legislation foresees a review in 2011 and possible postponement of the 2013 marketing ban to enforce the testing ban for systemic and repeated-dose animal tests. For this purpose, a 119-page report commissioned by the European Commission was published recently. Here, a group of 17 independent experts from the US, Europe, and Japan was brought together to evaluate the report. The expert panel strongly endorsed the report and its conclusions. A number of important options not considered were identified; these do not, however, affect the overall conclusions regarding the current lack of availability of a full replacement, especially for the areas of repeated dose toxicity, carcinogenicity testing, and reproductive toxicity, though a roadmap for change is emerging. However, some of these options may provide adequate data for replacement of some animal studies in the near future pending validation. Various recommendations expand the original report. The reviewers agree with the report that there is greater promise in the short term for the areas of sensitization and toxicokinetics. Additional opportunities lie in more global collaborations and the inclusion of other industry sectors.

A harmonized and efficient clinical research environment would benefit patients and enhance European competitiveness. Commentary.

PubMed

Amato, Antonino; Aringhieri, Eugenio; Boccia, Stefania; Buccella, Filippo; Gorini, Barbara; Gramaglia, Donatella; Masetti, Riccardo; Rossi, Paolo; Pelicci, Pier Giuseppe

2017-01-01

The forthcoming implementation of the European Clinical Trial Regulation (Regulation (EU) No. 536/2014), which is expected to facilitate the conduct of clinical trials across the European Union, will require National Authorities to create the best conditions for the implementation of the new Regulation through national guidelines, so that sponsors may reconsider Europe as a prime location for planning clinical trials. During a meeting titled "Innovation in Clinical Research", an expert panel discussed potential local advances fostering competitiveness of European clinical research with representatives of the pharmaceutical industry, patient organisations and Italian regulatory agency in view of the forthcoming implementation of (EU) No. 536/2014 on clinical trials of medicinal products. In this article we summarise the findings of the meeting, describe features characterising clinical research patterns and offer some suggestions on the possible involvement of all stakeholders in order to foster research innovation and allow the timely access to novel medicines for patients.

Defining consensus norms for palliative care of people with intellectual disabilities in Europe, using Delphi methods: A White Paper from the European Association of Palliative Care

PubMed Central

Tuffrey-Wijne, Irene; McLaughlin, Dorry; Curfs, Leopold; Dusart, Anne; Hoenger, Catherine; McEnhill, Linda; Read, Sue; Ryan, Karen; Satgé, Daniel; Straßer, Benjamin; Westergård, Britt-Evy; Oliver, David

2015-01-01

Background: People with intellectual disabilities often present with unique challenges that make it more difficult to meet their palliative care needs. Aim: To define consensus norms for palliative care of people with intellectual disabilities in Europe. Design: Delphi study in four rounds: (1) a taskforce of 12 experts from seven European countries drafted the norms, based on available empirical knowledge and regional/national guidelines; (2) using an online survey, 34 experts from 18 European countries evaluated the draft norms, provided feedback and distributed the survey within their professional networks. Criteria for consensus were clearly defined; (3) modifications and recommendations were made by the taskforce; and (4) the European Association for Palliative Care reviewed and approved the final version. Setting and participants: Taskforce members: identified through international networking strategies. Expert panel: a purposive sample identified through taskforce members’ networks. Results: A total of 80 experts from 15 European countries evaluated 52 items within the following 13 norms: equity of access, communication, recognising the need for palliative care, assessment of total needs, symptom management, end-of-life decision making, involving those who matter, collaboration, support for family/carers, preparing for death, bereavement support, education/training and developing/managing services. None of the items scored less than 86% agreement, making a further round unnecessary. In light of respondents’ comments, several items were modified and one item was deleted. Conclusion: This White Paper presents the first guidance for clinical practice, policy and research related to palliative care for people with intellectual disabilities based on evidence and European consensus, setting a benchmark for changes in policy and practice. PMID:26346181

Learning from Consumer-Oriented Review Efforts To Guide the Development of a System of Expert Panels To Identify and Share Promising and Exemplary Products and Programs. Working Papers. Volumes One and Two.

ERIC Educational Resources Information Center

Office of Educational Research and Improvement (ED), Washington, DC. Office of Reform Assistance and Dissemination.

These volumes contain working papers related to the development of the Office of Educational Research and Improvement (OERI) Facilitated System of Expert Panels. Introductory papers by Susan Klein, Michael Scriven, Sharon Bobbitt and Susan Klein, and Michael Scriven and Lois-ellin Datta (printed in both volumes) set the stage for the discussions…

Standardization of Negative Controls in Diagnostic Immunohistochemistry: Recommendations From the International Ad Hoc Expert Panel

PubMed Central

Torlakovic, Emina E.; Francis, Glenn; Garratt, John; Gilks, Blake; Hyjek, Elizabeth; Ibrahim, Merdol; Miller, Rodney; Nielsen, Søren; Petcu, Eugen B.; Swanson, Paul E.; Taylor, Clive R.; Vyberg, Mogens

2014-01-01

Standardization of controls, both positive and negative controls, is needed for diagnostic immunohistochemistry (dIHC). The use of IHC-negative controls, irrespective of type, although well established, is not standardized. As such, the relevance and applicability of negative controls continues to challenge both pathologists and laboratory budgets. Despite the clear theoretical notion that appropriate controls serve to demonstrate the sensitivity and specificity of the dIHC test, it remains unclear which types of positive and negative controls are applicable and/or useful in day-to-day clinical practice. There is a perceived need to provide “best practice recommendations” for the use of negative controls. This perception is driven not only by logistics and cost issues, but also by increased pressure for accurate IHC testing, especially when IHC is performed for predictive markers, the number of which is rising as personalized medicine continues to develop. Herein, an international ad hoc expert panel reviews classification of negative controls relevant to clinical practice, proposes standard terminology for negative controls, considers the total evidence of IHC specificity that is available to pathologists, and develops a set of recommendations for the use of negative controls in dIHC based on “fit-for-use” principles. PMID:24714041

A European Sustainable Tourism Labels proposal using a composite indicator

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blancas, Francisco Javier, E-mail: fjblaper@upo.es; Lozano-Oyola, Macarena, E-mail: mlozoyo@upo.es; González, Mercedes, E-mail: m_gonzalez@uma.es

The tourism sector in Europe faces important challenges which it must deal with to promote its future development. In this context, the European Commission considers that two key issues must be addressed. On the one hand, a better base of socio-economic knowledge about tourism and its relationship with the environment is needed, and, on the other hand, it is necessary to improve the image of European areas as quality sustainable tourism destinations. In this paper we present analytical tools that cover these needs. Specifically, we define a system of sustainable tourism indicators and we obtain a composite indicator incorporating weightsmore » quantified using a panel of experts. Employing the values of this global indicator as a basis, we define a Sustainable Tourism Country-Brand Ranking which assesses the perception of each country-brand depending on its degree of sustainability, and a system of sustainable tourism labels which reward the management carried out. - Highlights: • We define a system of indicators to improve the knowledge about sustainable tourism. • We obtain composite indicators based on expert knowledge. • The Sustainable Tourism Country-Brand Ranking would improve the image of destinations. • We define a Sustainable Tourism Labels System to assess country-brands. • The conclusions of the empirical analysis can be extrapolated to other tourist areas.« less

ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer

PubMed Central

Colombo, Nicoletta; Creutzberg, Carien; Amant, Frederic; Bosse, Tjalling; González-Martín, Antonio; Ledermann, Jonathan; Marth, Christian; Nout, Remi; Querleu, Denis; Mirza, Mansoor Raza; Sessa, Cristiana

2016-01-01

Abstract The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11–13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically-relevant questions about endometrial cancer relating to the following four areas: prevention and screening, surgery, adjuvant treatment and advanced and recurrent disease. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. Results of this consensus conference, together with a summary of evidence supporting each recommendation, are detailed in this article. All participants have approved this final article. PMID:26645990

Evaluation of tuberculosis diagnostics in children: 1. Proposed clinical case definitions for classification of intrathoracic tuberculosis disease. Consensus from an expert panel.

PubMed

Graham, Stephen M; Ahmed, Tahmeed; Amanullah, Farhana; Browning, Renee; Cardenas, Vicky; Casenghi, Martina; Cuevas, Luis E; Gale, Marianne; Gie, Robert P; Grzemska, Malgosia; Handelsman, Ed; Hatherill, Mark; Hesseling, Anneke C; Jean-Philippe, Patrick; Kampmann, Beate; Kabra, Sushil Kumar; Lienhardt, Christian; Lighter-Fisher, Jennifer; Madhi, Shabir; Makhene, Mamodikoe; Marais, Ben J; McNeeley, David F; Menzies, Heather; Mitchell, Charles; Modi, Surbhi; Mofenson, Lynne; Musoke, Philippa; Nachman, Sharon; Powell, Clydette; Rigaud, Mona; Rouzier, Vanessa; Starke, Jeffrey R; Swaminathan, Soumya; Wingfield, Claire

2012-05-15

There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis.

Evaluation of Tuberculosis Diagnostics in Children: 1. Proposed Clinical Case Definitions for Classification of Intrathoracic Tuberculosis Disease. Consensus From an Expert Panel

PubMed Central

Graham, Stephen M.; Ahmed, Tahmeed; Amanullah, Farhana; Browning, Renee; Cardenas, Vicky; Casenghi, Martina; Cuevas, Luis E.; Gale, Marianne; Gie, Robert P.; Grzemska, Malgosia; Handelsman, Ed; Hatherill, Mark; Hesseling, Anneke C.; Jean-Philippe, Patrick; Kampmann, Beate; Kabra, Sushil Kumar; Lienhardt, Christian; Lighter-Fisher, Jennifer; Madhi, Shabir; Makhene, Mamodikoe; Marais, Ben J.; McNeeley, David F.; Menzies, Heather; Mitchell, Charles; Modi, Surbhi; Mofenson, Lynne; Musoke, Philippa; Nachman, Sharon; Powell, Clydette; Rigaud, Mona; Rouzier, Vanessa; Starke, Jeffrey R.; Swaminathan, Soumya; Wingfield, Claire

2012-01-01

There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis. PMID:22448023

An overview of HyFIE Technical Research Project: cross-testing in main European hypersonic wind tunnels on EXPERT body

NASA Astrophysics Data System (ADS)

Brazier, Jean-Philippe; Martinez Schramm, Jan; Paris, Sébastien; Gawehn, Thomas; Reimann, Bodo

2016-09-01

HyFIE project aimed at improving the measurement techniques in hypersonic wind tunnels and comparing the experimental data provided by four major European facilities: DLR HEG and H2K, ONERA F4 and VKI Longshot. A common geometry of EXPERT body was chosen and four different models were used. A large amount of experimental data was collected and compared with the results of numerical simulations. Collapsing all the measured values showed a good agreement between the different facilities, as well as between experimental and computed data.

Future Challenges in Higher Education--Bologna Experts' Community Case Study

ERIC Educational Resources Information Center

Yemini, Miri

2012-01-01

This work presents results from systematic analysis of the challenges for the future of higher education in European and neighboring countries as it was extracted from the Bologna experts and Higher Education Reform experts' opinions. Opinions of more than 100 experts from 35 countries were documented and analyzed. Significant differences in the…

Panel Session on the Future of Few-Body Physics

NASA Astrophysics Data System (ADS)

Bakker, Bernard L. G.; Carbonell, Jaume; Elster, Charlotte; Epelbaum, Evgeny; Kalantar-Nayestanaki, Nasser; Richard, Jean-Marc

2014-08-01

During the 22nd European Few-Body Conference, a session was devoted to a panel discussion on the future of few-body physics. The panel members were Charlotte Elster, Jaume Carbonell, Evgeny Epelbaum, Nasser Kalantar-Nayestanaki, and Jean-Marc Richard. The session was chaired by Ben Bakker. After presentations by the panel members, several topics were discussed with the audience. The conclusions of this discussion are presented in this paper.

Expert panel on practice patterns in the management of cow's milk protein allergy and associated economic burden of disease on health service in Turkey.

PubMed

Sekerel, Bulent Enis; Seyhun, Oznur

2017-09-01

practice patterns in CMPA in Turkey, use of expert clinical opinion of the panel members rather than real-life data on practice patterns that were used to identify direct medical costs might raise a concern with the validity and reliability of the data. Also, while this was a three-step study with six experts included in the first stage (developing local guidelines for diagnosis, treatment, and follow-up of infants with CMPA in Turkey) and 410 pediatricians included in the second stage (a cross-sectional questionnaire-survey to determine pediatricians' awareness and practice of CMPA in infants and children), only four members were included in the present Delphi panel, which allows a limited discussion. Third, lack of sensitivity analyses and exclusion of indirect costs and costs related to alterations in quality of life, behavior of infants, and general well-being of infants and their parents from the cost-analysis seems to be another limitation that may have caused under-estimation of relative cost-effectiveness of the formulae. Fourth, calculation of costs per local guidelines rather than real-life practice patterns is another limitation that, otherwise, would extend the knowledge achieved in the current study. Notwithstanding these limitations, the present expert panel provided practice patterns in the management of CMPA and an estimate of the associated costs, depending on the symptom profile at initial admission for the first time in Turkey. In conclusion, in providing the first health economic data on CMPA in Turkey, the findings revealed that CMPA imposes a substantial burden on the Turkish healthcare system from both a payer perspective and societal perspective, and indicated clinical nutrition as a primary cost driver. Management of infants presenting with eczema, exclusively formula-fed infants, and first line use of AAF were associated with higher estimates for 2-year direct medical costs.

Switching long acting antipsychotic medications to aripiprazole long acting once-a-month: expert consensus by a panel of Italian and Spanish psychiatrists.

PubMed

Fagiolini, Andrea; Alfonsi, Emilia; Amodeo, Giovanni; Cenci, Mario; Di Lella, Michele; Farinella, Francesco; Ferraiuolo, Fabrizio; Fraguas, David; Loparco, Natale; Gutierrez-Rojas, Luis; Mignone, Maria Laura; Pataracchia, Giuseppe; Pillai, Gianluca; Russo, Felicia; Sanchez-Gistau, Vanessa; Spinogatti, Franco; Toscano, Marco; Villari, Vincenzo; De Filippis, Sergio

2016-01-01

Aripiprazole long acting once-monthly (AOM) is a long acting atypical antipsychotic with proven efficacy in schizophrenia and with a pharmacological and a side effect profile that is different from other antipsychotics. These and other characteristics make AOM a possible alternative in patients requiring a change in long acting antipsychotic treatment due to issues such as lack of efficacy or persistent side effects. Both clinical and pharmacological factors should be considered when switching antipsychotics, and specific guidelines for long acting antipsychotic switching that address all these factors are needed. A panel of Italian and Spanish experts in psychiatry met to discuss the strategies for the switch to AOM in patients with schizophrenia. Real life clinical experiences were shared and the clinical strategies to improve the likelihood of success were discussed. Due to its specific pharmacological and tolerability profile, AOM represents a suitable alternative for patients with schizophrenia requiring a switch to a new LAI treatment because of lack of efficacy or persistent side effects from another LAI. Possible strategies for the switch to AOM are presented in this expert consensus paper in an attempt to provide guidance throughout the entire switching process.

Expert Consensus Contouring Guidelines for Intensity Modulated Radiation Therapy in Esophageal and Gastroesophageal Junction Cancer.

PubMed

Wu, Abraham J; Bosch, Walter R; Chang, Daniel T; Hong, Theodore S; Jabbour, Salma K; Kleinberg, Lawrence R; Mamon, Harvey J; Thomas, Charles R; Goodman, Karyn A

2015-07-15

Current guidelines for esophageal cancer contouring are derived from traditional 2-dimensional fields based on bony landmarks, and they do not provide sufficient anatomic detail to ensure consistent contouring for more conformal radiation therapy techniques such as intensity modulated radiation therapy (IMRT). Therefore, we convened an expert panel with the specific aim to derive contouring guidelines and generate an atlas for the clinical target volume (CTV) in esophageal or gastroesophageal junction (GEJ) cancer. Eight expert academically based gastrointestinal radiation oncologists participated. Three sample cases were chosen: a GEJ cancer, a distal esophageal cancer, and a mid-upper esophageal cancer. Uniform computed tomographic (CT) simulation datasets and accompanying diagnostic positron emission tomographic/CT images were distributed to each expert, and the expert was instructed to generate gross tumor volume (GTV) and CTV contours for each case. All contours were aggregated and subjected to quantitative analysis to assess the degree of concordance between experts and to generate draft consensus contours. The panel then refined these contours to generate the contouring atlas. The κ statistics indicated substantial agreement between panelists for each of the 3 test cases. A consensus CTV atlas was generated for the 3 test cases, each representing common anatomic presentations of esophageal cancer. The panel agreed on guidelines and principles to facilitate the generalizability of the atlas to individual cases. This expert panel successfully reached agreement on contouring guidelines for esophageal and GEJ IMRT and generated a reference CTV atlas. This atlas will serve as a reference for IMRT contours for clinical practice and prospective trial design. Subsequent patterns of failure analyses of clinical datasets using these guidelines may require modification in the future. Copyright © 2015 Elsevier Inc. All rights reserved.

Expert Consensus Contouring Guidelines for Intensity Modulated Radiation Therapy in Esophageal and Gastroesophageal Junction Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wu, Abraham J., E-mail: wua@mskcc.org; Bosch, Walter R.; Chang, Daniel T.

Purpose/Objective(s): Current guidelines for esophageal cancer contouring are derived from traditional 2-dimensional fields based on bony landmarks, and they do not provide sufficient anatomic detail to ensure consistent contouring for more conformal radiation therapy techniques such as intensity modulated radiation therapy (IMRT). Therefore, we convened an expert panel with the specific aim to derive contouring guidelines and generate an atlas for the clinical target volume (CTV) in esophageal or gastroesophageal junction (GEJ) cancer. Methods and Materials: Eight expert academically based gastrointestinal radiation oncologists participated. Three sample cases were chosen: a GEJ cancer, a distal esophageal cancer, and a mid-upper esophagealmore » cancer. Uniform computed tomographic (CT) simulation datasets and accompanying diagnostic positron emission tomographic/CT images were distributed to each expert, and the expert was instructed to generate gross tumor volume (GTV) and CTV contours for each case. All contours were aggregated and subjected to quantitative analysis to assess the degree of concordance between experts and to generate draft consensus contours. The panel then refined these contours to generate the contouring atlas. Results: The κ statistics indicated substantial agreement between panelists for each of the 3 test cases. A consensus CTV atlas was generated for the 3 test cases, each representing common anatomic presentations of esophageal cancer. The panel agreed on guidelines and principles to facilitate the generalizability of the atlas to individual cases. Conclusions: This expert panel successfully reached agreement on contouring guidelines for esophageal and GEJ IMRT and generated a reference CTV atlas. This atlas will serve as a reference for IMRT contours for clinical practice and prospective trial design. Subsequent patterns of failure analyses of clinical datasets using these guidelines may require modification in the future.« less

Statin-associated muscle symptoms: impact on statin therapy—European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management

PubMed Central

Stroes, Erik S.; Thompson, Paul D.; Corsini, Alberto; Vladutiu, Georgirene D.; Raal, Frederick J.; Ray, Kausik K.; Roden, Michael; Stein, Evan; Tokgözoğlu, Lale; Nordestgaard, Børge G.; Bruckert, Eric; De Backer, Guy; Krauss, Ronald M.; Laufs, Ulrich; Santos, Raul D.; Hegele, Robert A.; Hovingh, G. Kees; Leiter, Lawrence A.; Mach, Francois; März, Winfried; Newman, Connie B.; Wiklund, Olov; Jacobson, Terry A.; Catapano, Alberico L.; Chapman, M. John; Ginsberg, Henry N.; Stroes, Erik; Thompson, Paul D.; Corsini, Alberto; Vladutiu, Georgirene D.; Raal, Frederick J.; Ray, Kausik K.; Roden, Michael; Stein, Evan; Tokgözoğlu, Lale; Nordestgaard, Børge G.; Bruckert, Eric; Krauss, Ronald M.; Laufs, Ulrich; Santos, Raul D.; März, Winfried; Newman, Connie B.; John Chapman, M.; Ginsberg, Henry N.; John Chapman, M.; Ginsberg, Henry N.; de Backer, Guy; Catapano, Alberico L.; Hegele, Robert A.; Kees Hovingh, G.; Jacobson, Terry A.; Leiter, Lawrence; Mach, Francois; Wiklund, Olov

2015-01-01

Statin-associated muscle symptoms (SAMS) are one of the principal reasons for statin non-adherence and/or discontinuation, contributing to adverse cardiovascular outcomes. This European Atherosclerosis Society (EAS) Consensus Panel overviews current understanding of the pathophysiology of statin-associated myopathy, and provides guidance for diagnosis and management of SAMS. Statin-associated myopathy, with significant elevation of serum creatine kinase (CK), is a rare but serious side effect of statins, affecting 1 per 1000 to 1 per 10 000 people on standard statin doses. Statin-associated muscle symptoms cover a broader range of clinical presentations, usually with normal or minimally elevated CK levels, with a prevalence of 7–29% in registries and observational studies. Preclinical studies show that statins decrease mitochondrial function, attenuate energy production, and alter muscle protein degradation, thereby providing a potential link between statins and muscle symptoms; controlled mechanistic and genetic studies in humans are necessary to further understanding. The Panel proposes to identify SAMS by symptoms typical of statin myalgia (i.e. muscle pain or aching) and their temporal association with discontinuation and response to repetitive statin re-challenge. In people with SAMS, the Panel recommends the use of a maximally tolerated statin dose combined with non-statin lipid-lowering therapies to attain recommended low-density lipoprotein cholesterol targets. The Panel recommends a structured work-up to identify individuals with clinically relevant SAMS generally to at least three different statins, so that they can be offered therapeutic regimens to satisfactorily address their cardiovascular risk. Further research into the underlying pathophysiological mechanisms may offer future therapeutic potential. PMID:25694464

Drugs foresight 2020: a Delphi expert panel study.

PubMed

Lintonen, Tomi; Konu, Anne; Rönkä, Sanna; Kotovirta, Elina

2014-05-03

Historically substance misuse has been relatively common in western countries, but comparatively few Finns report drug use. The Drugs 2020 study aimed at foreseeing changes in the drug situation in Finland by the year 2020. The Delphi method was used, utilizing drug experts of the EU national network in Finland. Marked growth was foreseen in drug use, especially in synthetic designer drugs and misuse of medicinal drugs. Significant increase was also expected in growing cannabis at home. However, the control of drug market was expected to shift more into the hands of organized crime. No consensus was reached on how drug prices will develop in the time period. Drug use is likely to remain punishable although the use and possession of cannabis may be treated less severely. It seems likely that health and social services resources will be directed towards medicinal treatment. Foresight can be utilized in preparing for the future; desirable developments can be fostered, and measures can be taken to curb probable but undesirable lines of development. Based on the results of this study, the experts' view is that it is highly likely that the Finnish society will have to prepare for an increase in the demand for drug-related care, both in terms of content of the care and financing the services. Also, the forecasted increase in the role of legal prescription medicine used as intoxicants will call for efforts not only in changing prescription practices but in border and police control measures, as well. Parallel developments have been foreseen in the UK and Sweden, and it is likely that similar trends will actualize also in other western countries.

Guidance for contact tracing of cases of Lassa fever, Ebola or Marburg haemorrhagic fever on an airplane: results of a European expert consultation

PubMed Central

2012-01-01

Background Travel from countries where viral haemorrhagic fevers (VHF) are endemic has increased significantly over the past decades. In several reported VHF events on airplanes, passenger trace back was initiated but the scale of the trace back differed considerably. The absence of guidance documents to help the decision on necessity and scale of the trace back contributed to this variation. This article outlines the recommendations of an expert panel on Lassa fever, Ebola and Marburg haemorrhagic fever to the wider scientific community in order to advise the relevant stakeholders in the decision and scale of a possible passenger trace back. Method The evidence was collected through review of published literature and through the views of an expert panel. The guidance was agreed by consensus. Results Only a few events of VHF cases during air travel are reported in literature, with no documented infection in followed up contacts, so that no evidence of transmission of VHF during air travel exists to date. Based on this and the expert opinion, it was recommended that passenger trace back was undertaken only if: the index case had symptoms during the flight; the flight was within 21 days after detection of the event; and for Lassa fever if exposure of body fluid has been reported. The trace back should only be done after confirmation of the index case. Passengers and crew with direct contact, seat neighbours (+/− 1 seat), crew and cleaning personal of the section of the index case should be included in the trace back. Conclusion No evidence has been found for the transmission of VHF in airplanes. This information should be taken into account, when a trace back decision has to be taken, because such a measure produces an enormous work load. The procedure suggested by the expert group can guide decisions made in future events, where a patient with suspected VHF infection travelled on a plane. However, the actual decision on start and scale of a trace back always lies

ESMO-ESGO-ESTRO consensus conference on endometrial cancer: Diagnosis, treatment and follow-up.

PubMed

Colombo, Nicoletta; Creutzberg, Carien; Amant, Frederic; Bosse, Tjalling; González-Martín, Antonio; Ledermann, Jonathan; Marth, Christian; Nout, Remi; Querleu, Denis; Mirza, Mansoor Raza; Sessa, Cristiana

2015-12-01

The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11-13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically-relevant questions about endometrial cancer relating to the following four areas: Prevention and screening, surgery, adjuvant treatment and advanced and recurrent disease. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. Results of this consensus conference, together with a summary of evidence supporting each recommendation, are detailed in this article. All participants have approved this final article. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Can fire safety in hotels be improved? Results from the survey of a panel of experts in Spain.

PubMed

Rubio-Romero, Juan Carlos; Márquez-Sierra, Francisco; Suárez-Cebador, Manuel

2016-06-08

The hotel industry is an important driver of the European labour market with over 250,000 hotels employing some 2 million people. In Spain, 240 workers were injured by fires in hotels from 2004 to 2008. Fire is considered to be the most important risk in the hotel industry, but the lack of an EU-wide data recording system for hotels makes it difficult to give exact figures for fire events. We analysed the state of fire prevention systems in hotels in Spain with the aim of proposing strategies to improve fire safety. A 10-item questionnaire was administered from 2007 to 2009 to 15 Spanish experts in fire safety. The questions were measured using a Likert scale and classified into 4 sections: current state of installations, influence of establishment characteristics, application of regulations and priority ranking of actions. Descriptive statistics summarized the data and t-tests evaluated the agreement foreach statement in the questionnaire. The statistical analysis showed homogeneity in the responses by the experts in all four categories: current state of fire safety installations, influence of establishment characteristics, application of regulations, and priority of actions. There was consensus among the experts over the necessity to improve the enforcement of regulations and also regarding the existence of an association between the hotel category (in Spain they are ranked using a 1 to 5 "star" rating system) and the level of fire safety; hotels with a higher category had higher levels of safety. There is a need to identify ways to apply fire safety standards to older hotels so that they comply with new regulations, to standardize regulations for different regions and countries, to improve the maintenance of installations and equipment, to increase the effectiveness of inspections conducted by government bodies, and to raise the general awareness of stakeholders involved in hotel fire prevention.

Current and Emerging Ethical Issues in Counseling: A Delphi Study of Expert Opinions

ERIC Educational Resources Information Center

Herlihy, Barbara; Dufrene, Roxane L.

2011-01-01

A Delphi study was conducted to ascertain the opinions of panel experts regarding the most important current and emerging ethical issues facing the counseling profession. Expert opinions on ethical issues in counselor preparation also were sought. Eighteen panelists responded to 3 rounds of data collection interspersed with feedback. Themes that…

Toward Earlier Inclusion of Pregnant and Postpartum Women in Tuberculosis Drug Trials: Consensus Statements From an International Expert Panel

PubMed Central

Gupta, Amita; Mathad, Jyoti S.; Abdel-Rahman, Susan M.; Albano, Jessica D.; Botgros, Radu; Brown, Vikki; Browning, Renee S.; Dawson, Liza; Dooley, Kelly E.; Gnanashanmugam, Devasena; Grinsztejn, Beatriz; Hernandez-Diaz, Sonia; Jean-Philippe, Patrick; Kim, Peter; Lyerly, Anne D.; Mirochnick, Mark; Mofenson, Lynne M.; Montepiedra, Grace; Piper, Jeanna; Sahin, Leyla; Savic, Radojka; Smith, Betsy; Spiegel, Hans; Swaminathan, Soumya; Watts, D. Heather; White, Amina

2016-01-01

Tuberculosis is a major cause of morbidity and mortality in women of childbearing age (15–44 years). Despite increased tuberculosis risk during pregnancy, optimal clinical treatment remains unclear: safety, tolerability, and pharmacokinetic data for many tuberculosis drugs are lacking, and trials of promising new tuberculosis drugs exclude pregnant women. To advance inclusion of pregnant and postpartum women in tuberculosis drug trials, the US National Institutes of Health convened an international expert panel. Discussions generated consensus statements (>75% agreement among panelists) identifying high-priority research areas during pregnancy, including: (1) preventing progression of latent tuberculosis infection, especially in women coinfected with human immunodeficiency virus; (2) evaluating new agents/regimens for treatment of multidrug-resistant tuberculosis; and (3) evaluating safety, tolerability and pharmacokinetics of tuberculosis drugs already in use during pregnancy and postpartum. Incorporating pregnant women into clinical trials would extend evidence-based tuberculosis prevention and treatment standards to this special population. PMID:26658057

The effectiveness of scoliosis screening programs: methods for systematic review and expert panel recommendations formulation

PubMed Central

2013-01-01

Background Literature on scoliosis screening is vast, however because of the observational nature of available data and methodological flaws, data interpretation is often complex, leading to incomplete and sometimes, somewhat misleading conclusions. The need to propose a set of methods for critical appraisal of the literature about scoliosis screening, a comprehensive summary and rating of the available evidence appeared essential. Methods To address these gaps, the study aims were: i) To propose a framework for the assessment of published studies on scoliosis screening effectiveness; ii) To suggest specific questions to be answered on screening effectiveness instead of trying to reach a global position for or against the programs; iii) To contextualize the knowledge through expert panel consultation and meaningful recommendations. The general methodological approach proceeds through the following steps: Elaboration of the conceptual framework; Formulation of the review questions; Identification of the criteria for the review; Selection of the studies; Critical assessment of the studies; Results synthesis; Formulation and grading of recommendations in response to the questions. This plan follows at best GRADE Group (Grades of Recommendation, Assessment, Development and Evaluation) requirements for systematic reviews, assessing quality of evidence and grading the strength of recommendations. Conclusions In this article, the methods developed in support of this work are presented since they may be of some interest for similar reviews in scoliosis and orthopaedic fields. PMID:23883346

Pediatric cyanide poisoning by fire smoke inhalation: a European expert consensus. Toxicology Surveillance System of the Intoxications Working Group of the Spanish Society of Paediatric Emergencies.

PubMed

Mintegi, Santiago; Clerigue, Nuria; Tipo, Vincenzo; Ponticiello, Eduardo; Lonati, Davide; Burillo-Putze, Guillermo; Delvau, Nicolas; Anseeuw, Kurt

2013-11-01

Most fire-related deaths are attributable to smoke inhalation rather than burns. The inhalation of fire smoke, which contains not only carbon monoxide but also a complex mixture of gases, seems to be the major cause of morbidity and mortality in fire victims, mainly in enclosed spaces. Cyanide gas exposure is quite common during smoke inhalation, and cyanide is present in the blood of fire victims in most cases and may play an important role in death by smoke inhalation. Cyanide poisoning may, however, be difficult to diagnose and treat. In these children, hydrogen cyanide seems to be a major source of concern, and the rapid administration of the antidote, hydroxocobalamin, may be critical for these children.European experts recently met to formulate an algorithm for prehospital and hospital management of adult patients with acute cyanide poisoning. Subsequently, a group of European pediatric experts met to evaluate and adopt that algorithm for use in the pediatric population.

The Expert System Programme of the European Space Agency

NASA Astrophysics Data System (ADS)

Lafay, J. F.; Allard, F.

1992-08-01

ESA's Expert System Demonstration (ESD) program is discussed in terms of its goals, structure, three-phase approach, and initial results. ESD is intended to demonstrate the benefits of AI and knowledge-based systems for in-orbit infrastructures by developing a strategic technology to contribute to ESA missions. Three phases were defined for: (1) program definition and review of existing work; (2) demonstration of applications prototypes; and (3) the development of operational systems from successful prototypes. Applications of 16 proposed expert-system candidates are grouped into payload-engineering and crew/operations categories. The candidates are to be evaluated in terms of their potential contribution to strategic goals such as improving scientific return and automating operator functions to eliminate human error.

Symptomatic Treatment of Cough Among Adult Patients With Lung Cancer: CHEST Guideline and Expert Panel Report.

PubMed

Molassiotis, Alex; Smith, Jaclyn A; Mazzone, Peter; Blackhall, Fiona; Irwin, Richard S

2017-04-01

Cough among patients with lung cancer is a common but often undertreated symptom. We used a 2015 Cochrane systematic review, among other sources of evidence, to update the recommendations and suggestions of the American College of Chest Physicians (CHEST) 2006 guideline on this topic. The CHEST methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework were used. The Expert Cough Panel based their recommendations on data from the Cochrane systematic review on the topic, uncontrolled studies, case studies, and the clinical context. Final grading was reached by consensus according to the Delphi method. The Cochrane systematic review identified 17 trials of primarily low-quality evidence. Such evidence was related to both nonpharmacologic (cough suppression) and pharmacologic (demulcents, opioids, peripherally acting antitussives, or local anesthetics) treatments, as well as endobronchial brachytherapy. Compared with the 2006 CHEST Cough Guideline, the current recommendations and suggestions are more specific and follow a step-up approach to the management of cough among patients with lung cancer, acknowledging the low-quality evidence in the field and the urgent need to develop more effective, evidence-based interventions through high-quality research. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Report of an Expert Panel on the reanalysis by of a 90-day study conducted by Monsanto in support of the safety of a genetically modified corn variety (MON 863).

PubMed

Doull, J; Gaylor, D; Greim, H A; Lovell, D P; Lynch, B; Munro, I C

2007-11-01

MON 863, a genetically engineered corn variety that contains the gene for modified Bacillus thuringiensis Cry3Bb1 protein to protect against corn rootworm, was tested in a 90-day toxicity study as part of the process to gain regulatory approval. This study was reanalyzed by Séralini et al. who contended that the study showed possible hepatorenal effects of MON 863. An Expert Panel was convened to assess the original study results as analyzed by the Monsanto Company and the reanalysis conducted by Séralini et al. The Expert Panel concludes that the Séralini et al. reanalysis provided no evidence to indicate that MON 863 was associated with adverse effects in the 90-day rat study. In each case, statistical findings reported by both Monsanto and Séralini et al. were considered to be unrelated to treatment or of no biological or clinical importance because they failed to demonstrate a dose-response relationship, reproducibility over time, association with other relevant changes (e.g., histopathology), occurrence in both sexes, difference outside the normal range of variation, or biological plausibility with respect to cause-and-effect. The Séralini et al. reanalysis does not advance any new scientific data to indicate that MON 863 caused adverse effects in the 90-day rat study.

ERS/ECDC Statement: European Union standards for tuberculosis care, 2017 update.

PubMed

Migliori, Giovanni Battista; Sotgiu, Giovanni; Rosales-Klintz, Senia; Centis, Rosella; D'Ambrosio, Lia; Abubakar, Ibrahim; Bothamley, Graham; Caminero, Jose Antonio; Cirillo, Daniela Maria; Dara, Masoud; de Vries, Gerard; Aliberti, Stefano; Dinh-Xuan, Anh Tuan; Duarte, Raquel; Midulla, Fabio; Solovic, Ivan; Subotic, Dragan R; Amicosante, Massimo; Correia, Ana Maria; Cirule, Andra; Gualano, Gina; Kunst, Heinke; Palmieri, Fabrizio; Riekstina, Vija; Tiberi, Simon; Verduin, Remi; van der Werf, Marieke J

2018-05-01

The International Standards for Tuberculosis Care define the essential level of care for managing patients who have or are presumed to have tuberculosis, or are at increased risk of developing the disease. The resources and capacity in the European Union (EU) and the European Economic Area permit higher standards of care to secure quality and timely TB diagnosis, prevention and treatment. On this basis, the European Union Standards for Tuberculosis Care (ESTC) were published in 2012 as standards specifically tailored to the EU setting. Since the publication of the ESTC, new scientific evidence has become available and, therefore, the standards were reviewed and updated.A panel of international experts, led by a writing group from the European Respiratory Society (ERS) and the European Centre for Disease Prevention and Control (ECDC), updated the ESTC on the basis of new published evidence. The underlying principles of these patient-centred standards remain unchanged. The second edition of the ESTC includes 21 standards in the areas of diagnosis, treatment, HIV and comorbidities, and public health and prevention.The ESTC target clinicians and public health workers, provide an easy-to-use resource and act as a guide through all the required activities to ensure optimal diagnosis, treatment and prevention of TB. The content of this work is copyright of the authors or their employers. Design and branding are copyright ©ERS 2018.

Curricular priorities for business ethics in medical practice and research: recommendations from Delphi consensus panels.

PubMed

DuBois, James M; Kraus, Elena M; Gursahani, Kamal; Mikulec, Anthony; Bakanas, Erin

2014-11-15

No published curricula in the area of medical business ethics exist. This is surprising given that physicians wrestle daily with business decisions and that professional associations, the Institute of Medicine, Health and Human Services, Congress, and industry have issued related guidelines over the past 5 years. To fill this gap, the authors aimed (1) to identify the full range of medical business ethics topics that experts consider important to teach, and (2) to establish curricular priorities through expert consensus. In spring 2012, the authors conducted an online Delphi survey with two heterogeneous panels of experts recruited in the United States. One panel focused on business ethics in medical practice (n = 14), and 1 focused on business ethics in medical research (n = 12). Panel 1 generated an initial list of 14 major topics related to business ethics in medical practice, and subsequently rated 6 topics as very important or essential to teach. Panel 2 generated an initial list of 10 major topics related to business ethics in medical research, and subsequently rated 5 as very important or essential. In both domains, the panel strongly recommended addressing problems that conflicts of interest can cause, legal guidelines, and the goals or ideals of the profession. The Bander Center for Medical Business Ethics at Saint Louis University will use the results of the Delphi panel to develop online curricular resources for each of the highest rated topics.

Expert panel answers questions for Super Safety and Health Day at KSC.

NASA Technical Reports Server (NTRS)

1999-01-01

A panel of NASA and contractor senior staff, plus officers from the 45th Space Wing, discuss safety- and health-related concerns in front of an audience of KSC employees, as part of Super Safety and Health Day. Moderating at the podium is Loren Shriver, deputy director for Launch & Payload Processing. Seated left to right are Burt Summerfield, associate director of the Biomedical Office; Colonel William S. Swindling, commander, 45th Medical Group, Patrick Air Force Base, Fla.; Ron Dittemore, manager, Space Shuttle Programs, Johnson Space Center; Roy Bridges, Center Director; Col. Tom Deppe, vice commander, 45th Space Wing, Patrick Air Force Base; Jim Schoefield, program manager, Payload Ground Operations, Boeing; Bill Hickman, program manager, Space Gateway Support; and Ed Adamek, vice president and associate program manager for Ground Operations, United Space Alliance. The panel was one of the presentations during KSC's second annual day-long dedication to safety. Most normal work activities were suspended to allow personnel to attend related activities. The theme, 'Safety and Health Go Hand in Hand,' emphasized KSC's commitment to place the safety and health of the public, astronauts, employees and space-related resources first and foremost. Events also included a keynote address, vendor exhibits, and safety training in work groups. The keynote address and panel session were also broadcast internally over NASA television.

European Stroke Science Workshop

PubMed Central

Mattle, Heinrich P.; Brainin, Michael; Chamorro, Angel; Diener, Hans Christoph; Hacke, Werner; Leys, Didier; Norrving, Bo; Ward, Nick

2012-01-01

The European Stroke Organisation (ESO) held its first European Stroke Science Workshop in Garmisch-Partenkirchen, Germany (15-17 December 2011). Stroke experts based in Europe were invited to present and discuss their current research. The scope of the workshop was to review the most recent findings of selected topics in stroke, to exchange ideas, to stimulate new research and to enhance collaboration between European stroke research groups. Seven scientific sessions were held, each starting with a keynote lecture to review the state of the art of the given topic, followed by 4 or 5 short presentations by experts. They were asked to limit their presentations to 10 slides containing only recent information. The meeting was organized by the executive committee of the ESO (Heinrich Mattle, chairman, Michael Brainin, Angel Chamorro, Werner Hacke, Didier Leys) and supported by the European Stroke Conference (Michael Hennerici). In this article we summarize the main contents of this successful workshop. PMID:22836350

Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions: Endorsed by the Chinese Society of Cardiology.

PubMed

Räber, Lorenz; Mintz, Gary S; Koskinas, Konstantinos C; Johnson, Thomas W; Holm, Niels R; Onuma, Yoshinubo; Radu, Maria D; Joner, Michael; Yu, Bo; Jia, Haibo; Menevau, Nicolas; de la Torre Hernandez, Jose M; Escaned, Javier; Hill, Jonathan; Prati, Francesco; Colombo, Antonio; di Mario, Carlo; Regar, Evelyn; Capodanno, Davide; Wijns, William; Byrne, Robert A; Guagliumi, Giulio

2018-05-22

This Consensus Document is the first of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The first document appraises the role of intracoronary imaging to guide percutaneous coronary interventions (PCIs) in clinical practice. Current evidence regarding the impact of intracoronary imaging guidance on cardiovascular outcomes is summarized, and patients or lesions most likely to derive clinical benefit from an imaging-guided intervention are identified. The relevance of the use of IVUS or OCT prior to PCI for optimizing stent sizing (stent length and diameter) and planning the procedural strategy is discussed. Regarding post-implantation imaging, the consensus group recommends key parameters that characterize an optimal PCI result and provides cut-offs to guide corrective measures and optimize the stenting result. Moreover, routine performance of intracoronary imaging in patients with stent failure (restenosis or stent thrombosis) is recommended. Finally, strengths and limitations of IVUS and OCT for guiding PCI and assessing stent failures and areas that warrant further research are critically discussed.

Expert panel answers questions for Super Safety and Health Day at KSC.

NASA Technical Reports Server (NTRS)

1999-01-01

A panel of NASA and contractor senior staff, plus officers from the 45th Space Wing, discuss safety- and health-related concerns in front of an audience of KSC employees as part of Super Safety and Health Day. Moderating at the podium is Loren Shriver, deputy director for Launch & Payload Processing. Seated left to right are Burt Summerfield, associate director of the Biomedical Office; Colonel William S. Swindling, commander, 45th Medical Group, Patrick Air Force Base, Fla.; Ron Dittemore, manager, Space Shuttle Programs, Johnson Space Center; Roy Bridges, Center Director; Col. Tom Deppe, vice commander, 45th Space Wing, Patrick Air Force Base; Jim Schoefield, program manager, Payload Ground Operations, Boeing; Bill Hickman, program manager, Space Gateway Support; and Ed Adamek, vice president and associate program manager for Ground Operations, United Space Alliance. Answering a question at the microphone on the floor is Dave King, director, Shuttle Processing. The panel was one of the presentations during KSC's second annual day-long dedication to safety. Most normal work activities were suspended to allow personnel to attend related activities. The theme, 'Safety and Health Go Hand in Hand,' emphasized KSC's commitment to place the safety and health of the public, astronauts, employees and space- related resources first and foremost. Events also included a keynote address, vendor exhibits, and safety training in work groups. The keynote address and panel session were also broadcast internally over NASA television.

European undergraduate curriculum in geriatric medicine developed using an international modified Delphi technique

PubMed Central

Masud, Tahir; Blundell, Adrian; Gordon, Adam Lee; Mulpeter, Ken; Roller, Regina; Singler, Katrin; Goeldlin, Adrian; Stuck, Andreas

2014-01-01

Introduction: the rise in the number of older, frail adults necessitates that future doctors are adequately trained in the skills of geriatric medicine. Few countries have dedicated curricula in geriatric medicine at the undergraduate level. The aim of this project was to develop a consensus among geriatricians on a curriculum with the minimal requirements that a medical student should achieve by the end of medical school. Methods: a modified Delphi process was used. First, educational experts and geriatricians proposed a set of learning objectives based on a literature review. Second, three Delphi rounds involving a panel with 49 experts representing 29 countries affiliated to the European Union of Medical Specialists (UEMS) was used to gain consensus for a final curriculum. Results: the number of disagreements following Delphi Rounds 1 and 2 were 81 and 53, respectively. Complete agreement was reached following the third round. The final curriculum consisted of detailed objectives grouped under 10 overarching learning outcomes. Discussion: a consensus on the minimum requirements of geriatric learning objectives for medical students has been agreed by European geriatricians. Major efforts will be needed to implement these requirements, given the large variation in the quality of geriatric teaching in medical schools. This curriculum is a first step to help improve teaching of geriatrics in medical schools, and will also serve as a basis for advancing postgraduate training in geriatrics across Europe. PMID:24603283

Ethical acceptability of research on human-animal chimeric embryos: summary of opinions by the Japanese Expert Panel on Bioethics.

PubMed

Mizuno, Hiroshi; Akutsu, Hidenori; Kato, Kazuto

2015-01-01

Human-animal chimeric embryos are embryos obtained by introducing human cells into a non-human animal embryo. It is envisaged that the application of human-animal chimeric embryos may make possible many useful research projects including producing three-dimensional human organs in animals and verification of the pluripotency of human ES cells or iPS cells in vivo. The use of human-animal chimeric embryos, however, raises several ethical and moral concerns. The most fundamental one is that human-animal chimeric embryos possess the potential to develop into organisms containing human-derived tissue, which may lead to infringing upon the identity of the human species, and thus impairing human dignity. The Japanese Expert Panel on Bioethics in the Cabinet Office carefully considered the scientific significance and ethical acceptability of the issue and released its "Opinions regarding the handling of research using human-animal chimeric embryos". The Panel proposed a framework of case-by-case review, and suggested that the following points must be carefully reviewed from the perspective of ethical acceptability: (a) Types of animal embryos and types of animals receiving embryo transfers, particularly in dealing with non-human primates; (b) Types of human cells and organs intended for production, particularly in dealing with human nerve or germ cells; and (c) Extent of the period required for post-transfer studies. The scientific knowledge that can be gained from transfer into an animal uterus and from the production of an individual must be clarified to avoid unnecessary generation of chimeric animals. The time is ripe for the scientific community and governments to start discussing the ethical issues for establishing a global consensus.

Panel 4: Report of the Microbiology Panel

PubMed Central

Barenkamp, Stephen J.; Chonmaitree, Tasnee; Hakansson, Anders P.; Heikkinen, Terho; King, Samantha; Nokso-Koivisto, Johanna; Novotny, Laura A.; Patel, Janak A.; Pettigrew, Melinda; Swords, W. Edward

2017-01-01

Objective To perform a comprehensive review of the literature from July 2011 until June 2015 on the virology and bacteriology of otitis media in children. Data Sources PubMed database of the National Library of Medicine. Review Methods Two subpanels comprising experts in the virology and bacteriology of otitis media were created. Each panel reviewed the relevant literature in the fields of virology and bacteriology and generated draft reviews. These initial reviews were distributed to all panel members prior to meeting together at the Post-symposium Research Conference of the 18th International Symposium on Recent Advances in Otitis Media, National Harbor, Maryland, in June 2015. A final draft was created, circulated, and approved by all panel members. Conclusions Excellent progress has been made in the past 4 years in advancing our understanding of the microbiology of otitis media. Numerous advances were made in basic laboratory studies, in animal models of otitis media, in better understanding the epidemiology of disease, and in clinical practice. Implications for Practice (1) Many viruses cause acute otitis media without bacterial coinfection, and such cases do not require antibiotic treatment. (2) When respiratory syncytial virus, metapneumovirus, and influenza virus peak in the community, practitioners can expect to see an increase in clinical otitis media cases. (3) Biomarkers that predict which children with upper respiratory tract infections will develop otitis media may be available in the future. (4) Compounds that target newly identified bacterial virulence determinants may be available as future treatment options for children with otitis media. PMID:28372529

Panel 4: Report of the Microbiology Panel.

PubMed

Barenkamp, Stephen J; Chonmaitree, Tasnee; Hakansson, Anders P; Heikkinen, Terho; King, Samantha; Nokso-Koivisto, Johanna; Novotny, Laura A; Patel, Janak A; Pettigrew, Melinda; Swords, W Edward

2017-04-01

Objective To perform a comprehensive review of the literature from July 2011 until June 2015 on the virology and bacteriology of otitis media in children. Data Sources PubMed database of the National Library of Medicine. Review Methods Two subpanels comprising experts in the virology and bacteriology of otitis media were created. Each panel reviewed the relevant literature in the fields of virology and bacteriology and generated draft reviews. These initial reviews were distributed to all panel members prior to meeting together at the Post-symposium Research Conference of the 18th International Symposium on Recent Advances in Otitis Media, National Harbor, Maryland, in June 2015. A final draft was created, circulated, and approved by all panel members. Conclusions Excellent progress has been made in the past 4 years in advancing our understanding of the microbiology of otitis media. Numerous advances were made in basic laboratory studies, in animal models of otitis media, in better understanding the epidemiology of disease, and in clinical practice. Implications for Practice (1) Many viruses cause acute otitis media without bacterial coinfection, and such cases do not require antibiotic treatment. (2) When respiratory syncytial virus, metapneumovirus, and influenza virus peak in the community, practitioners can expect to see an increase in clinical otitis media cases. (3) Biomarkers that predict which children with upper respiratory tract infections will develop otitis media may be available in the future. (4) Compounds that target newly identified bacterial virulence determinants may be available as future treatment options for children with otitis media.

Cough in the Athlete: CHEST Guideline and Expert Panel Report.

PubMed

Boulet, Louis-Philippe; Turmel, Julie; Irwin, Richard S

2017-02-01

Cough is a common symptom experienced by athletes, particularly after exercise. We performed a systematic review to assess the following in this population: (1) the main causes of acute and recurrent cough, either exercise-induced or not, (2) how cough is assessed, and (3) how cough is treated in this population. From the systematic review, suggestions for management were developed. This review was performed according to the CHEST methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework until April 2015. To be included, studies had to meet the following criteria: participants had to be athletes and adults and adolescents aged ≥ 12 years and had to complain of cough, regardless of its duration or relationship to exercise. The Expert Cough Panel based their suggestions on the data extracted from the review and final grading by consensus according to a Delphi process. Only 60 reports fulfilled the inclusion criteria, and the results of our analysis revealed only low-quality evidence on the causes of cough and how to assess and treat cough specifically in athletes. Although there was no formal evaluation of causes of cough in the athletic population, the most common causes reported were asthma, exercise-induced bronchoconstriction, respiratory tract infection (RTI), upper airway cough syndrome (UACS) (mostly from rhinitis), and environmental exposures. Cough was also reported to be related to exercise-induced vocal cord dysfunction among a variety of less common causes. Although gastroesophageal reflux disease (GERD) is frequent in athletes, we found no publication on cough and GERD in this population. Assessment of the causes of cough was performed mainly with bronchoprovocation tests and suspected disease-specific investigations. The evidence to guide treatment of cough in the athlete was weak or nonexistent, depending on the cause. As data on cough in athletes were hidden in a set of other data (respiratory

[Assessment and training of strength and balance for fall prevention in the elderly: recommendations of an interdisciplinary expert panel].

PubMed

Granacher, U; Muehlbauer, T; Gschwind, Y J; Pfenninger, B; Kressig, R W

2014-08-01

The proportion of elderly people in societies of western industrialized countries is continuously rising. Biologic aging induces deficits in balance and muscle strength/power in old age, which is responsible for an increased prevalence of falls. Therefore, nationwide and easy-to-administer fall prevention programs have to be developed in order to contribute to the autonomy and quality of life in old age and to help reduce the financial burden on the public health care system due to the treatment of fall-related injuries. This narrative (qualitative) literature review deals with a) the reasons for an increased prevalence of falls in old age, b) important clinical tests for fall-risk assessment, and c) evidence-based intervention/training programs for fall prevention in old age. The findings of this literature review are based on a cost-free practice guide that is available to the public (via the internet) and that was created by an expert panel (i.e., geriatricians, exercise scientists, physiotherapists, geriatric therapists). The present review provides the scientific foundation of the practice guide.

Optimising the Inflammatory Bowel Disease Unit to Improve Quality of Care: Expert Recommendations.

PubMed

Louis, Edouard; Dotan, Iris; Ghosh, Subrata; Mlynarsky, Liat; Reenaers, Catherine; Schreiber, Stefan

2015-08-01

The best care setting for patients with inflammatory bowel disease [IBD] may be in a dedicated unit. Whereas not all gastroenterology units have the same resources to develop dedicated IBD facilities and services, there are steps that can be taken by any unit to optimise patients' access to interdisciplinary expert care. A series of pragmatic recommendations relating to IBD unit optimisation have been developed through discussion among a large panel of international experts. Suggested recommendations were extracted through systematic search of published evidence and structured requests for expert opinion. Physicians [n = 238] identified as IBD specialists by publications or clinical focus on IBD were invited for discussion and recommendation modification [Barcelona, Spain; 2014]. Final recommendations were voted on by the group. Participants also completed an online survey to evaluate their own experience related to IBD units. A total of 60% of attendees completed the survey, with 15% self-classifying their centre as a dedicated IBD unit. Only half of respondents indicated that they had a defined IBD treatment algorithm in place. Key recommendations included the need to develop a multidisciplinary team covering specifically-defined specialist expertise in IBD, to instil processes that facilitate cross-functional communication and to invest in shared care models of IBD management. Optimising the setup of IBD units will require progressive leadership and willingness to challenge the status quo in order to provide better quality of care for our patients. IBD units are an important step towards harmonising care for IBD across Europe and for establishing standards for disease management programmes. © European Crohn’s and Colitis Organisation 2015.

Burden of disease and costs of exposure to endocrine disrupting chemicals in the European Union: an updated analysis.

PubMed

Trasande, L; Zoeller, R T; Hass, U; Kortenkamp, A; Grandjean, P; Myers, J P; DiGangi, J; Hunt, P M; Rudel, R; Sathyanarayana, S; Bellanger, M; Hauser, R; Legler, J; Skakkebaek, N E; Heindel, J J

2016-07-01

A previous report documented that endocrine disrupting chemicals contribute substantially to certain forms of disease and disability. In the present analysis, our main objective was to update a range of health and economic costs that can be reasonably attributed to endocrine disrupting chemical exposures in the European Union, leveraging new burden and disease cost estimates of female reproductive conditions from accompanying report. Expert panels evaluated the epidemiologic evidence, using adapted criteria from the WHO Grading of Recommendations Assessment, Development and Evaluation Working Group, and evaluated laboratory and animal evidence of endocrine disruption using definitions recently promulgated by the Danish Environmental Protection Agency. The Delphi method was used to make decisions on the strength of the data. Expert panels consensus was achieved for probable (>20%) endocrine disrupting chemical causation for IQ loss and associated intellectual disability; autism; attention deficit hyperactivity disorder; endometriosis; fibroids; childhood obesity; adult obesity; adult diabetes; cryptorchidism; male infertility, and mortality associated with reduced testosterone. Accounting for probability of causation, and using the midpoint of each range for probability of causation, Monte Carlo simulations produced a median annual cost of €163 billion (1.28% of EU Gross Domestic Product) across 1000 simulations. We conclude that endocrine disrupting chemical exposures in the EU are likely to contribute substantially to disease and dysfunction across the life course with costs in the hundreds of billions of Euros per year. These estimates represent only those endocrine disrupting chemicals with the highest probability of causation; a broader analysis would have produced greater estimates of burden of disease and costs. © 2016 American Society of Andrology and European Academy of Andrology.

Sparks Fade, Knowledge Stays: The National Early Literacy Panel's Report Lacks Staying Power

ERIC Educational Resources Information Center

Neuman, Susan B.

2010-01-01

In this article, the author talks about "Developing Early Literacy," the report of the National Early Literacy Panel. The panel, which consisted of nine experts, was convened by the National Institute for Literacy to synthesize the research on the development of literacy from birth through age 5. Over the eight years of their work, only 190…

Establishing research priorities for patient safety in emergency medicine: a multidisciplinary consensus panel.

PubMed

Plint, Amy C; Stang, Antonia S; Calder, Lisa A

2015-01-01

Patient safety in the context of emergency medicine is a relatively new field of study. To date, no broad research agenda for patient safety in emergency medicine has been established. The objective of this study was to establish patient safety-related research priorities for emergency medicine. These priorities would provide a foundation for high-quality research, important direction to both researchers and health-care funders, and an essential step in improving health-care safety and patient outcomes in the high-risk emergency department (ED) setting. A four-phase consensus procedure with a multidisciplinary expert panel was organized to identify, assess, and agree on research priorities for patient safety in emergency medicine. The 19-member panel consisted of clinicians, administrators, and researchers from adult and pediatric emergency medicine, patient safety, pharmacy, and mental health; as well as representatives from patient safety organizations. In phase 1, we developed an initial list of potential research priorities by electronically surveying a purposeful and convenience sample of patient safety experts, ED clinicians, administrators, and researchers from across North America using contact lists from multiple organizations. We used simple content analysis to remove duplication and categorize the research priorities identified by survey respondents. Our expert panel reached consensus on a final list of research priorities through an in-person meeting (phase 3) and two rounds of a modified Delphi process (phases 2 and 4). After phases 1 and 2, 66 unique research priorities were identified for expert panel review. At the end of phase 4, consensus was reached for 15 research priorities. These priorities represent four themes: (1) methods to identify patient safety issues (five priorities), (2) understanding human and environmental factors related to patient safety (four priorities), (3) the patient perspective (one priority), and (4) interventions for

Pantex Falling Man - Independent Review Panel Report.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bertolini, Louis; Brannon, Nathan; Olson, Jared

2014-11-01

Consolidated Nuclear Security (CNS) Pantex took the initiative to organize a Review Panel of subject matter experts to independently assess the adequacy of the Pantex Tripping Man Analysis methodology. The purpose of this report is to capture the details of the assessment including the scope, approach, results, and detailed Appendices. Along with the assessment of the analysis methodology, the panel evaluated the adequacy with which the methodology was applied as well as congruence with Department of Energy (DOE) standards 3009 and 3016. The approach included the review of relevant documentation, interactive discussion with Pantex staff, and the iterative process ofmore » evaluating critical lines of inquiry.« less

Daily baseline skin care in the prevention, treatment, and supportive care of skin toxicity in oncology patients: recommendations from a multinational expert panel

PubMed Central

Bensadoun, René-Jean; Humbert, Phillipe; Krutman, Jean; Luger, Thomas; Triller, Raoul; Rougier, André; Seite, Sophie; Dreno, Brigitte

2013-01-01

Skin reactions due to radiotherapy and chemotherapy are a significant problem for an important number of cancer patients. While effective for treating cancer, they disturb cutaneous barrier function, causing a reaction soon after initiation of treatment that impacts patient quality of life. Managing these symptoms with cosmetics and nonpharmaceutical skin care products for camouflage or personal hygiene may be important for increasing patient self-esteem. However, inappropriate product choice or use could worsen side effects. Although recommendations exist for the pharmaceutical treatment of skin reactions, there are no recommendations for the choice or use of dermatologic skin care products for oncology patients. The present guidelines were developed by a board of European experts in dermatology and oncology to provide cancer care professionals with guidance for the appropriate use of non-pharmaceutical, dermocosmetic skin care management of cutaneous toxicities associated with radiotherapy and systemic chemotherapy, including epidermal growth factor inhibitors and monoclonal antibodies. The experts hope that these recommendations will improve the management of cutaneous side effects and hence quality of life for oncology patients. PMID:24353440

Expert Recommendations on Treating Psoriasis in Special Circumstances (Part II).

PubMed

Carrascosa, J M; Galán, M; de Lucas, R; Pérez-Ferriols, A; Ribera, M; Yanguas, I

2016-11-01

There is insufficient information on how best to treat moderate to severe psoriasis in difficult clinical circumstances. We considered 5 areas where there is conflicting or insufficient evidence: pediatric psoriasis, risk of infection in patients being treated with biologics, psoriasis in difficult locations, biologic drug survival, and impact of disease on quality of life. Following discussion of the issues by an expert panel of dermatologists specialized in the management of psoriasis, participants answered a questionnaire survey according to the Delphi method. Consensus was reached on 66 (70.9%) of the 93 items analyzed; the experts agreed with 49 statements and disagreed with 17. It was agreed that body mass index, metabolic comorbidities, and quality of life should be monitored in children with psoriasis. The experts also agreed that the most appropriate systemic treatment for this age group was methotrexate, while the most appropriate biologic treatment was etanercept. Although it was recognized that the available evidence was inconsistent and difficult to extrapolate, the panel agreed that biologic drug survival could be increased by flexible, individualized dosing regimens, continuous treatment, and combination therapies. Finally, consensus was reached on using the Dermatology Quality of Life Index to assess treatment effectiveness and aid decision-making in clinical practice. The structured opinion of experts guides decision-making regarding aspects of clinical practice for which there is incomplete or conflicting information. Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

New Methodology for an Expert-Designed Map From International Classification of Diseases (ICD) to Abbreviated Injury Scale (AIS) 3+ Severity Injury.

PubMed

Zonfrillo, Mark R; Weaver, Ashley A; Gillich, Patrick J; Price, Janet P; Stitzel, Joel D

2015-01-01

There has been a longstanding desire for a map to convert International Classification of Diseases (ICD) injury codes to Abbreviated Injury Scale (AIS) codes to reflect the severity of those diagnoses. The Association for the Advancement of Automotive Medicine (AAAM) was tasked by European Union representatives to create a categorical map classifying diagnoses codes as serious injury (Abbreviated Injury Scale [AIS] 3+), minor/moderate injury (AIS 1/2), or indeterminate. This study's objective was to map injury-related ICD-9-CM (clinical modification) and ICD-10-CM codes to these severity categories. Approximately 19,000 ICD codes were mapped, including injuries from the following categories: amputations, blood vessel injury, burns, crushing injury, dislocations/sprains/strains, foreign body, fractures, internal organ, nerve/spinal cord injury, intracranial, laceration, open wounds, and superficial injury/contusion. Two parallel activities were completed to create the maps: (1) An in-person expert panel and (2) an electronic survey. The panel consisted of expert users of AIS and ICD from North America, the United Kingdom, and Australia. The panel met in person for 5 days, with follow-up virtual meetings to create and revise the maps. Additional qualitative data were documented to resolve potential discrepancies in mapping. The electronic survey was completed by 95 injury coding professionals from North America, Spain, Australia, and New Zealand over 12 weeks. ICD-to-AIS maps were created for: ICD-9-CM and ICD-10-CM. Both maps indicated whether the corresponding AIS 2005/Update 2008 severity score for each ICD code was AIS 3+, 1/2, or indeterminable. Though some ICD codes could be mapped to multiple AIS codes, the maximum severity of all potentially mapped injuries determined the final severity categorization. The in-person panel consisted of 13 experts, with 11 Certified AIS specialists (CAISS) with a median of 8 years and an average of 15 years of coding experience

NCATE's Blue Ribbon Panel Report and NAPDS: Working Together

ERIC Educational Resources Information Center

Van Scoy, Irma J.

2012-01-01

An expert panel including representatives from schools/districts, teacher education, and professional education associations was convened by the National Council for the Accreditation of Teacher Education (NCATE) to make recommendations regarding clinical preparation in teacher education. This article presents an analysis of how the ten design…

Defining, treating and preventing hospital acquired pneumonia: European perspective.

PubMed

Torres, Antoni; Ewig, Santiago; Lode, Harmut; Carlet, Jean

2009-01-01

Many controversies still remain in the management of hospital acquired pneumonia (HAP), and ventilation-acquired pneumonia (VAP), Three European Societies, European Respiratory Society (ERS), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and European Society of Intensive Care Medicine (ESICM), were interested in producing a document on HAP and VAP with European perspective. The scientific committees from each Society designated one chairman; Antoni Torres (ERS), Harmut Lode (ESCMID) and Jean Carlet (ESICM). The chairmen of this Task Force suggested names from each Society to be a member of the panel. They also choose controversial topics on the field and others that were not covered by the last IDSA/ATS guidelines. Each topic was assigned to a pair of members to be reviewed and written. Finally, the panel defined 20 consensual points that were circulated several times among the members of the panel until total agreement was reached. A combination of evidences and clinical-based medicine was used to reach these consensus. This manuscript reviews in depth several controversial or new topics in HAP and VAP. In addition 20 consensual points are presented. This manuscript may be useful for the development of future guidelines and to stimulate clinical research by lying out what is currently accepted and what is unknown or controversial.

75 FR 7469 - Panel Member List for Hydropower Licensing Study Dispute Resolution; Notice Extending Filing Date...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-19

... List for Hydropower Licensing Study Dispute Resolution; Notice Extending Filing Date for Applications for Panel Member List for Hydropower Licensing Study Dispute Resolution February 4, 2010. On October... on a list of resource experts willing to serve as a third panel member in the Commission's hydropower...

Expert recommendations for implementing change (ERIC): protocol for a mixed methods study

PubMed Central

2014-01-01

Background Identifying feasible and effective implementation strategies that are contextually appropriate is a challenge for researchers and implementers, exacerbated by the lack of conceptual clarity surrounding terms and definitions for implementation strategies, as well as a literature that provides imperfect guidance regarding how one might select strategies for a given healthcare quality improvement effort. In this study, we will engage an Expert Panel comprising implementation scientists and mental health clinical managers to: establish consensus on a common nomenclature for implementation strategy terms, definitions and categories; and develop recommendations to enhance the match between implementation strategies selected to facilitate the use of evidence-based programs and the context of certain service settings, in this case the U.S. Department of Veterans Affairs (VA) mental health services. Methods/Design This study will use purposive sampling to recruit an Expert Panel comprising implementation science experts and VA mental health clinical managers. A novel, four-stage sequential mixed methods design will be employed. During Stage 1, the Expert Panel will participate in a modified Delphi process in which a published taxonomy of implementation strategies will be used to establish consensus on terms and definitions for implementation strategies. In Stage 2, the panelists will complete a concept mapping task, which will yield conceptually distinct categories of implementation strategies as well as ratings of the feasibility and effectiveness of each strategy. Utilizing the common nomenclature developed in Stages 1 and 2, panelists will complete an innovative menu-based choice task in Stage 3 that involves matching implementation strategies to hypothetical implementation scenarios with varying contexts. This allows for quantitative characterizations of the relative necessity of each implementation strategy for a given scenario. In Stage 4, a live web

75 FR 80082 - Meetings of Humanities Panel

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-21

... THE NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES Meetings of Humanities Panel AGENCY: The... assistance under the National Foundation on the Arts and the Humanities Act of 1965, as amended, including... applications for Political Science and Law/European, Asian, and Middle Eastern Studies in Kluge Fellowships...

Expert Consensus on Characteristics of Wisdom: A Delphi Method Study

ERIC Educational Resources Information Center

Jeste, Dilip V.; Ardelt, Monika; Blazer, Dan; Kraemer, Helena C.; Vaillant, George; Meeks, Thomas W.

2010-01-01

Purpose: Wisdom has received increasing attention in empirical research in recent years, especially in gerontology and psychology, but consistent definitions of wisdom remain elusive. We sought to better characterize this concept via an expert consensus panel using a 2-phase Delphi method. Design and Methods: A survey questionnaire comprised 53…

Developing a framework of, and quality indicators for, general practice management in Europe.

PubMed

Engels, Yvonne; Campbell, Stephen; Dautzenberg, Maaike; van den Hombergh, Pieter; Brinkmann, Henrik; Szécsényi, Joachim; Falcoff, Hector; Seuntjens, Luc; Kuenzi, Beat; Grol, Richard

2005-04-01

To develop a framework for general practice management made up of quality indicators shared by six European countries. Two-round postal Delphi questionnaire in the setting of general practice in Belgium, France, Germany, The Netherlands, Switzerland and the United Kingdom. Six national expert panels, each consisting of 10 members, primarily primary care practitioners and experts in the field of quality in primary care participated in the study. The main outcome measures were: (a) a European framework with indicators for the organization of primary care; and (b) ratings of the face validity of the usefulness of the indicators by expert panels in six countries. Agreement was reached about a definition of practice management across five domains (infrastructure, staff, information, finance, and quality and safety), and a common set of indicators for the organization of general practice. The panellist response rate was 95%. Sixty-two indicators (37%) were rated face valid by all six panels. Examples include out of hours service, accessibility, the content of doctors' bags and staff involvement in quality improvement. No indicators were rated invalid by all six panels. It proved to be possible to develop a European set of indicators for assessing the quality of practice management, despite the differences in health care systems and cultures in the six different countries. These indicators will now be used in a quality assessment procedure of practice management in nine European countries. While organizational indicators are part of the new GMS contract in the UK, this research shows that many practice management issues within primary care are also of relevance in other European countries.

Sentinel node biopsy for prostate cancer: report from a consensus panel meeting.

PubMed

van der Poel, Henk G; Wit, Esther M; Acar, Cenk; van den Berg, Nynke S; van Leeuwen, Fijs W B; Valdes Olmos, Renato A; Winter, Alexander; Wawroschek, Friedhelm; Liedberg, Fredrik; Maclennan, Steven; Lam, Thomas

2017-08-01

To explore the evidence and knowledge gaps in sentinel node biopsy (SNB) in prostate cancer through a consensus panel of experts. A two-round Delphi survey among experts was followed by a consensus panel meeting of 16 experts in February 2016. Agreement voting was performed using the research and development project/University of California, Los Angeles Appropriateness Methodology on 150 statements in nine domains. The disagreement index based on the interpercentile range, adjusted for symmetry score, was used to assess consensus and non-consensus among panel members. Consensus was obtained on 91 of 150 statements (61%). The main outcomes were: (1) the results from an extended lymph node dissection (eLND) are still considered the 'gold standard', and sentinel node (SN) detection should be combined with eLND, at least in patients with intermediate- and high-risk prostate cancer; (2) the role of SN detection in low-risk prostate cancer is unclear; and (3) future studies should contain oncological endpoints as number of positive nodes outside the eLND template, false-negative and false-positive SN procedures, and recurrence-free survival. A high rate of consensus was obtained regarding outcome measures of future clinical trials on SNB (89%). Consensus on tracer technology was only obtained in 47% of statements, reflecting a need for further research and standardization in this area. The low-level evidence in the available literature and the composition of mainly SNB users in the panel constitute the major limitations of the study. Consensus on a majority of elementary statements on SN detection in prostate cancer was obtained.; therefore, the results from this consensus report will provide a basis for the design of further studies in the field. A group of experts identified evidence and knowledge gaps on SN detection in prostate cancer and its application in daily practice. Information from the consensus statements can be used to direct further studies. © 2017 The

Requirements specification for nickel cadmium battery expert system

NASA Technical Reports Server (NTRS)

1986-01-01

The requirements for performance, design, test, and qualification of a computer program identified as NICBES, Nickel Cadmium Battery Expert System, is established. The specific spacecraft power system configuration selected was the Hubble Space Telescope (HST) Electrical Power System (EPS) Testbed. Power for the HST comes from a system of 13 Solar Panel Arrays (SPAs) linked to 6 Nickel Cadmium Batteries which are connected to 3 Busses. An expert system, NICBES, will be developed at Martin Marietta Aerospace to recognize a testbed anomaly, identify the malfunctioning component and recommend a course of action. Besides fault diagnosis, NICBES will be able to evaluate battery status, give advice on battery status and provide decision support for the operator. These requirements are detailed.

The Art of Sharing the Diagnosis and Management of Alzheimer's Disease With Patients and Caregivers: Recommendations of an Expert Consensus Panel

PubMed Central

Christensen, Daniel D.; Griffith, Patrick A.; Kerwin, Diana R.; Hunt, Gail; Hall, Eric J.

2010-01-01

Objective: To develop a set of recommendations for primary care physicians (PCPs) suggesting how best to communicate with patients, caregivers, and other family members regarding the diagnosis and management of Alzheimer's disease (AD). Participants: A national roundtable of 6 leading professionals involved in treating or advocating for patients with AD was convened on March 14, 2008. This roundtable included 4 leading academic physicians with diverse backgrounds (a geriatric psychiatrist, a neuropsychiatrist, a neurologist, and a geriatrician) from geographically diverse regions of the United States, who were invited on the basis of their national reputation in the field and experience working with minority populations with dementia; the executive director of a national AD advocacy organization; the executive director of a national advocacy organization for caregivers; and a medical correspondent with expertise in interviewing and small group leadership. Evidence: Expert opinion supported by academic literature (search limited to PubMed, English language, 1996–2008, search terms: Alzheimer's disease, primary care, diagnosis, management, caregiver, family, patient-physician relationship). Consensus Process: Moderated dialogue aimed at generating consensus opinion; only statements endorsed by all authors were included in the final article. Conclusions: Diagnosis and management of AD by PCPs, utilizing specialist consultation as needed, may contribute to earlier diagnosis and treatment, improved doctor-patient and doctor-caregiver communication, increased attention to caregiver needs, and better clinical and quality-of-life outcomes for patients and caregivers. A set of expert panel recommendations describing practical strategies for achieving these goals was successfully developed. PMID:20582302

Adjuvant bisphosphonates in early breast cancer: consensus guidance for clinical practice from a European Panel.

PubMed

Hadji, P; Coleman, R E; Wilson, C; Powles, T J; Clézardin, P; Aapro, M; Costa, L; Body, J-J; Markopoulos, C; Santini, D; Diel, I; Di Leo, A; Cameron, D; Dodwell, D; Smith, I; Gnant, M; Gray, R; Harbeck, N; Thurlimann, B; Untch, M; Cortes, J; Martin, M; Albert, U-S; Conte, P-F; Ejlertsen, B; Bergh, J; Kaufmann, M; Holen, I

2016-03-01

Bisphosphonates have been studied in randomised trials in early breast cancer to investigate their ability to prevent cancer treatment-induced bone loss (CTIBL) and reduce the risk of disease recurrence and metastasis. Treatment benefits have been reported but bisphosphonates do not currently have regulatory approval for either of these potential indications. This consensus paper provides a review of the evidence and offers guidance to breast cancer clinicians on the use of bisphosphonates in early breast cancer. Using the nominal group methodology for consensus, a systematic review of the literature was augmented by a workshop held in October 2014 for breast cancer and bone specialists to present and debate the available pre-clinical and clinical evidence for the use of adjuvant bisphosphonates. This was followed by a questionnaire to all members of the writing committee to identify areas of consensus. The panel recommended that bisphosphonates should be considered as part of routine clinical practice for the prevention of CTIBL in all patients with a T score of <-2.0 or ≥2 clinical risk factors for fracture. Compelling evidence from a meta-analysis of trial data of >18,000 patients supports clinically significant benefits of bisphosphonates on the development of bone metastases and breast cancer mortality in post-menopausal women or those receiving ovarian suppression therapy. Therefore, the panel recommends that bisphosphonates (either intravenous zoledronic acid or oral clodronate) are considered as part of the adjuvant breast cancer treatment in this population and the potential benefits and risks discussed with relevant patients. © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel.

PubMed

Kales, Helen C; Gitlin, Laura N; Lyketsos, Constantine G

2014-04-01

Noncognitive neuropsychiatric symptoms (NPS) of dementia (aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, disinhibition) affect individuals with dementia nearly universally across dementia stages and etiologies. NPS are associated with poor outcomes for individuals with dementia and caregivers, including excess morbidity and mortality, greater healthcare use, and earlier nursing home placement, as well as caregiver stress, depression, and difficulty with employment. Although the Food and Drug Administration has not approved pharmacotherapy for NPS, psychotropic medications are frequently used to manage these symptoms, but in the few cases of proven pharmacological efficacy, significant risk of adverse effects may offset benefits. There is evidence of efficacy and limited potential for adverse effects of nonpharmacological treatments, typically considered first line, but their uptake as preferred treatments remains inadequate in real-world clinical settings. Thus, the field currently finds itself in a predicament in terms of management of these difficult symptoms. It was in this context that the University of Michigan Program for Positive Aging, working in collaboration with the Johns Hopkins Alzheimer's Disease Research Center and Center for Innovative Care in Aging sponsored and convened a multidisciplinary expert panel in Detroit, Michigan, in fall 2011 with three objectives: to define critical elements of care for NPS in dementia; to construct an approach describing the sequential and iterative steps of managing NPS in real-world clinical settings that can be used as a basis for integrating nonpharmacological and pharmacological approaches; and to discuss how the approach generated could be implemented in research and clinical care. © Published 2014. This article is a U.S. Government work and is in the public domain in the U.S.A.

Occupational and Environmental Contributions to Chronic Cough in Adults: Chest Expert Panel Report.

PubMed

Tarlo, Susan M; Altman, Kenneth W; Oppenheimer, John; Lim, Kaiser; Vertigan, Anne; Prezant, David; Irwin, Richard S

2016-10-01

In response to occupational and environmental exposures, cough can be an isolated symptom reflecting exposure to an irritant with little physiological consequence, or it can be a manifestation of more significant disease. This document reviews occupational and environmental contributions to chronic cough in adults, focusing on aspects not previously covered in the 2006 ACCP Cough Guideline or our more recent systematic review, and suggests an approach to investigation of these factors when suspected. MEDLINE and TOXLINE literature searches were supplemented by articles identified by the cough panel occupational and environmental subgroup members, to identify occupational and environmental aspects of chronic cough not previously covered in the 2006 ACCP Cough Guideline. Based on the literature reviews and the Delphi methodology, the cough panel occupational and environmental subgroup developed guideline suggestions that were approved after review and voting by the full cough panel. The literature review identified relevant articles regarding: mechanisms; allergic environmental causes; chronic cough and the recreational and involuntary inhalation of tobacco and marijuana smoke; nonallergic environmental triggers; laryngeal syndromes; and occupational diseases and exposures. Consensus-based statements were developed for the approach to diagnosis due to a lack of strong evidence from published literature. Despite increased understanding of cough related to occupational and environmental triggers, there remains a gap between the recommended assessment of occupational and environmental causes of cough and the reported systematic assessment of these factors. There is a need for further documentation of occupational and environmental causes of cough in the future. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

A European Humus Forms Reference Base

NASA Astrophysics Data System (ADS)

Zanella, A.; Englisch, M.; Ponge, J.-F.; Jabiol, B.; Sartori, G.; Gardi, C.

2012-04-01

From 2003 on, a panel of experts in humus and humus dynamics (Humus group) has been working about a standardisation and improvement of existing national humus classifications. Some important goals have been reached, in order to share data and experiences: a) definition of specific terms; b) description of 15 types of diagnostic horizons; c) of 10 basic humus forms references; d) subdivision of each main reference in 2-4 sub-unities; e) elaboration of a general European Humus Form Reference Base (http://hal-agroparistech.archives-ouvertes.fr/docs/00/56/17/95/PDF/Humus_Forms_ERB_31_01_2011.pdf); f) publication of the scientific significance of this base of classification as an article [A European morpho-functional classification of humus forms. Geoderma, 164 (3-4), 138-145]. The classification will be updated every 2 years and presently the Humus group is assessing biological (general: soil, vegetation, biome; specific: fungi, bacteria, pedofauna), physical (air temperature, rainfall) and chemical (pH, mineral elements, organic matter, quality and quantity of humic components…) factors which characterize basic humus forms and their varieties. The content of the new version of the classification is planned to be more "practical", like an ecological manual which lists associated humus forms and environmental data in the aim to contribute to a more precise environmental diagnosis of every analysed terrestrial and semiterrestrial European ecosystem. The Humus group is also involved in an endeavour to include humus forms in the World Reference Base for Soils (WRB-FAO) according to nomenclatural principles erected for soil profiles. Thirty basic references have been defined, complemented by a set of qualifiers (prefixes and suffixes), allowing to classify European humus forms and probably a large majority of humus forms known worldwide. The principles of the classification, the diagnostic horizons and humus forms main references are presented at the General Assembly of

Experts' opinions on the role of diet in caries prevention.

PubMed

van Loveren, C; Duggal, M S

2004-01-01

A questionnaire was sent to 54 experts in preventive dentistry in 23 European countries in order to make an inventory of existing national dietary guidelines for the prevention of dental caries. In addition, the experts were asked to give their personal opinion on several issues concerning the relationship between diet and dental caries. Forty-five experts from 20 countries returned the questionnaire. In 13 European countries dietary guidelines for caries prevention were available issued by a National (Dental) Association or a Government Body. All guidelines emphasised a reduction of the frequency of intakes of cariogenic foods. Two of them included a threshold level for the amount of sugar. When asked for their personal opinions, almost all experts mentioned reduction of frequency of 'cariogenic' intakes as the principal dietary messages for caries prevention. Four experts, however, explicitly mentioned that proper oral hygiene with fluoride toothpaste is more important. There was no agreement among the experts about a daily number of cariogenic intakes in between meals that can be regarded as safe, nor whether the message: 'Use products with sugar substitutes' should be part of the dietary guidelines for the prevention of dental caries. There was no agreement amongst experts on preventive dentistry in Europe on the contemporary validity of the paradigm: 'Sucrose is the arch criminal of dental caries.' Taking the variation in opinions into account and the fact that a balanced diet may lead to a moderate eating and snacking frequency, the authors propose that the emphasis on good versus bad foods for caries prevention should be replaced by an emphasis on good versus bad diets. Copyright 2004 S. Karger AG, Basel

Can journalistic "false balance" distort public perception of consensus in expert opinion?

PubMed

Koehler, Derek J

2016-03-01

Media critics have expressed concern that journalistic "false balance" can distort the public's perceptions of what ought to be noncontroversial subjects (e.g., climate change). I report several experiments testing the influence of presenting conflicting comments from 2 experts who disagree on an issue (balance condition) in addition to a complete count of the number of experts on a panel who favor either side. Compared with a control condition, who received only the complete count, participants in the balance condition gave ratings of the perceived agreement among the experts that did not discriminate as clearly between issues with and without strong expert consensus. Participants in the balance condition also perceived less agreement among the experts in general, and were less likely to think that there was enough agreement among experts on the high-consensus issues to guide government policy. Evidently, "false balance" can distort perceptions of expert opinion even when participants would seem to have all the information needed to correct for its influence. (c) 2016 APA, all rights reserved).

Challenges of coverage policy development for next-generation tumor sequencing panels: experts and payers weigh in.

PubMed

Trosman, Julia R; Weldon, Christine B; Kelley, R Kate; Phillips, Kathryn A

2015-03-01

Next-generation tumor sequencing (NGTS) panels, which include multiple established and novel targets across cancers, are emerging in oncology practice, but lack formal positive coverage by US payers. Lack of coverage may impact access and adoption. This study identified challenges of NGTS coverage by private payers. We conducted semi-structured interviews with 14 NGTS experts on potential NGTS benefits, and with 10 major payers, representing more than 125,000,000 enrollees, on NGTS coverage considerations. We used the framework approach of qualitative research for study design and thematic analyses and simple frequencies to further describe findings. All interviewed payers see potential NGTS benefits, but all noted challenges to formal coverage: 80% state that inherent features of NGTS do not fit the medical necessity definition required for coverage, 70% view NGTS as a bundle of targets versus comprehensive tumor characterization and may evaluate each target individually, and 70% express skepticism regarding new evidence methods proposed for NGTS. Fifty percent of payers expressed sufficient concerns about NGTS adoption and implementation that will preclude their ability to issue positive coverage policies. Payers perceive that NGTS holds significant promise but, in its current form, poses disruptive challenges to coverage policy frameworks. Proactive multidisciplinary efforts to define the direction for NGTS development, evidence generation, and incorporation into coverage policy are necessary to realize its promise and provide patient access. This study contributes to current literature, as possibly the first study to directly interview US payers on NGTS coverage and reimbursement. Copyright © 2015 by the National Comprehensive Cancer Network.

Challenges of Coverage Policy Development for Next-Generation Tumor Sequencing Panels: Experts and Payers Weigh In

PubMed Central

Trosman, Julia R.; Weldon, Christine B.; Kate Kelley, R.; Phillips, Kathryn A.

2015-01-01

Background Next-generation tumor sequencing (NGTS) panels, which include multiple established and novel targets across cancers, are emerging in oncology practice, but lack formal positive coverage by US payers. Lack of coverage may impact access and adoption. This study identified challenges of NGTS coverage by private payers. Methods We conducted semi-structured interviews with 14 NGTS experts on potential NGTS benefits, and with 10 major payers, representing more than 125,000,000 enrollees, on NGTS coverage considerations. We used the framework approach of qualitative research for study design and thematic analyses and simple frequencies to further describe findings. Results All interviewed payers see potential NGTS benefits, but all noted challenges to formal coverage: 80% state that inherent features of NGTS do not fit the medical necessity definition required for coverage, 70% view NGTS as a bundle of targets versus comprehensive tumor characterization and may evaluate each target individually, and 70% express skepticism regarding new evidence methods proposed for NGTS. Fifty percent of payers expressed sufficient concerns about NGTS adoption and implementation that will preclude their ability to issue positive coverage policies. Conclusions Payers perceive that NGTS holds significant promise but, in its current form, poses disruptive challenges to coverage policy frameworks. Proactive multidisciplinary efforts to define the direction for NGTS development, evidence generation, and incorporation into coverage policy are necessary to realize its promise and provide patient access. This study contributes to current literature, as possibly the first study to directly interview US payers on NGTS coverage and reimbursement. PMID:25736008

Obesity, diabetes, and associated costs of exposure to endocrine-disrupting chemicals in the European Union.

PubMed

Legler, Juliette; Fletcher, Tony; Govarts, Eva; Porta, Miquel; Blumberg, Bruce; Heindel, Jerrold J; Trasande, Leonardo

2015-04-01

Obesity and diabetes are epidemic in the European Union (EU). Exposure to endocrine-disrupting chemicals (EDCs) is increasingly recognized as a contributor, independent of diet and physical activity. The objective was to estimate obesity, diabetes, and associated costs that can be reasonably attributed to EDC exposures in the EU. An expert panel evaluated evidence for probability of causation using weight-of-evidence characterization adapted from that applied by the Intergovernmental Panel on Climate Change. Exposure-response relationships and reference levels were evaluated for relevant EDCs, and biomarker data were organized from peer-reviewed studies to represent European exposure and burden of disease. Cost estimation as of 2010 utilized published cost estimates for childhood obesity, adult obesity, and adult diabetes. Setting, Patients and Participants, and Intervention: Cost estimation was performed from the societal perspective. The panel identified a 40% to 69% probability of dichlorodiphenyldichloroethylene causing 1555 cases of overweight at age 10 (sensitivity analysis: 1555-5463) in 2010 with associated costs of €24.6 million (sensitivity analysis: €24.6-86.4 million). A 20% to 39% probability was identified for dichlorodiphenyldichloroethylene causing 28 200 cases of adult diabetes (sensitivity analysis: 28 200-56 400) with associated costs of €835 million (sensitivity analysis: €835 million-16.6 billion). The panel also identified a 40% to 69% probability of phthalate exposure causing 53 900 cases of obesity in older women and €15.6 billion in associated costs. Phthalate exposure was also found to have a 40% to 69% probability of causing 20 500 new-onset cases of diabetes in older women with €607 million in associated costs. Prenatal bisphenol A exposure was identified to have a 20% to 69% probability of causing 42 400 cases of childhood obesity, with associated lifetime costs of €1.54 billion. EDC exposures in the EU contribute

Experts Examine Ukraine Energy Security Needs

NASA Astrophysics Data System (ADS)

Showstack, Randy

2014-07-01

Russia's recent annexation of Crimea and the ongoing tensions between Russia and Ukraine have heightened concerns about how Ukraine will meet its continuing energy needs. Despite the current situation, Ukraine's long-term energy future looks promising if tensions diminish and other measures are taken, experts said during a 1 July panel on Russia, Ukraine, and energy held at the Woodrow Wilson International Center for Scholars in Washington, D. C. However, they said, a serious short-term concern is whether the country will make it through this coming winter with sufficient energy supplies.

Expert consensus-building for developing guidelines: lessons learned from a dengue economics workshop.

PubMed

Constenla, Dagna; Lefcourt, Noah; Garcia, Cristina

2013-09-01

A workshop with 20 experts of diverse backgrounds from five countries in the Americas was convened for two-and-a-half days in March 2012 to discuss and develop a standardized methodology for assessing the economic cost of dengue. This article discusses a number of factors that contributed to the workshop's success, including: engaging the experts at various stages of the process; convening a multidisciplinary group to reduce expert bias and provide a more comprehensive and integrated approach; facilitating guided small- and large-group discussions; developing effective cross-cultural collectivism, trust, communication, and empathy across the expert panel; establishing clear lines of responsibilities within each group of experts; breaking down the complex issues into smaller and simpler ideas; providing ample background materials in multiple languages prior to the workshop. Challenges and areas for improvement are also covered.

Final report of the cosmetic ingredient review expert panel on the safety assessment of Polyisobutene and Hydrogenated Polyisobutene as used in cosmetics.

PubMed

2008-01-01

controls. Neither Polyisobutene nor Hydrogenated Polyisobutene were ocular irritants, nor were they dermal irritants or sensitizers. Polyisobutene was not comedogenic in a rabbit ear study. Polyisobutene did not induce transformation in the Syrian hamster embryo (SHE) cell transformation assay, but did enhance 3-methylcholanthrene-induced transformation of C3H/10T1/2 cells. In a carcinogenicity study in mice, Polyisobutene was not carcinogenic, nor did it promote the carcinogenicity of 7,12-dimethylbenz(alpha)anthracene. Clinical patch tests uncovered no evidence of dermal irritation and repeat-insult patch tests with a product containing 4% Hydrogenated Polyisobutene or 1.44% Hydrogenated Polyisobutene found no reactions greater than slight erythema. These products also were not phototoxic or photoallergenic. The product containing 4% Hydrogenated Polyisobutene was not an ocular irritant in a clinical test. The Cosmetic Ingredient Review (CIR) Expert Panel recognized that there are data gaps regarding use and concentration of these ingredients. However, the overall information available on the types of products in which these ingredients are used and at what concentrations indicate a pattern of use, which was considered by the Expert Panel in assessing safety. Although there is an absence of dermal absorption data for Polyisobutene and Hydrogenated Polyisobutene, the available octanol water partition coefficient data and the low solubility in water suggest very slow absorption, so additional data are not needed. Gastrointestinal absorption is also not a major concern due to the low solubility of these chemicals. Although one in vitro study did report that Polyisobutene did promote cellular transformation, a mouse study did not find evidence of tumor promotion. Because lifetime exposure studies using rats and dogs exposed to Polybutene failed to demonstrate any carcinogenic or tumor promotion effect, and a three-generation reproductive/developmental toxicity study produced

[Advanced Prostate Cancer Consensus Conference 2017 : Discussion of the recommendations for diagnosis and treatment of metastatic prostate cancer by a German panel of experts].

PubMed

Schostak, M; König, F; Bögemann, M; Goebell, P; Hammerer, P; Machtens, S; Schwentner, C; Thomas, C; von Amsberg, G; von Rundstedt, F-C; Heidenreich, A

2018-05-28

In March 2017 the 'Advanced Prostate Cancer Consensus Conference' (APCCC) took place in St. Gallen (Switzerland). The APCCC-panelists are internationally well known experts. With the actual data in mind they discussed treatment options for patients with advanced prostate cancer in order to update the international APCCC-recommendations from the previous meeting in 2015. Recently these consensus recommendations have been published in "European Urology".A group of German experts discussed this year APCCC-votes during the meeting and the recommendations that were concluded from the votes from the German perspective. Reasons for an additional German discussion are country-specific variations that may have influenced the APCCC-votes und recommendations. Due to the concept of the APCCC-meeting the wording of the questions could not always be as necessary.One focus of this year consensus discussion was the treatment of metastatic castration-naive prostate cancer (mCNPC). There are new data which may also influence the therapeutic situation of patients with metastatic castration-resistant prostate cancer (mCRPC). Further points of discussion were the impact of new imaging procedures in the clinical setting as well as the treatment of oligometastatic prostate cancer.

Family Responsibilities: How Are They Shared in European Households?

ERIC Educational Resources Information Center

Statistics in Focus: Population and Social Conditions, 1997

1997-01-01

This newsletter focuses on the division of family responsibilities in European households, which is based on results of the European Community Household Panel, a multi-dimensional survey covering several subjects, including demographic and employment characteristics. The survey was based on a questionnaire adapted by various national data…

Environmental effects of ozone depletion, UV radiation and interactions with climate change: UNEP Environmental Effects Assessment Panel, update 2017

EPA Science Inventory

The Environmental Effects Assessment Panel (EEAP) is one of three Panels of experts that inform the Parties to the Montreal Protocol. The EEAP focuses on the effects of UV radiation on human health, terrestrial and aquatic ecosystems, air quality, and materials, as well as on the...

Developing Literacy in Second-Language Learners: Report of the National Literacy Panel on Language-Minority Children and Youth

ERIC Educational Resources Information Center

August, Diane, Ed.; Shanahan, Timothy, Ed.

2006-01-01

This volume reports the findings of the National Literacy Panel on Language-Minority Children and Youth. The formal charge to the panel--a distinguished group of expert researchers in reading, language, bilingualism, research methods, and education--was to identify, assess, and synthesize research on the education of language-minority children and…

Defining the Key Competencies in Radiation Protection for Endovascular Procedures: A Multispecialty Delphi Consensus Study.

PubMed

Doyen, Bart; Maurel, Blandine; Cole, Jonathan; Maertens, Heidi; Mastracci, Tara; Van Herzeele, Isabelle

2018-02-01

Radiation protection training courses currently focus on broad knowledge topics which may not always be relevant in daily practice. The goal of this study was to determine the key competencies in radiation protection that every endovascular team member should possess and apply routinely, through multispecialty clinical content expert consensus. Consensus was obtained through a two round modified Delphi methodology. The expert panel consisted of European vascular surgeons, interventional radiologists, and interventional cardiologists/angiologists experienced in endovascular procedures. An initial list of statements, covering knowledge skills, technical skills and attitudes was created, based on a literature search. Additional statements could be suggested by the experts in the first Delphi round. Each of the statements had to be rated on a 5- point Likert scale. A statement was considered to be a key competency when the internal consistency was greater than alpha = 0.80 and at least 80% of the experts agreed (rating 4/5) or strongly agreed (rating 5/5) with the statement. Questionnaires were emailed to panel members using the Surveymonkey service. Forty-one of 65 (63.1%) invited experts agreed to participate in the study. The response rates were 36 out of 41 (87.8%): overall 38 out of 41(92.6%) in the first round and 36 out of 38 (94.7%) in the second round. The 71 primary statements were supplemented with nine items suggested by the panel. The results showed excellent consensus among responders (Cronbach's alpha = 0.937 first round; 0.958 s round). Experts achieved a consensus that 30 of 33 knowledge skills (90.9%), 23 of 27 technical skills (82.1%), and 15 of 20 attitudes (75.0%) should be considered as key competencies. A multispecialty European endovascular expert panel reached consensus about the key competencies in radiation protection. These results may serve to create practical and relevant radiation protection training courses in the future, enhancing

Breast cancer screening in the era of density notification legislation: summary of 2014 Massachusetts experience and suggestion of an evidence-based management algorithm by multi-disciplinary expert panel.

PubMed

Freer, Phoebe E; Slanetz, Priscilla J; Haas, Jennifer S; Tung, Nadine M; Hughes, Kevin S; Armstrong, Katrina; Semine, A Alan; Troyan, Susan L; Birdwell, Robyn L

2015-09-01

Stemming from breast density notification legislation in Massachusetts effective 2015, we sought to develop a collaborative evidence-based approach to density notification that could be used by practitioners across the state. Our goal was to develop an evidence-based consensus management algorithm to help patients and health care providers follow best practices to implement a coordinated, evidence-based, cost-effective, sustainable practice and to standardize care in recommendations for supplemental screening. We formed the Massachusetts Breast Risk Education and Assessment Task Force (MA-BREAST) a multi-institutional, multi-disciplinary panel of expert radiologists, surgeons, primary care physicians, and oncologists to develop a collaborative approach to density notification legislation. Using evidence-based data from the Institute for Clinical and Economic Review, the Cochrane review, National Comprehensive Cancer Network guidelines, American Cancer Society recommendations, and American College of Radiology appropriateness criteria, the group collaboratively developed an evidence-based best-practices algorithm. The expert consensus algorithm uses breast density as one element in the risk stratification to determine the need for supplemental screening. Women with dense breasts and otherwise low risk (<15% lifetime risk), do not routinely require supplemental screening per the expert consensus. Women of high risk (>20% lifetime) should consider supplemental screening MRI in addition to routine mammography regardless of breast density. We report the development of the multi-disciplinary collaborative approach to density notification. We propose a risk stratification algorithm to assess personal level of risk to determine the need for supplemental screening for an individual woman.

OECD Health Care Quality Indicator Project. The expert panel on primary care prevention and health promotion.

PubMed

Marshall, Martin; Klazinga, Niek; Leatherman, Sheila; Hardy, Charlie; Bergmann, Eckhard; Pisco, Luis; Mattke, Soeren; Mainz, Jan

2006-09-01

This article describes a project undertaken as part of the Organization for Economic Co-operation and Development (OECD)'s Healthcare Quality Indicator (HCQI) Project, which aimed to develop a set of quality indicators representing the domains of primary care, prevention and health promotion, and which could be used to assess the performance of primary care systems. Existing quality indicators from around the world were mapped to an organizing framework which related primary care, prevention, and health promotion. The indicators were judged against the US Institute of Medicine's assessment criteria of importance and scientific soundness, and only those which met these criteria and were likely to be feasible were included. An initial large set of indicators was reduced by the primary care expert panel using a modified Delphi process. A set of 27 indicators was produced. Six of them were related to health promotion, covering health-related behaviours that are typically targeted by health education and outreach campaigns, 13 to preventive care with a focus on prenatal care and immunizations and eight to primary clinical care mainly addressing activities related to risk reduction. The indicators selected placed a strong emphasis on the public health aspects of primary care. This project represents an important but preliminary step towards a set of measures to evaluate and compare primary care quality. Further work is required to assess the operational feasibility of the indicators and the validity of any benchmarking data drawn from international comparisons. A conceptual framework needs to be developed that comprehensively captures the complex construct of primary care as a basis for the selection of additional indicators.

Chronic obstructive lung disease "expert system": validation of a predictive tool for assisting diagnosis.

PubMed

Braido, Fulvio; Santus, Pierachille; Corsico, Angelo Guido; Di Marco, Fabiano; Melioli, Giovanni; Scichilone, Nicola; Solidoro, Paolo

2018-01-01

The purposes of this study were development and validation of an expert system (ES) aimed at supporting the diagnosis of chronic obstructive lung disease (COLD). A questionnaire and a WebFlex code were developed and validated in silico. An expert panel pilot validation on 60 cases and a clinical validation on 241 cases were performed. The developed questionnaire and code validated in silico resulted in a suitable tool to support the medical diagnosis. The clinical validation of the ES was performed in an academic setting that included six different reference centers for respiratory diseases. The results of the ES expressed as a score associated with the risk of suffering from COLD were matched and compared with the final clinical diagnoses. A set of 60 patients were evaluated by a pilot expert panel validation with the aim of calculating the sample size for the clinical validation study. The concordance analysis between these preliminary ES scores and diagnoses performed by the experts indicated that the accuracy was 94.7% when both experts and the system confirmed the COLD diagnosis and 86.3% when COLD was excluded. Based on these results, the sample size of the validation set was established in 240 patients. The clinical validation, performed on 241 patients, resulted in ES accuracy of 97.5%, with confirmed COLD diagnosis in 53.6% of the cases and excluded COLD diagnosis in 32% of the cases. In 11.2% of cases, a diagnosis of COLD was made by the experts, although the imaging results showed a potential concomitant disorder. The ES presented here (COLD ES ) is a safe and robust supporting tool for COLD diagnosis in primary care settings.

An evidence-based approach to interactive health communication: a challenge to medicine in the information age. Science Panel on Interactive Communication and Health.

PubMed

Robinson, T N; Patrick, K; Eng, T R; Gustafson, D

1998-10-14

To examine the current status of interactive health communication (IHC) and propose evidence-based approaches to improve the quality of such applications. The Science Panel on Interactive Communication and Health, a 14-member, nonfederal panel with expertise in clinical medicine and nursing, public health, media and instructional design, health systems engineering, decision sciences, computer and communication technologies, and health communication, convened by the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services. Published studies, online resources, expert panel opinions, and opinions from outside experts in fields related to IHC. The panel met 9 times during more than 2 years. Government agencies and private-sector experts provided review and feedback on the panel's work. Interactive health communication applications have great potential to improve health, but they may also cause harm. To date, few applications have been adequately evaluated. Physicians and other health professionals should promote and participate in an evidence-based approach to the development and diffusion of IHC applications and endorse efforts to rigorously evaluate the safety, quality, and utility of these resources. A standardized reporting template is proposed to help developers and evaluators of IHC applications conduct evaluations and disclose their results and to help clinicians, purchasers, and consumers judge the quality of IHC applications.

Treatment for Addiction: Advancing the Common Good. Recommendations from a Join Together Policy Panel on Treatment and Recovery.

ERIC Educational Resources Information Center

Join Together, Boston, MA.

Join Together convened a panel of experts to review U.S. policies for addiction treatment and recovery. Although the panel reached an agreement on six recommendations for policy changes that can make help more accessible and expand treatment to more people. These recommendations are: (1) treatment for alcoholism and other drug addiction must be…

Expert consensus on best evaluative practices in community-based rehabilitation.

PubMed

Grandisson, Marie; Thibeault, Rachel; Hébert, Michèle; Cameron, Debra

2016-01-01

The objective of this study was to generate expert consensus on best evaluative practices for community-based rehabilitation (CBR). This consensus includes key features of the evaluation process and methods, and discussion of whether a shared framework should be used to report findings and, if so, which framework should play this role. A Delphi study with two predefined rounds was conducted. Experts in CBR from a wide range of geographical areas and disciplinary backgrounds were recruited to complete the questionnaires. Both quantitative and qualitative analyses were performed to generate the recommendations for best practices in CBR evaluation. A panel of 42 experts reached consensus on 13 recommendations for best evaluative practices in CBR. In regard to the critical qualities of sound CBR evaluation processes, panellists emphasized that these processes should be inclusive, participatory, empowering and respectful of local cultures and languages. The group agreed that evaluators should consider the use of mixed methods and participatory tools, and should combine indicators from a universal list of CBR indicators with locally generated ones. The group also agreed that a common framework should guide CBR evaluations, and that this framework should be a flexible combination between the CBR Matrix and the CBR Principles. An expert panel reached consensus on key features of best evaluative practices in CBR. Knowledge transfer initiatives are now required to develop guidelines, tools and training opportunities to facilitate CBR program evaluations. CBR evaluation processes should strive to be inclusive, participatory, empowering and respectful of local cultures and languages. CBR evaluators should strongly consider using mixed methods, participatory tools, a combination of indicators generated with the local community and with others from a bank of CBR indicators. CBR evaluations should be situated within a shared, but flexible, framework. This shared framework could

2014 Consensus conference on viscoelastic test-based transfusion guidelines for early trauma resuscitation: Report of the panel.

PubMed

Inaba, Kenji; Rizoli, Sandro; Veigas, Precilla V; Callum, Jeannie; Davenport, Ross; Hess, John; Maegele, Marc

2015-06-01

There has been an increased interest in the use of viscoelastic testing to guide blood product replacement during the acute resuscitation of the injured patient. Currently, no uniformly accepted guidelines exist for how this technology should be integrated into clinical care. In September 2014, an international multidisciplinary group of leaders in the field of trauma coagulopathy and resuscitation was assembled for a 2-day consensus conference in Philadelphia, Pennsylvania. This panel included trauma surgeons, hematologists, blood bank specialists, anesthesiologists, and the lay public.Nine questions regarding the impact of viscoelastic testing in the early resuscitation of trauma patients were developed before the conference by panel consensus. Early use was defined as baseline viscoelastic test result thresholds obtained within the first minutes of hospital arrival-when conventional laboratory results are not available. The available data for each question were then reviewed in person using standardized presentations by the expert panel. A consensus summary document was then developed and reviewed by the panel in an open forum. Finally, a two-round Delphi poll was administered to the panel of experts regarding viscoelastic thresholds for triggering the initiation of specific treatments including fibrinogen, platelets, plasma, and prothrombin complex concentrates. This report summarizes the findings and recommendations of this consensus conference.

Targeted mutation screening panels expose systematic population bias in detection of cystic fibrosis risk.

PubMed

Lim, Regine M; Silver, Ari J; Silver, Maxwell J; Borroto, Carlos; Spurrier, Brett; Petrossian, Tanya C; Larson, Jessica L; Silver, Lee M

2016-02-01

Carrier screening for mutations contributing to cystic fibrosis (CF) is typically accomplished with panels composed of variants that are clinically validated primarily in patients of European descent. This approach has created a static genetic and phenotypic profile for CF. An opportunity now exists to reevaluate the disease profile of CFTR at a global population level. CFTR allele and genotype frequencies were obtained from a nonpatient cohort with more than 60,000 unrelated personal genomes collected by the Exome Aggregation Consortium. Likely disease-contributing mutations were identified with the use of public database annotations and computational tools. We identified 131 previously described and likely pathogenic variants and another 210 untested variants with a high probability of causing protein damage. None of the current genetic screening panels or existing CFTR mutation databases covered a majority of deleterious variants in any geographical population outside of Europe. Both clinical annotation and mutation coverage by commercially available targeted screening panels for CF are strongly biased toward detection of reproductive risk in persons of European descent. South and East Asian populations are severely underrepresented, in part because of a definition of disease that preferences the phenotype associated with European-typical CFTR alleles.

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update.

PubMed

Sweet, David G; Carnielli, Virgilio; Greisen, Gorm; Hallman, Mikko; Ozek, Eren; Plavka, Richard; Saugstad, Ola Didrik; Simeoni, Umberto; Speer, Christian P; Vento, Máximo; Visser, Gerard H A; Halliday, Henry L

2017-01-01

Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the beginning of 2016. Optimizing the outcome for babies with RDS includes consideration of when to use antenatal steroids, and good obstetric practice includes methods of predicting the risk of preterm delivery and also consideration of whether transfer to a perinatal centre is necessary and safe. Methods for optimal delivery room management have become more evidence based, and protocols for lung protection, including initiation of continuous positive airway pressure and titration of oxygen, should be implemented from soon after birth. Surfactant replacement therapy is a crucial part of the management of RDS, and newer protocols for surfactant administration are aimed at avoiding exposure to mechanical ventilation, and there is more evidence of differences among various surfactants in clinical use. Newer methods of maintaining babies on non-invasive respiratory support have been developed and offer potential for greater comfort and less chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease although minimizing the time spent on mechanical ventilation using caffeine and if necessary postnatal steroids are also important considerations. Protocols for optimizing the general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome. © 2016 S. Karger AG, Basel.

Quality assessment of expert answers to lay questions about cystic fibrosis from various language zones in Europe: the ECORN-CF project.

PubMed

d'Alquen, Daniela; De Boeck, Kris; Bradley, Judy; Vávrová, Věra; Dembski, Birgit; Wagner, Thomas O F; Pfalz, Annette; Hebestreit, Helge

2012-02-06

The European Centres of Reference Network for Cystic Fibrosis (ECORN-CF) established an Internet forum which provides the opportunity for CF patients and other interested people to ask experts questions about CF in their mother language. The objectives of this study were to: 1) develop a detailed quality assessment tool to analyze quality of expert answers, 2) evaluate the intra- and inter-rater agreement of this tool, and 3) explore changes in the quality of expert answers over the time frame of the project. The quality assessment tool was developed by an expert panel. Five experts within the ECORN-CF project used the quality assessment tool to analyze the quality of 108 expert answers published on ECORN-CF from six language zones. 25 expert answers were scored at two time points, one year apart. Quality of answers was also assessed at an early and later period of the project. Individual rater scores and group mean scores were analyzed for each expert answer. A scoring system and training manual were developed analyzing two quality categories of answers: content and formal quality. For content quality, the grades based on group mean scores for all raters showed substantial agreement between two time points, however this was not the case for the grades based on individual rater scores. For formal quality the grades based on group mean scores showed only slight agreement between two time points and there was also poor agreement between time points for the individual grades. The inter-rater agreement for content quality was fair (mean kappa value 0.232 ± 0.036, p < 0.001) while only slight agreement was observed for the grades of the formal quality (mean kappa value 0.105 ± 0.024, p < 0.001). The quality of expert answers was rated high (four language zones) or satisfactory (two language zones) and did not change over time. The quality assessment tool described in this study was feasible and reliable when content quality was assessed by a group of raters. Within

Expert Recommended Strategies for Classroom Management for Beginning Teachers Placed in Hard-to-Staff Schools in Urban School Districts

ERIC Educational Resources Information Center

Alexis, Chelly C.

2014-01-01

Purpose: The purpose of this study was to get the opinion of a panel of experts as to which classroom management strategies should be implemented in urban school district mentoring programs to help beginning teachers who are placed in hard-to-staff schools in Los Angeles County, California. Methodology: This Delphi study included 20 expert mentors…

Outcomes and Recommendations of an Indian Expert Panel for Improved Practice in Controlled Ovarian Stimulation for Assisted Reproductive Technology.

PubMed

Ahemmed, Baiju; Sundarapandian, Vani; Gutgutia, Rohit; Balasubramanyam, Sathya; Jagtap, Richa; Biliangady, Reeta; Gupta, Priti; Jadhav, Sachin; Satwik, Ruma; Dewda, Pavitra Raj; Thakor, Priti; Esteves, Sandro C

2017-01-01

Purpose. To improve success of in vitro fertilization (IVF), assisted reproductive technology (ART) experts addressed four questions. What is optimum oocytes number leading to highest live birth rate (LBR)? Are cohort size and embryo quality correlated? Does gonadotropin type affect oocyte yield? Should "freeze-all" policy be adopted in cycles with progesterone >1.5 ng/mL on day of human chorionic gonadotropin (hCG) administration? Methods. Electronic database search included ten studies on which panel gave opinions for improving current practice in controlled ovarian stimulation for ART. Results. Strong association existed between retrieved oocytes number (RON) and LBRs. RON impacted likelihood of ovarian hyperstimulation syndrome (OHSS). Embryo euploidy decreased with age, not with cohort size. Progesterone > 1.5 ng/dL did not impair cycle outcomes in patients with high cohorts and showed disparate results on day of hCG administration. Conclusions. Ovarian stimulation should be designed to retrieve 10-15 oocytes/treatment. Accurate dosage, gonadotropin type, should be selected as per prediction markers of ovarian response. Gonadotropin-releasing hormone (GnRH) antagonist based protocols are advised to avoid OHSS. Cumulative pregnancy rate was most relevant pregnancy endpoint in ART. Cycles with serum progesterone ≥1.5 ng/dL on day of hCG administration should not adopt "freeze-all" policy. Further research is needed due to lack of data availability on progesterone threshold or index.

Perspectives for food research and European collaboration in the European Research Area and the new Framework Programme.

PubMed

Breslin, L

2001-08-01

Since 1987, successive framework programmes have contributed to strengthen European food research through the establishment of networks between research institutions, universities and companies from various European countries. In the FAIR programme (1994-1998), 118 research projects comprising nearly 1,000 participants from the European Union and Associated States have been supported in the food area with a European funding of about [symbol: see text] 108 million. Within the Quality of Life and Management of Living Resources programme (1998-2002), food research is mostly supported within the key action 'food, nutrition and health' with a budget of [symbol: see text] 290 million. After the first four deadlines, 735 eligible research proposals have already been received. Further to their evaluation by a panel of independent experts, 108 proposals have been funded or selected for funding representing a total contribution of about [symbol: see text] 168 million. Among those, several clusters of projects are now running on important topics such as probiotics, coeliac diseases, mycotoxins, GMO, safety and food for the elderly. In addition, technology stimulation measures are largely benefiting SMEs to foster their innovation potential. In January 2000, the European Commission adopted a Communication entitled "Towards the European Research Area (ERA)" with the objective to contribute to developing better framework conditions for research in Europe. On 21 February 2001, the Commission adopted proposals to be submitted to the European Parliament and Council for the next framework programme for research and innovation (2002-2006). The new framework programme that is becoming one of the financial instruments of the ERA aims at catalysing the integration of European research by: strengthening of links between the Community research effort and national and regional research policies; concentrating on a limited number of priority fields or research to which activities at the

Handling and Reporting of Orchidectomy Specimens with Testicular Cancer: Areas of Consensus and Variation among 25 Experts and 225 European Pathologists

PubMed Central

Berney, Daniel M; Algaba, Ferran; Amin, Mahul; Delahunt, Brett; Compérat, Eva; Epstein, Jonathan I; Humphrey, Peter; Idrees, Mohammed; Lopez-Beltran, Antonio; Magi-Galluzzi, Cristina; Mikuz, Gregor; Montironi, Rodolfo; Oliva, Esther; Srigley, John; Reuter, Victor E; Trpkov, Kiril; Ulbright, Thomas M; Varma, Murali; Verrill, Clare; Young, Robert H; Zhou, Ming; Egevad, Lars

2016-01-01

Background The handling and reporting of testicular tumours is difficult due to their rarity. Design A survey developed by the European Network of Uro-Pathology (ENUP) and sent to its members and experts to assess the evaluation of testicular germ cell tumours Results 25 experts (E) and 225 ENUP members replied. Areas of disagreement included immaturity in teratomas, reported by 32% (E) but 68% (ENUP). Although the presence of rete testis invasion was widely reported, the distinction between pagetoid and stromal invasion was made by 96% (E) but only 63% (ENUP). Immunohistochemistry was used in more than 50% of cases by 68% (ENUP) and 12% (E). Staging revealed the greatest areas of disagreement. Invasion of the tunica vaginalis without vascular invasion was interpreted as T1 by 52% (E) and 67% (ENUP), but T2 by the remainder. Tumour invading the hilar adipose tissue adjacent to the epididymis without vascular invasion was interpreted as T1: 40% (E), 43% (ENUP), T2: 36% (E), 30% (ENUP) and T3: 24% (E), 27% (ENUP). Conclusions There is remarkable consensus in many areas of testicular pathology. Significant areas of disagreement included staging and reporting of histologic types, both of which have the potential to impact on therapy. PMID:25619976

External quality mechanisms for health care: summary of the ExPeRT project on visitatie, accreditation, EFQM and ISO assessment in European Union countries. External Peer Review Techniques. European Foundation for Quality Management. International Organization for Standardization.

PubMed

Shaw, C D

2000-06-01

This paper is a summary of the operation, findings and conclusions of a European Union project on external peer review techniques, termed 'ExPeRT', to research the scope, mechanisms and use of external quality mechanisms in the improvement of health care. Many of the themes outlined are described in detail in other papers that have been prepared specifically for this issue of The International Journal for Quality in Health Care. Although the emphasis of this project and of this issue of the Journal is on Europe, the conclusions are more widely relevant.

Breast Cancer Screening in the Era of Density Notification Legislation: Summary of 2014 Massachusetts Experience and Suggestion of An Evidence-Based Management Algorithm by Multi-disciplinary Expert Panel

PubMed Central

Freer, Phoebe E.; Slanetz, Priscilla J.; Haas, Jennifer S.; Tung, Nadine M.; Hughes, Kevin S.; Armstrong, Katrina; Semine, A. Alan; Troyan, Susan L.; Birdwell, Robyn L.

2015-01-01

Purpose Stemming from breast density notification legislation in Massachusetts effective 2015, we sought to develop a collaborative evidence-based approach to density notification that could be used by practitioners across the state. Our goal was to develop an evidence-based consensus management algorithm to help patients and health care providers follow best practices to implement a coordinated, evidence-based, cost-effective, sustainable practice and to standardize care in recommendations for supplemental screening. Methods We formed the Massachusetts Breast Risk Education and Assessment Task Force (MA-BREAST) a multi-institutional, multi-disciplinary panel of expert radiologists, surgeons, primary care physicians, and oncologists to develop a collaborative approach to density notification legislation. Using evidence-based data from the Institute for Clinical and Economic Review (ICER), the Cochrane review, National Comprehensive Cancer Network (NCCN) guidelines, American Cancer Society (ACS) recommendations, and American College of Radiology (ACR) appropriateness criteria, the group collaboratively developed an evidence-based best-practices algorithm. Results The expert consensus algorithm uses breast density as one element in the risk stratification to determine the need for supplemental screening. Women with dense breasts and otherwise low risk (<15% lifetime risk), do not routinely require supplemental screening per the expert consensus. Women of high risk (>20% lifetime) should consider supplemental screening MRI in addition to routine mammography regardless of breast density. Conclusion We report the development of the multi-disciplinary collaborative approach to density notification. We propose a risk stratification algorithm to assess personal level of risk to determine the need for supplemental screening for an individual woman. PMID:26290416

Key priorities in the prevention and control of healthcare-associated infection: a survey of European and other international infection prevention experts.

PubMed

Dettenkofer, Markus; Humphreys, Hilary; Saenz, Henri; Carlet, Jean; Hanberger, Håkan; Ruef, Christian; Widmer, Andreas; Wolkewitz, Martin; Cookson, Barry

2016-12-01

Prevention and control of healthcare-associated infection (HCAI) are important within and beyond Europe. However, it is unclear which areas are considered important by HCAI prevention and control professionals. This study assesses the priorities in the prevention and control of HCAI as judged by experts in the field. A survey was conducted by the European Society of Clinical Microbiology and Infectious Diseases focussing on seven topics using SurveyMonkey ® . Through a newsletter distributed by email, about 5000 individuals were targeted throughout the world in February and March 2013. Participants were asked to rate the importance of particular topics from one (low importance) to ten (extraordinary importance), and there was no restriction on giving equal importance to more than one topic. A total of 589 experts from 86 countries participated including 462 from Europe (response rate: 11.8 %). Physicians accounted for 60 % of participants, and 57 % had ten or more years' experience in this area. Microbial epidemiology/resistance achieved the highest priority scoring with 8.9, followed by surveillance 8.2, and decolonisation/disinfection/antiseptics with 7.9. Under epidemiology/resistance, highly resistant Gram-negative bacilli scored highest (9.0-9.2). The provision of computerised healthcare information systems for the early detection of outbreaks was accorded the top priority under surveillance. The prevention of surgical site and central line infections ranked highest under the category of specific HCAI and HCAI in certain settings. Differences between regions are described. These findings reflect the concerns of experts in HCAI prevention and control. The results from this survey should inform national and international agencies on future action and research priorities.

61. Upper panel in cornerpower panel lcpa lower panel in ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

61. Upper panel in corner-power panel lcpa lower panel in corner-oxygen regeneration unit, at right-air conditioner control panel, on floor-bio-pack 45 for emergency breathing, looking northwest - Ellsworth Air Force Base, Delta Flight, Launch Control Facility, County Road CS23A, North of Exit 127, Interior, Jackson County, SD

Neurobehavioral deficits, diseases, and associated costs of exposure to endocrine-disrupting chemicals in the European Union.

PubMed

Bellanger, Martine; Demeneix, Barbara; Grandjean, Philippe; Zoeller, R Thomas; Trasande, Leonardo

2015-04-01

Epidemiological studies and animal models demonstrate that endocrine-disrupting chemicals (EDCs) contribute to cognitive deficits and neurodevelopmental disabilities. The objective was to estimate neurodevelopmental disability and associated costs that can be reasonably attributed to EDC exposure in the European Union. An expert panel applied a weight-of-evidence characterization adapted from the Intergovernmental Panel on Climate Change. Exposure-response relationships and reference levels were evaluated for relevant EDCs, and biomarker data were organized from peer-reviewed studies to represent European exposure and approximate burden of disease. Cost estimation as of 2010 utilized lifetime economic productivity estimates, lifetime cost estimates for autism spectrum disorder, and annual costs for attention-deficit hyperactivity disorder. Setting, Patients and Participants, and Intervention: Cost estimation was carried out from a societal perspective, ie, including direct costs (eg, treatment costs) and indirect costs such as productivity loss. The panel identified a 70-100% probability that polybrominated diphenyl ether and organophosphate exposures contribute to IQ loss in the European population. Polybrominated diphenyl ether exposures were associated with 873,000 (sensitivity analysis, 148,000 to 2.02 million) lost IQ points and 3290 (sensitivity analysis, 3290 to 8080) cases of intellectual disability, at costs of €9.59 billion (sensitivity analysis, €1.58 billion to €22.4 billion). Organophosphate exposures were associated with 13.0 million (sensitivity analysis, 4.24 million to 17.1 million) lost IQ points and 59 300 (sensitivity analysis, 16,500 to 84,400) cases of intellectual disability, at costs of €146 billion (sensitivity analysis, €46.8 billion to €194 billion). Autism spectrum disorder causation by multiple EDCs was assigned a 20-39% probability, with 316 (sensitivity analysis, 126-631) attributable cases at a cost of €199 million

Panel 3: Genetics and Precision Medicine of Otitis Media.

PubMed

Lin, Jizhen; Hafrén, Hena; Kerschner, Joseph; Li, Jian-Dong; Brown, Steve; Zheng, Qing Y; Preciado, Diego; Nakamura, Yoshihisa; Huang, Qiuhong; Zhang, Yan

2017-04-01

Objective The objective is to perform a comprehensive review of the literature up to 2015 on the genetics and precision medicine relevant to otitis media. Data Sources PubMed database of the National Library of Medicine. Review Methods Two subpanels were formed comprising experts in the genetics and precision medicine of otitis media. Each of the panels reviewed the literature in their respective fields and wrote draft reviews. The reviews were shared with all panel members, and a merged draft was created. The entire panel met at the 18th International Symposium on Recent Advances in Otitis Media in June 2015 and discussed the review and refined the content. A final draft was made, circulated, and approved by the panel members. Conclusion Many genes relevant to otitis media have been identified in the last 4 years in advancing our knowledge regarding the predisposition of the middle ear mucosa to commensals and pathogens. Advances include mutant animal models and clinical studies. Many signaling pathways are involved in the predisposition of otitis media. Implications for Practice New knowledge on the genetic background relevant to otitis media forms a basis of novel potential interventions, including potential new ways to treat otitis media.

Solar panel thermal cycling testing by solar simulation and infrared radiation methods

NASA Technical Reports Server (NTRS)

Nuss, H. E.

1980-01-01

For the solar panels of the European Space Agency (ESA) satellites OTS/MAROTS and ECS/MARECS the thermal cycling tests were performed by using solar simulation methods. The performance data of two different solar simulators used and the thermal test results are described. The solar simulation thermal cycling tests for the ECS/MARECS solar panels were carried out with the aid of a rotatable multipanel test rig by which simultaneous testing of three solar panels was possible. As an alternative thermal test method, the capability of an infrared radiation method was studied and infrared simulation tests for the ultralight panel and the INTELSAT 5 solar panels were performed. The setup and the characteristics of the infrared radiation unit using a quartz lamp array of approx. 15 sq and LN2-cooled shutter and the thermal test results are presented. The irradiation uniformity, the solar panel temperature distribution, temperature changing rates for both test methods are compared. Results indicate the infrared simulation is an effective solar panel thermal testing method.

Estimating burden and disease costs of exposure to endocrine-disrupting chemicals in the European union.

PubMed

Trasande, Leonardo; Zoeller, R Thomas; Hass, Ulla; Kortenkamp, Andreas; Grandjean, Philippe; Myers, John Peterson; DiGangi, Joseph; Bellanger, Martine; Hauser, Russ; Legler, Juliette; Skakkebaek, Niels E; Heindel, Jerrold J

2015-04-01

Rapidly increasing evidence has documented that endocrine-disrupting chemicals (EDCs) contribute substantially to disease and disability. The objective was to quantify a range of health and economic costs that can be reasonably attributed to EDC exposures in the European Union (EU). A Steering Committee of scientists adapted the Intergovernmental Panel on Climate Change weight-of-evidence characterization for probability of causation based upon levels of available epidemiological and toxicological evidence for one or more chemicals contributing to disease by an endocrine disruptor mechanism. To evaluate the epidemiological evidence, the Steering Committee adapted the World Health Organization Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group criteria, whereas the Steering Committee adapted definitions recently promulgated by the Danish Environmental Protection Agency for evaluating laboratory and animal evidence of endocrine disruption. Expert panels used the Delphi method to make decisions on the strength of the data. Expert panels achieved consensus at least for probable (>20%) EDC causation for IQ loss and associated intellectual disability, autism, attention-deficit hyperactivity disorder, childhood obesity, adult obesity, adult diabetes, cryptorchidism, male infertility, and mortality associated with reduced testosterone. Accounting for probability of causation and using the midpoint of each range for probability of causation, Monte Carlo simulations produced a median cost of €157 billion (or $209 billion, corresponding to 1.23% of EU gross domestic product) annually across 1000 simulations. Notably, using the lowest end of the probability range for each relationship in the Monte Carlo simulations produced a median range of €109 billion that differed modestly from base case probability inputs. EDC exposures in the EU are likely to contribute substantially to disease and dysfunction across the life course with costs in

Estimating Burden and Disease Costs of Exposure to Endocrine-Disrupting Chemicals in the European Union

PubMed Central

Zoeller, R. Thomas; Hass, Ulla; Kortenkamp, Andreas; Grandjean, Philippe; Myers, John Peterson; DiGangi, Joseph; Bellanger, Martine; Hauser, Russ; Legler, Juliette; Skakkebaek, Niels E.; Heindel, Jerrold J.

2015-01-01

Context: Rapidly increasing evidence has documented that endocrine-disrupting chemicals (EDCs) contribute substantially to disease and disability. Objective: The objective was to quantify a range of health and economic costs that can be reasonably attributed to EDC exposures in the European Union (EU). Design: A Steering Committee of scientists adapted the Intergovernmental Panel on Climate Change weight-of-evidence characterization for probability of causation based upon levels of available epidemiological and toxicological evidence for one or more chemicals contributing to disease by an endocrine disruptor mechanism. To evaluate the epidemiological evidence, the Steering Committee adapted the World Health Organization Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group criteria, whereas the Steering Committee adapted definitions recently promulgated by the Danish Environmental Protection Agency for evaluating laboratory and animal evidence of endocrine disruption. Expert panels used the Delphi method to make decisions on the strength of the data. Results: Expert panels achieved consensus at least for probable (>20%) EDC causation for IQ loss and associated intellectual disability, autism, attention-deficit hyperactivity disorder, childhood obesity, adult obesity, adult diabetes, cryptorchidism, male infertility, and mortality associated with reduced testosterone. Accounting for probability of causation and using the midpoint of each range for probability of causation, Monte Carlo simulations produced a median cost of €157 billion (or $209 billion, corresponding to 1.23% of EU gross domestic product) annually across 1000 simulations. Notably, using the lowest end of the probability range for each relationship in the Monte Carlo simulations produced a median range of €109 billion that differed modestly from base case probability inputs. Conclusions: EDC exposures in the EU are likely to contribute substantially to disease and

Brazil to Join the European Southern Observatory

NASA Astrophysics Data System (ADS)

2010-12-01

conducted where every aspect of this large project was scrutinised by an international panel of independent experts. The panel found that the E-ELT project is technically ready to enter the construction phase. The go-ahead for E-ELT construction is planned for 2011 and when operations start early in the next decade, European, Brazilian and Chilean astronomers will have access to this giant telescope. The president of ESO's governing body, the Council, Laurent Vigroux, concludes: "Astronomers in Brazil will benefit from collaborating with European colleagues, and naturally from having observing time at ESO's world-class observatories at La Silla and Paranal, as well as on ALMA, which ESO is constructing with its international partners." Notes [1] After ratification of Brazil's membership, the ESO Member States will be Austria, Belgium, Brazil, the Czech Republic, Denmark, France, Finland, Germany, Italy, the Netherlands, Portugal, Spain, Sweden, Switzerland and the United Kingdom. More information ESO, the European Southern Observatory, is the foremost intergovernmental astronomy organisation in Europe and the world's most productive astronomical observatory. It is supported by 14 countries: Austria, Belgium, the Czech Republic, Denmark, France, Finland, Germany, Italy, the Netherlands, Portugal, Spain, Sweden, Switzerland and the United Kingdom. ESO carries out an ambitious programme focused on the design, construction and operation of powerful ground-based observing facilities enabling astronomers to make important scientific discoveries. ESO also plays a leading role in promoting and organising cooperation in astronomical research. ESO operates three unique world-class observing sites in Chile: La Silla, Paranal and Chajnantor. At Paranal, ESO operates the Very Large Telescope, the world's most advanced visible-light astronomical observatory and VISTA, the world's largest survey telescope. ESO is the European partner of a revolutionary astronomical telescope ALMA, the

Targeted temperature management in the ICU: guidelines from a French expert panel.

PubMed

Cariou, Alain; Payen, Jean-François; Asehnoune, Karim; Audibert, Gerard; Botte, Astrid; Brissaud, Olivier; Debaty, Guillaume; Deltour, Sandrine; Deye, Nicolas; Engrand, Nicolas; Francony, Gilles; Legriel, Stéphane; Levy, Bruno; Meyer, Philippe; Orban, Jean-Christophe; Renolleau, Sylvain; Vigue, Bernard; De Saint Blanquat, Laure; Mathien, Cyrille; Velly, Lionel

2017-12-01

Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term "targeted temperature management" (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method. Indications are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of TTM in adult and paediatric critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de Réanimation de Langue Française [SRLF]) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d'Anesthésie Réanimation [SFAR]) with the participation of the French Emergency Medicine Association (Société Française de Médecine d'Urgence [SFMU]), the French Group for Pediatric Intensive Care and Emergencies (Groupe Francophone de Réanimation et Urgences Pédiatriques [GFRUP]), the French National Association of Neuro-Anesthesiology and Critical Care (Association Nationale de Neuro-Anesthésie Réanimation Française [ANARLF]), and the French Neurovascular Society (Société Française Neurovasculaire [SFNV]). Fifteen experts and two coordinators agreed to consider questions concerning TTM and its practical implementation in five clinical situations: cardiac arrest, traumatic brain injury, stroke, other brain injuries, and shock. This resulted in 30 recommendations

Obesity, Diabetes, and Associated Costs of Exposure to Endocrine-Disrupting Chemicals in the European Union

PubMed Central

Legler, Juliette; Fletcher, Tony; Govarts, Eva; Porta, Miquel; Blumberg, Bruce; Heindel, Jerrold J.

2015-01-01

Context: Obesity and diabetes are epidemic in the European Union (EU). Exposure to endocrine-disrupting chemicals (EDCs) is increasingly recognized as a contributor, independent of diet and physical activity. Objective: The objective was to estimate obesity, diabetes, and associated costs that can be reasonably attributed to EDC exposures in the EU. Design: An expert panel evaluated evidence for probability of causation using weight-of-evidence characterization adapted from that applied by the Intergovernmental Panel on Climate Change. Exposure-response relationships and reference levels were evaluated for relevant EDCs, and biomarker data were organized from peer-reviewed studies to represent European exposure and burden of disease. Cost estimation as of 2010 utilized published cost estimates for childhood obesity, adult obesity, and adult diabetes. Setting, Patients and Participants, and Intervention: Cost estimation was performed from the societal perspective. Results: The panel identified a 40% to 69% probability of dichlorodiphenyldichloroethylene causing 1555 cases of overweight at age 10 (sensitivity analysis: 1555–5463) in 2010 with associated costs of €24.6 million (sensitivity analysis: €24.6–86.4 million). A 20% to 39% probability was identified for dichlorodiphenyldichloroethylene causing 28 200 cases of adult diabetes (sensitivity analysis: 28 200–56 400) with associated costs of €835 million (sensitivity analysis: €835 million–16.6 billion). The panel also identified a 40% to 69% probability of phthalate exposure causing 53 900 cases of obesity in older women and €15.6 billion in associated costs. Phthalate exposure was also found to have a 40% to 69% probability of causing 20 500 new-onset cases of diabetes in older women with €607 million in associated costs. Prenatal bisphenol A exposure was identified to have a 20% to 69% probability of causing 42 400 cases of childhood obesity, with associated lifetime costs of €1.54 billion

Sleep-deprived motor vehicle operators are unfit to drive: a multidisciplinary expert consensus statement on drowsy driving.

PubMed

Czeisler, Charles A; Wickwire, Emerson M; Barger, Laura K; Dement, William C; Gamble, Karen; Hartenbaum, Natalie; Ohayon, Maurice M; Pelayo, Rafael; Phillips, Barbara; Strohl, Kingman; Tefft, Brian; Rajaratnam, Shantha M W; Malhotra, Raman; Whiton, Kaitlyn; Hirshkowitz, Max

2016-06-01

This article presents the consensus findings of the National Sleep Foundation Drowsy Driving Consensus Working Group, which was an expert panel assembled to establish a consensus statement regarding sleep-related driving impairment. The National Sleep Foundation assembled a expert panel comprised of experts from the sleep community and experts appointed by stakeholder organizations. A systematic literature review identified 346 studies that were abstracted and provided to the panelists for review. A modified Delphi RAND/UCLA Appropriateness Method with 2 rounds of voting was used to reach consensus. A final consensus was reached that sleep deprivation renders motorists unfit to drive a motor vehicle. After reviewing growing evidence of impairment and increased crash risk among drivers who obtained less than optimal sleep duration in the preceding 24 hours, the panelists recognized the need for public policy guidance as to when it is certainly unsafe to drive. Toward this end, the panelists agreed upon the following expert consensus statement: "Drivers who have slept for two hours or less in the preceding 24 hours are not fit to operate a motor vehicle." Panelists further agreed that most healthy drivers would likely be impaired with only 3 to 5 hours of sleep during the prior 24 hours. There is consensus among experts that healthy individuals who have slept for 2 hours or less in the preceding 24 hours are too impaired to safely operate a motor vehicle. Prevention of drowsy driving will require sustained and collaborative effort from multiple stakeholders. Implications and limitations of the consensus recommendations are discussed. Copyright © 2016. Published by Elsevier Inc.

The Politics of the Economics of Education in the European Union

ERIC Educational Resources Information Center

Jones, Peter

2010-01-01

This article critically examines the work of the European Commission-sponsored network, the European Expert Network on Economics of Education (EENEE). The aim is to develop understanding of the context and significance of the mobilization of the economics of education research and policy paradigm within the European Union's Education and Training…

EFOMP policy statement 16: The role and competences of medical physicists and medical physics experts under 2013/59/EURATOM.

PubMed

Caruana, Carmel J; Tsapaki, Virginia; Damilakis, John; Brambilla, Marco; Martín, Guadalupe Martín; Dimov, Asen; Bosmans, Hilde; Egan, Gillian; Bacher, Klaus; McClean, Brendan

2018-04-01

On 5 December 2013 the European Council promulgated Directive 2013/59/EURATOM. This Directive is important for Medical Physicists and Medical Physics Experts as it puts the profession on solid foundations and describes it more comprehensively. Much commentary regarding the role and competences has been developed in the context of the European Commission project "European Guidelines on the Medical Physics Expert" published as Radiation Protection Report RP174. The guidelines elaborate on the role and responsibilities under 2013/59/EURATOM in terms of a mission statement and competence profile in the specialty areas of Medical Physics relating to medical radiological services, namely Diagnostic and Interventional Radiology, Radiation Oncology and Nuclear Medicine. The present policy statement summarises the provisions of Directive 2013/59/EURATOM regarding the role and competences, reiterates the results of the European Guidelines on the Medical Physics Expert document relating to role and competences of the profession and provides additional commentary regarding further issues arising following the publication of the RP174 guidelines. Copyright © 2018. Published by Elsevier Ltd.

European survey on principles of prudent antibiotic prescribing teaching in undergraduate students.

PubMed

Pulcini, C; Wencker, F; Frimodt-Møller, N; Kern, W V; Nathwani, D; Rodríguez-Baño, J; Simonsen, G S; Vlahović-Palčevski, V; Gyssens, I C

2015-04-01

We surveyed European medical schools regarding teaching of prudent antibiotic prescribing in the undergraduate curriculum. We performed a cross-sectional survey in 13 European countries (Belgium, Croatia, Denmark, France, Germany, Italy, Netherlands, Norway, Serbia, Slovenia, Spain, Switzerland, United Kingdom) in 2013. Proportional sampling was used, resulting in the selection of two to four medical schools per country. A standardized questionnaire based on literature review and validated by a panel of experts was sent to lecturers in infectious diseases, medical microbiology and clinical pharmacology. In-depth interviews were conducted with four lecturers. Thirty-five of 37 medical schools were included in the study. Prudent antibiotic use principles were taught in all but one medical school, but only four of 13 countries had a national programme. Interactive teaching formats were used less frequently than passive formats. The teaching was mandatory for 53% of the courses and started before clinical training in 71%. We observed wide variations in exposure of students to important principles of prudent antibiotic use among countries and within the same country. Some major principles were poorly covered (e.g. reassessment and duration of antibiotic therapy, communication skills). Whereas 77% of the respondents fully agreed that the teaching of these principles should be prioritized, lack of time, mainly due to rigid curriculum policies, was the main reported barrier to implementation. Given the study design, these are probably optimistic results. Teaching of prudent antibiotic prescribing principles should be improved. National and European programmes for development of specific learning outcomes or competencies are urgently needed. Copyright © 2014 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Clinical diagnosis of pneumonia, typical of experts.

PubMed

Miettinen, Olli S; Flegel, Kenneth M; Steurer, Johann

2008-04-01

Clinical diagnosis of pneumonia is a concern when a patient presents with recent cough--new or worsened--together with fever as the chief complaint. Given this presentation, the doctor would benefit from having access to software that specifies, first, what diagnostic indicators experts typically use in that diagnosis; then, upon entry of those facts, what experts' typical probability of pneumonia is in such a case; and finally, how much this probability might change upon adding the facts from chest radiography. We specified a set of 36 hypothetical presentations of this type by patients 20-70 years of age, involving a comprehensive set of clinical-diagnostic indicators. Members of three separate expert panels independently set the probability of pneumonia in each of these cases, and also the range of possible post-radiography probabilities. A logistic function of the diagnostic indicators was fitted to the medians of the probabilities. The median probability of pneumonia was a joint function of the patient's age and current rate of cigarette smoking; history as to the cough's duration, the fever's maximum, dyspnea (including whether on effort only) and rigors; and physical examination as to temperature, signs of upper respiratory infection, prolongation of expiration, dullness on percussion and some auscultation findings. Non-contributory were history of wheezing, pain on inspiration, type of sputum and signs of cold or influenza. This probability function, and the post-radiography functions based on the same indicators, are accessible at http://www.evimed.ch/pneumonia. The expert inputs to clinical diagnosis that were derived and made readily accessible provide for expertly clinical diagnosis of pneumonia, relevant for decisions about radiography and treatment without it.

Expert operator's associate: A knowledge based system for spacecraft control

NASA Technical Reports Server (NTRS)

Nielsen, Mogens; Grue, Klaus; Lecouat, Francois

1991-01-01

The Expert Operator's Associate (EOA) project is presented which studies the applicability of expert systems for day-to-day space operations. A prototype expert system is developed, which operates on-line with an existing spacecraft control system at the European Space Operations Centre, and functions as an 'operator's assistant' in controlling satellites. The prototype is demonstrated using an existing real-time simulation model of the MARECS-B2 telecommunication satellite. By developing a prototype system, the extent to which reliability and effectivens of operations can be enhanced by AI based support is examined. In addition the study examines the questions of acquisition and representation of the 'knowledge' for such systems, and the feasibility of 'migration' of some (currently) ground-based functions into future spaceborne autonomous systems.

Nutritional support and parenteral nutrition in cancer patients: an expert consensus report.

PubMed

Virizuela, J A; Camblor-Álvarez, M; Luengo-Pérez, L M; Grande, E; Álvarez-Hernández, J; Sendrós-Madroño, M J; Jiménez-Fonseca, P; Cervera-Peris, M; Ocón-Bretón, M J

2018-05-01

Malnutrition is a frequent medical problem of cancer patients that negatively impacts their quality of life. A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Nutrition convened to discuss the management of the nutritional support in cancer patients. Of the 18 questions addressed, 9 focused on nutritional support, 5 were related to parenteral nutrition (PN) and 4 about home PN (HPN). The panel of experts recommends using nutritional screening routinely, at diagnosis and throughout the disease course, for detecting the risk of malnutrition and, if it is positive, to perform a complete nutritional assessment, to diagnose malnutrition. Currently, there are different screening tools and methods that allow us to detect nutritional risk. Based on the evidence and experience, the panel stated that PN is indicated mainly when it is not possible to use the digestive tract and/or oral feeding and/or enteral nutrition is not sufficient or possible. The nutritional needs of the cancer patients, except in those cases where individualized measures are required, should be considered similar to healthy individuals (25-30 kcal/kg/day). The panel considers that the nutritional monitoring of the cancer patient should be multidisciplinary and adapted to the characteristics of each center. Additionally, the objective of the HPN is to improve or maintain the nutritional status of a patient at home. This document seeks to lay down a set of recommendations and to identify key issues that may be useful for the nutritional management of cancer patients.

Expert opinion survey on the impacts of air pollutants on forests of the USA

Treesearch

J.M. Pye; J.E. de Steiguer; C. Love

1988-01-01

A panel of experts was surveyed to obtain five air pollutants (SO2 NO2, O3, H2SO4, and HNO3) on growth, mortality, and leaf area of forests of the continental U.S. for later input to economic analysis. Results from the first two of three...

Pressure ulcer and patient characteristics--A point prevalence study in a tertiary hospital of India based on the European Pressure Ulcer Advisory Panel minimum data set.

PubMed

Mehta, Chitra; George, Joby V; Mehta, Yatin; Wangmo, Namgyal

2015-08-01

Pressure ulcers is a frequent problem in hospitalized patients. Several prevalence studies have been conducted across the globe. Little information is available regarding prevalence of pressure ulcers in India. The aim was to identify the prevalence of pressure ulcers in one of the tertiary hospital in northern India and the factors associated with its development. A cross sectional point prevalence study. European Pressure Ulcer Advisory Panel (EPUAP) data collection form. Ethics approval was obtained prior to start of the study. Total of 358 patients were enrolled in the study. All patients above 18 years of age admitted in intensive care units and wards were included in the study. Patients admitted in emergency, day care, coronary care unit were excluded because of their short duration of hospital stay (varies from 24 to 72 h usually). All patients admitted before midnight on the predetermined day were included. The Braden scale was used to identify the risk of developing pressure ulcers. European Pressure ulcer advisory panel (EPUAP) minimum data set was used to collect prevalence data. The overall prevalence rate was 7.8%.The sacrum and heel were more commonly affected. Grade III pressure ulcers were the most common (42.8%). The pressure ulcer prevalence rate in our hospital was lower than that published in international studies. Severe forms of pressure ulcers were commonly encountered This data provides background information that may help us in developing protocols for applying effective practices for prevention of pressure ulcers. Copyright © 2015 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

Outcomes and Recommendations of an Indian Expert Panel for Improved Practice in Controlled Ovarian Stimulation for Assisted Reproductive Technology

PubMed Central

Ahemmed, Baiju; Sundarapandian, Vani; Gutgutia, Rohit; Balasubramanyam, Sathya; Jagtap, Richa; Biliangady, Reeta; Gupta, Priti; Jadhav, Sachin; Satwik, Ruma; Thakor, Priti

2017-01-01

Purpose. To improve success of in vitro fertilization (IVF), assisted reproductive technology (ART) experts addressed four questions. What is optimum oocytes number leading to highest live birth rate (LBR)? Are cohort size and embryo quality correlated? Does gonadotropin type affect oocyte yield? Should “freeze-all” policy be adopted in cycles with progesterone >1.5 ng/mL on day of human chorionic gonadotropin (hCG) administration? Methods. Electronic database search included ten studies on which panel gave opinions for improving current practice in controlled ovarian stimulation for ART. Results. Strong association existed between retrieved oocytes number (RON) and LBRs. RON impacted likelihood of ovarian hyperstimulation syndrome (OHSS). Embryo euploidy decreased with age, not with cohort size. Progesterone > 1.5 ng/dL did not impair cycle outcomes in patients with high cohorts and showed disparate results on day of hCG administration. Conclusions. Ovarian stimulation should be designed to retrieve 10–15 oocytes/treatment. Accurate dosage, gonadotropin type, should be selected as per prediction markers of ovarian response. Gonadotropin-releasing hormone (GnRH) antagonist based protocols are advised to avoid OHSS. Cumulative pregnancy rate was most relevant pregnancy endpoint in ART. Cycles with serum progesterone ≥1.5 ng/dL on day of hCG administration should not adopt “freeze-all” policy. Further research is needed due to lack of data availability on progesterone threshold or index. PMID:28246628

Regulatory considerations surrounding the deployment of Bt-expressing cowpea in Africa: report of the deliberations of an expert panel.

PubMed

Huesing, Joseph; Romeis, Jörg; Ellstrand, Norman; Raybould, Alan; Hellmich, Richard; Wolt, Jeff; Ehlers, Jeff; Dabiré, Clémentine; Fatokun, Christian; Hokanson, Karen; Ishiyaku, Mohammad F; Margam, Venu; Obokoh, Nompumelelo; Mignouna, Jacob; Nangayo, Francis; Ouedraogo, Jeremy; Pasquet, Rémy; Pittendrigh, Barry; Schaal, Barbara; Stein, Jeff; Tamò, Manuele; Murdock, Larry

2011-01-01

Cowpea (Vigna unguiculata spp unguiculata) is adapted to the drier agro-ecological zones of West Africa where it is a major source of dietary protein and widely used as a fodder crop. Improving the productivity of cowpea can enhance food availability and security in West Africa. Insect predation--predominately from the legume pod borer (Maruca vitrata), flower thrips (Megalurothrips sjostedti) and a complex of pod-sucking bugs (e.g., Clavigralla spp)--is a major yield-limiting factor in West African cowpea production. Dramatic increases in yield are shown when M. vitrata is controlled with insecticides. However, availability, costs, and safety considerations limit pesticides as a viable option for boosting cowpea production. Development of Bt-cowpea through genetic modification (GM) to control the legume pod borer is a promising approach to cowpea improvement. Cowpea expressing the lepidopteran-active Cry1Ab protein from Bacillus thuringiensis is being developed as a first generation Bt-cowpea crop for West Africa. Appropriate stewardship of Bt-cowpea to assure its sustainability under West African conditions is critical to its successful development. A first step in this process is an environmental risk assessment to determine the likelihood and magnitude of adverse effects of the Cry1Ab protein on key environmental protection goals in West Africa. Here we describe the results of an expert panel convened in 2009 to develop the problem formulation phase for Bt-cowpea and to address specific issues around gene flow, non-target arthropods, and insect resistance management.

Providing culturally appropriate mental health first aid to an Aboriginal or Torres Strait Islander adolescent: development of expert consensus guidelines.

PubMed

Chalmers, Kathryn J; Bond, Kathy S; Jorm, Anthony F; Kelly, Claire M; Kitchener, Betty A; Williams-Tchen, Aj

2014-01-28

It is estimated that the prevalence of mental illness is higher in Aboriginal and Torres Strait Islander adolescents compared to non-Aboriginal adolescents. Despite this, only a small proportion of Aboriginal youth have contact with mental health services, possibly due to factors such as remoteness, language barriers, affordability and cultural sensitivity issues. This research aimed to develop culturally appropriate guidelines for anyone who is providing first aid to an Australian Aboriginal or Torres Strait Islander adolescent who is experiencing a mental health crisis or developing a mental illness. A panel of Australian Aboriginal people who are experts in Aboriginal youth mental health, participated in a Delphi study investigating how members of the public can be culturally appropriate when helping an Aboriginal or Torres Strait Islander adolescent with mental health problems. The panel varied in size across the three sequential rounds, from 37-41 participants. Panellists were presented with statements about cultural considerations and communication strategies via online questionnaires and were encouraged to suggest additional content. All statements endorsed as either Essential or Important by ≥ 90% of panel members were written into a guideline document. To assess the panel members' satisfaction with the research method, participants were invited to provide their feedback after the final survey. From a total of 304 statements shown to the panel of experts, 194 statements were endorsed. The methodology was found to be useful and appropriate by the panellists. Aboriginal and Torres Strait Islander Youth mental health experts were able to reach consensus about what the appropriate communication strategies for providing mental health first aid to an Aboriginal and Torres Strait Islander adolescent. These outcomes will help ensure that the community provides the best possible support to Aboriginal adolescents who are developing mental illnesses or are in a

Providing culturally appropriate mental health first aid to an Aboriginal or Torres Strait Islander adolescent: development of expert consensus guidelines

PubMed Central

2014-01-01

Background It is estimated that the prevalence of mental illness is higher in Aboriginal and Torres Strait Islander adolescents compared to non-Aboriginal adolescents. Despite this, only a small proportion of Aboriginal youth have contact with mental health services, possibly due to factors such as remoteness, language barriers, affordability and cultural sensitivity issues. This research aimed to develop culturally appropriate guidelines for anyone who is providing first aid to an Australian Aboriginal or Torres Strait Islander adolescent who is experiencing a mental health crisis or developing a mental illness. Methods A panel of Australian Aboriginal people who are experts in Aboriginal youth mental health, participated in a Delphi study investigating how members of the public can be culturally appropriate when helping an Aboriginal or Torres Strait Islander adolescent with mental health problems. The panel varied in size across the three sequential rounds, from 37–41 participants. Panellists were presented with statements about cultural considerations and communication strategies via online questionnaires and were encouraged to suggest additional content. All statements endorsed as either Essential or Important by ≥ 90% of panel members were written into a guideline document. To assess the panel members’ satisfaction with the research method, participants were invited to provide their feedback after the final survey. Results From a total of 304 statements shown to the panel of experts, 194 statements were endorsed. The methodology was found to be useful and appropriate by the panellists. Conclusion Aboriginal and Torres Strait Islander Youth mental health experts were able to reach consensus about what the appropriate communication strategies for providing mental health first aid to an Aboriginal and Torres Strait Islander adolescent. These outcomes will help ensure that the community provides the best possible support to Aboriginal adolescents who

Future scenarios of Korea national parks: Delphi survey of Korean parks of experts

Treesearch

Byung-kyu Lee; Wilbur F. LaPage

2003-01-01

A three-wave Delphi survey of a panel of 40 key experts very knowledgeable of Korean national parks was conducted between February 2001 and March in 2002. In Wave 1, park professionals, environmental Nongovernmental Organizations (NGOs) managers, and a retiree identified the issues the Korean park system is facing. Findings from Wave 1 of the survey were analyzed and...

Future of the Korea national parks: a preliminary Delphi study of key experts

Treesearch

Byung-kyu Lee; Wilbur F. LaPage

2002-01-01

A preliminary Delphi survey of a panel of key experts who are very knowledgeable of Korean national parks was conducted between February and March in 2001. Park professionals, environmental NGO directors, interested citizens, and retirees identified issues facing the Korean park system (Wave1). Findings from wave I of the survey provided the baseline for a series of...

Panel 5: Immunology.

PubMed

Kyd, Jennelle M; Hotomi, Muneki; Kono, Masamitsu; Kurabi, Arwa; Pichichero, Michael; Ryan, Allen; Swords, W Edward; Thornton, Ruth

2017-04-01

Objective To perform a state-of-the-art review of the literature from January 2012 through May 2015 on studies that advanced our knowledge of the innate and adaptive immunology related to otitis media. This review also proposes future directions for research in this area. Data Sources PubMed database of the National Library of Medicine. Review Methods Three subpanels comprising experts in the field focused on sections relevant to cytokines, innate immunity, and adaptive immunity. The review focused on animal, cell line, and human studies and was critical in relation to the recommendations from the previous publication and for determination of the proposed goals and priorities. The panel met at the 18th International Symposium on Recent Advances in Otitis Media in June 2015 to consolidate its prior search results and discuss, plan, and refine the review. The panel approved the final draft. Conclusion From 2012 to 2014, tremendous progresses in immunology of otitis media were established-especially in the areas of innate immunity associated with the pathogenesis of otitis media. Implications for Practice The advances of the past 4 years formed the basis for a series of short- and long-term research goals in an effort to guide the field. Accomplishing these goals will provide opportunities for the development of novel interventions, including new ways to better treat and prevent otitis media, especially for recurrent otitis media.

Nutritional advice for community patients: insights from a panel discussion.

PubMed

Thomas, Linda V; Jenkins, Gill; Belton, Julie; Clements, Suzie; Jacob, Ciara; Johnson, Naomi; Joy, Deirdre; Low, Jennifer; Munson, Eileen; Sheppard, Jessica

2016-03-01

This article describes the conclusions of an expert panel that discussed four case studies; these were examples of patients typically encountered by nurses working in the community. The panel considered the nutritional and lifestyle advice that could be given by nurses relating to conditions such as irritable bowel syndrome (IBS), depression, chronic fatigue syndrome, vulnerability to common infections, elderly care, recurrent urinary tract infection, antibiotic use, and risk of type 2 diabetes. A general conclusion was the importance of motivational interviewing techniques in achieving full understanding of patients' concerns and to determine the best health strategy. As well as specific guidance appropriate for each disorder, a range of information sources for both health professionals and patients are listed in the paper. The panel noted that, although general nutritional advice can be given by nurses working at GP surgeries and in the community, patients should always be referred to registered dietitians or nutritionists if significant dietary changes are considered.

Will the Oxygen-Phosphorus Paradigm Persist? - Expert Views of the Future of Management and Restoration of Eutrophic Lakes

NASA Astrophysics Data System (ADS)

Nygrén, Nina A.; Tapio, Petri; Horppila, Jukka

2017-11-01

In the age of climate change, the demand and lack of pure water challenges many communities. Substantial amount of effort is put in every year to manage and restore degraded lakes while the long-term effects of those efforts are only poorly known or monitored. Oxygenation, or aeration, is used extensively for the restoration of eutrophic lakes, although many studies question whether this process improves the status of the lakes in the long-term. The desired effect of oxygenation is based on paradigmatic theories that, in the light of recent literature, might not be adequate when long-term improvements are sought. This article canvasses expert views on the feasibility of the `oxygen-phosphorus paradigm' as well as the future of the management and restoration of eutrophic lakes, based on an international, two-rounded, expert panel survey (Delphi study), employing 200 freshwater experts from 33 nationalities, contacted at three conferences on the topic. The conclusion is that the oxygen-phosphorus paradigm seems to be rather persistent. The experts considered oxygenation to be a valid short-term lake restoration method, but not without harmful side-effects. In addition, experts' low level of trust in the adequacy of the scientific knowledge on the effects of restorations and in the use of the scientific knowledge as a basis of choice of restoration methods, could be signs of a paradigm shift towards an outlook emphasizing more effective catchment management over short-term restorations. The expert panel also anticipated that reducing external nutrient loads from both point and diffuse sources will succeed in the future.

Nine Experts Describe the Essence of Rational-Emotive Therapy while Standing on One Foot.

ERIC Educational Resources Information Center

Weinrach, Stephen G.

1996-01-01

Determined extent of agreement among a panel of nine rational-emotive therapy (RET) experts about essence of RET. Responses were categorized as either general cognitive behavior therapy (CBT) or RET-specific. A case can be made for subsuming many aspects of CBT under RET because of associated origins of CBT and RET. (FC)

Enlargement Futures Project: Expert Panel on Technology, Knowledge and Learning. Final Report.

ERIC Educational Resources Information Center

Gourova, Elissaveta; Ducatel, Ken; Gavigan, James; Scapolo, Fabiana; Di Pietrogiacomo, Paola

The next 10 years provide an opportunity for the European Union (EU) to renew the science and technology (S&T) base and build necessary knowledge-society capacities and capabilities in Pre-Accession Countries (PACs). Applied research has faced a major downsize; redressing the balance in the research and development systems is urgently needed.…

Introduction and Overview of the Industrial Interactive Panel Session

NASA Astrophysics Data System (ADS)

Seiler, David

2014-03-01

A unique industrial panel covering the challenges and needs of various industries and how being innovative is important. The session involves two invited industry speakers (24 minutes each) who will set the stage for the interactive round table panel session. The Panel, led by moderator Mark Bernius (Morgan Advanced Materials), consists of the two invited speakers plus an additional five industry panelists. The first thirty minutes of the panel session has the five additional panelists introducing themselves and their work/company. These introductions could include what they or their company does, sharing one or two technical highlights, listing some challenges or needs for physicists, and what innovation breakthroughs are needed in their industries. The final hour of the session will be highly interactive with questions to the panel coming from the moderator, the audience, and the panelists themselves. Questions that might be addressed include: how physicists are or could be critical in advancing innovation; how can AIP/APS/FIAP help industry get the physics help they need to be innovative (knowledge, the right staff, etc.); what role can students and post docs play in advancing industry's mission; etc. We invite you to participate in this interactive session and ask our industry experts your own interesting and challenging questions. The invited speakers are George Thompson, Intel, and Rick Watkins, Nike. The panel members also include Jason Cleveland, Asylum Research; Robert Doering, Texas Instruments; William Gallagher, IBM T.J. Watson Research Center; James Hollenhorst, Agilent Technologies; and Martin Poitzsch, Schlumberger-Doll Research.

Paraneoplastic autoantibody panels: sensitivity and specificity, a retrospective cohort.

PubMed

Albadareen, Rawan; Gronseth, Gary; Goeden, Marcie; Sharrock, Matthew; Lechtenberg, Colleen; Wang, Yunxia

2017-06-01

Experts in the autoimmune paraneoplastic field recommend autoantibody testing as "panels" to improve the poor sensitivity of individual autoantibodies in detecting paraneoplastic neurological syndromes (PNS). The sensitivity of those panels was not reported to date in a fashion devoid of incorporation bias. We aimed to assess the collective sensitivity and specificity of one of the commonly used panels in detecting PNS. A single-centered retrospective cohort of all patients tested for paraneoplastic evaluation panel (PAVAL; test ID: 83380) over one year for the suspicion of PNS. Case adjudication was based on newly proposed diagnostic criteria in line with previously published literature, but modified to exclude serological status to avoid incorporation bias. Measures of diagnostic accuracy were subsequently calculated. Cases that failed to show association with malignancy within the follow-up time studied, reflecting a possibly pure autoimmune process was considered paraneoplastic-like syndromes. Out of 321 patients tested, 51 patients tested positive. Thirty-two patients met diagnostic criteria for paraneoplastic/paraneoplastic-like syndromes. The calculated collective sensitivity was 34% (95% CI: 17-53), specificity was 86% (95% CI: 81-90), Youden's index 0.2 and a positive clinical utility index 0.07 suggesting poor utility for case-detection. This is the first reported diagnostic accuracy measures of paraneoplastic panels without incorporation bias. Despite recommended panel testing to improve detection of PNS, sensitivity remains low with poor utility for case-detection. The high-calculated specificity suggests a possible role in confirming the condition in difficult cases suspicious for PNS, when enough supportive evidence is lacking on ancillary testing.

European Surveillance of Antimicrobial Consumption (ESAC): quality indicators for outpatient antibiotic use in Europe

PubMed Central

Coenen, Samuel; Ferech, Matus; Haaijer‐Ruskamp, Flora M; Butler, Chris C; Stichele, Robert H Vander; Verheij, Theo J M; Monnet, Dominique L; Little, Paul; Goossens, Herman

2007-01-01

Background and objective Indicators to measure the quality of healthcare are increasingly used by healthcare professionals and policy makers. In the context of increasing antimicrobial resistance, this study aimed to develop valid drug‐specific quality indicators for outpatient antibiotic use in Europe, derived from European Surveillance of Antimicrobial Consumption (ESAC) data. Methods 27 experts (15 countries), in a European Science Foundation workshop, built on the expertise within the European Drug Utilisation Research Group, the General Practice Respiratory Infections Network, the ESCMID Study Group on Primary Care Topics, the Belgian Antibiotic Policy Coordination Committee, the World Health Organization, ESAC, and other experts. A set of proposed indicators was developed using 1997–2003 ESAC data. Participants scored the relevance of each indicator to reducing antimicrobial resistance, patient health benefit, cost effectiveness and public health policy makers (scale: 1 (completely disagree) to 9 (completely agree)). The scores were processed according to the UCLA‐RAND appropriateness method. Indicators were judged relevant if the median score was not in the 1–6 interval and if there was consensus (number of scores within the 1–3 interval was fewer than one third of the panel). From the relevant indicators providing overlapping information, the one with the highest scores was selected for the final set of quality indicators—values were updated with 2004 ESAC data. Results 22 participants (12 countries) completed scoring of a set of 22 proposed indicators. Nine were rated as relevant antibiotic prescribing indicators on all four dimensions; five were rated as relevant if only relevance to reducing antimicrobial resistance and public health policy makers was taken into account. A final set of 12 indicators was selected. Conclusion 12 of the proposed ESAC‐based quality indicators for outpatient antibiotic use in Europe have face validity and are

A framework to start the debate on neonatal screening policies in the EU: an Expert Opinion Document.

PubMed

Cornel, Martina C; Rigter, Tessel; Weinreich, Stephanie S; Burgard, Peter; Hoffmann, Georg F; Lindner, Martin; Gerard Loeber, J; Rupp, Kathrin; Taruscio, Domenica; Vittozzi, Luciano

2014-01-01

The European Union (EU) Council Recommendation on rare diseases urged the member states to implement national and EU collaborative actions to improve the health care of rare disease patients. Following this recommendation, the European Commission launched a tender on newborn screening (NBS) to report on current practices of laboratory testing, form a network of experts and provide guidance on how to further implement NBS screening in a responsible way, the latter of which was provided in an Expert Opinion document. After consultation of experts from EU member states, (potential) candidate member states and European Free Trade Association countries, in a consensus meeting in June 2011, 70 expert opinions were finalized. They included the need to develop case definitions for all disorders screened for to facilitate assessment and international outcome studies. Decision whether a screening program should be performed can be based on screening criteria updated from the traditional Wilson and Jungner (1968) criteria, relating to disease, treatment, test and cost. The interest of the child should be central in the assessment of pros and cons. A European NBS body should assess evidence on (new) screening candidate disorders. For rare conditions, best level evidence should be used. The health system should ensure treatment to cases diagnosed by screening, controlled and revised by follow-up outcome studies. Screening methodology should aim to avoid unintended findings, such as mild forms and carrier status information, as much as possible. Activities to improve NBS in Europe, such as training and scientific evaluation, could benefit from collaboration at EU level and beyond.

The Richer, the Happier? An Empirical Investigation in Selected European Countries

ERIC Educational Resources Information Center

Seghieri, Chiara; Desantis, Gustavo; Tanturri, Maria Letizia

2006-01-01

This study analyses the relationship between subjective and objective measures of well-being in selected European countries using the data of the European Community Household Panel (ECHP). In the first part of the paper, we develop a random-effect ordered probit model, separately for each country, relating the subjective measure of income…

Use of Management Pathways or Algorithms in Children With Chronic Cough: CHEST Guideline and Expert Panel Report.

PubMed

Chang, Anne B; Oppenheimer, John J; Weinberger, Miles M; Rubin, Bruce K; Weir, Kelly; Grant, Cameron C; Irwin, Richard S

2017-04-01

Using management algorithms or pathways potentially improves clinical outcomes. We undertook systematic reviews to examine various aspects in the generic approach (use of cough algorithms and tests) to the management of chronic cough in children (aged ≤ 14 years) based on key questions (KQs) using the Population, Intervention, Comparison, Outcome format. We used the CHEST Expert Cough Panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework. Data from the systematic reviews in conjunction with patients' values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain the final grading. Combining data from systematic reviews addressing five KQs, we found high-quality evidence that a systematic approach to the management of chronic cough improves clinical outcomes. Although there was evidence from several pathways, the highest evidence was from the use of the CHEST approach. However, there was no or little evidence to address some of the KQs posed. Compared with the 2006 Cough Guidelines, there is now high-quality evidence that in children aged ≤ 14 years with chronic cough (> 4 weeks' duration), the use of cough management protocols (or algorithms) improves clinical outcomes, and cough management or testing algorithms should differ depending on the associated characteristics of the cough and clinical history. A chest radiograph and, when age appropriate, spirometry (pre- and post-β 2 agonist) should be undertaken. Other tests should not be routinely performed and undertaken in accordance with the clinical setting and the child's clinical symptoms and signs (eg, tests for tuberculosis when the child has been exposed). Copyright © 2017 American College of Chest Physicians. All rights reserved.

Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis: CHEST Guideline and Expert Panel Report.

PubMed

Chang, Anne B; Oppenheimer, John J; Weinberger, Miles M; Rubin, Bruce K; Grant, Cameron C; Weir, Kelly; Irwin, Richard S

2017-04-01

Wet or productive cough is common in children with chronic cough. We formulated recommendations based on systematic reviews related to the management of chronic wet cough in children (aged ≤ 14 years) based on two key questions: (1) how effective are antibiotics in improving the resolution of cough? If so, what antibiotic should be used and for how long? and (2) when should children be referred for further investigations? We used the CHEST expert cough panel's protocol for systematic reviews and the American College of Chest Physicians (CHEST) methodologic guidelines and GRADE framework (the Grading of Recommendations Assessment, Development and Evaluation). Data from the systematic reviews in conjunction with patients' values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain consensus for the recommendations/suggestions made. Combining data from the systematic reviews, we found high-quality evidence in children aged ≤ 14 years with chronic (> 4 weeks' duration) wet/productive cough that using appropriate antibiotics improves cough resolution, and further investigations (eg, flexible bronchoscopy, chest CT scans, immunity tests) should be undertaken when specific cough pointers (eg, digital clubbing) are present. When the wet cough does not improve following 4 weeks of antibiotic treatment, there is moderate-quality evidence that further investigations should be considered to look for an underlying disease. New recommendations include the recognition of the clinical diagnostic entity of protracted bacterial bronchitis. Compared with the 2006 Cough Guidelines, there is now high-quality evidence for some, but not all, aspects of the management of chronic wet cough in specialist settings. However, further studies (particularly in primary health) are required. Copyright © 2017 American College of Chest Physicians. All rights reserved.

Initial Approach to Childhood Obesity in Spain. A Multisociety Expert Panel Assessment.

PubMed

Vilallonga, Ramon; Moreno Villares, José Manuel; Yeste Fernández, Diego; Sánchez Santos, Raquel; Casanueva Freijo, Felipe; Santolaya Ochando, Francisco; Leal Hernando, Nuria; Lecube Torelló, Albert; Castaño González, Luis Antonio; Feliu, Albert; Lopez-Nava, Gontrand; Frutos, Dolores; de la Cruz Vigo, Felipe; Torres Garcia, Antonio J; Ruiz de Adana, Juan Carlos

2017-04-01

In recent years, the incidence of childhood obesity in Europe, and Spain in particular, has increased dramatically. Bariatric surgery could play a major role in treating of adolescents with severe obesity. However, no specific guidelines for bariatric surgery currently exist in Spain. The Board of the Spanish Society for Obesity Surgery and Metabolic Diseases (SECO) proposed a study of childhood obesity by using the Delphi method. This prospective study involved 60 experts from nine national societies. Each society leader recruited experts from their society in obesity-related fields. Two online questionnaires were taken, and consensus on guidelines for various obesity treatments was reached according to the percentage of answers in favor or against inclusion of a given guideline. Based on these results, preoperative, surgical management and follow-up of childhood obesity management among others were analyzed. The survey results indicated significant concern among all societies regarding obesity. There was strong consensus with regard to adolescents and obesity, medical treatment, dietary recommendations, environmental and social factors, and goals for adolescents with obesity. Consensus on the use of intragastric balloons and other techniques was not reached. However, biliopancreatic diversion was rejected as a primary treatment, and mandatory psychological/psychiatric assessment was agreed upon. Inclusion criteria accepted were similar to those for adults with the exception of surgery in those with a body mass index <40. Spanish obesity-related societies are aware of the societal problem of childhood obesity. Multisociety development of national approaches may arise from consensus-building studies among specialists.

Motion generation of robotic surgical tasks: learning from expert demonstrations.

PubMed

Reiley, Carol E; Plaku, Erion; Hager, Gregory D

2010-01-01

Robotic surgical assistants offer the possibility of automating portions of a task that are time consuming and tedious in order to reduce the cognitive workload of a surgeon. This paper proposes using programming by demonstration to build generative models and generate smooth trajectories that capture the underlying structure of the motion data recorded from expert demonstrations. Specifically, motion data from Intuitive Surgical's da Vinci Surgical System of a panel of expert surgeons performing three surgical tasks are recorded. The trials are decomposed into subtasks or surgemes, which are then temporally aligned through dynamic time warping. Next, a Gaussian Mixture Model (GMM) encodes the experts' underlying motion structure. Gaussian Mixture Regression (GMR) is then used to extract a smooth reference trajectory to reproduce a trajectory of the task. The approach is evaluated through an automated skill assessment measurement. Results suggest that this paper presents a means to (i) extract important features of the task, (ii) create a metric to evaluate robot imitative performance (iii) generate smoother trajectories for reproduction of three common medical tasks.

A proposed panel of biomarkers of healthy ageing.

PubMed

Lara, Jose; Cooper, Rachel; Nissan, Jack; Ginty, Annie T; Khaw, Kay-Tee; Deary, Ian J; Lord, Janet M; Kuh, Diana; Mathers, John C

2015-09-15

There is no criterion reference for assessing healthy ageing and this creates difficulties when conducting and comparing research on ageing across studies. A cardinal feature of ageing is loss of function which translates into wide-ranging consequences for the individual and for family, carers and society. We undertook comprehensive reviews of the literature searching for biomarkers of ageing on five ageing-related domains including physical capability and cognitive, physiological and musculoskeletal, endocrine and immune functions. Where available, we used existing systematic reviews, meta-analyses and other authoritative reports such as the recently launched NIH Toolbox for assessment of neurological and behavioural function, which includes test batteries for cognitive and motor function (the latter described here as physical capability). We invited international experts to comment on our draft recommendations. In addition, we hosted an experts workshop in Newcastle, UK, on 22-23 October 2012, aiming to help capture the state-of-the-art in this complex area and to provide an opportunity for the wider ageing research community to critique the proposed panel of biomarkers. Here we have identified important biomarkers of healthy ageing classified as subdomains of the main areas proposed. Cardiovascular and lung function, glucose metabolism and musculoskeletal function are key subdomains of physiological function. Strength, locomotion, balance and dexterity are key physical capability subdomains. Memory, processing speed and executive function emerged as key subdomains of cognitive function. Markers of the HPA-axis, sex hormones and growth hormones were important biomarkers of endocrine function. Finally, inflammatory factors were identified as important biomarkers of immune function. We present recommendations for a panel of biomarkers that address these major areas of function which decline during ageing. This biomarker panel may have utility in epidemiological

Identification, prevention and management of cardiovascular risk in chronic myeloid leukaemia patients candidate to ponatinib: an expert opinion.

PubMed

Breccia, Massimo; Pregno, Patrizia; Spallarossa, Paolo; Arboscello, Eleonora; Ciceri, Fabio; Giorgi, Mauro; Grossi, Alberto; Mallardo, Mario; Nodari, Savina; Ottolini, Stefano; Sala, Carla; Tortorella, Giovanni; Rosti, Gianantonio; Pane, Fabrizio; Minotti, Giorgio; Baccarani, Michele

2017-04-01

Ponatinib (Iclusig, ARIAD Pharmaceuticals-Incyte Co.) is a third-generation structure-guided tyrosine kinase inhibitor that is approved for treatment of Philadelphia chromosome-positive leukaemias resistant or intolerant to other inhibitors. The clinical use of ponatinib is complicated by the possible development of cardiovascular events, primarily hypertension and arterial or venous thrombotic events. The US Food and Drug Administration and the European Medicine Agency recommend that the cardiovascular profile of patients candidate for ponatinib should be carefully evaluated. For patients deemed to carry a high risk of cardiovascular events, other life-saving therapeutic options should be considered. When alternative options are not available, treatment with ponatinib is indicated but requires that haematologists and cardiologists collaborate and identify modalities of surveillance and risk mitigation in the best interest of the patient. This article reports on the expert opinion provided by a panel of Italian haematologists, cardiologists and clinical pharmacologists. It summarises suggestions that may help to improve the therapeutic index of ponatinib, primarily in the settings of chronic-phase chronic myeloid leukaemia.

ISEA 2007 Panel: Integration of Better Exposure Characterizations into Disaster Preparedness for Responders and the Public

EPA Science Inventory

An expert panel was convened in October 2007 at the International Society for Exposure Analysis (ISEA) Annual Meeting in Durham, NC, entitled “The Path Forward in Disaster Preparedness Since WTC—Exposure Characterization and Mitigation: Substantial Unfinished Business!” The pane...

21. TILES OF THE NEW WORLD PANEL, NORTH WALL OF ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

21. TILES OF THE NEW WORLD PANEL, NORTH WALL OF THE INDIAN HOUSE. THE RELIEF BROCADE TILES ILLUSTRATE SCENES OF NATIVE AMERICAN HISTORY AND CULTURE, AND THE EARLY EUROPEAN EXPLORATION OF THE NEW WORLD. - Moravian Pottery & Tile Works, Southwest side of State Route 313 (Swamp Road), Northwest of East Court Street, Doylestown, Bucks County, PA

Female Reproductive Disorders, Diseases, and Costs of Exposure to Endocrine Disrupting Chemicals in the European Union.

PubMed

Hunt, Patricia A; Sathyanarayana, Sheela; Fowler, Paul A; Trasande, Leonardo

2016-04-01

A growing body of evidence suggests that endocrine-disrupting chemicals (EDCs) contribute to female reproductive disorders. To calculate the associated combined health care and economic costs attributable to specific EDC exposures within the European Union (EU). An expert panel evaluated evidence for probability of causation using the Intergovernmental Panel on Climate Change weight-of-evidence characterization. Exposure-response relationships and reference levels were evaluated, and biomarker data were organized from carefully identified studies from the peer-reviewed literature to represent European exposure and approximate burden of disease as it occurred in 2010. Cost-of-illness estimation used multiple peer-reviewed sources. Cost estimation was carried out from a societal perspective, ie, including direct costs (eg, treatment costs) and indirect costs such as productivity loss. The most robust EDC-related data for female reproductive disorders exist for 1) diphenyldichloroethene-attributable fibroids and 2) phthalate-attributable endometriosis in Europe. In both cases, the strength of epidemiological evidence was rated as low and the toxicological evidence as moderate, with an assigned probability of causation of 20%–39%. Across the EU, attributable cases were estimated to be 56 700 and 145 000 women, respectively, with total combined economic and health care costs potentially reaching €163 million and €1.25 billion. EDCs (diphenyldichloroethene and phthalates) may contribute substantially to the most common reproductive disorders in women, endometriosis and fibroids, costing nearly €1.5 billion annually. These estimates represent only EDCs for which there were sufficient epidemiologic studies and those with the highest probability of causation. These public health costs should be considered as the EU contemplates regulatory action on EDCs.

Hypoactive Sexual Desire Disorder: International Society for the Study of Women's Sexual Health (ISSWSH) Expert Consensus Panel Review.

PubMed

Goldstein, Irwin; Kim, Noel N; Clayton, Anita H; DeRogatis, Leonard R; Giraldi, Annamaria; Parish, Sharon J; Pfaus, James; Simon, James A; Kingsberg, Sheryl A; Meston, Cindy; Stahl, Stephen M; Wallen, Kim; Worsley, Roisin

2017-01-01

The objective of the International Society for the Study of Women's Sexual Health expert consensus panel was to develop a concise, clinically relevant, evidence-based review of the epidemiology, physiology, pathogenesis, diagnosis, and treatment of hypoactive sexual desire disorder (HSDD), a sexual dysfunction affecting approximately 10% of adult women. Etiologic factors include conditions or drugs that decrease brain dopamine, melanocortin, oxytocin, and norepinephrine levels and augment brain serotonin, endocannabinoid, prolactin, and opioid levels. Symptoms include lack or loss of motivation to participate in sexual activity due to absent or decreased spontaneous desire, sexual desire in response to erotic cues or stimulation, or ability to maintain desire or interest through sexual activity for at least 6 months, with accompanying distress. Treatment follows a biopsychosocial model and is guided by history and assessment of symptoms. Sex therapy has been the standard treatment, although there is a paucity of studies assessing efficacy, except for mindfulness-based cognitive behavior therapy. Bupropion and buspirone may be considered off-label treatments for HSDD, despite limited safety and efficacy data. Menopausal women with HSDD may benefit from off-label testosterone treatment, as evidenced by multiple clinical trials reporting some efficacy and short-term safety. Currently, flibanserin is the only Food and Drug Administration-approved medication to treat premenopausal women with generalized acquired HSDD. Based on existing data, we hypothesize that all these therapies alter central inhibitory and excitatory pathways. In conclusion, HSDD significantly affects quality of life in women and can effectively be managed by health care providers with appropriate assessments and individualized treatments. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Expert surgical consensus for prenatal counseling using the Delphi method.

PubMed

Berman, Loren; Jackson, Jordan; Miller, Kristen; Kowalski, Rebecca; Kolm, Paul; Luks, Francois I

2017-11-28

Pediatric surgeons frequently offer prenatal consultation for congenital pulmonary airway malformation (CPAM) and congenital diaphragmatic hernia (CDH); however, there is no evidence-based consensus to guide prenatal decision making and counseling for these conditions. Eliciting feedback from experts is integral to defining best practice regarding prenatal counseling and intervention. A Delphi consensus process was undertaken using a panel of pediatric surgeons identified as experts in fetal therapy to address current limitations. Areas of discrepancy in the literature on CPAM and CDH were identified and used to generate a list of content and intervention questions. Experts were invited to participate in an online Delphi survey. Items that did not reach first-round consensus were broken down into additional questions, and consensus was achieved in the second round. Fifty-four surgeons (69%) responded to at least one of the two survey rounds. During round one, consensus was reached on 54 of 89 survey questions (61%), and 45 new questions were developed. During round two, consensus was reached on 53 of 60 survey questions (88%). We determined expert consensus to establish guidelines regarding perinatal management of CPAM and CDH. Our results can help educate pediatric surgeons participating in perinatal care of these patients. V. Copyright © 2017 Elsevier Inc. All rights reserved.

Standardization of pediatric uroradiological terms: a multidisciplinary European glossary.

PubMed

Vivier, Pierre-Hugues; Augdal, Thomas A; Avni, Fred E; Bacchetta, Justine; Beetz, Rolf; Bjerre, Anna K; Blickman, Johan; Cochat, Pierre; Coppo, Rosana; Damasio, Beatrice; Darge, Kassa; El-Ghoneimi, Alaa; Hoebeke, Piet; Läckgren, Göran; Leclair, Marc-David; Lobo, Maria-Luisa; Manzoni, Gianantonio; Marks, Stephen D; Mattioli, Girolamo; Mentzel, Hans-Joachim; Mouriquand, Pierre; Nevéus, Tryggve; Ntoulia, Aikaterini; Ording-Muller, Lil-Sofie; Oswald, Josef; Papadopoulou, Frederica; Porcellini, Gabriella; Ring, Ekkehard; Rösch, Wolfgang; Teixeira, Ana F; Riccabona, Michael

2018-02-01

To promote the standardization of nephro-uroradiological terms used in children, the European Society of Paediatric Radiology uroradiology taskforce wrote a detailed glossary. This work has been subsequently submitted to European experts in pediatric urology and nephrology for discussion and acceptance to improve the quality of radiological reports and communication between different clinicians involved in pediatric urology and nephrology.

Laser welding on trough panel: 3D body part

NASA Astrophysics Data System (ADS)

Shirai, Masato; Hisano, Hirohiko

2003-03-01

Laser welding for automotive bodies has been introduced mainly by European car manufacturers since more than 10 years ago. Their purposes of laser welding introduction were mainly vehicle performance improvement and lightweight. And laser welding was applied to limited portion where shapes of panels are simple and easy to fit welded flanges. Toyota also has introduced laser welding onto 3 dimensional parts named trough panel since 1999. Our purpose of the introduction was common use of equipment. Trough panel has a complex shape and different shapes in each car type. In order to realize common use of welding equipment, we introduced parts locating equipment which had unique, small & simple jigs fo each car type and NC (Numerical Controlled) locators and air-cooled small laser head developed by ourselves to the trough welding process. Laser welding replaced spot welding and was applied linearly like stitches. Length of laser welding was determined according to comparison with statistic tensile strength and fatigue strength of spot welding.

Uncertainty in geological linework: communicating the expert's tacit model to the data user(s) by expert elicitation.

NASA Astrophysics Data System (ADS)

Lawley, Russell; Barron, Mark; Lark, Murray

2015-04-01

At BGS, expert elicitation has been used to evaluate uncertainty of surveyed boundaries in several, common, geological scenarios. As a result, a 'collective' understanding of the issues surrounding each scenario has emerged. The work has provoked wider debate in three key areas: a) what can we do to resolve those scenarios where a 'consensus' of understanding cannot be achieved b) what does it mean for survey practices and subsequent use of maps in 3D models c) how do we communicate the 'collective' understanding of geological mapping (with or without consensus for specific scenarios). Previous work elicited expert judgement for uncertainty in six contrasting mapping scenarios. In five cases it was possible to arrive at a consensus model; in a sixth case experts with different experience (length of service, academic background) took very different views of the nature of the mapping problem. The scenario concerned identification of the boundary between two contrasting tills (one derived from Triassic source materials being red in colour; the other, derived from Jurassic materials being grey in colour). Initial debate during the elicitation identified that the colour contrast should provide some degree of confidence in locating the boundary via traditional auger-traverse survey methods. However, as the elicitation progressed, it became clear that the complexities of the relationship between the two Tills were not uniformly understood across the experts and the panel could not agree a consensus regarding the spatial uncertainty of the boundary. The elicitation process allowed a significant degree of structured knowledge-exchange between experts of differing backgrounds and was successful in identifying a measure of uncertainty for what was considered a contentious scenario. However, the findings have significant implications for a boundary-scenario that is widely mapped across the central regions of Great Britain. We will discuss our experience of the use of

75 FR 27554 - Science Advisory Board Staff Office; Request for Nominations of Experts for the SAB Arsenic...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-17

... Nominations of Experts for the SAB Arsenic Review Panel AGENCY: Environmental Protection Agency (EPA). ACTION... (IRIS) assessment for inorganic arsenic (noncancer). DATES: Nominations should be submitted by June 7...://www.epa.gov/sab . SUPPLEMENTARY INFORMATION: EPA is revising an assessment for arsenic in support of...

Pennsylvania's Exemplary Special Projects 1976-1990 as Reviewed and Rated by the FOCUS Panel.

ERIC Educational Resources Information Center

Royce, Sherry

This document reviews 117 special projects selected by a panel of literacy experts using three criteria: effectiveness, innovation, and adaptability. Special projects are grouped by the area, or major thrust, of the project and product. The nine areas are as follows: counseling, curriculum, English as a Second Language, management, promotion,…

National Institute of Statistical Sciences Data Confidentiality Technical Panel: Final Report. NCES 2011-608

ERIC Educational Resources Information Center

Karr, Alan

2011-01-01

NCES asked the National Institute of Statistical Sciences (NISS) to convene a technical panel of survey and policy experts to examine the NCES current and planned data dissemination strategies for confidential data with respect to: mandates and directives that NCES make data available; current and prospective technologies for protecting and…

EXPERT: An atmospheric re-entry test-bed

NASA Astrophysics Data System (ADS)

Massobrio, F.; Viotto, R.; Serpico, M.; Sansone, A.; Caporicci, M.; Muylaert, J.-M.

2007-06-01

In recognition of the importance of an independent European access to the International Space Station (ISS) and in preparation for the future needs of exploration missions, ESA is conducting parallel activities to generate flight data using atmospheric re-entry test-beds and to identify vehicle design solutions for human and cargo transportation vehicles serving the ISS and beyond. The EXPERT (European eXPErimental Re-entry Test-bed) vehicle represents the major on-going development in the first class of activities. Its results may also benefit in due time scientific missions to planets with an atmosphere and future reusable launcher programmes. The objective of EXPERT is to provide a test-bed for the validation of aerothermodynamics models, codes and ground test facilities in a representative flight environment, to improve the understanding of issues related to analysis, testing and extrapolation to flight. The vehicle will be launched on a sub-orbital trajectory using a Volna missile. The EXPERT concept is based on a symmetrical re-entry capsule whose shape is composed of simple geometrical elements. The suborbital trajectory will reach 120 km altitude and a re-entry velocity of 5 6km/s. The dimensions of the capsule are 1.6 m high and 1.3 m diameter; the overall mass is in the range of 250 350kg, depending upon the mission parameters and the payload/instrumentation complement. A consistent number of scientific experiments are foreseen on-board, from innovative air data system to shock wave/boundary layer interaction, from sharp hot structures characterisation to natural and induced regime transition. Currently the project is approaching completion of the phase B, with Alenia Spazio leading the industrial team and CIRA coordinating the scientific payload development under ESA contract.

Space Network Interoperability Panel (SNIP) study

NASA Technical Reports Server (NTRS)

Ryan, Thomas; Lenhart, Klaus; Hara, Hideo

1991-01-01

The Space Network Interoperability Panel (SNIP) study is a tripartite study that involves the National Aeronautics and Space Administration (NASA), the European Space Agency (ESA), and the National Space Development Agency (NASDA) of Japan. SNIP involves an ongoing interoperability study of the Data Relay Satellite (DRS) Systems of the three organizations. The study is broken down into two parts; Phase one deals with S-band (2 GHz) interoperability and Phase two deals with Ka-band (20/30 GHz) interoperability (in addition to S-band). In 1987 the SNIP formed a Working Group to define and study operations concepts and technical subjects to assure compatibility of the international data relay systems. Since that time a number of Panel and Working Group meetings have been held to continue the study. Interoperability is of interest to the three agencies because it offers a number of potential operation and economic benefits. This paper presents the history and status of the SNIP study.

A European Competence Framework for Industrial Pharmacy Practice in Biotechnology.

PubMed

Atkinson, Jeffrey; Crowley, Pat; De Paepe, Kristien; Gennery, Brian; Koster, Andries; Martini, Luigi; Moffat, Vivien; Nicholson, Jane; Pauwels, Gunther; Ronsisvalle, Giuseppe; Sousa, Vitor; van Schravendijk, Chris; Wilson, Keith

2015-07-29

The PHAR-IN (" Competences for industrial pharmacy practice in biotechnology ") looked at whether there is a difference in how industrial employees and academics rank competences for practice in the biotechnological industry. A small expert panel consisting of the authors of this paper produced a biotechnology competence framework by drawing up an initial list of competences then ranking them in importance using a three-stage Delphi process. The framework was next evaluated and validated by a large expert panel of academics ( n = 37) and industrial employees ( n = 154). Results show that priorities for industrial employees and academics were similar. The competences for biotechnology practice that received the highest scores were mainly in: "Research and Development", '"Upstream" and "Downstream" Processing', "Product development and formulation", "Aseptic processing", "Analytical methodology", "Product stability", and "Regulation". The main area of disagreement was in the category "Ethics and drug safety" where academics ranked competences higher than did industrial employees.

A European Competence Framework for Industrial Pharmacy Practice in Biotechnology

PubMed Central

Atkinson, Jeffrey; Crowley, Pat; De Paepe, Kristien; Gennery, Brian; Koster, Andries; Martini, Luigi; Moffat, Vivien; Nicholson, Jane; Pauwels, Gunther; Ronsisvalle, Giuseppe; Sousa, Vitor; van Schravendijk, Chris; Wilson, Keith

2015-01-01

The PHAR-IN (“Competences for industrial pharmacy practice in biotechnology”) looked at whether there is a difference in how industrial employees and academics rank competences for practice in the biotechnological industry. A small expert panel consisting of the authors of this paper produced a biotechnology competence framework by drawing up an initial list of competences then ranking them in importance using a three-stage Delphi process. The framework was next evaluated and validated by a large expert panel of academics (n = 37) and industrial employees (n = 154). Results show that priorities for industrial employees and academics were similar. The competences for biotechnology practice that received the highest scores were mainly in: “Research and Development”,‘“Upstream” and “Downstream” Processing’, “Product development and formulation”,“Aseptic processing”, “Analytical methodology”, “Product stability”, and “Regulation”. The main area of disagreement was in the category “Ethics and drug safety” where academics ranked competences higher than did industrial employees. PMID:28975907

Defining the content and delivery of an intervention to Change AdhereNce to treatment in BonchiEctasis (CAN-BE): a qualitative approach incorporating the Theoretical Domains Framework, behavioural change techniques and stakeholder expert panels.

PubMed

McCullough, Amanda R; Ryan, Cristín; O'Neill, Brenda; Bradley, Judy M; Elborn, J Stuart; Hughes, Carmel M

2015-08-22

Low patient adherence to treatment is associated with poorer health outcomes in bronchiectasis. We sought to use the Theoretical Domains Framework (TDF) (a framework derived from 33 psychological theories) and behavioural change techniques (BCTs) to define the content of an intervention to change patients' adherence in bronchiectasis (Stage 1 and 2) and stakeholder expert panels to define its delivery (Stage 3). We conducted semi-structured interviews with patients with bronchiectasis about barriers and motivators to adherence to treatment and focus groups or interviews with bronchiectasis healthcare professionals (HCPs) about their ability to change patients' adherence to treatment. We coded these data to the 12 domain TDF to identify relevant domains for patients and HCPs (Stage 1). Three researchers independently mapped relevant domains for patients and HCPs to a list of 35 BCTs to identify two lists (patient and HCP) of potential BCTs for inclusion (Stage 2). We presented these lists to three expert panels (two with patients and one with HCPs/academics from across the UK). We asked panels who the intervention should target, who should deliver it, at what intensity, in what format and setting, and using which outcome measures (Stage 3). Eight TDF domains were perceived to influence patients' and HCPs' behaviours: Knowledge, Skills, Beliefs about capability, Beliefs about consequences, Motivation, Social influences, Behavioural regulation and Nature of behaviours (Stage 1). Twelve BCTs common to patients and HCPs were included in the intervention: Monitoring, Self-monitoring, Feedback, Action planning, Problem solving, Persuasive communication, Goal/target specified:behaviour/outcome, Information regarding behaviour/outcome, Role play, Social support and Cognitive restructuring (Stage 2). Participants thought that an individualised combination of these BCTs should be delivered to all patients, by a member of staff, over several one-to-one and/or group visits in

Bioburden release of Ariane 5 Fairing Acoustic Protection Panels

NASA Astrophysics Data System (ADS)

Stieglmeier, Michaela; Rohr, Thomas; Schmeitzky, Olivier; Rumler, Peter; Kminek, Gerhard

The ESA-NASA ExoMars mission will be subject to strict Planetary Protection constrictions. The original ExoMars mission concept was based on an Ariane 5 launch system. Like all launch systems, the Ariane 5 fairing is lined with acoustic protection panels. These panels consist of an outer polyester/cotton fabric and an inner open celled foam. During launch the panels will be exposed to vibrations and a decrease in pressure. A release of possible external and/ or embedded microbes would cause a contamination of the satellite. Planetary Protection requirements for ExoMars imply the determination of the bioburden release from the Ariane 5 Fairing Acoustic Protection Panels (FAP-panels). Thus a study at ESTEC was performed comparing the bioburden release of a sterilized and non-sterilized panel by simulating a launch environment. Panels were mounted in test jigs above a sterile ground plate. Sterile stainless steel witness plates for the determination of bioburden release were mounted on the latter. The launch environment was simulated in two different tests. In a vacuum chamber the panels were exposed to a depressurization event. For the simulation of the vibrations the jigs were mounted in the Large European Acoustic Facility (LEAF) at ESTEC. After each test witness plates were demounted under sterile conditions and analyzed for microbial growth by incubating them in agar. Furthermore pieces of the outer fabric as well as the inner foam were taken and examined for embedded microbes. In total the amount of embedded microbes was very low and there was no significant difference between the sterilized and non-sterilized panel concerning the released bioburden. Thus sterilization of the Ariane 5 FAP-panels seems not necessary to comply with Planetary Protection constraints. Although the ExoMars project will use a different launch system in the new mission concept, the data acquired during these tests can be used for future scientific satellites launched with Ariane 5.

Effective medical treatment of opiate addiction. National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction.

PubMed

1998-12-09

To provide clinicians, patients, and the general public with a responsible assessment of the effective approaches to treat opiate dependence. A nonfederal, nonadvocate, 12-member panel representing the fields of psychology, psychiatry, behavioral medicine, family medicine, drug abuse, epidemiology, and the public. In addition, 25 experts from these same fields presented data to the panel and a conference audience of 600. Presentations and discussions were divided into 3 phases over 2 1/2 days: (1) presentations by investigators working in the areas relevant to the consensus questions during a 2-day public session; (2) questions and statements from conference attendees during open discussion periods that are part of the public session; and (3) closed deliberations by the panel during the remainder of the second day and morning of a third day. The conference was organized and supported by the Office of Medical Applications of Research, National Institutes of Health. The literature was searched through MEDLINE and other National Library of Medicine and online databases from January 1994 through September 1997 and an extensive bibliography of 941 references was provided to the panel and the conference audience. Experts prepared abstracts for their presentations as speakers at the conference with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. The panel, answering predefined questions, developed its conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately following its

Recommendations for ICT use in Alzheimer's disease assessment: Monaco CTAD Expert Meeting.

PubMed

Robert, P H; Konig, A; Andrieu, S; Bremond, F; Chemin, I; Chung, P C; Dartigues, J F; Dubois, B; Feutren, G; Guillemaud, R; Kenisberg, P A; Nave, S; Vellas, B; Verhey, F; Yesavage, J; Mallea, P

2013-01-01

Alzheimer disease (AD) and other related dementia represent a major challenge for health care systems within the aging population. It is therefore important to develop better instruments for assessing disease severity and disease progression to optimize patient's care and support to care providers, and also provide better tools for clinical research. In this area, Information and Communication Technologies (ICT) are of particular interest. Such techniques enable accurate and standardized assessments of patients' performance and actions in real time and real life situations. The aim of this article is to provide basic recommendation concerning the development and the use of ICT for Alzheimer's disease and related disorders. During he ICT and Mental Health workshop (CTAD meeting held in Monaco on the 30th October 2012) an expert panel was set up to prepare the first recommendations for the use of ICT in dementia research. The expert panel included geriatrician, epidemiologist, neurologist, psychiatrist, psychologist, ICT engineers, representatives from the industry and patient association. The recommendations are divided into three sections corresponding to 1/ the clinical targets of interest for the use of ICT, 2/ the conditions, the type of sensors and the outputs (scores) that could be used and obtained, 3/ finally the last section concerns specifically the use of ICT within clinical trials.

Examination of U.S. Puberty Timing Data from 1940 to 1994 for Secular Trends: Panel Findings

EPA Science Inventory

Five articles based on "The Role of Environmental Factors on the Onset and Progression of Puberty" expert panel workshop findings were published as a Supplement to Pediatrics on Feb. 1, 2008. This workshop, sponsored by EPA, NIEHS, and Serono International and held in November o...

Aerothermodynamics of expert ballistic vehicle at hypersonic speeds

NASA Astrophysics Data System (ADS)

Kharitonov, A. M.; Adamov, N. P.; Chirkashenko, V. F.; Mazhul, I. I.; Shpak, S. I.; Shiplyuk, A. N.; Vasenyov, L. G.; Zvegintsev, V. I.; Muylaert, J. M.

2012-01-01

The European EXPErimental Re-entry Test bed (EXPERT) vehicle is intended for studying various basic phenomena, such as the boundary-layer transition on blunted bodies, real gas effects during shock wave/boundary layer interaction, and effect of surface catalycity. Another task is to develop methods for recalculating the results of windtunnel experiments to flight conditions. The EXPERT program implies large-scale preflight research, in particular, various calculations with the use of advanced numerical methods, experimental studies of the models in various wind tunnels, and comparative analysis of data obtained for possible extrapolation of data to in-flight conditions. The experimental studies are performed in various aerodynamic centers of Europe and Russia under contracts with ESA-ESTEC. In particular, extensive experiments are performed at the Von Karman Institute for Fluid Dynamics (VKI, Belgium) and also at the DLR aerospace center in Germany. At ITAM SB RAS, the experimental studies of the EXPERT model characteristic were performed under ISTC Projects 2109, 3151, and 3550, in the T-313 supersonic wind tunnel and AT-303 hypersonic wind tunnel.

New chairman takes helm at Climate Change Panel

NASA Astrophysics Data System (ADS)

Showstack, Randy

An Indian industrial engineer and economist who supports the Kyoto Protocol, and who has sharply criticized the administration of George W. Bush on the climate change issue for not doing enough to curb greenhouse gas emissions, won the first-ever contested election for chairman of the Intergovernmental Panel on Climate Change (IPCC) during a meeting on 19 April.Rajendra Pachauri is the first representative from a developing country to chair the IPCC, a panel of about 2,500 experts on a wide range of areas related to climate change. The IPCC was established in 1988 by the World Meteorological Organization and the United Nations Environment Programme. In total, the IPCC currently includes 192 member states. Although the bulk of the IPCC's work is conducted by three technical working groups, the chairman plays a key role in facilitating the overall process of the IPCC, organizing the scientific debate within the IPCC, and serving as chief spokesman.

Development of a panel of genome-wide ancestry informative markers to study admixture throughout the Americas.

PubMed

Galanter, Joshua Mark; Fernandez-Lopez, Juan Carlos; Gignoux, Christopher R; Barnholtz-Sloan, Jill; Fernandez-Rozadilla, Ceres; Via, Marc; Hidalgo-Miranda, Alfredo; Contreras, Alejandra V; Figueroa, Laura Uribe; Raska, Paola; Jimenez-Sanchez, Gerardo; Zolezzi, Irma Silva; Torres, Maria; Ponte, Clara Ruiz; Ruiz, Yarimar; Salas, Antonio; Nguyen, Elizabeth; Eng, Celeste; Borjas, Lisbeth; Zabala, William; Barreto, Guillermo; González, Fernando Rondón; Ibarra, Adriana; Taboada, Patricia; Porras, Liliana; Moreno, Fabián; Bigham, Abigail; Gutierrez, Gerardo; Brutsaert, Tom; León-Velarde, Fabiola; Moore, Lorna G; Vargas, Enrique; Cruz, Miguel; Escobedo, Jorge; Rodriguez-Santana, José; Rodriguez-Cintrón, William; Chapela, Rocio; Ford, Jean G; Bustamante, Carlos; Seminara, Daniela; Shriver, Mark; Ziv, Elad; Burchard, Esteban Gonzalez; Haile, Robert; Parra, Esteban; Carracedo, Angel

2012-01-01

Most individuals throughout the Americas are admixed descendants of Native American, European, and African ancestors. Complex historical factors have resulted in varying proportions of ancestral contributions between individuals within and among ethnic groups. We developed a panel of 446 ancestry informative markers (AIMs) optimized to estimate ancestral proportions in individuals and populations throughout Latin America. We used genome-wide data from 953 individuals from diverse African, European, and Native American populations to select AIMs optimized for each of the three main continental populations that form the basis of modern Latin American populations. We selected markers on the basis of locus-specific branch length to be informative, well distributed throughout the genome, capable of being genotyped on widely available commercial platforms, and applicable throughout the Americas by minimizing within-continent heterogeneity. We then validated the panel in samples from four admixed populations by comparing ancestry estimates based on the AIMs panel to estimates based on genome-wide association study (GWAS) data. The panel provided balanced discriminatory power among the three ancestral populations and accurate estimates of individual ancestry proportions (R² > 0.9 for ancestral components with significant between-subject variance). Finally, we genotyped samples from 18 populations from Latin America using the AIMs panel and estimated variability in ancestry within and between these populations. This panel and its reference genotype information will be useful resources to explore population history of admixture in Latin America and to correct for the potential effects of population stratification in admixed samples in the region.

Development of a Panel of Genome-Wide Ancestry Informative Markers to Study Admixture Throughout the Americas

PubMed Central

Galanter, Joshua Mark; Fernandez-Lopez, Juan Carlos; Gignoux, Christopher R.; Barnholtz-Sloan, Jill; Fernandez-Rozadilla, Ceres; Via, Marc; Hidalgo-Miranda, Alfredo; Contreras, Alejandra V.; Figueroa, Laura Uribe; Raska, Paola; Jimenez-Sanchez, Gerardo; Silva Zolezzi, Irma; Torres, Maria; Ponte, Clara Ruiz; Ruiz, Yarimar; Salas, Antonio; Nguyen, Elizabeth; Eng, Celeste; Borjas, Lisbeth; Zabala, William; Barreto, Guillermo; Rondón González, Fernando; Ibarra, Adriana; Taboada, Patricia; Porras, Liliana; Moreno, Fabián; Bigham, Abigail; Gutierrez, Gerardo; Brutsaert, Tom; León-Velarde, Fabiola; Moore, Lorna G.; Vargas, Enrique; Cruz, Miguel; Escobedo, Jorge; Rodriguez-Santana, José; Rodriguez-Cintrón, William; Chapela, Rocio; Ford, Jean G.; Bustamante, Carlos; Seminara, Daniela; Shriver, Mark; Ziv, Elad; Gonzalez Burchard, Esteban; Haile, Robert

2012-01-01

Most individuals throughout the Americas are admixed descendants of Native American, European, and African ancestors. Complex historical factors have resulted in varying proportions of ancestral contributions between individuals within and among ethnic groups. We developed a panel of 446 ancestry informative markers (AIMs) optimized to estimate ancestral proportions in individuals and populations throughout Latin America. We used genome-wide data from 953 individuals from diverse African, European, and Native American populations to select AIMs optimized for each of the three main continental populations that form the basis of modern Latin American populations. We selected markers on the basis of locus-specific branch length to be informative, well distributed throughout the genome, capable of being genotyped on widely available commercial platforms, and applicable throughout the Americas by minimizing within-continent heterogeneity. We then validated the panel in samples from four admixed populations by comparing ancestry estimates based on the AIMs panel to estimates based on genome-wide association study (GWAS) data. The panel provided balanced discriminatory power among the three ancestral populations and accurate estimates of individual ancestry proportions (R2>0.9 for ancestral components with significant between-subject variance). Finally, we genotyped samples from 18 populations from Latin America using the AIMs panel and estimated variability in ancestry within and between these populations. This panel and its reference genotype information will be useful resources to explore population history of admixture in Latin America and to correct for the potential effects of population stratification in admixed samples in the region. PMID:22412386

Consumer preferences for fresh tomato at the European scale: a common segmentation on taste and firmness.

PubMed

Causse, Mathilde; Friguet, Chloé; Coiret, Clément; Lépicier, Mélanie; Navez, Brigitte; Lee, Monica; Holthuysen, Nancy; Sinesio, Fiorella; Moneta, Elisabetta; Grandillo, Silvana

2010-01-01

Although tomato flavor has not been a major goal for breeders, nowadays it becomes important as it is a subject of consumer complaint. A better knowledge of tomato consumer preferences, at the European level, should provide the basis for improvement of fruit quality and for market segmentation. In the framework of a large European project, 806 consumers from 3 countries, The Netherlands, France, and Italy, were presented with a set of 16 varieties representing the diversity of fresh tomato offer in order to evaluate their preferences. In parallel, sensory profiles were constructed by expert panels in each country. Preference maps were then constructed in each country revealing the structure of consumer preferences and allowing identification of the most important characteristics. Then a global analysis revealed that preferences were quite homogeneous across countries. This study identified the overall flavor and firmness as the most important traits for improving tomato fruit quality. It showed that consumer preferences from different European countries, with different cultures and food practices, are segmented following similar patterns when projected onto a common referential plan. Moreover, the results clearly showed that diversification of taste and texture is required to satisfy all consumers' expectations as some consumers preferred firm tomatoes, while others preferred melting ones and were more or less demanding in terms of sweetness and flavor intensity. Detailed comparisons also showed the importance of the fruit appearance in consumer preference. © 2010 Institute of Food Technologists®

Recent advances in acute lymphoblastic leukemia in children and adolescents: an expert panel discussion.

PubMed

Asselin, Barbara L; Gaynon, Paul; Whitlock, James A

2013-12-01

Acute lymphoblastic leukemia (ALL) is the most common form of childhood leukemia, representing 75% to 80% of cases of acute leukemia among children. Dramatic improvements in the cure rates and survival outcomes for children with ALL have been seen over the past several decades; currently the 5-year survival rate for childhood ALL is more than 80%. These improvements have come about because of advances in the understanding of the molecular genetics and pathogenesis of the disease, incorporation of risk-adapted therapy, and the advent of new targeted agents. Scientific advances have provided new insights into leukemogenesis, drug resistance, and host pharmacogenomics, identified novel subtypes of leukemia, and suggested potential targets for therapy. At the same time novel monoclonal antibodies, small molecule inhibitors, chemotherapeutics, and cell-based treatment strategies have been developed and investigated. In this article, experts will discuss some of the current challenges and future directions in the treatment of pediatric ALL. The authors will offer expert guidance to practicing oncologists on how to best incorporate newer treatment approaches into the care of children and adolescents with ALL. The most important ongoing clinical trials in the area will also be reviewed.

European Population Substructure: Clustering of Northern and Southern Populations

PubMed Central

Seldin, Michael F; Shigeta, Russell; Villoslada, Pablo; Selmi, Carlo; Tuomilehto, Jaakko; Silva, Gabriel; Belmont, John W; Klareskog, Lars; Gregersen, Peter K

2006-01-01

Using a genome-wide single nucleotide polymorphism (SNP) panel, we observed population structure in a diverse group of Europeans and European Americans. Under a variety of conditions and tests, there is a consistent and reproducible distinction between “northern” and “southern” European population groups: most individual participants with southern European ancestry (Italian, Spanish, Portuguese, and Greek) have >85% membership in the “southern” population; and most northern, western, eastern, and central Europeans have >90% in the “northern” population group. Ashkenazi Jewish as well as Sephardic Jewish origin also showed >85% membership in the “southern” population, consistent with a later Mediterranean origin of these ethnic groups. Based on this work, we have developed a core set of informative SNP markers that can control for this partition in European population structure in a variety of clinical and genetic studies. PMID:17044734

90. TILES OF THE NEW WORLD PANEL, NORTH WALL OF ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

90. TILES OF THE NEW WORLD PANEL, NORTH WALL OF THE INDIAN HOUSE. THE RELIEF BROCADE TILES ILLUSTRATE SCENES OF NATIVE AMERICAN HISTORY AND CULTURE, AND THE EARLY EUROPEAN EXPLORATION OF THE NEW WORLD. SAME VIEW AS PA-107-21. - Moravian Pottery & Tile Works, Southwest side of State Route 313 (Swamp Road), Northwest of East Court Street, Doylestown, Bucks County, PA

Consumer panel study on elderly people's wishes concerning services.

PubMed

Valkila, Noora; Litja, Heli; Aalto, Leena; Saari, Arto

2010-01-01

This study informs on the wishes and needs of elderly people themselves regarding services for the elderly. The data for the study were gathered using a consumer panel method. Elderly people desire assistance in heavy cleaning chores, in outdoor activities and in carrying out their personal business. Elderly people felt that there should be more recreational services available. Elderly people link aging with feelings of insecurity and loneliness. Becoming a service user for the first time is felt to be a very difficult step to take, and so this decision is postponed as long as possible. The elderly people desire a service for assessing their individual service needs in an organized, expert and objective fashion. The study indicates that elderly people value the human contact gained through service provision. The consumer panel method for collecting data was successful. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

Vitamin D status correction in Saudi Arabia: an experts' consensus under the auspices of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases (ESCEO).

PubMed

Al-Daghri, Nasser M; Al-Saleh, Yousef; Aljohani, Naji; Sulimani, Riad; Al-Othman, Abdulaziz M; Alfawaz, Hanan; Fouda, Mona; Al-Amri, Fahad; Shahrani, Awad; Alharbi, Mohammed; Alshahrani, Fahad; Tamimi, Waleed; Sabico, Shaun; Rizzoli, Rene; Reginster, Jean-Yves

2017-12-01

Vitamin D deficiency is common in the Middle East and in Saudi Arabia, in particular. While several international recommendations on the management of vitamin D deficiency have been documented and practiced globally, these recommendations should be adapted to the conditions of the Middle Eastern region. To address this challenge, the Prince Mutaib Chair for Biomarkers of Osteoporosis (PMCO) in King Saud University (KSU), Riyadh, KSA, together with local experts and in cooperation with the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO), organized a panel that formulated unified recommendations in the diagnosis and treatment of vitamin D deficiency in the region. The selection of local and international experts commenced during the 2nd International Vitamin D Symposium conducted in Riyadh, Saudi Arabia, last January 20--21, 2016. Reviews of the most recent literature were done, and face-to-face meetings were conducted for revisions and final recommendations. Vitamin D sufficiency is defined as circulating serum 25(OH)D ≥50 nmol (≥20 ng/ml) for the general population and vitamin D adequacy as serum 25(OH)D >75 nmol/L l (>30 ng/ml) for the frail and osteoporotic elderly. Despite overwhelming prevalence of vitamin D deficiency, universal screening is not recommended. Recommendations for the general population, children, pregnant/lactating women, post-menopausal women, the elderly, and those with subsequent metabolic diseases were provided. Vitamin D sufficiency is defined as circulating serum 25(OH)D ≥50 nmol (≥20 ng/ml) for the general population and vitamin D adequacy as serum 25(OH)D >75 nmol/L l (>30 ng/ml) for the frail and osteoporotic elderly. Despite overwhelming prevalence of vitamin D deficiency, universal screening is not recommended. Recommendations for the general population, children, pregnant/lactating women, post-menopausal women, the elderly, and those with subsequent metabolic diseases were

Standardization of pediatric uroradiological terms: A multidisciplinary European glossary.

PubMed

Vivier, Pierre-Hugues; Augdal, Thomas A; Avni, Fred E; Bacchetta, Justine; Beetz, Rolf; Bjerre, Anna K; Blickman, Johan; Cochat, Pierre; Coppo, Rosana; Damasio, Beatrice; Darge, Kassa; El-Ghoneimi, Alaa; Hoebeke, Piet; Läckgren, Göran; Leclair, Marc-David; Lobo, Maria-Luisa; Manzoni, Gianantonio; Marks, Stephen D; Mattioli, Girolamo; Mentzel, Hans-Joachim; Mouriquand, Pierre; Nevéus, Tryggve; Ntoulia, Aikaterini; Ording-Muller, Lil-Sofie; Oswald, Josef; Papadopoulou, Frederica; Porcellini, Gabriella; Ring, Ekkehard; Rösch, Wolfgang; Teixeira, Ana F; Riccabona, Michael

2017-12-01

To promote the standardization of nephro-uroradiological terms used in children, the European Society of Pediatric Radiology uroradiology taskforce wrote a detailed glossary. This work has been subsequently submitted to European experts in pediatric urology and nephrology for discussion and acceptance to improve the quality of radiological reports and communication among different clinicians involved in pediatric urology and nephrology. Copyright © 2017. Published by Elsevier Ltd.

Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment.

PubMed

de Wit, Maike; Ortner, Petra; Lipp, Hans-Peter; Sehouli, Jalid; Untch, Michael; Ruhnke, Markus; Mayer-Steinacker, Regine; Bokemeyer, Carsten; Jordan, Karin

2013-01-01

Cytotoxic extravasation is a rare but potentially serious and painful complication of intravenous drug administration in oncology. Literature is anecdotal, and systematic clinical trials are scarce. The German working group for Supportive Care in Cancer (ASORS) has prepared an expert opinion for the diagnosis, prophylaxis and management of cytotoxic extravasation based on an interdisciplinary expert panel. A Pubmed search was conducted for diagnosis, risk factors, symptoms, prophylaxis, and treatment of extravasation by the respective responsible expert. A writing committee compiled the manuscript and proposed the level of recommendation. In a consensus meeting, 13 experts reviewed and discussed the current practice in diagnosis and management of cytotoxic extravasation. In a telephone voting among the experts, the level of recommendation by ASORS was determined. Every effort should be made to reduce the risk of extravasation. Staff training, patient education, usage of right materials and infusion techniques have been identified to be mandatory to minimalize the risk of extravasation. Extravasation must be diagnosed as soon as possible, and specific therapy including antidotes dependent on the extravasated drug should be initiated immediately. An extravasation emergency set should be available wherever intravenous cytotoxics are applied. Documentation and post-treatment follow-up are recommended. We have developed a literature- and expert-based consensus recommendation to avoid cytotoxic extravasation. It also provides practical management instructions which should help to avoid surgery and serious late effects. Copyright © 2013 S. Karger AG, Basel.

Geriatric Assessment-Guided Care Processes for Older Adults: A Delphi Consensus of Geriatric Oncology Experts.

PubMed

Mohile, Supriya Gupta; Velarde, Carla; Hurria, Arti; Magnuson, Allison; Lowenstein, Lisa; Pandya, Chintan; O'Donovan, Anita; Gorawara-Bhat, Rita; Dale, William

2015-09-01

Structured care processes that provide a framework for how oncologists can incorporate geriatric assessment (GA) into clinical practice could improve outcomes for vulnerable older adults with cancer, a growing population at high risk of toxicity from cancer treatment. We sought to obtain consensus from an expert panel on the use of GA in clinical practice and to develop algorithms of GA-guided care processes. The Delphi technique, a well-recognized structured and reiterative process to reach consensus, was used. Participants were geriatric oncology experts who attended NIH-funded U13 or Cancer and Aging Research Group conferences. Consensus was defined as an interquartile range of 2 or more units, or 66.7% or greater, selecting a utility/helpfulness rating of 7 or greater on a 10-point Likert scale. For nominal data, consensus was defined as agreement among 66.7% or more of the group. From 33 invited, 30 participants completed all 3 rounds. Most experts (75%) used GA in clinical care, and the remainder were involved in geriatric oncology research. The panel met consensus that "all patients aged 75 years or older and those who are younger with age-related health concerns" should undergo GA and that all domains (function, physical performance, comorbidity/polypharmacy, cognition, nutrition, psychological status, and social support) should be included. Consensus was met for how GA could guide nononcologic interventions and cancer treatment decisions. Algorithms for GA-guided care processes were developed. This Delphi investigation of geriatric oncology experts demonstrated that GA should be performed for older patients with cancer to guide care processes. Copyright © 2015 by the National Comprehensive Cancer Network.

Finding and engaging patients and the public to work collaboratively on an acute infection microbiology research public panel.

PubMed

Grier, Sally; Evans, David; Gibson, Andy; Chin, Teh Li; Stoddart, Margaret; Kok, Michele; Campbell, Richard; Kenny, Val; MacGowan, Alasdair

2018-01-01

In 2015 a microbiology team in Bristol joined a European research project that aims to develop new antibiotics to fight drug resistant infections. The microbiology team were convinced of the benefits of patient and public involvement, but had found it difficult to find former patients to work with on earlier microbiology research. This paper describes how the team overcame this challenge to successfully recruit a PPI panel to develop PPI within the European project.The advice from people with experience in public involvement was to decide what criteria were desirable for panel membership, think about what the work of the panel might involve and how long the project will go on. The team decided that experience of suffering a serious acute infection would qualify people to comment on this project. Next, the team needed to identify ways of finding people to join the PPI panel.The microbiology research team tried different ways to approach potential panel members. These included distributing flyers at public research events, sending emails to potentially interested people, posting a message on the hospital Facebook page and approaching eligible people known to the team. A direct approach was the most successful method - either by email, mail or in person. Ultimately 16 people were selected to form the panel. Key factors for success were planning what the work of the panel might be, perseverance despite early lack of success, and one person having overall responsibility for setting up the panel, with the support of the whole team. Background In 2015 the microbiology research team became involved in a large European programme of research aiming to bring new antimicrobial drugs onto the market to combat the increasing problem of multi-drug resistant infection. With the purpose of developing patient and public involvement (PPI) in this project, the team decided to recruit a PPI panel to work with. The microbiology team had previously worked with a PPI panel on other

Expert Panel Consensus for and Analysis of Key Attributes on Websites Devoted to Weight Control

ERIC Educational Resources Information Center

Brown, Stephen L.; Land, Diane; Johnson, Chandrika; Miller, Kim

2014-01-01

Background: Obesity presents major challenges to public health in the United States. Trials of web-based interventions for weight control suggest that the Internet is a promising option for program delivery. Purpose: This study sought consensus among experts regarding critical components of successful weight control and to systematically examine…

Highlights of the Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents.

ERIC Educational Resources Information Center

National Heart, Lung, and Blood Inst. (DHHS/NIH), Bethesda, MD.

Studies have shown that high blood cholesterol levels play a role in the development of coronary heart disease in adults, and that the process leading to atherosclerosis begins in childhood. To address the problem of high cholesterol levels in children, the Panel on Blood Cholesterol Levels recommends complementary approaches for individuals and…

Use of glucocorticoids in rheumatoid arthritis - pratical modalities of glucocorticoid therapy: recommendations for clinical practice based on data from the literature and expert opinion.

PubMed

Dernis, Emmanuelle; Ruyssen-Witrand, Adeline; Mouterde, Gaël; Maillefert, Jean-Francis; Tebib, Jacques; Cantagrel, Alain; Claudepierre, Pascal; Fautrel, Bruno; Gaudin, Philippe; Pham, Thao; Schaeverbeke, Thierry; Wendling, Daniel; Saraux, Alain; Loët, Xavier Le

2010-10-01

To develop recommendations about the use of glucocorticoids in patients with established rheumatoid arthritis (RA) managed in everyday practice, using the evidence-based approach and expert opinion. A three-step procedure was used: a scientific committee used a Delphi procedure to select five questions, which formed the basis for developing the recommendations; a systematic literature review was conducted by searching the Medline and Embase databases and the abstracts of meetings held by the Société Française de Rhumatologie (SFR), American College of Rheumatology (ACR), and European League Against Rheumatism (EULAR); and recommendations were developed and validated by a panel of experts based on the data from the literature review and on their experience. For each recommendation, the level of evidence and extent of agreement among experts were determined. The five questions pertained to the use of glucocorticoids in RA patients: role for intravenous glucocorticoid bolus therapy, role for intraarticular injections, and practical modalities of glucocorticoid administration and discontinuation. From the literature search, 93 articles were selected based on their titles and abstracts. Of these, 50 were selected for the literature review. Eight recommendations about the use of glucocorticoid therapy in everyday practice in patients with established RA were validated by a vote among all participating experts: bolus glucocorticoid therapy should be reserved for highly selected situations; triamcinolone hexacetonide is the preferred glucocorticoid for intraarticular therapy, and the joint should be rested for about 24h after the injection; for oral glucocorticoid therapy, agents with a short half-life taken once daily should be preferred; and when discontinuing glucocorticoid therapy, the patient and usual physician should be informed of the risk of adrenal insufficiency. Copyright © 2010 Société française de rhumatologie. Published by Elsevier SAS. All rights

Experimental investigation to evaluate the potential environmental hazards of photovoltaic panels.

PubMed

Tammaro, Marco; Salluzzo, Antonio; Rimauro, Juri; Schiavo, Simona; Manzo, Sonia

2016-04-05

Recently the potential environmental hazard of photovoltaic modules together with their management as waste has attracted the attention of scientists. Particular concern is aroused by the several metals contained in photovoltaic panels whose potential release in the environment were scarcely investigated. Here, for the first time, the potential environmental hazard of panels produced in the last 30 years was investigated through the assessment of up to 18 releasable metals. Besides, the corresponding ecotoxicological effects were also evaluated. Experimental data were compared with the current European and Italian law limits for drinking water, discharge on soil and landfill inert disposal in order to understand the actual pollution load. Results showed that less than 3% of the samples respected all law limits and around 21% was not ecotoxic. By considering the technological evolutions in manufacturing, we have shown that during the years crystalline silicon panels have lower tendency to release hazardous metals with respect to thin film panels. In addition, a prediction of the amounts of lead, chromium, cadmium and nickel releasable from next photovoltaic waste was performed. The prevision up to 2050 showed high amounts of lead (30t) and cadmium (2.9t) releasable from crystalline and thin film panels respectively. Copyright © 2015 Elsevier B.V. All rights reserved.

[The relic in the Panels of São Vicente de Fora].

PubMed

Goyri-O'Neill, João; Camisão-Soares, Artur; Neves Marques, Cláudia

2013-01-01

The Panels of São Vicente de Fora, a polyptych dated from 1470 to 1480, are a work composed of 6 panels, authored by Nuno Gonçalves, a painter of King Afonso V. This work reveals one of the most remarkable collective portraits of European painting, making this polyptych an inexhaustible source of readings and interpretations, fueling a secular controversy. The present work aims analyzing precise an iconographic anatomical image repainted in the 6th panel, or the panel of the Relic. This consists of a central image within a structure shown by a red figure with special reverence. The investigation conducted and justification was based on direct observation and comparative analysis of iconographic data collected in the Museum of Antique Art. The bone pieces were selected at the Museum of Anatomy, Department of Anatomy, Faculty of Medical Sciences, New University of Lisbon, and the comparative analyses performed by two observers, with further analysis of the images obtained in the National Museum of Ancient Art using specific software. After watching these, it was concluded that this representation of a relic in the Panels of São Vicente is an iconic representation of an Occipital bone, fractured at its lower edge, being evident, almost complete, its vertical portion or scale.

The perspective of European researchers of national occupational safety and health institutes for contributing to a European research agenda: a modified Delphi study

PubMed Central

Gagliardi, Diana; Rondinone, Bruna M; Mirabile, Marco; Buresti, Giuliana; Ellwood, Peter; Hery, Michel; Paszkiewicz, Peter; Valenti, Antonio; Iavicoli, Sergio

2017-01-01

Objectives This study, developed within the frame of the Partnership for European Research on Occupational Safety and Health joint research activities and based on the frame designed by the 2013 European Agency for Safety and Health at Work (EU-OSHA) study, is the first example of using the points of view of European occupational safety and health (OSH) researchers. The objective is to identify priorities for OSH research that may contribute to the achievement of present and future sustainable growth objectives set by the European strategies. Methods The study was carried out using a modified Delphi method with a two-round survey. Each round involved a panel of about 110 researchers representing the network member institutes was selected according to specific criteria, including the ownership of research expertise in at least one of the four macroareas identified by the reference report developed by EU-OSHA in 2013. Results The study identified some innovative research topics (for example, ‘Emerging technological devices’ and ‘OSH consequences of markets integration’) and research priorities (ie, crowdsourcing, e-work, zero-hours contracts) that are not reflected in previous studies of this nature. The absence of any reference to violence and harassment at work among the researchers’ proposals is a major difference from previous similar studies, while topics related to gender issues and electromagnetic fields show a lower importance. Conclusions The innovative design of a research priorities identification process, which takes advantage of a large, representative and qualified panel of European researchers allowed the definition of a number of research priorities able to support the inclusion of innovative OSH research issues in the scope of the next European research agenda. PMID:28645965

European standards for protective apparel against UV radiation.

PubMed

Laperre, Jan; Foubert, Fred

2002-01-01

The first European standard which describes the test procedure to determine the UV-protection factor of clothing is about to be completed. A second part of the same standard, dealing with labelling and marking aspects, is ready to be submitted to public enquiry. In this effort a group of experts from most EU member states have cooperated with a high degree of consensus. In this chapter we explain this European standard together with the standard developed in the UK.

Cough in Ambulatory Immunocompromised Adults: CHEST Expert Panel Report.

PubMed

Rosen, Mark J; Ireland, Belinda; Narasimhan, Mangala; French, Cynthia; Irwin, Richard S

2017-11-01

Cough is a common symptom prompting patients to seek medical care. Like patients in the general population, patients with compromised immune systems also seek care for cough. However, it is unclear whether the causes of cough in immunocompromised patients who are deemed unlikely to have a life-threating condition and a normal or unchanged chest radiograph are similar to those in persons with cough and normal immune systems. We conducted a systematic review to answer the question: What are the most common causes of cough in ambulatory immunodeficient adults with normal chest radiographs? Studies of patients ≥ 18 years of age with immune deficiency, cough of any duration, and normal or unchanged chest radiographs were included and assessed for relevance and quality. Based on the systematic review, suggestions were developed and voted on using the American College of Chest Physicians (CHEST) methodology framework. The results of the systematic review revealed no high-quality evidence to guide the clinician in determining the likely causes of cough specifically in immunocompromised ambulatory patients with normal chest radiographs. Based on a systematic review, we found no evidence to assess whether or not the proper initial evaluation of cough in immunocompromised patients is different from that in immunocompetent persons. A consensus of the panel suggested that the initial diagnostic algorithm should be similar to that for immunocompetent persons but that the context of the type and severity of the immune defect, geographic location, and social determinants be considered. The major modifications to the 2006 CHEST Cough Guidelines are the suggestions that TB should be part of the initial evaluation of patients with cough and HIV infection who reside in regions with a high prevalence of TB, regardless of the radiographic findings, and that specific causes and immune defects be considered in all patients in whom the initial evaluation is unrevealing. Copyright �

The stoma appliances market in five European countries: a comparative analysis.

PubMed

Cornago, Dante; Garattini, Livio

2002-01-01

This comparative exercise analysed the domestic market for stoma appliances in five European countries--Denmark, France, Germany, Italy and the United Kingdom. National legislation, prescription procedures, delivery modalities and the market were investigated in each country. The analysis involved reviewing national and international literature on stoma appliances and interviewing a selected expert panel of market operators in each country comprising at least one health authority representative, one distributor of medical devices and one manufacturer. No specific relationship was found between the health care system framework and the stoma market, except for a greater inclination towards home care in national health services. All five countries reimburse stoma bags, but the distribution of these appliances varies widely, ranging from Denmark, where home delivery is mandatory, to Italy, where any channel can be used. The comparative analysis underlined two important features of the stoma bag market: the discretion of enterostomists in directing patients towards a specific brand of bags, and the patients' high brand loyalty. Despite that, the analysis did not identify any single country that could be considered a benchmark for stoma bag regulation. Each country deals with stoma appliances in different ways, making this a very fragmented market.

The role and choice criteria of antihistamines in allergy management - expert opinion.

PubMed

Kuna, Piotr; Jurkiewicz, Dariusz; Czarnecka-Operacz, Magdalena M; Pawliczak, Rafał; Woroń, Jarosław; Moniuszko, Marcin; Emeryk, Andrzej

2016-12-01

Allergic diseases are the most common chronic conditions lasting throughout the patient's life. They not only cause significant deterioration in the quality of life of patients but also lead to significant absenteeism and reduced productivity, resulting in very high costs for society. Effective and safe treatment of allergic diseases is therefore one of the main challenges for public health and should be carried out by all the specialists in family medicine, internists and paediatricians in collaboration with allergists, otorhinolaryngologists and dermatologists. Antihistamines are most commonly used in the treatment of allergies. Several dozen drugs are available on the pharmaceutical market, and their generic forms are advertised widely as very effective drugs for the treatment of allergic diseases. What is the truth? What are the data from clinical trials and observational studies? Are all drugs equally effective and safe for the patient? According to a panel of experts representing various fields of medicine, inappropriate treatment of allergies can be very risky for patients, and seemingly equally acting medications may differ greatly. Therefore, a panel of experts gathered the latest data from the entire scientific literature and analysed the latest standards and recommendations prepared by scientific societies. This paper provides a summary of these studies and highlights the importance for the patient of the proper choice of drug to treat his allergies.

Replacement, Reduction, Refinement - Animal welfare progress in European Pharmacopoeia monographs: activities of the European Pharmacopoeia Commission from 2007 to 2017.

PubMed

Lang, C; Kolaj-Robin, O; Cirefice, G; Taconet, L; Pel, E; Jouette, S; Buda, M; Milne, C; Charton, E

2018-01-01

Since the opening for signature of the European Convention for the Protection of Animals Used for Experimental and Other Scientific Purposes in 1986, the European Pharmacopoeia Commission and its experts have carried out a programme of work committed to Replacing, Reducing and Refining (3Rs) the use of animals for test purposes. While updates on achievements in the field of the 3Rs are regularly provided, this article summarises the activities of the Ph. Eur. Commission in this field within the last decade.

Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel Using a Novel Online Process

PubMed Central

Barber, Claire E. H.; Marshall, Deborah A; Alvarez, Nanette; John Mancini, G. B.; Lacaille, Diane; Keeling, Stephanie; Aviña-Zubieta, J. Antonio; Khodyakov, Dmitry; Barnabe, Cheryl; Faris, Peter; Smith, Alexa; Noormohamed, Raheem; Hazlewood, Glen; Martin, Liam O.; Esdaile, John M.

2016-01-01

Objective Patients with rheumatoid arthritis (RA) have a high risk of premature cardiovascular disease (CVD). We developed CVD quality indicators (QIs) for screening and use in Rheumatology clinics. Methods A systematic review of the literature on CVD risk reduction in RA and the general population was conducted. Based on the best practices identified from this review, a draft set of 12 candidate QIs were presented to a Canadian panel of rheumatologists and cardiologists (n=6) from three academic centers to achieve consensus on the QI specifications. The resulting 11 QIs were then evaluated by an online modified-Delphi panel of multidisciplinary health professionals and patients (n = 43) to determine their relevance, validity and feasibility in three rounds of online voting and threaded discussion using a modified RAND/UCLA Appropriateness Methodology. Results Response rates for the online panel were 86%. All 11 QIs were rated as highly relevant, valid and feasible (median rating ≥7 on a 1–9 scale) with no significant disagreement. The final QI set addresses the following themes: communication to primary care about increased CV risk in RA, CV risk assessment, defining smoking status and providing cessation counseling, screening and addressing hypertension, dyslipidemia and diabetes, exercise recommendations, body mass index screening and lifestyle counseling, minimizing corticosteroid use and communicating to patients at high risk of CVD about the risks/benefits of non-steroidal anti-inflammatory drugs. Conclusion Eleven QIs for CVD care in RA patients have been developed and are rated as highly relevant, valid and feasible by an international multidisciplinary panel. PMID:26178275

Women's health and fertility, family planning and pregnancy in immune-mediated rheumatic diseases: a report from a south-eastern European Expert Meeting.

PubMed

Ntali, Stella; Damjanov, Nemanja; Drakakis, Peter; Ionescu, Ruxandra; Kalinova, Desislava; Rashkov, Rasho; Malamitsi-Puchner, Ariadne; Mantzaris, Gerassimos; Michala, Lina; Pamfil, Cristina; Rednic, Simona; Tektonidou, Maria G; Tsiodras, Sotirios; Vassilopoulos, Dimitrios; Vojinovic, Jelena; Bertsias, George K; Boumpas, Dimitrios T

2014-01-01

With current advances in medical treatment, reproductive issues have become more important for women with chronic immune-mediated diseases. Most, if not all, patients report that their disease affects their personal relationships, their decision to have children, and the size of their family. These decisions are multi-factorial, influenced mainly by concerns over the effect of pregnancy on the rheumatic disease, the impact of disease activity during pregnancy on foetal health, the patient's ability to care for the child, and the possible harmful effects medication could have on the child, both pre- and post-natally during breastfeeding. Apart from that, women's health issues tend to be overlooked in favour of the management of the underlying rheumatic disease. To this end, we convened an expert panel to review the published literature on women's health and reproductive issues and provide evidence- and eminence-based points to consider for the treating physicians. We conclude that there is a need for a change in mind-set from one which 'cautions against pregnancy' to one which 'embraces pregnancy' through the practice of individualised, pre- and post-conceptual, multi-disciplinary care.

Towards a consensus definition of maternal sepsis: results of a systematic review and expert consultation.

PubMed

Bonet, Mercedes; Nogueira Pileggi, Vicky; Rijken, Marcus J; Coomarasamy, Arri; Lissauer, David; Souza, João Paulo; Gülmezoglu, Ahmet Metin

2017-05-30

There is a need for a clear and actionable definition of maternal sepsis, in order to better assess the burden of this condition, trigger timely and effective treatment and allow comparisons across facilities and countries. The objective of this study was to review maternal sepsis definitions and identification criteria and to report on the results of an expert consultation to develop a new international definition of maternal sepsis. All original and review articles and WHO documents, as well as clinical guidelines providing definitions and/or identification criteria of maternal sepsis were included. A multidisciplinary international panel of experts was surveyed through an online consultation in March-April 2016 on their opinion on the existing sepsis definitions, including new definition of sepsis proposed for the adult population (2016 Third International Consensus Definitions for Sepsis and Septic Shock) and importance of different criteria for identification of maternal sepsis. The definition was agreed using an iterative process in an expert face-to-face consensus development meeting convened by WHO and Jhpiego. Standardizing the definition of maternal sepsis and aligning it with the current understanding of sepsis in the adult population was considered a mandatory step to improve the assessment of the burden of maternal sepsis by the expert panel. The literature review and expert consultation resulted in a new WHO consensus definition "Maternal sepsis is a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, child-birth, post-abortion, or post-partum period". Plans are in progress to validate the new WHO definition of maternal sepsis in a large international population. The operationalization of the new maternal sepsis definition requires generation of a set of practical criteria to identify women with sepsis. These criteria should enable clinicians to focus on the timely initiation of actionable elements of

A panel of 74 AISNPs: Improved ancestry inference within Eastern Asia.

PubMed

Li, Cai-Xia; Pakstis, Andrew J; Jiang, Li; Wei, Yi-Liang; Sun, Qi-Fan; Wu, Hong; Bulbul, Ozlem; Wang, Ping; Kang, Long-Li; Kidd, Judith R; Kidd, Kenneth K

2016-07-01

Many ancestry informative SNP (AISNP) panels have been published. Ancestry resolution in them varies from three to eight continental clusters of populations depending on the panel used. However, none of these panels differentiates well among East Asian populations. To meet this need, we have developed a 74 AISNP panel after analyzing a much larger number of SNPs for Fst and allele frequency differences between two geographically close population groups within East Asia. The 74 AISNP panel can now distinguish at least 10 biogeographic groups of populations globally: Sub-Saharan Africa, North Africa, Europe, Southwest Asia, South Asia, North Asia, East Asia, Southeast Asia, Pacific and Americas. Compared with our previous 55-AISNP panel, Southeast Asia and North Asia are two newly assignable clusters. For individual ancestry assignment, the likelihood ratio and ancestry components were analyzed on a different set of 500 test individuals from 11 populations. All individuals from five of the test populations - Yoruba (YRI), European (CEU), Han Chinese in Henan (CHNH), Rondonian Surui (SUR) and Ticuna (TIC) - were assigned to their appropriate geographical regions unambiguously. For the other test populations, most of the individuals were assigned to their self-identified geographical regions with a certain degree of overlap with adjacent populations. These alternative ancestry components for each individual thus help give a clearer picture of the possible group origins of the individual. We have demonstrated that the new AISNP panel can achieve a deeper resolution of global ancestry. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Induced seismicity hazard and risk by enhanced geothermal systems: an expert elicitation approach

NASA Astrophysics Data System (ADS)

Trutnevyte, Evelina; Azevedo, Inês L.

2018-03-01

Induced seismicity is a concern for multiple geoenergy applications, including low-carbon enhanced geothermal systems (EGS). We present the results of an international expert elicitation (n = 14) on EGS induced seismicity hazard and risk. Using a hypothetical scenario of an EGS plant and its geological context, we show that expert best-guess estimates of annualized exceedance probabilities of an M ≥ 3 event range from 0.2%-95% during reservoir stimulation and 0.2%-100% during operation. Best-guess annualized exceedance probabilities of M ≥ 5 event span from 0.002%-2% during stimulation and 0.003%-3% during operation. Assuming that tectonic M7 events could occur, some experts do not exclude induced (triggered) events of up to M7 too. If an induced M = 3 event happens at 5 km depth beneath a town with 10 000 inhabitants, most experts estimate a 50% probability that the loss is contained within 500 000 USD without any injuries or fatalities. In the case of an induced M = 5 event, there is 50% chance that the loss is below 50 million USD with the most-likely outcome of 50 injuries and one fatality or none. As we observe a vast diversity in quantitative expert judgements and underlying mental models, we conclude with implications for induced seismicity risk governance. That is, we suggest documenting individual expert judgements in induced seismicity elicitations before proceeding to consensual judgements, to convene larger expert panels in order not to cherry-pick the experts, and to aim for multi-organization multi-model assessments of EGS induced seismicity hazard and risk.

Unleashing Expert Judgment in the IPCC's Fifth Assessment Report

NASA Astrophysics Data System (ADS)

Freeman, P. T.; Mach, K. J.; Mastrandrea, M.; Field, C. B.

2016-12-01

IPCC assessments are critical vehicles for evaluating and synthesizing existing knowledge about climate change, its impacts, and potential options for adaptation and mitigation. In these assessments, rigorous expert judgment is essential for characterizing current scientific understanding including persistent and complex uncertainties related to climate change. Over its history the IPCC has iteratively developed frameworks for evaluating and communicating what is known and what is not known about climate change science. In this presentation, we explore advances and challenges in approaches to evaluating and communicating expert judgment in the Intergovernmental Panel on Climate Change's Fifth Assessment Report (IPCC AR5). We present an analysis of the frequency of the use of calibrated degree-of-certainty terms in the policymaker summaries from the IPCC's AR5 and Fourth Assessment Report (AR4). We find that revised guidance for IPCC author teams in the AR5 improved the development of balanced judgments on scientific evidence across disciplines. Overall, degree-of-certainty terms are more abundant in the AR5 policymaker summaries compared to those of the AR4, demonstrating an increased commitment to extensively and transparently characterizing expert judgments underpinning report conclusions. This analysis also shows that while working groups still favor different degree-of-certainty scales in the AR5, authors employed a wider array of degree-of-certainty scales to communicate expert judgment supporting report findings compared to the policymaker summaries of the AR4. Finally, our analysis reveals greater inclusion of lower-certainty findings in the AR5 as compared to the AR4, critical for communicating a fuller range of possible climate change impacts and response options. Building on our findings we propose a simpler, more transparent, and more rigorous framework for developing and communicating expert judgments in future climate and environmental assessments.

Benefit-risk of Patients' Online Access to their Medical Records: Consensus Exercise of an International Expert Group.

PubMed

Liyanage, Harshana; Liaw, Siaw-Teng; Konstantara, Emmanouela; Mold, Freda; Schreiber, Richard; Kuziemsky, Craig; Terry, Amanda L; de Lusignan, Simon

2018-04-22

 Patients' access to their computerised medical records (CMRs) is a legal right in many countries. However, little is reported about the benefit-risk associated with patients' online access to their CMRs.  To conduct a consensus exercise to assess the impact of patients' online access to their CMRs on the quality of care as defined in six domains by the Institute of Medicine (IoM), now the National Academy of Medicine (NAM).  A five-round Delphi study was conducted. Round One explored experts' (n = 37) viewpoints on providing patients with access to their CMRs. Round Two rated the appropriateness of statements arising from Round One (n = 16). The third round was an online panel discussion of findings (n = 13) with the members of both the International Medical Informatics Association and the European Federation of Medical Informatics Primary Health Care Informatics Working Groups. Two additional rounds, a survey of the revised consensus statements and an online workshop, were carried out to further refine consensus statements.  Thirty-seven responses from Round One were used as a basis to initially develop 15 statements which were categorised using IoM's domains of care quality. The experts agreed that providing patients online access to their CMRs for bookings, results, and prescriptions increased efficiency and improved the quality of medical records. Experts also anticipated that patients would proactively use their online access to share data with different health care providers, including emergencies. However, experts differed on whether access to limited or summary data was more useful to patients than accessing their complete records. They thought online access would change recording practice, but they were unclear about the benefit-risk of high and onerous levels of security. The 5-round process, finally, produced 16 consensus statements.  Patients' online access to their CMRs should be part of all CMR systems. It improves the process

Heat exchanger panel

NASA Technical Reports Server (NTRS)

Warburton, Robert E. (Inventor); Cuva, William J. (Inventor)

2005-01-01

The present invention relates to a heat exchanger panel which has broad utility in high temperature environments. The heat exchanger panel has a first panel, a second panel, and at least one fluid containment device positioned intermediate the first and second panels. At least one of the first panel and the second panel have at least one feature on an interior surface to accommodate the at least one fluid containment device. In a preferred embodiment, each of the first and second panels is formed from a high conductivity, high temperature composite material. Also, in a preferred embodiment, the first and second panels are joined together by one or more composite fasteners.

Development of geriatric competencies for emergency medicine residents using an expert consensus process.

PubMed

Hogan, Teresita M; Losman, Eve D; Carpenter, Christopher R; Sauvigne, Karen; Irmiter, Cheryl; Emanuel, Linda; Leipzig, Rosanne M

2010-03-01

The emergency department (ED) visit rate for older patients exceeds that of all age groups other than infants. The aging population will increase elder ED patient utilization to 35% to 60% of all visits. Older patients can have complex clinical presentations and be resource-intensive. Evidence indicates that emergency physicians fail to provide consistent high-quality care for elder ED patients, resulting in poor clinical outcomes. The objective was to develop a consensus document, "Geriatric Competencies for Emergency Medicine Residents," by identified experts. This is a minimum set of behaviorally based performance standards that all residents should be able to demonstrate by completion of their residency training. This consensus-based process utilized an inductive, qualitative, multiphase method to determine the minimum geriatric competencies needed by emergency medicine (EM) residents. Assessments of face validity and reliability were used throughout the project. In Phase I, participants (n=363) identified 12 domains and 300 potential competencies. In Phase II, an expert panel (n=24) clustered the Phase I responses, resulting in eight domains and 72 competencies. In Phase III, the expert panel reduced the competencies to 26. In Phase IV, analysis of face validity and reliability yielded a 100% consensus for eight domains and 26 competencies. The domains identified were atypical presentation of disease; trauma, including falls; cognitive and behavioral disorders; emergent intervention modifications; medication management; transitions of care; pain management and palliative care; and effect of comorbid conditions. The Geriatric Competencies for EM Residents is a consensus document that can form the basis for EM residency curricula and assessment to meet the demands of our aging population. Copyright (c) 2010 by the Society for Academic Emergency Medicine.

Development of Geriatric Competencies for Emergency Medicine Residents Using an Expert Consensus Process

PubMed Central

Hogan, Teresita M.; Losman, Eve D.; Carpenter, Christopher R.; Sauvigne, Karen; Irmiter, Cheryl; Emanuel, Linda; Leipzig, Rosanne M.

2011-01-01

Background The emergency department (ED) visit rate for older patients exceeds that of all age groups other than infants. The aging population will increase elder ED patient utilization to 35% to 60% of all visits. Older patients can have complex clinical presentations and be resource-intensive. Evidence indicates that emergency physicians fail to provide consistent high-quality care for elder ED patients, resulting in poor clinical outcomes. Objectives The objective was to develop a consensus document, “Geriatric Competencies for Emergency Medicine Residents,” by identified experts. This is a minimum set of behaviorally based performance standards that all residents should be able to demonstrate by completion of their residency training. Methods This consensus-based process utilized an inductive, qualitative, multiphase method to determine the minimum geriatric competencies needed by emergency medicine (EM) residents. Assessments of face validity and reliability were used throughout the project. Results In Phase I, participants (n = 363) identified 12 domains and 300 potential competencies. In Phase II, an expert panel (n = 24) clustered the Phase I responses, resulting in eight domains and 72 competencies. In Phase III, the expert panel reduced the competencies to 26. In Phase IV, analysis of face validity and reliability yielded a 100% consensus for eight domains and 26 competencies. The domains identified were atypical presentation of disease; trauma, including falls; cognitive and behavioral disorders; emergent intervention modifications; medication management; transitions of care; pain management and palliative care; and effect of comorbid conditions. Conclusions The Geriatric Competencies for EM Residents is a consensus document that can form the basis for EM residency curricula and assessment to meet the demands of our aging population. PMID:20370765

Localized neuropathic pain: an expert consensus on local treatments

PubMed Central

Pickering, Gisèle; Martin, Elodie; Tiberghien, Florence; Delorme, Claire; Mick, Gérard

2017-01-01

Background Pain localization is one of the hallmarks for the choice of first-line treatment in neuropathic pain. This literature review has been conducted to provide an overview of the current knowledge regarding the etiology and pathophysiology of localized neuropathic pain (LNP), its assessment and the existing topical pharmacological treatments. Materials and methods Literature review was performed using Medline from 2010 to December 2016, and all studies involving LNP and treatments were examined. A multidisciplinary expert panel of five pain specialists in this article reports a consensus on topical approaches that may be recommended to alleviate LNP and on their advantages in clinical practice. Results Successive international recommendations have included topical 5% lidocaine and 8% capsaicin for LNP treatment. The expert panel considers that these compounds can be a first-line treatment for LNP, especially in elderly patients and patients with comorbidities and polypharmacy. Regulatory LNP indications should cover the whole range of LNP and not be restricted to specific etiologies or sites. Precautions for the use of plasters must be followed cautiously. Conclusion Although there is a real need for more randomized controlled trials for both drugs, publications clearly demonstrate excellent risk/benefit ratios, safety, tolerance and continued efficacy throughout long-term treatment. A major advantage of both plasters is that they have proven efficacy and may reduce the risk of adverse events such as cognitive impairment, confusion, somnolence, dizziness and constipation that are often associated with systemic neuropathic pain treatment and reduce the quality of life. Topical modalities also may be used in combination with other drugs and analgesics with limited drug–drug interactions. PMID:29066862

Potential environmental hazards of photovoltaic panel disposal: Discussion of Tammaro et al. (2015).

PubMed

Sinha, Parikhit

2017-02-05

In their recent publication in Journal of Hazardous Materials (http://dx.doi.org/10.1016/j.jhazmat.2015.12.018), Tammaro et al. evaluate the potential environmental impacts of an illegal disposal scenario of photovoltaic panels in the European Union. Critical assumptions that underlie the study's conclusions would benefit from clarification. A scenario of photovoltaic panels finely crushed and abandoned in nature is not supported with field breakage data, in which photovoltaic panels remain largely intact with a number of glass fractures or cracks, as opposed to breakage into cm-scale pieces. Fate and transport analysis is necessary to evaluate how leachate transforms and disperses in moving from the point of emissions to the point of exposure, prior to making comparisons with drinking water limits. Some hazardous metal content has declined in both crystalline silicon and thin film panels, including a 50% decline in semiconductor material intensity in CdTe thin film panels (g CdTe/W) from 2009 to 2015. Waste laws, recycling requirements and minimum treatment standards under the EU WEEE Directive, and illegal disposal rates affect the accuracy of forecasts of releasable metal amounts from PV panels in Europe through 2050. Copyright © 2016 Elsevier B.V. All rights reserved.

[Locally advanced head and neck cancers: recommendations of an expert panel and perspectives for the use of TPF regimen (docetaxel, cisplatin and fluoro-uracil) as induction therapy].

PubMed

Bardet, E; Bourhis, J; Cals, L; Fayette, J; Guigay, J; Hans, S; Saint-Guily, J Lacau; Lagarde, F; Lallemant, B; Milano, G; Rolland, F; Lefebvre, J-L

2009-10-01

The purpose of the present article was to evaluate indications, regimens, treatment modalities, and predictive factors of response to treatment in locally advanced squamous cell carcinoma of the head and neck (SCCHN). An expert panel including otolaryngology and head and neck surgery specialists, oncologists, radiotherapists and biologists analyzed the literature providing a synthesis and giving some recommendations. Findings from the main randomized phase III trials highlight that the TPF regimen (docetaxel, cisplatin, fluorouracil) represent a preferential option when induction chemotherapy is indicated in either operable or non-operable patients. Given the potential fragility of patients presenting with SCCHN, treatment modalities in routine use require applying preventive measures and tailored follow-up according to each patient's profile. As regards predictive factors of response to TPF regimen, no factor is currently validated, but ongoing trials should provide better knowledge. Progresses in induction chemotherapy have allowed improving the prognosis of patients with locally advanced SCCHN. The TPF regimen represents a major improvement in this indication, and ongoing strategic clinical trials should refine its indications.

Role of biomarkers in the management of antibiotic therapy: an expert panel review: I – currently available biomarkers for clinical use in acute infections

PubMed Central

2013-01-01

In the context of worldwide increasing antimicrobial resistance, good antimicrobial prescribing in more needed than ever; unfortunately, information available to clinicians often are insufficient to rely on. Biomarkers might provide help for decision-making and improve antibiotic management. The purpose of this expert panel review was to examine currently available literature on the potential role of biomarkers to improve antimicrobial prescribing, by answering three questions: 1) Which are the biomarkers available for this purpose?; 2) What is their potential role in the initiation of antibiotic therapy?; and 3) What is their role in the decision to stop antibiotic therapy? To answer these questions, studies reviewed were limited to recent clinical studies (<15 years), involving a substantial number of patients (>50) and restricted to controlled trials and meta-analyses for answering questions 2 and 3. With regard to the first question concerning routinely available biomarkers, which might be useful for antibiotic management of acute infections, these are currently limited to C-reactive protein (CRP) and procalcitonin (PCT). Other promising biomarkers that may prove useful in the near future but need to undergo more extensive clinical testing include sTREM-1, suPAR, ProADM, and Presepsin. New approaches to biomarkers of infections include point-of-care testing and genomics. PMID:23837559

Aflibercept treatment for neovascular AMD beyond the first year: consensus recommendations by a UK expert roundtable panel, 2017 update

PubMed Central

Patel, Praveen J; Devonport, Helen; Sivaprasad, Sobha; Ross, Adam H; Walters, Gavin; Gale, Richard P; Lotery, Andrew J; Mahmood, Sajjad; Talks, James S; Napier, Jackie

2017-01-01

National recommendations on continued administration of aflibercept solution for injection after the first year of treatment for neovascular age-related macular degeneration (nAMD) have been developed by an expert panel of UK retina specialists, based on clinician experience and treatment outcomes seen in year 2. The 2017 update reiterates that the treatment goal is to maintain or improve the macular structural and functional gains achieved in year 1 while attempting to reduce or minimize the treatment burden, recognizing the need for ongoing treatment. At the end of year 1 (ie, the decision visit at month 11), two treatment options should be considered: do not extend the treatment interval and maintain fixed 8-weekly dosing, or extend the treatment interval using a treat-and-extend regimen up to a maximum 12 weeks. Criteria for considering not extending the treatment interval are persistent macular fluid with stable vision, recurrent fluid, decrease in vision in the presence of fluid, macular hemorrhage, new choroidal neovascularization or any other sign(s) of exudative disease activity considered vision threatening in the opinion of the treating clinician. Treatment extension is recommended for eyes with a dry macula (ie, without macular fluid) and stable vision. Under both options, the treatment interval may be shortened if visual and/or anatomic outcomes deteriorate. Monitoring without treatment may be considered for eyes with a fluid-free macula for a minimum duration of 48 weeks. A patient completing one full year of monitoring without requiring injections may be considered for discharge from clinic. The treatment algorithm incorporates return to fixed 8-weekly dosing for disease reactivation during treatment extension and reinstatement of treatment for disease recurrence following discontinuation or discharge. For bilateral nAMD, either the eye requiring the more intensive treatment or the eye with the better vision, guided by local clinical practice, should

Aflibercept treatment for neovascular AMD beyond the first year: consensus recommendations by a UK expert roundtable panel, 2017 update.

PubMed

Patel, Praveen J; Devonport, Helen; Sivaprasad, Sobha; Ross, Adam H; Walters, Gavin; Gale, Richard P; Lotery, Andrew J; Mahmood, Sajjad; Talks, James S; Napier, Jackie

2017-01-01

National recommendations on continued administration of aflibercept solution for injection after the first year of treatment for neovascular age-related macular degeneration (nAMD) have been developed by an expert panel of UK retina specialists, based on clinician experience and treatment outcomes seen in year 2. The 2017 update reiterates that the treatment goal is to maintain or improve the macular structural and functional gains achieved in year 1 while attempting to reduce or minimize the treatment burden, recognizing the need for ongoing treatment. At the end of year 1 (ie, the decision visit at month 11), two treatment options should be considered: do not extend the treatment interval and maintain fixed 8-weekly dosing, or extend the treatment interval using a treat-and-extend regimen up to a maximum 12 weeks. Criteria for considering not extending the treatment interval are persistent macular fluid with stable vision, recurrent fluid, decrease in vision in the presence of fluid, macular hemorrhage, new choroidal neovascularization or any other sign(s) of exudative disease activity considered vision threatening in the opinion of the treating clinician. Treatment extension is recommended for eyes with a dry macula (ie, without macular fluid) and stable vision. Under both options, the treatment interval may be shortened if visual and/or anatomic outcomes deteriorate. Monitoring without treatment may be considered for eyes with a fluid-free macula for a minimum duration of 48 weeks. A patient completing one full year of monitoring without requiring injections may be considered for discharge from clinic. The treatment algorithm incorporates return to fixed 8-weekly dosing for disease reactivation during treatment extension and reinstatement of treatment for disease recurrence following discontinuation or discharge. For bilateral nAMD, either the eye requiring the more intensive treatment or the eye with the better vision, guided by local clinical practice, should

Expert agreed standards for the selection and development of cancer support group leaders: an online reactive Delphi study.

PubMed

Pomery, Amanda; Schofield, Penelope; Xhilaga, Miranda; Gough, Karla

2018-01-01

The aim of this study was to develop pragmatic, consensus-based minimum standards for the role of a cancer support group leader. Secondly, to produce a structured interview designed to assess the knowledge, skills and attributes of the individuals who seek to undertake the role. An expert panel of 73 academics, health professionals, cancer agency workers and cancer support group leaders were invited to participate in a reactive online Delphi study involving three online questionnaire rounds. Participants determined and ranked requisite knowledge, skills and attributes (KSA) for cancer support group leaders, differentiated ideal from required KSA to establish minimum standards, and agreed on a method of rating KSA to determine suitability and readiness. Forty-five experts (62%) participated in round 1, 36 (49%) in round 2 and 23 (31%) in round 3. In round 1, experts confirmed 59 KSA identified via a systemic review and identified a further 55 KSA. In round 2, using agreement ≥75%, 52 KSA emerged as minimum standards for support group leaders. In round 3, consensus was reached on almost every aspect of the content and structure of a structured interview. Panel member comments guided refinement of wording, re-ordering of questions and improvement of probing questions. Alongside a novel structured interview, the first consensus-based minimum standards have been developed for cancer support group leaders, incorporating expert consensus and pragmatic considerations. Pilot and field testing will be used to appraise aspects of clinical utility and establish a rational scoring model for the structured interview.

Expert Consensus Survey on Medication Adherence in Psychiatric Patients and Use of a Digital Medicine System.

PubMed

Hatch, Ainslie; Docherty, John P; Carpenter, Daniel; Ross, Ruth; Weiden, Peter J

2017-07-01

There is an unmet need to objectively assess adherence problems that are a common cause of unexplained or unexpected suboptimal outcome. A digital medicine system (DMS) has been developed to address this need in patients with serious mental illness. To conduct a quantitative expert consensus survey to (1) assess relative importance of causes of suboptimal outcomes, (2) examine modalities used to assess adherence, (3) provide guidance on when and how to use the DMS in clinical practice once available, and (4) suggest interventions for specific reasons for nonadherence. A panel of 58 experts in psychiatry completed a 23-question survey (October 13 through December 23, 2013) and rated their responses on a 9-point Likert scale. A χ² test of score distributions was used to determine consensus (P < .05). The panel rated adherence as the most important factor in suboptimal outcomes and yet the least likely to be assessed accurately. All predefined uses of the DMS received high mean first-line ratings (≥ 7.4). The experts recognized the utility of the DMS in managing adherence problems, identified clinical situations appropriate for DMS, and assessed potential benefits and challenges of this technology. Consensus was reached on first-line interventions for 10 of 11 reasons for nonadherence. The results provide a guide to clinicians on the evaluation of suboptimal outcomes, when and how to use the DMS, and the most appropriate interventions to address detected adherence problems. © Copyright 2017 Physicians Postgraduate Press, Inc.

NESSUS/EXPERT - An expert system for probabilistic structural analysis methods

NASA Technical Reports Server (NTRS)

Millwater, H.; Palmer, K.; Fink, P.

1988-01-01

An expert system (NESSUS/EXPERT) is presented which provides assistance in using probabilistic structural analysis methods. NESSUS/EXPERT is an interactive menu-driven expert system that provides information to assist in the use of the probabilistic finite element code NESSUS/FEM and the fast probability integrator. NESSUS/EXPERT was developed with a combination of FORTRAN and CLIPS, a C language expert system tool, to exploit the strengths of each language.

MO-E-BRB-03: Panel Member

DOE Office of Scientific and Technical Information (OSTI.GOV)

Salter, B.

2016-06-15

In this interactive session, lung SBRT patient cases will be presented to highlight real-world considerations for ensuring safe and accurate treatment delivery. An expert panel of speakers will discuss challenges specific to lung SBRT including patient selection, patient immobilization techniques, 4D CT simulation and respiratory motion management, target delineation for treatment planning, online treatment alignment, and established prescription regimens and OAR dose limits. Practical examples of cases, including the patient flow thought the clinical process are presented and audience participation will be encouraged. This panel session is designed to provide case demonstration and review for lung SBRT in terms ofmore » (1) clinical appropriateness in patient selection, (2) strategies for simulation, including 4D and respiratory motion management, and (3) applying multi imaging modality (4D CT imaging, MRI, PET) for tumor volume delineation and motion extent, and (4) image guidance in treatment delivery. Learning Objectives: Understand the established requirements for patient selection in lung SBRT Become familiar with the various immobilization strategies for lung SBRT, including technology for respiratory motion management Understand the benefits and pitfalls of applying multi imaging modality (4D CT imaging, MRI, PET) for tumor volume delineation and motion extent determination for lung SBRT Understand established prescription regimes and OAR dose limits.« less

MO-E-BRB-01: Panel Member

DOE Office of Scientific and Technical Information (OSTI.GOV)

Benedict, S.

2016-06-15

In this interactive session, lung SBRT patient cases will be presented to highlight real-world considerations for ensuring safe and accurate treatment delivery. An expert panel of speakers will discuss challenges specific to lung SBRT including patient selection, patient immobilization techniques, 4D CT simulation and respiratory motion management, target delineation for treatment planning, online treatment alignment, and established prescription regimens and OAR dose limits. Practical examples of cases, including the patient flow thought the clinical process are presented and audience participation will be encouraged. This panel session is designed to provide case demonstration and review for lung SBRT in terms ofmore » (1) clinical appropriateness in patient selection, (2) strategies for simulation, including 4D and respiratory motion management, and (3) applying multi imaging modality (4D CT imaging, MRI, PET) for tumor volume delineation and motion extent, and (4) image guidance in treatment delivery. Learning Objectives: Understand the established requirements for patient selection in lung SBRT Become familiar with the various immobilization strategies for lung SBRT, including technology for respiratory motion management Understand the benefits and pitfalls of applying multi imaging modality (4D CT imaging, MRI, PET) for tumor volume delineation and motion extent determination for lung SBRT Understand established prescription regimes and OAR dose limits.« less

The perspective of European researchers of national occupational safety and health institutes for contributing to a European research agenda: a modified Delphi study.

PubMed

Gagliardi, Diana; Rondinone, Bruna M; Mirabile, Marco; Buresti, Giuliana; Ellwood, Peter; Hery, Michel; Paszkiewicz, Peter; Valenti, Antonio; Iavicoli, Sergio

2017-06-23

This study, developed within the frame of the Partnership for European Research on Occupational Safety and Health joint research activities and based on the frame designed by the 2013 European Agency for Safety and Health at Work (EU-OSHA) study, is the first example of using the points of view of European occupational safety and health (OSH) researchers.The objective is to identify priorities for OSH research that may contribute to the achievement of present and future sustainable growth objectives set by the European strategies. The study was carried out using a modified Delphi method with a two-round survey. Each round involved a panel of about 110 researchers representing the network member institutes was selected according to specific criteria, including the ownership of research expertise in at least one of the four macroareas identified by the reference report developed by EU-OSHA in 2013. The study identified some innovative research topics (for example, 'Emerging technological devices' and 'OSH consequences of markets integration') and research priorities (ie, crowdsourcing, e-work, zero-hours contract s ) that are not reflected in previous studies of this nature.The absence of any reference to violence and harassment at work among the researchers' proposals is a major difference from previous similar studies, while topics related to gender issues and electromagnetic fields show a lower importance. The innovative design of a research priorities identification process, which takes advantage of a large, representative and qualified panel of European researchers allowed the definition of a number of research priorities able to support the inclusion of innovative OSH research issues in the scope of the next European research agenda. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Pilot Validation Study of the European Association of Urology Robotic Training Curriculum.

PubMed

Volpe, Alessandro; Ahmed, Kamran; Dasgupta, Prokar; Ficarra, Vincenzo; Novara, Giacomo; van der Poel, Henk; Mottrie, Alexandre

2015-08-01

The development of structured and validated training curricula is one of the current priorities in robot-assisted urological surgery. To establish the feasibility, acceptability, face validity, and educational impact of a structured training curriculum for robot-assisted radical prostatectomy (RARP), and to assess improvements in performance and ability to perform RARP after completion of the curriculum. A 12-wk training curriculum was developed based on an expert panel discussion and used to train ten fellows from major European teaching institutions. The curriculum included: (1) e-learning, (2) 1 wk of structured simulation-based training (virtual reality synthetic, animal, and cadaveric platforms), and (3) supervised modular training for RARP. The feasibility, acceptability, face validity, and educational impact were assessed using quantitative surveys. Improvement in the technical skills of participants over the training period was evaluated using the inbuilt validated assessment metrics on the da Vinci surgical simulator (dVSS). A final RARP performed by fellows on completion of their training was assessed using the Global Evaluative Assessment of Robotic Skills (GEARS) score and generic and procedure-specific scoring criteria. The median baseline experience of participants as console surgeon was 4 mo (interquartile range [IQR] 0-6.5 mo). All participants completed the curriculum and were involved in a median of 18 RARPs (IQR 14-36) during modular training. The overall score for dVSS tasks significantly increased over the training period (p<0.001-0.005). At the end of the curriculum, eight fellows (80%) were deemed able by their mentors to perform a RARP independently, safely, and effectively. At assessment of the final RARP, the participants achieved an average score ≥4 (scale 1-5) for all domains using the GEARS scale and an average score >10 (scale 4-16) for all procedural steps using a generic dedicated scoring tool. In performance comparison using this

Follow-up intervals in patients with Cushing's disease: recommendations from a panel of experienced pituitary clinicians.

PubMed

Geer, Eliza B; Ayala, Alejandro; Bonert, Vivien; Carmichael, John D; Gordon, Murray B; Katznelson, Laurence; Manuylova, Ekaterina; Shafiq, Ismat; Surampudi, Vijaya; Swerdloff, Ronald S; Broder, Michael S; Cherepanov, Dasha; Eagan, Marianne; Lee, Jackie; Said, Qayyim; Neary, Maureen P; Biller, Beverly M K

2017-08-01

Follow-up guidelines are needed to assess quality of care and to ensure best long-term outcomes for patients with Cushing's disease (CD). The purpose of this study was to assess agreement by experts on recommended follow-up intervals for CD patients at different phases in their treatment course. The RAND/UCLA modified Delphi process was used to assess expert consensus. Eleven clinicians who regularly manage CD patients rated 79 hypothetical patient scenarios before and after ("second round") an in-person panel discussion to clarify definitions. Scenarios described CD patients at various time points after treatment. For each scenario, panelists recommended follow-up intervals in weeks. Panel consensus was assigned as follows: "agreement" if no more than two responses were outside a 2 week window around the median response; "disagreement" if more than two responses were outside a 2 week window around the median response. Recommendations were developed based on second round results. Panel agreement was 65.9% before and 88.6% after the in-person discussion. The panel recommended follow-up within 8 weeks for patients in remission on glucocorticoid replacement and within 1 year of surgery; within 4 weeks for patients with uncontrolled persistent or recurrent disease; within 8-24 weeks in post-radiotherapy patients controlled on medical therapy; and within 24 weeks in asymptomatic patients with stable plasma ACTH concentrations after bilateral adrenalectomy. With a high level of consensus using the Delphi process, panelists recommended regular follow-up in most patient scenarios for this chronic condition. These recommendations may be useful for assessment of CD care both in research and clinical practice.

The role and choice criteria of antihistamines in allergy management – expert opinion

PubMed Central

Jurkiewicz, Dariusz; Czarnecka-Operacz, Magdalena M.; Pawliczak, Rafał; Woroń, Jarosław; Moniuszko, Marcin; Emeryk, Andrzej

2016-01-01

Allergic diseases are the most common chronic conditions lasting throughout the patient’s life. They not only cause significant deterioration in the quality of life of patients but also lead to significant absenteeism and reduced productivity, resulting in very high costs for society. Effective and safe treatment of allergic diseases is therefore one of the main challenges for public health and should be carried out by all the specialists in family medicine, internists and paediatricians in collaboration with allergists, otorhinolaryngologists and dermatologists. Antihistamines are most commonly used in the treatment of allergies. Several dozen drugs are available on the pharmaceutical market, and their generic forms are advertised widely as very effective drugs for the treatment of allergic diseases. What is the truth? What are the data from clinical trials and observational studies? Are all drugs equally effective and safe for the patient? According to a panel of experts representing various fields of medicine, inappropriate treatment of allergies can be very risky for patients, and seemingly equally acting medications may differ greatly. Therefore, a panel of experts gathered the latest data from the entire scientific literature and analysed the latest standards and recommendations prepared by scientific societies. This paper provides a summary of these studies and highlights the importance for the patient of the proper choice of drug to treat his allergies. PMID:28035215

Development and training of a learning expert system in an autonomous mobile robot via simulation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Spelt, P.F.; Lyness, E.; DeSaussure, G.

1989-11-01

The Center for Engineering Systems Advanced Research (CESAR) conducts basic research in the area of intelligent machines. Recently at CESAR a learning expert system was created to operate on board an autonomous robot working at a process control panel. The authors discuss two-computer simulation system used to create, evaluate and train this learning system. The simulation system has a graphics display of the current status of the process being simulated, and the same program which does the simulating also drives the actual control panel. Simulation results were validated on the actual robot. The speed and safety values of using amore » computerized simulator to train a learning computer, and future uses of the simulation system, are discussed.« less

An expert panel-based study on recognition of gastro-esophageal reflux in difficult esophageal pH-impedance tracings.

PubMed

Smits, M J; Loots, C M; van Wijk, M P; Bredenoord, A J; Benninga, M A; Smout, A J P M

2015-05-01

Despite existing criteria for scoring gastro-esophageal reflux (GER) in esophageal multichannel pH-impedance measurement (pH-I) tracings, inter- and intra-rater variability is large and agreement with automated analysis is poor. To identify parameters of difficult to analyze pH-I patterns and combine these into a statistical model that can identify GER episodes with an international consensus as gold standard. Twenty-one experts from 10 countries were asked to mark GER presence for adult and pediatric pH-I patterns in an online pre-assessment. During a consensus meeting, experts voted on patterns not reaching majority consensus (>70% agreement). Agreement was calculated between raters, between consensus and individual raters, and between consensus and software generated automated analysis. With eight selected parameters, multiple logistic regression analysis was performed to describe an algorithm sensitive and specific for detection of GER. Majority consensus was reached for 35/79 episodes in the online pre-assessment (interrater κ = 0.332). Mean agreement between pre-assessment scores and final consensus was moderate (κ = 0.466). Combining eight pH-I parameters did not result in a statistically significant model able to identify presence of GER. Recognizing a pattern as retrograde is the best indicator of GER, with 100% sensitivity and 81% specificity with expert consensus as gold standard. Agreement between experts scoring difficult impedance patterns for presence or absence of GER is poor. Combining several characteristics into a statistical model did not improve diagnostic accuracy. Only the parameter 'retrograde propagation pattern' is an indicator of GER in difficult pH-I patterns. © 2015 John Wiley & Sons Ltd.

[Medical expert consensus in AH on the clinical use of triple fixed-dose antihypertensive therapy in Spain].

PubMed

Mazón, P; Galve, E; Gómez, J; Gorostidi, M; Górriz, J L; Mediavilla, J D

The opinion of experts (different specialties) on the triple fixed-dose antihypertensive therapy in clinical practice may differ. Online questionnaire with controversial aspects of the triple therapy answered by panel of experts in hypertension (HT) using two-round modified Delphi method. The questionnaire was completed by 158 experts: Internal Medicine (49), Nephrology (26), Cardiology (83). Consensus was reached (agreement) on 27/45 items (60%); 7 items showed differences statistically significant. Consensus was reached regarding: Predictive factors in the need for combination therapy and its efficacy vs. increasing the dose of a pretreatment, and advantage of triple therapy (prescription/adherence/cost/pressure control) vs. free combination. This consensus provides an overview of the clinical use of triple therapy in moderate-severe and resistant/difficult to control HT. Copyright © 2016 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

Research Synthesis Methods in an Age of Globalized Risks: Lessons from the Global Burden of Foodborne Disease Expert Elicitation.

PubMed

2016-02-01

We live in an age that increasingly calls for national or regional management of global risks. This article discusses the contributions that expert elicitation can bring to efforts to manage global risks and identifies challenges faced in conducting expert elicitation at this scale. In doing so it draws on lessons learned from conducting an expert elicitation as part of the World Health Organizations (WHO) initiative to estimate the global burden of foodborne disease; a study commissioned by the Foodborne Disease Epidemiology Reference Group (FERG). Expert elicitation is designed to fill gaps in data and research using structured, transparent methods. Such gaps are a significant challenge for global risk modeling. Experience with the WHO FERG expert elicitation shows that it is feasible to conduct an expert elicitation at a global scale, but that challenges do arise, including: defining an informative, yet feasible geographical structure for the elicitation; defining what constitutes expertise in a global setting; structuring international, multidisciplinary expert panels; and managing demands on experts' time in the elicitation. This article was written as part of a workshop, "Methods for Research Synthesis: A Cross-Disciplinary Approach" held at the Harvard Center for Risk Analysis on October 13, 2013. © 2016 Society for Risk Analysis.

Guidelines of care for vascular lasers and intense pulse light sources from the European Society for Laser Dermatology.

PubMed

Adamič, M; Pavlović, M D; Troilius Rubin, A; Palmetun-Ekbäck, M; Boixeda, P

2015-09-01

Lasers and non-coherent intense pulse light sources (IPLS) are based on the principle of selective photothermolysis and can be used for the treatment of many vascular skin lesions. A variety of lasers has been developed for the treatment of congenital and acquired vascular lesions which incorporate these concepts into their design. Although laser and light sources are very popular due to their non-invasive nature, caution should be considered by practitioners and patients to avoid permanent side-effects. The aim of these guidelines is to give evidence-based recommendations for the use of lasers and IPLS in the treatment of vascular lesions. These guidelines were produced by a Consensus Panel made up of experts in the field of vascular laser surgery under the auspices of the European Society of Laser Dermatology. Recommendations on the use of vascular lasers and IPLS were made based on the quality of evidence for efficacy, safety, tolerability, cosmetic outcome, patient satisfaction/preference and, where appropriate, on the experts' opinion. The recommendations of these guidelines are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines. Lasers and IPLS are very useful and sometimes the only available method to treat various vascular lesions. It is of a paramount importance that the type of laser or IPLS and their specific parameters are adapted to the indication but also that the treating physician is familiar with the device to be used. The crucial issue in treating vascular lesions is to recognize the immediate end-point after laser treatment. This is the single most important factor to ensure both the efficacy of the treatment and avoidance of serious side-effects. © 2015 European Academy of Dermatology and Venereology.

Assessing quality of maternity care in Hungary: expert validation and testing of the mother-centered prenatal care (MCPC) survey instrument.

PubMed

Rubashkin, Nicholas; Szebik, Imre; Baji, Petra; Szántó, Zsuzsa; Susánszky, Éva; Vedam, Saraswathi

2017-11-16

Instruments to assess quality of maternity care in Central and Eastern European (CEE) region are scarce, despite reports of poor doctor-patient communication, non-evidence-based care, and informal cash payments. We validated and tested an online questionnaire to study maternity care experiences among Hungarian women. Following literature review, we collated validated items and scales from two previous English-language surveys and adapted them to the Hungarian context. An expert panel assessed items for clarity and relevance on a 4-point ordinal scale. We calculated item-level Content Validation Index (CVI) scores. We designed 9 new items concerning informal cash payments, as well as 7 new "model of care" categories based on mode of payment. The final questionnaire (N = 111 items) was tested in two samples of Hungarian women, representative (N = 600) and convenience (N = 657). We conducted bivariate analysis and thematic analysis of open-ended responses. Experts rated pre-existing English-language items as clear and relevant to Hungarian women's maternity care experiences with an average CVI for included questions of 0.97. Significant differences emerged across the model of care categories in terms of informal payments, informed consent practices, and women's perceptions of autonomy. Thematic analysis (N = 1015) of women's responses identified 13 priority areas of the maternity care experience, 9 of which were addressed by the questionnaire. We developed and validated a comprehensive questionnaire that can be used to evaluate respectful maternity care, evidence-based practice, and informal cash payments in CEE region and beyond.

Advances in the physics basis for the European DEMO design

NASA Astrophysics Data System (ADS)

Wenninger, R.; Arbeiter, F.; Aubert, J.; Aho-Mantila, L.; Albanese, R.; Ambrosino, R.; Angioni, C.; Artaud, J.-F.; Bernert, M.; Fable, E.; Fasoli, A.; Federici, G.; Garcia, J.; Giruzzi, G.; Jenko, F.; Maget, P.; Mattei, M.; Maviglia, F.; Poli, E.; Ramogida, G.; Reux, C.; Schneider, M.; Sieglin, B.; Villone, F.; Wischmeier, M.; Zohm, H.

2015-06-01

In the European fusion roadmap, ITER is followed by a demonstration fusion power reactor (DEMO), for which a conceptual design is under development. This paper reports the first results of a coherent effort to develop the relevant physics knowledge for that (DEMO Physics Basis), carried out by European experts. The program currently includes investigations in the areas of scenario modeling, transport, MHD, heating & current drive, fast particles, plasma wall interaction and disruptions.

7 CFR 1940.968 - Rural Economic Development Review Panel Grant (Panel Grant).

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 13 2013-01-01 2013-01-01 false Rural Economic Development Review Panel Grant (Panel... of Certain Rural Development Programs § 1940.968 Rural Economic Development Review Panel Grant (Panel... associated with a State rural economic development review panel. (b) Objective. The objective of the Panel...

Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative

PubMed Central

Sivera, Francisca; Andrés, Mariano; Carmona, Loreto; Kydd, Alison S R; Moi, John; Seth, Rakhi; Sriranganathan, Melonie; van Durme, Caroline; van Echteld, Irene; Vinik, Ophir; Wechalekar, Mihir D; Aletaha, Daniel; Bombardier, Claire; Buchbinder, Rachelle; Edwards, Christopher J; Landewé, Robert B; Bijlsma, Johannes W; Branco, Jaime C; Burgos-Vargas, Rubén; Catrina, Anca I; Elewaut, Dirk; Ferrari, Antonio J L; Kiely, Patrick; Leeb, Burkhard F; Montecucco, Carlomaurizio; Müller-Ladner, Ulf; Østergaard, Mikkel; Zochling, Jane; Falzon, Louise; van der Heijde, Désirée M

2014-01-01

We aimed to develop evidence-based multinational recommendations for the diagnosis and management of gout. Using a formal voting process, a panel of 78 international rheumatologists developed 10 key clinical questions pertinent to the diagnosis and management of gout. Each question was investigated with a systematic literature review. Medline, Embase, Cochrane CENTRAL and abstracts from 2010–2011 European League Against Rheumatism and American College of Rheumatology meetings were searched in each review. Relevant studies were independently reviewed by two individuals for data extraction and synthesis and risk of bias assessment. Using this evidence, rheumatologists from 14 countries (Europe, South America and Australasia) developed national recommendations. After rounds of discussion and voting, multinational recommendations were formulated. Each recommendation was graded according to the level of evidence. Agreement and potential impact on clinical practice were assessed. Combining evidence and clinical expertise, 10 recommendations were produced. One recommendation referred to the diagnosis of gout, two referred to cardiovascular and renal comorbidities, six focused on different aspects of the management of gout (including drug treatment and monitoring), and the last recommendation referred to the management of asymptomatic hyperuricaemia. The level of agreement with the recommendations ranged from 8.1 to 9.2 (mean 8.7) on a 1–10 scale, with 10 representing full agreement. Ten recommendations on the diagnosis and management of gout were established. They are evidence-based and supported by a large panel of rheumatologists from 14 countries, enhancing their utility in clinical practice. PMID:23868909

[Physician Involvement in the Activities of the European Medicines Agency].

PubMed

Silva, Ivana

2017-11-29

For more than two decades of activity, the European Medicines Agency has been operating as part of a network with the national medicines agencies in Europe, bringing together - in its various scienti c committees and working groups - European experts on a wide range of topics related to quality assurance, safety and ef cacy of medicines. The work carried out within the European Medicines Agency activities and the conclusions reached at European level affect millions of citizens. The European Medicines Agency considers that it is of great importance to maintain, in a sustainable and consistent manner, the active participation of general practitioners, as well as other medical specialists, in the process of medicines' evaluation and supervision. This article summarizes how the participation of doctors and health professionals in general is promoted in the European Medicines Agency activities.

The European Hematology Association Roadmap for European Hematology Research: a consensus document.

PubMed

Engert, Andreas; Balduini, Carlo; Brand, Anneke; Coiffier, Bertrand; Cordonnier, Catherine; Döhner, Hartmut; de Wit, Thom Duyvené; Eichinger, Sabine; Fibbe, Willem; Green, Tony; de Haas, Fleur; Iolascon, Achille; Jaffredo, Thierry; Rodeghiero, Francesco; Salles, Gilles; Schuringa, Jan Jacob

2016-02-01

The European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European hematology research. Initiated by the EHA, around 300 experts contributed to the consensus document, which will help European policy makers, research funders, research organizations, researchers, and patient groups make better informed decisions on hematology research. It also aims to raise public awareness of the burden of blood disorders on European society, which purely in economic terms is estimated at €23 billion per year, a level of cost that is not matched in current European hematology research funding. In recent decades, hematology research has improved our fundamental understanding of the biology of blood disorders, and has improved diagnostics and treatments, sometimes in revolutionary ways. This progress highlights the potential of focused basic research programs such as this EHA Roadmap.The EHA Roadmap identifies nine 'sections' in hematology: normal hematopoiesis, malignant lymphoid and myeloid diseases, anemias and related diseases, platelet disorders, blood coagulation and hemostatic disorders, transfusion medicine, infections in hematology, and hematopoietic stem cell transplantation. These sections span 60 smaller groups of diseases or disorders.The EHA Roadmap identifies priorities and needs across the field of hematology, including those to develop targeted therapies based on genomic profiling and chemical biology, to eradicate minimal residual malignant disease, and to develop cellular immunotherapies, combination treatments, gene therapies, hematopoietic stem cell treatments, and treatments that are better tolerated by elderly patients. Copyright© Ferrata Storti Foundation.

The European Hematology Association Roadmap for European Hematology Research: a consensus document

PubMed Central

Engert, Andreas; Balduini, Carlo; Brand, Anneke; Coiffier, Bertrand; Cordonnier, Catherine; Döhner, Hartmut; de Wit, Thom Duyvené; Eichinger, Sabine; Fibbe, Willem; Green, Tony; de Haas, Fleur; Iolascon, Achille; Jaffredo, Thierry; Rodeghiero, Francesco; Salles, Gilles; Schuringa, Jan Jacob

2016-01-01

The European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European hematology research. Initiated by the EHA, around 300 experts contributed to the consensus document, which will help European policy makers, research funders, research organizations, researchers, and patient groups make better informed decisions on hematology research. It also aims to raise public awareness of the burden of blood disorders on European society, which purely in economic terms is estimated at €23 billion per year, a level of cost that is not matched in current European hematology research funding. In recent decades, hematology research has improved our fundamental understanding of the biology of blood disorders, and has improved diagnostics and treatments, sometimes in revolutionary ways. This progress highlights the potential of focused basic research programs such as this EHA Roadmap. The EHA Roadmap identifies nine ‘sections’ in hematology: normal hematopoiesis, malignant lymphoid and myeloid diseases, anemias and related diseases, platelet disorders, blood coagulation and hemostatic disorders, transfusion medicine, infections in hematology, and hematopoietic stem cell transplantation. These sections span 60 smaller groups of diseases or disorders. The EHA Roadmap identifies priorities and needs across the field of hematology, including those to develop targeted therapies based on genomic profiling and chemical biology, to eradicate minimal residual malignant disease, and to develop cellular immunotherapies, combination treatments, gene therapies, hematopoietic stem cell treatments, and treatments that are better tolerated by elderly patients. PMID:26819058

Treatment of severe psoriasis in children: recommendations of an Italian expert group.

PubMed

Fortina, Anna Belloni; Bardazzi, Federico; Berti, Samantha; Carnevale, Claudia; Di Lernia, Vito; El Hachem, Maya; Neri, Iria; Gelmetti, Carlo Mario; Lora, Viviana; Mazzatenta, Carlo; Milioto, Mirella; Moretta, Gaia; Patrizi, Annalisa; Peris, Ketty; Villani, Alberto

2017-10-01

This article provides comprehensive recommendations for the systemic treatment of severe pediatric psoriasis based on evidence obtained from a systematic review of the literature and the consensus opinion of expert dermatologists and pediatricians. For each systemic treatment, the grade of recommendation (A, B, C) based on the treatment's approval by the European Medicines Agency for childhood psoriasis and the experts' opinions is discussed. The grade of recommendation for narrow-band-ultraviolet B phototherapy, cyclosporine, and retinoids is C, while that for methotrexate is C/B. The use of adalimumab, etanercept, and ustekinumab has a grade A recommendation. No conventional systemic treatments are approved for pediatric psoriasis. Adalimumab is approved by the European Medicines Agency as a first-line treatment for severe chronic plaque psoriasis in children (≥ 4 years old) and adolescents. Etanercept and ustekinumab are approved as second-line therapy in children ≥ 6 and ≥ 12 years, respectively. A treatment algorithm as well as practical tools (i.e., tabular summaries of differential diagnoses, treatment mechanism of actions, dosing regimens, control parameters) are provided to assist in therapeutic reasoning and decision-making for individual patients. These treatment recommendations are endorsed by major Italian Pediatric and Dermatology Societies. What is Known: • Guidelines for the treatment of severe pediatric psoriasis are lacking and most traditional systemic treatments are not approved for use in young patients. Although there has been decades of experience with some of the traditional agents such as phototherapy, acitretin, and cyclosporine in children, there are no RCTs on their pediatric use while RCTs investigating new biologic agents have been performed. What is New: • In this manuscript, an Italian multidisciplinary team of experts focused on treatment recommendations for severe forms of psoriasis in children based on an up

Definition of a COPD self-management intervention: International Expert Group consensus.

PubMed

Effing, Tanja W; Vercoulen, Jan H; Bourbeau, Jean; Trappenburg, Jaap; Lenferink, Anke; Cafarella, Paul; Coultas, David; Meek, Paula; van der Valk, Paul; Bischoff, Erik W M A; Bucknall, Christine; Dewan, Naresh A; Early, Frances; Fan, Vincent; Frith, Peter; Janssen, Daisy J A; Mitchell, Katy; Morgan, Mike; Nici, Linda; Patel, Irem; Walters, Haydn; Rice, Kathryn L; Singh, Sally; Zuwallack, Richard; Benzo, Roberto; Goldstein, Roger; Partridge, Martyn R; van der Palen, Job

2016-07-01

There is an urgent need for consensus on what defines a chronic obstructive pulmonary disease (COPD) self-management intervention. We aimed to obtain consensus regarding the conceptual definition of a COPD self-management intervention by engaging an international panel of COPD self-management experts using Delphi technique features and an additional group meeting.In each consensus round the experts were asked to provide feedback on the proposed definition and to score their level of agreement (1=totally disagree; 5=totally agree). The information provided was used to modify the definition for the next consensus round. Thematic analysis was used for free text responses and descriptive statistics were used for agreement scores.In total, 28 experts participated. The consensus round response rate varied randomly over the five rounds (ranging from 48% (n=13) to 85% (n=23)), and mean definition agreement scores increased from 3.8 (round 1) to 4.8 (round 5) with an increasing percentage of experts allocating the highest score of 5 (round 1: 14% (n=3); round 5: 83% (n=19)).In this study we reached consensus regarding a conceptual definition of what should be a COPD self-management intervention, clarifying the requisites for such an intervention. Operationalisation of this conceptual definition in the near future will be an essential next step. The content of this work is not subject to copyright. Design and branding are copyright ©ERS 2016.

International, Expert-Based, Consensus Statement Regarding the Management of Acute Diverticulitis.

PubMed

O'Leary, D Peter; Lynch, Noel; Clancy, Cillian; Winter, Desmond C; Myers, Eddie

2015-09-01

This Delphi study provides consensus related to many aspects of acute diverticulitis and identifies other areas in need of research. To generate an international, expert-based, consensus statement to address controversies in the management of acute diverticulitis. This study was conducted using the Delphi technique from April 3 through October 21, 2014. A survey website was used and a panel of acute diverticulitis experts was formed via the snowball method. The top 5 acute diverticulitis experts in 5 international geographic regions were identified based on their number of publications related to acute diverticulitis. The Delphi study used 3 rounds of questions, after which the consensus statement was collated. A consensus statement related to the management of acute diverticulitis. Twenty items were selected for inclusion in the consensus statement following 3 rounds of questioning. A clear definition of uncomplicated and complicated diverticulitis is provided. In uncomplicated diverticulitis, consensus was reached regarding appropriate laboratory and radiological evaluation of patients as well as nonsurgical, surgical, and follow-up strategies. A number of important topics, including antibiotic treatment, failed to reach consensus. In addition, consensus was reached regarding many nonsurgical and surgical treatment strategies in complicated diverticulitis. Controversy continues internationally regarding the management of acute diverticulitis. This study demonstrates that there is more nonconsensus among experts than consensus regarding most issues, even in the same region. It also provides insight into the status quo regarding the treatment of acute diverticulitis and provides important direction for future research.

Expert Statement on the Single-Agent Use of Inhaled Bronchodilator in the Treatment of Stable Mild-Moderate Chronic Obstructive Pulmonary Disease.

PubMed

Riesco Miranda, Juan Antonio; Alcázar, Bernardino; Alfageme, Inmaculada; Casanova, Ciro; Celli, Bartolomé; de-Torres, Juan P; Jiménez Ruiz, Carlos A

2017-10-01

To describe the evidence- and experience-based expert consensus on the use of single-agent bronchodilators in patients with stable mild-moderate chronic obstructive pulmonary disease (COPD). Using Delphi methodology, a panel of 7 respiratory medicine experts was established, who, in the first nominal group meeting defined the scope, users, and document sections. The panel drew up 14 questions on the use of single-agent bronchodilators in patients with mild-moderate stable COPD to be answered with a systematic review of the literature. The results of the review were discussed in a second nominal group meeting and 17 statements were generated. Agreement/disagreement with the statements was tested among16 different experts including respiratory medicine experts and primary care physicians. Statements were scored from1 (total disagreement) to10 (total agreement). Agreement was considered if at least 70% voted ≥7. The level of evidence and grade of recommendation of the systematic literature review was assessed using the Oxford Centre for Evidence-based Medicine levels. A total of 12 of the 17 statements were selected. Specific statements were generated on different profiles of patients with stable mild-moderate COPD in whom single-agent bronchodilators could be prescribed. These statements on the use of single-agent bronchodilators might improve the outcomes and prognosis of patients with stable mild-moderate COPD. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

Interactive optical panel

DOEpatents

Veligdan, J.T.

1995-10-03

An interactive optical panel assembly includes an optical panel having a plurality of ribbon optical waveguides stacked together with opposite ends thereof defining panel first and second faces. A light source provides an image beam to the panel first face for being channeled through the waveguides and emitted from the panel second face in the form of a viewable light image. A remote device produces a response beam over a discrete selection area of the panel second face for being channeled through at least one of the waveguides toward the panel first face. A light sensor is disposed across a plurality of the waveguides for detecting the response beam therein for providing interactive capability. 10 figs.

Influenza vaccination: key facts for general practitioners in Europe-a synthesis by European experts based on national guidelines and best practices in the United Kingdom and the Netherlands.

PubMed

Kassianos, George; Blank, Patricia; Falup-Pecurariu, Oana; Kuchar, Ernest; Kyncl, Jan; De Lejarazu, Raul Ortiz; Nitsch-Osuch, Aneta; van Essen, Gerrit A

2016-01-01

Currently there is no influenza vaccination guidance for European general practitioners. Furthermore, although the European Council recommends a target seasonal influenza vaccination rate of 75% in the elderly (65 years and above) and in anyone aged >6 months with a chronic medical condition, there remain wide discrepancies throughout Europe. A harmonised guideline regarding not only vaccination strategy but also for the consistent diagnosis of influenza across Europe is essential to support a common approach for the implementation of seasonal influenza vaccination across Europe. This document is based on pre-existing guidelines available in the UK and Netherlands and has been approved by a group of European experts for use throughout Europe. As well as providing a standardised influenza diagnosis, it also reviews the current recommendations for influenza vaccination, the types of vaccine available, the contraindications, vaccine use in special populations (in pregnancy, children, and in those with egg allergy), and concomitant administration with other vaccines. The effectiveness, safety, and timing of the seasonal influenza vaccine are also reviewed. A second section provides practical guidance for general practitioners for the implementation of a seasonal influenza vaccination program, including the selection and notification of those eligible for vaccination, as well as suggestions for the organisation of a vaccination programme. Finally, suggested responses to common patient misconceptions and frequently asked questions are included. The aim of this article is to harmonise the diagnosis of seasonal influenza and the approach of European general practitioners to seasonal influenza vaccination in order to better identify influenza outbreaks and to move towards reaching the target vaccination rate of 75% throughout Europe.

Influenza vaccination: key facts for general practitioners in Europe—a synthesis by European experts based on national guidelines and best practices in the United Kingdom and the Netherlands

PubMed Central

Kassianos, George; Blank, Patricia; Falup-Pecurariu, Oana; Kuchar, Ernest; Kyncl, Jan; De Lejarazu, Raul Ortiz; Nitsch-Osuch, Aneta; van Essen, Gerrit A

2016-01-01

Currently there is no influenza vaccination guidance for European general practitioners. Furthermore, although the European Council recommends a target seasonal influenza vaccination rate of 75% in the elderly (65 years and above) and in anyone aged >6 months with a chronic medical condition, there remain wide discrepancies throughout Europe. A harmonised guideline regarding not only vaccination strategy but also for the consistent diagnosis of influenza across Europe is essential to support a common approach for the implementation of seasonal influenza vaccination across Europe. This document is based on pre-existing guidelines available in the UK and Netherlands and has been approved by a group of European experts for use throughout Europe. As well as providing a standardised influenza diagnosis, it also reviews the current recommendations for influenza vaccination, the types of vaccine available, the contraindications, vaccine use in special populations (in pregnancy, children, and in those with egg allergy), and concomitant administration with other vaccines. The effectiveness, safety, and timing of the seasonal influenza vaccine are also reviewed. A second section provides practical guidance for general practitioners for the implementation of a seasonal influenza vaccination program, including the selection and notification of those eligible for vaccination, as well as suggestions for the organisation of a vaccination programme. Finally, suggested responses to common patient misconceptions and frequently asked questions are included. The aim of this article is to harmonise the diagnosis of seasonal influenza and the approach of European general practitioners to seasonal influenza vaccination in order to better identify influenza outbreaks and to move towards reaching the target vaccination rate of 75% throughout Europe. PMID:27540408

75 FR 6030 - EPA Science Advisory Board Staff Office Request for Nominations of Experts for the SAB Lead (Pb...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-05

... requesting public nominations of experts to form an SAB Ad Hoc Panel to review EPA's draft technical analyses... residential dust. OPPT is developing draft technical analyses that will be used to support: (a) Possible... that the SAB conduct a review of these draft technical analyses. The SAB was established by 42 U.S.C...

Expert and non-expert knowledge in medical practice.

PubMed

Nordin, I

2000-01-01

One problematic aspect of the rationality of medical practice concerns the relation between expert knowledge and non-expert knowledge. In medical practice it is important to match medical knowledge with the self-knowledge of the individual patient. This paper tries to study the problem of such matching by describing a model for technological paradigms and comparing it with an ideal of technological rationality. The professionalised experts tend to base their decisions and actions mostly on medical knowledge while the rationality of medicine also involves just as important elements of the personal evaluation and knowledge of the patients. Since both types of knowledge are necessary for rational decisions, the gap between the expert and the non-expert has to be bridged in some way. A solution to the problem is suggested in terms of pluralism, with the patient as ultimate decision-maker.

EuroFlow antibody panels for standardized n-dimensional flow cytometric immunophenotyping of normal, reactive and malignant leukocytes

PubMed Central

van Dongen, J J M; Lhermitte, L; Böttcher, S; Almeida, J; van der Velden, V H J; Flores-Montero, J; Rawstron, A; Asnafi, V; Lécrevisse, Q; Lucio, P; Mejstrikova, E; Szczepański, T; Kalina, T; de Tute, R; Brüggemann, M; Sedek, L; Cullen, M; Langerak, A W; Mendonça, A; Macintyre, E; Martin-Ayuso, M; Hrusak, O; Vidriales, M B; Orfao, A

2012-01-01

Most consensus leukemia & lymphoma antibody panels consist of lists of markers based on expert opinions, but they have not been validated. Here we present the validated EuroFlow 8-color antibody panels for immunophenotyping of hematological malignancies. The single-tube screening panels and multi-tube classification panels fit into the EuroFlow diagnostic algorithm with entries defined by clinical and laboratory parameters. The panels were constructed in 2–7 sequential design–evaluation–redesign rounds, using novel Infinicyt software tools for multivariate data analysis. Two groups of markers are combined in each 8-color tube: (i) backbone markers to identify distinct cell populations in a sample, and (ii) markers for characterization of specific cell populations. In multi-tube panels, the backbone markers were optimally placed at the same fluorochrome position in every tube, to provide identical multidimensional localization of the target cell population(s). The characterization markers were positioned according to the diagnostic utility of the combined markers. Each proposed antibody combination was tested against reference databases of normal and malignant cells from healthy subjects and WHO-based disease entities, respectively. The EuroFlow studies resulted in validated and flexible 8-color antibody panels for multidimensional identification and characterization of normal and aberrant cells, optimally suited for immunophenotypic screening and classification of hematological malignancies. PMID:22552007

Motor Cortex Stimulation in Patients Suffering from Chronic Neuropathic Pain: Summary of Expert Meeting and Premeeting Questionnaire, Combined with Literature Review.

PubMed

Kurt, Erkan; Henssen, Dylan J H A; Steegers, Monique; Staal, Michiel; Beese, Ulrich; Maarrawi, Joseph; Pirotte, Benoit; Garcia-Larrea, Luis; Rasche, Dirk; Vesper, Jan; Holsheimer, Jan; Duyvendak, Wim; Herregodts, Patrick; van Dongen, Robert; Moens, Maarten

2017-12-01

Motor cortex stimulation (MCS) was introduced in the early 1990s by Tsubokawa and his group for patients diagnosed with drug-resistant, central neuropathic pain. Inconsistencies concerning the details of this therapy and its outcomes and poor methodology of most clinical essays divide the neuromodulation society worldwide into "believers" and "nonbelievers." A European expert meeting was organized in Brussels, Belgium by the Benelux Neuromodulation Society in order to develop uniform MCS protocols in the preoperative, intraoperative, and postoperative courses. An expert meeting was organized, and a questionnaire was sent out to all the invited participants before this expert meeting. An extensive literature research was conducted in order to enrich the results. Topics that were addressed during the expert meeting were 1) inclusion and exclusion criteria, 2) targeting and methods of stimulation, 3) effects of MCS, and 4) results from the questionnaire. Substantial commonalities but also important methodologic divergencies emerged from the discussion of MCS experts from 7 European Centers. From this meeting and questionnaire, all participants concluded that there is a need for more homogenous standardized protocols for MCS regarding patient selection, implantation procedure, stimulation parameters, and follow-up-course. Copyright © 2017 Elsevier Inc. All rights reserved.

Expert - Non-expert differences in visual behaviour during alpine slalom skiing.

PubMed

Decroix, Marjolein; Wazir, Mohd Rozilee Wazir Norjali; Zeuwts, Linus; Deconinck, Frederik F J A; Lenoir, Matthieu; Vansteenkiste, Pieter

2017-10-01

The aim of this study was to investigate visual behaviour of expert and non-expert ski athletes during an alpine slalom. Fourteen non-experts and five expert slalom skiers completed an alpine slalom course in an indoor ski slope while wearing a head-mounted eye tracking device. Experts completed the slalom clearly faster than non-experts, but no significant difference was found in timing and position of the turn initiation. Although both groups already looked at future obstacles approximately 0,5s before passing the upcoming pole, the higher speed of experts implied that they shifted gaze spatially earlier in the bend than non-experts. Furthermore, experts focussed more on the second next pole while non-expert slalom skiers looked more to the snow surface immediately in front of their body. No difference was found in the fixation frequency, average fixation duration, and quiet eye duration between both groups. These results suggest that experts focus on the timing of their actions while non-experts still need to pay attention to the execution of these actions. These results also might suggest that ski trainers should instruct non-experts and experts to focus on the next pole and, shift their gaze to the second next pole shortly before reaching it. Based on the current study it seems unadvisable to instruct slalom skiers to look several poles ahead during the actual slalom. However, future research should test if these results still hold on a real outdoor slope, including multiple vertical gates. Copyright © 2017 Elsevier B.V. All rights reserved.

Data Base Management Systems Panel. Third workshop summary

NASA Technical Reports Server (NTRS)

Urena, J. L. (Editor)

1981-01-01

The discussions and results of a review by a panel of data base management system (DRMS) experts of various aspects of the use of DBMSs within NASA/Office of Space and Terrestrial Applications (OSTA) and related organizations are summarized. The topics discussed included the present status of the use of DBMS technology and of the various ongoing DBMS-related efforts within NASA. The report drafts of a study that seeks to determine the functional requirements for a generalized DBMS for the NASA/OSTA and related data bases are examined. Future problems and possibilities with the use of DBMS technology are also considered. A list of recommendations for NASA/OSTA data systems is included.

The Blue Ribbon Panel on Depowered and Advanced Airbags — Status Report on Airbag Performance

PubMed Central

Ferguson, Susan A.; Schneider, Lawrence; Segui-Gomez, Maria; Arbogast, Kristy; Augenstein, Jeffrey; Digges, Kennerly H.

2003-01-01

SUMMARY In February 2000, a group of highway safety organizations sent a letter to the Secretary of the U.S. Department of Transportation expressing concern about a possible return to the 30-mph rigid barrier test using unbelted dummies previously required by Federal Motor Vehicle Safety Standard (FMVSS) 208. The letter asked the National Highway Traffic Safety Administration (NHTSA) to expedite data collection of the real-world crash experience of airbag-equipped vehicles certified to the 30-mph sled test using unbelted dummies because of suggestions that depowered airbags may not provide the same level of protection, particularly to larger, unbelted occupants. For the same reason, the letter also recommended that the auto industry commit funding for additional data collection and to establish a panel of experts to evaluate the data. In response, the Alliance of Automobile Manufacturers (Alliance) committed to funding a 3-year program to be managed by an independent third party. A panel of experts consisting of representatives from the highway safety research community, the National Transportation Safety Board, academia, medical institutions, and the insurance industry was established as the Blue Ribbon Panel (BRP) for Evaluation of Depowered and Advanced Airbags and met for the first time in February 2001. The BRP also includes representatives from NHTSA and the automobile industry who participate as observers. The BRP held its first public meeting in April 2003 to provide an update of its activities and to summarize the real-world evidence on the performance of depowered airbags. This AAAM session will provide a brief summary of the public meeting. PMID:12941215

Mixed Images and Merging Semantics in European Curricula

ERIC Educational Resources Information Center

Sivesind, Kirsten

2013-01-01

Due to European agreements and policy expectations, national authorities are revising their formal curricula in line with an evidence-oriented policy. The article explores how new trends in formulating curricula can be regarded as an outcome of experts' semantics and impact on education policy. The article reanalyses documentation from a project,…

A comparative analysis of domiciliary oxygen therapy in five European countries.

PubMed

Garattini, L; Cornago, D; Tediosi, F

2001-11-01

This comparative study analyses the domestic market of domiciliary oxygen therapy in five European countries (Denmark, France, Germany, Italy, and the UK) according to a common checklist of subjects. Domestic legislation, prescription procedures, delivery, and the market situation concerning oxygen therapy were considered. The analysis involved (i) reviewing the literature on oxygen therapy in national and international journals, and (ii) interviewing a selected expert panel of market operators in each country (composed of at least one civil servant, one physician, one distributor, and one oxygen manufacturer). The analysis did not find any specific relationship between the health care system framework and the oxygen therapy market, except for a greater inclination towards home care in national health services. In all these countries oxygen therapy is reimbursed, but the type of supply and its diffusion differ widely. The spread of domiciliary care has undermined the traditional role of pharmacies in the oxygen distribution chain in all countries except Italy. The study did not help identify any specific country that can be considered a benchmark for oxygen therapy, each one dealing with oxygen therapy in a different way. An economic evaluation of the different supply modalities could help improve decision making by public authorities.

Tuberculosis among migrant populations in the European Union and the European Economic Area.

PubMed

Odone, Anna; Tillmann, Taavi; Sandgren, Andreas; Williams, Gemma; Rechel, Bernd; Ingleby, David; Noori, Teymur; Mladovsky, Philipa; McKee, Martin

2015-06-01

Although tuberculosis (TB) incidence has been decreasing in the European Union/European Economic Area (EU/EEA) in the last decades, specific subgroups of the population, such as migrants, remain at high risk of TB. This study is based on the report 'Key Infectious Diseases in Migrant Populations in the EU/EEA' commissioned by The European Centre for Disease Prevention and Control. We collected, critically appraised and summarized the available evidence on the TB burden in migrants in the EU/EEA. Data were collected through: (i) a comprehensive literature review; (ii) analysis of data from The European Surveillance System (TESSy) and (iii) evidence provided by TB experts during an infectious disease workshop in 2012. In 2010, of the 73,996 TB cases notified in the EU/EEA, 25% were of foreign origin. The overall decrease of TB cases observed in recent years has not been reflected in migrant populations. Foreign-born people with TB exhibit different socioeconomic and clinical characteristics than native sufferers. This is one of the first studies to use multiple data sources, including the largest available European database on infectious disease notifications, to assess the burden and provide a comprehensive description and analysis of specific TB features in migrants in the EU/EEA. Strengthened information about health determinants and factors for migrants' vulnerability is needed to plan, implement and evaluate targeted TB care and control interventions for migrants in the EU/EEA. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association.

Quiet Honeycomb Panels

NASA Technical Reports Server (NTRS)

Palumbo, Daniel L.; Klos, Jacob

2010-01-01

Sandwich honeycomb composite panels are lightweight and strong, and, therefore, provide a reasonable alternative to the aluminum ring frame/stringer architecture currently used for most aircraft airframes. The drawback to honeycomb panels is that they radiate noise into the aircraft cabin veil- efficiently provoking the need for additional sound treatment which adds weight and reduces the material's cost advantage. A series of honeycomb panels was made -hick incorporated different design strategies aimed at reducing the honeycomb panels' radiation efficiency while at the same time maintaining their strength. The majority of the designs were centered around the concept of creating areas of reduced stiffness in the panel by adding voids and recesses to the core. The effort culminated with a reinforced/recessed panel which had 6 dB higher transmission loss than the baseline solid core panel while maintaining comparable strength.

Interactive optical panel

DOEpatents

Veligdan, James T.

1995-10-03

An interactive optical panel assembly 34 includes an optical panel 10 having a plurality of ribbon optical waveguides 12 stacked together with opposite ends thereof defining panel first and second faces 16, 18. A light source 20 provides an image beam 22 to the panel first face 16 for being channeled through the waveguides 12 and emitted from the panel second face 18 in the form of a viewable light image 24a. A remote device 38 produces a response beam 40 over a discrete selection area 36 of the panel second face 18 for being channeled through at least one of the waveguides 12 toward the panel first face 16. A light sensor 42,50 is disposed across a plurality of the waveguides 12 for detecting the response beam 40 therein for providing interactive capability.

Conclusions of the expert panel: importance of erlotinib as a second-line therapeutic option

PubMed Central

Castagnari, Aldo

2008-01-01

During the Experts Meeting on Lung Cancer, participants emphasized the usefulness of erlotinib as second-line therapy for lung cancer. They noted that, although there are no comparative studies, erlotinib could be as effective as docetaxel and pemetrexed in second-line therapy. Regarding the toxicity profile of each of these drugs – one of the key issues considered in the meeting – specialists pointed out how important it is to clearly identify existing differences in this issue. Each drug has different degrees of toxicity, and this information is crucial at the time of choosing the therapeutic regimen. Erlotinib treatment could be an effective option for second-line therapy. PMID:18831720

A European Research Agenda for Somatic Symptom Disorders, Bodily Distress Disorders, and Functional Disorders: Results of an Estimate-Talk-Estimate Delphi Expert Study.

PubMed

van der Feltz-Cornelis, Christina M; Elfeddali, Iman; Werneke, Ursula; Malt, Ulrik F; Van den Bergh, Omer; Schaefert, Rainer; Kop, Willem J; Lobo, Antonio; Sharpe, Michael; Söllner, Wolfgang; Löwe, Bernd

2018-01-01

Background: Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD) are associated with high medical and societal costs and pose a substantial challenge to the population and health policy of Europe. To meet this challenge, a specific research agenda is needed as one of the cornerstones of sustainable mental health research and health policy for SSD, BDD, and FD in Europe. Aim: To identify the main challenges and research priorities concerning SSD, BDD, and FD from a European perspective. Methods: Delphi study conducted from July 2016 until October 2017 in 3 rounds with 3 workshop meetings and 3 online surveys, involving 75 experts and 21 European countries. EURONET-SOMA and the European Association of Psychosomatic Medicine (EAPM) hosted the meetings. Results: Eight research priorities were identified: (1) Assessment of diagnostic profiles relevant to course and treatment outcome. (2) Development and evaluation of new, effective interventions. (3) Validation studies on questionnaires or semi-structured interviews that assess chronic medical conditions in this context. (4) Research into patients preferences for diagnosis and treatment. (5) Development of new methodologic designs to identify and explore mediators and moderators of clinical course and treatment outcomes (6). Translational research exploring how psychological and somatic symptoms develop from somatic conditions and biological and behavioral pathogenic factors. (7) Development of new, effective interventions to personalize treatment. (8) Implementation studies of treatment interventions in different settings, such as primary care, occupational care, general hospital and specialty mental health settings. The general public and policymakers will benefit from the development of new, effective, personalized interventions for SSD, BDD, and FD, that will be enhanced by translational research, as well as from the outcomes of research into patient involvement, GP

Reference-based phasing using the Haplotype Reference Consortium panel.

PubMed

Loh, Po-Ru; Danecek, Petr; Palamara, Pier Francesco; Fuchsberger, Christian; A Reshef, Yakir; K Finucane, Hilary; Schoenherr, Sebastian; Forer, Lukas; McCarthy, Shane; Abecasis, Goncalo R; Durbin, Richard; L Price, Alkes

2016-11-01

Haplotype phasing is a fundamental problem in medical and population genetics. Phasing is generally performed via statistical phasing in a genotyped cohort, an approach that can yield high accuracy in very large cohorts but attains lower accuracy in smaller cohorts. Here we instead explore the paradigm of reference-based phasing. We introduce a new phasing algorithm, Eagle2, that attains high accuracy across a broad range of cohort sizes by efficiently leveraging information from large external reference panels (such as the Haplotype Reference Consortium; HRC) using a new data structure based on the positional Burrows-Wheeler transform. We demonstrate that Eagle2 attains a ∼20× speedup and ∼10% increase in accuracy compared to reference-based phasing using SHAPEIT2. On European-ancestry samples, Eagle2 with the HRC panel achieves >2× the accuracy of 1000 Genomes-based phasing. Eagle2 is open source and freely available for HRC-based phasing via the Sanger Imputation Service and the Michigan Imputation Server.

Expert judgments about RD&D and the future of nuclear energy.

PubMed

Anadón, Laura D; Bosetti, Valentina; Bunn, Matthew; Catenacci, Michela; Lee, Audrey

2012-11-06

Probabilistic estimates of the cost and performance of future nuclear energy systems under different scenarios of government research, development, and demonstration (RD&D) spending were obtained from 30 U.S. and 30 European nuclear technology experts. We used a novel elicitation approach which combined individual and group elicitation. With no change from current RD&D funding levels, experts on average expected current (Gen. III/III+) designs to be somewhat more expensive in 2030 than they were in 2010, and they expected the next generation of designs (Gen. IV) to be more expensive still as of 2030. Projected costs of proposed small modular reactors (SMRs) were similar to those of Gen. IV systems. The experts almost unanimously recommended large increases in government support for nuclear RD&D (generally 2-3 times current spending). The majority expected that such RD&D would have only a modest effect on cost, but would improve performance in other areas, such as safety, waste management, and uranium resource utilization. The U.S. and E.U. experts were in relative agreement regarding how government RD&D funds should be allocated, placing particular focus on very high temperature reactors, sodium-cooled fast reactors, fuels and materials, and fuel cycle technologies.

The impact of the internet on community pharmacy practice: a comparison of a Delphi panel's forecast with emerging trends.

PubMed

Holmes, Erin R; Tipton, David J; Desselle, Shane P

2002-01-01

The purpose of this study was to forecast the impact of Internet pharmacy commerce on various stakeholders. A panel of experts assembled from a list of academicians in the social and administrative pharmaceutical sciences participated in a three-iteration Delphi procedure. Feedback from the aggregate responses of the panel was used to construct questionnaires employed in subsequent iterations of the Delphi. The panel converged to form a consensus upon a variety of issues. They forecasted the attainment of a 10-15% share in the market of prescription and over-the-counter pharmaceuticals through on-line purchases, the formation of strategic alliances among stakeholders in the drug distribution process, a shift in marketing strategies by brick-and-mortar stores, an increase in the prevalence of niching among pharmacy service providers and a subsequent growth in the implementation of cognitive services throughout the industry. With few exceptions, the forecast produced by the Delphi panel appears to be coming to fruition.

Safety Panel Resources

NASA Technical Reports Server (NTRS)

Stewart, Christine E.

2008-01-01

The goal of this paper is to explore what resources are potentially available to safety panels and to provide some guidance on how to utilize those resources. While the examples used in this paper will concentrate on the Flight Equipment and Reliability Review Panel (FESRRP) and Extravehicular Activity (EVA) hardware that have come through that panel, as well as resources at Johnson Space Center, the paper will address how this applies to safety panels in general, and where possible cite examples for other safety panels.

Identifying key conservation threats to Alpine birds through expert knowledge

PubMed Central

Pedrini, Paolo; Brambilla, Mattia; Rolando, Antonio; Girardello, Marco

2016-01-01

Alpine biodiversity is subject to a range of increasing threats, but the scarcity of data for many taxa means that it is difficult to assess the level and likely future impact of a given threat. Expert opinion can be a useful tool to address knowledge gaps in the absence of adequate data. Experts with experience in Alpine ecology were approached to rank threat levels for 69 Alpine bird species over the next 50 years for the whole European Alps in relation to ten categories: land abandonment, climate change, renewable energy, fire, forestry practices, grazing practices, hunting, leisure, mining and urbanization. There was a high degree of concordance in ranking of perceived threats among experts for most threat categories. The major overall perceived threats to Alpine birds identified through expert knowledge were land abandonment, urbanization, leisure and forestry, although other perceived threats were ranked highly for particular species groups (renewable energy and hunting for raptors, hunting for gamebirds). For groups of species defined according to their breeding habitat, open habitat species and treeline species were perceived as the most threatened. A spatial risk assessment tool based on summed scores for the whole community showed threat levels were highest for bird communities of the northern and western Alps. Development of the approaches given in this paper, including addressing biases in the selection of experts and adopting a more detailed ranking procedure, could prove useful in the future in identifying future threats, and in carrying out risk assessments based on levels of threat to the whole bird community. PMID:26966659

Public, experts join at town meeting

NASA Astrophysics Data System (ADS)

Bush, Susan

About 80 citizens concerned with the threat of ozone depletion attended a public meeting on June 9 in Charlottesville, Va., to discuss the issue with a panel of six leading ozone experts. Held in conjunction with the Quadrennial Ozone Symposium, the town meeting was videotaped for airing on public broadcast stations this fall. The meeting was aimed at nonexperts, to “get the word out” to the public, said the moderator, journalist Peter Hackes.The lively, sometimes heated discussion showed the public's high awareness and concern over problems associated with ozone depletion. During the nearly 2-hour meeting topics ranged from the reparability of the ozone layer, to steps the public can take to help mitigate ozone loss, to reports of increased cases of skin cancer due to more ultraviolet radiation reaching the Earth's surface. There were also some claims that ozone depletion is overexaggerated and is a hoax for scientists to get more research funding.

European evidence-based guidelines on pancreatic cystic neoplasms

PubMed Central

Del Chiaro, Marco

2018-01-01

Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts performed systematic reviews and used GRADE methodology to answer relevant clinical questions on nine topics (biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystic neoplasm, rare cysts, (neo)adjuvant treatment, and pathology). Recommendations include conservative management, relative and absolute indications for surgery. A conservative approach is recommended for asymptomatic MCN and IPMN measuring <40 mm without an enhancing nodule. Relative indications for surgery in IPMN include a main pancreatic duct (MPD) diameter between 5 and 9.9 mm or a cyst diameter ≥40 mm. Absolute indications for surgery in IPMN, due to the high-risk of malignant transformation, include jaundice, an enhancing mural nodule >5 mm, and MPD diameter >10 mm. Lifelong follow-up of IPMN is recommended in patients who are fit for surgery. The European evidence-based guidelines on PCN aim to improve the diagnosis and management of PCN. PMID:29574408

Fire Resistance of Large-Scale Cross-Laminated Timber Panels

NASA Astrophysics Data System (ADS)

Henek, Vladan; Venkrbec, Václav; Novotný, Miloslav

2017-12-01

Wooden structures are increasingly being used in the construction of residential buildings. A common and often published reason to avoid wooden structures is their insufficient fire resistance, which reduces bearing capacity. For this reason, composite sandwich structures began to be designed to eliminate this drawback, as well as others. Recently, however, the trend is for a return to the original, wood-only variant and a search is underway for new technical means of improving the properties of such structures. Many timber structure technologies are known, but structures made from cross-laminated timber (CLT) panels have been used very often in recent years. CLT panels, also known as X-LAM, are currently gaining popularity in Europe. In the case of CLT panels composed of several layers of boards, they can be said to offer a certain advantage in that after the surface layer of a board has burnt and the subsurface layer has dried, oxygen is not drawn to the unburned wood for further combustion and thus the burning process ceases. CLT panels do not need to be specially modified or coated with fire resistant materials, although they are usually lined with gypsum-fibre fire resistant boards due to guidelines set out in the relevant standards. This paper presents a new method for the assessment of load-bearing perimeter walls fabricated from CLT panels without the use of an inner fire-retardant lining to ensure fire resistance at the level required by European standards (i.e. those harmonized for the Czech construction industry). The calculations were verified through laboratory tests which show that better parameters can be achieved during the classification of structures from the fire resistance point of view. The aim of the article is to utilize the results of assessment and testing by an accredited laboratory in order to demonstrate the possibilities of using CLT panels for the construction of multistorey as well as multi-purpose buildings in the Czech Republic.

Civil society engagement in innovation and research through the European Public Health Association.

PubMed

Zeegers Paget, Dineke; Barnhoorn, Floris; McCarthy, Mark; Alexanderson, Kristina; Conceição, Claudia; Devillé, Walter; Grimaud, Olivier; Katreniakova, Zuzana; Narkauskaité, Laura; Saliba, Amanda; Sammut, Marvic; Voss, Margaretha

2013-11-01

The European Public Health Association (EUPHA) proposed and led PHIRE (Public Health Innovation and Research in Europe), with co-financing by the European Commission, to assess public health innovation and research at national level in Europe. PHIRE was also designed to promote organizational development and capacity building of EUPHA. We assess the success and limitations of using EUPHA's participative structures. In total, 30 European countries were included-27 EU countries, Iceland, Norway and Switzerland. EUPHA thematic section presidents were asked to identify country informants to report, through a web-based questionnaire, on eight public health innovations. National public health associations (EUPHA member organizations) were requested to identify their national public health research programmes and calls, review the health research system, coordinate a stakeholder workshop and provide a national report. The section and national reports were assessed for responses and completeness. Half of the final responding CIs were members of EUPHA sections and the other half gained from other sources. Experts declined to respond for reasons including lack of time, knowledge of the innovation or funding. National public health associations held PHIRE workshops with Ministries of Health in 14 countries; information for 10 countries was gained through discussions within the national association, or country visits by PHIRE partners. Six countries provided no response. Some national associations had too weak organizational structures for the work or insufficient financial resources or criticism of the project. EUPHA is the leading civil society organization giving support to public health research in Europe. PHIRE created new knowledge and supported organizational development. EUPHA sections gained expert reports on public health innovations in European countries and national public health associations reported on national public health research systems. Significant advances

Biofuels and Food Security. A report by the High Level Panel of Experts on Food Security and Nutrition

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

In October 2011, the UN Committee on World Food Security (CFS) recommended a ''review of biofuels policies -- where applicable and if necessary -- according to balanced science-based assessments of the opportunities and challenges that they may represent for food security so that biofuels can be produced where it is socially, economically and environmentally feasible to do so''. In line with this, the CFS requested the HLPE (High Level Panel of Experts) to ''conduct a science-based comparative literature analysis taking into consideration the work produced by the FAO and Global Bioenergy Partnership (GBEP) of the positive and negative effects ofmore » biofuels on food security''. Recommendations from the report include the following. Food security policies and biofuel policies cannot be separated because they mutually interact. Food security and the right to food should be priority concerns in the design of any biofuel policy. Governments should adopt the principle: biofuels shall not compromise food security and therefore should be managed so that food access or the resources necessary for the production of food, principally land, biodiversity, water and labour are not put at risk. The CFS should undertake action to ensure that this principle is operable in the very varied contexts in which all countries find themselves. Given the trend to the emergence of a global biofuels market, and a context moving from policy-driven to market-driven biofuels, there is an urgent need for close and pro-active coordination of food security, biofuel/bioenergy policies and energy policies, at national and international levels, as well as rapid response mechanisms in case of crisis. There is also an urgent need to create an enabling, responsible climate for food and non-food investments compatible with food security. The HLPE recommends that governments adopt a coordinated food security and energy security strategy, which would require articulation around the following five axes

Expert views on most suitable monetary incentives on food to stimulate healthy eating.

PubMed

Waterlander, Wilma E; Steenhuis, Ingrid H M; de Vet, Emely; Schuit, Albertine J; Seidell, Jacob C

2010-06-01

Pricing strategies are an important component in the marketing mix and may also be useful in stimulating healthier food choices. However, due to competing interests and feasibility problems, the introduction of pricing strategies is complicated. For successfully introducing food pricing strategies, it is essential to explore incentives that are not only promising but also realizable and being approved by different sectors. We aimed to assemble a list of pricing strategies by exploring expert views using the Delphi method. Subjects included experts from academia, industry, retail, agriculture, policymakers, consumers and non-governmental organizations. Data were collected in three rounds. In round one, experts designed promising pricing strategies. Based on a time-budget model incorporating Sleep, Leisure, Occupation, Transportation and Home-based activities, these strategies were in the subsequent rounds judged on several criteria. Results were analysed using median and interquartile deviations scores. We found fair consensus levels among experts and a varied list of promising pricing strategies. The panel agreed on the potential success of offering small presents, providing price-cuts on healthy foods and discounting healthier foods more frequently. Also, it was found that experts gave higher rates to pricing strategies for which the implementation responsibilities could be placed elsewhere. The resulted list of promising monetary incentives is an essential first step for the future design of pricing strategies. Following this study, it is important to determine how to make solid agreements on responsibility and implementation issues. Also, consumer perceptions regarding the proposed pricing strategies should be studied.

Expert system technology

NASA Technical Reports Server (NTRS)

Prince, Mary Ellen

1987-01-01

The expert system is a computer program which attempts to reproduce the problem-solving behavior of an expert, who is able to view problems from a broad perspective and arrive at conclusions rapidly, using intuition, shortcuts, and analogies to previous situations. Expert systems are a departure from the usual artificial intelligence approach to problem solving. Researchers have traditionally tried to develop general modes of human intelligence that could be applied to many different situations. Expert systems, on the other hand, tend to rely on large quantities of domain specific knowledge, much of it heuristic. The reasoning component of the system is relatively simple and straightforward. For this reason, expert systems are often called knowledge based systems. The report expands on the foregoing. Section 1 discusses the architecture of a typical expert system. Section 2 deals with the characteristics that make a problem a suitable candidate for expert system solution. Section 3 surveys current technology, describing some of the software aids available for expert system development. Section 4 discusses the limitations of the latter. The concluding section makes predictions of future trends.

Advanced concentrator panels

NASA Technical Reports Server (NTRS)

Bell, D. M.; Bedard, R. J., Jr.

1981-01-01

The prototype fabrication of a lightweight, high-quality cellular glass substrate reflective panel for use in an advanced point-focusing solar concentrator was completed. The reflective panel is a gore shaped segment of an 11-m paraboloidal dish. The overall concentrator design and the design of the reflective panels are described. prototype-specific panel design modifications are discussed and the fabrication approach and procedure outlined.

Classification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report.

PubMed

Irwin, Richard S; French, Cynthia L; Chang, Anne B; Altman, Kenneth W

2018-01-01

We performed systematic reviews using the population, intervention, comparison, outcome (PICO) format to answer the following key clinical question: Are the CHEST 2006 classifications of acute, subacute and chronic cough and associated management algorithms in adults that were based on durations of cough useful? We used the CHEST Expert Cough Panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development, and Evaluation framework. Data from the systematic reviews in conjunction with patient values and preferences and the clinical context were used to form recommendations or suggestions. Delphi methodology was used to obtain the final grading. With respect to acute cough (< 3 weeks), only three studies met our criteria for quality assessment, and all had a high risk of bias. As predicted by the 2006 CHEST Cough Guidelines, the most common causes were respiratory infections, most likely of viral cause, followed by exacerbations of underlying diseases such as asthma and COPD and pneumonia. The subjects resided on three continents: North America, Europe, and Asia. With respect to subacute cough (duration, 3-8 weeks), only two studies met our criteria for quality assessment, and both had a high risk of bias. As predicted by the 2006 guidelines, the most common causes were postinfectious cough and exacerbation of underlying diseases such as asthma, COPD, and upper airway cough syndrome (UACS). The subjects resided in countries in Asia. With respect to chronic cough (> 8 weeks), 11 studies met our criteria for quality assessment, and all had a high risk of bias. As predicted by the 2006 guidelines, the most common causes were UACS from rhinosinus conditions, asthma, gastroesophageal reflux disease, nonasthmatic eosinophilic bronchitis, combinations of these four conditions, and, less commonly, a variety of miscellaneous conditions and atopic cough in Asian

Motor-response learning at a process control panel by an autonomous robot

DOE Office of Scientific and Technical Information (OSTI.GOV)

Spelt, P.F.; de Saussure, G.; Lyness, E.

1988-01-01

The Center for Engineering Systems Advanced Research (CESAR) was founded at Oak Ridge National Laboratory (ORNL) by the Department of Energy's Office of Energy Research/Division of Engineering and Geoscience (DOE-OER/DEG) to conduct basic research in the area of intelligent machines. Therefore, researchers at the CESAR Laboratory are engaged in a variety of research activities in the field of machine learning. In this paper, we describe our approach to a class of machine learning which involves motor response acquisition using feedback from trial-and-error learning. Our formulation is being experimentally validated using an autonomous robot, learning tasks of control panel monitoring andmore » manipulation for effect process control. The CLIPS Expert System and the associated knowledge base used by the robot in the learning process, which reside in a hypercube computer aboard the robot, are described in detail. Benchmark testing of the learning process on a robot/control panel simulation system consisting of two intercommunicating computers is presented, along with results of sample problems used to train and test the expert system. These data illustrate machine learning and the resulting performance improvement in the robot for problems similar to, but not identical with, those on which the robot was trained. Conclusions are drawn concerning the learning problems, and implications for future work on machine learning for autonomous robots are discussed. 16 refs., 4 figs., 1 tab.« less

BBMRI-ERIC as a resource for pharmaceutical and life science industries: the development of biobank-based Expert Centres.

PubMed

van Ommen, Gert-Jan B; Törnwall, Outi; Bréchot, Christian; Dagher, Georges; Galli, Joakim; Hveem, Kristian; Landegren, Ulf; Luchinat, Claudio; Metspalu, Andres; Nilsson, Cecilia; Solesvik, Ove V; Perola, Markus; Litton, Jan-Eric; Zatloukal, Kurt

2015-07-01

Biological resources (cells, tissues, bodily fluids or biomolecules) are considered essential raw material for the advancement of health-related biotechnology, for research and development in life sciences, and for ultimately improving human health. Stored in local biobanks, access to the human biological samples and related medical data for transnational research is often limited, in particular for the international life science industry. The recently established pan-European Biobanking and BioMolecular resources Research Infrastructure-European Research Infrastructure Consortium (BBMRI-ERIC) aims to improve accessibility and interoperability between academic and industrial parties to benefit personalized medicine, disease prevention to promote development of new diagnostics, devices and medicines. BBMRI-ERIC is developing the concept of Expert Centre as public-private partnerships in the precompetitive, not-for-profit field to provide a new structure to perform research projects that would face difficulties under currently established models of academic-industry collaboration. By definition, Expert Centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions. This paper presents the rationale behind the Expert Centres and illustrates the novel concept with model examples.

BBMRI-ERIC as a resource for pharmaceutical and life science industries: the development of biobank-based Expert Centres

PubMed Central

van Ommen, Gert-Jan B; Törnwall, Outi; Bréchot, Christian; Dagher, Georges; Galli, Joakim; Hveem, Kristian; Landegren, Ulf; Luchinat, Claudio; Metspalu, Andres; Nilsson, Cecilia; Solesvik, Ove V; Perola, Markus; Litton, Jan-Eric; Zatloukal, Kurt

2015-01-01

Biological resources (cells, tissues, bodily fluids or biomolecules) are considered essential raw material for the advancement of health-related biotechnology, for research and development in life sciences, and for ultimately improving human health. Stored in local biobanks, access to the human biological samples and related medical data for transnational research is often limited, in particular for the international life science industry. The recently established pan-European Biobanking and BioMolecular resources Research Infrastructure-European Research Infrastructure Consortium (BBMRI-ERIC) aims to improve accessibility and interoperability between academic and industrial parties to benefit personalized medicine, disease prevention to promote development of new diagnostics, devices and medicines. BBMRI-ERIC is developing the concept of Expert Centre as public–private partnerships in the precompetitive, not-for-profit field to provide a new structure to perform research projects that would face difficulties under currently established models of academic–industry collaboration. By definition, Expert Centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions. This paper presents the rationale behind the Expert Centres and illustrates the novel concept with model examples. PMID:25407005

Assessment of heterogeneity between European Populations: a Baltic and Danish replication case-control study of SNPs from a recent European ulcerative colitis genome wide association study.

PubMed

Andersen, Vibeke; Ernst, Anja; Sventoraityte, Jurgita; Kupcinskas, Limas; Jacobsen, Bent A; Krarup, Henrik B; Vogel, Ulla; Jonaitis, Laimas; Denapiene, Goda; Kiudelis, Gediminas; Balschun, Tobias; Franke, Andre

2011-10-13

Differences in the genetic architecture of inflammatory bowel disease between different European countries and ethnicities have previously been reported. In the present study, we wanted to assess the role of 11 newly identified UC risk variants, derived from a recent European UC genome wide association study (GWAS) (Franke et al., 2010), for 1) association with UC in the Nordic countries, 2) for population heterogeneity between the Nordic countries and the rest of Europe, and, 3) eventually, to drive some of the previous findings towards overall genome-wide significance. Eleven SNPs were replicated in a Danish sample consisting of 560 UC patients and 796 controls and nine missing SNPs of the German GWAS study were successfully genotyped in the Baltic sample comprising 441 UC cases and 1156 controls. The independent replication data was then jointly analysed with the original data and systematic comparisons of the findings between ethnicities were made. Pearson's χ2, Breslow-Day (BD) and Cochran-Mantel-Haenszel (CMH) tests were used for association analyses and heterogeneity testing. The rs5771069 (IL17REL) SNP was not associated with UC in the Danish panel. The rs5771069 (IL17REL) SNP was significantly associated with UC in the combined Baltic, Danish and Norwegian UC study sample driven by the Norwegian panel (OR = 0.89, 95% CI: 0.79-0.98, P = 0.02). No association was found between rs7809799 (SMURF1/KPNA7) and UC (OR = 1.20, 95% CI: 0.95-1.52, P = 0.10) or between UC and all other remaining SNPs. We had 94% chance of detecting an association for rs7809799 (SMURF1/KPNA7) in the combined replication sample, whereas the power were 55% or lower for the remaining SNPs.Statistically significant PBD was found for OR heterogeneity between the combined Baltic, Danish, and Norwegian panel versus the combined German, British, Belgian, and Greek panel (rs7520292 (P = 0.001), rs12518307 (P = 0.007), and rs2395609 (TCP11) (P = 0.01), respectively).No SNP reached genome

Genetic Testing Integration Panels (GTIPs): A novel approach for considering integration of direct-to-consumer and other new genetic tests into patient care

PubMed Central

Uhlmann, Wendy R.; Sharp, Richard R.

2014-01-01

There has been a dramatic increase in the number of genetic tests available but few tests have practice guidelines. In addition, many tests have become available outside of genetics clinics through direct-to-consumer (DTC) companies and several offer tests not considered standard of care. To address several practical challenges associated with the rapid introduction of clinical and DTC genetic tests, we propose that genetic counselors and geneticists organize expert panels in their institutions to discuss the integration of new tests into patient care. We propose the establishment of Genetic Testing Integration Panels (GTIPs) to bring together local experts in medical genetics, genetic counseling, bioethics and law, health communication and clinical laboratory genetics. We describe key features of this approach and consider some of the potential advantages and limitations of using a GTIP to address the many clinical challenges raised by rapidly emerging clinical and DTC genetic tests. PMID:22246561

Flow cytometry immunophenotyping in integrated diagnostics of patients with newly diagnosed cytopenia: one tube 10-color 14-antibody screening panel and 3-tube extensive panel for detection of MDS-related features.

PubMed

Porwit, A; Rajab, A

2015-05-01

Acute leukemia, myelodysplastic syndromes (MDS), myeloproliferative neoplasms and lymphomas are the most prevalent diagnoses in adults presenting with new onset cytopenia. Here, we describe two 10-color panels of surface markers (screening and comprehensive panel) applied at the Flow Cytometry Laboratory, University Health Network, Toronto, ON, Canada. A 10-color flow cytometry is applied using the stain-lyse-wash sample preparation method. In patients with <10% blasts and no clear involvement by hematological malignancy based on cytomorphological evaluation of bone marrow (BM) smear, the recently published one-tube 10-color 14-antibody screening panel is applied. This panel allows detection of major B- and T-cell abnormalities, enumeration of cells in blast region (CD45 dim), and gives insight into myeloid BM compartment, including calculation of four-parameter score for MDS-related abnormalities. In patients who present with ≥10 - <20% blasts in blood or BM smears, a comprehensive three-tube panel of surface markers is used up front. The analysis is focused on the detection of abnormal antigen expression patterns not seen in normal/reactive BM, according to the guidelines developed by International/European LeukemiaNet Working Group for Flow Cytometry in MDS. In patients with ≥20% blasts, an additional tube is added to allow the detection of cytoplasmic markers necessary to diagnose mixed phenotype acute leukemia. © 2015 John Wiley & Sons Ltd.

A Review of Traditional and Novel Treatments for Seizures in Autism Spectrum Disorder: Findings from a Systematic Review and Expert Panel

PubMed Central

Frye, Richard E.; Rossignol, Daniel; Casanova, Manuel F.; Brown, Gregory L.; Martin, Victoria; Edelson, Stephen; Coben, Robert; Lewine, Jeffrey; Slattery, John C.; Lau, Chrystal; Hardy, Paul; Fatemi, S. Hossein; Folsom, Timothy D.; MacFabe, Derrick; Adams, James B.

2013-01-01

Despite the fact that seizures are commonly associated with autism spectrum disorder (ASD), the effectiveness of treatments for seizures has not been well studied in individuals with ASD. This manuscript reviews both traditional and novel treatments for seizures associated with ASD. Studies were selected by systematically searching major electronic databases and by a panel of experts that treat ASD individuals. Only a few anti-epileptic drugs (AEDs) have undergone carefully controlled trials in ASD, but these trials examined outcomes other than seizures. Several lines of evidence point to valproate, lamotrigine, and levetiracetam as the most effective and tolerable AEDs for individuals with ASD. Limited evidence supports the use of traditional non-AED treatments, such as the ketogenic and modified Atkins diet, multiple subpial transections, immunomodulation, and neurofeedback treatments. Although specific treatments may be more appropriate for specific genetic and metabolic syndromes associated with ASD and seizures, there are few studies which have documented the effectiveness of treatments for seizures for specific syndromes. Limited evidence supports l-carnitine, multivitamins, and N-acetyl-l-cysteine in mitochondrial disease and dysfunction, folinic acid in cerebral folate abnormalities and early treatment with vigabatrin in tuberous sclerosis complex. Finally, there is limited evidence for a number of novel treatments, particularly magnesium with pyridoxine, omega-3 fatty acids, the gluten-free casein-free diet, and low-frequency repetitive transcranial magnetic simulation. Zinc and l-carnosine are potential novel treatments supported by basic research but not clinical studies. This review demonstrates the wide variety of treatments used to treat seizures in individuals with ASD as well as the striking lack of clinical trials performed to support the use of these treatments. Additional studies concerning these treatments for controlling seizures in individuals

A review of traditional and novel treatments for seizures in autism spectrum disorder: findings from a systematic review and expert panel.

PubMed

Frye, Richard E; Rossignol, Daniel; Casanova, Manuel F; Brown, Gregory L; Martin, Victoria; Edelson, Stephen; Coben, Robert; Lewine, Jeffrey; Slattery, John C; Lau, Chrystal; Hardy, Paul; Fatemi, S Hossein; Folsom, Timothy D; Macfabe, Derrick; Adams, James B

2013-09-13

Despite the fact that seizures are commonly associated with autism spectrum disorder (ASD), the effectiveness of treatments for seizures has not been well studied in individuals with ASD. This manuscript reviews both traditional and novel treatments for seizures associated with ASD. Studies were selected by systematically searching major electronic databases and by a panel of experts that treat ASD individuals. Only a few anti-epileptic drugs (AEDs) have undergone carefully controlled trials in ASD, but these trials examined outcomes other than seizures. Several lines of evidence point to valproate, lamotrigine, and levetiracetam as the most effective and tolerable AEDs for individuals with ASD. Limited evidence supports the use of traditional non-AED treatments, such as the ketogenic and modified Atkins diet, multiple subpial transections, immunomodulation, and neurofeedback treatments. Although specific treatments may be more appropriate for specific genetic and metabolic syndromes associated with ASD and seizures, there are few studies which have documented the effectiveness of treatments for seizures for specific syndromes. Limited evidence supports l-carnitine, multivitamins, and N-acetyl-l-cysteine in mitochondrial disease and dysfunction, folinic acid in cerebral folate abnormalities and early treatment with vigabatrin in tuberous sclerosis complex. Finally, there is limited evidence for a number of novel treatments, particularly magnesium with pyridoxine, omega-3 fatty acids, the gluten-free casein-free diet, and low-frequency repetitive transcranial magnetic simulation. Zinc and l-carnosine are potential novel treatments supported by basic research but not clinical studies. This review demonstrates the wide variety of treatments used to treat seizures in individuals with ASD as well as the striking lack of clinical trials performed to support the use of these treatments. Additional studies concerning these treatments for controlling seizures in individuals

Early diagnosis of peripheral nervous system involvement in Fabry disease and treatment of neuropathic pain: the report of an expert panel

PubMed Central

2011-01-01

Background Fabry disease is an inherited metabolic disorder characterized by progressive lysosomal accumulation of lipids in a variety of cell types, including neural cells. Small, unmyelinated nerve fibers are particularly affected and small fiber peripheral neuropathy often clinically manifests at young age. Peripheral pain can be chronic and/or occur as provoked attacks of excruciating pain. Manifestations of dysfunction of small autonomic fibers may include, among others, impaired sweating, gastrointestinal dysmotility, and abnormal pain perception. Patients with Fabry disease often remain undiagnosed until severe complications involving the kidney, heart, peripheral nerves and/or brain have arisen. Methods An international expert panel convened with the goal to provide guidance to clinicians who may encounter unrecognized patients with Fabry disease on how to diagnose these patients early using simple diagnostic tests. A further aim was to offer recommendations to control neuropathic pain. Results We describe the neuropathy in Fabry disease, focusing on peripheral small fiber dysfunction - the hallmark of early neurologic involvement in this disorder. The clinical course of peripheral pain is summarized, and the importance of medical history-taking, including family history, is highlighted. A thorough physical examination (e.g., angiokeratoma, corneal opacities) and simple non-invasive sensory perception tests could provide clues to the diagnosis of Fabry disease. Reported early clinical benefits of enzyme replacement therapy include reduction of neuropathic pain, and adequate management of residual pain to a tolerable and functional level can substantially improve the quality of life for patients. Conclusions Our recommendations can assist in diagnosing Fabry small fiber neuropathy early, and offer clinicians guidance in controlling peripheral pain. This is particularly important since management of pain in young patients with Fabry disease appears to be

Expert Witness: A system for developing expert medical testimony

NASA Technical Reports Server (NTRS)

Lewandowski, Raymond; Perkins, David; Leasure, David

1994-01-01

Expert Witness in an expert system designed to assist attorneys and medical experts in determining the merit of medical malpractice claims in the area of obstetrics. It substitutes the time of the medical expert with the time of a paralegal assistant guided by the expert system during the initial investigation of the medical records and patient interviews. The product of the system is a narrative transcript containing important data, immediate conclusions from the data, and overall conclusions of the case that the attorney and medical expert use to make decisions about whether and how to proceed with the case. The transcript may also contain directives for gathering additional information needed for the case. The system is a modified heuristic classifier and is implemented using over 600 CLIPS rules together with a C-based user interface. The data abstraction and solution refinement are implemented directly using forward chaining production and matching. The use of CLIPS and C is essential to delivering a system that runs on a generic PC platform. The direct implementation in CLIPS together with locality of inference ensures that the system will scale gracefully. Two years of use has revealed no errors in the reasoning.

Expert Seeker

NASA Technical Reports Server (NTRS)

Fernandez, Becerra

2003-01-01

Expert Seeker is a computer program of the knowledge-management-system (KMS) type that falls within the category of expertise-locator systems. The main goal of the KMS system implemented by Expert Seeker is to organize and distribute knowledge of who are the domain experts within and without a given institution, company, or other organization. The intent in developing this KMS was to enable the re-use of organizational knowledge and provide a methodology for querying existing information (including structured, semistructured, and unstructured information) in a way that could help identify organizational experts. More specifically, Expert Seeker was developed to make it possible, by use of an intranet, to do any or all of the following: Assist an employee in identifying who has the skills needed for specific projects and to determine whether the experts so identified are available. Assist managers in identifying employees who may need training opportunities. Assist managers in determining what expertise is lost when employees retire or otherwise leave. Facilitate the development of new ways of identifying opportunities for innovation and minimization of duplicated efforts. Assist employees in achieving competitive advantages through the application of knowledge-management concepts and related systems. Assist external organizations in requesting speakers for specific engagements or determining from whom they might be able to request help via electronic mail. Help foster an environment of collaboration for rapid development in today's environment, in which it is increasingly necessary to assemble teams of experts from government, universities, research laboratories, and industries, to quickly solve problems anytime, anywhere. Make experts more visible. Provide a central repository of information about employees, including information that, heretofore, has typically not been captured by the human-resources systems (e.g., information about past projects, patents, or

Genotype Imputation for Latinos Using the HapMap and 1000 Genomes Project Reference Panels.

PubMed

Gao, Xiaoyi; Haritunians, Talin; Marjoram, Paul; McKean-Cowdin, Roberta; Torres, Mina; Taylor, Kent D; Rotter, Jerome I; Gauderman, William J; Varma, Rohit

2012-01-01

Genotype imputation is a vital tool in genome-wide association studies (GWAS) and meta-analyses of multiple GWAS results. Imputation enables researchers to increase genomic coverage and to pool data generated using different genotyping platforms. HapMap samples are often employed as the reference panel. More recently, the 1000 Genomes Project resource is becoming the primary source for reference panels. Multiple GWAS and meta-analyses are targeting Latinos, the most populous, and fastest growing minority group in the US. However, genotype imputation resources for Latinos are rather limited compared to individuals of European ancestry at present, largely because of the lack of good reference data. One choice of reference panel for Latinos is one derived from the population of Mexican individuals in Los Angeles contained in the HapMap Phase 3 project and the 1000 Genomes Project. However, a detailed evaluation of the quality of the imputed genotypes derived from the public reference panels has not yet been reported. Using simulation studies, the Illumina OmniExpress GWAS data from the Los Angles Latino Eye Study and the MACH software package, we evaluated the accuracy of genotype imputation in Latinos. Our results show that the 1000 Genomes Project AMR + CEU + YRI reference panel provides the highest imputation accuracy for Latinos, and that also including Asian samples in the panel can reduce imputation accuracy. We also provide the imputation accuracy for each autosomal chromosome using the 1000 Genomes Project panel for Latinos. Our results serve as a guide to future imputation based analysis in Latinos.

Establishing Key Performance Indicators [KPIs] and Their Importance for the Surgical Management of Inflammatory Bowel Disease-Results From a Pan-European, Delphi Consensus Study.

PubMed

Morar, Pritesh S; Hollingshead, James; Bemelman, Willem; Sevdalis, Nick; Pinkney, Thomas; Wilson, Graeme; Dunlop, Malcolm; Davies, R Justin; Guy, Richard; Fearnhead, Nicola; Brown, Steven; Warusavitarne, Janindra; Edwards, Cathryn; Faiz, Omar

2017-10-27

Key performance indicators [KPIs] exist across a range of areas in medicine. They help to monitor outcomes, reduce variation, and drive up standards across services. KPIs exist for inflammatory bowel disease [IBD] care, but none specifically cover inflammatory bowel disease [IBD] surgical service provision. This was a consensus-based study using a panel of expert IBD clinicians from across Europe. Items were developed and fed through a Delphi process to achieve consensus. Items were ranked on a Likert scale from 1 [not important] to 5 [very important]. Consensus was defined when the inter quartile range was ≤ 1, and items with a median score > 3 were considered for inclusion. A panel of 21 experts [14 surgeons and 7 gastroenterologists] was recruited. Consensus was achieved on procedure-specific KPIs for ileocaecal and perianal surgery for Crohn's disease, [N = 10] with themes relating to morbidity [N = 7], multidisciplinary input [N = 2], and quality of life [N = 1]; and for subtotal colectomy, proctocolectomy and ileoanal pouch surgery for ulcerative colitis [N = 11], with themes relating to mortality [N = 2], morbidity [N = 8], and service provision [N = 1]. Consensus was also achieved for measures of the quality of IBD surgical service provision and quality assurance in IBD surgery. This study has provided measurable KPIs for the provision of surgical services in IBD. These indicators cover IBD surgery in general, the governance and structures of the surgical services, and separate indicators for specific subareas of surgery. Monitoring of IBD services with these KPIs may reduce variation across services and improve quality. Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com

Health literacy lost in translations? Introducing the European Health Literacy Glossary.

PubMed

Sørensen, Kristine; Brand, Helmut

2014-12-01

Health literacy has gained momentum in the Western world, yet in Europe the concept of health literacy is only marginally integrated in research, policy and practice. The present paper presents how translation may act as an influential factor with regard to integration of the health literacy notion in Europe. This study has compared five data sources that provide translations of health literacy: The European Union's Health Strategy; the translations applied in the European Health Literacy Project; national health expert opinions and Google Translate. The comparison integrated Peter Fawcett's translation techniques as a framework for analysis. The results showed a total of 28 translations: 22 from the European Union Health Strategy; 6 from the HLS-EU project; 17 from experts; 25 from Google Translate. Some countries are consistent in translations of health literacy, other countries diverge, the reasons being that health literacy is not yet mainstreamed and the translations are primarily driven by a latent polarized discourse of the concept of literacy. The study showed that translations in general reveals enriched insights in the cohesion of health literacy as one notion and provides the European Health Literacy Glossary that can inform health professionals, academia and decision-makers to further advance health literacy across Europe. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Testing expert systems

NASA Technical Reports Server (NTRS)

Chang, C. L.; Stachowitz, R. A.

1988-01-01

Software quality is of primary concern in all large-scale expert system development efforts. Building appropriate validation and test tools for ensuring software reliability of expert systems is therefore required. The Expert Systems Validation Associate (EVA) is a validation system under development at the Lockheed Artificial Intelligence Center. EVA provides a wide range of validation and test tools to check correctness, consistency, and completeness of an expert system. Testing a major function of EVA. It means executing an expert system with test cases with the intent of finding errors. In this paper, we describe many different types of testing such as function-based testing, structure-based testing, and data-based testing. We describe how appropriate test cases may be selected in order to perform good and thorough testing of an expert system.

ISA implementation and uncertainty: a literature review and expert elicitation study.

PubMed

van der Pas, J W G M; Marchau, V A W J; Walker, W E; van Wee, G P; Vlassenroot, S H

2012-09-01

Each day, an average of over 116 people die from traffic accidents in the European Union. One out of three fatalities is estimated to be the result of speeding. The current state of technology makes it possible to make speeding more difficult, or even impossible, by placing intelligent speed limiters (so called ISA devices) in vehicles. Although the ISA technology has been available for some years now, and reducing the number of road traffic fatalities and injuries has been high on the European political agenda, implementation still seems to be far away. Experts indicate that there are still too many uncertainties surrounding ISA implementation, and dealing with these uncertainties is essential for implementing ISA. In this paper, a systematic and representative inventory of the uncertainties is made based upon the literature. Furthermore, experts in the field of ISA were surveyed and asked which uncertainties are barriers for ISA implementation, and how uncertain these uncertainties are. We found that the long-term effects and the effects of large-scale implementation of ISA are still uncertain and are the most important barriers for the implementation of the most effective types of ISA. One way to deal with these uncertainties would be to start implementation on a small scale and gradually expand the penetration, in order to learn how ISA influences the transport system over time. Copyright © 2010 Elsevier Ltd. All rights reserved.

Food, plant food, and vegetarian diets in the US dietary guidelines: conclusions of an expert panel.

PubMed

Jacobs, David R; Haddad, Ella H; Lanou, Amy Joy; Messina, Mark J

2009-05-01

We summarize conclusions drawn from a panel discussion at the "Fifth International Congress on Vegetarian Nutrition" about the roles of and emphasis on food, plant food, and vegetarianism in current and future US dietary guidelines. The most general recommendation of the panel was that future dietary guidelines, following the lead of the 2005 Dietary Guidelines Advisory Committee, should emphasize food-based recommendations and thinking to the full extent that evidence allows. Although nutrient-based thinking and Dietary Reference Intakes (DRIs) may help ensure an adequate diet in the sense that deficiency states are avoided, the emphasis on DRIs may not capture many important nutritional issues and may inhibit a focus on foods. More generally, in the context of the conference on vegetarian nutrition, this report focuses on the history and structure of the Dietary Guidelines Advisory Committee, on various plant food-oriented recommendations that are supported by literature evidence, and on mechanisms for participating in the process of forming dietary guidelines. Among recommendations that likely would improve health and the environment, some are oriented toward increased plant food consumption and some toward vegetarianism. The literature on health effects of individual foods and whole lifestyle diets is insufficient and justifies a call for future food-oriented research, including expanding the evidence base for plant-based and vegetarian diets. The Dietary Guidelines Advisory Committee's role should be carried forward to creation of a publicly accessible icon (eg, the current pyramid) and related materials to ensure that the science base is fully translated for the public.

Building a strong European alliance for personality disorder research and intervention.

PubMed

Mehlum, Lars; Bateman, Anthony; Dalewijk, Henk Jan; Doering, Stephan; Kaera, Andres; Moran, Paul Anthony; Renneberg, Babette; Ribaudi, Joaquim Soler; Simonsen, Sebastian; Wilberg, Theresa; Bohus, Martin

2018-01-01

People with personality disorders frequently face stigma, ignorance and pessimism regarding the treatability of their disorders. This is despite substantial progress that has been made in developing a number of effective evidence based psychotherapeutic treatments. However, expertise in how to systematically deliver these treatments in a sustainable way throughout Europe is largely lacking. To bridge the gap between evidence based treatments and their implementation in health services, the European Society for the Study of Personality Disorders is currently building a new alliance of experts to promote personality disorder scholarship, and to support the development of clinical expertise and systematic treatment implementation throughout Europe. The aim of this paper is to describe how the Society is currently using its interdisciplinary and international roster of experts to address the specific treatment and research needs of the European personality disorder field, particularly to countries in which expertise in the field is less developed.

[Homozygous familial hypercholesterolaemia: Spanish adaptation of the position paper from the Consensus Panel on Familial Hypercholesterolaemia of the European Atherosclerosis Society. Consensus document of the Spanish Society of Arteriosclerosis (SEA) and Familial Hypercholesterolaemia Foundation (FHF)].

PubMed

Ascaso, Juan F; Mata, Pedro; Arbona, Cristina; Civeira, Fernando; Valdivielso, Pedro; Masana, Luis

2015-01-01

Homozygous familial hypercholesterolaemia (HoFH) is a rare life-threatening disease characterized by markedly elevated circulating levels of low-density lipoprotein cholesterol (LDL-C) and accelerated, premature atherosclerotic cardiovascular disease (ACVD). The Consensus Panel on Familial Hypercholesterolaemia of the European Atherosclerosis Society (EAS) has recently published a clinical guide to diagnose and manage HoFH (Eur Heart J. 2014;35:2146-57). Both the Spanish Society of Atherosclerosis (SEA) and Familial Hypercholesterolaemia Foundation (FHF) consider this European Consensus document of great value and utility. However, there are particularities in our country which advise to have a Spanish adaptation of the European HoFH document in order to approximate this clinical guide to our environment. In Spain, chronic treatment with statins, ezetimibe and resins (colesevelam) has a reduced contribution in the National Health System (NHS) and is one of the few European countries where LDL apheresis is included in the Basic Service Portfolio coverage. This Spanish document also includes clinical experience in the management of these patients in our country. The Drafting Committee emphasizes the need for early identification of HoFH patients, prompt referral to specialized units, and an early and appropriate treatment. These recommendations will provide a guidance for HoFH patient management in Spain. Copyright © 2015 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

ESPEN expert group recommendations for action against cancer-related malnutrition.

PubMed

Arends, J; Baracos, V; Bertz, H; Bozzetti, F; Calder, P C; Deutz, N E P; Erickson, N; Laviano, A; Lisanti, M P; Lobo, D N; McMillan, D C; Muscaritoli, M; Ockenga, J; Pirlich, M; Strasser, F; de van der Schueren, M; Van Gossum, A; Vaupel, P; Weimann, A

2017-10-01

Patients with cancer are at particularly high risk for malnutrition because both the disease and its treatments threaten their nutritional status. Yet cancer-related nutritional risk is sometimes overlooked or under-treated by clinicians, patients, and their families. The European Society for Clinical Nutrition and Metabolism (ESPEN) recently published evidence-based guidelines for nutritional care in patients with cancer. In further support of these guidelines, an ESPEN oncology expert group met for a Cancer and Nutrition Workshop in Berlin on October 24 and 25, 2016. The group examined the causes and consequences of cancer-related malnutrition, reviewed treatment approaches currently available, and built the rationale and impetus for clinicians involved with care of patients with cancer to take actions that facilitate nutrition support in practice. The content of this position paper is based on presentations and discussions at the Berlin meeting. The expert group emphasized 3 key steps to update nutritional care for people with cancer: (1) screen all patients with cancer for nutritional risk early in the course of their care, regardless of body mass index and weight history; (2) expand nutrition-related assessment practices to include measures of anorexia, body composition, inflammatory biomarkers, resting energy expenditure, and physical function; (3) use multimodal nutritional interventions with individualized plans, including care focused on increasing nutritional intake, lessening inflammation and hypermetabolic stress, and increasing physical activity. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Expert Systems: An Overview.

ERIC Educational Resources Information Center

Adiga, Sadashiv

1984-01-01

Discusses: (1) the architecture of expert systems; (2) features that distinguish expert systems from conventional programs; (3) conditions necessary to select a particular application for the development of successful expert systems; (4) issues to be resolved when building expert systems; and (5) limitations. Examples of selected expert systems…

Expert and competent non-expert visual cues during simulated diagnosis in intensive care.

PubMed

McCormack, Clare; Wiggins, Mark W; Loveday, Thomas; Festa, Marino

2014-01-01

The aim of this study was to examine the information acquisition strategies of expert and competent non-expert intensive care physicians during two simulated diagnostic scenarios involving respiratory distress in an infant. Specifically, the information acquisition performance of six experts and 12 competent non-experts was examined using an eye-tracker during the initial 90 s of the assessment of the patient. The results indicated that, in comparison to competent non-experts, experts recorded longer mean fixations, irrespective of the scenario. When the dwell times were examined against specific areas of interest, the results revealed that competent non-experts recorded greater overall dwell times on the nurse, where experts recorded relatively greater dwell times on the head and face of the manikin. In the context of the scenarios, experts recorded differential dwell times, spending relatively more time on the head and face during the seizure scenario than during the coughing scenario. The differences evident between experts and competent non-experts were interpreted as evidence of the relative availability of task-specific cues or heuristics in memory that might direct the process of information acquisition amongst expert physicians. The implications are discussed for the training and assessment of diagnostic skills.

European Code against Cancer 4th Edition: Process of reviewing the scientific evidence and revising the recommendations.

PubMed

Minozzi, Silvia; Armaroli, Paola; Espina, Carolina; Villain, Patricia; Wiseman, Martin; Schüz, Joachim; Segnan, Nereo

2015-12-01

The European Code Against Cancer is a set of recommendations to give advice on cancer prevention. Its 4th edition is an update of the 3rd edition, from 2003. Working Groups of independent experts from different fields of cancer prevention were appointed to review the recommendations, supported by a Literature Group to provide scientific and technical support in the assessment of the scientific evidence, through systematic reviews of the literature. Common procedures were developed to guide the experts in identifying, retrieving, assessing, interpreting and summarizing the scientific evidence in order to revise the recommendations. The Code strictly followed the concept of providing advice to European Union citizens based on the current best available science. The advice, if followed, would be expected to reduce cancer risk, referring both to avoiding or reducing exposure to carcinogenic agents or changing behaviour related to cancer risk and to participating in medical interventions able to avert specific cancers or their consequences. The information sources and procedures for the review of the scientific evidence are described here in detail. The 12 recommendations of the 4th edition of the European Code Against Cancer were ultimately approved by a Scientific Committee of leading European cancer and public health experts. Copyright © 2015 International Agency for Research on Cancer. Published by Elsevier Ltd. All rights reserved.

PANEL LIBRARY AND EDITOR

NASA Technical Reports Server (NTRS)

Raible, E.

1994-01-01

The Panel Library and Editor is a graphical user interface (GUI) builder for the Silicon Graphics IRIS workstation family. The toolkit creates "widgets" which can be manipulated by the user. Its appearance is similar to that of the X-Windows System. The Panel Library is written in C and is used by programmers writing user-friendly mouse-driven applications for the IRIS. GUIs built using the Panel Library consist of "actuators" and "panels." Actuators are buttons, dials, sliders, or other mouse-driven symbols. Panels are groups of actuators that occupy separate windows on the IRIS workstation. The application user can alter variables in the graphics program, or fire off functions with a click on a button. The evolution of data values can be tracked with meters and strip charts, and dialog boxes with text processing can be built. Panels can be stored as icons when not in use. The Panel Editor is a program used to interactively create and test panel library interfaces in a simple and efficient way. The Panel Editor itself uses a panel library interface, so all actions are mouse driven. Extensive context-sensitive on-line help is provided. Programmers can graphically create and test the user interface without writing a single line of code. Once an interface is judged satisfactory, the Panel Editor will dump it out as a file of C code that can be used in an application. The Panel Library (v9.8) and Editor (v1.1) are written in C-Language (63%) and Scheme, a dialect of LISP, (37%) for Silicon Graphics 4D series workstations running IRIX 3.2 or higher. Approximately 10Mb of disk space is required once compiled. 1.5Mb of main memory is required to execute the panel editor. This program is available on a .25 inch streaming magnetic tape cartridge in UNIX tar format for an IRIS, and includes a copy of XScheme, the public-domain Scheme interpreter used by the Panel Editor. The Panel Library Programmer's Manual is included on the distribution media. The Panel Library and

Universal Health Coverage in Francophone Sub-Saharan Africa: Assessment of Global Health Experts' Confidence in Policy Options.

PubMed

Paul, Elisabeth; Fecher, Fabienne; Meloni, Remo; van Lerberghe, Wim

2018-05-29

Many countries rely on standard recipes for accelerating progress toward universal health coverage (UHC). With limited generalizable empirical evidence, expert confidence and consensus plays a major role in shaping country policy choices. This article presents an exploratory attempt conducted between April and September 2016 to measure confidence and consensus among a panel of global health experts in terms of the effectiveness and feasibility of a number of policy options commonly proposed for achieving UHC in low- and middle-income countries, such as fee exemptions for certain groups of people, ring-fenced domestic health budgets, and public-private partnerships. To ensure a relative homogeneity of contexts, we focused on French-speaking sub-Saharan Africa. We initially used the Delphi method to arrive at expert consensus, but since no consensus emerged after 2 rounds, we adjusted our approach to a statistical analysis of the results from our questionnaire by measuring the degree of consensus on each policy option through 100 (signifying total consensus) minus the size of the interquartile range of the individual scores. Seventeen global health experts from various backgrounds, but with at least 20 years' experience in the broad region, participated in the 2 rounds of the study. The results provide an initial "mapping" of the opinions of a group of experts and suggest interesting lessons. For the 18 policy options proposed, consensus emerged only on strengthening the supply of quality primary health care services (judged as being effective with a confidence score of 79 and consensus score of 90), and on fee exemptions for the poorest (judged as being fairly easy to implement with a confidence score of 66 and consensus score of 85). For none of the 18 common policy options was there consensus on both potential effectiveness and feasibility, with very diverging opinions concerning 5 policy options. The lack of confidence and consensus within the panel seems to

Enlargement Futures Project: Information and Communication Technologies. Final Report. Enlargement Futures Series.

ERIC Educational Resources Information Center

Gourova, Elissaveta; Burgelman, Jean-Claude; Bogdanowicz, Marc; Herrmann, Christoph

Trends in the development and utilization of information and communication technologies (ICT) in the 13 candidate countries for admission into the European Union(the CC13) were examined by a 12-member panel of experts and its staff. The analysis focused on the following topics: (1) the communication infrastructure available in the CC13; (2) issues…

Techniques for capturing expert knowledge - An expert systems/hypertext approach

NASA Technical Reports Server (NTRS)

Lafferty, Larry; Taylor, Greg; Schumann, Robin; Evans, Randy; Koller, Albert M., Jr.

1990-01-01

The knowledge-acquisition strategy developed for the Explosive Hazards Classification (EHC) Expert System is described in which expert systems and hypertext are combined, and broad applications are proposed. The EHC expert system is based on rapid prototyping in which primary knowledge acquisition from experts is not emphasized; the explosive hazards technical bulletin, technical guidance, and minimal interviewing are used to develop the knowledge-based system. Hypertext is used to capture the technical information with respect to four issues including procedural, materials, test, and classification issues. The hypertext display allows the integration of multiple knowlege representations such as clarifications or opinions, and thereby allows the performance of a broad range of tasks on a single machine. Among other recommendations, it is suggested that the integration of hypertext and expert systems makes the resulting synergistic system highly efficient.

Reinforced Honeycomb Panels

NASA Technical Reports Server (NTRS)

Bhat, Balakrishna T.; Akutagawa, Wesley; Wang, Taylor G.; Barber, Dan

1989-01-01

New honeycomb panel structure has increased strength and stiffness with little increase in weight. Some or all of walls of honeycomb cells reinforced with honeycomb panels having smaller cells, lightweight foam, or other reinforcing material. Strong, lightweight reinforced panels used in aircraft, car and truck bodies, cabinets for equipment and appliances, and buildings.

Development of a standardised training curriculum for robotic surgery: a consensus statement from an international multidisciplinary group of experts.

PubMed

Ahmed, Kamran; Khan, Reenam; Mottrie, Alexandre; Lovegrove, Catherine; Abaza, Ronny; Ahlawat, Rajesh; Ahlering, Thomas; Ahlgren, Goran; Artibani, Walter; Barret, Eric; Cathelineau, Xavier; Challacombe, Ben; Coloby, Patrick; Khan, Muhammad S; Hubert, Jacques; Michel, Maurice Stephan; Montorsi, Francesco; Murphy, Declan; Palou, Joan; Patel, Vipul; Piechaud, Pierre-Thierry; Van Poppel, Hendrik; Rischmann, Pascal; Sanchez-Salas, Rafael; Siemer, Stefan; Stoeckle, Michael; Stolzenburg, Jens-Uwe; Terrier, Jean-Etienne; Thüroff, Joachim W; Vaessen, Christophe; Van Der Poel, Henk G; Van Cleynenbreugel, Ben; Volpe, Alessandro; Wagner, Christian; Wiklund, Peter; Wilson, Timothy; Wirth, Manfred; Witt, Jörn; Dasgupta, Prokar

2015-07-01

To explore the views of experts about the development and validation of a robotic surgery training curriculum, and how this should be implemented. An international expert panel was invited to a structured session for discussion. The study was of a mixed design, including qualitative and quantitative components based on focus group interviews during the European Association of Urology (EAU) Robotic Urology Section (ERUS) (2012), EAU (2013) and ERUS (2013) meetings. After introduction to the aims, principles and current status of the curriculum development, group responses were elicited. After content analysis of recorded interviews generated themes were discussed at the second meeting, where consensus was achieved on each theme. This discussion also underwent content analysis, and was used to draft a curriculum proposal. At the third meeting, a quantitative questionnaire about this curriculum was disseminated to attendees to assess the level of agreement with the key points. In all, 150 min (19 pages) of the focus group discussion was transcribed (21 316 words). Themes were agreed by two raters (median agreement κ 0.89) and they included: need for a training curriculum (inter-rater agreement κ 0.85); identification of learning needs (κ 0.83); development of the curriculum contents (κ 0.81); an overview of available curricula (κ 0.79); settings for robotic surgery training ((κ 0.89); assessment and training of trainers (κ 0.92); requirements for certification and patient safety (κ 0.83); and need for a universally standardised curriculum (κ 0.78). A training curriculum was proposed based on the above discussions. This group proposes a multi-step curriculum for robotic training. Studies are in process to validate the effectiveness of the curriculum and to assess transfer of skills to the operating room. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

Defining Responses to Therapy and Study Outcomes in Clinical Trials of Invasive Fungal Diseases: Mycoses Study Group and European Organization for Research and Treatment of Cancer Consensus Criteria

PubMed Central

Segal, Brahm H.; Herbrecht, Raoul; Stevens, David A.; Ostrosky-Zeichner, Luis; Sobel, Jack; Viscoli, Claudio; Walsh, Thomas J.; Maertens, Johan; Patterson, Thomas F.; Perfect, John R.; Dupont, Bertrand; Wingard, John R.; Calandra, Thierry; Kauffman, Carol A.; Graybill, John R.; Baden, Lindsey R.; Pappas, Peter G.; Bennett, John E.; Kontoyiannis, Dimitrios P.; Cordonnier, Catherine; Viviani, Maria Anna; Bille, Jacques; Almyroudis, Nikolaos G.; Wheat, L. Joseph; Graninger, Wolfgang; Bow, Eric J.; Holland, Steven M.; Kullberg, Bart-Jan; Dismukes, William E.; De Pauw, Ben E.

2009-01-01

Invasive fungal diseases (IFDs) have become major causes of morbidity and mortality among highly immunocompromised patients. Authoritative consensus criteria to diagnose IFD have been useful in establishing eligibility criteria for antifungal trials. There is an important need for generation of consensus definitions of outcomes of IFD that will form a standard for evaluating treatment success and failure in clinical trials. Therefore, an expert international panel consisting of the Mycoses Study Group and the European Organization for Research and Treatment of Cancer was convened to propose guidelines for assessing treatment responses in clinical trials of IFDs and for defining study outcomes. Major fungal diseases that are discussed include invasive disease due to Candida species, Aspergillus species and other molds, Cryptococcus neoformans, Histoplasma capsulatum, and Coccidioides immitis. We also discuss potential pitfalls in assessing outcome, such as conflicting clinical, radiological, and/or mycological data and gaps in knowledge. PMID:18637757

Defining Advance Care Planning for Adults: A Consensus Definition from a Multidisciplinary Delphi Panel

PubMed Central

Sudore, Rebecca L.; Lum, Hillary D.; You, John J.; Hanson, Laura C.; Meier, Diane E.; Pantilat, Steven Z.; Matlock, Daniel D.; Rietjens, Judith A. C.; Korfage, Ida J.; Ritchie, Christine S.; Kutner, Jean S.; Teno, Joan M.; Thomas, Judy; McMahan, Ryan D.; Heyland, Daren K.

2017-01-01

Background Despite increasing interest in advance care planning (ACP) and prior ACP descriptions, a consensus definition does not yet exist to guide clinical, research, and policy initiatives. Objective To develop a consensus definition of ACP for adults. Design Delphi Panel Setting/Participants Participants included a multidisciplinary panel of international ACP experts consisting of 52 clinicians, researchers, and policy leaders from 4 countries, and a patient/surrogate advisory committee. Measurements We conducted 10 rounds of a modified Delphi method and qualitatively analyzed panelists’ input. Panelists identified several themes lacking consensus, and iteratively discussed and developed a final consensus definition. Results Panelists identified several tensions concerning ACP concepts such as whether the definition should focus on conversations vs. written advance directives; patients’ values vs. treatment preferences; current shared decision making vs. future medical decisions; and who should be included in the process. The panel achieved a final consensus one-sentence definition and accompanying goals statement: “Advance care planning is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. The goal of advance care planning is to help ensure that people receive medical care that is consistent with their values, goals and preferences during serious and chronic illness.” The panel also described strategies to best support adults in ACP. Conclusions A multidisciplinary Delphi panel developed a consensus definition for ACP for adults that can be used to inform implementation and measurement of ACP clinical, research, and policy initiatives. PMID:28062339

The European Narcolepsy Network (EU-NN) database.

PubMed

Khatami, Ramin; Luca, Gianina; Baumann, Christian R; Bassetti, Claudio L; Bruni, Oliviero; Canellas, Francesca; Dauvilliers, Yves; Del Rio-Villegas, Rafael; Feketeova, Eva; Ferri, Raffaele; Geisler, Peter; Högl, Birgit; Jennum, Poul; Kornum, Birgitte R; Lecendreux, Michel; Martins-da-Silva, Antonio; Mathis, Johannes; Mayer, Geert; Paiva, Teresa; Partinen, Markku; Peraita-Adrados, Rosa; Plazzi, Guiseppe; Santamaria, Joan; Sonka, Karel; Riha, Renata; Tafti, Mehdi; Wierzbicka, Aleksandra; Young, Peter; Lammers, Gert Jan; Overeem, Sebastiaan

2016-06-01

Narcolepsy with cataplexy is a rare disease with an estimated prevalence of 0.02% in European populations. Narcolepsy shares many features of rare disorders, in particular the lack of awareness of the disease with serious consequences for healthcare supply. Similar to other rare diseases, only a few European countries have registered narcolepsy cases in databases of the International Classification of Diseases or in registries of the European health authorities. A promising approach to identify disease-specific adverse health effects and needs in healthcare delivery in the field of rare diseases is to establish a distributed expert network. A first and important step is to create a database that allows collection, storage and dissemination of data on narcolepsy in a comprehensive and systematic way. Here, the first prospective web-based European narcolepsy database hosted by the European Narcolepsy Network is introduced. The database structure, standardization of data acquisition and quality control procedures are described, and an overview provided of the first 1079 patients from 18 European specialized centres. Due to its standardization this continuously increasing data pool is most promising to provide a better insight into many unsolved aspects of narcolepsy and related disorders, including clear phenotype characterization of subtypes of narcolepsy, more precise epidemiological data and knowledge on the natural history of narcolepsy, expectations about treatment effects, identification of post-marketing medication side-effects, and will contribute to improve clinical trial designs and provide facilities to further develop phase III trials. © 2016 European Sleep Research Society.

Expert systems built by the Expert: An evaluation of OPS5

NASA Technical Reports Server (NTRS)

Jackson, Robert

1987-01-01

Two expert systems were written in OPS5 by the expert, a Ph.D. astronomer with no prior experience in artificial intelligence or expert systems, without the use of a knowledge engineer. The first system was built from scratch and uses 146 rules to check for duplication of scientific information within a pool of prospective observations. The second system was grafted onto another expert system and uses 149 additional rules to estimate the spacecraft and ground resources consumed by a set of prospective observations. The small vocabulary, the IF this occurs THEN do that logical structure of OPS5, and the ability to follow program execution allowed the expert to design and implement these systems with only the data structures and rules of another OPS5 system as an example. The modularity of the rules in OPS5 allowed the second system to modify the rulebase of the system onto which it was grafted without changing the code or the operation of that system. These experiences show that experts are able to develop their own expert systems due to the ease of programming and code reusability in OPS5.

The Expert Witness

ERIC Educational Resources Information Center

Environmental Science and Technology, 1975

1975-01-01

As consumers organize and industry begins to feel the economic pinch of pollution control laws, litigation may increase as will the need for the expert witness. Discussed are the functions and preparations of expert witnesses, their role and conduct in judicial proceedings, and the techniques of being an expert witness. (BT)

Uncertainty in geological linework: communicating the expert's tacit model to the data user(s) by expert elicitation.

NASA Astrophysics Data System (ADS)

Lawley, Russell; Barron, Mark; Lee, Katy

2014-05-01

elicitation is to extract this model in a useable, quantitative, form by a robust and transparent procedure. At BGS expert elicitation is being used to evaluate the uncertainty of mapped boundaries in different common mapping scenarios, with a view to building a 'collective' understanding of the challenges each scenario presents. For example, a 'sharp contact (at surface) between highly contrasting sedimentary rocks' represents one level of survey challenge that should be accurately met by all surveyors, even novices. In contrast, a 'transitional boundary defined by localised facies-variation' may require much more experience to resolve (without recourse to significantly more sampling). We will describe the initial phase of this exercise in which uncertainty models were elicited for mapped boundaries in six contrasting scenarios. Each scenario was presented to a panel of experts with varied expertise and career history. In five cases it was possible to arrive at a consensus model, in a sixth case experts with different experience took different views of the nature of the mapping problem. We will discuss our experience of the use of elicitation methodology and the implications of our results for further work at the BGS to quantify uncertainty in map products. In particular we will consider the value of elicitation as a means to capture the expertise of individuals as they retire, and as the composition of the organization's staff changes in response to the management and policy decisions.

Defining European preparedness and research needs regarding emerging infectious animal diseases: results from a Delphi expert consultation.

PubMed

Wentholt, M T A; Cardoen, S; Imberechts, H; Van Huffel, X; Ooms, B W; Frewer, L J

2012-02-01

Emerging and major infectious animal diseases can have significant international impact on social, economic and environmental level, and are being driven by various factors. Prevention and control measures should be prepared at both national and international level to mitigate these disease risks. Research to support such policy development is mostly carried out at national level and dedicated transnational research programmes are still in its infancy. This research reports on part of a process to develop a common strategic research agenda on emerging and major infectious diseases of livestock in Europe, covering a 5-15-year time span. A two round online Delphi study was conducted to explore the views of experts on issues relating to research needs on emerging infectious diseases of livestock in Europe. Drivers that may influence the incidence of emerging infectious animal diseases in both the short (next 5 years) and medium term (10-15 years) were identified. Drivers related to regulatory measures and biological science developments were thought to decrease the incidence, and socio-economic factors to increase the incidence of emerging infectious animal diseases. From the first round a list of threats to animal health was compiled and participants combined these threats with relevant drivers in the second round. Next to identifying threats to animal health, also possible mitigatory actions to reduce the negative impact of these threats were identified. Participants emphasised that interdisciplinary research is needed to understand drivers of emerging infectious animal diseases, as well as to develop prevention and control measures which are both socio-economic and technical. From this it can be concluded that interdisciplinary research combining both natural and social research themes is required. Some of the European member states research budget needs to be allocated so that effective prevention and mitigation strategies can be developed. Copyright © 2011

Expert perspectives on hereditary angioedema: Key areas for advancements in care across the patient journey

PubMed Central

Baş, Murat; Bernstein, Jonathan A.; Boccon-Gibod, Isabelle; Bova, Maria; Dempster, John; Grumach, Anete Sevciovic; Magerl, Markus; Poarch, Kimberly; Ferreira, Manuel Branco

2016-01-01

Background: Published literature documents the substantial burden of hereditary angioedema (HAE) with C1 inhibitor deficiency on the quality of life and work productivity of patients. However, despite advances in the field and the availability of guidelines to advise health care providers (HCP) on the diagnosis and management of HAE, there are still many challenges to overcome. For example, delayed diagnosis and misdiagnosis are common, and treatment practices vary worldwide. Objective: An international expert panel was convened to consider opportunities for improvements that would benefit patients with HAE. Methods: Based on professional and personal experiences, the experts developed schematics to describe the journey of patients through the following stages: (1) onset of symptoms and initial evaluation; (2) referral/diagnosis; and (3) management of HAE. More importantly, the panel identified key areas in which it was possible to optimize the support provided to patients and HCPs along this journey. Results: Overall, this approach highlighted the need for wider dissemination of algorithms and scientific data to more effectively educate HCPs from multiple disciplines and the need for more research to inform appropriate treatment decisions. Furthermore, HAE awareness campaigns, accurate online information, and referral to patient advocacy groups were all considered helpful approaches to support patients. Conclusion: More detailed and widespread information on the diagnosis and management of HAE is needed and may lead to advancements in care throughout the journey of the patient with HAE. PMID:27661998

Solar reflection panels

DOEpatents

Diver, Jr., Richard B.; Grossman, James W [Albuquerque, NM; Reshetnik, Michael [Boulder, CO

2006-07-18

A solar collector comprising a glass mirror, and a composite panel, wherein the back of the mirror is affixed to a front surface of the composite panel. The composite panel comprises a front sheet affixed to a surface of a core material, preferably a core material comprising a honeycomb structure, and a back sheet affixed to an opposite surface of the core material. The invention may further comprise a sealing strip, preferably comprising EPDM, positioned between the glass mirror and the front surface of the composite panel. The invention also is of methods of making such solar collectors.

Reduced SNP Panels for Genetic Identification and Introgression Analysis in the Dark Honey Bee (Apis mellifera mellifera)

PubMed Central

Muñoz, Irene; Henriques, Dora; Johnston, J. Spencer; Chávez-Galarza, Julio; Kryger, Per; Pinto, M. Alice

2015-01-01

Beekeeping activities, especially queen trading, have shaped the distribution of honey bee (Apis mellifera) subspecies in Europe, and have resulted in extensive introductions of two eastern European C-lineage subspecies (A. m. ligustica and A. m. carnica) into the native range of the M-lineage A. m. mellifera subspecies in Western Europe. As a consequence, replacement and gene flow between native and commercial populations have occurred at varying levels across western European populations. Genetic identification and introgression analysis using molecular markers is an important tool for management and conservation of honey bee subspecies. Previous studies have monitored introgression by using microsatellite, PCR-RFLP markers and most recently, high density assays using single nucleotide polymorphism (SNP) markers. While the latter are almost prohibitively expensive, the information gained to date can be exploited to create a reduced panel containing the most ancestry-informative markers (AIMs) for those purposes with very little loss of information. The objective of this study was to design reduced panels of AIMs to verify the origin of A. m. mellifera individuals and to provide accurate estimates of the level of C-lineage introgression into their genome. The discriminant power of the SNPs using a variety of metrics and approaches including the Weir & Cockerham’s FST, an FST-based outlier test, Delta, informativeness (In), and PCA was evaluated. This study shows that reduced AIMs panels assign individuals to the correct origin and calculates the admixture level with a high degree of accuracy. These panels provide an essential tool in Europe for genetic stock identification and estimation of admixture levels which can assist management strategies and monitor honey bee conservation programs. PMID:25875986

Quiet eye gaze behavior of expert, and near-expert, baseball plate umpires.

PubMed

Millslagle, Duane G; Hines, Bridget B; Smith, Melissa S